Alcohol: Abstinence over moderation

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“Drink alcohol in moderation” has long been the recommendation coming out of health organizations and doctors’ offices. To be more specific, we have been told that men should not exceed more than 2 drinks per day (~196 g per week) and women should not exceed 1 drink per day (98 g per week) (1). However the conclusions coming out of recent scientific reports are a total game-changer. The evidence is mounting which make it absolutely challenging for any reasonable doctor or health organization to continue to recommend current alcohol guidelines. Below we will explore the conclusions coming out of these recent studies and demonstrate that the time may have come not just to lower the recommendations, but bring it down to zero. Abstinence is the call of the hour.


 
Let’s begin with some stunning statements made by the researchers of a recent paper:

“The level of alcohol consumption that minimized harm across health outcomes was zero standard drinks per week.” (2)

 

“Alcohol is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimized health loss is zero.” (2) 


You read that correctly. The scientists say that the alcohol level associated with the lowest risk of harm to health is zero. Not one drink per day, half a drink per day or even a quarter; it is zero.

This is from a scientific paper published on August 23, 2018, in the journal: The Lancet, which made major headlines in the media. In fact, the headline from the BBC article on this paper read: “No alcohol safe to drink, global study confirms” (3). That is a radical yet non-exaggerated title; this is exactly what the researchers found. The scientists found that alcohol was:

  • The seventh leading risk factor for both death and years of life that is lost due to disability 

  • Among young to middle aged adults (15 to 49 years of age), alcohol was the leading risk factor for death, globally. 

  • For those above 50 years of age, cancer was the leading cause of death due to alcohol consumption being associated with 27.1% of all female cancer deaths and 18.9% of male cancer deaths. 

  • Alcohol was only associated with a lower risk of death for diabetes and ischemic heart disease. 

  • And the safest level of alcohol consumption was zero.


But how about the heart?


Aren’t there studies showing that alcohol is good for the heart? Should not that be taken into consideration? Well, the researchers did factor that in, and this is what they found: 

“In estimating the weighted relative risk curve, we found that consuming zero standard drinks daily minimised the overall risk of all health loss. The risk rose monotonically with increasing amounts of daily drinking. This weighted relative risk curve took into account the protective effects of alcohol use associated with ischemic heart disease and diabetes in females. However, these protective effects were offset by the risks associated with cancers, which increased monotonically with consumption.” (2)


Could the researchers be any more clearer? Even when factoring in the heart benefits, it did not change the outcome. The level that lead to the lowest risk is zero. 

In another study released earlier this year (2018), researchers found that alcohol consumption was actually associated with increased risk of death for various heart and vascular diseases including: stroke, fatal hypertensive disease, fatal aortic aneurysm, coronary disease and heart failure by up to 15 and 24% in some cases (2). Alcohol was only associated with a lowered risk of death for heart attack (6% lower risk) (2). And the sad thing is that the lowest risk of death was found at levels lower than 100 g per week, which is well below the current recommended guidelines.


Why is alcohol so detrimental?


What might be surprising for many readers is how powerfully alcohol is associated with cancer. This is because the conversation is always dominated by alcohol’s benefits on the heart. But the alcohol-cancer relationship is actually an already well-documented association. Alcohol consumption is associated with increased risk of various cancers such as those of the: oral cavity, pharynx, esophagus, colon, liver, larynx and female breast (4, 5). And this is not surprising since alcohol is a group 1 carcinogen; meaning: it causes cancer. In fact, the International Agency for Research on Cancer (IARC), a division of the World Health Organization, lists the “Ethanol in alcoholic beverages” and the “Acetaldehyde associated with consumption of alcoholic beverages,” as group 1 carcinogens (6). “Carcinogen” means cancer-causing. Group 1 carcinogens are those that the IARC is absolutely certain causes cancer. Alcohol is in that group along with such substances as asbestos, benzopyrene, coal-tar pitch, Epstein-barr virus, hepatitis B and C viruses, human papilloma-virus types 16, 18, PCB and formaldehyde. 

 

The form does not matter either. As one paper reports: 

“All alcoholic drinks (beer, wine, rice wine, sake, spirits or licquors) have similar effects on cancer risk, the total amount of ethanol consumed is the factor determining risk.” (7)

 

How does alcohol cause cancer? Though there is still much to discover in this area, scientists have several explanations. For example, the acetaldehyde in alcoholic beverages may result in DNA damage (8). Alcohol may disrupt estrogen metabolism which may explain the strong link between alcohol and breast cancer in women (8). Other potential mechanisms include production of reactive oxygen species, changes folate metabolism, and suppression of the immune system. 

 

So the next time you are told or want to recommend alcohol because it is “beneficial for the heart,” it is worth taking a pause and asking yourself: “But how about cancer?”

 


Conclusion: Abstinence, not moderation


So what conclusions can be drawn from previous studies and current ones?

  • The phrase “alcohol is good for the heart” needs some serious qualifiers. Without qualifiers, it is a misleading and over-generalized statement with potentially harmful repercussions.

  • Alcohol is strongly associated with cancer. It is a carcinogen.

  • The amount that is associated with the least health harm is: not moderation, but zero.


We need to be honest with ourselves. If there was any other substance: food, drink, herb, supplement or otherwise, with the health profile as alcohol, it would be vilified. To recommend such a substance, even in moderation, would be considered absolutely unethical. But for some reason alcohol keeps on getting a pass. If there was ever a time when that needs to stop, the time has truly come. Alcohol is not a health-promoting substance, rather it is a health-endangering substance that is better kept completely out of one’s lifestyle.


We need to also stop recommending alcohol for heart health. Why exchange a slightly lowered risk for heart attack death in exchange for increased risk of other heart diseases and cancer? Do we really believe that in order for the public to achieve a small increased benefit for heart health, it is worth increasing their risk of cancer at the same time? Not to mention all the other potential social and emotional issues that are associated with alcohol use? There are so many superior, more wholesome ways to promote heart health such as a whole-foods, plant-based diet combined with moderate intensity physical activity. We need a renewed perspective with regard to this matter.


It is high-time for medical and health professionals to completely shift our recommendations to patients and give them the truth: Alcohol is detrimental to health, and the most responsible recommendation to give is not moderation, it is abstinence.  



References

  1. Wood A et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. The Lancet. Vol 391, Iss 10129, P 1513 – 1323, April 14, 2018


  2. GBD 2016 Alcohol collaborators. Alcohol use and burden for 196 countries and territories, 1990 – 2016: a systematic analysis for the Global Burden of Disease study 2016. The Lancet. August 23, 2018. 


  3.  Ives, L. No alcohol safe to drink, global study confirms. Online at: https://www.bbc.com/news/health-45283401


  4.   Bagnardi V & Rota M et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. British Journal of Cancer (2015) 112, 530 – 593


  5. Rehm J & Shield K et al. Alcohol Consumption. International Agency for Research on Cancer 


  6. Agents Classified by the IARC Monographs, Volumes 1 – 122. https://monographs.iarc.fr/wp-content/uploads/2018/07/ClassificationsAlphaOrder.pdf


  7.  Weiderpass, E. Lifestyle and Cancer Risk. Journal of Preventive Medicine and Public Health. November 2010, Vol. 43, No. 6. 459 – 471


  8. Praud, D & Rota M et al. Cancer incidence and mortality attributable to alcohol consumption. International Journal of Cancer. 138. 1380 – 1387 (2016). 

 

George Cho