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How much wine is okay?

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If you want to get scare stories into the news about our eating or drinking habits, simply say they’re as harmful as smoking, and panic headlines will be sure to follow.

In the past few months, there have been two examples of this kind of scaremongering about drinking. “How many cigarettes are there in a bottle of wine?” was the bizarre title of a research article published in BMC Public Health at the end of March.1

Close on its heels was another article,2 this time in noted medical journal The Lancet, generating headlines such as, “Even one drink a day increases stroke risk.” One of the senior authors was quoted as concluding, “The alcohol industry. . . should be regulated in a similar way to the tobacco industry.”

These two alcohol studies had been published in reputable journals, so the media understandably took the press releases at face value. However, careful scrutiny of the full texts of the actual papers reveals that these studies add little of value to the many thousands of alcohol research papers published in the last 50 years, with methodology weaknesses that leave them far from conclusive.

Each paper expresses the authors’ frustration with half a century of evidence beset by an ongoing paradox: that alcohol can be both bad and good for your health. The evidence from the research data is overwhelming that, while excessive drinking can be harmful, a modest daily tipple is beneficial – significantly reducing the risk of heart disease, in particular.3

However, this inherent health contradiction sticks in the craw of many in the medical establishment, whose stated agenda is to try to reduce alcohol consumption by publicizing its hazards.

Turning off the taps
Consequently, in the last few years, there has been a concerted effort to publish medical research studies whose conclusions are that alcohol is uniformly harmful, and thus that the health paradox doesn’t really exist.

The Lancet study is a case in point. At first sight, it’s a highly credible piece of research: a decade-long comparison of the health data from half a million people – some drinkers, some non-drinkers.

Also impressive is that one of the researchers is the world’s most famous living epidemiologist, Professor Sir Richard Peto of Oxford University, one of the pioneers of the research linking smoking to lung cancer in the 1970s.

But here comes a problem: the half million people in Professor Peto’s study were all Chinese. Why a problem? Because roughly 50 percent of East Asians have a unique set of alcohol-processing enzymes, which makes them highly unusual in terms of the health consequences of drinking.

Peto and his team claim that the drinkers they chose had similar enzymes to Europeans. However, the control group of non-drinkers did not, making the two groups genetically disparate, and thus seriously diminishing the validity of any comparison.

And the study’s difficulties don’t end there. Another notable difference in this population is the Chinese drinking culture. Most Chinese drinkers are men, most Chinese drinks are very strong spirits, and a good deal are consumed in a binge-drinking environment. It’s been known for years that the most harmful alcohol type is spirits, and that the most harmful pattern of drinking is bingeing.

Nevertheless, the study reported remarkably few ill effects from drinking. For example, drinkers’ risk of having a heart attack was no different from that of non-drinkers.

Their only significant health difference was in two major types of stroke: a 58 percent increased risk for hemorrhagic stroke (where a blood vessel bursts in the brain), and 27 percent for ischemic stroke (where blood flow is blocked or interrupted).

Overstated dangers
These were the figures for the very heaviest drinkers, but in practical terms, they mean very little. All they tell us is that Chinese heavy drinkers have less than a two-fold extra risk of a stroke. By comparison, heavy smokers have 25 times the extra risk of lung cancer.

Nevertheless, Peto and his team trumpeted these findings as a great success, primarily because there was no evidence of any health benefits to low alcohol intake. This, they claimed, was a substantial nail in the coffin for alcohol’s value as a health tonic.

What they failed to point out, however, was that this was entirely predictable given the Chinese pattern of drinking. Binge drinking is always bad news for health, as a recent study of Finnish drinkers (reportedly Europe’s most infamous bingers) has confirmed. 4

Even when overall alcohol intake, averaged over weeks or months, remains low, if it’s consumed in a pattern of bingeing, it can have a hazardous impact on some key liver enzymes, with knock-on effects for the rest of the body.

The strangest aspect of the Lancet study is that it contradicts the earlier findings of Professor Peto himself. As one of the key figures behind the smoking-lung cancer connection emerging from an investigation of some 12,000 British physicians, he produced the landmark research that kickstarted today’s anti-smoking legislation.

Rarely mentioned, however, is that the very same investigation found that the physicians who drank alcohol had substantially reduced risk of dying from a range of fatal diseases. The doctors who drank outlived their non-drinking colleagues by a significant margin.5

Conflicting interests
Possibly to explore these counterintuitive results, in the mid-1990s, Peto joined forces with researchers in the US, tracking the causes of death of half a million Americans. The result? Once again, non-drinkers were found to have shorter lifespans than drinkers, largely due to higher rates of heart disease.

The drinkers’ health benefits were most marked for moderate alcohol consumption, but they also persisted at much higher intakes.6

Peto’s earlier research, however, was not mentioned in his latest Chinese collaboration.

Furthermore, the senior authors behind the BMC Public Health paper seeking to equate the risks of drinking to those of smoking are two British campaigners for increased restrictions on alcohol consumption – a potential conflict of interest declared neither in their paper nor to the public. Also unclear was that their study was simply their own non-specialist assessment of the existing information on the topic, and not new research.

Their conclusion was unique in the entire history of alcohol research: “Drinking one bottle of wine per week is associated with an increase in absolute lifetime risk of cancer equivalent to smoking ten cigarettes a week for women, and five for men.”

The real cancer connection
Let’s test that claim against the actual evidence. The most common cancer in women is in the breast, as the BMC authors acknowledge.

A decade ago, two French biostatisticians did an in-depth analysis of the breast cancer risk of 1,500 women in Southern France.7 They chose the Hérault area, “where wine is an integral part of the population’s dietary habits,” and identified every single woman – young and old – diagnosed with breast cancer over a two-year period.

These women’s entire lifestyles were then analyzed in detail, including the types of alcohol they drank, how much and how often. Another matched control group of healthy women without breast cancer was similarly surveyed.

The findings were dramatic. None of the breast cancer cases appeared to have any association with alcohol intake, no matter how much or what type of alcohol the women drank. As an aside, the single most important
lifestyle factor connected with breast cancer was “high consumption of red meat” (roughly doubling the cancer risk).

Alcohol intake up to 12 grams a day (equivalent to a very large glass of wine) actually reduced the risk of breast cancer – by nearly half. The greatest protection occurred among women who drank wine every day; there was no benefit whatsoever if their intake was “sporadic.” Higher intakes of wine did not increase breast cancer risk.

“Low and regular consumption of wine reduces the risk of breast cancer,” the authors concluded. Therefore, “it is perhaps not suitable to advise that all low alcohol consumers, especially wine drinkers, reduce their alcohol intake.”

In 2014, very similar results were found among Greek women, with researchers from Harokopio University in Athens reporting that, “Moderate alcohol intake, and especially wine consumption, seem to be associated with breast cancer prevention.”8

Of course it’s well known that the French and Greeks are particularly healthy, mainly because of their Mediterranean diet. However, American wine-lovers aren’t far behind them in the breast-cancer stakes.

In a US National Cancer Institute-sponsored study of over 13,000 women, about half of whom had been diagnosed with breast cancer, the wine drinkers were found to have no extra risk whatsoever.9

Wine: a health tonic?
But what about men, who were also told that drinking a bottle of wine a week is as bad as smoking?

Men’s major cancer killers are in the lung, prostate and bowel. In a study of 84,170 Americans, researchers at the Kaiser Permanente Research group in Pasadena found that, for each glass of red wine consumed per month, the risk of lung cancer declined by 2 percent. The most substantial benefit – a staggering 85 percent reduction in risk – occurred in ex-smokers drinking more than a glass of red wine a day.10

In a meta-analysis of 17 studies that examined the connection between alcohol consumption and lung cancer, wine was found to decrease cancer risk by about 30 percent, with its protective effect strongest in older men and smokers.11

Prostate cancer is also greatly reduced among wine drinkers. According to a 2005 study by researchers at Seattle’s Fred Hutchinson Cancer Research Center: “Each additional glass of red wine consumed per week showed a statistically significant 6 percent decrease in relative risk of prostate cancer.”12

In other words, the more wine the merrier – and particularly in the worst cases of the disease. “The more clinically aggressive prostate cancer is where the strongest reduction in risk was observed,” reported lead author Dr Janet Stanford.

“Among men who consumed four or more 4-ounce glasses of red wine per week, we saw about a 60 percent lower incidence of the more aggressive types of prostate cancer,”

Less dramatic, but still favorable. results were found in a cohort study conducted in the Netherlands. This tracked the health of almost 60,000 men over six years, and saw no change in prostate cancer risk among men who drank red wine, no matter how much they consumed.13

The bowels also seem to be protected by wine, with Danish researchers declaring it to have an “anticarcinogenic effect” following a 15-year study of nearly 30,000 people.14

Another large study conducted by researchers at Cambridge University agrees, reporting that among the nearly 25,000 participants, wine drinkers saw a roughly 40 percent reduction in their risk of colorectal cancer.15

So, there is consistent evidence across both sexes that drinking wine not only doesn’t cause any major cancers, it may actually prevent them. And yet a leading British medical journal, whose papers are supposedly peer-reviewed before publication, is prepared to declare that “Drinking one bottle of wine per week is associated with an increase in absolute lifetime risk of cancer equivalent to smoking ten cigarettes a week for women, and five for men.”

The evidence is clear that wine, when consumed in moderation with meals, is one of the world’s most health-giving natural products.16 The next time you see scare stories about this life-enhancing liquid, remember this: if they sound too bad to be true, they aren’t.

Tony Edwards is author of The Good News About Booze (Premium Publishing, 2013)

1 BMC Public Health, 2019; 19: 316
2 Lancet, 2019; 393: 1831-42
3 Addiction, 2017; 112: 968-1001
4 Alcohol, Mar 16, 2019
5 BMJ, 1994; 309: 911
6 N Engl J Med, 1997; 337:1705-14
7 Ann Epidemiol, 2008; 18, 467-75
8 Nutr Cancer, 2014; 66: 810-7
9 Cancer Epidemiol Biomarkers Prev, 2009; 18: 1007-10
10 Cancer Epidemiol Biomarkers Prev, 2008; 17: 2692-9
11 Cancer Epidemiol Biomarkers Prev, 2007; 16: 2436-47
12 Int J Cancer, 2005; 113: 133-140
13 Cancer Causes Control, 1999; 10: 597-605
14 Gut, 2003; 52: 861-7
15 Cancer Epidemiol, 2009; 33: 347-54
16 Diseases, 2018; 6: E73

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