There Really May Be No Health Benefits to Drinking Alcohol

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In studies on alcohol and mortality, former drinkers may be misclassified as lifelong abstainers. But, once you remove that “systematic error,'' moderate consumption, such as a glass of wine a day, doesn’t appear to be protective. “Clinicians need to be highly skeptical about the hypothesized health benefits of alcohol consumption and should not advise their patients to drink to improve their life expectancy. This is especially important given increasing awareness of cancer risks from even moderate alcohol use.” As I discuss in my video, Do Any Benefits of Alcohol Outweigh the Risks?, if there are only harms without any benefits, then routine alcohol intake should be zero.

Many population studies classified those who “quit drinking in response to ill health” as nondrinkers. The problem of reverse causation is that poor health may have led to abstaining from alcohol consumption, rather than abstaining from alcohol consumption leading to poor health. This is one reason why interventional trials (like randomized controlled trials) tend to offer better evidence than observational studies of populations, which can suffer from reverse causation and confounding factors. Indeed, light to moderate drinkers “display a range of healthy behaviors, such as better diet and more physical activity,” so they may be more likely to drink their wine with a salad than a cheeseburger, and that’s why the alcohol appeared protective. 

Randomized controlled trials can be difficult to execute, though. We can’t have people smoke a pack a day for a few decades, for instance, so we may need to rely on observational studies — or use a new tool. 

Can we study people who were randomly assigned since conception not to drink as much? Remarkably, yes. 

The Science

Our liver detoxifies alcohol into carbon dioxide and water by two enzymes, ADH1B and ALDH2. Acetaldehyde is produced in the process, which can cause nausea and flushing sensations. For those born with variants of either enzyme, acetaldehyde can build up, making alcohol consumption an unpleasant experience. So, they are born less likely to drink as much. Do they have an increased risk of heart disease, as the original observational studies would suggest? No, they have a reduced risk of heart disease, which “suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.”

This “sheds doubt on protective associations between ‘moderate’ alcohol consumption and coronary heart disease. Given the harms attributed to alcohol use, it is not surprising that reports suggesting possible mortality benefits for low-level users attracted enthusiasm among consumers, the media, and the alcohol industry … [but] these apparent benefits are now evaporating …”

If something looks too good to be true, it usually is. “As an intoxicating, addictive, toxic, carcinogenic drug, alcohol is not a good choice as a therapeutic agent,” even if it did help. There are better ways to prevent heart attacks, namely diet and exercise (and, when necessary, drugs).

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Tags: healthy living, Mental Health, wellness

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Written By

Dr. Michael Greger

A founding member and Fellow of the American College of Lifestyle Medicine, Michael Greger, MD, is a physician, New York T... See Full Bio

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