“There is no safe level of alcohol,” WHO Europe headlined in 2018. “Zero alcohol consumption minimizes the overall risk of health loss,” warned the senior author of the Lancet study that the agency proclaimed. Not a drop!
That research was based on international consumption and health figures, bridged across 195 countries. But combining national data from all these countries is creating a nonexistent cake out of disparate ingredients. Health conditions in Burundi, Haiti and the Solomon Islands don’t match those in Paris, New York and Vancouver. As Walter Willett, professor of epidemiology and nutrition at the Harvard School of Public Health, pointed out in critiquing the WHO diagnosis: “Our decisions about drinking in the United States shouldn’t be influenced by what alcohol does to tuberculosis.”
And the WHO study didn’t actually examine individuals. Instead, it was deduced from a health economics statistical analysis. Yet the Global Burden study, as it was called, was not the only international study on drinking to appear in The Lancet in 2018. A meta-analysis of 83 prospective studies, which together tracked 600,000 individuals from “high-income countries,” also appeared. It found that, “compared to moderate drinkers, ‘never drinkers’ experienced 30 percent more heart disease and strokes, and a 20 percent higher overall death rate.”
A relentless parade of research and data tells us that alcohol, overall, enhances health and prolongs life.
The WHO warning has nonetheless inspired an onslaught of new anti-alcohol exhortations throughout US media: “America has a drinking problem” (The Atlantic), “Did drinking give me breast cancer?” (Mother Jones), “Happy? Sad? Stressed? How drinking became the answer to everything“ (New York Times).
So we shouldn’t have been surprised when, in February, it was announced:
According to the Centers for Disease Control, drinking alcohol of any kind can increase your risk for certain cancers. The National Toxicology Program lists consumption of alcohol as a known human carcinogen.
A group of health organizations is looking to get that message out loud and clear. In a Citizen Petition, the American Society of Clinical Oncology and the American Institute for Cancer Research, along with others, are asking for a new cancer warning label to be added on all alcoholic beverages.
What miscreant could possibly oppose such a noble project?
Alcohol can, like many other things (such as cold cuts and perhaps lox), cause cancer, and people deserve to know that. But limiting messaging about beverage alcohol to its potential harms is an inexcusable public health disservice.
That’s because a relentless parade of research and data tells us that alcohol, overall, enhances health and prolongs life. Five major recent studies have clearly shown that people who drink alcohol moderately, relative to those who abstain, live significantly longer and better.
Of course, there are objections to the research—there always are. I will address the leading arguments that will be made against these studies after I describe their results.
In the meantime, the utter inability of American health institutions to acknowledge the benefits of alcohol resembles nothing so much as anti-vaccination denialism. Here’s what contemporary epidemiological research reveals.
Five Important Studies Showing Alcohol’s Benefits
1. Alcohol consumption in later life and reaching longevity: The Netherlands Cohort Study (Age and Aging, 2020).
This was a prospective study of a cohort group, where people were identified as “young” seniors (ages 68-70) and followed for 20 or more years to compare who survived until 90 and who did not. There was a significant positive association between starting-point alcohol intake and the probability of reaching 90 years for both men and women. Overall, the highest probability of reaching 90 was found in those consuming 5 < 15 g/d alcohol (up to a drink daily), with RR = 1.36.
Translation: RR is your “relative risk.” You would be 1.36 times more likely to reach 90 if you drank compared to abstaining, based on a multivariate analysis in which smoking, body mass, physical activity, history of illnesses, and education and occupation were included and their impact separated out—i.e., the impact of drinking was isolated.
Even men who drank several drinks more and women having up to another drink daily outlived those who abstained.
2. Alcohol intake and cognitively healthy longevity in community-dwelling adults: The Rancho Bernardo Study (Journal of Alzheimer’s Disease, 2017).
Another prospective study involved a group of seniors living in an upscale American residential development. Alcohol intake was measured and analyzed against people’s likelihood of reaching 90 with their cognitive faculties intact over a 20-year period.
Among Americans, this California group of seniors was unusually likely to imbibe. Most participants (88 percent) reported some current alcohol intake. Almost half drank regularly (49 percent reported a moderate amount of alcohol intake, and 48 percent reported drinking near-daily).
The study concluded: “Relative to nondrinkers, moderate and heavy drinkers (up to 3 drinks/day for women and for men 65 years and older, up to 4 drinks/day for men under 65 years) had significantly higher adjusted odds of survival to age 85 without cognitive impairment.”
3. The 90+ Study by the University of California Irvine’s Institute for Memory Impairments and Neurological Disorders (American Association for the Advancement of Science Conference, 2018).
Time magazine covered the results of the 90+ Study—which examines the habits of people who live to at least 90—as they were reported at the annual conference of the American Association for the Advancement of Science.
As the article noted of the findings: “Drinking about two glasses of wine or beer a day was linked to an 18% drop in a person’s risk of early death—an even stronger effect than the life-preserving practice of exercise, according to the researchers.”
4. Harvard Nurses’ Health and Health Professionals Studies (Circulation, 2018).
Insider magazine reported the results of 30 years of data for 120,000 health professionals tracked by the Harvard School of Public Health. The article responded to a recent trend: Dry January, which polling had suggested was attempted by one in five Americans:
Researchers at the Harvard TH Chan School of Public Health studied 30 years of data on nearly 80,000 women and 40,000 men to understand how their lifestyle habits affected their lifespan. Aside from eating a balanced diet and avoiding cigarettes, they found that the healthiest people with the longest life expectancies also drank a few units of alcohol a week.
Women who reported drinking up to 15g of alcohol a day (roughly one drink), and men who had up to 30g a day were less likely to prematurely develop diabetes and heart disease than those who had avoided alcohol altogether or drank in excess, the study found. This was the case particularly if they also exercised regularly, didn’t smoke, and ate plenty of vegetables. [This report omits a fifth included health factor: body mass.]
Moderate drinking, it should be noted, reduces disease even for those with the other positive health indicators. Yet curiously, the Chan School of Public Health omits mentioning these benefits in its newsletter addressing prevention of heart disease.
5. Consuming alcohol in moderation can lower mortality risks (Journal of the American College of Cardiology, 2017).
The press release accompanying this study published in the American College of Cardiology’s flagship journal describes:
Men and women who engage in light-to-moderate alcohol consumption have a decreased risk of mortality from all-causes and cardiovascular disease …
Bo Xi, MD, et al., looked at the relationship between all-cause, cardiovascular disease and cancer mortality risks and current alcohol consumption patterns. The researchers used data from 333,247 participants obtained through the National Health Interview Surveys from 1997 to 2009.
In an accompanying editorial, Giovanni de Gaetano, MD, PhD, said that while younger adults should not expect considerable benefit from moderate drinking, “for most older persons, the overall benefits of light drinking, especially the reduced cardiovascular disease risk, clearly outweigh possible cancer risk.”
A Public Health Messaging Imperative
The sheer regularity of such findings—compiled in long-term research projects by highly respected investigators with large and varied groups of subjects, published in leading journals and funded by international health bodies—means that rejection of these results is an irrational, knee-jerk cultural response.
All negative alcohol impacts simply don’t carry as much weight on the scale of life as alcohol’s cardiovascular benefits.
And what is the cost of such denial? On our way to answering that, let’s note some objections commonly raised to such research.
1. The research is funded and promoted by the alcohol industry.
The Netherlands Cohort Study is funded by the Dutch Cancer Society, the World Cancer Research Fund, the European Union (EU), and the Netherlands Organisation for Health Research and Development.
The Rancho Bernardo Study of Healthy Aging is a half-century-old study of a retirement community near San Diego funded by the National Institutes of Health (NIH), administered through the University of California San Diego.
The 90+ Study is a similarly decades-long research project out of the University of California Irvine’s Institute for Memory Impairments and Neurological Disorders.
The Harvard Health Professionals and Nurses Health Studies are research tracking tens of thousands of American health professionals administered by the Harvard School of Public Health, funded by the National Cancer Institute. (The NCI, one of the National Institutes of Health, is not to be confused with the American Institute for Cancer Research that wants a warning label, which is a private professional association.)
The National Health Interview Survey (NHIS) whose results were reported by the American College of Cardiology is a massive federal study established by the NIH in 1957 to monitor Americans’ health through national surveys.
2. Research on alcohol intake doesn’t take into account other factors in people’s lives that may impact their health and longevity.
All research of this caliber measures and assesses the impact of other influential factors in longevity. If there is a key missing variable, it has to have escaped the notice of an awful lot of keen scientific minds.
3. The research doesn’t recognize that people often quit drinking because they are ill (or addicted)—the “sick quitters” hypothesis.
Once again: Do you think all those researchers missed that? There are two ways in which research accounts for sick quitters: Comparing drinkers with lifetime abstainers, or (in prospective studies) assessing illness at baseline.
4. Alcohol may reduce heart disease. But this is more than made up for by drinkers’ incidence of cancer, particularly for women.
No, it isn’t. Longevity is a net measure of survival. And the alcohol loading for impacted cancers (about 5 percent) is significantly lower than the coefficient for its cardiovascular benefits: The Lancet study examining subjects in wealthier countries found a 30 percent reduction in coronary artery disease, yielding a 20 percent reduction in overall mortality.
Alongside this, coronary artery diseases are the largest killer of women as well as men in the US, exceeding all forms of cancer. Moreover, lung cancer, which has not been shown to be affected by moderate drinking, is by far the most common cause of cancer death, outpacing breast, digestive tract and liver cancers.
All negative alcohol impacts that can potentially be noted—and will be, for instance by the ever-vigilant Times—simply don’t carry as much weight on the scale of life as alcohol’s cardiovascular benefits.
5. There’s no cost to simply telling people not to drink.
Yes, there is. People are welcome to abstain for whatever reasons they want. But reliable research tells us that most people reduce their likelihood of illness and death by drinking.
A public health message that conveys the dangers of alcohol, but ignores the benefits of drinking, is therefore loading the dice against most people.
And all these health considerations don’t even account for pleasure.