Further Reading

Are there any positive effects of drinking alcohol?

Stanton,

Are there any positive effects of drinking alcohol?

Al

Dear Al:

There are many. The primary health benefits that have been noted from alcohol are a reduction in coronary heart disease, the number one killer in America, and the reduction in ischemic stroke, or stroke due to occlusion of the arteries in the brain due to plaque build up, which is the number three killer. Because of alcohol's beneficial effects in these two areas, moderate drinkers on average live longer than abstainers. Yes, Al, abstinence from alcohol is a risk factor for heart disease and stroke, and as a result for premature death.

Public health agencies have been so flamboozled by this finding that they constantly seek to understate it (this process is currently taking place in the formulation of the U.S. Dietary Guidelines, which are released by the departments of Agriculture and Health and Human Services every five years). The systematic distortions of the data in this area are worth noting briefly in order to refute them:

  1. The benefits of moderate drinking for heart disease and mortality are not well established.
    In fact, by now about fifty studies have discovered that moderate drinkers live longer on average than abstainers. So many studies of this type have been published that a number of meta-analyses have been conducted — these are studies that construct statistical models based on the combined results of individual studies. Perhaps the most renown epidemiologist in the world, Sir Richard Doll (whose picture hangs in Britain's National Portrait Gallery), has termed the evidence for alcohol's salutary effects for the heart as "massive."
  2. Behaviors aside from drinking, such as diet, account for the longer lives of moderate drinkers, or else results of such studies are misleading because many abstainers quit drinking due to illness or a drinking problem.
    No reputable epidemiological study of alcohol in the last ten years has failed to control for other likely health behaviors or conditions, like diet or weight and smoking. Likewise, any epidemiological study of alcohol conducted today either eliminates those who abstain for health reasons, analyzes only lifetime abstainers, or in other ways guarantees that the abstainer category is not weighed down by the sick and alcoholic.
  3. Since generally only older individuals die of heart disease, the benefits noted for alcohol apply only to those over the age of fifty.
    In fact, the largest study yet published on the effects of drinking on overall mortality, conducted by the American Cancer Society with a half million Americans, found that men and women over age 30 lived longer on average when they drank moderately. Of course, it is likely that such benefits begin to accrue before the age of 30 even though their consequences do not appear until later (particularly considering that atherosclerosis has been noted in Americans in their twenties and even younger).

It is ironic that groups which terms themselves public service health organizations take as their task to deny the validity of overwhelming data which show that drinking moderately is for most people beneficial, even adding to their expected life span. How have they decided that their mission is to keep this news from the mass and file of Americans?

However, the really untold secret is that drinkers as a group share a number of psychological, social, and cognitive benefits over abstainers. Archie Brodsky and I have forthcoming a review of these data: during the past decade, epidemiological research has found consistent associations between moderate alcohol consumption and such beneficial psychosocial outcomes as:

  1. a subjective sense of good health;
  2. better mental health on some indicators, such as reduced anxiety and depression, especially in response to stress;
  3. better long-term cognitive functioning, usually measured in old age;
  4. better work performance, measured in higher income;
  5. better work performance, measured in reduced absence or disability;
  6. better social integration and adjustment.

Indeed, drinking successfully is one of a handful of controllable health behaviors that significantly contributes to overall physical and emotional well-being.

Stanton

Dear Stanton:

You cite in argument 3 a study that found "... that men and women over age 30 lived longer on average when they drank moderately." How could researchers know this as most people do not die until several decades after their thirties? Was the study begun in, say, the fifties or sixties, and now the researchers are reaping the research rewards? Thank you for an extremely enlightening site. I have sent it to several of my more thoughtful friends.

Fred Ledoux

Dear Fred:

The crucial aspect of this research is that these studies are "longitudinal" or "prospective," meaning that people are identified according to their drinking at point 1 then followed for years and their survival noted at point 2. In the American Cancer Society study, by Thun and his colleagues (New England Journal of Medicine, 337:1705-114, 1997), 490,000 men and women were followed for eight years. Of course, you wouldn't expect a lot of people to die by age 38. This age group was actually identified as those 30-59, as opposed to those aged 60 and older, so we are examining deaths for this group occuring between the ages of 38 and 67. A total of 46,000 subjects of all ages died over the eight years, over 12,000 of them in the younger group. The investigators summarized for the entire population:

[T]he rates of death from all cardiovascular diseases combined were 30 to 40 percent lower among men (relative risk 0.7. . .) and women (relative risk 0.6. . .) reporting at least one drink daily than among nondrinkers. The largest reduction. . .occurred in mortality from coronary heart disease among drinkers who, at enrollment, had reported heart disease, stroke, or some other indication of pre-existing risk of cardiovascular disease. This subgroup contained one third of all the people in the study.*

In other words, it is for those who have developed coronary artery disease who are most likely to live longer from drinking regularly (with everything else the researchers could control for). How many doctors do you think mention this to their patients at risk for, or suffering from, heart disease?

*Nonetheless, these data do not find an advantage for women under 50 who do not have a risk factor for heart disease. Indeed, for women under forty, mortality risk "was slightly but not significantly increased."

Best wishes for a long life,
Stanton