Alcohol — is it all bad?
There has been an ongoing debate for many years about the possible benefits and significant dangers of the consumption of alcohol. There are not too many people in the medical field who disagree that heavy drinking, defined as more than 14 drinks per week for men and seven drinks per week for women or binge drinking, defined as five or more drinks during any one session, carries with it a significant health risk.
We are all aware of the pervasive effects on the liver, the brain, the heart and the increased risk of many common cancers in people who have a regular consumption of alcohol at this level.
The age-old debate, however, is whether there is any health benefit from being a moderate drinker? A study just published in the Journal of the American College of Cardiology looked at data from a large population sample of 333,250 people followed for 12 years. They looked at six different categories of drinkers and examined the death rates over this period. 34,750 people died during the survey. Around 7000 deaths were due to heart disease, 2000 deaths due to cerebrovascular disease and 8400 deaths due to cancer.
Heavy drinking men had a 25% increased death rate and just under 70% higher risk of death due to cancer. This did not appear to be the case for the women who were heavier drinkers. They did not have a higher death rate. This is probably because the definition of heavy drinking being more than 7 standard drinks per week in women is too rigid. Interestingly, there was no association between heavy alcohol consumption and a high risk of death due to cardiovascular disease in both men and women.
The moderate drinkers had reduced death rates due to all causes from somewhere between 13 to 25% and a 21 to 34% lower risk of death from cardiovascular disease for both men and women.
This was equally the case in the light drinkers as well.
It is important to realise that this is American data, whereas information from the Mediterranean studies shows even more significant benefits from light to moderate alcohol intake.
Another study from Denmark followed 71,000 participants 29,000 men and 42,000 women for around 5 years and found that men who consumed 14 alcoholic beverages per week (a standard drink in Denmark contains 12 g of ethanol) had a 43% lower risk of developing diabetes whereas a woman who consumed nine drinks every week had a 58% lower risk, compared with abstainers. The greatest benefit appeared in those people who consumed alcohol on 3 to 4 days per week. The moderate consumption of wine also appeared to show the greatest benefit.
Another study from California reviewed 1350 adults with 730 women and 620 men over 29 years showing that moderate consumption of alcohol defined as one standard drink per day for women and two drinks a day for men up to age 65 showed less cognitive decline in the moderate drinkers compared with the non-drinkers or heavy drinkers.
But, it’s not all good news! Another American study published in the British Journal of Dermatology suggested that for every 10 g increase in alcohol per day there was a greater risk of non-melanoma skin cancers. Interestingly, another study from Europe showed no association. This latest study looked at 13 case-control and cohort studies involving just under 92,000 cases of basal cell cancer and a 3300 cases of squamous cell skin cancer. For every 10 g of alcohol intake per day it was a 7% increase risk for basis of cancer and an 11% increase rest for squamous cell cancer.
On balance, there appears to be a modest health benefit from moderate drinking. I do not believe that any doctor should be encouraging anyone to drink for health reasons but if you do enjoy 1–2 drinks most days a week the evidence is clear that apart from the potential skin cancer issues, the internal benefits do appear to be there. I do believe, however, that it is important to make the point that the greatest benefits from moderate alcohol consumption appear more in the European and Mediterranean data where generally a healthier diet is consumed.
I think it is important to realise that it is not one component of our lifestyle that leads to good health but the entire package. If you combine moderate drinking with a very stressful lifestyle, cigarette smoking and a poor diet, clearly you will derive no benefits. But, if you consume 1 to 2 drinks per day, most days of the week, practice other healthy lifestyle principles along with having a happy, less stressed life, then it is my opinion that you derive some extra benefit from that low dose consumption of alcohol.