Monday, July 3, 2023

Alcohol and health - the last word?

Tons of ink have been spilled on the health effects, good and bad, of alcohol consumption. Beneficial effects on the heart were discussed in the 1990’s based on “the French paradox.” A paper published in 1995 noted that there was less ischemic heart disease in France compared to the U.S. despite the fact that saturated fat intakes and prevalence of smoking were higher.

The relative immunity of the French to ischemic heart disease was attributed to their high alcohol consumption and to their intake of antioxidant vitamins, both supplied by wine. The custom of drinking wine with the meal was thought to confer protection against some of the adverse effects of the food. Resveratrol, a chemical found in grape skins, was thought to be a major factor and for a while many pharmaceutical firms investigated using it.

At the same time, the adverse effects of alcohol are numerous: liver disease, traffic accidents, gout and many cancers are all higher in heavy drinkers. A recent study from China showed that there was a higher incidence of 61 diseases among males who regularly drank alcohol.

What is the truth?

A study published this spring in JAMA Network Open looked at 107 studies of the relationship between alcohol consumption and mortality. They compared non-drinkers, light drinkers (1-2 drinks/day for men, 1/day for women), moderate drinkers (3-4/day) and heavy drinkers (5 or more drinks/day). Note that a “standard drink” is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of hard liquor.

Compared to lifetime non-drinkers, occasional or light drinkers had a similar mortality while moderate drinkers had a modestly (5%) higher mortality and heavy drinkers had a 22% higher mortality rate. With very heavy drinkers a whopping 35% higher death rate was found.

Notably, women who drank any quantity of alcohol had a 20% higher mortality than female lifetime non-drinkers. (Women absorb and metabolize alcohol differently than men. In general, women have less body water than men of similar body weight, so that women reach higher concentrations of alcohol in the blood after drinking equivalent amounts of alcohol.)

What are my take-aways from this study? Do not drink because it is “heart healthy.” There is no amount of alcohol that reduces your mortality. If you enjoy a beer or a glass of wine with dinner, you can stick with it - you may be trading fewer heart attacks for more liver disease but the overall effect is neutral. If you drink heavily, please cut down. The life you save will be your own.

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