You can buy T-shirts, tote bags and stemware printed with the long-held belief that “a glass of wine a day keeps the doctor away.” But does it?
According to research published in the journal PLOS Medicine by Ulrich John of University Medicine Greifswald, Germany and colleagues, if you drink alcohol in the name of health, you might want to reconsider your position.
In their study of 4,028 adults, the researchers found that increased mortality among abstainers may largely be explained by other factors, such as a history of alcohol or drug dependence, smoking and poor health.
Doctors in many countries recommend light alcohol intake — a glass of wine or pint of beer per day — to benefit patients’ health, says John. This is an interpretation of older epidemiological studies “with many shortcomings,” which suggest that alcohol abstainers have a higher mortality rate than those who drink low to moderate amounts.
The new study found no significant difference in mortality between abstainers in good health and those who drank moderately, and counters recommendations to drink alcohol for wellness reasons.
The main message is that people should remember to reduce their drinking, (regardless) of whether they are high consumers or very low consumers.
“Our study is now one more mosaic stone in the evidence,” says John, “which is coming to show that what we believed for decades might not be true.”
Evidence suggests that other health behaviours — including a sedentary lifestyle, tobacco and substance use — have a dose-dependent relationship to mortality and health disorders: the greater the exposure, the higher the risk. John found it “very implausible” that alcohol should be an exception.
The main shortcoming of the older epidemiological findings, he explains, is the lack of detail about the drinking habits of abstainers. Current abstainers include both past drinkers and lifelong abstainers: the previous research didn’t explore factors such as how much the former group drank and when they stopped. There’s also the “sick quitter” hypothesis — referring to a subgroup of abstainers who stop drinking because of illness or drug interactions — which was of interest to John and his colleagues.
“We undertook this research to ask, what kind of people are these? What characteristics do they have?” he says.
Between 1996 and 1997, John’s research group investigated 4,028 adults using standardized diagnostic interviews, which included “very exact” information on health, alcohol and drug use, and smoking habits. Twenty years later, the researchers revisited the data — which included mortality information — and drew comparisons between alcohol abstainers and low to moderate drinkers.
They found that 91 per cent of alcohol abstainers were former drinkers and 72 per cent identified with at least one of the following risk factors: a former alcohol or drug use disorder, former risky alcohol consumption (drinking “a little bit too much per day”), efforts to cut down or stop drinking, daily tobacco smoking, or fair to poor health. There was no statistically significant difference in mortality rate between the healthy abstainers without any of these “factors that predict early death” and those who drank low to moderate amounts of alcohol.
Large epidemiological studies such as the Women’s Health Initiative Observational Study have shown that drinking even small amounts of alcohol increases the risk of breast cancer, says John, which is the most common type worldwide and the second leading cause of death from cancer among Canadian women. Drinking alcohol can also raise blood pressure levels and has been linked to increased risk of hypertension, a major cause of premature death.
“If people talk about alcohol, they always warn of becoming alcohol dependent … but these people are less than two per cent of the health disorders which may accrue from alcohol,” he adds. “Prevalent health disorders — cardiovascular disorders and cancers — should be much more stressed, and particularly breast cancer. It’s very, very important because it’s the number one cancer among females.”
There are parallels between the tobacco and alcohol industries, John highlights, and he sees the benefit of taking the same actions, such as health warning labels on packaging. Though they share similarities, alcohol lacks a strong global movement comparable to initiatives like the WHO Framework Convention on Tobacco Control.
“Alcohol has a very, very long tradition in culture. So, it will be a huge endeavour to go ahead with this message that the best is to stay abstinent from alcohol,” says John.
Despite the risks, from articles touting “immune-boosting cocktails” to those promoting the antioxidant properties of red wine, alcohol still benefits from the health halo effect. “We have all these lessons learned from the tobacco industry and the alcohol industry acts in a very, very similar way. So they support studies and investigations about these hypotheses, and particularly resveratrol.”
Resveratrol, an antioxidant found in more than 70 plant species — especially grapes — is often cited as being central to wine’s purported health benefits. While “it is not known whether there is a safe and effective dosage for chronic disease prevention,” according to the Linus Pauling Institute, most supplements contain 250 to 500 milligrams of resveratrol; a 150-millilitre (5-ounce) glass of red wine, on the other hand, has less than a milligram (0.2–0.5 mg, depending on the type of grape).
“You have to take huge amounts to have an effect,” says John. “And based on the evidence we have right now, these hypotheses do not make sense.”
In Ontario alone, alcohol sales increased by more than $2 million a day in the first four months of the pandemic, according to March 2021 research published in the Annals of Internal Medicine. On social media, alcohol is the subject of overwhelmingly favourable depictions. Another recent study published in the Journal of Studies on Alcohol and Drugs found that almost all (98 per cent) of #alcohol videos on TikTok portray drinking positively.
Given the influence of social media platforms on health behaviours, and the fact that more than one-third of TikTok users are underage, this finding is significant. “Increased youth exposure to alcohol marketing on social media is linked to earlier drinking initiation and greater levels of overall alcohol consumption,” lead researcher Alex Russell of the University of Arkansas said in a statement.
John’s conclusion from their study, as well as a mounting body of evidence, is that no matter how much you drink, you should drink less. “The main message is that people should remember to reduce their drinking, (regardless) of whether they are high consumers or very low consumers.”
The best way to prevent alcohol-related health disorders — “namely cardiovascular disease and cancers, and mortality as well” — is not to drink it at all, he adds, which is in line with the World Cancer Research Fund’s recommendations. But people might also change their drinking, limiting it to a glass of wine on holidays, for example, and abstaining the rest of the time.
Going dry for the month of January has been gaining traction in recent years (as has its fall counterpart, Sober October). Hot on the heels of New Year’s Eve, participating in alcohol-free challenges like Dry January can be enlightening. “Many people do not know that they are, in reality, alcohol dependent,” says John. “And this is the best way to learn.”