Sunday, September 26, 2021

A leading Australian doctor has made a surprising finding regarding alcohol - and the best type of alcohol to drink for your health

Dr Paul Gow

Socially, when I say I’m a liver specialist, people imagine me to be a puritanical teetotaller. But I am actually quite the opposite. I enjoy a drink. I don’t enjoy all types of alcohol. Spirits remind me of bad hangovers as a younger man, beer makes me feel bloated, but wine? Wine, I thoroughly enjoy.

The fact that people are surprised that a liver specialist enjoys alcohol relates, of course, to the fact that alcohol causes liver disease and therefore people think I should know better.

The truth though, is that for most individuals, alcohol can be beneficial – rather than detrimental.

For decades we have heard the message that alcohol causes cirrhosis, alcohol is a drug of addiction and alcohol ruins lives and, of course, all of these things are true. But it doesn’t have to be like that. Modest alcohol intake almost certainly does more good than harm.

Keep in mind, that when I talk about moderate alcohol intake, I mean up to 2 units of alcohol for women and up to 3 units for men on any given day, with a maximum of 7 units for women and 14 for men over a week.

A healthy liver can manage moderate alcohol intake. The job of a normal healthy liver is to filter bad chemicals from the blood and manufacture good chemicals.  Most of the bad chemicals the liver filters out are broken down remnants of what we’ve eaten. There’s nothing to worry about – this is, after all, the liver’s primary role.

All the blood from the gut (including chemicals we have eaten) drains through the liver – and the liver takes out the bad stuff, keeps the good stuff and manufactures essential chemicals. Alcohol therefore (in moderation), is metabolised by the healthy liver without any issue.

The French embrace.  Two decades ago, an article in the prestigious medical journal The Lancet coined the term ‘The French Paradox’. The paradox was that the French – despite a diet high in saturated fats – had a low incidence of death from cardiac disease.

The explanation for this apparent disparity was the moderate alcohol consumption typical of the French diet – and the premise that moderate alcohol intake protected the heart.

Ever since, there has been growing evidence moderate alcohol intake doesn’t just protect individuals from fatty liver disease and heart disease, but also against diabetes, dementia and numerous other conditions.

Although we still don’t know why, alcohol has been shown to be antioxidant, anti-inflammatory, blood pressure lowering and have anticoagulant properties. All these are good.

It is well recognised that heavy alcohol consumption can increase the risk of all sorts of cancer – the most common being liver cancer and throat (laryngeal) cancer.

What is less clear, but still crucially important, is whether moderate amounts of alcohol increase the risk of cancer. For most (but not all) cancers, there is no evidence that moderate alcohol has any effect on cancer risk.

However, there is evidence that moderate alcohol increases the risk of cancer of the mouth, throat (oral and pharyngeal cancer), breast, liver and oesophagus. Given the high rates of breast cancer in our population, this is certainly troubling.

On the other hand, moderate alcohol appears to be protective with respect to the risk of certain other cancers – including kidney cancer and lymphoma.

The Million Women Study reported no increase in the risk of breast cancers in women having 3 or fewer drinks/week.

But in women having 3–6 drinks per week, the rate of breast cancer increased slightly compared to non-drinkers, by about 8 per cent.

It is now well accepted that even small volumes of alcohol increase the risk of breast cancer in women. It also appears that there is a gradient of increasing risk with increasing alcohol intake.

Alcohol and longevity

Statistically, moderate drinkers live on average, 2 years longer than non-drinkers.  Some report a survival advantage of more than 3 years, while others report as little as 6 months.

All the studies however, report that moderate drinkers live longer than non-drinkers.

One other very important piece of information gained from these reports is that life-years gained by moderate drinkers are typically years of good health.

It’s also important to put the health benefits of moderate alcohol in context compared with other powerful public health messages such as exercise, stopping smoking and avoiding obesity.

Of these issues, the one that exerts the greatest effect in terms of life-years gained is to avoid or stop smoking.

Non-smokers live on average about 6 years longer than smokers. Regular exercise offers a survival benefit of about 3 years, while avoiding obesity adds an extra 12 months.

When considered like this, some data suggests that moderate alcohol intake is perhaps two- or three-fold more powerful as a lifestyle choice to increase longevity than avoiding obesity. The lifestyle measures discussed here are generally addictive in their effect on longevity.

For example, a non-smoking, regular exerciser who drinks moderately and isn’t obese lives between 8 and 15 years longer on average than their counterpart who smokes, doesn’t exercise, doesn’t drink and is obese.

Which type of alcoholic drink has the greatest health benefits?

From the existing data, all types of alcoholic drinks are associated with potentially positive health benefits, with the proviso that they are consumed in moderation. However, red wine appears to be associated with slightly greater health benefits.

The occasional binge

Don’t be tempted to binge drink. Drinking alcohol with the specific intention of getting drunk, typically leads to alcohol- induced harm.

Having more than 4 standard drinks at one sitting for women, or 5 for men, has negative social consequences such as increased risk of trauma, traffic accidents and violence.

And for your liver, repeated episodes of binge drinking are detrimental and associated with a marked increase in the risk of developing cirrhosis.

Binging also appears to have specific detrimental effects on heart health and is associated with an increased risk of death from heart disease.

My recommendations

The scientific evidence surrounding moderate alcohol intake and health is not totally resolved. I, personally, am a believer that moderate alcohol offers net benefits to a person’s health but there are many others in the scientific community who interpret the data differently.

There’s a term in astronomy known as ‘the Goldilocks zone’.

The Goldilocks zone is the region around a star where planets are at just the right temperature to have liquid water. Not so hot that all the water is burnt off, and not so cold that the water is frozen, but just right.

A glass of wine at Christmas probably isn’t enough to reap the metabolic benefits that moderate alcohol intake has been associated with.

If, however, you have a glass of wine with your evening meal 3, 4 or even 5 nights a week, you are definitely in the Goldilocks zone.

1 comment:

Norse said...

I have had my share of alcohol and hashish and was too drunk or stoned to look for evidence to frame it as healthy. I was indeed in for the buzz and the same applied when drinking or smoking moderately. I suppose I am now being a bit of a buzzkill, which is quite opposite of how I used to be.