We all know that Bacchus was a man. Based on gender stereotypes, most of us assume that women are less likely to excessively imbibe alcohol then men. (For the sake of transparency, the Superbowl was playing while I wrote this and all that celebrated testosterone caused me to make that last statement). But not necessarily so… According to a recent CDC report in “Vital Signs,” more than 14 million US women binge drink about three times a month and consume an average of six drinks per binge. This number includes one in eight women and one in five high school girls! The report states that binge drinking is most common in young women, women who are white or Hispanic, and among women with household incomes of $75,000 or more. Oh…and half of all high school girls who drink alcohol report binge drinking.

A woman’s ability to metabolize alcohol differs significantly from that of a man. When we drink alcohol it is absorbed more quickly, deactivated by enzymes less efficiently, and gets to the brain faster. (Well, we always knew that our brains have rapid and superior circulation. ) We generally weigh less than men so we are also less likely to dilute the stuff. As a result, one drink for a women has the impact of two for a man.

The definition of binge drinking for a woman is consumption of four or more alcohol drinks on an occasion. And an occasion is considered to be 2 to 3 hours. Although binge drinking in high school or college can lead to a higher incidence of alcoholism in later life, most binge drinkers are non-alcoholics and not alcohol dependent. The CDC reports that drinking too much (which of course includes binge drinking) results in about 23,000 deaths in women and girls each year and increases the chances of breast cancer, heart disease, sexually-transmitted diseases, unintended pregnancy as well as other health problems. If a woman binge drinks while pregnant, she risks exposing her baby to high levels of alcohol during its development which can lead to miscarriage, low birth weight, sudden infant death syndrome (SIDS), attention deficit/hyperactivity disorder (ADHD), and fetal alcohol syndrome (facial disfigurement and mental deficiencies). This is where I’m supposed to say it’s not safe to drink alcohol any time during pregnancy.

Aside from giving warnings, the CDC and its Guide to Community Preventive Services recommend certain strategies for preventing excessive alcohol consumption.. These include:  

*Increasing alcohol taxes.

*Reducing the number and concentration of stores that sell alcohol in a given area.

*Continuing government controls over alcohol sales.

*Maintaining or reducing the days and hours of alcohol sales.

*Enhanced enforcement of laws prohibiting sales to minors.

*Electronic screening and counseling for excessive alcohol use.

I know some of this sounds excessive and may go against our sense of what the government should and should not do. (There are no blue laws in California, and according to that wonderful series Boardwalk Empire, prohibition doesn’t work!) To help avoid teenage binging, the best plan might be to make sure that our teens can’t get into our liquor closet and of course, maintain zero tolerance for alcohol use before, during and after school parties. And then we should listen to the anti-binge advice ourselves. Remember abstaining from that second and certainly the third drink may lessen our risk for breast cancer, heart disease, stupid behavior, and worse yet, the wrong sexual and reproductive decisions. We just don’t need that extra glass of wine, cocktail or beer to enjoy the game, the dinner or the party. The salute ” Le Chaim” (translated, for those of you who need it) to “To Life” need not be accompanied by 4 drinks…one is healthier and should suffice.

A quick personal note: I am traveling to Mozambique next week with several women to see the school we built through the LA Associates of Save the Children. I will be happy to share pictures and stories upon my return.

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Every once in a while I have a culinary break down and snack on potato chips….they gratify so many tastes: salt, fat, crispy carbs and empower a feeling of “so what.”  Turns out that I (and you) would be better off snacking on nuts. At least that’s the conclusion of a prospective investigation of lifestyle behaviors and diet published in the June issue of The New England Journal of Medicine. The authors combined questionnaires on lifestyle factors and weight change for 120,877 women and men who were free of chronic disease and who participated in 3 studies with follow-up periods ranging from 1986 to 2006 (The Nurses Health Study), 1991 to 2003 (the Nurses Health Study II…this involved younger nurses; Nurses I and II were all women) and 1986 to 2006 (the Health Professionals Follow-up Study… all male). Their diets were assessed as to consumption of fruits, vegetables, whole grains, refined grains (what I call the white stuff), potatoes (including boiled, mashed potatoes and french fries), potato chips, whole-fat dairy products, low-fat dairy products, sugar-sweetened beverages, sweets and desserts, processed meats, unprocessed red meats, fried foods and trans fats. In other words, pretty much everything we know that can be bad for our health. The studies also evaluated nuts, 100%-fruit juices, diet sodas and subtypes of dairy products and potatoes. The participants were questioned about their physical activity, television watching, alcohol use, sleep duration and cigarette smoking.

The participants’ food and weight changes were assessed every 4 years. When the average weight gain was calculated for the 3 groups it was 3.35 lb…doesn’t sound like a huge amount, but when calculated over 20 years this comes to 16.8 lb. (There goes a size 6, an 8 and even a10!) And here are the foods and behaviors that were associated with weight gain, as well as those that were related to weight loss:

FOOD OR BEHAVIOR	WEIGHT GAIN (+) or L0SS (-) PER 4 YEARS
Potato Chips Potatoes Refined grains Sweets and desserts Sugar Sweetened beverages Unprocessed Red Meats Processed meats Vegetables Whole grains Fruits Nuts Yogurt Physical activity Alcohol use Smoking cessation (new quitters) Former smokers Sleep (weight gained with less than 6 hours or more than 8 hours) Television watching	+ 1.69 lb +1.28 lb +0.37 lb + 0.41 lb +1.0 lb + 0.95 lb + 0.92 lb - 0.22 lb - 0.37 lb - 0.49 lb - 0.57 lb - 0.82 lb - 1.76 lb + 0.41 lb per drink per day + 5.17 lb + 0.14 lb + 0.31 lb per hour per day

I’m sure you will (and should) now ask: How many potato chips or nuts does one have to consume to gain or lose weight during that 4 year period? Just one serving per day! (And for the amount that constitutes a serving, you have to look on the package or bottle insert and/or use common nutritional sense.)

Please note that the weight gain that was associated with refined grains was similar to that of a serving of sweets and desserts. Inverse associations with weight gain (i.e. loss) were seen with the consumption of vegetables, whole grains, fruits, nuts and yogurt. No significant differences in weight gain were seen for high-fat versus low-fat and skim milk. The authors weren’t sure why yogurt consumption helped prevent weight gain. They hypothesized that changes in colonic bacteria caused by the yogurt might prevent weight gain. And they thought that even though vegetables, nuts, fruits and whole grains provide calories (and according to thermodynamic law a calorie is a calorie and energy put in the body will be stored unless it is used up); their consumption reduced the intake of  the other foods that were more likely to cause weight gain. It was interesting that drinking 100%-fruit juice was associated with less weight gain than sugar-sweetened beverages. The reason may be that the fruit juices are consumed in smaller portions. (It’s hard to drink a “big gulp” of orange juice!)

Finally, (and we would expect this) the women and men with who exercised daily lost 1.76 pounds within each 4-year period.

Now for the smoking issue… I don’t want this data to stop anyone from deciding to stop.  Smoking is thought to alter the distribution of body fat, promoting internal abdominal fat (called visceral fat) rather than fat on the rest of the body. So weight might be less while smoking but this visceral fat is dangerous and is linked to a high risk of diabetes. Any so called weight loss from smoking is ultimately harmful. (Just think of the fat going invisibly inside your abdomen as your thighs, arms and the tush lose circumference; and that this bad fat can kill you!),  The immediate weight gain that can occur after smoking cessation actually represents a healthier distribution of fat, moreover that weight eventually declines.
Here are some stats that match the overall data from these 3 studies: Between 1971 and 2004 the average dietary intake of calories in the United States increased by 22% among women and 10% among men, mainly due to increased consumption of refined carbohydrates, starches and sugar-sweetened beverages. Just 50 to 150 extra calories a day will cause the gradual weight gains, and over time those pounds add up and demolish our figures (and health).

Bottom line: Eat those vegetables, whole grains, fruits, nuts and yogurt.  Cut down on all those processed carbs and starches. Limit your TV time (you are more likely to eat the bad stuff while sitting there watching TV, even if you Tivo out the commercials for potato chips), make sure you exercise (at least 30 minutes most every day) stop smoking as soon as possible (better yet never start) and  sleep 7 to 8 hours a day. Well our mothers knew all that!

I just returned from Israel and frankly would not be able to function without a caffeine push. To add to my thanks for that cappuccino (or 2) is a new study that appeared in the journal Stroke. (Yes, there are journals that are titled for diseases.) Researchers at the very well known Karolinska Institute in Stockholm followed 35,670 women (ages 49 to 83 years) who did not have a history pf cardiovascular disease or cancer over a 10 year period of time. (These women were actually participating in the Swedish Mammography Cohort study looking at links between diet, lifestyle and disease.) They assessed coffee consumption using a self-administered questionnaire. The questionnaire made no distinction between caffeinated and decaffeinated cups of coffee, but it is well known (reference The Girl with the Dragon Tattoo as well as the other novels by Steg Larsson) that decaffeinated consumption of coffee in Sweden is low.

The researchers found that 1 to even more than 5 cups of coffee a day lowered risk for stroke, cerebral infarction (lack of oxygen and death of the tissue from an occlusion of an artery) as well as sub arachnoid hemorrhage by 25%! The amount of coffee did not seem to make a difference; it just had to be a daily beverage. And when they took into consideration smoking, weight, history of diabetes, hypertension and alcohol consumption, the decrease in stoke incidence was still there if coffee was consumed on a regular basis.  Wow! This doesn’t mean that the latter factors are not important…but even if they exist, coffee appears to decrease the risk of those women who are at risk.

The authors of the study suggested that coffee drinking reduces stroke by decreasing mild inflammation, acting as an antioxidant and improving insulin sensitivity. Right now, I just want it to keep me awake!