Breast Cancer & Alcohol: How Much is Safe?

Breast Cancer & Alcohol: How Much is Safe?
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Nearly 5,000 breast cancer deaths a year may be attributable to just light drinking (up to one drink a day).

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Recently, the IARC, the International Agency for Research on Cancer, the official World Health Organization body that decides what is and is not cancer-causing, concluded that alcoholic beverages—all alcoholic beverages—are to be considered “carcinogenic to humans.”

“[M]ost recent research has focused on acetaldehyde, the first and most toxic [alcohol] metabolite, as a cancer-causing agent.” Seems that bacteria in our mouths oxidize alcohol into this carcinogen called acetaldehyde, which we then swallow.

“There is convincing evidence that alcohol consumption increases the risk of [breast] cancer…” But: “Most of the data derive from studies that focused on the effect of moderate/high alcohol intakes, while little is known about light alcohol drinking (up to 1 drink/day).”

Hence, this new meta-analysis of studies that compared light drinkers to non-drinkers, and found “a moderate but significant association with breast cancer, based on the results of more than 100 studies.”

They estimate that about 5,000 breast cancer deaths a year are “attributable to light drinking”—meaning nearly 5,000 women that died of breast cancer maybe wouldn’t have, if they had just stayed away from alcohol completely, leading to an editorial in the medical journal Breast that concluded “women who consume alcohol chronically have an increased risk for breast cancer that is dose dependent but without threshold.” Meaning there’s apparently no level of alcohol consumption that doesn’t raise breast cancer risk at least a little. So, no “safe threshold. Any level of alcohol consumption appears to increase the risk of developing an alcohol related cancer.”

For example, the Harvard Nurses’ Study found that even consumption of less than a single drink per day may be associated with a modest increase in risk. Forget a single drink; what about “a single sip?” A new study found that even holding a teaspoon of hard liquor in your mouth for 5 seconds—and then spitting it out—results in “carcinogenic concentrations of acetaldehyde…produced from [the alcohol] in the oral cavity instantly after a small sip of strong alcoholic beverage, and the exposure continues” for about 10 minutes after spitting it out. And, you didn’t even drink it!

Even alcohol-containing mouthwash can give you a carcinogenic spike. The researchers conclude: “All in all,…there is a rather low margin of safety in the use of alcohol-containing mouthwash. Typical use will reach the concentration range… above which adverse effects are to be expected. Till the establishment of a more solid scientific basis for a threshold level of acetaldehyde in saliva, prudent public health policy would recommend generally refraining from using alcohol in such products.”

So, why isn’t the same recommendation made for alcoholic beverages? Well, as the Harvard paper concludes, individuals “will need to weigh the risks of light to moderate alcohol use on breast cancer development against” the benefits for heart disease prevention “to make the best personal choice regarding alcohol consumption.” They’re talking about the famous J-shaped curve. While smoking is bad, and more smoking is worse, and exercising is good, and more exercise is better, for alcohol, there appears to be this beneficial effect of small doses. A six-pack a day raises overall mortality, but so does teetotaling.

The #1 killer of women isn’t breast cancer; it’s heart disease, and a drink a day reduces the risk of heart disease. Why just reduce the risk of heart disease, though, when you may nearly eliminate the risk of heart disease with a healthy diet? So, a plant-based diet that excludes certain plant-based beverages may be the best for overall survival.

Please consider volunteering to help out on the site.

Images thanks to zyphichore via flickr

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Recently, the IARC, the International Agency for Research on Cancer, the official World Health Organization body that decides what is and is not cancer-causing, concluded that alcoholic beverages—all alcoholic beverages—are to be considered “carcinogenic to humans.”

“[M]ost recent research has focused on acetaldehyde, the first and most toxic [alcohol] metabolite, as a cancer-causing agent.” Seems that bacteria in our mouths oxidize alcohol into this carcinogen called acetaldehyde, which we then swallow.

“There is convincing evidence that alcohol consumption increases the risk of [breast] cancer…” But: “Most of the data derive from studies that focused on the effect of moderate/high alcohol intakes, while little is known about light alcohol drinking (up to 1 drink/day).”

Hence, this new meta-analysis of studies that compared light drinkers to non-drinkers, and found “a moderate but significant association with breast cancer, based on the results of more than 100 studies.”

They estimate that about 5,000 breast cancer deaths a year are “attributable to light drinking”—meaning nearly 5,000 women that died of breast cancer maybe wouldn’t have, if they had just stayed away from alcohol completely, leading to an editorial in the medical journal Breast that concluded “women who consume alcohol chronically have an increased risk for breast cancer that is dose dependent but without threshold.” Meaning there’s apparently no level of alcohol consumption that doesn’t raise breast cancer risk at least a little. So, no “safe threshold. Any level of alcohol consumption appears to increase the risk of developing an alcohol related cancer.”

For example, the Harvard Nurses’ Study found that even consumption of less than a single drink per day may be associated with a modest increase in risk. Forget a single drink; what about “a single sip?” A new study found that even holding a teaspoon of hard liquor in your mouth for 5 seconds—and then spitting it out—results in “carcinogenic concentrations of acetaldehyde…produced from [the alcohol] in the oral cavity instantly after a small sip of strong alcoholic beverage, and the exposure continues” for about 10 minutes after spitting it out. And, you didn’t even drink it!

Even alcohol-containing mouthwash can give you a carcinogenic spike. The researchers conclude: “All in all,…there is a rather low margin of safety in the use of alcohol-containing mouthwash. Typical use will reach the concentration range… above which adverse effects are to be expected. Till the establishment of a more solid scientific basis for a threshold level of acetaldehyde in saliva, prudent public health policy would recommend generally refraining from using alcohol in such products.”

So, why isn’t the same recommendation made for alcoholic beverages? Well, as the Harvard paper concludes, individuals “will need to weigh the risks of light to moderate alcohol use on breast cancer development against” the benefits for heart disease prevention “to make the best personal choice regarding alcohol consumption.” They’re talking about the famous J-shaped curve. While smoking is bad, and more smoking is worse, and exercising is good, and more exercise is better, for alcohol, there appears to be this beneficial effect of small doses. A six-pack a day raises overall mortality, but so does teetotaling.

The #1 killer of women isn’t breast cancer; it’s heart disease, and a drink a day reduces the risk of heart disease. Why just reduce the risk of heart disease, though, when you may nearly eliminate the risk of heart disease with a healthy diet? So, a plant-based diet that excludes certain plant-based beverages may be the best for overall survival.

Please consider volunteering to help out on the site.

Images thanks to zyphichore via flickr

Doctor's Note

Previously, I’ve addressed alcohol’s pros and cons in Alcohol Risks vs. Benefits. The other mouthwash video I referred to is Don’t Use Antiseptic Mouthwash, which is part of my video series on improving athletic performance with nitrate-containing vegetables (if interested, start with Doping with Beet Juice).

Also, be sure to check out Breast Cancer Risk: Red Wine vs. White Wine

How else might one reduce breast cancer risk? See, for example:

And, of course, check out my many other videos on breast cancer.

Finally, be sure to see my associated blog posts for further context: Breast Cancer & Alcohol: How Much Is Safe? and Breast Cancer & Wine.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

27 responses to “Breast Cancer & Alcohol: How Much is Safe?

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  1. I wonder what the risk is if your use mouthwash like I do.
    Rinse with mouthwash, spit, light rinse with water, toothpaste, rinse and re-rinse until my mouth does not have any visible paste left. :{} ?




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  2. What about social drinking? My heritage is French, Italian, and Spanish. Needless to say, we are wine drinkers. And for generations, the women in my family have lived well into their 80’s and 90’s. Most of us drink moderately, and not hard liquor either, but almost exclusively red wine. However, when we get together for family gatherings, we have been known to polish off a couple of bottles of wine. Does this social bonding help protect us against our ‘bad habit’.

    According to Dr. Dean Ornish, people with strong bonds — friends and family ties — enjoy a bolstered immunity which may protect them from coming down with maladies like cancer and heart disease, which affect the rest of the population eating the same diet (usually meat-based). Now, I am a vegan and I have a healthy life style overall, but I do enjoy an occasional glass of wine. And I don’t have any of the risk factors that are associated with developing cancer. What is wrong with women enjoying an occassional glass of wine?

    I have to say, I often wonder if some of these studies targeted at women aren’t motivated by a puritanical bias on the part of the researchers. I suppose we’ll hear next that men may still drink moderately, but if you’re a women, you’d better not take so much as a sip. Look, I know that many of these studies are not fool-proof. Researchers may be affected by unconscious biases towards certain groups (e.g. women drinkers). And the results may be skewed. So I have some questions. Did they take a healthy vegan lifestyle into consideration, or were they looking mainly at meat eaters? This is still a puritanical society when it comes to what women can or can’t do. Well, perhaps I’m just rationalizing. I do like my wine. All the same, I’d like to see more studies before I accept these results. I don’t see anything wrong with an occasional glass of wine enjoyed among friends.




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    1. A lot of problems, which affect both genders, are associated with alcohol consumption – of course some of them dose dependent: Violence (probably mostly men), car accidents, hypertension, stroke, colorectalcancer, diabetes, osteoporosis, atrial fibrillation, heart failure etc. The true safe upper limit for both genders is probably low. That said, I drink wine every week, and I have no intention of stopping that. And you make a good point, you eat healthy, it is a part of social life, social bonding, eating well, it makes you relax, it tastes great – and hey its plant based! :-)




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    2. For perspective, breast cancer accounts for only 3.3 out of 100 deaths among American women. Cardiovascular diseases accounted for 10 fold the number of deaths. (http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf)

      I think these two papers are worth perusing:

      Sun, Qi, et al. “Alcohol consumption at midlife and successful ageing in women: a prospective cohort analysis in the nurses’ health study.” PLoS medicine 8.9 (2011): e1001090. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001090

      Women who drank moderately (and even daily) had a better chance of living to 70 without a medical history of serious diseases (cancer, diabetes, cardiovascular disease and stroke, Parkinson’s, MS, etc.), loss of cognitive function, disability, or mental illness. This measure aggregates a whole range of potential health setbacks.

      And on the other side:

      Britton, A., M. G. Marmot, and M. Shipley. “Who benefits most from the cardioprotective properties of alcohol consumption—health freaks or couch potatoes?.” J EPIDEMIOL COMMUN H 62.10 (2008): 905-908. http://jech.bmj.com/content/62/10/905.short

      Physically active non-smoking women with healthy diets didn’t get the heart/stroke risk benefit from alcohol seen in the general population.




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  3. I have started to have some tooth problems and I started to swish with salt water instead of the alcohol based mouthwash. I find the salt water is far more soothing than the alcohol based mouthwash, which is very irritating. Is salt water the best thing to swish one’s mouth with? I do use sea salt and of course don’t drink the salt water.




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  4. Hello, what about kefir? when you leave it several days it generates a little of alcohol , may be less than 1% but it’s alcohol




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  5. I heard Dr. Oz recommend a glass of beer per day as being beneficial.
    I think that was irresponsible. Some don’t want to stop at one glass. And with the information in this video, it would be best to avoid all alcohol and go plant-based.




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  6. The teetotalers in the studies showing the J shaped curve may have been people who had a history of alcohol dependence. They also may have been abstaining because of other health problems such as liver disease. They need to re-do those studies, excluding those with a history of alcohol related diseases, and controlling adequately for other health-related behaviors.




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      1. I would respectfully disagree with this. I used to work for a company (in Australia) that manufactured herbal tinctures (amongst many other herbal products) and some of the tinctures were up to 95% EtOH with MOST of them being between 40-70% EtOH! So, it would depend upon the company manufacturing the tincture.

        My point being that if you are using a tincture that is 95% EtOH, even a low dose is going to be a significant amount of EtOH when it is almost pure EtOH! Therefore, it would be important to read the label to see what %EtOH was being used.




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    1. Unless you’re drinking tinctures by the glassful, a drop or two of alcohol only matters if you’re trying to eliminate every trace of dietary alcohol which is just about impossible. Alcohol is naturally produced even in non-fermented fruits at low levels and this doesn’t seem like a worthwhile battle. Drinking alcohol by the glassful is worth questioning – I rarely do this personally because my focus is on packing nutrients in and alcohol just sucks a lot of those goodies right back out.




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  7. I have a few concerns with this video, primarily regarding the link between breast cancer risk and alcohol consumption. The meta-analysis used by Dr. Greger has important limitations and qualifications that should be noted, and which place the information, and any subsequent advice and decision-making, into proper perspective. First, the researchers used articles that only demonstrated an association between alcohol consumption and breast cancer (and other cancers as well, but I’ll limit my comments to BC). The analysis in no way controlled for extraneous variables that could also account for the increase in breast cancer risk. For example, the researchers did not control for smoking status in the analysis. Given that people who drink are more likely to smoke, we are left wondering if the main effect is due to alcohol or cigarettes. The authors note this limitation in their paper, and interestingly they cite research on people who have never smoked, but drank alcohol, and the risk ratio in that group is below 1.0 (it was .95, which if anything would indicate less risk relative to abstainers). The analyses did in no way control for any third variables that could (a) correlate with drinking and (b) explain variance in cancer risk independent of drinking.

    This particular criticism is especially important given that that RR (risk ratio) was 1.05. This is a very small effect – in fact, the confidence interval was 1.02 – 1.08, which most researchers would consider quite small. Given that an RR of 1.0 is no effect at all, it was surprising to see the authors refer to this as a “moderate” effect. If this is moderate, what would be small? In any case, given that important third variables such as smoking, diet and other relevant lifestyle factors were not controlled, it is reasonable to have serious doubts that the RR would have remained at 1.05 if these variables were controlled.

    I do not want to be overly critical of Dr. Greger, but these are important limitations of this research that should be mentioned and weighed to some extent. Watching this video, the conclusion seems to be that drinking any amount of alcohol leaves you – the individual viewer – concluding that you are immediately vulnerable to cancer after taking one drink. Both the limitations of this study, in conjunction with problems applying epidemiological study results to individual risk analysis (a separate issue beyond this comment space) make me uneasy with such conclusions and advice implied.

    My two cents.




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  8. Hello!
    I recently found Dr. Gregor and this website after eating a strict plant only diet for over three years (and I stay away from unhealthy vegan foods, as well)! My question involves alcoholism.
    I am a recovering alcoholic (or at very least a binge drinker). I have never been a liquor person, but I would consume light beer as if they were going to stop making it, and did so for a long time. To quantify, I am talking about at least 8-10 light beers over the course of an evening into the night time and leading right up to bed, and then around 5 or whenever I got home from work the next day, begin the whole process over again.
    My question is: now that I have considerably cleaned up my life, and have stopped drinking entirely, is there anything I should be doing for myself to repair any damage that I have probably caused to my body? Are there any supplements you recommend? Are there any outright signs that I do have damage from alcohol that needs more attention than just pouring fresh juice and whole foods into myself can do alone?
    I really appreciate all of your great videos, and the time that all of you take to spread the not-so-common sense word of living long and prospering with a whole foods plant only diet.

    Joe




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    1. Joe: That’s so awesome that you have got yourself on a healthy path, both getting rid of the alcohol and working on eating healthy. Dr. Greger may have some videos on helping people who have consumed a lot of alcohol, but nothing is coming to mind to me right now. However, I bet Dr. Greger has some videos on conditions ex-alcoholics are likely to deal with. I really don’t know anything about this area, but as a guess, isn’t liver problems a potential issue? If so, I believe that this site has some videos about liver health. Etc. So, my advice is to pick specific topics you are concerned about and then to do a search on those in the Search box at the top of the screen and to use the Health Topics page (which can be hit or miss in terms of helpfulness/having anything on a particular topic, but is really worth checking out).
      .
      Finally, I would recommend that you get a hold of a copy of Dr. Greger’s new book How Not To Die. It’s a great summary of the information that is available here on the website, but the book is organized and condensed. Also, the book has a Part 2 section on specific recommendations for daily eating. I think those recommendations would apply to you as much as to anyone else.
      .
      Hope that helps. Good luck.




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    2. Hi Joe. This is quite a long time from when you posted, but for you or anyone needing this info, your liver is capable of regeneration (that’s how a partial liver transplant can work) given the chance, so if you have immediate problems the issue is providing support until that can happen. Since you’re several years out and it sounds like you’re making good food choices, you’re probably fine, but you can help at any point by supplementing with milk thistle (silymarin) – there’s ample research now demonstrating benefit in reducing fibrosis and scar formation. And if you’re eating a lot of plants you may have “caught up” but it won’t hurt to take a B complex (if you don’t need it you’ll just have bright shiny pee). Since your liver takes a big hit processing sugar and fat, keep those low. I don’t know if you take any pharmaceuticals but if so, research their liver toxicity individually (including OTCs) as some are extraordinarily hepatotoxic. Hope things are still going great for you!




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  9. I remember learning about acet(aldehydes) in organic chemistry ( khan academy) a few days ago by using an oxidation reagent on primary alcohols. At first I didn’t understand why we have to take organic chemistry but now I’m beginning to understand why.




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