The chemical called ethyl alcohol, or ethanol, looks deceptively simple.  Just take 2 carbon atoms and surround each with a hydrogen atom wherever one can attach to these 2 carbon atoms, except one site, on which an oxygen-hydrogen combination is attached and you get what most of us simply call alcohol.

Make that 3 carbon atoms and place the oxygen-hydrogen group on the middle carbon atom, and instead of drinking alcohol, you get rubbing alcohol.  This is an alcohol that kills nearly every cell and virus, and if we drank it, us.

In fact, make a chain of carbon atoms into an alcohol, and most of the time you create a chemical that kills most cells, and us too.

So what is it about this little 2 carbon alcohol that makes it so popular, and not nearly as dangerous as the deadly poisons most alcohols are?

And what is the relationship of humanity to this alcohol over the eons?  Recent books reveal that our relationship to this alcohol are profound, and can be traced to a time that dates back to a place twice as old as Stonehedge.

A recent article in The Atlantic, does an astounding job of telling us so many interesting stories of this alcohol and humanity, from deep history, and now more recently across American history, our history.

Here is the article- https://www.theatlantic.com/magazine/archive/2021/07/america-drinking-alone-problem/619017/

Alcohol Across Life

As noted above, most alcohols are pretty devastating poisons.  Again think of rubbing alcohol and wood alcohol.  These chemicals tend to dissolve cells quite nicely, so they destroy living tissue.

The one exception to this pattern is the 2 carbon alcohol, ethanol, the only alcohol widely referred to as simply alcohol, and used in human beverages.

But this alcohol is exceptional mainly because somehow humanity evolved the ability to not be easily killed by it.  Ethanol is as deadly as other alcohols, but for animals that can change it before it kills their cells, they can survive exposure to it.

The record across life is that some bacteria figured out how to neutralize ethanol, creating an enzyme called alcohol dehydrogenase.  This enzyme has been adapted across life.  Variations in other one-celled organisms have allowed them to both create and to defuse ethanol.  Yeast use a variation of this enzyme to turn sugar into ethanol.  We call this chemical reaction fermentation and it is the source of all the ethanol, or alcohol, we drink.

Some scientists think that yeast devoted much effort to change sugar to alcohol to kill off other cells that could not manage such high exposures.  It is a very clever strategy, and is used to so widely that in the forest, rotting fruit contains concentrations of ethanol typically at about 4%, making it 8 proof, like a weak beer.

Most mammals have some of this enzyme, but about 10 million years ago, a primate emerged that increased the amount of this enzyme 40 fold!  This primate could handle 40 times more alcohol, specifically ethanol, than other animals.  About 4 million years later, the first ancestor of humanity to diverge from the chimpanzees and bonobos appeared, and carried this super gene for alcohol neutralizing enzymes.

All humans today carry this extra power to neutralize alcohol, but the level of activity of this enzyme does vary from one group of humanity to another.  Notably, in regions of the world where rice is the dominant grain, this enzyme is less active, and so people in these regions cannot tolerate alcohol as readily.

Even so, humans far more than any living mammal, can drink ethanol with far less threat of immediate poisoning.

What Comes with Our Special Human Ability to Survive Exposures to Alcohol

From this point forward, we will use the word alcohol to refer to only one alcohol, ethyl alcohol or ethanol, the two carbon simple alcohol.

So somehow humans evolved a way to survive ingesting 40 times more alcohol than other primates, but was there a reason?  Major increases in ability usually happen in evolution as a result of some advantage in function.  The honest truth is that no one knows why humanity can tolerate alcohol so well, but there is one reason that seems to be emerging as most plausible.

Perhaps the greatest power that humans have as animals is their ability to combine thoughts and purposes.  Think of any great, good or bad, accomplishment of humanity, and it almost always features the collaboration of large numbers of people.  According to E.O. Wilson, the world’s leading expert on how social animals connect and collaborate, human beings are one of the most elaborately and successful animals.

The theory goes that alcohol has played an important role in helping adult humans collaborate across history.  Across many cultures, the use of alcohol is present at most important gatherings.  Many people experience an easing of social tensions when alcohol is served.  Of course, alcohol is clearly not necessary to have successful social interactions.  We would argue that humanity should find other ways to manage the challenge of collaboration, but across history, one could argue alcohol played a role.

One interesting site that is twice as old as Stonehenge makes the point.  This site features large stones erected in circular patterns that is reminiscent of Stonehenge, but this site is in Turkey, and goes back 12,000 years old, or as old as agriculture.

The site it called Göbekli Tepe, and recent findings indicate that one of its functions was to serve as a gathering place for huge crowds of people, and one of the main activities at Göbekli Tepe was drinking alcohol.

The authors of the Atlantic essay also inform us that the ship carrying the Puritans from the Netherlands to the Americas was aiming for the Dutch colonies on Manhattan, but they stopped short of their trip, so say the logs, largely because the ship was running low on alcohol, and one of the first things the Puritans did when the set up their Plimouth Plantation was grow grain to make beer.

In fact, across history, most people when they drank alcohol drank wine or beer.  Leave sugary fruits on the ground to rot, and they will ferment, as noted above yeast will create alcohol from the fruit’s sugar and leave it about 3% alcohol.  You can push that natural fermentation a bit, and make beer or wine which can get you to about 5-11% alcohol.  That’s about how concentrated a drink could get until someone found out how to distill, or concentrate the alcohol in fermented beverages.  Distillation can yield 100% alcohol, but most such drinks run about 50%.  Distillation began around 1200 in China and 1500 to 1800 in Europe.

As with most things, the Industrial Revolution allowed the manufacture of many items on massive, factory-sized scales, and that included the distilled drinks at about 50% alcohol.

Alcohol and America

Around the world, alcohol use varies widely be region.

As noted above, in much of East Asia, the ability to metabolize alcohol is far under the level lauded above, and so alcohol use is far lower than in other parts of the world.

The religion of Islam forbids the use of alcohol, so even though this prohibition is often violated, alcohol use across the Moslem world, from Morocco to Indonesia, is also very low.

In fact, across the world, only one region stands out for sustained, heavy drinking- Europe and places still run by their colonists.  That would of course include Europe- including Western Europe, Northern Europe, Eastern Europe, and Russia, and those European led colonies- Australia, much of South America, Canada, and yes, the United States.

Some patterns of regular alcohol use are steady and well-tolerated.  A familiar example might be Italy where wine is served at most meals, but alcohol is mainly ingested when at a meal with family, or friends.  Use of Italy is steady, about the same from year to year and era to era.  As a result the number of deaths from alcohol in Italy are at a far, far lower rate than in the US.

About 100,000 Americans die every year from using alcohol.  If we had Italy’s rate, that number would be about 5,000.  Twenty times lower!

But that number is just now.  Alcohol use in America is nearly unique across the whole world because of how severely it swings.  We seem to be the only nation that goes through decades of very heavy binging, then as a nation suddenly feel pangs of regret, and cut our use dramatically.  The numbers of people who develop cirrhosis, or die from overdose or alcohol-related injuries, goes up and down with these swings too.

No one knows why America never seems to settle for a steady approach to drinking.  Why do we have decades of intense drinking, alternating with fits of restraint?  This is a question still looking for an answer.

But the pattern causes curious behaviors, going all the way back to our very first days.  One distinction is the degree to which America drinks alone.   Consider Italy once again, where the glass of wine seems to be featured mainly at the family table or in gatherings with friends.  In this setting, alcohol seems to fit its evolutionary purpose, to enhance our ability to connect with others, to enjoy company, to be together.  Drinking alone serves none of these purposes, but America has developed this approach as well as any nation.

America’s first peak of intense drinking hit in the 1830s when we drank 3 times as much as we do now.  This heavy drinking continued through the trauma of the Civil War and to the twentieth century.  Men often got drunk at breakfast, and family abuse was common.  The epidemics of abuse, early death, and chronic drunkenness combined to make reducing drinking a progressive goal as important to many as the women’s right to vote, abolition, and other causes.  The sudden easy availability of distilled alcohol at the higher concentrations of 50% made possible by the Industrial Revolution played a large part in America’s embrace of heavy drinking.

Heavy drinking of intensely concentrated alcohol led to the creation of a new structure for drinking.  Until now the main place had been a table, where alcohol was enjoyed with family.  Now came the long counter where one could sit and have many strong drinks all alone.  That counter is the bar, a word ever since tightly associated with drinking across Europe and America.

And so began our first serious swing against drinking, culminating in Prohibition when the nation tried to stop all use of alcohol all together.  We are mostly familiar with how this effort failed.  But during Prohibition (1920-1933), deaths by alcohol in the United States dropped by half, and the use of alcohol in our nation was forever changed.

The repeal of Prohibition of course ushered in the first Happy Days and a dramatic surge in the use of alcohol, but eventually this spike faded.  By the 1980’s and 1990’s the use alcohol in America went into sharp decline.  The drop was big enough that there started to be fewer bars in America.

Then America came back to drinking more heavily.  This began in the 21st century.  Bar numbers remained lower, but places where we drink have begun to explode.  Now there are places to drink in grocery stores, nail salons, barber shops.  Alcohol comes increasingly in formats that almost hide the alcohol- including sodas.

What America can Learn from Evolution

Studies done in users of alcohol have found traces of our evolutionary roots.  People who drink with others, mainly to enhance the experience of being together, seem to suffer fewer harms from alcohol than those who drink all on their own.  Lighter drinking with friends and family appears to achieve measurable decreases in anxiety.  Drinking alone appears to fail to do this and may even deepen depressions.

Broadly speaking, large swaths of humanity seem to be steadily settled into one of 4 patterns of alcohol use- not much (the Islamic world, large parts of East Asia), steady social use on mostly more dilute drinks (southern Europe), steady heavier use of more concentrated drinks (parts of northern Europe and Russia) and the boom-and-bust cycle (mainly just us).

And the results are very predictable.  Go with little use, or the steady use of weaker drinks, and you stay within the lanes our bodies were built to handle, and far less harm happens.  Go with heavy use of stronger drinks, or much pumped up use of weaker drinks, the body will suffer, and deaths by alcohol soar.

The price paid for defying the realities of the how alcohol turns from treat to poison was outlined for readers of Real Answers in an earlier post- https://drlavinrealanswers.com/looking-health-impact-alcohol-new-look-low-level-use/

In this post the overuse of alcohol which is so characteristic of America is tied very closely to increased chances of dying of cancer, liver disease, diabetes, and a very sharp increase in death by injury.  About 50% of all deaths by car accident involve alcohol.

About 3.4 million Americans die a year now, and alcohol continues to cause about 100,000 of those deaths, making it the #3 cause of preventable death in America.   (#1 for many decades has been tobacco at 500,000, but just recently a new #1 surpassed tobacco killing 540,000 Americans a year- excess food).

Bottom Lines

1. An alcohol is a class of chemicals consisting of a chain of carbon atoms ending in a bond with one oxygen and one hydrogen atom.  One of the simplest of this class of compounds is the 2 carbon-atom alcohol, called ethyl alcohol, or ethanol.  This is one of the only alcohols that is not profoundly poisonous, and so it is the only one we drink.  We will refer to ethanol in this summary as alcohol going forward.
2. Humanity stands apart from all other primates in our ability to drink alcohol and not be poisoned.  About 10 million years ago, our primate lineage boosted our ability to chemically neutralize alcohol by a stunning factor of 40.
3. It appears that the evolutionary benefit being able to drink alcohol imparted was the boost in social cooperation which would emerge as one of the great powers evolution bestowed on humanity.
4. The gift of evolution to safely drink alcohol in order to increase our ability to get along, to collaborate is in full view across many nations around the world.
5. For reasons not easily explained, a different pattern of use of alcohol emerged as our nation came into being.  In contrast to most other nations, America has sustained a boom-and-bust cycle of alcohol use.  Our nation has seen swings towards intense use alternate in dramatic swings towards condemning use.  As a result American drinking goes way up and goes way down in cycles that typically span decades.
6. Our most recent swing down was in the 1980’s and 1990’s.  The shift actually led to the number of bars in the US dropping.  Our most recent swing upwards is now, and not marked by increased numbers of bars.  Our current American surge in use of alcohol is marked by drinking in more places (grocery stores, nail salons, barber shops) and with more non-alcohol appearing drinks (sodas).
7. American swings towards increased use of alcohol are always accompanied by surges in death by alcohol, by disease and accident.

The Takeaway:

Drinking alcohol in moderation, with family or with friends, to ease the value of coming together and enjoying each other’s company appears to be right in line with how humanity evolved.  More heavy use, more use alone without any social advantage, more concentrated drinks with more frequent intense inebriation is clearly related to bad outcomes in mental and physical health.

Somehow, our national culture needs to find a path where the vast majority of those of us who can, can feel comfortable with those who wish to drink alcohol, with others, in moderation.  It is time to drop our centuries old infatuation with one day going wild with drinks and then the next day recoiling from them.  Time to stop fighting our biology, and to start simply enjoying who we are and who we are built.

To your health,
Dr. Arthur Lavin