Does Alcohol Provide Any Health Benefit?
By Joseph E. Scherger, MD, MPH
Core Faculty, Eisenhower Health Family Medicine Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles
SYNOPSIS: The authors of a large systematic review and meta-analysis concluded there is no health benefit from moderate alcohol intake.
SOURCE: Zhao J, Stockwell T, Naimi T, et al. Association between daily alcohol intake and risk of all-cause mortality: A systematic review and meta-analysis. JAMA Netw Open 2023;6:e236185.
A research team from the University of Victoria in Canada conducted a systematic review and meta-analysis of 107 cohort studies involving more than 4.8 million people. The authors found no significant reductions in all-cause mortality rates for those who drank less than 25 g of ethanol per day. There was a higher risk of all-cause mortality among women who drank 25 g or more per day and among men who drank 45 g or more per day. The authors concluded low-volume alcohol-drinking was not associated with protection against death from all causes.
The findings of this study go against the observation of a “French paradox,” whereby better health and longer life span happens among those who eat a diet with more fat and consume alcohol regularly. These findings also go against the common belief that mild-to-moderate alcohol consumption reduces cardiovascular mortality risk by up to 40%.1-3 Recent studies have suggested that no amount of alcohol is helpful. A World Heart Federation study showed consuming one drink a day does not prevent heart disease; in fact, the more alcohol someone drinks, the more likely it is he or she can experience a heart attack.4,5
These recent studies certainly are sobering. I take them seriously, but I am not yet completely convinced all alcohol is bad. My own 50-year practice experience seems to indicate otherwise — specifically, drinkers seem to carry some protection against cardiovascular disease. This may be caused by elevations in HDL cholesterol levels.
Because I am older than age 70 years, I do not consume any alcohol. I would never recommend alcohol as a health benefit. Regardless, I plan to follow this issue carefully. Some alcohol intake is well ingrained in certain cultures, some members of which maintain otherwise healthy lifestyles. For example, the authors of the Blue Zone studies of people with the greatest longevity and good health lists as one of their recommendations “wine at 5.”6 This is in part because of how alcohol can fuel social gatherings, and frequent human interaction is an important part of maintaining good mental health.
Living in California, some wine intake is built into our culture, too. As the Austrian-American management consultant, educator, and author Peter Drucker famously said: “Culture eats strategy for breakfast.”
1. Fillmore KM, Kerr WC, Stockwell T, et al. Moderate alcohol use and reduced mortality risk: Systematic error in perspective studies. Ann Epidemiol 2007;17:S16-S23.
2. Roerecke M, Rehm J. The cardioprotective association of average alcohol consumption and ischaemic heart disease: A systematic review and meta-analysis. Addiction 2012;107:1246-1260.
3. Naimi TS, Brown DW, Brewer RD, et al. Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. Am J Prev Med 2005;28:369-373.
4. Schutte R, Smith L, Wannamethee G. Alcohol — the myth of cardiovascular protection. Clin Nutr 2022;41:348-355.
5. Biddinger KJ, Emdin CA, Haas ME, et al. Association of habitual alcohol intake with risk of cardiovascular disease. JAMA Netw Open 2022;5:e223849.
6. Buettner D. The Blue Zones: 9 Lessons for Living Longer From the People Who’ve Lived the Longest. Second edition. National Geographic; 2013.
The authors of a large systematic review and meta-analysis concluded there is no health benefit from moderate alcohol intake.
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