Diet Debate: Is it time to rethink safe alcohol limits?

It’s commonly accepted that moderate alcohol consumption is not only innocuous, but potentially beneficial to one’s health and longevity.

That is to say that having 1-2 drinks, 3-4 days per week, isn’t going to have negative effects on your health, and may even provide some benefits.

A “new study”, published last month in The Lancet, however, is calling this advice into question, and claiming that in fact there is no health benefit to moderate alcohol consumption, and that many countries should review their safe upper limits.

It’s been 8 years since I last looked into the health effects of alcohol consumption – is it about time I updated my views in light of new evidence?

New Evidence for Dangers of Moderate Drinking?

After the publication of the new meta-analysis in April, there were unsurprisingly the usual alarmist headlines such as:

Extra glass of wine a day ‘will shorten your life by 30 minutes’ – The Guardian (With subtitle “Drinking is as Harmful as Smoking”!).

Even One Drink A Day May Pose Health Risk, Study Finds – Forbes

So what new evidence has turned up in the last 8 years to turn that glass of wine per day from elixir of life to poisoned chalice?

A “New Look” at Old Data

First up, let’s be clear, this isn’t a “New Study”, but rather a “Meta-Analysis” of 83 different “prospective epidemiological studies”.

While there is undoubtedly now more data than when I last looked into the topic 8 years ago, the new “findings” are not down to new or different data, but due to a different way of analysing and interpreting the data.

Indeed, if you look at the conclusions of the individual studies that the meta-analysis looked at, you’ll actually find that they generally found correlations between moderate drinking and reduced risk of heart disease and all cause mortality, the exact opposite to the new analysis – But how can this be?

There’s Something Wrong with Non-Drinkers…

Europeans and Americans like to drink booze.

If you don’t, conclude the authors of this latest meta-analysis at least, there must be something wrong with you!

The data shows that (EU and US) people who don’t drink at all have higher risks of cardiovascular disease and all cause mortality.

What the data can’t tell us, unfortunately, is whether the apparent health benefits of moderate alcohol consumption are real, or if in fact the abstainers do so because of pre-existing health conditions which are also the cause of their shorter lifespans.

This problem of the “sick quitter” has long been a topic of debate – indeed, I covered it at length in my original post on alcohol consumption 8 years ago.

Based on these impossible to control for confounding factors, the authors of the new Lancet study chose to exclude the data from non-drinkers, and just analyse the data from “current drinkers” – i.e. only include individuals that drink at least a small amount of alcohol on a regular basis.

Too Much Alcohol is Still Bad for You

Using the new analysis, the data showed that the lowest consumers, those who drank 100g of alcohol per week or less (around 5 drinks per week), had the lowest risk of heart disease and all cause mortality.

For the most part, as alcohol consumption increased, health and longevity decreased.

The researchers then extrapolated from these findings, that if more alcohol is bad, then less alcohol must be good, therefore very little or no alcohol must be best.

One can imagine a graph with data points for 100g, 200g, 300g per week of alcohol per week against all-cause mortality and cardiovascular disease, and the researchers joining the dots between the data points, and then continuing the line down towards zero drinks and super low risk. Seems sensible?

But you don’t have to imagine any graphs, as we have the actual graphs from the study here:

Now call me crazy or contrarian, or perhaps I’m just too blinded by confirmation bias due to my love of a fine ale, wine or whiskey, but neither of these graphs particularly convinces me that total abstinence from alcohol looks likely to pay huge dividends.

On the contrary, cardiovascular disease risk actually decreases as alcohol consumption increases up to 100g.

Heavy Drinkers Probably Have Issues Too

While I agree that there could well be confounding factors that contribute to the reduced life expectancies of non-drinkers, one can’t discount the possibility that there could just as easily be confounding factors that contribute to the reduced life expectancies of heavy drinkers.

The researchers attempted to control for some factors such as age, sex, history of diabetes and smoking status, but as I’ve talked about before ad nauseam, humans are so complex, with so many inter-related habits and customs, it is impossible to separate causation from correlation. Perhaps, for example, heavy drinkers have a propensity for cancer causing Jazz Music!

Too Much of a Good Thing?

Now, don’t get me wrong. I think the evidence is pretty strong that excess alcohol consumption is not good for your health.

Perhaps the adverse effects are inflated due to the likelihood that the majority of heavy drinkers are also likely to participate in a whole gamut of unhealthy behaviours making it difficult to tease out the individual contributions of each one.

That said, in Europe at least, alcohol is a very acceptable vice. Try to quit smoking, avoid fast food, or take up exercise and your peers will most likely support you. Try to cut down or quit the booze however… We already concluded there’s something wrong with non-drinkers didn’t we?

The healthy eating, exercising, non-smoking heavy drinker, therefore, is not such an unusual beast, and could well be doing more damage to their longterm health than they are aware.

An Attempt to Knock off Alcohol’s Health Halo?

Though I highlighted the over hyped Guardian and Forbes articles before, a google search of the study also brings up plenty of articles heavily criticising the study, citing bias and methodological flaws.

Now, on the one hand, I can’t argue with anything that the author of the above criticism says.

In fact, I was coming to pretty much exactly the same conclusion until I came to write the previous paragraph.

I’m now starting to think that although I’d 100% agree that the authors over-hyped the study, that perhaps this was necessary!

What to do when you don’t know the facts?

The reality is that we still don’t really know the true health effects of moderate alcohol consumption.

Despite this lack of hard facts however, we’ve been sold pretty hard for the last few decades that moderate alcohol consumption is good for us.

Moderation is tricky however. People tend to latch onto simple messages such as X is Good, Y is Bad.

If a glass of wine a night is good for us, many people’s thinking goes, surely 2 or 3 can’t do any harm?

If there’s one thing that we can conclude from all this data on alcohol consumption, it is that we (as in Europeans and North Americans), love a good tipple. It seems to me pretty evident that we don’t need any encouragement to drink more than we already are.

Have the results of this latest analysis been over-hyped by the authors and press? Perhaps.

But following on from decades of the over-hype of purported health benefits of alcohol to a population that already has a culture of heavy alcohol consumption, and the marketing machine of an alcohol industry worth billions, could this be necessary to redress the balance?

Playing with Fire

I think the aim of the authors of this latest paper was to remind us that alcohol is a poison. A large enough dose in one session can kill you on the spot. Drinking more than 200g of alcohol per week could potentially reduce your life expectancy by up to 2 years and is associated with a host of unpleasant illnesses.

I love going out with my friends and socialising over a few fine ales or a bottle of wine. I don’t plan to stop. It’s tempting to call the authors killjoys or accuse them of having bias, but I think I have to concede that they probably have a point.

The science indicates that many, if not most of us, would benefit from reducing our alcohol consumption.

There is no firm evidence, however, that anyone is likely to benefit from increasing their alcohol consumption.

It’s about time, therefore, that we knocked on the head these messages of “Moderate alcohol consumption may be good for you”, as irrespective of whether or not it turns out to be true, we simply don’t need any encouragement to drink more.

A better approach would be to hammer home the message that alcohol is a toxin, one your body can tolerate in moderation without ill effects, but a toxin nonetheless. The aim not to deamonise alcohol consumption, or make people feel guilty for enjoying the odd drink or two, but simply to give people the facts.

The UK CMO’s latest advice is pretty sound

You can find the official UK safe drinking guidelines here: Drink Aware.

In 2016 the UK revised it’s guidelines for the first time in 20 years, recommending an upper limit of 14 units per week for both men and women (That’s 140g FYI). This reduced the previous upper limit for men of 21 units by a hefty 33%.

Further, they recommend that if you do drink up to the limit, it should be spread out over 3-4 days. I.e. if you stick to the weekly limit, but drink it all in one day, that’s not clever either…

14 units is often equated to 6 pints of beer, or 6 glasses of wine.

While that can be true, that’s 6 pints of 4% beer, and 6 x 125ml (small) glasses of 13% wine.

If you’re into craft beer, 6 pints a week is almost certainly taking you over the 14 unit limit.

Just a 1% increase in ABV to 5% will get you to 14 units in just 5 pints (2.8 units per pint). Beers with ABVs of 6, 7 and above are run of the mill nowadays and will get you there even faster.

250ml wine glasses are also not unusual. A 250ml glass of 14% wine (most Spanish wines are 14-15%) contains 3.5 units. Just 4 glasses will get you to your weekly limit.

Based on these figures, you can see it’s a very fine line between “moderate” drinker, and “heavy” drinker. Note also that this is the 140g limit. The Lancet study recommends a 100g limit, lower still!

Many people now consider one glass of wine with your evening meal as “Good for you”. If that’s a 250ml glass of 14% wine everyday though, that’s putting you into heavy drinker category – About 250g of alcohol per week. Split a bottle between two of you (if one glass is good, what harm can another half a glass do), and you’re up to 357g.

As a recap, more than 350g per week of alcohol consumption was associated with up to 5 years reduced life expectancy. That’s half a decade lost thanks to this “healthy habit”!

Now, obviously, I don’t think any scientists or medical professionals have ever recommended a large glass of strong wine per day as healthy or advisable, but thanks to bad reporting of dubious studies, the influence of the drinks industry, the huge variability of what exactly constitutes “a glass of wine/a beer”, and a heavy dose of wishful thinking, this is the message many people have taken home.

More Mindful Measures

I think I am actually going to reassess my drinking habits slightly based on the “results” of this study.

Well, really, there’s nothing new, but it’s a good reminder to review one’s habits.

Since moving to Spain, I’ve really got into wine, particularly with meals. It’s much harder to keep track of than beer, as you’re typically sharing bottles between friends and the glass gets topped up before it’s finished, so it’s hard to know exactly how much you’re drinking.

I’m also partial to higher alcohol beers, 6% plus. I hadn’t factored in what a big difference this makes to the alcohol level (duh!).

Going forwards, I’m going to try to be more mindful of how much wine I’m drinking – I’m pretty sure I drink it at a Yorkshire man drinking 3% bitter speed, rather than a Mediterranean moderated sipping speed, resulting in me getting topped up more than the average.

I’m also going to stick to <5% beers if I'm going to be having more than one in a session, and reserve the stronger ales if I'm just going to have the one, or if the bar offers smaller measures. Am I going to be fastidious about this, carefully calculating the grams of alcohol I consume on a day by day basis? No, I'm pretty sure that's not necessary. I think there's a lot of pleasure and enjoyment to be gained from social drinking, and insufficient evidence to warrant spoiling this through excessive worry. If, however, I can make a few small tweaks to quantity and strength without too much effort or compromising my enjoyment, I see no downside.