BHEKISISA
Is it cheers to saying cheers? Why science says no to drinking alcohol
Thirty years ago, having a drink or two every day was thought to be good for your heart — thanks in part to the so-called French paradox. But research now shows that even a little alcohol can up the chance of developing some types of cancer.
In 1991, the host of the news programme 60 Minutes in the United States (US) went to France in search of an answer: why were the French, with a diet known for being high in fat, less likely to die from heart disease than the Americans?
A French scientist told him, and millions of viewers, that drinking wine in moderation could explain this French paradox.
At the time, the US wine industry had been in a seven-year slump. Judging by subsequent sales, consumers quickly got on board.
More than thirty years later, however, the enthusiasm for drinking any kind of alcohol in moderation is waning.
A podcast episode in which Stanford neuroscientist Andrew Huberman described alcohol — even in moderation — as “poison”, was among the most-shared episodes on Apple Podcasts in South Africa last year.
Also in 2023, authors from the World Health Organisation wrote in Lancet Public Health that “no safe amount of alcohol consumption for cancers and health can be established”.
Their view mirrored shifts in some organisations’ guidelines for alcohol use over the past few years.
For example, the American Cancer Society (ACS) used to say that women who drink, should cap alcohol use at one drink a day and men, at two. (A drink was defined as 355ml of beer, 148ml of wine or 44ml of hard liquor.)
But its 2020 guidelines for cancer prevention say it’s “best not to drink alcohol” at all.
The reason for the change, says Marjorie McCullough, the ACS’ senior scientific director of epidemiology research, is that the evidence about the links between alcohol consumption and cancer has evolved, with research showing that drinking even small amounts of alcohol could up someone’s chance for developing some types of cancer, including breast cancer.
Until about the middle of last year, the Heart and Stroke Foundation South Africa’s website advised that those who drink, do so in moderation — up to one drink per day for women and two for men. (In this case, one drink is 340ml of beer, 120ml of wine, 60ml of sherry or 25ml of spirits.)
When contacted for this piece, the head of the Foundation, Pamela Naidoo, referred Bhekisisa to a World Heart Federation policy brief for updated recommendations that say there’s “no safe level of alcohol consumption”.
Alcohol and the heart: it’s complicated
The idea that moderate drinking — around two drinks a day or less — is good for the heart had gained momentum by the 1990s.
Some scientists believed moderate drinkers were less likely to have heart attacks than nondrinkers, partly because alcohol upped their “good” cholesterol levels. Cholesterol molecules made up of high-density fat-bound proteins are said to be of a “good” type because they help to carry cholesterol with a low density out of the blood and back to the liver, which prevents the waxy, fatty substance from building up in someone’s arteries, restricting blood flow, which could cause a heart attack.
However, research increasingly shows that the possible protective effects of drinking a little alcohol have been exaggerated.
Jürgen Rehm is a senior scientist at the Centre for Addiction and Mental Health in Toronto, Canada. He points to a 2023 study that found no evidence among Chinese men that regularly drinking small amounts is heart-healthy.
In fact, he says, “these [beneficial] effects are overemphasised because of problematic methodological designs and most of the research coming from [only] a few countries”.
One reason why the once-thought benefits of alcohol now seem to be smaller is that some studies made nondrinkers look worse off than they were.
This happened because abstainers were lumped together with sick people who used to drink, known as “sick quitters”.
Alcohol use might, therefore, not adequately explain why moderate drinkers are less likely to have heart attacks than nondrinkers.
Causing cancer since (at least) the 1980s
The link between alcohol and cancer is less contentious.
Alcohol use can make it more likely that someone could develop one of at least seven types of cancer — mostly of organs or tissues along the digestive tract, such as the mouth, throat, voice box, oesophagus, liver and colon — and also breast cancer in women.
One way in which this happens is that ethanol (the type of alcohol that gives drinks their zing) breaks down to a chemical called acetaldehyde, which damages DNA.
A 2017 study published in the European Journal of Public Health calculated that, in that year, there could have been 23,000 fewer new cancer cases in the European Union if people who drank up to two drinks a day did not drink at all. (A drink was defined as about 300ml of beer, 100ml of wine or a shot of spirits.)
Most of the cancer cases linked to what the authors called light to moderate drinking were breast cancers.
Rehm, the co-author of that study, told Bhekisisa breast cancer will likely make up a large share of cases caused by light to moderate alcohol use in other parts of the world too, including in Africa.
Even though the International Agency for Research on Cancer found, more than 30 years ago already, that alcohol can cause cancer, experts say few people are aware of the link.
According to McCullough, part of the problem is that some doctors aren’t aware of this either and that “there haven’t been broad public health campaigns to raise awareness”.
(How much) should we drink?
A 2022 analysis of data from the 2020 Global Burden of Diseases (GBD) Study cautions that a one-size-fits-all set of guidelines for alcohol use won’t work. Instead, things like people’s age and where they live should be factored in.
Broadly speaking, the authors suggest that people between 15 and 39 should avoid alcohol because they are more likely to get injured after drinking — for example, from being involved in car accidents or fights.
For older people, who are more likely to suffer from alcohol-linked diseases such as heart disease or cancer, it’s not as simple. For one, small amounts of alcohol could lower the risk of some diseases (like coronary heart disease) but increase the risk of others (for example, breast cancer).
This is where location comes in. The diseases that typically occur in a country or region influence the amount of alcohol that is considered safe for the people who live there.
Here it’s important to know what disability-adjusted life years or DALYs are: one DALY represents the loss of one year of full health because of disability or death.
Dana Bryazka, lead author of the GBD 2020 alcohol analysis and researcher at the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine, explains that in some places, a disease such as tuberculosis (TB) might make up a big share of total DALYs.
And because heavy drinking can make it easier for someone to develop TB because it weakens the immune system, the amount of alcohol that is considered safe for those adults would be lower than in a place where coronary heart disease makes up a big part of the DALYs.
Charles Parry, a substance abuse epidemiologist at the South African Medical Research Council who was part of the recent GBD analysis, says older people shouldn’t assume that drinking a little will benefit them.
“GBD results refer to population health rather than individual health, so it’s risky if people ‘blindly’ [apply] the population-level findings to themselves.”
Putting a cap on the tap
South Africa doesn’t have national drinking guidelines “because we don’t recommend alcohol intake”, says the health department’s spokesperson Foster Mohale. (The country’s food-based dietary guidelines used to recommend drinking “sensibly”, but this guideline was dropped in 2012.)
One of the countries that recently updated its drinking guidelines is Canada. Published in January 2023 and funded by the government, they recommend much lower alcohol use than in 2011.
Back then, women were urged to drink no more than 10 drinks a week and men to limit their weekly drinking to 15. (A drink was set at 341ml of beer or cider, 142ml of wine or 43ml of spirits.)
The new guidelines, though, say people should have only two drinks a week if they want to limit the chance of harm. At three to six drinks per week, someone’s risk of developing cancer increases, thereby putting them at “moderate risk”.
Put differently, explains Peter Butt, clinical associate professor at the University of Saskatchewan’s College of Medicine and co-chair of the project to update Canada’s drinking guidelines: if a Canadian has up to two drinks a week, the chances of alcohol use causing early death are 1 in 1,000. If someone has up to six drinks, the chances shoot up to 1 in 100.
Beyond this limit, “increasing risk [is] conferred by every additional drink,” according to the guidelines.
The drop in the number of drinks per week has been controversial, though.
Dan Malleck, a professor of health sciences at Brock University, told The Guardian: “We aren’t just machines with inputs and output of chemicals or nutrition.”
Cheers?
What does it all mean?
Overall, drinking less is better for your health.
Parry’s advice is to consider your health and history when deciding whether to keep drinking.
“For example, do you have a family history of cancer? Where do you drink — at home or do you walk to a pub or shebeen, which might put you at greater risk of injury? Do you have high blood pressure? Is it well managed?”
If you don’t drink, experts say it’s not a good idea to start.
As Butt notes: “We can’t choose what organ, or what aspect of a system, will be impacted by the alcohol we consume. The net whole-body effect [of alcohol] is negative.” DM
Liesl Pretorius is an award-winning freelance journalist from Johannesburg and a former editor at Africa Check, Netwerk24 and City Press. This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
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Alcohol is really starting to feel like a remnant of a bygone time. Walk past your local pub and take not of the demographic, it’s likely there will be an older crowd.
Why do we like beer for instance? Possibly because it’s been so heavily promoted by western culture as being desirable? Take a step back and you may realise it’s pretty rubbish.
Pubs in retirement villages perhaps – go to any clubs anywhere and alchohol flows freely without a ‘grey hair’ in sight.
Hahahahaha
Beer, in its infinite variety of forms, has been a part of most cultures for thousands of years, as has wine – ironically first produced in what is today Iran, I think. It’s not a ‘western’ construct at all.
There are lots of ‘could’ and ‘might’ and other speculative terms in the article that seem to indicate that moderate alcohol consumption may contribute to deaths. Personally, I love wine, enjoy beer and occasionally sip on a good whisky. In my mid-50s, I’ve yet to have any major health scare, am relatively fit and enjoy life to its fullest, whilst a teetotal sibling of mine is almost always ill, from the common cold to hospitalisation. Not a major sample to work with, but it’s mine and I’ll stick to it! Cheers!
What fantasy land are you living in?
Also, beer is one of the most delicious things on the planet!
Andrew Huberman is a youtube celebrity, masquerading as a “scientist”. Alcohol is a poison, viewed from a narrow perspective. So is the food we consume, taking into account modern mass production. I enjoy both.
Thanks for that, CE. Like probably, I’m getting more and more gatvol with these loudmouths who just seem to do it to make their fame and fortune. And when you hear that 23000 people in the EU might not have died if they’d stopped drinking two glasses of alcohol a night (out of FOUR HUNDRED AND FIFTY MILLION people!) you really do despair.
Sadly Charl is wrong. Huberman is a respected academic who works at Stanford.
“He hosts the Huberman Lab podcast, which he started in 2021 and he is partner, scientific advisor and promoter of dietary supplement companies since 2022.”
Oh right. And how can be both a neuroscientist AND an opthalmologist? Wow. Amazing.
Many scientists are cited in this piece.
Incorrect. Huberman is an associate professor of neurobiology and ophthalmology at Stanford University School of Medicine. He just happens to be one of the first academics to have used podcasting as a way of sharing their findings.
A new study has conclusively proved that breathing air will result in your death 100% of the time. Everyone who’s ever breathed air has died or will die at some time, so therefor, if you want to live stop breathing!
Not even funny … just outright SILLY
People who drink have sense of humor. Those who don’t drink will sadly also die in due course and therefore have no sense of humor.
But true
I chuckled…
Americans have blamed alcohol for society’s problems since the Pilgrims. It culminated in Prohibition, between 1920 and 1933.
Apart from boosting the mafia, Prohibition did not lead to a significant fall in death rates, as had been predicted.
But now, once again, Americans are thumping the tub and saying it should be banned.
They can go and jump in a lake of milk.
I’ll drink to that!
Oh dear, oh dear. For presumably intelligent people, you are kidding yourselves. Google the WHO article in The Lancet – 4/01/2024. Sad but true.
The WHO, the same organisation that shut down the world and told us we were all going to die from the flu? That one?
2 drinking related quips I’ve always enjoyed…
Not drinking doesn’t actually make you live longer …it just feels like it.
A lady turning 100 was asked by if she was amazed to have reached such a grand age drinking as much as she did. “Oh no dear”, she said “when I started it wasn’t bad for you”
On a more serious note, I have idly wondered whether the relaxing qualities of moderate alcohol consumption might counter the life reducing potential of stress at some level, and whether studies have been done regarding this.
Fanie spot on.
Did the study consider the stress levels of the subjects and what was going on their lives?
To meet research protocol requirements, science studies often struggle with too many variables so sometime are forced to just disregard certain information.
What makes all of this far more complex is that folk in four of the five Blue Zone countries, where living to a strong, vigorous busy ninety is the norm, and ten times as many live to 100, they drink 2 or 3 glass of wine or beer every day.
However there is a BUT and it’s a big one. They aren’t drinking commercial alcohol; it’s locally produced, unpasteurised and has no preservatives like sulphites added. Wine like that is a potent probiotic.
For those who are adamant they can’t or won’t quit, perhaps the solution is to start a home brew. Brewing apple cider, various wines and meads is not difficult. Beer is rather more trying.
I brew (and drink!) about 100L of mead every year, and am perhaps kidding myself that it actually contributes to wellness. Time will tell.
I agree with you home brewing in any culture is beneficial as it increases quality time between families, every family has genetic moral values.
No addictives used to create more strength for a wider dilution for more sales.
Take everything Europe says with a pinch of salt, they will say this is wrong and go and do it once out of cameras.
Aren’t some of those cancers hereditary?
We’ve been told, for a long time, that red wine is good for preventing cancer… Now this!
Maybe the way to go is for individual, case-by-case basis where one must weigh the odds against their specifics(like family history, age, etc).
Have we not seen people leading contrasting Lifestyles to the extreme, one being a teetotaler ;eating :healthy’ food and going to the gym (exercising) only to die of cancer prematurely, while on the other hand an alcoholic who eat junk food most of the time and never goes to the gym ends up living longer? , so, lifestyle alone, don’t explain this issue.
Alcohol is definitely one of the least healthy, most boring, most addictive, and most socially harmful drugs. That said, I do still enjoy a glass of wine from time to time.
For thousand of years, mankind has brewed and consumed alcohol, but now scientist claim it will kill us?
Frankly, considering the rampant breeding of the human species, we could use a little decimation.
“Science” does not say anything about alcohol consumption. Certain scientists claim that alcohol consumption of any amount raises the risk of getting cancer and other deleterious health consequences. However, there is no quantification of this risk. Is it greater than driving a car or walking across the street in a busy city? Articles like this are alarmist and unhelpful.
I’ve been drinking all my life. I’ve been healthy all my life. I’ve been to parties in my younger days where I drank myself into happy oblivion and survived. Many times. I’m not an alcoholic or habitual drinker and can go for long periods without touching the stull. As an octogenarian I feel fully qualified to say that I’ve followed the right path to a long life enriched by the enjoyment of drinking with friends and relatives. If drinking is so bad how come life expectancy is continuously rising around the world? Japan is a moderately average consumer of alcohol with less than 7% of its population abstaining, and yet it has the longest life expectancy on planet Earth. So, don’t be frightened by the alarmists. They’re everywhere and seldom right.
Is this a ‘tongue-in-the-cheek’ article? Because as a serious ‘provide information’ piece, it makes no sense! Rather haphazard quoting of conflicting sources.
I’m pretty sure everyone knows alcohol is bad for you…I wouldn’t have thought it would take a scientist to work that one out. Does that make me want to not drink? No, no it does not…
As others have said here, these articles are alarmist. No empirical conclusions can be drawn from these studies, there are far too many other variables involved- too many to list here….
I’m 66 & still working 10 to 12 hour days full-time, running a conservation/community foundation, travelling to & around East Africa every 6 weeks for 2 to 3 weeks at a time.
At the end of the day I look forward to a glass of white wine & 2 glasses of of red every night with dinner, a great stress reliever & leveller.
I’ve been doing this for +40 years. Not on any medication whatsoever, nothing, nada.
According to the ancient Greeks – “everything in moderation, including moderation itself”.
Eggs will kill you with their high cholesterol. NO They are good for you, eat more eggs.
Butter bad, Margarine good. NO margarine is full of trans fats clogging your arteries. Use butter .
Red wine is good for you. NO it will kill you.
I am too old to die young so will wait for the next set of “Experts” and keep on drinking.
“South Africa doesn’t have national drinking guidelines “because we don’t recommend alcohol intake”, says the health department’s spokesperson Foster Mohale.” – in a country with a serious drinking problem … ???