The Sober Truth About Moderate Drinking
New research has found that alcohol can reduce the risk of heart attacks and strokes. Some experts are sceptical, they tell Helen Rumbelow
We have the right to make informed choices that dramatically affect our health.
Surely understanding what we’re consuming and the health risks is more important than knowing what a Oxbow Lake is ?
The UK Government needs to ensure transparent labelling is mandatory on all foods and drinks.
Make misleading labelling illegal.
Helen Rumbelow Wednesday June 14 2023, 12.01am, The Times
When Joan Collins was asked about her drinking — she was once the advertising face of Cinzano — she replied that she had cut down to one glass of wine or a martini with dinner and, at 88, bemoaned that “practically everyone I know doesn’t drink any more. It’s a dying art.” Drinking is a dying art in both senses: rates are falling among the young as successive scientific studies confirm that even the smallest amount of alcohol is a grease for the slippery slope to an early death.
I know people don’t want to hear it, I know people will cite their whisky-pickled granny, or if no granny then the Queen Mother, who tippled on Dubonnet into her triple-figured old age. But never has government advice been so at odds with the best and latest research on reducing risk than with alcohol. The NHS advises a limit of 14 units of alcohol a week for both men and women (which, given the average size discrepancy between sexes, gives an indication of how accurate it is). However, earlier this year Canada took into account the declaration by the World Health Organisation in January that “there is no safe alcohol consumption” and scrapped its guidance, which had been in line with the UK’s, replacing it with something very much more puritan: no more than two drinks a week, and ideally quit alcohol altogether.
British culture is drenched in alcohol, whether it’s the pub boozers, the wine o’clock cork poppers or the summer picnickers marinated in Pimm’s. Should we be encouraged by new research that shows moderate alcohol consumption could reduce the risk of heart attacks and strokes? In a study published in the Journal of American College of Cardiology, those who had 1 to 14 drinks a week were less likely to have a cardiovascular event than those who had none, perhaps because it reduced their stress. This belongs to a slew of similar studies that seem to support the “a little of what you fancy does you good” wishful thinkers. Unfortunately, the consensus among the foremost researchers into alcohol and health is that this impression is entirely misleading.
Ian Gilmore is a professor of medicine at the University of Liverpool, the chairman of the Alcohol Health Alliance, which aims to reduce the preventable deaths caused by drinking, and until recently the director of the Liverpool Centre for Alcohol Research.
“It’s a story that everybody likes to hear, alcohol being good for the heart,” he says. “It plays into that paradigm of ‘moderation in all things’. I’m not a campaigner for abstinence and I don’t want to be seen as a killjoy, but I’m afraid the starting point is not true: that a little bit of alcohol is good for the heart.”
He explains that the health effects of alcohol have a long history of confusion: teetotallers are often already poorer and more ill than social drinkers, and moderate drinkers tend to adopt healthier lifestyles in other ways, which means that the harms of alcohol have been underestimated. However, in recent years scientists have cracked this problem with a technique called “Mendelian randomisation”, which eliminates the muddying effect. “It’s now the gold standard,” Gilmore says, and it has recently produced alcohol studies of the greatest accuracy.
“The best is the UK Biobank study, with 370,000 patients, that reported in 2021,” he says. “Any level of alcohol consumption did increase the risk of heart disease. The risks weren’t linear, they were exponential. So a little bit of drinking didn’t increase your risk of heart disease very much. But if you drank heavily, it really zoomed up the curve.
“That adds to what has become very clear in the last five to ten years, that even with a small intake of alcohol your cancer risk goes up.”
For example, one study in 2019 found a woman getting through one bottle of wine per week increases her cancer risk to the same extent as smoking ten cigarettes a week.
Another persistent myth is that of the medicinal effects of red wine. “I don’t think there is any convincing evidence,” Gilmore says. Should those who know or suspect they have a genetic risk for cancer or heart disease take special care?
“Genotyping has yet to get to the sophistication that we can get our gene profile and then modify our lifestyle. But that will probably come.”
The NHS guidelines were produced by a working party of the Royal College of Physicians in 1987. Richard Smith, a member of that group, later confessed that they had guessed at the numbers, which at that point were set at a recommended limit of 21 units for men and 14 for women. Smith said that their expert epidemiologist told them the data on what was safe was at that point weak, making an evidence-based limit impossible, “so those limits were really plucked out of the air”.
Gilmore was on the group that in 2016 reduced those NHS limits on alcohol to 14 units a week for everyone. Does that now seem too high?
“In rough terms the recommended limit of 1 to 14 units per week equates to keeping the risk of dying of an alcohol-related disease to about one in a hundred. One in a hundred is not a risk people would accept if it was something in your toothpaste, but by and large people do for something like alcohol that’s seen as good fun and a social benefit.”
If he was in the same group advising the NHS limits now, what would he say?
“It could be that they are a little out of date, given the latest research. I’d certainly argue for a fresh look at it. It is interesting that we always think about harm in the heaviest drinkers, the dependent drinkers. But if you think of the distribution curve of consumption, the majority of harm is actually in those drinking at lower levels, because there are more of them. If we could shift the whole curve down, we could save thousands of lives and make a huge impact on the cost of alcohol to the NHS.”
Iona Millwood is a senior epidemiologist at Oxford Population Health, a department of Oxford University. She is a lead author on one of their biggest projects, a study of half a million Chinese people. Their findings on alcohol were published last week, and confirmed that alcohol was not only a risk in the diseases already known about, but also in many others too, such as cataracts, adding up to a list of more than 60 diseases. It used the Mendelian randomisation, which, Millwood says, means it is more robust than most alcohol studies.
“When we do this, we can tease out the causal effects of drinking, compared with things that drinking is correlated with,” Millwood says. “We’ve done this now for stroke, and a whole range of other diseases, and we don’t see any causal protective effects of alcohol.”
Are the NHS guidelines too high?
“I can’t comment on that,” Millwood says. “But the evidence is increasing that alcohol is associated with a wide range of harms, and the more you drink, the more harms there are. In our Chinese study, using genetic methods, we don’t see any protective effects of moderate drinking.”
Both Millwood and Gilmore independently raise the issue of “informed choice”. People need to know the facts and then decide, Millwood says. Drinking alcohol is one of a range of health risks like, say, eating a bacon sandwich or going skydiving. Don’t kid yourself it’s in any way healthy, but if it makes you gloriously happy it may well be worth it.
“If you never got out of bed, you would avoid a lot of risks in life, but you might get a deep vein thrombosis from lying so long,” Gilmore says. “As chair of the Alcohol Health Alliance, we’re not campaigning for total abstinence. We’re campaigning for the people to have the right to know. For example, with labelling there’s more information on a bottle of milk than there is on a bottle of wine.”
Though Joan Collins may have had a slightly less fabulous life if her bar order had been limited to milk.