Is a Little Alcohol a Wonder Drug or Poison?
You may remember 10 years ago when cardiologists recommended every US adult have a glass of red wine every night, convinced that this could bend the heart attack rate down. However, lately, we’ve been hearing a different story in the media about light to moderate alcohol use. Is alcohol a toxin with no fully safe dose? So which is it? Let’s dig in.
The Red Wine Miracle Cure
A decade ago, the recommendations were clear, we would all be much healthier if we all had a glass of red wine with dinner. This all began with the French paradox. Let’s dig in.
In 1992, two French epidemiologists noted a lower cardiac mortality rate in southern France in comparison to Northern European countries, despite similar intake of cheeses, milk, and other foods high in saturated fatty acids [52]. This became known as the “French Paradox” and part of that story included red wine. The health benefits of red wine were believed to be due to polyphenolic compounds (flavinoids).
Indeed, a more recently published meta-analyses show about a 20% reduced rate of fatal heart attacks in those patients consuming the top third most flavonols from a small number of fruits and vegetables, tea, and red wine (2). To get a sense of how big that effect is, cholesterol-lowering statins have about a 0.3% reduction in heart attack rate over 5 years. However, is there another side to this story?
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Alcohol as a Toxin?
The research between alcohol use and health used to read like this 2009 study (3). Meaning that if you were a heavy drinker, your brain and health would be impacted. Makes sense and we’ve known this for many years. Then the research began to change. For example, check out this conclusion from a 2016 study (4):
“Alcohol use 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 minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.”
Yikes! Alcohol is such a toxin that there is no safe level of consumption? We need new worldwide laws restricting its sale? What’s bizarre here is that the authors of this paper call themselves “GBD 2016 Alcohol Collaborators”? Interesting name for an author group as it almost sounds like a group with a mission.
Prohibition 2.0?
Prohibition was a really bad idea that began with this same kind of crazy zeal. Alcohol was the problem and as a result, we needed to save people from themselves. It ended in failure and an entire generation breaking the law when the speakeasy was born. The term “scofflaw” was born.
However, if these authors are right about their conclusions, while restricting sales may be nutty, maybe alerting the public about severe toxicity is warranted? Like everything in medicine, when a hard line is taken, new research explores whether that conclusion was the right one based on the data. Hence a new 2020 meta-analysis was published which concluded (5):
“Major limitations in the design and reporting of included studies made it impossible to discern if the effects of ‘lower’ levels of alcohol intake are due to bias. Further review of the evidence is unlikely to resolve this issue without meta-analysis of individual patient data from cohort studies that address biases in the selection of participants and classification of alcohol consumption.”
Basically, in medical research speak, “those guys who published that there was no safe dose of alcohol, may have seen the bogey man on the data they wanted to see, but he probably wasn’t real”.
In addition, in that same year, this study was published which concluded (6):
“These findings suggested that low to moderate alcohol drinking was associated with better global cognition scores…”
Wow, people who were light to moderate alcohol drinkers had preservation of cognitive function compared to teetotalers! I’m starting to get mental whiplash!
This year another study was published looking at these past research findings that was deep in the research weeds (7). It concluded that the research methodologies of all of these and other papers aren’t good enough to draw these conclusions.
My Suggestions?
After seeing some of the recent media headlines, I began to get worried about my own aging brain. As a result, I gave up having a glass of wine or two a night, which was great as giving up those empty calories helped me lose weight. However, as I review all of this literature, the certainty you hear in the media about how there is no safe dose of alcohol is very premature. We really don’t know that at this point. Hence, I’ll still throwback 2-4 glasses of wine every weekend until we know much more.
The upshot? One of the reasons I love science is that it’s constantly going back and forth. If you believe for a second that researchers have no bias, forget about it, everyone has bias. So let’s let this all play out for a few more years.
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(1) Renaud, S. de, and Michel de Lorgeril. “Wine, alcohol, platelets, and the French paradox for coronary heart disease.” The Lancet 339.8808 (1992): 1523-1526.
(2) Huxley RR, Neil HA. The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2003 Aug;57(8):904-8. doi: 10.1038/sj.ejcn.1601624. PMID: 12879084.
(3) Sabia S, Elbaz A, Britton A, Bell S, Dugravot A, Shipley M, Kivimaki M, Singh-Manoux A. Alcohol consumption and cognitive decline in early old age. Neurology. 2014 Jan 28;82(4):332-9. doi: 10.1212/WNL.0000000000000063. Epub 2014 Jan 15. PMID: 24431298; PMCID: PMC3929201.
(4) GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018 Sep 22;392(10152):1015-1035. doi: 10.1016/S0140-6736(18)31310-2. Epub 2018 Aug 23. Erratum in: Lancet. 2018 Sep 29;392(10153):1116. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. PMID: 30146330; PMCID: PMC6148333.
(5) Brennan, S.E., McDonald, S., Page, M.J. et al. Long-term effects of alcohol consumption on cognitive function: a systematic review and dose-response analysis of evidence published between 2007 and 2018. Syst Rev 9, 33 (2020). https://doi.org/10.1186/s13643-019-1220-4
(6) Zhang R, Shen L, Miles T, et al. Association of Low to Moderate Alcohol Drinking With Cognitive Functions From Middle to Older Age Among US Adults. JAMA Netw Open. 2020;3(6):e207922. doi:10.1001/jamanetworkopen.2020.7922
(7) Charlton AJ, Perry CJ. The Effect of Chronic Alcohol on Cognitive Decline: Do Variations in Methodology Impact Study Outcome? An Overview of Research From the Past 5 Years. Front Neurosci. 2022 Mar 10;16:836827. doi: 10.3389/fnins.2022.836827. PMID: 35360176; PMCID: PMC8960615.
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