Today, the UK government has controversially published revised guidelines on safe drinking levels which see the recommended limits for men fall to 14 units a week, down from 21. The recommendations for women stay at 14. [You can access the report here.]
As wine lovers, we should be angry about this. Not because it’s telling us something we don’t want to hear, but because it is based on a highly questionable interpretation of the data. It seems as if the scientists and civil servants at the Department of Health are on a crusade to stop us drinking. They have an anti-alcohol agenda and this has led to a particular interpretation of the scientific literature on drinking and health which is, to put it bluntly, unprofessional and veering towards incompetent. In essence, we are looking at neo-prohibitionism manifesting itself in the guise of public health.
Drinking, when not to excess, is pleasurable and life-enhancing. Sharing a bottle of wine with a meal is a great pleasure. Drinking a negroni with a friend is a joy. Having a beer with a mate is life-enhancing. Alcohol, used correctly, is one of nature’s great gifts to humanity. Wine is deeply embedded within European culture, and it’s a rich, engaging part of life.
Alcohol abuse is terrible. Sharing a bottle of wine with a meal every night is not alcohol abuse. But this message from the government is evil in its intent: it wants to strip us of this joy, and make us feel guilty about doing something that is part of the pleasure of life. For no good reason. It smacks of control. Why would you want to take away fun from people, and then lie to them about why you are doing it? Can the government scientists really stand behind their conclusions as professionals? What is their real motivation?
So, let’s look at the science. The thorn in the side of neo-prohibitionists is the consistent observation that in Western populations moderate drinkers live longer than non-drinkers, who in turn live longer than heavy drinkers. This is called the ‘J-shaped curve’. It’s a consistent finding in what is known as “epidemiological” studies—those that look at the incidence and distribution of diseases, and their causal factors.
The J-shape refers to the curve on a graph you get if plot mortality (the risk of dying) against alcohol consumption. Moderate drinking increases life expectancy, mainly through its protective effects on the cardiovascular system—your heart and blood vessels. Heavy drinkers also enjoy this benefit, but their risk of death starts to increase because they are more likely to suffer from the various conditions related to heavy drinking, such as cirrhosis of the liver, stroke, certain cancers, and increased risk of accidental or violent death. It is a pretty robust finding that has been replicated in countless studies to the degree that it is no longer controversial.
It’s also quite a significant effect: one large study looking at research spanning back 25 years on the subject indicates that moderate drinkers cut their risk of heart attack by as much as one-quarter.
This message was reinforced by two papers published in the British Medical Journal in 2011, both from William Ghali and colleagues. These papers represented what is known as a meta-analysis, which is a study that attempts to bring together all published evidence on a particular subject from the medical literature in order to draw a more robust conclusion. In the first paper, Ghali carried out a review of the literature looking at studies that had examined the effect of alcohol consumption on biomarkers of coronary disease. They screened almost 5,000 articles, and included the results from 44, which were the relevant studies that met their criteria for suitable data. Overall, 13 biomarkers were included in the analysis. Alcohol was shown to significantly increase high-density lipoprotein (HDL) cholesterol, with a dose–response relationship, and it decreased fibrinogen levels. It didn’t change triglyceride levels but it increased adiponecting and apoplipoprotein A1. All of these changes are reported to be cardioprotective. The authors noted that these changes are “well within a pharmacologically relevant magnitude,” meaning that alcohol is acting as a prescribed medicine might. They point out that the degree of HDL cholesterol increase is better than can be achieved with any single therapy. Alcohol, consumed moderately, seems to be acting as a good drug.
The second paper looked at selected cardiovascular disease outcomes. It examined 4,235 studies, and 84 turned out to be suitable for inclusion in the meta-analysis. The results examined the relative risk of dying for drinkers versus nondrinkers, and once again came up with some significant results. A moderate drinker has 0.75 risk of dying of cardiovascular disease compared with a nondrinker, and 0.71 risk of incident coronary heart disease. An alcohol consumption of 2.5–14.9 g/day (roughly one or two drinks) results in a 14–25% reduction of risk of cardiovascular disease compared with abstainers. Both studies together suggest that alcohol may be having a causal role here: there is a dose–response relationship, and the association is specific, in that alcohol is not uniformly protective for other diseases, such as cancer.
I don’t drink because I think it’s healthy. But to deny this body of scientific evidence in order to produce a simple public health message is dishonest.
The other issue is risk. All drinking, we are told, carries a degree of risk. But as the evidence shows, the risk of dying only increases once you pass a certain consumption level. This is where the public health guidelines on healthy drinking should be focusing. And this point will differ for each individual: age, sex, weight, physical condition, psychology and biological make-up will all be factors here. But it is a much higher limit than 14 units.
So we should be angry about this report. We should be angry about being lied to. We should be questioning the motives of people who want to strip others of joy and make them feel guilty about doing something that’s more than just harmless – it’s actually a good thing. And there must be a lot of people within the department of health who realize that this latest set of guidelines are flawed, but who are scared of speaking out against the crazy neo-prohibitionist agenda.