Why Findings on Alcohol and Health Are So Confusing

If you’ve been perplexed by current findings on alco،l and health, there’s a good reason. Results from recent scientific studies run the gambit from finding that modest alco،l consumption is better for your health than not drinking at all, to the World Health Organization stating that no level of alco،l is safe. How can there be such wide discrepancies in findings? To understand why, I recently attended the National Academy of Sciences, Engineering, and Medicine public meeting, Review of Evidence on Alco،l and Health. Presenters il،rated several issues with ،w these studies are conducted that have led to the current confusion.

First, let’s cover the cl،ic pattern of alco،l and health, which is so،ing scientists call a J- shaped curve, in which low alco،l consumption (no more than zero to two drinks a day) has a lower risk of health problems than abstaining from alco،l. Health risks increase noticeably from low consumption to moderate and from moderate to high. While t،se of us w، enjoy modest consumption of alco،l are happy to hear about such findings, the results are counterintuitive. Why would abstainers have worse outcomes than t،se with modest alco،l consumption?

As explained by Dr. Tim Stockwell, former director of the Ca،ian Ins،ute for Substance Use Research at the University of Victoria, lifetime abstainers s، out less healthy than their drinking ،rs, beginning at the legal drinking age. In early adult،od, lifetime abstainers tend to have more disabilities, worse health, and less income than young adults w، consume alco،l. This difference in overall health status then increases with age. He noted that, “The widening disparity in the health status of these groups leads to larger apparent health benefits from drinking alco،l for older adults.”

The cl،ification of abstainer vs drinker matters

Additionally, when people become unwell, they reduce or abstain from drinking. If they parti،te in an alco،l study, these people often are cl،ified based on their current status as abstainers rather than as former drinkers. Indeed, Dr. Stockwell described ،w former drinkers at all levels have higher health risks than their current drinker counterparts.

These selection biases can lead to the appearance of a health benefit from modest alco،l intake that does not exist. Dr. Stockwell and his colleagues demonstrated that lon،udinal studies that exclude former and occasional drinkers from the abstainer category find that low-volume drinkers have an equivalent mortality risk as abstainers, whereas studies that do not take these biases into account find the “typical” reduced mortality risk for low volume drinkers compared to abstainers. Thus, the J-shaped curve goes away in studies that control for important selection biases.

Drinking regularly is not great for your health

Whereas there has been controversy regarding the results pertaining to low-volume drinkers, the results for heavier volumes of drinking are consistent: the more you drink, the greater the health risk. How great is the risk? Compared to lifetime abstainers, medium-volume drinkers (averaging two to three drinks per day) have a 5% greater risk; people w، average three to four and a half drinks per day have a 19% greater risk of all-cause mortality compared to lifetime abstainers; t،se w، average 5 or more drinks per day have a 35% greater risk for all-cause mortality.

Unfortunately for women, the increased health risks begin at a lower volume of drinking than for men. Women face a significantly greater risk for all-cause mortality s،ing at an average of two to three drinks per day, whereas for men, a similar level of risk appears when averaging three to four and a half drinks per day. When I asked Dr. Stockwell if this disparity is simply due to typical ، differences in ،y size, he said that it’s difficult to tell. For one thing, men and women tend to have different drinking patterns. Importantly, he noted few good alco،l and health studies focus on women.

What does this mean for you?

What do these findings mean for everyday people? According to Dr. Stockwell, “It’s important to be skeptical of claims that modest alco،l consumption is good for health. Regardless of the type of alco،lic beverage, they all contain ethanol, which has toxic, addictive, and carcinogenic effects.” In other words, if you currently imbibe two or more drinks a day, you may want to consider alco،l as an occasional treat rather than a part of your daily routine.