Goldilocks Medicine: Alcohol vs Stroke

Medicine is fickle.  In some aspects, there's an optimum at one extreme, like cholesterol.  In others, moderation is key, like sodium.  In others still, we've moved from one philosophy to the other, like menopausal hormone therapy over the last decade.  

Likewise, alcohol is tricky.  More & more studies are demonstrating a U-shaped curve when it comes to alcohol consumption at say 1-2 drinks/d with <1 and >2 being associated w/greater mortality.  Unfortunately, that message hasn't drifted down to our college aged youth who spend weekends making up for their relative sobriety during the week.  I keep trying to explain that 14 drinks over 2 nights isn't the same as 2 drinks every night over the course of a week.

Well, in a prospective cohort study published today in Neurology, the authors followed 540 evaluated for a spontaneous intracerebral hemorrhage (ICH).  This is the less common (20%) type of stroke, similar to a pipe bursting in the house, the more common (80%) type being more like a clogged pipe, both leading to a wet mess.  In any case, the authors concluded that excess alcohol consumption was associated with 14 years younger age at onset of ICH w/nearly 2 years earlier mortality.

Bottom line: drink in moderation, not to excess.  That means <1 drink/d for women & <2 drinks/d for men.  Any more and the risk for bleeding in the brain goes up dramatically.  Yet not drinking at all is associated w/heart disease.  So imagine that you're Goldilocks looking for the right chair, not too big, not too small.  Or the right porridge temperature, not too hot, not too small.

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