Alcohol consumption and its relationship to heart failure or CHF is not without controversy. On the one hand, alcohol is sometimes touted as heart healthy. On the other hand, alcohol is associated with heart problems like afib, cardiomyopathy, and hypertension. Based on the best available research, it appears that alcohol consumption of up to one drink per day did not worsen heart failure, increase mortality, or lead to increased hospitalizations.
Good News? Maybe. But…
- This doesn’t mean it’s good for you.
- It doesn’t mean it’s safe for you.
- And it certainly doesn’t mean there are any health benefits for you.
My article will help you better understand the facts, the risks, and the safety of alcohol in the setting of heart failure.
One thing I want to emphasize before we go any further is that heavy alcohol consumption is indeed dangerous and associated with poor outcomes and increased mortality. This is a fact and is not disputed. And excessive alcohol consumption is harmful to just about every organ in your body.
Let’s take a deeper dive into this subject…
The Research on Alcohol and Heart Failure
Knowledge is power!
By stating the facts, I am in no way recommending alcohol. However, I am sharing the data and the research in the hope that you will be empowered to make the best decision for you!
I went to google scholar and looked at the available research, both old and new. This recent journal article summed it up nicely, so I thought I’d quote it for you before I get on with the rest of the article.
The journal is “Circulation: Heart Failure” and it’s one of my favorites.
Among patients with left ventricular dysfunction and heart failure (regardless of etiology), a moderate alcohol consumption has not shown to be associated with greater risks of heart failure hospitalizations or mortality in clinical samples of patients with heart failure, compared with no drinking, whereas heavy drinking is associated with poor prognosis. However, relatively limited sample sizes and residual confounding are limitations of such observational data. (1) https://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.121.009459
Can Alcohol Cause Heart Failure?
Excessive alcohol consumption and abuse can lead to a specific type of heart failure called alcoholic cardiomyopathy, where the heart muscle thins and becomes weak. This condition is relatively rare but can be deadly.
Does Alcohol Make Heart Failure Worse?
If you already have heart failure, heavy drinking can be damaging. Here are some of the problems that can worsen your heart failure symptoms and possibly increase your disease’s progression.
- Increase Blood Pressure—not good!
- Increase Heart Rate—also not good!
- Cause Weight Gain—alcohol is high in calories you don’t need, and weight gain is harmful to heart failure patients.
- Lead to Fluid Overload—Heart failure patients are susceptible to fluid overload, and a couple of beers equal 24 extra ounces of fluid. This could tip you over the edge.
So, drinking more than one drink daily can increase your risk of the above problems. And it goes without saying that if you have a history of cardiomyopathy or alcohol abuse, then no amount of alcohol is safe.
Does Alcohol Have Heart Health Benefits?
I remember people saying, “Drink wine. It’s good for you,” or “One drink a day is good for your heart”.
Some studies suggest that drinking alcohol may be beneficial or increase lifespan, but those weren’t conclusive. And as more research was done, these results were called into question. When the entire body of evidence was examined, that recommendation was reversed.
A Note About Red Wine
Red wine has been called a nectar of the gods, full of antioxidants and beneficial nutrients. Physicians recommended a glass daily to increase HDL (“good cholesterol”) and improve heart health. But additional research did not seem to support this, and a 2016 study even pointed to an increase in the incidence of atrial fibrillation (afib) from even small amounts of alcohol. (2)
Red wine contains antioxidants, but these same antioxidants are found in dark purple or red grapes. There is some evidence that red wine is good for gut health, but you can get those same gut health benefits from eating a plant rich diet.
Beer
Some suggest that beer has beneficial antioxidants. It may, but that’s not a reason to start drinking it. Beer is high and calories and contributes a lot of fluid. The typical pub glass of beer is 20 ounces, so it’s more than one serving.
Again, there is no nutrient found in beer that beats out fruits and vegetables!
How Much Alcohol is Too Much?
It can be confusing to hear words like “moderate consumption is okay” from medical professionals. Let’s clearly define it.
One alcoholic drink is a quantity that contains approximately 14g of alcohol.
| Type | Quantity | % Alcohol |
| Beer | 12 ounces (typical pub glass is 20 oz) | 5% |
| Wine | 5 ounces | 12% |
| Hard Liquor | 1.5 ounces | 40% |
So moderate consumption is defined as follows:
· Female: 1 standard drink per day
· Male: 1-2 drinks per day
Hmmm. “1-2”. I suspect this was the recommendation because the research was less clear for men. And men are typically larger than women. Honestly, my advice is to err on the conservative side and use one drink as the recommendation for both men and women. This is purely my opinion, but I stand by it.
Alcohol and Medication Interactions
Alcohol has a blood thinning effect. So drinking alcohol while on blood thinners can increase your risk of dangerous bleeding. This is the medication interaction that concerns me most.
And alcohol can interfere with many other medications.
Keep in mind the liver metabolizes medications, and the liver metabolizes alcohol. You want your liver to be working well.
A full review of medications is necessary to be sure that you stay safe and your medications keep working.
Can We Even Make a Conclusion?
I really can’t make any “one size fits all” conclusion.
Everyone is Different
Of course, everyone is different. Everyone is on different medications, some of which can react with alcohol. Disease symptoms can vary widely. Some people may be more sensitive to the effects of alcohol than others. You may experience increased CHF or heart failure symptoms from even one drink. And heart failure can progress over time. Your physician’s recommendation may change if you progress to the later stages of heart failure.
It’s Hard to Get Conclusive Research
I sure wish there was a yes or no answer, but it goes back to what I mentioned. It’s tough to study humans in the large numbers needed over long periods and control what they eat and drink.
We can’t and shouldn’t put two people with heart failure in a room and give one lots of alcohol to see what happens. That would be unethical. And think about trying to study someone from age 30 until age 80 and then trying to determine exactly what caused heart failure. Or imagine studying someone newly diagnosed with heart failure for thirty years and try to figure out whether or not it was the red wine that made his heart failure progress.
We are forced to rely on other methods that aren’t quite as reliable so our conclusions are not always “one size fits all” or 100% certain.
To Sum it Up
Many people hesitate to discuss alcohol consumption with their medical team. If this is you, commit to having an open and honest discussion.
If you get the okay from your doctor, an occasional drink is fine. You should have it and enjoy it. Be realistic about why and when you consume alcohol. There is no health benefit to alcohol that you can’t get from a healthy diet high in plant foods.
I hope you enjoyed this article and found it helpful. If you have any comments, questions, or experiences, I’d love to hear from you.
Remember that this blog never substitutes for medical advice!
References
1. Andersson, Charlotte, et al. “Alcohol intake in patients with cardiomyopathy and heart failure: consensus and controversy.” Circulation: Heart Failure 15.8 (2022): e009459.
2. McManus, David D. et al. “Alcohol Consumption, Left Atrial Diameter, Atrial Fibrillation”, 14 Sep 2016 https://doi.org/10.1161/JAHA.116.004060 Journal of the American Heart Association. 2016;5:e004060
