Alcohol consumption: the good, the bad, and the indifferent

Dietary ethanol (alcohol) is the most widely consumed drug worldwide. High levels of mortality, morbidity, and social malaise are associated with abuse of alcohol, and increasing numbers of women and youth are abusing alcohol. However, strong epidemiological data demonstrate a U- or J-shaped relationship between volume of alcohol consumed and all-cause mortality or disease burden. Moderate alcohol consumption is associated with a lower risk of all-cause mortality and disease burden than are abstinence and immoderate drinking. A brief review of the absorption, distribution, metabolism, and excretion of ethanol is provided with a discussion of the impact of gender differences. Potential mechanisms by which ethanol, ethanol metabolites, and (or) phytochemicals, as associated with different types of ethanol-containing beverages, are discussed in regards to the beneficial and detrimental impacts they may have on physiological system functioning and mortality or disease burden. Per capita consumption of ethanol-containing beverages varies across geo-political regions worldwide. A more recent research focus is the impact of consumption patterns on consumption volumes as they relate to disease and mortality. Certain drinking patterns moderate overall volume of ethanol consumption. Thus, an emerging approach to the study of alcohol consumption in populations is to consider both the volume and pattern of consumption as they relate to mortality and disease burden. Alcohol consumption patterns among athletes are discussed; physiological implications of alcohol abuse in this population are outlined. Current guidelines for the consumption of alcohol are reviewed. Alcohol consumption guidelines reflect the current scientific understanding of both the benefits of moderate alcohol consumption and the detriments of immoderate alcohol consumption.