Are you allostatic loaded? New evidence supports healthy drinking

There’s no shortage of studies and opinions about the health benefits (and detriments) of drinking, but most of them have essentially the same approach: Find out what and how much people consume, and then see what their incidence of illness or mortality is over time. Wine generally looks better than other forms of alcohol intake, but it isn’t entirely exempt. Despite the immense amount of attention researchers have devoted to the question it remains notoriously difficult to get credible data, but a new approach called “allostatic loading” (AL) aims to bring a dose of objectivity. Originally described to model the effects of stress on the brain and its implications for overall health, AL is now generally interpreted to represent the physical effects on the body which accumulate as a consequence of exposure to chronic stress. It derives from the concept of allostasis, which involves the regulation of homeostasis in the body to decrease physiological consequences of stress.

How Allostatic Loading found good news for wine lovers

Here’s how AL works for the issue of wine and health: rather than try to determine how different levels and types of drinking relate to disease incidence or longevity, AL uses a panel of blood markers known to contribute to health risk. These include such biomarkers as 12-hour excretion of epinephrine and cortisol (stress), resting pulse and blood pressure (cardiac), C-reactive protein, Interleukin-6, and others (inflammation), Body Mass Index, cholesterol and triglyceride profiles (lipid metabolism), along with hemoglobin A1C and fasting glucose (glucose metabolism.) Taken together these constitute your personal allostatic load. Because it is a verifiable measurement of health status and highly predictive of outcomes, AL is a useful tool for public health studies.

Researchers at the UCLA School of Medicine and the Johns Hopkins University School of Public Health used an AL assessment consisting of 24 biomarkers to evaluate the positive and negative effects of different levels of drinking, and found encouraging news for wine lovers. Their data came from a cohort of 1255 adults from the “Midlife in the United States Study” (MIDUS), a long-term national study of health, aging, and well-being. About a third of the MIDUS subjects were nondrinkers, who were subdivided into lifelong abstainers/former light drinkers, former moderate, and former heavy; the drinkers were classified into light, moderate, and heavy, for a total of 6 groups. The headline is that all 3 groups of current drinkers had lower AL scores than the non-drinkers.

While this shouldn’t come as a surprise that moderate drinkers were healthier֊-the familiar J-shaped curve–it is interesting that all 3 groups of nondrinkers had similar AL scores. This sheds light on one of the vexing questions in wine and health known as the “sick quitter hypothesis,” which assumes that the comparatively worse health status of nondrinkers vs moderate drinkers is because it includes people who had to quit because of the effects of alcohol abuse on health. These findings add to other studies refuting the sick quitter conjecture by parsing out the subcategories of abstainers.

As always, there are weaknesses with this study, such as reliance on self-reported drinking, and it is a bit surprising that the reduced AL seems to apply across all levels of drinking. It would be helpful to know more about patterns of drinking and preferences, but that may be asking too much.  

Goldwater D, Karlamangla A, Merkin SS, Seeman T. Compared to non-drinkers, individuals who drink alcohol have a more favorable multisystem physiologic risk score as measured by allostatic load. PLoS One. 2019;14(9):e0223168.

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