Many of you have heard or read that moderate alcohol may be beneficial to your health. This notion has been around for a while. How did it start? What’s the truth about alcohol, and wine in particular? A CNN report from December, 1997 was titled "A Drink A Day Keeps The Grim Reaper Away." It stated that "researchers report that modest drinking is, on balance, healthful and alcohol's ill effects are offset by alcohol's benefit to the heart."

 

As a physician, it was important to me to go to the scientific literature myself to examine the evidence before I would start advising patients, as some doctors have, that alcohol be used for medicinal purposes.

 

Benefits of Wine and Other Alcoholic Drinks

First, I obtained the original research paper printed in the New England Journal of Medicine, December, 1997. Then, I did a literature search of all the articles that had been published on alcohol. What I found was quite surprising, considering all the popular press coverage of the beneficial and medicinal properties of alcohol. The largest and longest study at the time was published in the New England Journal of Medicine in December 1997, and was entitled "Alcohol Consumption and Mortality among Middle-aged and Elderly U.S. Adults."¹

 

It followed nearly 500,000 individuals for nine years and reported a 20% decrease in mortality for those aged 35 to 70 during the study period who consumed at least one alcoholic beverage per day as compared to non-drinkers.They attributed nearly all of the lower death rates to medicinal effects of alcohol in protections against cardiovascular disease.

 

From a purely medical point of view, should physicians start recommending alcohol consumption to protect against heart disease and to promote good health? Many people have interpreted these findings to suggest moderate drinking of alcoholic beverages should be part of a healthy lifestyle.

 

 

 

After carefully studying the original research paper from the New England Journal of Medicine (NEJM) plus reviewing over 50 other alcohol related articles published in the medical literature, I established the following six points that should be considered before using alcohol for medicinal purposes:

 

1. Alcohol is a well-established risk factor for numerous cancers.

 

The NEJM study showed a 30% increase in breast cancer in women consuming as little as one drink per day. This added to the already known increased risk of mouth, throat, esophageal, stomach, pancreatic, and liver cancer associated with alcohol consumption.²

 

The only reason that an overall decreased mortality rate was shown in the alcohol drinking population was because many more people die from heart disease than cancer. It would be irresponsible at the least for a physician to recommend a patient consume alcohol to decrease the chance of a heart attack by only 30%. The risk of that patient dying a slow, painful death from cancer would be increased with every drink they took. There are safer preventative measures available to help avoid or decrease risk of heart disease. 

 

2. By analyzing only those aged 35 to 70, the study did not accurately reflect the lifetime risk of alcohol consumption. Alcohol is the top risk factor for early death and disability in people aged 15-49.³

 

3. The mechanism by which alcohol gives cardiac protection may be harmful to other body systems. Alcohol appears to protect against heart attack in two ways. First, it reduces the buildup of plaque in the blood vessels. Second, alcohol acts as a blood thinner that prevents clots from forming in the already narrowed coronary arteries, which is the initial event in most heart attacks.⁴

 

Interfering with the delicate balance in the blood clotting mechanism may be a dangerous thing. A few years ago, it was noted that aspirin had blood thinning properties that prevented heart attacks. The initial reports were so impressive that thousands of physicians voluntarily started taking aspirin daily as a part of a study of the long term benefits.

The research project was stopped prematurely when it was noted that the aspirin group was experiencing an unexpectedly high incidence of hemorrhagic stroke. While trying to prevent a heart attack by thinning the blood, some of these doctors died, or were permanently disabled by bleeding into their brains. Now most doctors only recommend aspirin to patients who have already had one heart attack, because the risk of a second heart attack is greater than the aspirin-induced stroke.

 

This example clearly points out the danger of interfering, as alcohol does, with the delicate balance of the body in such areas of blood clotting. In addition, while preventing certain types of heart disease, alcohol has been clearly linked to heart rhythm problems and cardiomyopathy leading to congestive heart failure.⁵

 

4. The 30% decrease in the death rate from heart disease attributed to alcohol may be achieved and surpassed by other, much less risky, methods. Numerous studies have shown that simple lifestyle measures can reduce cardiac risk by 50 to 70% without any of the harmful side effects documented with alcohol usage.⁶

 

5. The study's methodology and analysis bring into question the validity of the conclusions. It must be understood that all studies relating health risk and alcohol consumption rely on voluntary questionnaires being accurately completed. No one actually follows the patients around to document their consumption or verify their claims. One of the editors of the NEJM who wrote an editorial response pointed out that the study group reported their yearly alcohol consumption to be only half of US government per capita estimates based on industry production and sales.⁷

 

 

 

He pointed out that either this study group did not reflect average American drinking habits, or they did not accurately complete their questionnaires. Anyone who has ever worked with alcoholics knows they are often in denial regarding their drinking patterns and some may have inaccurately placed themselves in the non-drinking groups statistics, which would have affected the validity of the conclusions.

 

Additionally, the NEJM study excluded from their statistics without explanation 32,000 individuals who had cancer or cirrhosis at the start of the study. These diseases are known to be closely linked to alcohol consumption and their exclusion could markedly affect mortality rates.

 

6. Beyond heart issues, alcohol has physiologic implications on virtually every major body system. When reading in the lay press one could easily conclude that most medical research in recent years has focused on the positive medicinal value of alcohol on the heart. In reality, a totally different picture emerges. 

 

 

Alcohol Causes Brain Damage and More

A search of research papers in the scientific literature  revealed over 300 published articles of which many  were review articles. Review articles summarize and condense research findings on a related topic. Of the review articles, 44 of the 48 showed  the toxic effects of alcohol. The articles that took the position that  alcohol offers cardiac benefits also included the negative side effects of alcohol. Here is only a sampling of statements taken from the abstracts of these articles.

No safe dose of alcohol for the brain was found. Moderate consumption is associated with more widespread adverse effects on the brain than previously recognised. . . . Detrimental effects of drinking appear to be greater than other modifiable factors. Current ‘low risk’ drinking guidelines should be revisited to take account of brain effects. (Topiwala, Anya et al, “No safe level of alcohol consumption for brain health: observational cohort study of 25,378 UK Biobank participants.” https://doi.org/10.1101/2021.05.10.21256931.) 

 

Alcohol is a neurotoxin associated with significant morbidity and mortality...it may raise blood pressure, damage the myocardium, precipitate arrhythmias and damage the developing fetal heart (Sceepers, B.C. "Alcohol and the Brain." British Journal of Hospital Medicine, 1997; 57: 543-51).

 

Alcohol’s contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. Chikritzhs T, Livingston M. “Alcohol and the Risk of Injury”. Nutrients. 2021; 13(8):2777.⁸

 

Alcohol can lead to potentially hazardous hypoglycemia (Meeking, D.R. "Alcohol ingestions and glycemic control.” Diabetic Medicine 1997; 14:279-83).

 

...alcohol related problems include liver disease, dementia, confusion, peripheral neuropathy, insomnia, seizure disorders, poor nutrition, incontinence, diarrhea, myopathy, inadequate self care, macrocytosis, depression, fractures, and adverse reactions to medications (Fink, A. "Alcohol related problems in older persons." Archives of Internal Medicine 1997; 157:242-3).

 

The influence of alcohol on sexual behavior is part of popular knowledge (Donovan, C. "A review of the literature examining the relationship between alcohol use and HIV related sexual risk-taking in young people." Addiction 1997; 90:319-28).

 

There is strong evidence that alcohol causes cancer at seven sites in the body and probably others. (Connor, J. “Alcohol consumption as a cause of cancer”. Addiction, July 2016; 112(2):222-228.)⁹

 

 

Other studies showed the relationship between alcohol and osteoporosis, chronic gastritis, peptic ulcers, decreased immune response, aggressive behavior, fetal malformation and spontaneous abortion, and this is only a sampling! It is difficult to see how anyone could review the data and conclude that the beneficial properties of alcohol outweigh the toxic effects even when taken in moderate amounts.

 

 

 

It’s also important to  consider the addictive potential of alcohol with its resultant social and economic implications. Approximately 10% of people who begin drinking will become sufficiently addicted to be considered problem drinkers or alcoholics. In a Gallup poll, one out of four Americans report their families being negatively impacted by alcohol abuse. The economic loss of worker productivity is measured in the billions of dollars. A medical pharmacology textbook states, "Alcohol is discussed here separately because its wide use and abuse leads to more behavioral and organic toxicity than any other agent. The social and therapeutic problems thus generated are an unavoidable concern of every practitioner...Ethyl alcohol is an addictive drug and it would no doubt immediately be placed under the jurisdiction of the Food and Drug Administration, if it were first discovered today."¹⁰

 

 

In conclusion, let's suppose you went to your physician and were offered a medication with the following informed consent:

 

"This is a drug which can reduce your chance of heart attack by 30%, but I must warn you that this drug is a direct brain and liver toxin. It will increase your chance of contracting cancer, and contribute to osteoporosis and ulcers. There's also a 5-10% chance that you will become hopelessly addicted to this drug, which could easily lead to losing your job or destroying your marriage. I must also inform you that there are some essential risk-free alternatives that are even more effective in preventing heart disease, but I think you'll really like the euphoric feeling you get when you take this drug."

 

First, the Federal Drug Administration would never allow a drug with this degree of risk-to-benefit profile to ever be marketed. Second, if they did, what patient in their right mind would accept such a prescription and ever trust the judgment of that physician again? It is probably fair to say that many people who claim to be using alcohol for medicinal purposes were already recreational drinkers who were happy to find some science supporting their lifestyle.

 

From a purely medical perspective, it is hard to justify alcohol use. The medical journal Cardiology Clinics summarizes this as follows: "Given the complex nature of alcohol disease relationships, alcohol consumption should not be considered a primary preventive strategy."11