Cancer Dietitian

Lifestyle tips for prevention and survivorship. Keeping you well beyond cancer!

Alcohol, Estrogen & Breast Cancer Risk and Survivorship

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In my last post, I did a quick and dirty write up of a Q&A session I had with our Breast Cancer Wellness Group. The whole issue of alcohol and breast cancer kept bugging me so I wanted to spend a little more time understanding how it influences risk for breast cancer and how significantly we see it influencing hormones.

With my reading, it was clear that I needed a clarification in my last post, so I posted an update on that page regarding foods and beverages and how they influence estrogen levels in the body. While I had previously stated that they didn’t influence it, what I should’ve said was that it doesn’t influence it significantly enough that we know that to be the mechanism for increased risk.

THE BOTTOM LINE:

I’m going to go ahead and put this up front, because sometimes I think people spend too much time stressing over little choices, when they should be out enjoying their life! So if you are ready for the bottom line, and go on about your day, here you go!

  • It is clear that the more you drink the higher the risk! The highest risk of an increase in hormone levels related to alcohol intake seems to be among women who consume more than 20g per day of alcohol (FYI a standard drink is about 14g of alcohol). I.E. the more a woman drank over the course of 20 years, the more likely she is to develop breast cancer.
  • The AICR evidence-based recommendation regarding alcohol and cancer risk is to not to drink alcohol. However, their recommendations also recognizes that modest amounts of alcohol may have a protective effect on heart disease and type 2 diabetes. If you do drink alcohol, limit your consumption to no more than two drinks a day for men and one drink a day for women. 
  • The AICR evidence-based report for breast cancer survivors also states that the data is limited, and there is not conclusive evidence showing a link between alcohol and breast cancer survivor mortality or risk for recurrence.

Truthfully, there are a lot of other things that influence our hormones more significantly. However, since I did so much reading on it, I thought I’d share some of the key points!

How to Interpret the “Studies”

Here is the major challenge that I find for my clients regarding how and where they get their information. Whether on news websites, social media or on TV, the headlines regarding topics like this can really get you worked up! Here’s one specifically on this issue from a few years ago:

This drives me crazy! When you actually read through the article, you find out that this “study” was done in a very small group of women over a very short period of time. Honestly, studies like this are almost worthless for those of us in the general public. It might be interesting for the researchers to determine what next steps to take their research, but for our day to day decisions as consumers, this study is TOTALLY WORTHLESS! Ugh – don’t waste my time.
When it comes to research and your day-to-day decisions, we want you to focus on the studies that have been well designed, have incorporated many, MANY participants and also many different types of participants so that we can know that it applies to almost everyone. Also – we want these studies to be LONG TERM and for their findings to be proven again when the study is DUPLICATED.
In other words – one study does not give us a definitive answer on anything. We want to focus on the findings of multiple studies that over and over are showing us the same results. That way we know it’s not just “by chance”.

Studies On Alcohol and Estrogen Levels

When it comes to knowing how much alcohol has influence over hormone levels, the data is still very limited. This means that there hasn’t been a lot of studies done, and among the ones done, there are mixed results. The one study that I found most useful is actually a 2011 reanalysis of 13 studies which was published in the British Journal of Cancer. The nice thing is that they are looking at multiples studies to see if there are common factors. Here was their conclusion:
Drinkers of 20+ g alcohol per day had higher levels of all hormones (including estrogen and other sex hormones), but lower SHBG (10% lower), than non-drinkers, with the largest difference for DHEAS (25% higher). FYI:
Even after you read through this, you have to realize that hormones have a very complex role within our bodies. We can’t simply look at just the one factor without taking into consideration how it functions within the complex system of the human body, regulating all kinds of cells, systems, risk for disease and overall well-being.
But let’s say we are going to dig into this deeper. They found increased levels of hormones when they compared non-drinkers to those who consumed 20+ grams of alcohol per day. There’s a very important question here when we want to put these findings into context for day to day decisions.

What is 20g of Alcohol?

If you’ve ever heard the recommendation to “drink in moderation,” health organizations are generally referring to one “drink” a day for women or two “drinks” a day for men. A “drink” is usually about 14g of alcohol and is typically:
  • 5 oz. of wine,
  • 12 oz. of beer
  • 1.5 ounces of liquor
However, the grams will depend on the actual % of alcohol in the drink.
Just for simplicity, let’s say that a woman who consumes about 8 ounces of wine will consume 22g of alcohol (~2.8g of alcohol per oz.). So if a woman consumed 8 ounces or more of wine every single day for years, she may be increasing her hormones about 25% more than if she had not had a drink at all.

If you are trying to decide between:

  1. Not drinking alcohol at all, and
  2. Drinking 8 ounces of wine every day.

I think the answer is clear. Opt for #1.

In the real world, most of us have a happy place somewhere in between. When it comes to day-to-day decisions for normal people like you and I, these study findings are often not particularly helpful. They are useful and interesting to those in the research world, but can just cause more confusion and disorientation for the general public. Even journalists are pretty bad about interpreting the results!

This is why I tend to key in on “evidence-based recommendations” from solid scientific groups. One of my favorites when it comes to nutrition, physical activity, and cancer is the American Institute for Cancer Research. They get all the really smart people together to review every (good and reliable) study that’s ever been done on various topics and rank the evidence and give consumer oriented recommendations.
What do they say about alcohol and breast cancer?

Here are 2 important statements from them:

  1. For overall cancer prevention, AICR recommends not to drink alcohol. However, our recommendations recognize that modest amounts of alcohol may have a protective effect on heart disease and type 2 diabetes. If you do drink alcohol, limit your consumption to no more than two drinks a day for men and one drink a day for women.
  2. AICR Diet and breast cancer survivorship: Data is limited and therefore no conclusive evidence on link with alcohol.
  3. AICR Diet and breast cancer risk (pre and post menopausal breast cancer): Even small amounts of alcohol increase breast cancer risk, so if you do decide to drink, keep to no more than 1 standard drink (12 ounces of beer, 5 ounces of wine, 1.5 ounces of liquor) per day.

What would Julie Do?

For some reason, people are always fascinated by what nutritionists eat/drink. When it comes to the drinking alcohol question, people ask me – ok, but what do you do?
I tend to define things as “habits” if I do them 3 times a week or more. Some habits are good habits and some, not so much! When it comes to drinking alcohol, I don’t want to make a “habit” out of it. However, I do enjoy a drink here and there. For me personally, I would not have a drink every single night of my life. So if I’m averaging 2 drinks a week, I think that’s a good place for me.
However, you have to decide what you are comfortable with. I know people who choose to avoid alcohol completely, which is a perfectly fine choice. And I know people who enjoy a glass of wine with dinner each night. It’s up to you to decide what is best for you. Get input from a trusted doctor that knows your health risks. Once you’ve made your choice, move on with life! You can always change your mind, but try not to get caught up in the latest headlines!
Hope that helps!
– Julie
Extra Reading:

 

Instant Pot: What's the Big Deal?
Cancer Nutrition Q&A Session with The Cancer Dietitian

This post may contain affiliate links for products I recommend. This means if you click on a link and purchase a product, Cancer Services, Inc. will receive a small percentage of the sale at no extra cost to you. We use these proceeds to support cancer patient direct services and community education in the Triad area of North Carolina. For more information, view our disclosure policy.

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