Alcohol — how much should we drink?
For many years there has been this ongoing debate in society regarding the potential health detriments, along with the possible health benefits, of consuming alcohol. Much of the evidence points to a J shaped curve suggesting 1–2 standard drinks per day may even confer some health benefit, compared with those people who are teetotallers.
The argument given by those people opposed to any alcohol consumption is that often the non-drinkers in society were previous heavy drinkers or even alcoholics and the prior damage caused to their body from alcohol made the non-drinking group look sicker than they otherwise would have been because of the prior drinkers being included.
There is no dispute that consuming consistently more than 3 standard alcoholic drinks on a daily basis is associated with a number of health detriments and in particular alcohol-related liver disease, varying forms of cerebral degeneration, along with atrial fibrillation and even dilated cardiomyopathy. There is also a strong link to peripheral neuropathy and many cancers.
A recent extensive trial published in the Lancet looked at just under 600,000 people from 19 developed countries around the world with records often dating back to 1964. There were 11,000 Australians in this trial.
The key findings here related to the consumption of standard drinks over a week. So we can be clear about what is a standard drink, 375 mls of full strength beer (4.8% alcohol) is equivalent to 1.4 standard drinks. 150 mls of wine (13.5% alcohol) is equivalent to 1.5 standard drinks. 30 mls of spirits (40% alcohol) is the equivalent of 0.95 standard drinks.
The lowest death rates in the study were in people who consumed less than 10 standard drinks per week. 10–20 standard drinks per week reduced life expectancy by 6 months. Greater than 35 standard drinks per week reduced life expectancy by 4–5 years. It was found that having 14 cans of beer per week (1–2 per day, not all on the same day!) increased death risk by around 5%, whereas greater than 21 cans of beer per week (3 per day) increased death risk by 20%.
Although I believe it is highly irresponsible for any doctor to encourage people to drink, I also believe it is important to have a more global view of the science. The vast majority of studies looking at alcohol consumption come from non-Mediterranean Europe, America and Australia. The problem here is that there is no separation between alcohol consumption and, often, poor dietary habits. For example, if you examine the standard American diet and add alcohol there are certainly no benefits and now with this new information probably significant detriments. But, studies performed in the more affluent Boston area known as the Male Physicians’ trial showed that one standard glass of red wine per day reduced sudden cardiac death by 80%. Probably even more compelling is all of the data from Mediterranean countries showing the low-dose consumption of alcohol (on average 2 standard drinks typically of red wine per day) is associated with a 50% reduction in heart disease and cancer.
Data, again from Boston, this time from the Nurses’ Health study, a 30 year study from Harvard University has shown that women who consume 1–2 glasses of wine per day may increase their breast cancer risk but taking a daily Multivitamin negates this risk if the vitamin is consumed for 15 years or more.
Thus, although I am not suggesting alcohol is a health tonic, low-dose consumption may offer some health benefits only if combined with healthy eating. This new data, although compelling and should not be ignored, should be put into perspective. As with most suggestions, moderation in all things.
