Alcohol Consumption - Naturopathic Perspectives

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For the past few decades, the health and medical community has recommended “moderate drinking” to the general public. However, recent scientific reports make it challenging for any reasonable doctor to continue this practice. Perhaps the time has come for the medical community to do-away with this unhelpful and unhealthful recommendation and instead champion the cause of abstinence over moderation.

Current Recommendations Are Too High

Currently, it is often recommended that men drink no more than 196 g per week and women 98 g per week of alcohol. This translates to about two drinks per day for men and one drink per day for women. However, in recent years, scientists have been sounding the alarm that these recommendations may be too high. For example, a study published earlier in 2018 looked at the relationship between alcohol consumption and risk of all-cause mortality, life-expectancy, and cardiovascular disease.^[1] For all-cause mortality, they found a “positive and curvilinear association with alcohol consumption, with the lowest risk for those consuming below 100 g per week. Associations were similar for men and women.”^[1]

We must first emphasize two things. First, for some of our lay-readers, it is important to point out that that a “positive association” does not mean “good.” In fact, in this case, it means the exact opposite. What the researchers are saying is that they found that more alcohol was associated with more risk of death. Second, remember that the current recommendation for men is not to exceed 196 g per week. Well, in this paper, they found that the lowest risk of death was found in those consuming less than 100 g per week. So, our current recommendations for men are at least 96 g higher than the amount found in this study to be associated with the lowest risk of death. The report continues to share findings on the risk of death for various cardiovascular diseases. What the scientists found was “roughly linear associations with stroke, coronary disease excluding myocardial infarction, heart failure, fatal hypertensive disease, and fatal aortic aneurysm. By contrast, there was an inverse and approximately log-linear association with myocardial infarction.”[1]

What does “linear association” mean? Simply put, the researchers are saying: “more alcohol, more risk of death.” This is significant; why? Because the health and medical community has been trumpeting for a while now that “alcohol is good for the heart.” However, this study showed that alcohol consumption above 100 g per week was associated with increased risk of death from various heart diseases. The only condition for which alcohol lowered the risk of death was heart attack. The paper concludes with findings that alcohol consumption at current recommendations was actually associated with lower life expectancy.[1] So, clearly, this paper, which by the way looked at more than half a million (599,912) subjects from three large study cohorts, paints a very different picture than what is often told about alcohol. The only real benefit observed here is that alcohol consumption lowered the risk of death of heart attack by 6%. For many other cardiovascular diseases, it increased the risk of death, in some cases by up to 15 and 24%. The sad part is that these increased risks were found at levels within the recommended guidelines. Clearly our guidelines are too high.

Recommended Levels Should Be Zero

So, clearly the above study demonstrates the strong possibility that the current recommendations are too high and that it should be lowered. But how low? It is the opinion of this author that the recommendations should be lowered right to the bottom. It should be zero. And to support this, we turn to another 2018 paper… On August 23, 2018, The Lancet published a scientific paper online which made major headlines in the media.^[2] In fact, the BBC reported on this scientific paper with the headline: “No alcohol safe to drink, global study confirms.”^[3] That is a stunning title with huge implications, and the reality is that the BBC was not exaggerating; this is exactly what the researchers found. Here are some of the scientists’ findings:

• Alcohol is the seventh leading risk factor for both death and years of life that is lost due to disability.
• Among young to middle-aged adults (15 to 49 years of age), alcohol is the leading risk factor for death, globally.
• For those above 50 years of age, cancer is the leading cause of death due to alcohol consumption being associated with 27.1% of all female cancer deaths and 18.9% of male cancer deaths.
• Alcohol is only associated with a lower risk of death for diabetes and ischemic heart disease.

The most pertinent finding is that the safe amount of alcohol was zero. The authors state it succinctly and unequivocally in their paper. They wrote: “The level of alcohol consumption that minimized harm across health outcomes was zero standard drinks per week.”^[2] “Alcohol is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimized health loss is zero.”^[2] But how about the benefits on the heart? Should not that be taken into consideration? Well, the researchers did factor that in, and this is what they found: “In estimating the weighted relative risk curve, we found that consuming zero standard drinks daily minimised the overall risk of all health loss. The risk rose monotonically with increasing amounts of daily drinking. This weighted relative risk curve took into account the protective effects of alcohol use associated with ischemic heart disease and diabetes in females. However, these protective effects were offset by the risks associated with cancers, which increased monotonically with consumption.”^[2] Could the researchers be any clearer? Even when factoring in the heart benefits, it did not change the outcome. The level that lead to the lowest risk is zero.

Alcohol Is Carcinogenic

The new finding arising from this study that might be surprising for many of the lay-readers is how powerfully alcohol is associated with cancer. This may be surprising to some of readers because the conversation of alcohol in relation to health is always dominated by its benefits on the heart. But this is an already well-documented association. Alcohol consumption is associated with increased risk of various cancers such as those of the oral cavity, pharynx, esophagus, colon, liver, larynx, and female breast.^[4][5] This is not surprising, since alcohol is a group 1 carcinogen, meaning it causes cancer. In fact, the International Agency for Research on Cancer (IARC), a division of the World Health Organization, lists the “ethanol in alcoholic beverages” and the “acetaldehyde associated with consumption of alcoholic beverages,” as group 1 carcinogens.^[6] “Carcinogen” means cancer-causing. Group 1 carcinogens are those that the IARC is certain causes cancer. Alcohol is in that group along with such substances as asbestos, benzopyrene, coal-tar pitch, Epstein-Barr virus, hepatitis B and C viruses, human papilloma virus types 16 and 18, PCB, and formaldehyde.

The form does not matter either. As one paper reports: “All alcoholic drinks (beer, wine, rice wine, sake, spirits or licquors [sic]) have similar effects on cancer risk, the total amount of ethanol consumed is the factor determining risk.”^[7] How does alcohol cause cancer? Though there is still much to discover in this area, scientists have several explanations. For example, the acetaldehyde in alcoholic beverages may result in DNA damage.^[8] Alcohol may disrupt estrogen metabolism, which may explain the strong link between alcohol and breast cancer in women.^[8] Other potential mechanisms include production of reactive oxygen species, changes to folate metabolism, and suppression of the immune system. So, the next time you are told or want to recommend alcohol because it is “beneficial for the heart,” it is worth taking a pause and asking yourself: “But how about cancer?”

Conclusion: Abstinence, Not Moderation

So, it is clear from the science that alcoholic beverages are not a healthy substance. Medical and health professionals need to stop recommending moderate amounts of alcohol for “heart health.” As we have seen, that is a gross misrepresentation and overgeneralization. We know that alcohol consumption is not a necessary, important, or helpful component of heart health. There are so many other superior ways to keep the heart healthy, such as a whole-foods, plant-based diet and moderate-intensity exercise. Do we really believe that for the public to achieve a small increased benefit for heart health, it is worth increasing their risk of cancer at the same time? Not to mention all the other potential social and emotional issues that are associated with alcohol use? Are these same issues associated with kale? With water? With other fruits and vegetables? With beans and whole grains? We need a renewed perspective regarding this matter. Medical and health professionals need to be honest with ourselves: If there was any other drink, food, herb, or supplement that had the same health profile as alcohol, you can be sure that the medical community would vilify that substance. It would likely be considered very unethical to recommend such a substance to patients. Then, how come alcohol gets a pass? It is high time for medical and health professionals to completely shift our recommendations to patients and give them the truth: Alcohol is detrimental to health, and the most responsible recommendation to give is not moderation; it is abstinence.