SOCIOLOGY AND PUBLIC HEALTH
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A series of articles in 2018 have revisited the impact of alcohol on one’s health, including the confusion of benefit versus harm for moderate alcohol consumption. Dating back to the early 1990’s, research institutions including the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reached an overall conclusion that moderate drinking, defined as consuming between 7 and 14 alcohol beverages per week, was associated with a reduction in heart disease risk. Today, researchers are looking at these guidelines with a more critical eye.
There are many factors involved in cardiovascular health. These include cholesterol levels, blood pressure, inflammatory factors, and genetics. An article by Kenneth Mukamal, MD published in Alcohol Research and Health in 2001 reviewed the existing studies of the time. It broke down the layers associated with heart disease, the biological factors connected to alcohol use, and the potential conflict present with what is termed the “Sick Quitter.”
Alcohol was found to increase HDL-cholesterol, which helps prevent heart disease. Alcohol also carries some anti-inflammatory benefit, through what are called antioxidants. French culture was seen as a unique part of this puzzle, as many people who drank red wine had lower rates of heart disease, despite the high-cholesterol French cuisine. Perhaps their wine consumption improved health through the antioxidants?
In contrast, alcohol was seen as a negative in the areas of increased triglycerides (a form of bad cholesterol) and high blood pressure. Moderate and heavy drinkers showed higher rates of these two symptoms, hence the impact of alcohol on the cardiovascular system was mixed. This analysis also acknowledged the severe health impacts of heavy drinking on the liver and nervous system, although this did not contribute to the final recommendations.
These articles balanced the perceived positive components of drinking with the negatives and gave the summary that mild to moderate alcohol use decreased heart disease. The message to the general public was that “some drinking” was better for you than “no drinking.” Because heart disease continues to be the number one cause of death in the United States, a recommendation of this sort carried massive implications for the general public. If Americans believed that they “should” drink, alcohol consumption would remain high.
Many of the people who completely abstained lived shorter lives than moderate drinkers, hence the assumption that some alcohol was better than none. At first look, the sample groups of people were thought to be the same. The only difference being a lifestyle choice of alcohol consumption, but this turned out to be incorrect. For many people, there was a bona fide health reason why they abstained, and this health burden may have shortened their lives, instead of the abstinence per se. This type of person was described as the “Sick Quitter.”
The Sick Quitter phenomenon was introduced through the 1990’s research, as a potential area of distinction between people who consumed mild or moderate alcohol amounts and those who completely abstained. The idea was that people who abstained from alcohol were likely different in many ways from the mild drinkers. They may be in recovery themselves from alcoholism and hence may carry some of the residual health harms from prior excessive drinking. They also may have genetic risks for health issues and made the choice to avoid alcohol for these reasons.
Despite acknowledging the Sick Quitter issue, the research, and analysis of drinking patterns and heart disease from the 1980’s and 1990’s compared abstainers to drinkers. It didn’t compare minimalist drinkers to moderate drinkers. A recent study in the British journal Lancet looked at this differently. It stratified all of the drinking for 600,000 individuals ranging from mild to heavy drinkers in a linear fashion. The take-home message from this study was that more alcohol meant more harm.
The analysis from the Lancet study reported that the safest drinking limit was about 7 drinks per week for all people, half of what had previously been recommended for men (historical CDC guidelines recommend an average of 7 drinks per week for women and 14 for men). They then found that as drinking increased into higher tiers, life expectancy decreased. For all alcohol users who drank between 7 and 14 drinks per week, they lived on average 6 months shorter. For those who drank between 14 and 21 drinks, their lives were between 1 and 2 years shorter. Finally, for those who consumed more than 24 drinks per week, the loss was 4-5 years.
The earlier data focused entirely on heart attacks. While there may be some reduction in heart attacks with alcohol consumption, the benefit may be outweighed by other causes of death. These include other forms of cardiovascular disease such as strokes and heart failure, as well as multiple forms of cancer connected to alcohol consumption. Breast cancer and some oral and throat cancers are all linked to alcohol usage.
Our clinical mission at CeDAR is to treat addiction. While this review of alcohol health literature does not specifically emphasize alcoholism and recovery, it can be highly useful for loved ones looking at drinking patterns. We work with many spouses who may consider sobriety in a gesture of solidarity with their loved ones. In understanding health consequences connected to alcohol intake, we hope to influence some family members to cut back their drinking.
The evolution of research is also an important factor in this discussion, as old truths can always be revisited and adjusted. The belief that a certain behavior is beneficial for your health carries marked implications for public wellness. Many of our lifestyle behaviors are assessed according to potential benefit versus risk.
The evolving awareness around alcohol harm reminds us somewhat of how tobacco was perceived through the 19th and early 20th century, although to a much lesser degree. Initially recommended by doctors to help with stress and a multitude of other ailments, tobacco later was revised as the number one killer in America. We always need to be mindful of how our health knowledge can change.