Americans who drink alcohol have endured years of ambiguous study, with some telling them moderate drinking might help them, others saying it sure will hurt them.
So is having a drink with dinner good or bad for your health? After a series of extensive meta-studies, the last of which was published in March, science is closing in on a definitive answer: yes.
Moderate alcohol consumption increases the odds, very slightly but definitely, that the drinker will contract one of many diseases or die a violent death.
Modest alcohol consumption may also confer modest health benefits, particularly to the heart, and especially in older people, who are at increased risk of heart disease.
On the second point, the scientific community remains divided.
“If you’re over 50 or 60 and you have a drink or two a day, I don’t think you have to worry about it, I don’t think you have to feel guilty,” Emmanuela said. Gakidou, professor of health measurement sciences at the University of Washington.
Gakidou was the lead author of a massive 2018 study, co-authored by over 500 researchers and published in The Lancet, which explored over a thousand previous studies and data sets on alcohol. .
The study found that, at one drink a day, a drinker’s risk of developing one of 23 health conditions increased by 0.5 percent. At two drinks a day, the risk increased by 7%.
These are tiny risks. And yet the study produced headlines like “The safest level of alcohol consumption is zero.”
Given what scientists now know, this claim is technically true. Some of the health risks associated with even moderate alcohol consumption are well documented.
“Everything related to violence and accidents increases with alcohol consumption,” Gakidou said, including drunk driving, home accidents and suicide. Moderate alcohol consumption increases the risk of cancer, but not by much.
But alcohol can also confer benefits. Numerous studies have suggested that moderate alcohol consumption reduces the risk of heart disease and stroke. Other studies have come to the opposite conclusion.
“When you look at all of them, there’s a lot of noise out there,” Gakidou said. But if you imagine all studies as dots plotted on a graph, “the scatter plot is mostly on the protective side, rather than the harmful side.”
Not so long ago, scientists and civilians alike believed that moderate alcohol consumption offered definite health benefits. Such positive thinking may have culminated in a 1991 episode of CBS newsmagazine 60 Minutes, which posed the idea that red wine improved heart health. Wine sales have exploded.
It turned out that the science behind these studies was flawed.
Yes, studies have shown that people who drink red wine live longer than people who don’t. But these wine drinkers enjoyed all sorts of other healthy habits and native benefits: income and education, balanced diets, healthy weights, a taste for exercise, and superior health care.
Many non-drinkers, on the other hand, did not drink for a reason: they were already ill, had disabilities or suffered from alcoholism.
“Over time, it gets worse,” said Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research. As the study subjects age, the abstainer category “fills with people who quit drinking because they had health problems.”
So when researchers compared the health of drinkers and non-drinkers, drinkers often came out on top.
Stockwell co-authored a new meta-study in a prestigious journal of the American Medical Association, which analyzed more than 100 previous studies to correct for these biases. The review found that the health risks started when women drank 25 grams of alcohol a day, less than two drinks. The risks rose for men who drank 45 grams of alcohol a day, or just over three drinks.
All risk is relative and the risks a drinker assumes by breaking a beer are not significant. On average, an adult who drinks six drinks a week will die two to three months sooner than a non-drinker.
“It’s a low risk, but it’s a big risk,” Stockwell said. “My revolutionary thinking is that you just tell consumers what the risk is, so they can understand.”
Many drinkers, of course, would gladly trade a few months of life for a glass of wine with dinner each evening.
Large studies have triggered gut reactions from both sides, drinkers and non-drinkers alike. Some readers felt cheated by decades of studies suggesting that moderate drinking is unquestionably good for you. Others felt that science and media coverage greatly inflated the dangers.
“Given the pleasure presumably associated with moderate drinking, saying there is no ‘safe’ level does not seem like an argument for abstaining,” a British statistician said of the 2018 study. “There is no level of safe driving, but the government does not recommend people avoid driving.”
The anger probably stemmed more from the alarmist headlines than from the studies themselves, which presented their findings in understated medical jargon.
“You measure a risk and announce it’s a risk, and then people get mad at you for telling them what to do,” Stockwell joked.
Gakidou, who is Greek, spoke to The Hill from Greece. “And if you talk to people about my culture, in Greece, if you tell them not to drink, you’re not very popular,” she said. “I think people around the world want confirmation that their approach to drinking is healthy.”
According to the 2018 meta-study, almost all adults drink in Denmark, while the average Portuguese man drinks seven glasses a day. Average life expectancy is 82 in Denmark and 81 in Portugal, about a decade longer than the global average of 72, data that illustrates the complexity of studying alcohol.
A big unknown, and a silver lining for drinkers, is the relationship between alcohol and heart attacks and strokes.
The only way to prove whether drinking alcohol increases or decreases these risks is to conduct a controlled experiment that compares drinkers and non-drinkers by randomly assigning subjects to drink or abstain.
Conducting such a clinical trial is trickier than it sounds: it could mean asking a subject to drink, knowing the proven link between alcohol and, say, death by vehicle. And proving the long-term effects of alcohol, by definition, requires a long-term study.
“You really need years,” said William Kerr, senior scientist at the nonprofit alcohol research group. “And it becomes difficult for people to stay on the program.”
Yet over the past decade, the National Institutes of Health has launched just such a study, spending $100 million to have scientists confirm or refute that alcohol could be part of a healthy diet.
And then, in 2018, the study was stopped. A New York Times investigation found that much of the funding came from the alcohol industry, hardly an unbiased part.
Thus, the potential health benefits of moderate alcohol consumption remain a mystery, while the modest health risks have been widely accepted.
Canada released new alcohol guidelines this year, stating that no amount of alcohol is safe and recommending no more than two drinks per week.
US guidelines suggest drinking no more than one drink per day for women or two per day for men. Some researchers would like to see the guidelines revised to only suggest one drink a day to anyone.
Kerr cautions, however, that many Americans may balk at a daily drink limit.
“Some people just don’t see it as alcohol,” he said.
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