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The truth about alcohol and your health

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The truth about alcohol and your health

Is alcohol good for us or not? Although an army of researchers has studied the merits and dangers of alcohol for years, there is still no consensus. Almost every week there are conflicting headlines, leaving the reader puzzled and bemused. For example, last July, one study proclaimed even moderate alcohol drinking raises the risk of cancer, and two weeks later, another concluded a glass of alcohol every day cuts the risk of premature death.

Both can’t be right, and yet this pattern of conflicting and confusing advice and alerts has been going on for years. Why?

The most obvious reason could be that behind the ‘good news about booze’ stories are naked commercial interests. For example, in the past the tobacco industry routinely funded scientific research that downplayed the risks of smoking. 

The food industry, too, has consistently suborned nutritional science—and still does. Food additives are a good example: almost all the studies that find they are harmless have been funded by the additive industry. 

An even more notorious example is sugar. A recent investigation found that 50 years ago the sugar industry “sponsored a research program that successfully cast doubt about the hazards of sucrose, while promoting fat as the dietary culprit in heart disease,” with disastrous consequences for world health.1  

Has the alcohol industry copied the food industry in corrupting science? It seems not. It’s true that the industry does fund some meta-analyses (pull-togethers of the existing evidence), but there appears to be no bias in the outcomes.2   

More importantly, the alcohol industry doesn’t usually fund original research. Indeed, a recent attempt to solicit industry cash for a major new research study provoked such an outcry that the proposal never got off the ground.3 

Although there are literally hundreds of  ‘alcohol and health’ studies published every year—some at great expense—almost all are funded by government health authorities, working mainly through universities and clinical research groups. 

But bias and corruption aren’t just a one-way street: in the case of alcohol, it can be used either to promote drinking or repress it. We all know that booze can cause severe addiction, with a host of damaging consequences from domestic violence to premature death. 

Although most who drink manage to escape this fate, there are enough ‘problem drinkers’ and alcoholics to encourage governments to set up research bodies to tackle the problem. Because such bodies are tasked with discouraging drinking, their public messaging is often blunt: no ifs, ands or buts, alcohol is bad for your health, just like tobacco.   

The Proof is in the Pinot

According to a study of over 300,000 drinkers included in the UK Biobank database, those who consumed alcohol mainly at mealtimes—even in fairly high quantities—saw a significant reduction in their risk of cancer, heart disease and overall mortality. Drinkers in this category consumed mainly wine or beer, and at levels ranging from 50 to 300 grams per week. That upper limit of 300 grams is equivalent to more than a half bottle of wine or two pints of beer every day. They were about 20 percent less likely to develop cancer or heart disease or to die from any cause.

Benefits and bias

However, the evidence is often against them. Research studies stretching back half a century repeatedly find that moderate drinkers live longer than non-drinkers, mainly due to a reduced risk of heart disease.4 

There have been various attempts to debunk that evidence, but the naysayers can’t get around two glaring findings: clinical trials show alcohol favorably influences biomarkers associated with heart disease,5 and moderate drinkers have less atherosclerosis (gunked-up arteries) than non-drinkers.6 

Other researchers have tried to refute the findings. One example among many is a 2016 study from the Centre for Addictions Research at the University of  Victoria in Canada, which involved a meta-analysis of moderate drinkers’ mortality rates. At the time, there were some 2,662 published epidemiological studies on the subject, but the study’s authors assessed only six. Unsurprisingly, they concluded that the evidence was too weak to be anything but “skeptical” about alcohol’s health benefits.7 

A similar approach was used in 2019 in a study subtitled: “How many cigarettes are there in a bottle of wine?” Two senior authors are well-known anti-alcohol campaigners, lobbying for alcohol taxes to be raised to those of tobacco. 

Like the Canadian paper, this was not an original study, but an assessment of the existing evidence about alcohol and cancer. However, despite the paper’s ominous subtitle, the authors didn’t cite any of the more than 10,000 separate studies on wine and cancer risk. 

As a whole, these reveal an unclear picture, with some studies even showing a decreased risk among wine drinkers, such as with lung cancer.8  

It could be that papers such as these pass the peer review process—designed to sift out pseudoscience—because they support the zeitgeist that all alcohol is bad for us. UK safe drinking guidelines issued in 2016 more than halved the previous recommended maximum limits of 1995, despite there being no significant changes in the health evidence over the previous 21 years. 

We now know those limits are suspect, thanks to some digging by British journalist Christopher Snowdon. He discovered that British medical authorities put pressure on their academic advisers to manipulate the epidemiological data, exaggerating alcohol’s health hazards and minimizing its benefits. As a result, the UK’s maximum safe limit of two “units” of alcohol per day (a pint of beer or a glass of wine) is now one of the world’s most draconian.9

Since 2016, much of UK academia has fallen in with the official anti-alcohol line. For example, in 2018 a Cambridge University research group published the results of a survey on the health of nearly 600,000 drinkers.10 The press release accompanying The Lancet’s publication trumpeted the fact that the study had “challenged” 50 years of evidence showing alcohol’s benefits to heart disease—a claim that fostered headlines such as “Drinking five glasses of wine a week can take years off your life,” and “Drinking is as harmful as smoking.”  

But all of this was a misrepresentation. Data sleuths soon discovered the truth: buried in the Lancet study’s voluminous appendix were the raw figures, which unequivocally showed the classic “J-curve” of health effects: a reduction in heart disease risk at moderate alcohol intakes, but a gently rising increase in risk at higher intakes. 

Does this kind of obfuscation explain the different headlines quoted at the start? Not necessarily. After all, those two studies were different: one was about cancer,11 the other about longevity12—and you can live a long time even with cancer. 

Nevertheless, it’s easy to spot bias with each of them. The most obvious criticism of the cancer study is its crudeness. It was simply a paper exercise, collecting data from around the globe, with the aim of showing that the higher a nation’s alcohol consumption, the higher its cancer rates. 

Design flaws

However, the flaws in that study design are legion. Here are just three: One, association does not mean causation—the classic error. Two, cancers have multiple causes, not necessarily alcohol-related. Three, the raw data can say nothing about the number of drinkers or their individual intakes. And yet the study claimed to be refined enough to claim that even moderate drinkers had an increased cancer risk. 

The researchers had used a theoretical “Monte Carlo-like approach”—an abstruse methodology whose gambling connotations don’t inspire confidence. Moreover, the study failed to mention a 2018 meta-analysis showing moderate drinking does not significantly increase overall cancer mortality.13 

The other study, which claimed drinking improves your health, was an in-depth analysis of cardiovascular disease (CVD) patients within the half-million-strong UK Biobank project, finding that people who continued to drink after a CVD diagnosis had better health outcomes than those who followed doctors’ orders to lay off the booze. 

The evidence was startling: almost any amount of alcohol intake was enough to reduce the risk of dying from CVD—or indeed from anything else. The benefit was strongest at intakes at levels up to roughly 20 grams of alcohol (around one pint of beer, two glasses of wine, or a large measure of spirits) a day. 

But that upbeat message was downplayed by the researchers, who told journalists: “Alcohol is associated with an increased risk of developing other illnesses—such as cancers. Those with cardiovascular disease who do not drink should not be encouraged to take up drinking.”14 

However, within a few days another study appeared—yet again contradicting the earlier ones. A nine-year survey of over 300,000 drinkers found that those who mainly drank alcohol with meals (i.e., wine or beer) had a roughly 20 percent reduced risk of cancer, heart disease and overall mortality. These health benefits were found in people who drank substantial amounts of alcohol, “greater than . . . 50 g/week and less than 300 g per week,” reported the research team. The upper figure is equivalent to more than a half bottle of wine or two pints of beer a day.15 

That dramatically different take-home message from the previous day’s study is made even more risible by the fact that both studies had used the very same database: the UK Biobank. It’s enough to drive you to drink—and, in moderation, that may do you some good.

 

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

 

References

1 

Am J Clin Nutr, 2018; 107: 484–94

2 

Adv Nutr, 2020; 11: 1384–91

3 

The New York Times, Jun 18, 2018. “It was supposed to be an unbiased study of drinking. They wanted to call it ‘Cheers.’”

4 

Alcohol Alcohol, 2002; 37: 409–15

5 

BMJ, 1999: 319: 1523–8

6 

Eur J Nutr, 2021; 60: 123–34

7 

J Stud Alcohol Drugs, 2016; 77: 185–98

8 

Cancer Epidemiol Biomarkers Prev, 2007; 16: 2436–47

9 

The Sunday Times, Oct 28, 2017. “Cut in drink limit ignored advice”

10

Lancet, 2018; 391(10129): 1513–23

11 

Lancet Oncol, 2021; 22: 1071–80

12

BMC Med, 2021; 19: 167

13

Cancer Res Treat, 2018; 50: 474–87

14

The Telegraph, July 27, 2021

15

Mayo Clin Proc, 2021; 96: 1758–69

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