A familiar substance has repeatedly been associated with protection against dementia. But we’re not allowed to learn that. Instead, government and public health bodies conceive their task to be to suppress positive data about alcohol.
Cases of dementia are expected to double worldwide by 2050. But in the United States, no new medication had been approved for addressing Alzheimer’s—the disease that most often causes the decline in mental abilities for which dementia is a general term—in almost 20 years. In June the Food and Drug Administration (FDA) approved such a drug. Yet FDA’s own panel of external advisers said that the treatment wasn’t proven effective. Amid much controversy, some said it could “cause harm.”
Meanwhile, a number of large, rigorous studies continue to indicate alcohol’s potential to significantly mitigate cognitive decline.
In 2000, Archie Brodsky and I reviewed in Drug and Alcohol Dependence the research literature on the psychological benefits of moderate alcohol consumption. Aside from producing feelings of well being, pleasure and sociability, one positive quality of alcohol had been repeatedly discerned—its ability to foster “long-term cognitive functioning.”
Since our review at the turn of the century, more and more research has affirmed this cognitive benefit from drinking. One project that did so was the British Whitehall Studies.
What Did Whitehall Demonstrate?
The Whitehall research investigated social determinants of cardiovascular disease and mortality among British civil servants. The Whitehall II Study, conducted originally from 1985 to 1988, examined the health of over 10,000 civil servants ages 35 to 55. Two thirds were men and one third women. Tracking of these subjects has continued.
The Whitehall Studies assessed alcohol use. A 2004 study of Whitehall II subjects found that, 11 years from baseline, “Those who consumed at least one drink in the past week, compared with those who did not, were significantly less likely to have poor cognitive function. The beneficial effect extended to those drinking more than 240 g per week (approximately 30 drinks or more). The effect was stronger for women than men. . . . The relations were not explained by confounding by smoking and by physical and mental health.” (My emphasis.)
The researchers concluded with this remarkable assertion: “for middle-aged subjects, increasing levels of alcohol consumption were associated with better function regarding some aspects of cognition.”
Positive associations with drinking have repeatedly appeared over decades in diverse populations.
In 2018, a 23-year follow-up was more nuanced: “alcohol consumption trajectories from midlife to early old age showed long term abstinence, decrease in consumption, and long term consumption >14 units/week to be associated with a higher risk of dementia compared with long term consumption of 1-14 units/week.”
Association, of course, is not causation. FDA-model clinical trials require randomly assigning target populations to receive or not receive a treatment. For various reasons, this research model is unworkable with alcohol. Yet positive associations with drinking have repeatedly appeared over decades in diverse populations even while undergoing adjustments for other likely influential variables.
But if you believe the prestigious Whitehall study conducted with a “captive” middle-class population from middle to old age, you should drink up to two drinks daily to avoid dementia. In this regard, alcohol seemingly acts like a medication!
Drinkers Can’t Be Trusted
Of course, no such claim was made based on the research. The authors of the initial Whitehall alcohol-cognitive study cautioned, despite alcohol’s indicated benefits, that “it is not proposed that these findings be used to encourage increased alcohol consumption.”
The conclusion of the latter study focused on reducing drinking targets: “The risk of dementia was increased in people who abstained from alcohol in midlife or consumed >14 units/week. In several countries, guidelines define thresholds for harmful alcohol consumption much higher than 14 units/week. The present findings encourage the downward revision of such guidelines to promote cognitive health at older ages.”
Abstinence or decreased drinking, however, were associated with more dementia than was heavier drinking. The risk ratios for dementia relative to continuous moderate drinking were 1.74 for abstinence, 1.55 for reduced drinking, and 1.40 for heavier drinking—heavier drinking was the healthiest category other than moderation.
Withholding information about the benefits of drinking has been the traditional response to positive indicators about alcohol. The first systematic program to study people’s health over time in a community was the Framingham Study. This research was launched by the United States Public Health Service in 1948 to investigate the risk factors for cardiovascular disease.
Carl Seltzer, an anthropologist and epidemiologist involved in the study, described how he was prohibited from publishing the alcohol finding by the National Institutes of Health.
Drinkers in Framingham were found to have fewer heart attacks during 35,563 person-years of follow-up. “In the community, alcohol consumption is not associated with increased risk for congestive heart failure, even among heavy drinkers (> or = 15 drinks/wk in men and > or = 8 drinks/wk in women). To the contrary, when consumed in moderation, alcohol appears to protect against congestive heart failure.” (My emphasis.)
But this result wasn’t permitted to see the light of publication until 2002—30 years after it was first discovered. In 1997, Carl Seltzer, an anthropologist and epidemiologist involved in the Framingham study, described how, in 1972, he was prohibited from publishing the alcohol finding by the National Institutes of Health (NIH). This would have been the earliest systematic report of such a result, which has since been widely replicated.
At the time it censored the publication of Selzer’s finding in 1972, the NIH felt obligated to explain its recalcitrance in a memorandum:
An article which openly invites the encouragement of undertaking drinking with the implication of prevention of coronary heart disease would be scientifically misleading and socially undesirable in view of the major health problem of alcoholism that already exists in the country.
Yet even after the Framingham results were belatedly released, public health experts were far from eager to publicize this lifesaving information.
In 2007, PBS broadcast a highly heralded special, The Hidden Epidemic: Heart Disease in America. The program, hosted by Larry King, featured Framingham. King led a panel of experts in discussing the role of exercise, diet—even sex—in heart health.
Alcohol was never mentioned.
While it was exploring the effects of alcohol, the Framingham Study also found benefits for cognitive performance from drinking, even at high levels: “women who drank moderately (2-4 drinks/day) showed superior performance in many cognitive domains relative to abstainers. For men, superior performance was found within the range of 4-8 drinks/day, although fewer significant relations were observed. These results were confirmed by prospective analyses of 24-year drinking history.” (My emphasis.)
In summary, two pioneering epidemiological projects—the British Whitehall cohort and American Framingham community studies—found strong evidence for the cognitive benefits of alcohol. Both studies found that dementia is more likely to be associated with drinking too little than with drinking more than the norm.
Did you know about such findings? Do they surprise you? Do you believe them? Why, or why not?
Supposed Negatives Are Amplified
Any apparent findings of negative effects of alcohol are meanwhile shouted from the rooftops. The primary example in recent history was WHO Europe’s ballyhooed headline “There is no safe level of alcohol.”
“Zero alcohol consumption minimizes the overall risk of health loss,” warned the senior author of the Lancet study that the agency proclaimed.
As I have noted in Filter, this opinion was reached from indiscriminately melding the impact of alcohol in 195 societies, with wildly varying public health variables and levels of development. No actual drinkers were examined; rather coefficients representing the impact of alcohol on each disease were multiplied across the prevalence of the diseases in each country.
As I further pointed out, a host of other reputable research since then (including a contemporary study in the Lancet) reached a contrary conclusion—that alcohol consumption preserves and extends life. Are those results worth knowing?
In 2019 and 2020, two prominent studies of drinking’s positive effects on cognitive functioning and its endurance over the life cycle were published.
One is a “scoping review” of alcohol use and dementia research from the years 2000-2017. The chief investigator, Jürgen Rehm, is the primary organizer of the World Health Organization’s Global Burden of Disease and the Impact of Mental and Addictive Disorders study, the one that declared that there is no level at which drinking is safe, let alone beneficial.
The subsequent, 2019, Rehm et al. review assessed the results from 28 methodologically sound studies the investigators identified. These component studies measured actual drinking outcomes. They were, in fact, meta-analyses that combined results from outcome research involving large numbers of subjects, who were usually older.
Rehm and his colleagues determined, based on the most credible research since 2000 (most of the studies were published post-2010), that “Although causality could not be established, light to moderate alcohol use in middle to late adulthood was associated with a decreased risk of cognitive impairment and dementia.”
But heavy drinking was hazardous, the authors found: “Reducing heavy alcohol use may be an effective dementia prevention strategy.”
Paternalism and Infantilization
A further study of a cohort of older subjects was reported in 2020 in JAMA Network. It asked the question: “Does an association exist between current low to moderate alcohol drinking and cognitive function trajectories or rates of cognitive decline from middle to older age among US adults?”
Answer: “Our study suggested that low to moderate drinking was associated with better total cognitive function and better individual cognition domain results for word recall, mental status, and vocabulary among middle-aged or older men and women in the United States.” This included “lower rates of decline in each of these cognition domains”—i.e., less dementia.
Public health agencies continue to wish away the idea that alcohol can be beneficial.
The 2020 report was part of the Health and Retirement Study. HRS follows a panel comprising a representative sample of nearly 20,000 older Americans. It is conducted at the University of Michigan with funding by the National Institute of Aging (NIA) and the Social Security Administration.
The range, different eras, and diverse populations represented by the research recording such results make alcohol’s role as an anti-dementia agent hard to ignore.
Nonetheless, public health agencies continue to wish away the idea that alcohol can be beneficial.
The National Institute of Aging website features the following under the heading “Facts About Aging and Alcohol:”
Uncle George’s and Grandma Betty’s Stories
Anyone at any age can have a drinking problem. Uncle George always liked his liquor, so his family may not see that his drinking is getting worse as he gets older. Grandma Betty was a teetotaler all her life until she started having a drink each night to help her get to sleep after her husband died. Now, no one realizes that she needs a couple of drinks to get through each day.
These are common stories.
How “common” are George’s and Betty’s cases? Most drinkers in HRS (85 percent) are low-to-moderate drinkers, having up to seven drinks a week for women and 14 for men. But the majority of this population of older Americans abstains. Since, compared with never-drinkers, low-to-moderate drinkers scored better on cognitive tests throughout the study and experienced less cognitive decline with age, this majority might reconsider.
When it comes to alcohol, the US agency charged with the well-being of older Americans offers cultural stereotypes rather than presenting its own data. The National Institute of Aging discourages healthy drinking by seniors and attacks their personal agency. This recalls NIH’s refusal to tell Americans that alcohol prevents heart disease. It’s for their own good!
Of course anyone can choose not to drink. But isn’t public health’s role to provide real information about drugs, including alcohol, on which adults can make sensible decisions? Instead, American public health agencies practice paternalism and infantilization.
Photograph by Andres Haro Dominguez on Unsplash
Archie Brodsky is a member of the Board of Directors of The Influence Foundation, which operates Filter.