By Aparna Mele MD
A big reveal study from the Cooper Institute in Dallas, published in the journal Medicine & Science in Sports and Exercise found that men with higher level of cardiovascular fitness are more than TWICE as likely to drink moderate amounts of alcohol (up to 14 drinks per week) as compared to their less fit peers. The fittest women were about twice as likely to be moderate drinkers as women with low aerobic capacities. Researchers assessed 38,000 healthy Americans ranging from age 20-86 who regularly completed aerobic treadmill tests and answered detailed questions about exercise and their drinking habits. For alcohol consumption, those consuming 3 or fewer drinks per week were considered light drinkers; up to 7 servings for women and 14 for men was considered moderate drinking; and consumption above that was considered heavy intake. They concluded with no degree of uncertainty that the country’s fittest people drink more. For women, being highly fit more than doubled the odds of being a moderate or heavy drinker. For men, it increased the odds by 63 percent. Furthermore, there appeared to be an upward trend such that heavy drinkers (more than 15 drinks a week) also displayed a higher likelihood of physical fitness. Of course, this study has limits, involving mostly involved affluent, white Americans, and it showed only an association between fitness and alcohol intake and not that one causes the other.
These results are seemingly quite surprising, given the concept of ‘habit clustering’, meaning an individual’s healthy mindset usually creates a number of healthy habits in that person and this is why many gym goers do not typically smoke and exercise buffs are more likely to eat a lot of kale instead of a lot of fast food. However, there are several hypotheses that could explain these findings. Social influence is a large driver, as teammates and training groups bonding over beers or margaritas after a grueling competition or workout. Consider the close association between running clubs and local microbreweries and the beer you get rewarded with as you cross the finish line in a Spartan race, People who are very fit, healthy and active are more likely to be heavy drinkers because they feel their exercise habits entitle them to an alcoholic reward. Many likely also put a ‘healthy halo’ over their heads, making them feel that their rigorous physical exertion and level of fitness justifies those extra cocktails. This is called the licensing effect: when you feel like you have done something good, you can then reward yourself by allowing yourself to do something less good or bad. However, there are also published studies that show that both exercise and alcohol intake stimulate the reward processing center of the brain. So after a successful 4 mile run, some athletes want to keep the endorphin and dopamine high going by throwing back 4 beers afterwards. A 2014 study from University of Houston linked both exercise and drinking to higher levels of sensation seeking, leading to higher release of dopamine, the pleasure neurotransmitter of the brain. In subsequent work, 4 distinct motivations that couple exercise and alcohol were delineated. These include the above ‘work hard, play hard’ mentality and the celebration mindset, both of which create the link of exercise leading to drinking. The other two are body image and guilt and these create the link that drinking leads to exercise. There are many personal stories of former addicts who have overcome their disease and become marathoners, crediting their sport for essentially saving their lives.
So, which is it? Does working out turn us into alcoholics or save us from becoming one? Sounds like in fact both are true. Exercise reinforces the reward-seeking behavior that leads to excess drinking, but also it might just compete with and push away the compulsion to drink. Regardless, it is worth keeping these interesting observations in mind, and for those of us with a heavy streak of sensation-seeking, perhaps our running thought should be to stop boozing and keep training like an animal!