This article debunks the myth that moderate alcohol consumption is healthy, highlighting recent research that shows no level of alcohol is completely safe. It calls for a reevaluation of drinking guidelines and increased awareness of alcohol's health risks.

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Is there a safe level for alcohol consumption?

Tipplers may not be very happy to read this news. Till now, following conventional wisdom, they, like many others, believed that a glass of wine a day is good for them. They used this notion to justify their drinking behaviour.

They noted that over the years, many studies suggested that moderate drinkers enjoy longer lives with lower risks of heart disease and other chronic ills than abstainers do.

Such myths encouraged the widespread belief that alcohol, in moderation, can be healthy. However, not all studies have endorsed this belief. The just published new analysis explains why.

Suffice it to say that alcohol consumption and its impact on health needs more serious study.

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Many studies have flaws

1. The lead researcher, Tim Stockwell, PhD, a scientist with the Canadian Institute for Substance Use Research at the University of Victoria, asserts that papers linking moderate drinking to health benefits suffer from fundamental design flaws.
2. A major flaw is that those studies have generally focused on older adults and failed to account for people’s lifetime drinking habits. Thus, groups labelled "abstainer" and "occasional drinker," which included some older adults who had cut back or ceased drinking due to a variety of health issues, were compared to moderate drinkers.
3. “That makes people who continue to drink look much healthier by comparison,” Stockwell said. And in this case, he noted, “looks are deceiving.”

Method of analysis

After a thorough investigation, the researchers discovered 107 longitudinal studies with 724 estimates of the correlation between alcohol use and all-cause death for 4,838,825 participants, or 425,564 recorded deaths.

“Higher quality” studies had a mean cohort age of 55 years or younger; they were followed up beyond 55 years and excluded former and occasional drinkers from abstainer reference groups.

When they combined all the data, it looked like light to moderate drinkers (that is, those who drank between one drink per week and two per day) Compared with abstainers, they had a 14% decreased chance of passing away during the study period.

This conclusion changed when the researchers carried out a closer analysis. The team had a handful of “higher quality” studies that included people who were relatively young at the outset (younger than 55y, on average) and that made sure former and those who drank occasionally were not regarded as "abstainers." Moderate drinking did not correlate with a longer life in those trials.

The researchers discovered that it was the “lower quality” studies of (older participants, no distinction between former drinkers and lifelong abstainers) that linked moderate drinking to greater longevity.

“If you look at the weakest studies,” Stockwell said, “that’s where you see health benefits.” “There is simply no completely ‘safe’ level of drinking,” He asserted.

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WHO statement

On 4 January 2023, WHO stated:

“we cannot talk about a so-called safe level of alcohol use…. It doesn’t matter how much you drink – the risk to the drinker’s health starts from the first drop of any alcoholic beverage”.

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The Lancet study

A report titled Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 (The Lancet on line 23 August 2018) stated thus:

“Alcohol use is a leading risk factor for disease burden worldwide, accounting for nearly 10% of global deaths among populations aged 15–49 years and poses dire ramifications for future population health in the absence of policy action today. The widely held view of the health benefits of alcohol needs revising, particularly as improved methods and analyses continue to show how much alcohol use contributes to global death and disability. Our results show that the safest level of drinking is none”

A press release from the Science Media Centre, London published the views of three experts on The Lancet report.

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Expert comments

While acknowledging that there are many challenges in interpreting the complex relationship between alcohol consumption and health, Dr. Tony Rao, Visiting Researcher at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, pointed out that the study has effectively addressed many of these issues.

“We can now be more confident that there is no safe limit for alcohol when considering overall health risks.” He clarified.

“The finding of a 7 per cent higher risk of developing any of the 23 alcohol-related disorders for people drinking an average of 17.5 units of alcohol per week compared with non-drinkers now challenges current U.K. guidance for lower-risk drinking, which recommends no more than 14 units per week. This may well be an underestimate in people aged 50 and over, as the study did not include mental disorders such as alcohol-related dementia.”, the psychiatrist warned.

Based on the data provided by the authors but not published in the paper, Prof David Spiegelhalter, Winton Professor for the Public Understanding of Risk at the University of Cambridge showed that the estimated harm to moderate drinkers is at a very low level and suggested that UK Guidelines off extremely minimal danger.

“Given the pleasure presumably associated with moderate drinking, claiming there is no ‘safe’ level does not seem an argument for abstention. There is no safe level of driving, but the government does not recommend that people avoid driving. Come to think of it, there is no safe level of living, but nobody would recommend abstention.”

Prof Jeremy Pearson, Associate Medical Director at the British Heart Foundation stated that while there may be a slight benefit to heart and circulatory health from modest drinking(?), many studies have demonstrated that the hazards of alcohol consumption for general health outweigh any benefits.

“This study confirms that drinking more than the recommended limit of alcohol increases your risk of suffering from heart and circulatory conditions, particularly hypertension and stroke, which are major contributors to death rates worldwide.”, he cautioned. "If more of us stuck to the UK drinking guidelines, we would take a big step in the right direction to reduce the scale of deaths caused by alcohol.”

It is not surprising that some writers concluded this many years ago: “Alcohol at any level is injurious to health” (The Wire, 27 August 2018).

The National Institute on Alcohol Abuse and Alcoholism has comprehensively summarised “Alcohol’s Effects on Health”. Every high school in India must hold alcohol risk awareness programmes based on this booklet.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr K S Parthasarathy is a former Secretary of the Atomic Energy Regulatory Board and is a medical physicist with a specialisation in radiation safety and regulatory matters.