Beer and other Health EffectsBeer and Health
For some diseases such as cancer and cardiovascular disease, the link to beer consumption is already quite clear. Beer can also affect the immune system, bone, joint and kidney health, gallstones, well being and the quality of life. However, more research is needed before strong conclusions can be made on these effects.
- Besides the positive effects of moderate beer consumption on cardiovascular disease, type 2 diabetes and dementia, there might be other health effects, but research is scarce.
- Moderate alcohol consumption and bone health appear to be positively related, but the potential beneficial effects of some individual components of beer (such as silicon) need more investigation.
- Some research shows moderate alcohol consumption may protect against rheumatoid arthritis, but results are mixed and a mechanism for this protective effect has not been determined.
- The risk of gout may increase with alcohol consumption, but the mechanism behind this is not clear, nor is the effect of different types of alcoholic beverages.
- Moderate alcohol consumption does not affect kidney functioning.
- For protective effects against kidney stones and gallstones, and beneficial effects on the immune system, research is very limited and the optimal amount of beer consumption has not yet been determined.
- Well being and the quality of life seem to improve with moderate beer consumption due to the alcohol, but this relationship also needs more research.
The immune system
Alcohol in small and moderate quantities may have a beneficial effect on the immune system. Some studies reported that moderate alcohol consumption of 10–40 g per day could decrease the risk of the common cold. 167Others saw a decrease in inflammation and a better response to vaccines. 258Besides alcohol, other components in beer such as polyphenols may influence the immune system. 23There is very limited research available and more is needed to determine what effects are caused by alcohol and what are caused by the non-alcoholic components in beer.
Light to moderate alcohol consumption (and specifically of beer), might reduce osteoporosis risk by increasing bone mineral density (BMD).
Osteoporosis is a disease causing brittle bones, prone to fractures. One in three European women aged 50 years and over and one out of five men of the same age, suffer from osteoporotic fractures. Besides gender, low body mass index (<18.5 kg/m2), older age, lack of physical exercise, previous bone fractures, and smoking, all increase the risk of osteoporosis.259
- Alcohol and bones
A high BMD is an indication of strong bones, not brittle ones. Experimental studies show BMD of the hips of men increases 3.4–4.5% with an intake of approximately 10–30 g of alcohol per day. The same amount of alcohol increased hip and spine BMD by 5.0–8.3% in post-menopausal women. 260However, the BMD of pre-menopausal women may decrease with alcohol consumption above 5 g per day, caused by a difference in hormone composition before and after menopause.28,261However, there is no research available on the effect of alcohol consumption in people who already have osteoporosis.262
With light to moderate alcohol consumption, there is limited research on how this affects BMD. One study proposed that 1–30 g of alcohol per day may influence bone remodelling from lower blood levels of osteocalcin. This shows that alcohol can attenuate bone turnover resulting in less bone loss. The protein osteocalcin supports the activity of cells that build up bone (osteoblasts), but the size of the impact of this mechanism remains unknown. 261,262 With more than 30 g of alcohol per day, however, the reverse is true. An increase in bone breakdown cells (osteoclasts) increase oxidative stress, increase the amounts of fat near bone marrow, and decrease calorie intake, which creates a different body composition with lower body fat and muscle mass, and these all seem to be related to low BMD and increases in the risk of osteoporosis.261
- Beer and bones
The limited available research suggests that specifically beer consumption may be good for bone health. A population study showed an increase in BMD for men and postmenopausal women when they consumed two glasses (around 700 ml) of beer per day, referring to the effect of alcohol but also to another constituent in beer, silicon. 260The involvement of silicon was seen in another population study where the effect of moderate beer drinking on BMD was compared to non-beer alcoholic beverages. When results were corrected for dietary silicon intake, the magnitude of the effect on BMD decreased for beer, but remained the same with non-beer alcoholic beverages. 28Information on the amount of silicon in beer can be found in Chapter 2.
Alcohol may play a role in decreasing the risk of rheumatoid arthritis, but may increase the risk of gout, another condition of the joints.
Rheumatoid arthritis is an inflammatory disease of the joints. The prevalence in Europe varies from 0.3% in France to 0.8% in the United Kingdom. However, only few countries have available data on the prevalence of rheumatoid arthritis and this makes it unclear how many people suffer from this condition in the EU. 263Risk factors for getting rheumatoid arthritis are smoking, obesity and being overweight, little physical exercise, and it tends to run in families showing a genetic link.
- Alcohol and rheumatoid arthritis
A meta-analysis found a 22% decrease in relative risk of rheumatoid arthritis for both women and men when looking at the results of multiple case-control studies (a type of population study). 264They did not find an effect of alcohol on risk of rheumatoid arthritis in another type of population study (cohort), 264but other researchers did. Women who drank 2–4 glasses of beer (350 ml per glass) per week had a 31% lower relative risk of rheumatoid arthritis than abstaining women. 265No research has been done in men. A mechanism for this effect is not yet established. Also there is no data available on the effect of alcohol in subjects already diagnosed with rheumatoid arthritis.
Gout is a form of inflammatory arthritis caused by a high amount of uric acid in the blood. It is not clear how many people have gout in Europe, but a recent study from the United Kingdom and Germany shows a stable prevalence of 1.4% in both countries.266
- Alcohol and gout
Alcohol consumption can increase the risk of gout. A meta-analysis saw an increase of 16% in relative risk when drinking only one drink (defined as 12.5 g per day). Consumption of 1–3 drinks per day (12.6–37.4 g) caused an increase of 56%. 267In this meta-analysis, no specific beverages were analysed as there are not enough studies that have looked at individual types of beverages, and the mechanism behind the association of gout and alcohol is not clear.
Moderate alcohol consumption may help to prevent kidney stones and it probably does not harm kidney function.
As alcohol increases urine output, it could help to prevent kidney stones, hard masses of calcium formed in the kidneys. How many people in Europe have kidney stones is not clear, but it is a common disease that increases in prevalence with obesity, and drinking enough fluids is important in prevention.
- Alcohol and kidney stones
A meta-analysis on fluids and kidney stone prevention described a 20% lower relative risk of developing kidney stones with an alcohol intake of 12 g per day. For every extra 10 g of alcohol per day another 20% was added to the total relative risk reduction (20% + 20% = 24%). This was the first meta-analysis undertaken, and more research is needed to confirm this finding.268
Chronic kidney disease
Kidney stones may increase the risk of chronic kidney disease (CKD), 269which is defined by a slower filtration rate in damaged kidneys. The main function of the kidneys is to filter waste products from the blood and convert it into urine. In the European population, 5.1–7.0% is at an early stage of CKD and 4.5–5.3% is in a more advanced stage.270
- Alcohol and kidney disease
CKD increases the risk of developing heart disease, and heart disease also increases the risk of CKD. There is strong scientific evidence that moderate alcohol consumption has a beneficial effect on the risk of heart diseases (see Chapter 5), but for CKD this cannot be concluded. A meta-analysis shows that alcohol consumption of less than 30 g per day for men and less than 15 g per day for women does not harm kidney function, though no beneficial effects have yet been found.271
Gallstones are hard masses in the gallbladder made largely from cholesterol. They are common in Europe, with prevalence ranging from 5.9% in Italy to 21.9% in Norway.272
- Alcohol and gallstones
The risk of gallstones may decrease with alcohol consumption, but evidence is scarce. In one cohort study, the relative risk of gallstones decreased by 3% per 7.9 g of alcohol consumed per day for men, though in women no protective effect was found. 273But in another cohort study, women did benefit from alcohol consumption with a 14% reduction in relative risk with the consumption of 5.0–14.9 g per day. 274As explained in Chapter 5, HDL cholesterol and alcohol are associated. With moderate alcohol consumption, HDL concentrations in the blood can increase, and which may also increase bile acid formation, keeping cholesterol soluble and preventing gallstones from developing. 273However, to prove this mechanism and the link between alcohol and gallstones, more research will be needed.
Well being and quality of life
People enjoy the relaxing effect of drinking beer and other alcoholic beverages, but there is limited research on the effects of moderate alcohol consumption on well being and the quality of life.
One review concluded that consumption of less than 20 g of alcohol per day may reduce stress and tension, and increases sociability and the feeling of well being. 275In an experimental study on social interaction, drinking 1–2 alcoholic drinks (grams not specified) made people more social, friendly and agreeable during a conversation according to the person they were talking to, but what caused these positive changes in mood and well being was not made clear.276
Quality of life
Multiple studies suggest that alcohol consumption of less than 30 g per day positively influences health-related quality of life. On the other hand, excessive alcohol consumption shows the reverse is true in research with adults more than 50 years old. 277In a population study in the USA, people were asked about their alcohol consumption and how they would rate their health. More moderate drinkers (defined as women consuming 42–98 g and men consuming 42–196 g of alcohol per week) rated their health above average as compared to abstainers and people with a higher alcohol intake.278
- Pain management
A review shows that moderate alcohol consumption (stated as less than 7 drinks per week for women and less than 14 drinks per week for men) can also help with pain management and thereby increase the quality of life. Patients with fibromyalgia, rheumatoid arthritis or chronic back pain who drank alcohol moderately, had less pain compared to abstainers. With fibromyalgia patients, a higher quality of life, better physical functioning and fewer symptoms of fibromyalgia were measured. However, excessive alcohol drinking increased the pain. It is not certain if the same effects are achieved with other comparable health problems and diseases, and as such, more research is suggested.279
- Social life in the elderly
When ageing, one faces many physical, psychosocial and social changes in life. Depression and loneliness are major problems among the elderly, and research shows elderly people prefer to keep engaged in social activities. 280Multiple cohort studies show an increase in the quality of life (measured by questionnaires on mental, physical, psychological and social functioning) with moderate alcohol consumption among people aged 50 years and over. 277,281,282A group of women aged 70–75 years who drank moderate amounts of alcohol (defined as 1–2 drinks per day, 3–6 days per week) rated their general, physical and mental health and social functioning higher than abstainers and women with a high alcohol consumption. 281On the other hand, the quality of life still decreased with moderate drinking as they became older, but less so as compared to abstainers and heavy drinkers.281,282