Gender and how we metabolize alcohol

Q: I’m a 45-year-old woman, and I’ve read that the recommended daily alcohol intake for women is lower than for men. I’ve also read that a certain amount of alcohol can be healthy — but why should my husband’s daily limit be higher than mine? And would my health suffer if I drink a manly amount?
A: The short answer to your second question is yes. If you are repeatedly exceeding the recommended daily alcohol limit for women, you could be putting your health at risk. But let’s start with your first question, why women are advised to drink less than men.
There are two main biological reasons that women are more sensitive to alcohol. First, alcohol is broken down in the liver and stomach lining by an enzyme called alcohol dehydrogenase (ADH). ADH goes to work before the alcohol reaches the blood. Women have considerably less ADH in their stomach linings than men.
Since women metabolize very little alcohol in their stomachs, more is left to be absorbed into their blood. As a result, one drink for a woman has about twice the effect as one for a man.
Second, pound for pound, a woman’s body contains less water and more fatty tissue than a man’s. Water dilutes alcohol in the blood, but fat holds onto alcohol. So a woman’s body maintains higher concentrations of alcohol for a longer time. This exposes the brain and other organs to more alcohol.
So, women get “high” after drinking less. They are also more likely to suffer health problems after drinking smaller quantities and for fewer years than men.
Alcohol does pose a variety of threats to your physical health. Although alcohol abuse is more common in men than in women, a woman’s chance of becoming dependent is equivalent to a man’s. And women who drink too much are more likely to damage their health and well-being and to die as a result of their drinking. For example, women who abuse or are dependent on alcohol are more vulnerable than men to alcoholic liver disease, such as hepatitis, and more likely to die from liver cirrhosis.
In addition, women are more likely than men to suffer alcohol-induced brain damage, such as loss of mental function and reduced brain size. Compared with women who don’t drink or who drink in moderation, women who drink heavily also have an increased risk of osteoporosis, falls and hip fractures. They are more likely to go through premature menopause or to suffer infertility and miscarriages.
Drinking too much is also hard on women’s hearts: It raises the risk of hypertension and cardiovascular diseases, including coronary artery disease, arrhythmias and cardiomyopathy. Last but not least, even modest amounts of alcohol increase the risk of breast cancer.
For women in particular, there is a very fine line between healthful and harmful drinking. While moderate drinking is defined as no more than seven drinks a week and no more than three on any given day, those levels aren’t set in stone. A woman’s response depends on her age, weight, genetic makeup, family history, risk of breast cancer, overall health, and even when she last ate.
Because women become addicted to alcohol more easily than men, even drinking moderately can be a slippery slope. This is especially true for older women. In fact, about half of all cases of alcoholism in women begin after age 59.
Certainly, no one should feel obliged to start drinking for the health benefits. There are plenty of other ways to safeguard your health, such as exercising regularly, eating nutritious food, keeping your weight under control and not smoking. But if you enjoy alcoholic beverages, it’s important to know where to draw the line. You should also be prepared to redraw that line, as you get older, especially as a woman.

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