Jul
27
2019

Occasional and moderate drinkers have lower mortality rates

A recent study showed that occasional and moderate drinkers have lower mortality rates. The study came from the Columbia University, New York and was done with a senior population in the US. (7,904 seniors born between 1931 and 1941). The researchers followed this population for 16 years, from 1998 to 2014. There were 5 categories of drinking.

5 drinking patterns

Lifetime abstainers: had less than 12 drinks in their lives.

Current abstainers: they drank in the past, but were abstainers during the present observation period.

Heavy drinkers: drinking 3 glasses or more per day or binging more than 5 drinks in a single day. For women heavy drinking was defined as having more than 2 drinks per day or binging more than 4 drinks in a single day.

Moderate drinkers: they drank 1 to 3 (men) or 1 to 2 (women) drinks per day 1 or more times per week.

Occasional drinkers: they drank less than 1 day per week (for instance once or twice per month) and drinking a maximum of 3 drinks for men and 2 drinks max for women.

Binge drinkers were incorporated into the heavy drinker category.

Findings

The key findings were that over 16 years occasional and moderate drinkers had a lower mortality than lifetime abstainers or current abstainers. Heavy drinkers had a higher mortality as well. The researchers depicted their data as survival curves in a graph. They also tabulated them as data.

A male moderate drinker had a 35% lower mortality, a male current abstainer had a 73% increased mortality, a male lifetime abstainer had a 19% increased mortality and a male heavy drinker had a 20% increased mortality. The researchers set the male occasional drinkers as the reference at 100%.

Women had the following results: a female moderate drinker had a 29% lower mortality, a female current abstainer had a 98% increased mortality, a female lifetime abstainer had a 71% increased mortality and a female heavy drinker had a 11% increased mortality. Again the female occasional drinkers were the reference set at 100%.

Comments about the limitations of the study

The researchers pointed out that the findings of the current abstainers were surprising. However, they were of the opinion that the volunteers in that group likely had health reasons why they quit drinking. If there were cardiac, pancreatic or liver problems (cirrhosis of the liver), these conditions may well have become the reason why they died earlier than the other groups.

They also pointed out that various confounding factors could interfere with the study. Such factors as mental health, body mass index (BMI) or socioeconomic status could interfere with the findings of the study. Further, the researchers found that smoking status in men showed less influence on mortality than it did in females.

Confounding factors

The authors of the study pointed out that it went on for 16 years with many assessments of the drinking status on an ongoing basis. Other studies were one-point assessments, which are not as reliable.

The authors were studying the effects of confounding factors, such as other diseases. They found that lung disease, depression, high blood pressure, stroke, heart disease, cancer and arthritis had their own effects on mortality figures. In addition they looked at the effects of daily activity difficulties, BMI, smoking status, education, age and race/ethnicity on mortality. When all of these confounding factors were normalized, occasional and moderate drinkers still had the lowest mortality.

Graph regarding percentage of survival as a function of time

One of the most convincing findings is the depiction of the data as a percentage of survival plotted as a function of time. This clearly shows that all the time over the entire 16 years the occasional and moderate drinkers had the longest survival times. It also shows clearly that the moderate drinkers lived longer than the occasional drinkers.

Discussion

We know from other studies that moderate alcohol consumption prevents fatty deposits in coronary arteries. Over the centuries pathologists found that the arteries of alcohol consuming individuals were entirely clear of fatty deposits, although they died of other diseases. However, in heavy drinkers the balance tips and cardiovascular disease is more prominent. The biggest effect of reducing mortality likely comes from a reduction in cardiovascular disease. However, alcohol can also cause various cancers. Because of this you will want to keep alcohol consumption in the lower ranges.

Occasional and moderate drinkers have lower mortality rates

Occasional and moderate drinkers have lower mortality rates

Conclusion

An important large study involving 7,904 seniors in the US that lasted 16 years has shown the following findings: Occasional and moderate drinkers had a lower mortality rate than lifetime abstainers or current abstainers. Heavy drinkers had a higher mortality rate as well. The researcher examined possible confounding factors, but after normalizing for these, the findings were still the same.

The French paradox answered

This study may explain the French paradox: the French eat cholesterol-rich foods. However, they live a long life without heart attacks. The difference to the US is probably that they consume red wine regularly. The study described here seems to indicate that occasional and moderate alcohol consumption prolongs life. It does not give anybody a ticket to overindulge, because “it is good for you”. The importance is the dosage: stay under the limit with your alcohol intake. Be an occasional consumer and don’t exceed the limit of moderate consumption. In this case you can raise a glass to your health!

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Apr
22
2017

Only Moderate Alcohol Consumption Benefits Your Heart

A new study from England finds that only moderate alcohol consumption benefits your heart. The study appeared on March 22, 2017 in Great Britain. 1.937 million people (51% women, 49% men) had participated in this investigation over 6 years. The lead author, Dr. Steven Bell is a genetic epidemiologist. He said that the purpose of this study was to clear up some of the confusion from previous studies. He wondered why the control group without alcohol exposure had more cardiac problems than the moderate group. It did make sense though, that the high alcohol group had worse cardiac problems.

But he and researchers from Cambridge University and University College London did this study to get more detail. They were curious why the current non-drinking group serving as a control did not undergo more scrutiny. It consisted of a mix of lifelong abstainers; people who drank formerly, but then gave it up. And the other group was those who drink on an occasional basis.

With this in mind the researchers designed their study. They also used larger numbers to increase the reliability of the study.

Details of English study

The data comes from the Clinical Practice Research Datalink providing anonymous patient records from general practices in England. The patients upon entry into the study had to be older than 30 years, but have no evidence of cardiovascular disease. A total of 1,937,360 patients qualified to be part of the study.

Based on patients’ records and patients recollections people, researchers looked at 5 classes of drinkers:

  • Non-drinkers (14.3%)
  • Former or ex-drinkers (stopped drinking at one point, 3.7%)
  • Occasional drinkers (drinking rarely, 11.9%)
  • Moderate drinkers (drinking within sensible limits, 61.7%)
  • Heavy drinkers (hazardous alcohol use, 8.4%)

Various cardiovascular diseases apart from heart attacks

The end point of the study researchers concentrated on the frequency of cardiovascular diseases like angina, heart attack, sudden cardiac death, stroke, peripheral arterial disease, abdominal aortic aneurysm and others. I only listed 6 of the 12 cardiovascular diagnoses as otherwise it would get too technical.

More information: Most study participants were non-smokers, their BMI was within normal limits, and they also did not have diabetes.

Findings of the study

There were significant differences among subclasses of alcohol consumption and the development of cardiovascular diseases over 6 years.

U-type dose response curve

The findings were in line with a number of previous similar studies that showed a U-type dose response curve between developing cardiovascular diseases and alcohol consumption. The group of non-drinkers (without former and occasional drinkers ) often had a 20% to 56% higher risk of developing cardiovascular disease, while moderate drinkers had no added risk.

Sudden cardiac deaths

On the other hand the heavy drinkers were at risk of developing cardiac arrest (50% increased risk) or heart failure (22% increased risk). A death from a sudden heart attack occurred in heavy drinkers with a 21% increased risk. A former drinker had a 40% increased risk for this, but a non-drinker a risk of 56% increased risk!

Smaller amounts of alcohol help to clean out arteries

A non-drinker had a 32% increased risk of getting a regular heart attack, a former drinker had a 31% increased risk, an occasional drinker 14%, a moderate drinker no added risk, and a heavy drinker had a 12% reduced risk! This seemed to show that drinking alcohol keeps the coronary arteries open and clean. I have had pathology demonstrations with Professor Dr. Adalbert Bohle at Tübingen University during my medical training in 1969. At that time he pointed out how clear and wide open the coronary arteries were in chronic alcoholics. It was not heart disease that killed those patients; they had died from end stage liver cirrhosis, and we saw pathological slides of that.

Strokes in heavy drinkers

Heavy drinkers get more ischemic strokes (33% risk increase) and more intracerebral hemorrhages (37% risk increase).

Lower leg arterial obstruction

Obstruction of blood vessels in the lower legs (peripheral arterial disease) is common with heavy drinkers (35% risk increase) and even former drinkers (32% risk increase). Non-drinkers have a 22% increased risk while moderate drinkers have a 0% risk (no increased risk).

Aortic aneurysms

There was no association between heavy drinking and aortic aneurysm. On the other hand, non-drinkers (32% increased risk) and former drinkers (23% increased risk) showed an increased risk of aortic aneurysm formation.

Other effects of alcohol consumption

The study above did not take into consideration that alcohol consumption has many other consequences beside cardiovascular effects. One for instance is the effect on the brain and the increase of serious car accidents. Another effect is the causation of cancer.

The American Cancer Society clearly states that alcohol consumption has been causatively associated with cancers in the following locations:

  • Mouth
  • Pharynx (throat)
  • Larynx (voice box)
  • Esophagus
  • Liver
  • Breast
  • Colon
  • Pancreas

The conundrum of alcohol benefit for heart attacks versus alcohol cause of cancer

Many studies have shown a dose-response curve between alcohol consumed and the development of these cancers. In other words there is never a safe low dose, below which no cancer risk would occur over time.

These authors conducted a metaanalysis of 16 prospective cohort studies including 6,300 patients. It showed that alcohol caused cancer of the colon and rectum. High intake of alcohol showed a 50% increased risk of causing colon cancer. With regard to rectal cancer the risk was 63% higher. In both cases the highest alcohol intake was compared to the lowest category of alcohol intake.

More on cancer risk from alcohol consumption

These authors concluded their discussion by pointing out that 6% of the worldwide cancer deaths are attributed to alcohol intake. They also stated that colorectal cancer risk increased by 50% in the heaviest alcohol users. Among the group of heavy drinkers the cancer death rate would likely be 9%. There would a reduction of mortality from cardiovascular disease by one third in middle and old age. The end result would be 6% mortality again; essentially there is no change.

No matter how you try to solve this equation, there is a risk of cancer deaths from exposure to alcohol. There is also a risk that heavy drinking can cause significant cardiovascular diseases mentioned.

Only moderate alcohol consumption benefits your heart

Only moderate alcohol consumption benefits your heart

Conclusion

Everything we do in life has consequences. With regard to drinking you know that accidents are more common in drinkers; with prolonged exposure to higher alcohol consumption you can get dementia. Moderate amounts appear to have significant protection from heart disease, but the risk for several cancers is not negligible. This point was not mentioned in the study I discussed in the beginning of my blog. In the latter part I included some data about cancer risks from alcohol consumption.

Heart attack prevention with small amounts of alcohol

The paradox remains that non-consumption of alcohol is associated with a significant cardiovascular risk because of a U-shape dose response curve. Moderate alcohol use is associated with the lowest cardiovascular risk. The question is whether we can balance moderate drinking with staying in the low cancer risk area. The recommendation of 1 glass of wine for women and 2 glasses of wine for men has been confirmed by the above study. This is considered a healthy preventative dose with respect to cardiovascular risk. It is the official recommendation for cardiovascular disease prevention. The cancer literature clearly states that there is a small cancer risk from moderate alcohol intake. This is particularly true for the 8 cancers discussed. The last word may not have been spoken yet about reduction of cardiovascular risk.

You can prevent heart attacks without the use of alcohol

Dr James Nicholls, the director of research and policy development at Alcohol Research UK had this to say. He pointed to the fact that there are other ways to prevent cardiovascular disease. For those who do not drink at present it would not make sense to take up drinking. You can strengthen your heart by starting a Mediterranean diet and starting to exercise regularly. The beneficial substance for your heart in red wine is resveratrol. Taken it as a supplement. Resveratrol has no side effects and does not have the cancer risk like an alcoholic drink does. Dr. Nicholls added, “If you drink within the existing guidelines it is unlikely that alcohol will either lengthen or shorten your life.” It is really up to every individual to balance the wine glass with personal health!

Feb
01
2014

Early Alcohol Use Will Result In Memory Loss Later In Life

Researchers found that heavy alcohol use in males during midlife paves the way to memory loss from dementia later in life.

I thought that this would be a good topic to review the effect of alcohol in general. Alcohol is a known cell poison, yet cardiologists keep on referring to the beneficial effects of that 1 glass of wine per day that will prolong your life. I will attempt to explain these diverse effects, where small amounts are supposed to be good for you while high amounts can be very damaging.

Review of the effects of alcohol

50% of the world population drinks alcohol, 10% to 20% have chronic alcoholism (Ref.1).  Just recently a Guardian news study was released showing that an astounding 25% of Russian men die before reaching the age of 55, compared to only 7% of men in the United kingdom and less than 1% of men in the US. The study looked at the effects of consuming large amounts of vodka.  There are about 10 million chronic alcoholics in the US. Chronic alcohol consumption leads to 100,000 deaths every year in the US. More than 50% of these deaths are from traffic accidents, the rest from medical problems caused by alcohol (Ref.1). Most of the alcohol gets detoxified through the liver cells and is metabolized into acetaldehyde. This involves the cytochrome P-450 system. That means that when a person also takes narcotics, sedatives or psychoactive drugs that are also metabolized through this liver enzyme system drugs and alcohol are taking much longer to be metabolized. This can lead to lethal overdoses that we hear about on TV all the time, hence the warning that you must not mix alcohol with drugs.

Early Alcohol Use Will Result In Memory Loss Later In Life

Early Alcohol Use Will Result In Memory Loss Later In Life

Alcohol is a cell and nerve poison. The most vulnerable organs in the body are the liver, brain, heart, pancreas, bone marrow and stomach. So, here are a number of conditions caused by drinking alcohol:

a)    Anemia: When a person drinks heavily and regularly anemia shows up in a blood test. Alcohol has a toxic effect on the bone marrow, which interferes with the production of red blood cells. But certain vitamins required by the bone marrow to manufacture red blood cells are often also missing in the diet of an alcoholic, which contributes to anemia as well.

b)    Cirrhosis of the liver develops in 10% to 20% of heavy drinkers. With cirrhosis part of the liver cells get replaced by fibrotic tissue and in advanced cases this can lead to a hepatic coma and death. Others are developing alcoholic hepatitis. This is an inflammation of the liver with fever and jaundice where the skin and eyeballs turn yellow. It is associated with severe abdominal pain.

c)    Gastritis: Alcoholic gastritis is common, but often undetected. The affected individual may just have stomach pains for a few days, or vomit food and/or blood in addition. With continued use of alcohol it may turn chronic. Alcoholic gastritis can turn into gastric ulcers with massive bleeding that often lead to death.

d)    Pancreatitis: The pancreas is a particularly vulnerable glandular tissue, which gets damaged by regular alcohol intake and with chronic alcohol intake gets partially replaced by fibrotic tissue causing the feared and painful chronic pancreatitis. This is a condition with vomiting and severe abdominal pains that can be unrelenting.

e)    High blood pressure, seizures, dementia, depression, heart irregularities and nerve damage:

You may ask yourself how all of these conditions would be reasonably under one heading. The heading for this is “nerve damage”. Let me explain: The sympathetic nerve is very sensitive to alcohol toxicity and when the sympathetic nerve fibers are damaged, you will develop high blood pressure. You see your physician, get blood pressure medication, but the pressure is difficult to control, if you continue to drink alcoholic beverages. It does not make sense to just add blood pressure pills and hope that this will cure your problem. Seizures are due to direct nerve damage in the more sensitive parts of the brain, which will cause these areas to produce extra electrical activities, which we call seizures. Again, just treating with anti-seizure medications is not the solution. Avoidance of alcohol is the other part of the treatment schedule. Dementia from heavy alcohol use is due to direct nerve atrophy in the brain. Our brain shrinks normally 1.9% to 2.8% per decade, depending on which research papers you read. But in the presence of heavy drinking the frontal lobe of the brain is particularly vulnerable to brain shrinkage.

As this publication shows, mild and moderate drinkers did not suffer more frontal lobe shrinkage than abstainers, but heavy drinkers had a 1.8-fold higher risk of frontal lobe shrinkage on average when compared to abstainers. It was calculated that alcohol had contributed 11.3% to that frontal lobe shrinkage.

The rest of the toxic effect on the nerve tissue explains why depression would develop. The frontal brain contains most of the serotonin producing nerve cells. When serotonin-producing nerve fibers get damaged, the body does not produce enough serotonin to prevent depression from setting in; GABA producing cells often also get damaged, which causes anxiety. It’s not good enough to just prescribe anxiolytic drugs to which the patient will get addicted. The whole person needs to be treated, and abstinence from alcohol has to be part of the program.

Heart irregularities (atrial fibrillation, ventricular fibrillation) can be life-threatening complications due to the toxic effect of alcohol on the nerve fibers within the heart muscle. Emergency physicians are aware of the connection of these conditions to alcohol consumption. Some people’s hearts are more sensitive to the effects of alcohol than others. The most common cause of temporary atrial fibrillation is excessive alcohol intake (holiday heart) according to Ref. 2.

Finally there is the effect of alcohol on nerves in the body. This explains that heavy alcohol consumers can come down with painful pins-and-needles sensations in their hands and feet or with numbness or loss of muscle strength. When the parasympathetic nervous system is affected embarrassing incontinence or constipation can result. Erectile dysfunction in men is also very common. Viagra and continuing to drink is not the solution.

f)      Gout: This painful formation of uric acid crystals in joints can be precipitated in sensitive individuals by consuming alcohol in combination with eating large helpings of beef. There may be a history of gout in the family. Treatment for this is to refrain from alcohol and avoid foods that are leading to uric acid production when ingested.

g)    Cancer: When the body detoxifies alcohol in the liver, the breakdown product is acetaldehyde, which is a known cancer producing substance. A whole array of cancers are known, which come from heavy, chronic alcohol consumption: cancers in the mouth, larynx, esophagus, stomach, pancreas, liver and colorectal cancer have all been linked to excessive alcohol intake.

h)    Cardiovascular disease: heart attacks and strokes can be caused particularly by binging; it is thought that binging makes platelets from the blood more sticky so they clump together and cause blood clots, which in turn leads to heart attacks and strokes.

i)      Infections: Alcohol weakens the immune system, which is another effect on the bone marrow similar to causing anemia, except that this is the toxic effect on the white blood cells and lymphocytes. Heavy alcohol consumers are more prone to pneumonia, to HIV, sexually transmitted diseases, and tuberculosis.

Cardiology view of preventative alcohol

Despite all of these hair raising toxic effects cardiologists have painted the rosy picture that 1 glass of wine for women and 2 glasses of wine for men per day will prevent heart disease. What is the true story here?

Ref.2 points out that there are about 100 prospective studies that confirm that there is an inverse relationship between mild to moderate alcohol consumption and “heart attack, ischemic stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes”. It describes further that the reduction of risk in these various studies was persistent and consisted of a 20% to 45% risk reduction. Using blood tests investigators have found that this is because of an increase of HDL cholesterol, reducing blood clotting, making platelets less sticky and reducing inflammation as evidenced by a reduction of the C-reactive protein. Further research has pinpointed that it is the phenols and resveratrol that are contained in alcoholic beverages that are responsible for the beneficial effects. The bad news is that three glasses of wine or more do the opposite, so does binge drinking. Unless you are extremely disciplined and never increase your allowed limit (1 drink for women, 2 drinks for men) you will CAUSE heart disease rather than PREVENT it (Ref.2). Some people have a family history of breast cancer or colon cancer and they should avoid alcohol altogether; also people coming from alcoholic families should avoid alcohol.

Conclusion

Where does this leave us with regard to prevention of heart attacks, strokes and hardening of the arteries in the legs (peripheral vascular disease)? If you are disciplined and stick to the limits, you could prevent 20% to 45% of cardiovascular risk. The brain study mentioned in the beginning of the blog would also confirm that there was no difference between dementia or brain shrinkage when mild to moderate drinkers were compared to abstainers over 10 years. What is not told by the wine industry is that the same effects that prevent cardiovascular disease in mild to moderate drinkers can also be achieved by natural means: exercising regularly will raise your protective HDL cholesterol; taking ginkgo biloba, flax seed and omega-3 fatty acids thins your blood and the platelets are getting less sticky; omega-3 reduces inflammation and resveratrol elongates telomeres making you live longer. At the A4M conference in Las Vegas in December 2011 there were three speakers who pointed out that even small amounts of alcohol will poison mitochondria of your cells and interfere with normal hormone action. This was enough to make me join those who abstain alcohol completely. One thing has not yet been investigated in long-term studies, namely how small effects of alcohol may affect the body over several decades and over an entire lifetime. Despite all the promises of interest groups that red wine is a trendy drink for those interested in heart health, the fundamental long-term studies are missing. What does a guy do with a healthy heart and a brain that is not functioning too well? I just do not want to be the guinea pig in that worldwide study.

More information on alcoholism: http://nethealthbook.com/drug-addiction/alcoholism/

References:

  1. Kumar: Robbins and Cotran: Pathologic Basis of Disease, Professional Edition, 8th ed. © 2009 Saunders
  2. Bonow: Braunwald’s Heart Disease – A Textbook of Cardiovascular Medicine, 9th ed. © 2011 Saunders

Last edited Nov. 7, 2014