Americans who drink alcohol have endured years of dubious studies, some telling them moderate drinking might help them, others saying it will definitely hurt them.
So is drinking something at dinner good or bad for our health? After a series of large meta-studies, the latest published in March, science is getting closer to a definitive answer: yes.
Moderate drinking increases the chances, very slightly but definitely, that the drinker will contract any of a number of diseases or die a violent death.
Modest alcohol consumption may also confer modest health benefits, especially for the heart, and especially among older people, who face a higher risk of heart disease.
On the second point, the scientific community remains divided.
“If you’re over 50 or 60 and enjoy a drink or two a day, I don’t think you need to worry. I don’t think you need to feel guilty about it,” said Emmanuela Gakidou, a professor of metric health sciences at the University of Washington.
Gakidou was the senior author of a massive 2018 study, co-written by more than 500 researchers and published in the Lancet, that explored more than a thousand previous studies and data sets on alcohol.
The study found that, with one drink a day, a drinker’s risk of developing one of 23 health problems increased by 0.5 percent. With two drinks a day, the risk increased by 7%.
These are minimal risks. Still, the study produced headlines like “The safest level of alcohol consumption is none.”
Given what scientists now know, this statement is technically true. Some of the health risks that accompany even moderate consumption are well documented.
“Everything related to violence and accidents increases with alcohol use,” Gakidou said, including drunk driving, domestic accidents and suicide. Moderate consumption increases the risk of cancer, although not by much.
But alcohol can also confer benefits. Many studies have suggested that moderate drinking 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 there,” Gakidou said. But if you imagine all the studies as points plotted on a graph, “the point cloud is mostly on the protective side, rather than the harmful side.”
Not too many years ago, scientists and civilians believed that moderate consumption had health benefits. Such positive thinking may have peaked in a 1991 episode of the CBS newsmagazine 60 Minutes, which posited the idea that red wine improves heart health. Wine sales soared.
As it turned out, the science behind those studies was flawed.
Yes, studies have found that people who drank red wine lived longer than people who didn’t. But those wine drinkers enjoyed all sorts of other healthy Indigenous habits and advantages: income and education, balanced diets, healthy weights, a passion for exercise, and superior health care.
Many non-drinkers, by contrast, didn’t drink for a reason: they were already ill, had disabilities, or suffered from alcoholism.
“As time goes on, things get worse,” said Canadian Institute for Substance Use Research scientist Tim Stockwell. As study subjects age, the abstainer category “is filling up with people who have stopped drinking because they had health problems.”
Thus, when researchers compared the health of drinkers and non-drinkers, the drinkers often came out ahead.
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 such biases. The review found that the health risks started when the women drank 25 grams of alcohol a day, less than two drinks. The risks were increased for men who drank 45 grams of alcohol a day, just over three drinks.
All risks are relative, and the risks a drinker takes by cracking a beer aren’t great. On average, an adult who drinks six glasses a week will die two to three months before a teetotaler.
“It’s a low risk, but it’s a significant 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 happily trade a few months of life for a glass of wine with dinner every night.
The big studies have sparked visceral reactions from both sides, from drinkers and non-drinkers alike. Some readers have felt cheated by decades of studies suggesting that moderate drinking was undoubtedly good for you. Others felt that science and press coverage greatly inflated the dangers.
“Given the pleasure presumably associated with moderate drinking, stating that there is no ‘safe’ level does not seem like an argument for abstention,” said a British statistician of the 2018 study. “There is no level of safe driving, but the government advises people not to drive.”
The anger likely stemmed more from the alarmist headlines than from the studies themselves, which presented their findings in medical journal jargon.
“You measure a risk and announce that 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 from my culture, in Greece, if you tell them not to drink, you’re not very popular,” he said. “I think people all over the world want confirmation that their approach to drinking is the healthy one.”
Nearly all adults drink in Denmark, according to the 2018 meta-study, while the average Portuguese man has seven drinks a day. The average life expectancy is 82 years in Denmark and 81 years in Portugal, about a decade higher than the global average of 72 years, data that illustrate the complexity of studying alcohol.
A great unknown, and a glimmer of hope for drinkers, is the relationship between alcohol and heart attacks and strokes.
The only way to show whether drinking increases or decreases these risks is to run 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 drinking and, say, vehicular death. And demonstrating the long-term effects of alcohol, by definition, requires long-term study.
“You really need years,” said William Kerr, senior scientist at the nonprofit Alcohol Research Group. “And it gets hard for people to stay on the show.”
Yet, in the last decade, the National Institutes of Health has launched just such a study, providing $100 million to scientists to confirm or deny that alcohol can be part of a healthy diet.
And then, in 2018, the studio was shut down. A New York Times investigation found that much of the funding came from the alcohol industry, hardly an impartial party.
And so the potential health benefits of modest alcohol consumption remain a mystery, while the modest health risks have gained wide acceptance.
Canada released new alcohol guidelines this year, advising that no amount of alcohol is safe and recommending no more than two drinks per week.
US guidelines suggest no more than one drink per day for women or two per day for men. Some researchers would like the guidelines to be revised to suggest no more than one drink a day for anyone.
Kerr cautions, however, that many Americans may balk at a daily drink limit.
“Some people just don’t see it as drinking,” she said.
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