Alcohol and Its Effects on A Child's Life

Today, were going to talk about a toxin. This may come as a surprise as toxin is one of the more common pseudoscience buzzwords. Truly, there seems to be an abundance of discussion in parenting blog circles about toxins. Ironically, many who espouse these beliefs themselves ingest an incredibly potent neurotoxin: alcohol. Now, to be clear, I too drink; in fact I am an avid brewer and self proclaimed beer connoisseur. But I am also a chemist so I am no stranger to just how dangerous a compound alcohol is. It may seem strange to be discussing an adult beverage on a blog about parenting. But it may surprise you just how deeply this drink affects our lives.

Figure 1: Ethanol Structure

Humans have a long cultural history with alcohol. In fact, there is evidence that we have been making some form of beer since 11,000 BCE (13,000 years ago). This makes some sense, as fermentation is an effective way to preserve the calories in grain. Furthermore, our ability to rapidly metabolize alcohol plausibly precedes us being human. In my humble opinion, it is alcohol's cultural relevance that prevents it from being treated with the same caution that we give to other, similarly toxic chemicals. But culture aside, it is important to define alcohol from a chemical perspective. In chemistry, alcohol actually defines a type of structure present in a compound. When a carbon atom is bonded to a hydroxide (OH) ion, this is termed an alcohol group. The alcohol we usually talk about is ethyl alcohol, aka ethanol (Fig 1). It is a deceptively simple compound: just 2 saturated carbons linked to that OH group. But it has some incredible (and dangerous) chemical properties. I'm not going to list them all, but I'll highlight some of the more relevant ones here. Take, for example its water solubility; its ability to dissolve in water. It is fully miscible in water, that is to say, at any concentration water and ethanol will completely mix. Interestingly, unlike other water-soluble compounds, ethanol has also been known to get cosy with lipids; crossing the cell membrane with ease and sometimes disrupting it in the process. As we will soon discuss, this can be very problematic for parenthood. It has a boiling point of around 78 °C; this makes it very volatile which in turn makes its "weak, ethereal, vinous odor," very noticable. Its flashpoint is a scorching 12 °C (for reference room temp is about 20 °C). Finally, it is a known carcinogen. In short, ethanol is an absolutely terrifying chemical.

So, if ethanol is so dangerous, why do we often hear about the suggestion that a little bit of alcohol is actually protective in adults? Well this is due to a couple things. First, and this is something that you should always be wary of, the media reports of studies making such claims often overstate the real impact of the results. Second, there is the so-called J-Curve. For some time now, the literature has shown a J-shaped curve that suggests, relative to abstinence, low to moderate drinking actually lowers all-cause mortality. However, major flaws in methodology have been shown that have called these findings into question. Based on this, what is the current clinical recommendation? Currently, the AMA is in agreement with the U.S. Dietary Guidelines for Americans. There it is stated,

If alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.

Given what I know about the chemistry of ethanol and in light of the lack of a consensus on the accuracy of the J-curve, the recommendation seems to me to be too high. Personally, unless there is a special occasion, I try to max out my drinking at one to two drinks per week. But of course there is no substitute for a discussion with a licenced physician when determining such limits for yourself.

You may have noticed that the Dietary Guidelines end with, "adults of legal drinking age." For the United States, the legal drinking age is 21. There is some contention within the public whether or not this is an appropriate age. Some say it should be lowered to 18. Others say it should be raised. Of course, this is largely a subjective topic, but we can be guided by science. Recent developments in neuroscience have suggested that the rational aspects of the brain don't stop development until the age of 25. Additionally, it is well known that drinking during adolescence can cause a number of problems with brain development. Personally, I feel that the drinking age is fine where it is. As long as the public is educated that there is still an increased risk with drinking during the later years of adolescence, I don't see any benefit by raising the age. Conversely, I don't think lowering it is a good idea either. It is clear that the risk to brain development is a time-dependant phenomenon. It seems shortsighted to give children with a higher risk of brain changes the right to buy alcohol.

So this brings me to a topic that hits close to home: Fetal Alcohol Spectrum Disorders (FASD). FASD is a neurodevelopmental disorder that results from drinking while pregnant. Now, it used to be that doctors would say something like a glass of wine a week is safe for a pregnant woman; some still do. But the fact of the matter is there is likely no safe amount of alcohol for a developing fetus. Thankfully, this is the current recommendation from the CDC. It may seem odd that we don't have a 100% definitive answer on the dangers of alcohol to a fetus. Unfortunately, this is the case with a lot of pregnancy recommendations. The research is largely observational; i.e. we have to use personal reporting and correlation to draw the best conclusions we can. After all, it's not exactly ethical to set up a controlled study that may accidentally disrupt or end the development of multiple pregnancies. Regardless of the specifics, we do know that drinking alcohol while pregnant results in FASD. FASD presents with a broad range of physical, cognitive, and behavioral symptoms. It sometimes presents with telling facial features, microcephaly, and a shorter than average height. Cognitively, it can present with poor coordination, hyperactive behavior, learning disabilities, speech and language delays, intellectual disability, and poor reasoning and judgment skills. In short, FASD is an entirely preventable condition that creates an incredible amount of difficulty for both the children living with it and the parents trying to manage it.

It may not just the women, however, who need to consider their alcohol consumption. There is considerable debate in the literature about the effect of paternal alcohol consumption and birth outcome. Some correlational evidence has shown an increased risk of spontaneous abortion. Other evidence from mouse studies has suggested there is little to no effect. Further studies suggests an effect on fertility. For me, I avoided it when my wife and I were trying to conceive. Better safe than sorry.

If there is one thing you should take home from this discussion it should be this: if you are pregnant or trying to become pregnant you should probably avoid alcohol completely. There is an enormous body of evidence stating that alcohol is never good for a fetus. I'd further suggest that even the dads-to-be out there avoid it, just in case. For those out there with teens, it is important that you teach them the risks associated with drinking. And finally, for the parents: we all know this child rearing thing is stressful. So go ahead a have a cold one. But drink responsibly. Cheers.