By Dawn Harris Sherling, M.D
To say the thinking around alcohol consumption in the U.S. swings like a pendulum might be an understatement. Pendulums generally move predictably back and forth. The advice on whether we should drink and how much is probably more like a small boat (captained by someone who has imbibed a bit too much) on choppy seas—you never know in which direction it might be pulled or if it might capsize completely.
At the turn of the 19th century, Benjamin Franklin is reported to have written that wine is “proof that God loves us and loves to see us happy.” This thinking was far from universal and after vociferous campaigning, about 100 years later, Prohibition, making alcohol consumption illegal, was briefly the law of the land. This, as readers of history or watchers of gangster movies know, like a flaming hot tequila shot, did not go down smoothly. Rules around alcohol sales and consumption have been all over the place ever since.
Well, now it’s 2020 and since agreeing on anything is definitely out, the medical powers that be have decided that it would be good time to re-examine our alcohol guidelines.
For the past thirty years, the dietary guidelines on alcohol issued by the government every five years, have been pretty consistent—no more than two drinks a day for men, one for women. This year, it has been proposed that men should now also be limited to one drink. Although it hasn’t made it into the official suggestions yet, it has also been proposed that women should drink less than one drink, and perhaps really, no one should be drinking at all.
But wait! Isn’t some level of alcohol consumption supposed to be protective against heart disease? And the answer is yes—the guidelines we have been looking at for thirty years are based on the data that moderate alcohol consumption does indeed reduce risk of atherosclerotic heart disease. Unfortunately, over the last several decades, research detailing the risks of alcohol has been emerging, associating its consumption with various cancers, accidental deaths, and not-so-surprising rates of addiction.
When a team of researchers aggregated the risks and benefits in an article that ran in the well-regarded medical journal, The Lancet in 2018, they proposed that the risks won out and there was no safe level of alcohol consumption they could recommend.
And that’s fair. The data around the risks of alcohol have been pouring in for a while. All things considered, it probably isn’t great for us. But neither are French Fries or sugar, both of which probably contribute to as many, if not more, health problems than alcohol does (though probably fewer car accidents). You’d be hard pressed to find a medical professional who advocates consumption of fries and sugar, so adding alcohol to the list of things better avoided isn’t a great leap.
But like that boat rocking back and forth, another study published in 2018 in Circulation, another well-regarded medical journal, noted that moderate alcohol consumption (which they defined as 0.5 to 1 drink a day for women and 0.5-2 drinks a day for men) was a marker for longevity.
How can both studies be true? Well, first, it should be acknowledged that both studies are population-based and not randomized trials and therefore not the best quality evidence. The people who drink a bit, but not too much, may also avoid too much sugar and exercise more. The people who don’t drink at all may have health problems, like diabetes, that make avoiding alcohol a good idea, but may cut their lives a bit short. It’s hard to know what exactly is contributing to the longevity. Could it be the alcohol? Sure. Could it be something else? Also yes.
Let’s be honest. 2020 has been a rough year and pretty much one in which news we don’t want to hear keeps popping up like ice cubes in a Moscow Mule. In short, alcohol probably isn’t great for us health-wise, but I’ll raise a drink to hoping the guideline writers give us a break and hold off a little while on making it official.