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How to Build Your Own Centenarian Decathlon

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By Mary Grace Descourouez, MS, NBC-HWC

How to Build Your Own Centenarian Decathlon

 

We all know about the Olympic Decathlon (ten track and field events held across two consecutive days), but have you heard about the Centenarian Decathlon?

Stanford alumni Peter Attia, MD, coined the term Centenarian Decathlon as the ten physical tasks you want to be able to do at age 100 (or in the final decade of life).

Everyone’s list is likely different, but the following is Dr. Attia’s personal list from his book Outlive. The list includes both common exercises as well as functional movements and lifestyle actions that most of us take for granted in middle age.

Dr. Peter Attia’s Centenarian Decathlon:

  1. Hike 1.5 miles on a hilly trail
  2. Get up off the floor using a maximum of one arm for support
  3. Pick up a 30-pound child from the floor
  4. Carry two five-pound bags of groceries for five block.
  5. Lift a 20-pound suitcase into the overhead compartment of a plane
  6. Balance on one leg for 30 seconds with eyes open. (Bonus: eyes closed for 15 seconds)
  7. Have sex
  8. Climb four flights of stairs in three minutes
  9. Open a jar
  10. Do thirty consecutive jump-rope skips

“There is a difference between lifespan and healthspan. Lifespan is the number of years you’re on this planet, but healthspan is the number of years that you’re healthy—being able to live independently and partake in activities you enjoy,” says Jonathan Bonnet, MD, MPH, and Clinical Associate (Affiliated) Professor at Stanford University School of Medicine. The Centenarian Decathlon requires a thoughtful analysis of what ‘health’ means for you as you age. Creating a personalized Centenarian Decathlon can serve as a powerful motivator and will help inform what types of exercises need to be done now in order to achieve those goals in the future.”

 Creating your own Centenarian Decathlon

Think about what you value in life. Is it being able to play with kids or grandkids? Traveling? Hiking? Sailing? Creating delicious meals in the kitchen? Identifying what is most important in your life will inform which activities will be on your personal Centenarian Decathlon.

“When creating your list of 10 functional activities, pair them with exercises that cultivate the type of abilities you would need to enjoy the activities you love,” says Dr. Bonnet. “For example, if you want to be able to play with a grandchild, being able to ‘lift 30 pounds from a squat position’ would be a valuable objective, as it would mimic picking up a small child from the floor.”

Here are examples of activities and values for a Centenarian Decathlon.

If you:

  • Enjoy bike rides with your spouse – Ride a bike for 1 hour.
  • Live in the snow and value being independent – Shovel snow off a driveway.
  • Enjoy playing golf with friends – Play 18 holes of golf.
  • Enjoy walking your dog – Walk 10,000 steps in a day.
  • Enjoy international travel – Lift a 20-pound suitcase into the overhead compartment. Climb 30 stairs without stopping.
  • Enjoy cooking – Lift a cast iron skillet with one hand. Carry two five-pound bags of groceries up four flights of stairs. Open a jar.
  • Enjoy being in nature – Hike up a steep hill for 10 minutes, operate a kayak, or whatever your favorite outdoor activity is.
  • Enjoy swimming in a pool – Tread water for 10 minutes. Get out of a pool without a ladder.
  • Enjoy dancing with your family in the kitchen – Perform 30 jumping jacks in one set for aerobic endurance.
  • Enjoy playing with children – Deadlift 30 pounds (to lift a young child from their crib or the floor). Get up off the floor using only one arm for support.

Lastly, it’s important to include activities that meet the following four fitness goals, which are important for healthy aging.

Fitness Goals Important for Healthy Aging:

1) Build muscle strength by doing activities such as:

  • Perform 10 push-ups in one set.
  • Perform 20 squats in one set.
  • Perform 10 bicep curls with 20-pound weights.

2) Cultivate stability, flexibility, mobility, and balance by doing activities such as:

  • Complete 30 minutes of Yoga or Pilates.
  • Walk up and down stairs with feet pointed perfectly forward (this is a sign of good ankle mobility).
  • Do a plank in perfect form for one minute (any core workout).

3) Increase maximal aerobic capacity (i.e., VO2 max or maximum oxygen consumption)

You can increase VO2 max with interval workouts where you give roughly 90 percent effort for a short amount of time (ideally 3-5 minutes), followed by a recovery period. Shorter intervals can be used initially to increase VO2 max, however, the duration of sessions should be increased for optimal results.

Examples include:

  • Perform 30 jumping jacks in 40 seconds, followed by 30-40 second recovery period (work up to repeating 6 times).
  • Perform 3 minutes of stair climbing, followed by a 3-minute recovery (work up to repeating five times).
  • Perform 4 minutes of interval running followed by a 4-minute recovery (work up to repeating)

4) Improve aerobic efficiency

You can improve aerobic efficiency with longer duration, steady state physical activity. These workouts are done at a much lower intensity, where you can hold a conversation, but not sing a song. The absolute intensity will vary depending on fitness, but could include activities, such as:

  • Walking 3-4 miles in 1 hour
  • Jogging for 30 minutes while maintaining a conversation
  • Riding a bike for 45 minutes at a 12-14 mph pace

“Each of these areas is important, though having a high VO2 max will generally allow one to do most things on a Decathlon list. If you can jog, that means you can hike. If you can hike, that means you can walk for three miles. If you can walk for three miles, you can likely go up a flight of stairs, and so on,” says Dr. Bonnet. “It’s not that VO2 max is magical by itself, it’s that it requires a certain amount of strength, stability, and aerobic efficiency to be able to attain a high VO2 max level.”

 

Now, take a moment to make YOUR list of 10 activities you’d like to do when you’re 100 (or in your final decade). Be sure to have a mix of strength, stability, VO2 max, and aerobic efficiency activities. Add a column to the right to note why this activity is valuable to you.

For example, at age 100, I want to:

  • Deadlift at least 50 pounds | in order to pick a suitcase up off the ground
  • Do a body weight step up | in order to be able to get up off the floor unassisted
  • Climb 4 flights of stairs in 3 minutes | in order to walk independently (e.g., hike up a hill, walk up a broken escalator at an airport, etc.) without requiring an elevator or ramp
  • Walk 2 miles in 1 hour | in order to walk my dog every evening

Continue until you’ve reached 10 activities.

Centenarian Decathlon is a Framework for Longevity

Now that you have your list, you need to make a plan regarding how you’re going to achieve the 10 goals listed on your personal Centenarian Decathlon. Since we naturally lose strength and aerobic capacity as we age, whatever it is we want to be able to do at age 100, we need to be doing much more now.

In his book, Dr. Attia writes: “Over the next thirty or forty years, your muscle strength will decline by about 8 to 17 per­cent per decade—accelerating as time goes on. So, if you want to pick up that thirty-pound grandkid or great-grandkid when you’re eighty, you’re going to have to be able to lift about fifty to fifty-five pounds now. Without hurting yourself. Can you do that?”

It’s time to ask ourselves, if we want to attain these 10 goals, what daily actions must we do now to get there?

Look at your list of 10 activities and add a column: What do I need to do now to be able to do this activity at age 100? Include the area of fitness and be sure all four areas are addressed at least once in your list of 10.

Note: a general rule of thumb that can be used to estimate approximate strength loss over 50 years is that the load at age 40 should be roughly 150 percent of what the intended goal is at 90 years old.

For example, at age 100, I want to:

  • Deadlift 30 pounds | in order to pick up a suitcase off the ground | so, now I need to deadlift 75 pounds (muscle strength)
  • Do a body weight step up | in order to be able to get up off the floor unassisted | so, now I need to do a step up holding dumbbells equal to 50 percent of my body weight (stability, balance, flexibility, mobility, muscle strength)
  • Climb 4 flights of stairs in 3 minutes | in order to walk independently (e.g., hike up a hill, walk up a broken escalator at an airport, etc.) without requiring an elevator or ramp | so, now I need to do climb 10 flights of stairs in 3 minutes (VO2 max)
  • Walk 2 miles in 1 hour | in order to walk my dog every evening | so, now I need to walk 5 miles in 1.5 hours two times per week (aerobic efficiency)

Continue until you’ve reached 10 activities.

Revisit this list every five years to update the column: Am I on track? What do I need to do now to be able to do this activity at age 100?

There you have it! Now you have a personalized framework for longevity and a specific pathway to win your very own Centenarian Decathlon. Be sure to take out this list on your 100th birthday and try out each activity!

“Having a personalized Centenarian Decathlon is valuable because it translates activities that matter most to you into tangible metrics that can be tracked over time,” says Dr. Bonnet. “While we may not be competing for a gold medal at the Olympics, the Centenarian Decathlon promises something better. A lifetime of being able to do the things we love with the people (and pets) that matter most.”

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What are Exercise Snacks and Why are they Important?

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By Yasaman Nourkhalaj

What are Exercise Snacks and Why are they Important?

We all enjoy a healthy snack like nuts and fruits or a less nutritious option like chips and sweets between our main meals, but have you ever heard of an exercise snack?

“Exercise snacks are short bouts of movements, anywhere from 30 seconds to five minutes, that don’t require going to the gym or any prep work. They are snacks, not meals,” says Marily Oppezzo, PhD, certified personal trainer and head of Stanford Lifestyle Medicine Healthful Nutrition pillar. “They can be anything that gets your heart rate up to a vigorous level–like jogging up the stairs at work or doing 20 jumping jacks–and you can accumulate vigorous activity multiple times throughout the day.” 

Exercise snacks are ideal for busy people. In our fast-paced lifestyle, it is challenging for many people to find the time to go to a gym and complete a formal workout. Exercise snacks offer an alternative way for busy folks to get their heart rate up and experience health benefits without changing their clothes or breaking a sweat.

Additionally, research shows that exercise snacks performed throughout the day may be more beneficial than a one-hour stint at the gym after sitting all day.

What Are Examples of Exercise Snacks?

If you have two minutes in your workday to get a snack from the refrigerator, you also have two minutes to do an exercise snack. Dr. Oppezzo explains, “Exercise snacks aren’t just a two-minute leisurely walk break. You’ll want the one-to-five-minute workout to elevate the heart rate to a point where it becomes hard to speak in complete sentences.”

Below are some examples of exercise snacks that Dr. Oppezzo recommends:

  • Instead of taking the elevator or walking up the stairs at work, jog up the flights.
  • Do 30 seconds of jumping jacks and 30 seconds of push-ups, repeating for two minutes while your food is warming up in the microwave.
  • Do one minute of burpees in the middle of your workday. If you cannot jump due to joint pain, here are instructions for walking-back burpees: put your hands on the back of a chair, step back, do a push-up, step forward, come to a squat and then reach for the sky. Repeat.
  • Do three minutes of the “Pet the Puppy” exercise. Instructions: stand up with feet hip-width distance, squat down, and pet an imaginary puppy; stand up, take a high knee step over the imaginary puppy with one leg followed by the other; squat down again and pet the puppy on the opposite side. Repeat petting and stepping (or jumping) over the puppy on the both sides.
  • High-knee march or jog in place, driving also with your arms, while your coffee is brewing.
  • Enjoy five minutes of Zumba on YouTube during your lunch break.

“With my clients, I’ve observed that becoming breathless with three or four exercise snacks throughout the day can sometimes be more stress-reducing than doing one longer workout and sitting the rest of the day,” says Dr. Oppezzo. “After raising your heart rate through exercise, your body has to kick into ‘calm down’ mode and exercise snacks give your body an opportunity to calm down multiple times throughout the day.”

Dr. Oppezzo is currently working on several exercise snack research studies. One is comparing breaks of walking and strength breaks throughout a sedentary day, and the other is helping identify the best ways to help people build exercise snacks as a habit.

Most people understand that many hours of sitting can be a health risk, but rather than focusing on total hours of sitting per day, Dr. Oppezzo recommends that we think about the number of hours we sit continuously without large muscle group movements. Therefore, she recommends a two-minute exercise snack every few hours of sitting. “We don’t know the optimal cadence of taking a break–every hour is easy to remember, but it’s not practical for many people,” says Dr. Oppezzo. “I would aim for taking a break every couple of hours, and try to make a few of your breaks heart-pumping exercise snacks.”

What Are the Benefits of Exercise Snacks?

Exercise snacks offer numerous health benefits, including improved cardiovascular health, muscular strength, and cognitive enhancement. This review article of several studies on exercise snacks showed significant benefits on cardiorespiratory fitness, including decreased total cholesterol, increased oxygen consumption, and overall cardiovascular function. A prospective cohort study, which follows and measures people over a long period of time without giving them a particular intervention, found that participants who self-reported three-to-four minute incidental (or non-intentional) short bursts of physical activity throughout the day had a 31 percent reduced risk in physical-activity related cancer incidence, especially in adults who did not regularly exercise.

“People think they have to go to the gym and kill themselves every day to get a health benefit. They think you need to ‘go big or go home,’ but the research shows that 60 seconds of vigorous movement still counts,” says Dr. Oppezzo. “We make exercise too complicated, but it doesn’t have to be. Rather than seeing exercise as an obligation or a chore, we can use exercise as a tool to manage stress and feel better. We can keep it simple with exercise snacks.”

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How Exercise Reduces Risk of Alzheimer’s Disease

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By Tanya Thakur, MBBS

How Exercise Reduces Risk of Alzheimer’s Disease

Alzheimer’s disease (AD) is one of the most devastating illnesses among older adults. The disease not only degrades memories but also affects one’s independence and takes a toll on family members.

AD is a progressive neurodegenerative disorder caused by the accumulation of abnormal misfolded protein deposits in the brain, including beta-amyloid plaques, tau tangles, and Hirano bodies. These deposits disrupt normal neuronal function, leading to the gradual loss of memory, cognitive skills, and, eventually, the ability to carry out daily activities.

AD is the most common cause of dementia, accounting for approximately 60 to 80 percent of cases. Presently, an estimated 6.7 million individuals in the U.S. have AD. In 2019, Alzheimer’s was ranked as the sixth leading cause of mortality among individuals aged 65 and above. Notably, between 2000 and 2019, while fatalities from stroke, heart disease, and HIV declined, deaths related to Alzheimer’s increased by more than 140 percent.

Even though scientists are working toward curing AD, we can take preventative measures by incorporating healthy habits, such as regular exercise, into our routine.

“It is a common misconception that we have minimal control over our risk of developing Alzheimer’s disease. However, nearly half of the Alzheimer’s cases could have been prevented or delayed by modifiable factors, including lifestyle changes,” says Sarita Khemani, MD, Clinical Associate Professor of Medicine and Neurosurgery Hospitalist at Stanford University. “Therefore, we should do everything in our power to incorporate healthy lifestyle habits as early as possible.”

The Link Between Exercise and Alzheimer’s Disease

There are many things we can do to reduce our risk of developing dementia. Several research studies have concluded that physical activity is one of the best ways to reduce risk significantly. For example, after analyzing 16 studies on exercise and dementia, the Alzheimer’s Society found that regular exercise reduces the risk of developing dementia by 28 percent and, specifically, AD by 45 percent.

The connection between the brain and aerobic exercise is likely due to neuroplasticity, which is the brain’s ability to adapt and form new neural connections or strengthen the existing ones. During aerobic exercise, our brain expresses cAMP response element binding (CREB) proteins that influence the transcription of synaptic genes, including those encoding for brain-derived neurotrophic factor (BDNF). BDNF supports neurogenesis (the formation of new neuron cells), neuroprotection, and angiogenesis (the formation of new blood vessels). BDNF also increases the volume of gray matter and the hippocampus (the site of memory in the brain).

Physical activity also serves as a potent modulator of other health risk factors, including hypertension, hypercholesterolemia, and insulin resistance, all of which increase the risk of developing dementia. Vascular damage caused by atherosclerosis can accelerate the cognitive decline associated with AD due to reduced blood and oxygen flow to the brain, leading to hypoxia of neural cells.

“Brain changes associated with Alzheimer’s begin approximately 20 years before symptoms appear,” says Dr. Khemani. “Exercise stands out as one of the most effective strategies for prevention, offering a low-cost, non-pharmacological, and low-risk option accessible to everyone.”

The Best Exercises to Prevent Alzheimer’s

While aerobic exercise increases BDNF levels, resistance exercises, such as lifting weights, are thought to have a greater influence on insulin-like growth factor-1 (IGF-1) levels. IGF-1 is a hormone that manages the effects of growth hormone in the body and is essential for promoting cognitive abilities.

Because aerobic and resistance exercises elicit different neurophysiological changes, studies have indicated that combining both modalities can enhance exercise-induced neuroplasticity to a greater extent than either modality alone.

For example, one study compared the effects of combined aerobic and strength training, aerobic exercise alone, and no exercise on cognitive function among dementia patients. After nine weeks, the combined exercise regimen yielded the most pronounced results across cognitive domains. Also, the observed gains in both motor and cognitive areas regressed towards baseline levels more than two months post-intervention, meaning it is essential to exercise regularly to sustain its neurological benefits.

Regarding the type of aerobic exercise most effective for AD prevention, Dr. Khemani recommends incorporating sprint intervals into our workouts. “We encourage our patients to engage in moderate-intensity exercises incorporating some high-intensity interval training, if possible, as these activities have been shown to be more impactful for Alzheimer’s prevention than light exercise alone,” she says.

 

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Supplements for Healthy Aging

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By Matthew Kaufman, MD

This blog is part of our Supplements newsletter. If you like this content, sign up to receive our monthly newsletter!

Key Takeaways:

Here are a few supplements that our health professionals recommend for healthy aging for individuals in midlife and beyond:

  • Creatine – To maintain and build muscle mass and potentially improve cognitive performance.
  • Vitamin D – To promote muscle and bone strength. 
  • Magnesium – To promote restful sleep and brain health.
  • B12 and B9 (folate) – To promote brain health. (B12 is particularly recommended for vegans since it is primarily found in animal products).
  • Multivitamin that is FDA-regulated or third-party tested. Unregulated supplements may not contain the active ingredients to live up to their advertised claims and may contain harmful ingredients.

As we age, taking too many supplements may be taxing to our liver and kidneys, so it’s best to screen to assess where we are deficient and supplement as needed.

Lifestyle choices are most important for maintaining good health as we age, and supplements do not replace a healthy diet and daily exercise.

As a Physical Medicine and Rehabilitation resident, my patients often ask me, “What supplements should I take as I get older?” While it is a complicated question without a clear answer, it’s important to consider. 

Rather than investigating how a supplement affects the entire body as we age, researchers study how supplements impact specific aspects of health, such as sleep, muscle mass, and brain health. However, we all know that we don’t age in only one domain–the aging process affects many parts of the body. Therefore, there are multiple supplements to consider, and which supplement you take depends on your individual goals.

So, whenever I am posed with this question, I always respond with these two questions: 

1) What are your goals regarding aging? Is it just a longer lifespan, or do you also want to feel good in your 70s and 80s and maintain high-quality interactions with people and places? 

2) What aging concerns do you want to address or avoid? Some examples include optimizing your bones and muscles for sustained athletic ability, brain health and cognition performance, and your ability to have restful sleep on a consistent basis.

Which Supplements Should I Take for Healthy Aging?

Supplements to Maintain Muscle Mass and Bone Strength

As we age, the most important things we can do to maintain muscle and bone strength are resistance training at least twice weekly and consume adequate protein, especially from food (both plant and animal sources). Without these two things in place, supplements alone have not been shown to be helpful. 

Regarding protein, I recommend consuming 1.2 – 1.6 grams per kg of body weight per day. This translates to approximately 0.65 grams of protein multiplied by your body weight in pounds, to be consumed evenly over three to four meals per day. 

To maintain and build muscle mass as we age, I also recommend creatine. Consuming between 5 – 25 grams of creatine per day (either as a supplement or in food) has been shown to increase strength and muscle protein synthesis, and maintain lean body mass.

Vitamin D supplementation also has substantial evidence showing improvements in muscle and bone strength in older adults.

Supplements for Brain Health and Cognitive Performance

Some studies show that vitamin D may improve brain health and cognitive performance. Also, magnesium and higher doses of creatine have emerging evidence suggesting they could also be helpful. B vitamins like B6, B12, and B9 (folate) have also been shown to help with cognition prior to diagnosis of mild cognitive impairment and Alzheimer’s Disease.

Many people take omega-3 supplements intending to improve cognition; however, the data is not as strong as many people suspect. Some studies suggest that these supplements are effective, and some don’t. Most experts believe that getting omega-3s from food (such as fatty fish, walnuts, and chia seeds) is preferable to getting them from a supplement in that they are better absorbed in the body. For my patients, I recommend consuming omega-3s by eating more salmon and enjoying a low-inflammatory diet, such as the Mediterranean diet.

Supplements for Sleep

There is not currently a supplement that the American Academy of Sleep would recommend, however, melatonin is the most popular sleep supplement. If you find melatonin helpful, it’s important to use it at the minimum effective dose to prevent circadian rhythm shifts. There is also recent evidence that magnesium is helpful for sleep.

Lifespan vs. Healthspan

 Lifespan is the number of years we are alive, whereas healthspan is how many of those years we feel good (physically and mentally) and are healthy enough to live independently and free from debilitating diseases. 

Although there is no magic pill for a longer life, these supplements may improve your healthspan by increasing your levels of functioning and slowing the progression of chronic conditions. Healthy aging is not only about preventing illness or falls; it also encompasses the ability to engage in activities we enjoy, spend quality time with people we love, and maintain a sense of purpose and excitement as an older adult. 

When choosing a supplement, it is crucial to remember that the FDA does not regulate most supplements. Therefore, there is minimal oversight regarding the ingredients in these supplements and whether they live up to their advertised claims. Without regulation, some supplements don’t contain the active ingredient, and they may even contain ingredients that are harmful, such as heavy metals, not listed on the bottle. Therefore, it is essential to go with supplements that are third-party tested or recommended by health professionals you trust and not just rely on advertising.  

Lastly, it is most important to recognize that supplements cannot replace a poor diet or lack of exercise. We must take supplements in the context of other healthy lifestyle choices, such as adequate nutrition, sleep, exercise, and working with a medical professional to treat any medical conditions. 

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Alcohol: Is There a Healthy Way to Drink?

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By Maya Shetty, BS

This blog is part of our Nutrition newsletter. If you like this content, sign up to receive our monthly newsletter!

“Salud!” If you’ve ever raised a glass to your health, you’re not alone. For decades, many have believed that minimal alcohol consumption is potentially beneficial for your health. However, not every researcher would agree. A growing body of evidence reveals health concerns about alcohol use, making it crucial to understand the spectrum from harmless to harmful levels of consumption to keep your body healthy. 

“Alcohol will impact everyone’s health differently,” says Douglas Noordsy, MD, Clinical Professor of Psychiatry at Stanford University School of Medicine and Assistant Director of Stanford Lifestyle Medicine. “Rather than a daily habit, drinking alcohol should be seen as an indulgence, something you have once in a while to celebrate.”

Experts have conflicting views regarding how much alcohol carries risks. Some believe that drinking in moderation is safe, while others believe that even light drinking can cause harm.

“While many believe light to moderate alcohol intake is safe and even healthy, this reality is far from true,” states Cindy Kin, MD, a colorectal surgeon and Associate Professor of Surgery at Stanford University. “In fact, no level of alcohol can be considered beneficial for our health.”

Isn’t One Glass of Red Wine Good for the Heart?

“Studies have gone back and forth, with some suggesting potential cardiovascular benefits of light drinking, while others point to increased risk of cancer and liver disease even when consumed at low intake levels. As a result, many are confused about headlines proclaiming alcohol as either good or bad for health,” says Dr. Noordsy.

The origin of this belief traces back to the 1980s, rooted in a concept known as The French Paradox–the observation that despite consuming a diet high in saturated fat, France had a low incidence of heart disease. Researchers of the era decided that this unexpected trend was attributed to the widespread consumption of wine in the region. This correlation led to extensive research into wine and the identification of polyphenols, thought to be responsible for wine’s apparent cardioprotective potential. 

Since then, numerous observational studies have claimed that light to moderate wine intake has beneficial effects. “However, these studies overlooked some crucial factors,” says Dr. Kin. While early observations indicated poorer cardiovascular outcomes for non-drinkers than for moderate drinkers, researchers overlooked that many non-drinkers abstained due to existing health conditions that led to overall poorer health outcomes. Additionally, those self-identified as light drinkers were more likely to lead healthier lifestyles overall. This oversight has fostered a misleading impression that associates better cardiovascular outcomes with light drinking, falsely implicating alcohol as the causal factor. As a result, enjoying a glass or two of wine a day has become widely accepted as a  healthy habit. 

While red wine contains antioxidants like resveratrol, found in grape skins as well as in peanuts, dark chocolate, and blueberries, which might have heart-healthy benefits like reducing cholesterol and lowering blood pressure, the quantities are often misunderstood. To achieve the levels of resveratrol observed beneficial in mice studies, one would need to consume an impractical amount of red wine—somewhere between a hundred to a thousand glasses daily. Thus, while the idea of resveratrol’s benefits is enticing, the practical reality makes it an unrealistic source for therapeutic effects.

How Much Alcohol is Too Much?

Many people believe alcohol becomes a concern only when consumed excessively. “Excessive alcohol use” is defined as exceeding the US Dietary Guidelines’ recommendations, which advise males to limit themselves to two drinks per day and females to one drink per day, on average. Two-thirds of adult drinkers report drinking above this level at least once a month.

However, a growing body of recent research shows that even modest quantities of alcohol can be harmful to our health. Such consistent findings have prompted the World Health Organization to assert that “when it comes to alcohol consumption, there is no safe amount that does not affect health.”

The main issue with alcohol is that it enters the bloodstream and quickly spreads throughout the entire body (especially when consumed without food). Unlike most substances, alcohol is both water- and fat-soluble, allowing it to permeate nearly every cell and tissue, including the highly secure blood-brain barrier that protects our central nervous system. 

While the liver does most of the alcohol metabolism, other organs also process alcohol, such as the kidneys and lungs. As our organs work to break it down into a usable fuel source, acetaldehyde is produced, which is toxic due to its ability to damage and kill cells indiscriminately. As acetaldehyde enters the brain, it causes a disruption in our neural circuitry that creates the sensation of “tipsiness” associated with alcohol. And, the more “tipsy” one feels, the greater the amount of toxic acetaldehyde in the blood.

Rather than following strict guidelines about how much to drink, Dr. Noordsy recommends that individuals take note of their personal perceptions of intoxication and pace themselves accordingly. He recommends using the feeling of being “tipsy” as the signal to slow down or stop drinking. “The ‘tipsy’ feeling is the indicator that blood alcohol levels have risen to the point that you’re starting to put your health at risk. And the more ‘tipsy’ you become, the higher the risk,” states Dr. Noordsy. “If you’re having alcohol with food, your blood alcohol level won’t be as high as compared to having drinks by themselves. So, if you’re enjoying a glass of wine as part of your meal, that’s a very different thing than drinking in a way that’s leading to the feeling of intoxication.”

Health Concerns Linked to Alcohol Use

Recent data from the World Health Organization reveals that each year, alcohol contributes to three million deaths globally and accounts for 5.1 percent of the worldwide burden of disease and injury. Alcohol’s detrimental effects span more than 200 disease and injury conditions, encompassing everything from alcohol dependence and liver cirrhosis to a range of non-communicable diseases (such as heart disease, cancer, chronic respiratory disease, and diabetes) and mental health disorders.

Liver Disease

Acetaldehyde, a derivative of alcohol metabolism, inflicts significant harm on the body’s cells, especially within the liver. Given the liver’s primary role in detoxifying our bloodstream, it bears the brunt of the detrimental effects of alcohol metabolism. This continual strain can result in the buildup of fat, chronic inflammation, and potentially irreversible damage to the liver. 

A study analyzing the livers of 3,649 participants discovered a concerning correlation: as daily alcohol intake increased, so did the accumulation of fat in the liver. Alarmingly, no identifiable threshold existed below which these harmful effects were absent, suggesting that even individuals who consume alcohol in minimal amounts are not immune to the accumulation of liver fat.

Fat accumulation hinders the liver’s vital metabolic functions, including blood sugar regulation, cholesterol processing, and nutrient absorption. It also increases the risk of inflammation around the liver, known as alcoholic hepatitis. 

“The good news is that abstaining entirely from alcohol can reverse these changes, however, continuing to drink alcohol can lead to irreversible damage, scarring, liver dysfunction, and in advanced cases, liver failure,” states Dr. Kin. “This is especially concerning because fatty liver often presents no early symptoms, with individuals potentially unaware until it advances or results in serious complications.”

Another important consideration is that people who have non-alcoholic fatty liver disease, caused by obesity and other metabolic syndromes, have a much higher risk of developing alcoholic liver disease. 

“This means that even small amounts of alcohol will cause the same level of alcohol-related liver disease (fibrosis, cirrhosis, etc.) as would larger amounts of alcohol consumed by someone without underlying fatty liver,” explains Dr. Kin. “Therefore, people who are already dealing with metabolic diseases should be extra cautious around alcohol because their livers are working extra hard already.”

Cancer

Alcohol is designated as a carcinogen by the International Agency for Research on Cancer due to its association with higher risk for many common cancers.

“Alcohol increases cancer risk specifically in areas it is in close contact with, such as the mouth, pharynx, and digestive tract. It also has carcinogenic effects throughout other parts of the body,” states Dr. Kin.

Underlying its harmful effects, chronic inflammation from alcohol consumption elevates cell turnover, heightening DNA mutation risks. Additionally, alcohol is believed to promote tumor growth while inhibiting tumor-suppressive molecules.

In 2017, the European Union reported nearly 23,000 cancer cases tied to light to moderate alcohol use, with half attributed to female breast cancers. Even at levels as low as three drinks per week on average, there is a slight but measurable increase in breast cancer risk. Notably, raising daily alcohol intake by just 10 grams—equivalent to what’s in a standard beer or wine—escalates the risk of breast cancer by 10 percent.

Cardiovascular Health

Despite popular belief, alcohol consumption, regardless of the amount, is linked to an increased risk of cardiovascular disease. A comprehensive study of 371,463 individuals found that as alcohol consumption increased, so did the risks of conditions like hypertension and coronary artery disease. Light alcohol intake (less than 8.4 drinks per week) led to a minimal but noticeable increase in cardiovascular risk. Researchers also found that when accounting for various lifestyle factors, the perceived protective benefits of modest alcohol intake against cardiovascular risks diminished significantly.

There are numerous reasons hypothesized for these detrimental effects, especially surrounding the metabolic effects of alcohol. “Alcohol offers no nutritional benefits; it’s essentially empty calories that are consumed on top of the calories required by your body. On top of this, alcohol interrupts the body’s regular metabolic functions. As the body prioritizes removing this toxic substance, it compromises processes like nutrient absorption and fat metabolism. This disruption promotes the storage of visceral fat, the harmful fat surrounding organs,” explains Dr. Kin. “This fat increases inflammation and poses significant risks, especially around the heart.”

Hormone Imbalance

Alcohol consumption raises estrogen levels in both males and females by increasing the activity of the enzyme responsible for converting androgens to estrogen. This accelerated conversion can lead to issues like gynecomastia (enlarged breasts in males), decreased libido, and increased fat accumulation. Additionally, consistent alcohol exposure can reduce testosterone levels over time, which is associated with reduced libido, fatigue, decreased bone density and muscle mass, and potential fertility issues in both males and females.

Additionally, regular alcohol consumption of more than 3.5 drinks per week for males and 2.6 drinks per week for females can cause chronic changes and reduced control of the hypothalamic-pituitary-adrenal axis. This disturbance may lead to an increase of the stress hormone cortisol released throughout the day.

Microbiome Issues

Alcohol also disrupts the gut microbiome by killing beneficial bacteria and other essential microbes. Additionally, alcohol’s pro-inflammatory properties trigger the release of inflammatory cytokines, causing gut inflammation and making the intestinal lining more permeable. This increased permeability can allow undigested food particles to enter the bloodstream. Over time, chronic alcohol consumption can further imbalance the gut microbiome, promoting bacterial overgrowth and dysbiosis. These disruptions can trigger immune responses, increasing susceptibility to food intolerances.

Brain Health

When alcohol is consumed, it enters the brain and suppresses neural networks involved in memory formation and storage. Through chronic consumption, this disruption can have permanent effects. A study involving over 36,000 middle-aged adults revealed that even moderate drinkers, consuming one to two drinks per day on average, displayed thinning of the neocortex and other brain regions, indicating neuron loss. This research also found that increased alcohol consumption correlates with diminished brain volume and reduced gray matter, which are the areas of the brain highly concentrated with neurons. As alcohol intake rose, so did the severity of these detrimental effects. 

Fortunately, for most casual drinkers, abstaining from alcohol for two to six months can reverse damage to the prefrontal cortex and neural circuitry. However, chronic users may only experience partial recovery and might endure lasting effects.

“As alcohol consumption increases, so does one’s risk of cognitive decline and dementia,” states Dr. Noordsy.

Mental Health

As anxiety and depression continue to rise in the US, alcohol use also increases as individuals self-medicate to reduce stress. Also, the nightly glass of wine may cause more stress the following day since it impairs cognitive and physical performance, reducing one’s ability to cope. “During the pandemic, we observed a startling rise in cases of alcohol-induced hepatitis, indicating a growing reliance on alcohol as a coping mechanism,” says Dr. Kin. 

One study, however, showed that light to moderate alcohol consumption may be beneficial to mental health by offering short-term relief by reducing stress signals in the brain. Although Dr. Noordsy acknowledges this study, he states that “learning to manage stress through physical exercise, mind-body and mindfulness practices can lead to safer and likely more effective mediation of impacts of stress than relying on alcohol use.” 

Is There a Healthy Way to Consume Alcohol?

Given the extensive research on the detrimental health effects of alcohol, both Dr. Kin and Dr. Noordsy recommend abstaining from alcohol, or at least drinking very rarely, if one is experiencing or has a family history of liver disease, cancer, cardiovascular disease, hormone imbalances, gut microbiome issues, dementia, or mental health disorders, including addiction.

The precise amount of alcohol that is harmful is difficult for experts to confirm because it’s different for each person. Therefore, when it comes to alcohol and health, Dr. Noordsy recommends a balanced, personalized approach keeping in mind one’s individual risk factors and health goals.

“While heavy, regular consumption is linked to health problems, an occasional drink with meals may pose little risk for most adults,” says Dr. Noordsy. “However, individuals with personal or family histories of certain cancers or other conditions may need to be more careful with alcohol intake. We put thought into our nutrition and exercise habits, and we need to be just as thoughtful about the role that alcohol plays in our lives and make informed decisions regarding how much is the right amount for ourselves.”

Although less inclined to recommend light alcohol consumption, Dr. Kin acknowledges that it is an ingrained part of people’s social and cultural lives, similar to many other things that individuals consume that do not contribute to health. So, she encourages individuals to reframe their mindset around alcohol. 

“Rather than viewing alcohol as a daily routine, consider it a treat reserved for special occasions or celebrations, much like enjoying a slice of birthday cake,” she says.

 

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