Just how risky is alcohol?


alcoholNow that the media storm has blown over it is time to bite the bullet and dig a small bit into the latest Lancet article on alcohol that came out on 23rd August. It has been generally believed that a glass or two, and no more is actually beneficial. For example a study into individuals aged 90+ observed that there appeared to be a correlation that … “was associated with 18% reduced risk of premature death”. 

Does the latest Lancet article change that view?

OK, let me be open about this, I have a natural bias in play. Since I enjoy a glass or two I’d really like to believe it to be beneficial, yet I do also have to recognise that studies such as the 90+ study are a correlation and not a causal relationship.

There are some rather clear facts …

  • People who are drinking large amounts of Alcohol will most probably not make it to 90+. We know that the more you drink the more adverse the health effects will be, so that 90+ study was focusing on moderate consumption.

Knowing that the 90+ folks enjoy a glass a two is not the entire story. If you are 90+ and still enjoying a glass or two each day, then it is distinctly probable that it is your good health that enables you to be able to enjoy a glass or two, and it is not the glass or two that causes your good health. The things that might be the actual causal reason for your good health may be something quite different, such as exercise, diet, genes, etc…

Silly example: Folks who are 90+ play bingo, therefore playing bingo enables you to live to be 90+ … right?

What does the latest article in the Lancet reveal?

Let’s take a look.

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

The study is basically a huge exercise from the Gates Foundation-funded Institute for Health Metrics and Evaluation (IHME) in Seattle.

We know heavy Alcohol use is a leading risk factor for death and disability, but when it comes to moderate consumption it becomes complicated. For some conditions it appears to offer possible protective effects, but that consumption also brings risks for other things.

What exactly is new about this study?

Before this new study was published there was some evidence to suggest that a low intake might have a protective effect on specific conditions such as ischaemic heart disease and diabetes. That evidence had problems, it relied on self-reported survey data to estimate consumption levels and trends. What this new study does is to improve available estimates of alcohol use and its associated health burden in five ways.

  1. They consolidated 694 individual and population-level data sources to estimate alcohol consumption levels among current drinkers.
  2. They developed a method to adjust population-level consumption for alcohol consumed by tourists.
  3. They improved pre-existing methods that account for unrecorded population-level consumption.
  4. They did a new systematic review and meta-analysis of alcohol use and 23 associated health outcomes, which they used to estimate new dose–response curves of relative risk.
  5. Using the new relative risk curves and a new analytical method, they estimated the exposure of alcohol consumption that minimises an individual’s total attributable risk.

What did they find?

Basically it boils down to this.

The ideal level of alcohol consumption that minimised harm across health outcomes was zero standard drinks per week.

Yikes!

It goes into a lot of detail, but essentially this is what they are saying …

Some numbers

Via the associated press release …

  • Globally, one in three people drink alcohol (equivalent to 2.4 billion people), and 2.2% of women and 6.8% of men die from alcohol-related health problems each year.
  • Alcohol use was ranked as the seventh leading risk factor for premature death and disability worldwide in 2016, and was the leading cause for people aged 15-49 years old. In this age group, it is associated with tuberculosis, road injuries, and self-harm.
  • For people aged 50 years and older, cancers were a leading cause of alcohol-related death, constituting 27.1% of deaths in women and 18.9% of deaths in men.
  • The authors suggest there is no safe level of alcohol as beneficial effects against ischemic heart disease are outweighed by the adverse effects on other areas of health, particularly cancers.

Translation of this Risk

The authors of the Lancet article are arguing that due to the relative risks (balancing the benefits against other risks) that there are no safe limits and that zero is best.

But what exactly is the risk of just 1 drink per day?

The associated press release spells it out like this …

They estimate that, for one year, in people aged 15-95 years, drinking one alcoholic drink a day increases the risk of developing one of the 23 alcohol-related health problems by 0.5%, compared with not drinking at all (from 914 people in 100,000 for one year for non-drinkers aged 15-95 years, to 918 in 100,000 people a year for 15-95 year olds who consume one alcoholic drink a day).

In other words, no drinking means that 914  people out of 100,000 develop a health issue, and adding just one drink per day into the mix means that 4 more people out of that same 100,000 experience a health problem … the other 99,082 don’t.

While one drink a day is not risk free, this is a very low-risk, and is on par with many other very low risks.

Note that they start with a baseline of 1 for zero alcohol. This is because being alive is a low risk. The risk is real, but nobody would seriously suggest life abstention to avoid that risk.

Bottom Line: Don’t panic, if you enjoy a glass or two then don’t fret that it will cost you many years of lifespan, it probably won’t, the risk is very low. But don’t over do it, because the data is clear, heavy usage will.

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