By Joel Achenbach | The Washington Post
To keep health risks to a minimum, the optimal amount of alcohol that someone has to consume is not. That is the simple, surprising conclusion of an extensive study, co-written by 512 researchers from 243 institutions, which were published in the prestigious journal The Lancet on Thursday.
The researchers have compiled a database between 1990 and 2016 with over a thousand alcohol studies and data sources, as well as mortality and disability data from 195 countries and territories. The goal was to estimate how alcohol affects the risk of 23 health problems. The number that jumped out was ultimately zero. Everything more than that was associated with health risk & # 39; s.
"What's undervalued, what's surprising is that no amount of drinking is good for you," said Emmanuela Gakidou, a professor of world health at the University of Washington and the senior author of the report.
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"People should no longer think that a drink or two a day is good for you, which is best for you to not drink at all," she said.
The report shows that 2.8 million people around the world died from alcohol-related causes in 2016, which is about the same as the 2.0 million that died in 1990. For people aged 15 to 49 years, alcohol is the most important risk factor for experiencing a negative health outcome.
This is a sobering report for the approximately 2 billion people who drink alcohol. The report challenges the controversial hypothesis that moderate drinking yields a clear health benefit. That idea took place in the nineties after news stories about the French paradox: the French have a relatively low heart disease despite a fat diet. Some researchers pointed out the consumption of red wine among the French as potentially protective.
Numerous peer-reviewed studies found evidence that people who consume a drink or two a day are less likely to have heart disease than those who abstain or drink excessively.
But the new study, which noted the lower risk of heart disease due to moderate alcohol use, and a decrease in the number of diabetes in women, found that many other health risks are negating and overwhelming the health benefits. This includes the risk of breast cancer, laryngeal cancer, stroke, cirrhosis, tuberculosis, interpersonal violence, self-injury and transport accidents.
"Current and emerging scientific evidence does not suggest that there are general health benefits due to moderate alcohol consumption," said Robert Brewer, who runs the alcohol program at the US Centers for Disease Control and Prevention and was not involved in the new study. He pointed out that alcohol studies have long been followed by confounders & # 39; – factors that give a misleading impression of cause and effect.
"People who report in moderation are often very different than people who do not drink at all, they tend to be a healthier population, they tend to exercise more, they are generally more prosperous, they have more access to health care, "Brewer said.
The National Institutes of Health had sponsored a massive clinical trial, largely insured by the alcohol industry through funding given to a non-profit foundation, to test the moderately-drinking hypothesis. A New York Times report in March revealed that researchers were in communication with representatives of the alcohol industry and a subsequent NIH study concluded that the design of the study was flawed.
Chief author Max Griswold of the University of Washington said that this new report is the largest alcohol research to date.
It follows another, less drastic analysis of alcohol and mortality, published in the Lancet in April. The earlier suggested that mortality rates start to rise when people drink more than 100 grams of pure alcohol (roughly what they drink in seven standard American beers) per week.
Drinkers can be reassured that the new Lancet report does not focus on individuals, but on populations. It estimates the risks of alcohol-related illnesses and disabilities per 100,000 people as a function of alcohol consumption. The authors do not suggest that there is a significant risk when taking a sip of alcohol. The risks & # 39; s dramatically increase with heavy drinking.
The US dietary guidelines define low-risk drinking as a drink per day for women and two per day for men (and none for people younger than 21 or pregnant). Brewer of the CDC said that if people adhere to the guidelines, "the risk of damage across the board will be low, it will not be zero, but it will be low."
Gakidou repeated that.
"It's a very small risk with one drink a day, it goes up when you go to two drinks a day, and it all depends on all other risk factors that the individual has," she said. "For a certain person, drinking a drink can not hurt them."
She breaks the numbers in an e-mail. She said that with one drink a day, a person's risk of developing one of the 23 conditions associated with alcohol increases by 0.5 percent – a small increase in risk & # 39 ;, as she put it. With two glasses a day, the risk is 7 percent higher. With five drinks a day it is 37 percent higher, she said.
The authors of the report suggest that public health officials should pay more attention to alcohol throughout the planet. Any reduction in average use in a population should provide a health benefit.
US health officials have highlighted the problem of alcohol abuse and have said that legislators should consider a variety of actions, including alcohol taxes and alcohol retailer density limits.
"Alcohol consumption is very responsive to price," Brewer said.
The United Kingdom is already conducting a kind of experiment, setting a minimum price for each unit of alcohol sold in Scotland. A similar minimum is planned for Northern Ireland and Wales. England has no minimum. The proponents believe they will soon see a difference in health outcomes to prove that the Scottish model pays off, according to a commentary published in The Lancet.
"We have to change prices, it is disproportionately cheap," said David Nutt, a professor at Imperial College London who reviewed the Lancet report but was not part of the research team. "We have to remove cheap alcohol – the competitively priced beers and pils and wines and sherries."
The new report contains a number of opening figures on alcohol consumption. In Denmark almost everyone drinks: 97 percent of men and 95 percent of women. The United States is relatively moderate, with 73 percent of men and 60 percent of women who drink. That places it at the 51st and 47th place worldwide for men and women respectively. The statistics relate to people aged 15 and older.
The heaviest drinking nation is Romania, where men consume an average of 8.2 drinks per day. That is followed by Portugal at 7.2. Luxembourg, Lithuania and Ukraine are on average 7.0 in men.
For women, the heaviest consumption in Ukraine, with an average of 4.2 drinks per day, followed by Andorra, Luxembourg, Belarus and Sweden.
In contrast, a number of countries with a majority of Muslims report almost no alcohol consumption. The average for women in Iran is essentially zero, registering at 0.0003 drinks per day, the lowest percentage worldwide. The lowest for men is in Pakistan, with an average of 0.0007 drinks per day.
Americans should note that this study used a relatively conservative (or what someone who orders at a bar regarded as unpleasant) definition of a drink: 10 grams of pure alcohol. In the United States a "standard drink" is 14 grams – about the same amount of alcohol as in a typical American beer of 12 ounces or a glass of table wine of 5 ounces.
The averages on consumption are increased by the heaviest drinkers, Griswold notes. The study did not distinguish between beer, wine and spirits.
Griswold noted that he still drinks alcohol – but added, "Not so much, after this study."