© Axel Bueckert | Dreamstime.com – Alcohol drinking problemDrinking moderate amounts of alcohol every day does not – as once thought – protect against death from heart disease, nor does it contribute to a longer life, according to a sweeping new analysis of alcohol research.
The review, which examined existing research on the health and drinking habits of nearly 5 million people, is one of the largest studies to debunk the widely held belief that moderate drinking of wine or other alcoholic beverages is good for you. Last year, researchers in Britain examined genetic and medical data of nearly 400,000 people and concluded that even low alcohol intake was associated with increased risk of disease.
The new study, which appears Friday in Jama Network Open, also found that drinking relatively low levels of alcohol – 25 grams a day for women (less than 1 ounce) and 45 grams (about 1.5 ounces) or more per day for men – actually increased the risk of death.
A standard wine pour is about 5 ounces. The standard serving size for beer is 12 ounces, and for distilled spirits, 1.5 ounces.
“This study punctures the hope of many that moderate alcohol use is healthy,” said Robert DuPont, a psychiatrist and substance abuse expert who served as the first director of the National Institute on Drug Abuse.
“The bottom-line message is that in terms of health, less alcohol is better,” said Tim Naimi, who is an author of the study and is the director of the Canadian Institute for Substance Use Research and a professor of public health and social policy at the University of Victoria. “Or you could say: Drink less, live more.”
The belief that daily alcohol consumption is good for you dates to the 1980s, when researchers identified the “French paradox” – the suggestion that low rates of cardiovascular disease among men in France was associated with daily wine consumption. Although later analyses found flaws in the research, the belief that moderate drinking improved health became widely accepted. Much of the research into the health effects of alcohol has been funded by the alcohol industry. One recent report found that 13,500 studies have been directly or indirectly paid for by the industry.
“It’s often been thought that wine is something special, that alcohol in wine somehow has magic properties,” said lead author Tim Stockwell, a professor of psychology at the University of Victoria. “It was just a publicity coup for the wine industry three decades ago. The role of alcohol in wine as protective is now disputed, and the evidence doesn’t hold up.”
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Finding bias in alcohol studies
The new review, called a “meta-analysis,” looked at 107 observational studies that involved more than 4.8 million people. The study stressed that previous estimates of the benefits of moderate alcohol consumption on the risk of death by “all causes” – meaning anything, including heart disease, cancer, infections and automobile accidents – were “significantly” biased by flaws in study design.
Earlier research did not adjust for numerous factors that could influence the outcome, for example, age, sex, economic status and lifestyle behaviors such as exercise, smoking and diet, they said. Using statistical software, the researchers essentially removed the bias, adjusting for various factors that could skew the research. After doing so, they found no significant declines in the risk of death by any causes among the moderate drinkers.
“We concluded these were bad studies,” said Stockwell, a former director of the Canadian Institute for Substance Use Research. “There wasn’t a single perfect study in there. They were open to bias in so many ways.”
The new analysis pointed out that previous research has shown what is known in the scientific field as a “J” shaped curve, a distribution of results suggesting that the lowest rates of heart attacks occur among those with low to moderate alcohol use, while higher rates occur at the extremes – those who do not drink at all or those who have very high rates of alcohol consumption.
However, the authors stressed that such results were wrongly skewed in favor of light to moderate drinking by the fact that, in comparison with those who do not drink, the light-to-moderate drinkers are generally healthier than those who do not drink on a range of health indicators, including dental hygiene, physical activity, eating habits, weight and income.
Another problem is that people may abstain from alcohol because of health problems, biasing study results to wrongly suggest that not drinking is less healthful than drinking. The study said that earlier research did not control for these biases because it failed to remove these “sick quitters” or former drinkers, many of whom cut down or stopped for health reasons.
“These abstainers are often older people who gave up alcohol because their health was bad,” Stockwell said. “Being able to drink is a sign you are still healthy, not the cause of it. There are lots of ways these studies give false results that are misinterpreted to mean alcohol is good for you.”
The findings were criticized by a spokesperson for the Distilled Spirits Council, who focused on the fact that the studies reviewed initially showed a “J-curve” benefit to light and moderate drinking, rather than the larger finding that removing bias from the studies produced a different result.
“The conclusion of this study is not supported by the very data presented in it,” said Amanda Berger, the vice president for science and health at the Council, which represents the leading producers and marketers of distilled spirits. “The authors’ results demonstrate a ‘J-curve’ in the relationship between alcohol consumption and all-cause mortality, which suggests that those who drink in moderation live longer than those who do not.”
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Unwelcome news for those who enjoy alcohol
Stockwell acknowledged that the study’s findings would not come as welcome news to those who enjoy a few worry-free daily drinks.
“This is controversial because people like to drink,” Stockwell said. “It’s our favorite recreational drug. We use it for pleasure and relaxation, and the last thing we want to hear is that it causes any harm. . . . It’s comforting to think that drinking is good for our health, but unfortunately it’s based on poor science.”
The latest study is another piece in the growing consensus questioning the still-widespread belief that moderate drinking contributes to good health, the authors said. The World Heart Federation, for example, declared in a January 2022 policy brief that “contrary to popular opinion, alcohol is not good for the heart,” adding that any level of alcohol consumption can lead to loss of healthy life.
The most recent Dietary Guidelines for Americans 2020-2025 recommend that adults limit alcohol intake to two drinks or fewer a day for men and one drink or less for women, adding “that drinking less is better for health than drinking more,” and urging pregnant women to abstain.
The guidelines also warn that even drinking within the recommended limits may increase the overall risk of death attributable to various causes, including some types of cancer and heart disease, even at levels of less than one drink per day.
Donald Hensrud, an associate professor of nutrition and preventive medicine at the Mayo Clinic, who was not involved in the study, said there has been “increasing evidence” that even moderate drinking may not be beneficial to health and longevity for most people.“This analysis builds upon that,” he said. “When my patients ask me about alcohol, I discuss this evidence with them, recommend they minimize their consumption, and discuss practical ways they can do this, such as decreasing the number of days they consume any alcohol, and consume more non-alcohol-containing drinks.”No, moderate drinking isn’t good for your health
