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Alcohol consumption and health

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The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity, in which he reported his finding that drinking alcohol in moderation was associated with greater longevity than either abstaining or drinking heavily.Pearl, Raymond. Alcohol and Longevity. NY: Knopf, 1926. Subsequently, various studies have examined the health effects of different degrees of alcoholic beverage consumption (Blackwelder, W. C., et al. Alcohol and mortality. The Honolulu Heart Study. American Journal of Medicine, 1980, 68(2), 164-169., Ellison, Hennekens, Rimm et al., Rogers, Trevisan et al.). While it is widely recognized that alcoholism has negative health effects, moderate consumption, frequently defined as the consumption of 1-4 alcoholic drinks in a day (depending on the age and gender of the subjects) has been found in some research to have a positive effect on longevity (Camargo et al., Yuan et al., Coate, Doll & Peto, Klatsky). See Alcoholic beverages — recommended maximum intake for a list of governments' guidances on alcohol intake which, for a man, range from 168–280g per week.

A number of independent peer-reviewed studies in modern medical literature support the finding that moderate alcohol consumption is associated with benefits in longevity because of reductions in coronary heart disease, stroke, and some other diseases (Dairdron et al.; Ely & Berne; Facchini et al.; Langer et al.; Mennen et al,; Paassilta et al.; Rimm et al.; Thun et al,; Wang & Barker; Zhang et al.). Proposed mechanisms of these benefits include the effect of alcohol on cholesterol levels, insulin activity, blood pressure, and the chemistry of blood clotting. Frequently, such studies qualify these findings with admonitions against heavy alcohol consumption or abuse, due to the negative health effects often associated with this behavior.

However, latest major researches suggest that benefits of alcohol are either too small or overweighed by negative effects that alcohol conspumtion should not be recommended for anyone. Still, moderate usage does not cause significant health risk BBC [Alcohol's health benefits doubted] [2]

Contents

Background

Research extending back as far as 1926 has demonstrated that drinking in moderation is associated with greater longevity than is either abstaining or abusing alcohol.[#endnote_Pearl]

One possible explanation is the effect of alcohol on cardiovascular disease, the leading cause of mortality in the United States and many other industrialized countries. This has been studied since 1904 (Cabot).

Physiological effects of ethanol

Medical research demonstrates that, consumed in moderation, alcohol increases HDL (“good cholesterol”), decreases thrombosis (blood clotting), reduces fibrinogen (a blood clotter), increases fibrinolysis (clot dissolving), reduces artery spasm from stress, increases coronary blood flow and increases insulin sensitivity -- all good for heart health (Mennin; Passsilta; Rimm; Zhang).

Alcohol production in the body

It is inevitable that all humans always have some amount of alcohol in their bodies at all times, even if they never drink alcoholic beverages in their lives. This is because of a process called endogenous ethanol production. Many of the bacteria in the intestines use alcohol fermentation as a form of respiration. This metabolic method produces alcohol as a waste product, in the same way that metabolism results in the formation of carbon dioxide and water. Thus, human bodies always contain some quantity of alcohol produced by these benign bacteria.

Medical research

Alcohol consumption and longevity

The U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) has completed an extensive review of current scientific knowledge about the health effects of moderate alcohol consumption. It found that the lowest death rate from all causes occurs at the level of one to two drinks per day. That is, moderate drinkers have the greatest longevity.[link]

Research in various countries has found the all-cause risk of death to range from 20 to 28% lower among moderate drinkers than among abstainers (Boffetta et al., Camargo et al., Coate, Fuchs et al., Klatsky et al., 1981, Yuan).

The medical studies establishing this relationship are large (some include over 200,000 people), cross-cultural (have been conducted in countries around the world), and are sometimes long-term (the longest beginning in 1948 and continuing to this day).[link]

To test the hypothesis that the results may reflect the poor health of alcoholics who now abstain, some studies have restricted the abstainers studied to lifelong teetotalers. Others have controlled for lifestyle factors, income levels, educational levels and other factors. The results have remained the same: moderate drinkers tend to live longer than abstainers or heavy drinkers (Klatsky et al., 1990)

Doll et al. (2005) published the results of a 23-year prospective study of 12,000 male British physicians aged 48-78, finding that overall mortality was significantly lower in the group consuming an average of 2–3 "units" (unit = 8g) per day than in the non-alcohol-drinking group (relative risk 0.81, confidence interval 0.76-0.87, P = 0.001).[#endnote_Doll] The authors noted that the causes of death that are already known to be augmentable by alcohol accounted for only 5% of the deaths (1% liver disease, 2% cancer of the mouth, pharynx, larynx, or oesophagus, and 2% external causes of death) and were significantly elevated only among men consuming >2 units/day.

In a 1996 American Heart Association scientific statement, Thomas A. Pearson, MD, Ph.D noted, "A large number of observational studies have consistently demonstrated a U-shaped relation between alcohol consumption and total mortality. This relation appears to hold in men and women who are middle aged or older. The lowest mortality occurs in those who consume one or two drinks per day. In teetotalers or occasional drinkers, the rates are higher than in those consuming one or two drinks per day. In persons who consume three or more drinks per day, total mortality climbs rapidly with increasing numbers of drinks per day."[#endnote_Pearson]

Alcohol consumption and heart disease

The Director of the National Institute on Alcohol Abuse and Alcoholism has written that "numerous well-designed studies have concluded that moderate drinking is associated with improved cardiovascular health," [link] and the Nutrition Committee of the American Heart Association reports that "the lowest mortality occurs in those who consume one or two drinks per day." [link]

The World Health Organization Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease could no longer be doubted. (Wilkie, S. Global overview of drinking recommendations and guidelines. AIM Digest, Supplement, June 1997, 2-4, p. 4). Consumption of red wine may be particularly favourable, since red wines contain certain polyphenol antioxidants associated with cardiovascular health.

In the above-noted AHA statement, Pearson reviewed the evidence supporting the effect of alcohol consumption on coronary heart disease (CHD): "More than a dozen prospective studies have demonstrated a consistent, strong, dose-response relation between increasing alcohol consumption and decreasing incidence of CHD. The data are similar in men and women in a number of different geographic and ethnic groups. Consumption of one or two drinks per day is associated with a reduction in risk of approximately 30% to 50%. Studies of coronary narrowings defined by cardiac catheterization or autopsy show a reduction in atherosclerosis in persons who consume moderate amounts of alcohol. In general, the inverse association is independent of potential confounders, such as diet and cigarette smoking. Concerns that the association could be an artifact due to cessation of alcohol consumption in persons who already have CHD have largely been disproved."[#endnote_Pearson]

Alcohol consumption and stroke

Compared to abstaining, drinking in moderation is associated with a reduced risk of stroke, whereas abusing alcohol is associated with an increased in risk of stroke.

Berger et al.,(1999) in a study of over 22,000 male physicians aged 40-84 years old over an average of 12 years, concluded, "Light-to-moderate alcohol consumption reduces the overall risk of stroke and the risk of ischemic stroke in men. The benefit is apparent with as little as one drink per week. Greater consumption, up to one drink per day, does not increase the observed benefit." [#endnote_Berger]

A 2003 meta-analysis by Reynolds et al. of 35 previous studies of the effect of alcohol consumption on stroke risk found that "compared with abstainers, consumption of more than 60 g of alcohol per day (i.e., over four standard drinks -- heavy drinking) was associated with an increased relative risk of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20), while consumption of less than 12 g/d was associated with a reduced relative risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80 (95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression analysis revealed a significant nonlinear relationship between alcohol consumption and total and ischemic stroke and a linear relationship between alcohol consumption and hemorrhagic stroke."[#endnote_Reynolds]

Alcohol and cancer

The U.S. Department of Health & Human Services’ National Toxicology Program listed alcohol as a known carcinogen in 2000.

However, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that "Although there is no evidence that alcohol itself is a carcinogen, alcohol may act as a cocarcinogen by enhancing the carcinogenic effects of other chemicals. For example, studies indicate that alcohol enhances tobacco's ability to stimulate tumor formation in rats (Garro & Lieber). In humans, the risk for mouth, tracheal, and esophageal cancer is 35 times greater for people who both smoke and drink than for people who neither smoke nor drink (Blot et al.), implying a cocarcinogenic interaction between alcohol and tobacco-related carcinogens (Garro & Lieber)." [link]

The NIAAA emphasizes that "Although epidemiologic studies have found a clear association between alcohol consumption and development of certain types of cancer, study findings are often inconsistent and may vary by country and by type of cancer." [link]

Some studies find that drinking in moderation significantly reduces the risk of some malignant tumors such as kidney cancer (Rashidkhani et al.), thyroid cancer in women (Rosing et al.) and non-Hodgkins lymphoma. A review of findings from nine international studies found that drinking of alcohol reduces the risk of non-Hodgkin’s lymphoma by 27%, report scientists at the National Cancer Institute. The cancer is the sixth most common in the United States. Beer, wine and liquor were found to be equally effective in protecting against the disease (Morton et al.)

Chronic heavy abuse of alcohol increases risk. "Considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol (Rothman)" indicates the NIAAA. [link]

Drinking alcohol, especially along with smoking, increases the risk of cancers of the mouth, esophagus, pharynx, larynx and liver in men, and of breast cancer in women, according to the National Cancer Institute. Fortunately, except for breast cancer, these cancers are all rare (NIAAA). Moderate consumption doesn’t significantly increase the risk of the most common cancers, except for breast cancer. Also fortunately, an exhaustive review of the research evidence has found that women who drink alcohol and have a high folate intake have no more risk of breast cancer than those who abstain from alcohol[link] [link][link]

Alcohol consumption and other diseases

Issues

Health effect and type of alcohol consumed

In "Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits?" (BMJ 1996;312:731-736 (23 March)) Eric B. Rimm et al. concluded that "results from observational studies where alcohol consumption can be linked directly to an individual's risk of coronary heart disease, provide strong evidence that all alcoholic drinks are linked with lower risk. Thus, a substantial portion of the benefit is from alcohol rather than other components of each type of drink."[#endnote_Rimm]

Well known medical authority Dr. Dean Edell explains that there are “differences of opinion about whether beer, wine, or liquor offers the quickest route to a longer life. Of ten major studies, one-third found this true for wine, one-third for beer, and one-third for liquor. Most researchers now believe that it is the alcohol in all of them that provides the magic, but they don’t rule out other components of alcoholic beverages” (Edell).

One study (Cordova)suggests that red wine, particularly from areas of cold climate, seems to offer increased cardio-vascular protection and speculates without evidence that the effect results from polyphenols, chemical components contained in grape skin. Some speculate that it is by far more beneficial to drink grape juice than any type of alcoholic beverage. This speculation is inconsistent with the vast body of medical research evidence on the subject.

Recommending alcohol consumption to \"teetotalers\"

Recommendation to an abstainer to become a moderate drinker is controversial because of the health hazards of alcohol abuse, the fear that the information will be abused by heavy drinkers seeking a justification for their behavior.

"Given that there is a vast panoply of very effective and under-used cardiovascular drugs and that the beneficial effects of alcohol are small and ill-understood, all those present at the Novartis Foundation meeting concurred that global recommendations such as '1-3 drinks per day are good for you' are not only meaningless but also irresponsible." Sara Abdulla [Is alcohol really good for you?] Journal of the Royal Society of Medicine December 1997 Volume 90 Number 12 ISSN 0141-0768

Comparison with health benefits of exercise and diet

Some of the benefits of moderate drinking could be obtained from having a low-fat diet, exercising regularly (for heart health), and eliminating excess salt from the diet. On the other hand, Dr. Eric Rimm of Harvard reports that people have increases of 10 to 30 percent in HDL in a week from drinking alcohol. He says that “nothing else in the diet can have such a dramatic impact on HDL in such a short time” (Underwood).

Drinking alcohol in moderation can have a greater impact on reducing heart disease than any other factor than the cessation of smoking. And both drinking in moderation and not smoking contribute to the effectiveness of other lifestyle improvements (Ellison, 1998).

See also

Notes

References

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