Surely alcohol can’t be all bad?

It’s good for you too.

Until April this year, Henry and I were the sort who’d pooh-pooh any research that suggested drinking in moderation was unhealthy. “Look at us,” we’d say, pointing at our exercise focused, pescatarian lifestyle and 30 inch waistlines.

A counterargument pointing out the advantages of the Mediterranean diet, complete with plentiful vino rosso, was always a reliable one to fall back on.

Yum but where’s the vino?

Then we’d open a bottle of something white and crisp to celebrate our continuing superiority over matters of health. Doctors always know best.

Distant memories now …

We should all know the health risks associated with alcohol but what’s the evidence for anything that’s good about our favourite bottle of Shiraz?

So are they right?

Much of the research has centred on cardiovascular disease and the widely-held view has been that some alcohol is protective: specifically red wine.

The term ‘French paradox’ was coined in 1992 to describe the relatively low incidence of cardiovascular disease found in the French population, despite a relatively high dietary intake of saturated fats, which was attributed to the consumption of red wine.

But the problem with such epidemiological studies is separating out other factors – so-called ‘confounders’ – that could be responsible for the linkage. For instance, red wine drinkers might exercise more than abstainers or eat more fruits and vegetables, which would help to mitigate against dietary excesses. Admittedly, that’s unlikely in France, so the paradox persists.

No direct comparisons have been done to determine the effect of the key components in red wine on the risk of developing heart disease or stroke. Compounds like flavonoids and other antioxidants may be found in other foods such as fruit and vegetables. The best known effect is a small increase in ‘good’ HDL cholesterol, although moderate exercise may be just as effective.

It’s worth looking at the history of the red wine debate, which goes back four decades to a paper published in the US Annals of Internal Medicine in 1974, in which the health records of 120,000 insurance plan members were scrutinised. The key finding was that non-smoking drinkers had half the risk of a heart attack as non-smoking non-drinkers, suggesting that alcohol consumption could lower the risk of coronary heart disease.

Two problems with this research were: a) that it was retrospective, and b) the drinking behaviour wasn’t validated. But it was still hugely influential in how people viewed drinking. Alcoholics Anonymous wasn’t amused and tried its chances in court, alleging commercial bias, to get its publication retracted.

It didn’t go in AA’s favour

A UK study published in the British Medical Journal in 2017 dug a bit deeper, analysing the records of 2 million adults seen in general practice. But rather than just the risk of heart attacks, the authors explored alcohol-related outcomes for 12 different types of cardiovascular disease. They found that moderate alcohol consumption was associated with a lower risk of some cardiovascular diseases, but not all, including stroke.

When heavy drinkers were compared with moderate drinkers, the risk of stroke and sudden death became even more apparent, although the risk of heart attack remained less:

Heavy drinking digs deeper into health

But the distinction between heavy and moderate drinking isn’t a binary thing. We also know that some people metabolise ethanol faster than others. So it would be easy to find yourself in the wrong camp and at risk of stroke. Is that price worth paying for the sake of 175 ml of red wine per day?

A study published in the Lancet in 2018 suggests not. The Global Burden of Disease study examined the correlation between alcohol use and its effects, from 1990 to 2016, using the health records of 28 million 15 to 95-year-olds across 195 countries.

The study revealed that just one drink a day increased the risk of developing one of 23 alcohol-related illnesses by 0.5 percent in comparison to not drinking at all. And for every additional drink consumed regularly, this percentage increased.

According to the study, alcohol led to 2.8 million deaths in 2016 and was responsible for 20 percent of deaths in the 15 to 49 age group.

The level of alcohol consumption that minimised harm across all health outcomes was zero drinks per week.

The conclusions of the study are unambiguous: alcohol is a colossal global health issue and small reductions in alcohol-related harms at low levels of alcohol intake are outweighed by the increased risk of other alcohol-related harms, including cancer. It’s hardly surprising then that the UK’s Chief Medical Officer concluded: “There is no safe level of alcohol consumption”.

So where does this leave us? The way I see it, any small health benefits from moderate drinking seem too finely balanced and are probably achievable with a modicum of changes to diet and exercise. I’m not into nannyism, but I’m almost in agreement with the Chief Medical Officer on this occasion. Still, there’s no way of living that’s without risk and it must come down to personal choice.

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