Part of what has gotten the media in a whirl over alcohol is a new international study (Published in the Lancet on April 14, 2018; DOI: https://doi.org/10.1016/S0140-6736(18)30134-X) on alcohol consumption that found that there are no overall benefits from moderate drinking and, in addition, calls into question the U.S. guidelines that say men can safely drink twice as much as women. The study features Angela M. Wood, PhD (University of Cambridge, UK) and 120 co-authors, 599,912 current drinkers without previous cardiovascular disease in 19 high-income countries and aggregated data from multiple studies of drinking patterns. The names and numbers are impressive.

The bottom line of the international study cited above is: Moderate drinking may mean less alcohol than people think; and that’s a big public health deal. The idea that moderate drinking may not be good for you by lowering the risk of a heart attack and the interpretation of ‘moderation’ itself, arising from the new international study are not likely to be welcomed by the alcohol industry. I personally expect that it will be fiercely fought. Anna Almendraia, a Senior Reporter for the Huffington Post, wrote: Alcohol Companies Are Funding Research to Make You Want To Drink More; “We don’t trust nutrition studies funded by soda companies. Why would we trust alcohol studies funded by the booze industry? She starts right out with: “If you’ve ever seen headlines about how red wine is good for your heart, or how moderate alcohol use is linked to longer life, you’ve seen the alcohol industry’s influence on health science at work.” Don’t miss her article; she clearly spells out how the alcohol industry works to convince Americans that their products are actually good for them. In addition, she explains the easy to see conflict of interest in alcohol producers funding the scientific research that leads Americans to think that alcohol can improve heart health. I especially enjoyed her discussion of the “squishy” term “moderation” and how in practice it ends up meaning whatever the drinker wants it to mean.

The most important issue in the new “whirl over alcohol” is understanding the “abstainer’s bias” and how it has contributed to our present state of belief that alcohol is some kind of elixir of heart health. Tim Stockwell’s research, published in the Journal of Studies on Alcohol and Drugs, shows that when you exclude people who used to drink but now abstain; and also those who abstain for other health purposes, the purported benefits of alcohol vanish. Because people who quit drinking because of health problems are added to the abstainer’s statistics it biases the statistics toward worse health than those who are still in the moderate drinkers’ group and haven’t had to quit because of their health. One of Stockwell’s charts published in the Huffington Post article by Anna Almendraia on the “abstainer’s bias” can greatly facilitate understanding the issue.

Let me just share a couple of facts here:

• It has never been proven that there’s any amount of alcohol that’s safe for a pregnant woman.
• Alcohol consumption, even at the allegedly moderate level, is associated with stroke, aortic aneurysm, fatal hypertensive disease, heart failure and shorter life expectancy.
• The 2017 AICR Cancer Risk Awareness Survey Report and the American Society of Clinical Oncology website report that 60 to 70% of Americans are unaware of the alcohol-cancer link. There is convincing evidence linking alcohol with increased risk of cancers of the breast (postmenopausal), colorectum, esophagus (squamous cell), liver, mouth, pharynx, and larynx. In addition, there is also probably increased risk of stomach and premenopausal breast cancers. Certainly, the dose response issue is integrally involved – the more alcohol the higher the risk.

Note: Karen Collins, writing for Today’s Dietitian, offers three possible mechanisms that could raise cancer risk including:

• Alcohol’s ability to increase circulating estrogen. The most common form of breast cancer is estrogen receptor-positive breast cancer.
• DNA damage can occur from the free radicals formed as alcohol, a recognized carcinogen, is metabolized – forming acetaldehyde, another recognized carcinogen. In addition, alcohol may act as a solvent, increasing other carcinogens’ ability to damage cells.
• The chronic tissue inflammation that can result from drinking alcohol at levels high enough to produce oxidative stress. One example is the tissue damage in the liver from high levels of alcohol that leads to cirrhosis – can lead to hepatocellular liver cancer.
• As always, it seems, genetics get involved. Some people have a predisposition for an increased risk of cancer from alcohol.

The US Dietary guidelines 2015 to 2020 reads: “If alcohol is consumed, it should be consumed in moderation – up to one drink per day for women and up to two drinks per day for men – and only by adults of legal drinking age.” The previous guideline statement used to include information explicitly linking moderate alcohol consumption to lower risk for coronary heart disease and cardiovascular disease. The next statement, due to be released in 2020 may reduce the recommendation for men and women to one per day or less. Even better, would be that the statement includes some qualifying information about drinking at all.

Because more than 15 million adults and 600,000 teens have alcohol use disorder in the U.S., and more than 10% of children in the U.S. live with a parent who struggles with alcohol problems; and the heart health risks; and cancer risks some scientists are calling for moderate alcohol guidelines to be lowered. David Jernigan, a professor at the Department of Health Law, Policy and Management at the Boston University School of Public Health, said; There just aren’t a lot of products that are legally available that kill over 100,000 Americans every year and are still on the market.”

My wish is that this publication of new more valid information will not easily be swept under the rug. If I really want to believe in magic, I’d hope that we would not have to go through the “cigarette industry’s playbook;” like we did with cigarettes and sugar – but could just get the word out and help slow the risk of disease. I’m a pragmatist, marinated in reality, however; I know that the US alcoholic beverage sales were 234 billion dollars in 2017 and are expected to increase to 243 billion in US dollars in 2018. The industry is not going to let a tab like that go down easily. Expect to see big studies that “prove” that alcohol is an elixir for health. But do read or re-read Almendraia’s HuffPost article. My prediction is that this whirl is just the beginning of a full-fledged cyclone.