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No such thing as ‘free drinks’: Experts debate risks of alcohol consumption
PHILADELPHIA — Current national guidelines recommend that alcohol, if consumed at all, should be consumed in moderation — one drink per day for women and two for men — and not at all in those aged younger than 21 years.
At the 2019 Food & Nutrition Convention & Expo, experts evaluated data from a recent meta-analysis and discussed whether the guidelines should change.
Risks associated with drinking
“Drink less. It’s simple,” Max Griswold, a PhD student and policy researcher for the RAND Corporation, told Healio Primary Care.
Griswold presented findings from his 2016 study, published in the Lancet, that found any alcohol use increased the risk for adverse health conditions.
The study assessed the relative risk associated with alcohol using data from 592 retrospective and observational studies involving 28 million individuals and 21 disease outcomes.
Griswold and colleagues found that alcohol was the leading risk factor for global deaths among those aged 15 to 49 years. In addition, they found that 5.1% of all deaths in 2016, or 2.8 million deaths, were attributed to alcohol use.
Ischemic heart disease and type 2 diabetes both had J-shaped curves, meaning the risk went down with moderate alcohol consumption; however, for all other diseases, including cancers, the risk went up with any alcohol consumption. As the benefits for ischemic heart disease were typically not seen until patients were aged in their 70s, the study suggests that the benefits of alcohol consumption do not outweigh the risks for most patients.
“There’s no ‘free drinks,’” Griswold said during the presentation. “As soon as you start drinking, your risk increases for developing adverse health conditions.”
“I think we should be considering alcohol similarly to the recommendations that we make for smoking,” he told Healio Primary Care. “You’re not going to cause someone overnight to quit smoking, but I would hope that doctors are a little bit more forceful in their recommendations to drink less.”
A different view of the research
Eric Rimm, ScD, a professor of epidemiology and nutrition at Harvard TH Chan School of Public Health, agreed with Griswold that underage and binge drinking are detrimental to health and that alcohol in excess should not be recommended in dietary guidelines. However, he felt that meta-analyses only have modest value and explained that “when consumed at one to two drinks a day on most days, alcohol may enhance the flavor of meals, improve social interactions and extend life.”
During the presentation, Rimm noted that observational studies routinely ignore drinking and diet patterns. For instance, he said that many observational studies included in meta-analyses only included patients’ alcohol consumption at one moment in their life and did not follow up to find out if their consumption had changed.
Rimm explained that the Health Professionals Follow-up Study, a prospective study of health care workers, included data from patient dietary patterns and alcohol consumption every 4 years after enrollment. The study found that men who increased their alcohol consumption slightly over time had lower rates of heart disease, and those who stopped drinking altogether during the study had increased rates of diabetes and heart disease.
Rimm told Healio Primary Care “the most important thing is that physicians actually ask their patients about alcohol consumption,” and strongly advise against binge drinking.
If a patient drinks in moderation and seems to be healthy, it’s important to remind them “that it’s only one piece of being healthy. [Alcohol consumption] shouldn’t be addressed just by itself, it should be addressed in the context of a diet,” Rimm said. – by Erin Michael
References:
Griswold M, et al. Lancet. 2018;doi:10.1016/S0140-6736(18)31310-2.
Mukamal KJ, et al. N Engl J Med. 2003;doi:10.1056/NEJMoa022095.
NIH. Dietary guidelines for Americans 2015-2020. https://health.gov/dietaryguidelines/2015/guidelines. Accessed Oct. 30, 2019.
Disclosures: Griswold is employed by the RAND Corporation and is a consultant for the NIH, the National Institute of Justice and the U.S. Department of Defense. He also reports research support from the Institute for Health Metrics and Evaluation at the University of Washington. Rimm reports being a consultant for the National Academy of Sciences and the U.S. Department of Agriculture/U.S. Highbush Blueberry Council, and research support from the NIH, USDA and Robert Wood Johnson Foundation.