There is little ambiguity about alcohol and disease causation. What has often not been made very clear is whether little alcohol consumption can confer any health benefits. This discussion will not pretend to offer irrefutable evidence to answer the question. But here are what we know; that alcohol related organ specific disease occur in the liver, heart , brain and kidneys. Alcohol contibutes to higher blood pressure. Alcohol associated accidents account for marked proportion of morbidity and mortality in persons aged 18-49 years the world over. 

Alcohol consumption varies greatly from place to place and from persons to persons. It has little competition as the #1 social lubricant. Cultural practices among many other factors influence consumption. Some cultures have been known to serve alcohol as a compliment in diet. Alcohol is often used as a solvent and delivery vehicle in medicinal formulations and concoctions in Western, Eastern, West Indian and African practices. It is worth noting that much of the consumption that is of any health consequence happens outside of these pharmaco-therapeutic and maybe medicinal uses. Significant exposure to alcohol even for those who have non-pathologic use of alcohol come at times of festivities and holidays.

The link to its detrimental effect  described in most articles refer to more than little to moderate consumption. Generalizing descriptions of “little to moderate alcohol “ are of almost no practical help to the non-pathologic consumer in deciding what quantity to drink . The doctor and counselor don’t fair any better in offering precise advice using these descriptions . 

Key questions are

1. What is a “drink” 2. What is “light” or “moderate” alcohol consumption?

Precise understanding regarding quantity and consumption can provide a guide for actionable lifestyle adoptions and goals. Consequential recommendations from doctors on consumption can help shape public health policy and ultimately save lives. 

The definition of a drink may vary from place to place for example, in the US a medium glass (175 ml) of 12%  wine contains around two units of alcohol. However, British pubs and restaurants often present larger glasses (250 ml), which contain 3 units. In the United States of America, “one drink” has 14 grams of alcohol. In the United States the standard “one drink” of 14 grams of alcohol is found in a 12-ounce bottle of beer, 5-ounce (150ml) glass of wine (12% ABV), or 1.5-ounce (44ml) shot glass of distilled spirits. The big bottle of Star Beer, “a drink”, in Nigeria is 20 oz of 5.1% ABV contains approximately 24 grams alcohol. One standard bottle of wine (750 cc) has a total of 70 grams of alcohol at 12% ABV.

Moderate use means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

The many studies that have examine the subject highlight the health hazard and deleterious effect related to alcohol use.  

Here are some facts from these studies:

AGAINST 

2% of female deaths and 7% of male deaths in 2016 were considered alcohol related. Alcohol use bearing the 7th leading cause of death and disability in the world.

For major worldwide causes of death like tuberculosis , road accidents , and self-harm , risk markedly increased with alcohol use.

Among  young people aged 15-49 alcohol is the leading risk factor for death. 

For older adults alcohol related cancers accounted for leading cause of death.

FOR 

A silver-lining lies in the cardioprotective effect observed in light drinkers; persons who drank less than 1 drink a day had lower incidence of heart attack and cardiovascular diseases. Specifically , in one of the studies that compared those who drank little and those who did not , the risk of heart attack and related cardiovascular disease was about 14% lower for men drinking 0.8 drinks/day, and 18% lower for women drinking 0.9 drinks/day compared with those who did not drink at all.

It is note worthy that in this same subset of beneficiaries the risk for heart failure and stroke did not show similar benefit from light alcohol use.

RISK VS BENEFIT 

It must be emphasized that the observed benefit of light drinking does little to compensate for rise in the individual’s general health risks with rising amounts of alcohol use or the global health impact related to alcohol consumption including death and disability due to automobile accidents, infectious diseases, cancer, and even cardiovascular disease .

In summary, these studies have not revealed any findings that warrant any dramatic deviation from the long held conclusion that alcohol is detrimental to health. Rather the contrary appears to be the case. Neither is there convincing proof that light drinking is better than none at all.  

An article in the Lancet referring to a study ascribing some alcohol benefits does not put this mildly when it states “The conclusions of the study are clear and unambiguous: that alcohol is a colossal global health issue and small reductions in health-related harms at low levels of alcohol intake are outweighed by the increased risk of other health-related harms, including cancer. “

My counseling for the patient is that alcohol undoubtedly increases an individual’s general health risks. In fact no amount of alcohol consumed is safe and without risk. 

In a subset of people who are stable with little or no risk to develop disease, light drinking, consuming less than 3 drinks a week may provide benefits against heart attacks assuming you are otherwise healthy. However there is no corresponding benefit in the categories of stroke, heart failure and other diseases related to alcohol exposure .  

Some are apt to say “ Doc! at no speed of operating an automobile on a highway does it come without risk”. We have to remember that for most people some driving is compulsory. If one can’t say the same for alcohol then there may be a compelling reason not to drink even if it is little.

Think Alcohol and Remember :

-Injury and accidents

-Liver damage

-Cancer

-Heart disease

-Stroke

-Mental and Neurologic illnesses

References:

https://www.thelancet.com/article/S0140-6736(18)31571-X/fulltext

https://www.eurekalert.org/pub_releases/2019-04/tl-tlm040319.php

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Diagnosis of hypertension before the age of 40 years increased the rate of cardiovascular disease ( stroke and heart failure) by as much as 3.5 times compared to those who have normal blood pressure, a study, the CARDIA trial shows. In a similar Korean study this increase is as much as 85 %. Two seperate studies a world apart with similar findings give those of us in primary care reason for pause. Blood pressure in young adults age 18-30 years need to be addressed, treated and controlled. A reasonable primary prevention strategy for cardiovascular disease (CVD) will be to use the new but somewhat controversial American College of Cardiology (ACC)/American Heart Association (AHA) 2017 guideline for diagnosis of stage 1 hypertension to identify persons with hypertension in this age group. These group of patients stand to benefit from timely identification, intervention and treatment of hypertension. The American College of Cardiology (ACC)/American Heart Association (AHA) 2017 hypertension classification update reduced the threshold for hypertension from 140/90 mmHg to 130/80 mmHg, with stage 1 hypertension defined as a systolic BP (SBP) of 130 to 139 mmHg or a diastolic BP (DBP) of 80 to 89 mmHg.

Reference: https://jamanetwork.com/journals/jama/article-abstract/2712542

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