Friday, November 21, 2014

Moderate Alcohol Consumption - Osteoporosis (Bone) and Arthritis Benefits

Beneficial effect of moderate alcohol consumption on osteoporosis in women

Women after menopause tend to develop weaker bones from what is known as osteoporosis, which may lead to fractures (especially hip fractures) from falling. The weakness of the bones results from an imbalance between the normal resorption (a type of dissolving of old bone) and the laying down of new bone, an ongoing process for both men and women referred to as "bone turnover." For poorly understood reasons, after menopause the resorption of old bone in women continues but new bone is laid down less well, leading to a decrease in bone density. A variety of substances (calcium, vitamin D and various medications) have been used in an attempt to prevent the development of osteoporosis; in epidemiologic studies, moderate drinking of alcohol has also been shown to lower this risk.

An intervention published in Menopause, involved 40 healthy postmenopausal women of an average age of 56. The authors measured factors that relate to osteoporosis in post-menopausal women while subjects were consuming alcohol (19g a day), after they had stopped drinking, and after they had resumed their alcohol consumption. The authors state that excessive bone turnover, combined with an imbalance whereby bone resorption exceeds bone formation, is the principal cause of post-menopausal bone loss and conclude that alcohol decreases the turnover of bone in post-menopausal women, which leads to less resorption of bone, hence less osteoporosis. The study also showed that abstinence from alcohol resulted in increased markers of bone turnover (hence, higher risk of developing osteoporosis), whereas resumption of alcohol consumption reduced bone turnover markers.

Moderate alcohol intake associated with bone protection

In an epidemiological study of men and post-menopausal women primarily over 60 years of age, regular moderate alcohol intake was associated with greater bone mineral density (BMD). Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University found associations were strongest for beer and wine and, importantly, BMD was significantly lower in men drinking more than two servings of liquor per day. The results suggest that regular moderate consumption of beer or wine may have protective effects on bone, but that heavy drinking may contribute to bone loss.

"Previous research suggests that moderate alcohol consumption in older men and post-menopausal women may protect against BMD loss, a major risk factor for osteoporosis," said Katherine L. Tucker, PhD, corresponding author and director of the Dietary Assessment and Epidemiology Research Program at the USDA HNRCA. The 2005 Dietary Guidelines issued by the federal government defines moderate alcohol consumption as one drink per day for women and two drinks per day for men.

"Our study also looks at the possible effects of the three alcohol classes, beer, wine and liquor on BMD," Tucker continued. "We saw stronger associations between higher BMD and beer drinkers, who were mostly men, and wine drinkers, who were mostly women, compared to liquor drinkers." The results were published in the American Journal of Clinical Nutrition.

Tucker, who is also a professor at the Friedman School of Nutrition Science and Policy at Tufts, and colleagues analyzed BMD measurements taken at three hip sites and the lumbar spine in 1,182 men, 1,289 post-menopausal women, and 248 pre-menopausal women whose parents or in-laws participated in the original Framingham Heart Study. There was not enough data to determine the effects of more than two servings of alcohol per day in post-menopausal women or the effects of daily alcohol consumption on BMD in pre-menopausal women. Participants self-reported their alcohol intake on dietary questionnaires. One serving of beer equaled a glass, bottle or can (356 mL), one serving of wine equaled a 4-oz. glass (118 mL), and one serving of liquor equaled one mixed drink or shot (42 mL).

After adjusting for several other factors that may have accounted for the higher BMD, such as silicon intake, calcium intake and smoking history, the authors still saw an association between higher BMD and moderate alcohol consumption. One of the strongest associations was seen in men who reported consuming one or two servings of total alcohol (a combination of beer, wine and liquor) or one or two servings of beer per day. Hip BMD in this group was significantly greater compared to non-drinkers.

In contrast, the authors observed significantly lower BMD at the hip and spine in men who consumed more than two servings of liquor per day compared to men who consumed one or two servings of liquor per day. "There is a body of research showing alcoholism is devastating to bones," Tucker said. "It's a major risk factor for osteoporosis. No one should depend solely on alcohol to maintain bone health."

The authors hypothesize that the silicon found in beer is contributing to the higher BMD scores in the men who reported consuming one or two servings of total alcohol or beer per day, citing previous studies finding silicon has greater bioavailability as a liquid. It is less clear why liquor and wine might protect BMD.

"We cannot say definitively what component of these alcoholic drinks might be beneficial to bone health because our findings are from an observational study, as opposed to a clinical trial," Tucker said. "Future studies might dig deeper into patterns of alcohol consumption, as we relied on a self-reported dietary questionnaire. Another component of data worthy of exploration is whether the antioxidants found in wine, such as resveratrol or polyphenols, have a protective effect on bone in addition to other health benefits."

Study suggests moderate drinking lowers risk of developing rheumatoid arthritis in women

A follow-up study of more than 34,000 women in Sweden has shown that moderate drinkers, in comparison with abstainers, were at significantly lower risk of developing rheumatoid arthritis (RA), an often serious and disabling type of arthritis. RA is known to relate to inflammation, and it is thought that this inflammation is blocked to some degree by the consumption of alcohol. In this study, women who consumed at least 4 drinks per week (with a drink being defined as containing 15 grams of alcohol) had 37% lower risk of developing RA than subjects reporting never drinking or consuming less than 1 drink/week.

This large study is important as few prospective studies are of adequate size to have sufficient cases of RA to evaluate factors related to its development. The study supports previous research showing a lower risk of developing RA, or milder severity of the disease, among moderate drinkers than among abstainers.

Alcohol consumption lowers risk of developing several arthritic conditions

Alcohol consumption is associated with a significantly reduced risk of developing several arthritic conditions including Rheumatoid Arthritis (RA), Osteoarthritis (OA), reactive arthritis, psoriatic arthritis and spondylarthropathy, according to results of a study presented at EULAR 2010, the Annual Congress of the European League Against Rheumatism in Rome, Italy. Regardless of the type of arthritis, all patients reported drinking less alcohol than controls, leading to questions around the inflammatory pathways behind the effects seen.

In this Dutch study, alcohol consumption was associated with a significantly lower risk of developing RA.

Interestingly, researchers also found that the degree of systemic inflammation in patients was shown to increase as the amount of alcohol consumed decreased (p=0.001) and that there was no dose response relationship (low 0.12 (0.08-0.18), moderate 0.46 (0.36-0.59), high 0.17 (0.12-0.25)) between the amount of alcohol consumed and the risk of arthritis development. Researchers hypothesise that there could be two explanations for this inflammatory effect; either that patients with more severe disease activity consume less alcohol due to associated changes in their lifestyle, or that the presence of alcohol in the system could protect against the development of systemic inflammation.

"We know from previous research that alcohol consumption may confer a protective effect against developing RA, our data have shown that this effect may apply to other arthritic conditions too," said Dr Annekoos Leonoor Huidekoper, Leiden University Medical Centre, Netherlands and lead author of the study. "What intrigues us now is that the findings related to systemic inflammation, further research into the inflammatory pathways involved is needed to determine the exact nature of the association."

Patients with arthritic conditions (n=997; RA n=651, reactive arthritis, spondylaropathy or psoriatic arthritis n=273, osteoarthritis n=73) were enrolled from the Leiden Early Arthritis Cohort and healthy controls (n=6,874) recruited from the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis study. Alcohol consumption was recorded at baseline (units per week), and the effect of alcohol consumption on risk of disease development was analysed by univariate and multivariate logistic regression (statistical tests that predict the probability of an event occurring). Odds ratios and confidence intervals (95%) were adjusted for age, sex, Body Mass Index (BMI) and smoking.

Professor Paul Emery, President of EULAR and arc Professor of Rheumatology, Leeds Institute of Molecular Medicine, University of Leeds, UK said: "These are very interesting findings but we should assert the need for caution in the interpretation of these data. Alcohol should be consumed in moderation, with consideration for local public health recommendations. A number of social and medical problems are associated with increased consumption of alcohol; therefore any positive implications of its use must be understood within the wider health context."

Regular Tipple May Curb Risk of Rheumatoid Arthritis

Alcohol cuts the risk of developing rheumatoid arthritis by up to 50%, reveals research published in the Annals of the Rheumatic Diseases.

The Scandinavian researchers base their findings on more than 2750 people taking part in two separate studies, which assessed environmental and genetic risk factors for rheumatoid arthritis.

Over half the participants (1650) had the disease and had been matched for age, sex, and residential locality with randomly selected members of the general public.

All participants were quizzed about their lifestyle, including how much they smoked and drank. And blood samples were taken to check for genetic risk factors.

The results showed that drinking alcohol was associated with a significantly lower risk of developing rheumatoid arthritis. And the more alcohol was consumed, the lower the risk of rheumatoid arthritis.

Among those who drank regularly, the quarter with the highest consumption were up to 50% less likely to develop the disease compared with the half who drank the least.

The effect was the same for both men and women.

Among those with antibodies to a specific group of proteins involved in the development of the disease, alcohol cut the risk most in smokers with genetic risk factors for rheumatoid arthritis.

Smoking is known to be a major environmental risk factor for developing rheumatoid arthritis, and this risk is further increased in those who carry these genetic variants.

The authors conclude that their research reinforces the importance of lifestyle factors in the development of the disease, and that giving up smoking remains the single most important preventive measure.

They point to recent experimental research by other authors, which showed that alcohol protected against the development and severity of rheumatoid arthritis, although it is not clear exactly how it does this.

And they draw parallels with the links between moderate alcohol consumption and a reduced risk of other inflammatory processes, such as cardiovascular disease.

Long-term, moderate alcohol drinking may reduce future rheumatoid arthritis development

Having a beer a few times a week might help women avoid painful rheumatoid arthritis, a new study suggests.

The disease, which affects women more than men, is a form of arthritis linked to immune system dysfunction. According to the Arthritis Foundation, over 1.5 million Americans suffer from the disease, which typically begins in the 20s or 30s.

However, "long-term, moderate alcohol drinking may reduce future rheumatoid arthritis development" in women, said lead researcher Dr. Bing Lu, an assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School, in Boston.

Overall, moderate use of any form of alcohol reduced the risk by about 21 percent, but moderate beer drinking -- two to four beers per week -- cut women's odds for the disease by nearly a third, the study found.

The findings are published in the spring 2014 issue of Arthritis & Rheumatism.

In their research, Lu's group tracked the drinking habits of women in two large studies, the Nurses' Health Study and the Nurses' Health Study II. The first study began in 1976, and includes more than 121,000 registered nurses. The second includes more than 116,00 nurses, and started in 1989. Women answered questions about their health and lifestyle every two years and about diet, including alcohol consumption, every four years.

Long-term moderate alcohol drinking appeared to reduce the risk of getting rheumatoid arthritis, Lu said. But drinking a few beers per week seemed to have the best effect, providing a 31 percent reduction in risk.

Lu said his team can't yet explain how beer and other alcohol might reduce a woman's risk for rheumatoid arthritis. He also doesn't know if the findings would apply to men. "We don't know for men," Lu said, "but rheumatoid arthritis is primarily a woman's disease."

The new study does echo some previous research, noted one expert, Dr. Len Horovitz, an internist at Lenox Hill Hospital in New York City.

"There is a correlation between alcohol and a reduced risk of rheumatoid arthritis over time," he said, citing other studies. However, that doesn't mean that one necessarily leads to the other -- "there is a correlation [shown here], not cause and effect," Horovitz said.

Exactly how a little alcohol may reduce a woman's odds for the joint malady is complicated, he said. "The mechanism of action is very complex," Horovitz said, involving immune system activity and other factors.

Dr. Daniel Arkfeld, an associate professor of clinical medicine at the Keck School of Medicine, University of Southern California, Los Angeles, called the findings "astonishing."

He also pointed to prior studies that have linked moderate alcohol intake with lower rheumatoid arthritis risk, but added that none had focused on beer specifically.

It's possible that alcohol may work to boost levels of estrogen, which is protective against rheumatoid arthritis, Arkfeld said.

The new findings might be especially relevant for someone with a family history of the disease, added Dr. Scott Zashin, a rheumatologist in Dallas and a member of the media committee for the American College of Rheumatology.

"The likelihood of someone developing rheumatoid arthritis is not common," Zashin said. "But if you have a family history, your risk increases."

He said that "patients with a family history might enjoy a beer a few times a week if there is no other reason not to drink."

But while imbibing the occasional drink may be good for your health, Horovitz stressed that excessive drinking is never a good idea. Nor is the new finding a reason for people who don't drink beer to start doing so, he said.

Arkfeld offered one more caveat, noting that alcohol does not mix well with certain rheumatoid arthritis drugs due to the risk of liver effects. So in those who already have rheumatoid arthritis, checking with your doctor before upping your alcohol intake is advised, he said.

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