Is alcohol good for you?

Doubts Galore


By now, it is a familiar litany. Study after study suggests that alcohol in moderation may promote heart health and even ward off diabetes and dementia. The evidence is so plentiful that some experts consider moderate drinking — about one drink a day for women, about two for men — a central component of a healthy lifestyle.

But what if it’s all a big mistake?

For some scientists, the question will not go away. No study, these critics say, has ever proved a causal relationship between moderate drinking and lower risk of death. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy.

“The moderate drinkers tend to do everything right — they exercise, they don’t smoke, they eat right and they drink moderately,” said Kaye Middleton Fillmore, University of California.

Some researchers say they are haunted by the mistakes made in studies about hormone replacement therapy, which was widely prescribed for years on the basis of observational studies similar to the kind done on alcohol. “The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study,” said Dr Tim Naimi, Centre for Disease Control and Prevention.

Even avid supporters of moderate drinking temper their recommendations with warnings about the dangers of alcohol, which has been tied to breast cancer and can lead to accidents even when consumed in small amounts, and is linked with liver disease, cancers, heart damage and strokes when consumed in larger amounts.

Nothing is universal

“It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative,” said Dr Arthur L Klatsky, who wrote a landmark study in the early 1970s finding that members of the Kaiser Permanente health care plan who drank in moderation were less likely to be hospitalised for heart attacks than abstainers.

Health organisations have phrased their recommendations gingerly. The American Heart Association says people should not start drinking to protect themselves from heart disease. The 2005 US dietary guidelines say that “alcohol may have beneficial effects when consumed in moderation.”

The association was first made in the early 20th century. In 1924, a Johns Hopkins biologist, Raymond Pearl, published a graph with a U-shaped curve, its tall strands on either side representing the higher death rates of heavy drinkers and nondrinkers; in the middle were moderate drinkers, with the lowest rates. Dozens of other observational studies have replicated the findings, particularly with respect to heart disease.

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