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According to a famous series of papers in the Journal of the American Medical Association called the “Actual Causes of Death in the United States,” the leading killer of Americans in the year 2000 was tobacco, followed by diet and inactivity. The third-leading killer? Alcohol. About half of alcohol-related deaths were due to sudden causes like motor vehicle accidents; the other half were slower, and the leading cause was alcoholic liver disease.

Excessive alcohol consumption can lead to an accumulation of fat in the liver (known as fatty liver), which can cause inflammation and result in liver scarring and, eventually, liver failure. The Centers for Disease Control and Prevention defines excessive drinking as the regular consumption of more than one drink a day for women and more than two a day for men. A drink is defined as 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces (a “shot”) of hard liquor. Progression of the disease can usually be halted by stopping drinking, but sometimes it’s too late.

Once alcohol-induced hepatitis (liver inflammation) is diagnosed, three-year survival rates can be as high as 90 percent among people who stop drinking after diagnosis. But as many as 18 percent of them go on to develop cirrhosis, an irreparable scarring of the liver.

Alcohol consumption may also play a role in pancreatic cancer, among the most lethal forms of cancer, with just 6 percent of patients surviving five years after diagnosis. As many as 20 percent of pancreatic cancer cases may be a result of tobacco smoking, and other modifiable risk factors include obesity and heavy alcohol consumption.

Similarly, the primary risk factors for esophageal cancer include smoking and heavy alcohol consumption (though even light drinking appears to increase risk), as well as gastroesophageal reflux disease (GERD, also called acid reflux).

What about cancer of the breast? In 2010, the official World Health Organization body that assesses cancer risks formally upgraded its classification of alcohol to a definitive human breast carcinogen. In 2014, it clarified its position by stating that, regarding breast cancer, no amount of alcohol is safe.

But what about drinking “responsibly”? In 2013, scientists published a compilation of more than one hundred studies on breast cancer and light drinking (up to one alcoholic beverage a day) and found a small but statistically significant increase in breast cancer risk even among women who had at most one drink per day—except, perhaps, for red wine. Why red wine? A compound in it appears to suppress the activity of an enzyme called estrogen synthase, which breast tumors can use to create estrogen to fuel their own growth. This compound is found in the skin of the dark-purple grapes used to make red wine, which explains why white wine appears to provide no such benefit, since it’s produced without the skin.

The researchers concluded that the grapes in red wine may help cancel out some of the cancer-causing effects of the alcohol. But you can reap the benefits without the risks associated with imbibing alcoholic beverages by simply drinking grape juice or, even better, eating the purple grapes themselves—preferably ones with seeds, as they may be most effective at suppressing estrogen synthase.

Image Credit: Amanda Rae. This image has been modified.

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