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“Should We Recommend Alcohol for its Health Benefits?”. R. Curtis Ellison, MD Professor of Medicine & Public Health Section of Preventive Medicine & Epidemiology Boston University School of Medicine. YES!. NO!. IT DEPENDS!. The International Scientific Forum on Alcohol Research.

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should we recommend alcohol for its health benefits

“Should We Recommend Alcohol for its Health Benefits?”

R. Curtis Ellison, MD

Professor of Medicine & Public Health

Section of Preventive Medicine & Epidemiology

Boston University School of Medicine

the international scientific forum on alcohol research
The International Scientific Forum on Alcohol Research

I serve as the Scientific Co-Director of a Forum made up of an international group of 40 scientists doing research on alcohol and health and committed to balanced and well-researched data on the subject.

The Forum publishes critiques of emerging reports on alcohol & health through its Boston University web-site (www.bu.edu/alcohol-forum).

slide6

Members, International Scientific Forum on Alcohol Research

USA

Luc Djoussé, MD, DSc, Dept. of Medicine, Division of Aging, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA 

R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA

Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA

Tedd Goldfinger, DO, FACC, Desert Cardiology of Tucson Heart Center, Dept. of Cardiology, University of Arizona School of Medicine, Tucson, Arizona

Lynn Gretkowski, MD, Obstetrics/Gynecology, Mountainview, CA, Stanford University, Stanford, CA, USA 

Dwight Heath, PhD, Dept. of Anthropology, Brown University, Providence, RI, USA

Imke Janssen, PhD, Department of Preventive Medicine, Rush University Medical Centre, Chicago, IL

Arthur Klatsky, MD, Dept. of Cardiology, Kaiser Permanente Medical Center, Oakland, CA

Lynda Powell, MEd, PhD, Chair, Dept of Preventive Medicine, Rush University Medical School, Chicago, IL

Andrew L. Waterhouse, PhD, Marvin Sands Professor, Department of Viticulture and Enology, University of California, Davis; Davis, CA

Yuqing Zhang, MD, DSc, Epidemiology, Boston University School of Medicine, Boston, MA

slide7

Members, International Scientific Forum on Alcohol Research

Europe

Alberto Bertelli, MD, PhD, Institute of Human Anatomy, University of Milan, Italy

Giorgio Calabrese, MD, Docente di Dietetica e Nutrizione, Umana Università Cattolica del S. Cuore, Piacenza, Italy

Maria Isabel Covas, DPharm, PhD, Cardiovascular Risk and Nutrition Research Group, Institut Municipal d´Investigació Mèdica, Barcelona, Spain

Alan Crozier, PhD, Plant Biochemistry and Human Nutrition, University of Glasgow, Scotland, UK

Giovanni de Gaetano, MD, PhD, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy

Alun Evans, MD, Centre for Public Health, The Queen's University of Belfast, Belfast, UK

Oliver James, MD, Head of Medicine, University of Newcastle, UK

Ulrich Keil, MD, PhD, Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany

Rosa M. Lamuela-Raventos, PhD, Department of Nutrition and Food Science, University of Barcelona, Spain

Dominique Lanzmann-Petithory,MD, PhD, Nutrition/Cardiology, Praticien Hospitalier Hôpital Emile Roux, Paris, France

Rosa M. Lamuela-Raventos, PhD, Department of Nutrition and Food Science, University of Barcelona, Spain

Fulvio Mattivi, PhD, Head of the Department Good Quality and Nutrition, Research and Innovation Centre, Foundazione Edmund Mach, in San Michele all’Adige, Italy

Jean-Marc Orgogozo, MD, Professor of Neurology and Head of the Neurology Divisions, the University Hospital of Bordeaux, Pessac, France

Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark 

Jan Snel, PhD, Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Holland

Jeremy P E Spencer, Reader in Biochemistry, The University of Reading, UK

Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo,Norway

Pierre-Louis Teissedre, PhD, Faculty of Oenology - ISVV, University Victor Segalen Bordeaux 2, Bordeaux, France

Dag S. Thelle, MD, PhD, Senior Professor of Cardiovascular Epidemiology and Prevention, University of Gothenburg, Sweden; Senior Professor of Quantitative Medicine at the University of Oslo, Norway

Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy

David Vauzour, PhD, Senior Research Associate, Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK

slide8

Members, International Scientific Forum on Alcohol Research

Australia, New Zealand, South Africa

Dee Blackhurst, PhD, Lipid Laboratory, University of Cape Town Health Sciences Faculty, Cape Town, South Africa

Maritha J. Kotze, PhD,Human Genetics, Dept of Pathology, University of Stellenbosch, Tygerberg, South Africa

Arduino A. Mangoni, PhD, Strategic Professor of Clinical Pharmacology and Senior Consultant in Clinical Pharmacology and Internal Medicine, Department of Clinical Pharmacology, Flinders University, Bedford Park, SA; Australia

Ross McCormick PhD, MSC, MBChB, Associate Dean, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

Ian Puddey, MD, Dean, Faculty of Medicine, Dentistry & Health Sciences, University of Western Australia, Nedlands, Australia

CreinaStockley, PhD, MBA, Clinical Pharmacology, Health and Regulatory Information Manager, Australian Wine Research Institute, Glen Osmond, South Australia, Australia

Gordon Troup, MSc, DSc, School of Physics, Monash University, Victoria, Australia

David Van Velden, MD, Dept. of Pathology, Stellenbosch University, Stellenbosch, South Africa

slide9

Potential Conflict of Interest

Partial expenses for operating the Forum are from unrestricted donations to Boston University from associations and companies in the beverage industry (including NY Wine & Grape Foundation, Diageo, Brown-Forman)

As donors have no input into the papers reviewed by the Forum or the opinions published, the IRB at Boston University has deemed that these do not constitute a conflict of interest.

slide10

“Should We Recommend Alcohol for its Health Benefits?”

Among the factors that we must consider:

1. Is excessive alcohol intake associated with adverse health effects?

2. Is light-to-moderate alcohol intake associated with beneficial health effects? Is it the cause?

3. Does the pattern of drinking affect the net health effects? (speed of intake, with food, regular vs binge)

4. Does the type of beverage affect the net health effects?

5. Is the public often faced with biased, exaggerated statements about alcohol? What are proper guidelines?

slide11

Types of Scientific Evidence

Case reports

Ecologic data (comparing populations without individual data)

Case-control studies

Prospective cohort studies (may be population-based, must deal with confounders)

Experimental data

Human clinical trials (for intermediary outcomes,

for disease outcomes)

slide12

Potential Confounding in Observational Studies

  • There is often clustering of healthy lifestyle factors
  • We must deal with such potentially confounding variables:
      • Age
      • Sex
      • Cigarette smoking
      • Education, occupation, and income
      • Diet, physical activity, level of obesity
      • Previous alcohol use
  • Adjust for many of these factors through stratification and multivariable analysis techniques. 
research on alcohol and cardiovascular disease
Research on Alcohol and Cardiovascular Disease

Prospective epidemiologic studies for many decades, even when fully controlled for known confounding, have been amazingly consistent:

moderate drinkers are at lower risk of CHD than are abstainers.

alcohol consumption and chd mortality review meta analysis ronksley et al bmj 2011
Alcohol Consumption and CHD Mortality: Review & Meta-analysis. Ronksley et al. BMJ 2011
  • Reviewed 84 well-done prospective epidemiologic studies; > 1 million subjects.
  • Estimated effects of alcohol intake on mortality from coronary heart disease
effects of alcohol on cardiovascular disease ronksley et al 2011
Effects of Alcohol on Cardiovascular Disease(Ronksleyet al, 2011)

■ This meta-analysis showed risk reductions for moderate alcohol drinkers of

25% for CHD mortality

29% for incident coronary heart disease

25% for cardiovascular disease mortality

13 % for all-cause mortality.

alcohol mortality adjusting for ses and a propensity score lee et al 2009
Alcohol & Mortality, adjusting for SES and a Propensity Score (Lee et al, 2009)
  • 12,519 subjects, Health & Retirement Study
  • With demographic adjustments, moderate drinkers ( ≤ 1 drink/day vs non-drinkers) had a RR for mortality of 0.50.
  • With full adjustments for SES, RF, behavioral factors and a propensity score for moderate drinking, RR was 0.62 (CI 0.48-0.80).
net effect of moderate alcohol intake on mortality
Net Effect of Moderate Alcohol Intake on Mortality

(Konnopka et al, 2009)

  • Considered "moderate" up to 40 grams/day (more than 3 drinks/day) for men and up to 20 g/day (about 1 1/2 drinks/day) for women; included binge drinkers.
  • Deaths "avoided" by moderate alcohol use were about twice as high (n=29,818) as the number "caused" by moderate drinking (n=14,457)
slide20
Deaths Attributable to “Moderate” Alcohol Intake (weekly mean <40 g/d for men, < 20 g/day for women)(Rehm et al, Ann Epidem, 2007)
slide21
Deaths Attributable to “Moderate” Alcohol Intake (when “binge drinkers” excluded)(Rehm et al, Ann Epidem, 2007)
mechanisms of effect of alcohol polyphenols on cvd
Mechanisms of Effect of Alcohol/Polyphenols on CVD

Blood lipids (esp. HDL-cholesterol)

Coagulation, fibrinolysis

Arterial endothelium

Genes (alcohol and/or polyphenols)

Ventricular function

Inflammation

Glucose metabolism

slide23
Mechanisms of Effect of Alcohol on Cardiovascular Disease (Collins et al, Alcoholism: ClinExp Res, 2009)
healthy lifestyle for prevention of diseases of ageing
“Healthy Lifestyle” for Preventionof Diseases of Ageing

Don’t smoke

Stay lean (avoid becoming obese)

Exercise regularly

Eat a diet low in animal fat, with lots of fiber (fruits & vegetables) and whole grains

Unless contraindicated, consume ½ - 2 drinks of an alcoholic beverage daily

from Stampfer, Hu, Chiuve, et al

slide25

Effects of Alcohol on Risk of MI

by Other Lifestyle Factors

(1. non-smoking, 2. not obese, 3. active, 4. good diet)

Least healthy (0-1 factors)=▲; Moderate (2-3 factors)=□; Healthy (4 factors)=◊

(Mukamal et al, Arch Intern Med 2006;166:21

slide26

Risk of Diabetes by Alcohol & Lifestyle Factors

Joosten et al, Am J ClinNutr 2010

Healthy lifestyle factors: (1) BMI <25, (2) physically active, (3) non-smoker, (4) high adherence to Dash diet

__________Hazard Ratio, adjusted______ Moderate

No. of Healthy FactorsAbstainerDrinker* p-trend

None or 1 3.90 1.98 < 0.001

2 to 3 2.68 1.21 0.002

3 or 4 1.00 0.56 0.02

*“Moderate drinker” = 5 - 14.9 g/d for women, 5 - 29.9 g/d for men

meta analysis of interventional studies of alcohol and coronary heart disease
Meta-analysis of Interventional Studies of Alcohol and Coronary Heart Disease

Brien SE, Ronksley PE, Turner BJ, Mukamal KJ.

Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta- analysis of interventional studies.

Published in BMJ 2011;342:d636

human interventional studies on mechanisms of effects of alcohol on cv risk brien et al 2011
Human Interventional Studies on Mechanisms of Effects of Alcohol on CV Risk (Brien et al, 2011)
slide32

Wine Increases the Number and Functional Capacity of Circulating Endothelial Progenitor Cells by Enhancing Nitric Oxide Bioavailability

A Clinical Trial of 80 Healthy Adults

Huang et al, Arteriosclerosis Thrombis & VascBiol, 2010

“The intake of red wine significantly enhanced circulating

endothelial progenitor cell levels and improved their

functions by modifying nitric oxide bioavailability.”

omega 3 fatty acids an untapped resource for improving health

Omega-3 Fatty Acids: An Untapped Resource for Improving Health

R. Curtis Ellison, MD

Professor of Medicine & Public Health

Director, Institute on Lifestyle & Health

Boston University School of Medicine

Boston, MA,

slide35

Effects of Moderate Drinking

on All-cause Mortality

alcohol and mortality with repeated assessments of etoh
Alcohol and Mortality(With repeated assessments of ETOH)

The Zutphen Study (Streppel et al , 2009)

  • Men followed for up to 40 years, until death in the vast majority, with repeated assessments of alcohol intake
  • Up to 20 g/day of alcohol (vs none) was associated with 25-30% lower rates of cardiovascular and all-cause mortality
alcoholic beverages and incidence of dementia 34 year follow up mehlig et al 2008
Alcoholic Beverages and Incidence of Dementia: 34-Year Follow-upMehlig et al, 2008

HR 95% CI

Wine drinkers 0.6 0.4, 0.8

Wine only 0.3 0.1, 0.8

Spirits drinkers 1.5 1.0, 2.2

Conclusion: wine and spirits displayed opposing associations with dementia.

slide44
Does drinking pattern modify the effect of alcohol on risk of CHD? A meta-analysis.Bagnardi et al, 2008
slide46

Changes in Alcohol Intake & Subsequent Risk of Diabetes

Health Professionals Study, n = 38,031 subjects

Joosten et al¸ Diabetes 2011

For initial non-drinkers, a 7.5 g/d increase = 22% decrease in risk

Intake 4 yrs Later_____

Baseline>0-4.9 g/d5-29.9g/d≥30g/dp-trend

>0-4.9 g/d 1.00 0.75 0.35 < 0.001

5-29.9 g/d 1.09 0.74 0.59 < 0.001

≥ 30 g/d 0.78 0.67 0.50 0.08

slide47

Klatsky has clearly stated that advice regarding alcohol depends on the individual’s age, sex, past alcohol

use experience, cardiovascular risk, and other factors.

We can apply similar approaches in giving population advice, as well. He added that most people know very well what the difference is between light to moderate drinking and binge or excessive drinking. While some patients may rationalize their heavy drinking because of its purported health effects, he has yet to find someone who had developed alcohol abuse because of messages about the health effects of moderate drinking. Medical practitioners, in his view, have a ‘‘solemn duty’’ to tell the truth about alcohol consumption, as they understand it, to all of their patients.

Changes in Alcohol Intake & All-Cause Mortality

Among Women with Invasive Breast Cancer

Newcomb et al, J Clin Oncology, 2013

  (7, 780 deaths in 23,000 women with breast cancer) 

Changes in All-Cause Mortality

Change in alcohol HR 95% CI

Never drinker 1.0 --

Drinker

No change 0.86 0.71-1.03

Decreased 1.03 0.85-1.25

Increased 0.76 0.60-0.97

effects of moderate drinking on the diseases of ageing
Effects of Moderate Drinking on The Diseases of Ageing

CV Diseases(↓ heart disease, stroke, CHF, vascular dis.)

Metabolic Diseases(↓ diabetes, MS, osteoporosis)

Cognitive Disorders (↓ Alzheimer’s, dementia)

Obesity (emerging data suggest ↓ weight gain)

Cancer (Abuse ↑ UADT cancers; moderate alcohol ↓ kidney

cancer & lymphoma, slight↑breast & colon cancer risk)

Total mortality(↓ among moderate drinkers)

c onclusion
Conclusion

Data over many decades (observational studies, animal experiments, & human intervention trials) have consistently shown that

Moderate drinking, especially of wine, is associated with a lower risk of CVD and most of the other diseases of ageing.

slide50

Klatsky has clearly stated that advice regarding alcohol depends on the individual’s age, sex, past alcohol

use experience, cardiovascular risk, and other factors.

We can apply similar approaches in giving population advice, as well. He added that most people know very well what the difference is between light to moderate drinking and binge or excessive drinking. While some patients may rationalize their heavy drinking because of its purported health effects, he has yet to find someone who had developed alcohol abuse because of messages about the health effects of moderate drinking. Medical practitioners, in his view, have a ‘‘solemn duty’’ to tell the truth about alcohol consumption, as they understand it, to all of their patients.

cumulative outcomes whi manson et al jama 2013
Cumulative Outcomes, WHIManson et al, JAMA 2013

All cardiovascular endpoints

Cardiovascular deaths

All cancers

All-cause mortality

slide52

The Ultimate Clinical Trial on Alcohol & Health

Recruit 50,000 normal, healthy 60 year-old people who are occasional drinkers with no previous hx of misuse & not confirmed abstainers

Evaluate them in a run-in period, with incentives to remain for 20-25 years

Provide them with a blinded beverage (either containing alcohol or no alcohol)

Assure that they drink a certain amount (perhaps 12 grams/alcohol) every evening, avoiding all other alcoholic beverages (except perhaps for religious services, weddings, and funerals)

Closely monitor compliance (blood tests, bottle counts, etc.) ; use intensive incentives to assure continued participation

Arrange follow up for 20-25 years to see which group ages better and lives longer

(Unlike pharmaceutical trials, must not fund this study with grants from interested parties)

effects of smoking alcohol on risk of upper aero digestive cancers szyma ska et al 2011
Effects of Smoking & Alcohol on Risk of Upper Aero-digestive CancersSzymańska et al, 2011
  • Effects on Risk
    • Smoking, not heavy drinking ++
    • Heavy drinking and smoking ++++
    • Heavy drinking, not smoking +/-
slide56

Brooks PJ, Zakhari S. Moderate alcohol consumption and breast cancer in women: From epidemiology to mechanisms and interventions. Alcohol Clin Exp Res – October 2012

:

  • Pointed out complexity in evaluating the association of alcohol and breast cancer
  • Cited importance that the pattern of drinking, short duration of follow up, under-reporting of alcohol intake, etc., could have on results.
risk of all cancer deaths among lifetime abstainers and current drinkers
Risk of All-Cancer Deaths Among Lifetime Abstainers and Current Drinkers

National Health Interview Survey, > 300,000 subjects, 8,362 cancer deaths

Breslow et al, Am J Epidemiol 2011

No. RR of Cancer Death 95% CI

Lifetime Abstainer 1,958 1.0 --

Light drinker 1,669 0.87 0.80, 0.94

Moderate drinker* 1,091 0.96 0.87, 1.06

Heavier drinker 622 1.27 1.14, 1.43

*“moderate” = >3 – 7 dr/wk women, >3-14 dr/wk men)

environmental effects on cancer risk in the uk parkin et al br j cancer 2011
Environmental Effects on Cancer Risk in the UKParkin et al, Br J Cancer, 2011
  • An analysis estimated the proportion of cancer risk associated with environmental factors.
  • Smoking (attributed in 19.4% of cases) was the

largest factor associated with cancer risk.

  • Diet and obesity were the next most common; alcohol was attributed in 4% of cases.
research on overall cancer risk epic schutze et al 2013
Research on Overall Cancer Risk(EPIC, Schutze et al, 2013)

While heavy alcohol intake increases upper aero-digestive cancer, overall only 3 out of 10,000 cancers in women & 3 out of 1,000 cancers in men are related to moderate alcohol consumption.

The authors do not add that for moderate drinking, the net effect is a reduction in total mortality, or greater survival.

slide60

Klatsky has clearly stated that advice regarding alcohol depends on the individual’s age, sex, past alcohol

use experience, cardiovascular risk, and other factors.

We can apply similar approaches in giving population advice, as well. He added that most people know very well what the difference is between light to moderate drinking and binge or excessive drinking. While some patients may rationalize their heavy drinking because of its purported health effects, he has yet to find someone who had developed alcohol abuse because of messages about the health effects of moderate drinking. Medical practitioners, in his view, have a ‘‘solemn duty’’ to tell the truth about alcohol consumption, as they understand it, to all of their patients.

bias in reports on alcohol health
Bias in Reports on Alcohol & Health

An analysis by the Framingham Study in 1974, after 24 years of follow up in men, found that there were “4 major risk factors:”

● High blood cholesterol

● High blood pressure

● Cigarette smoking

● Abstinence from alcohol!

slide62
CHD Mortality in the Framingham Heart Study, by Alcohol Intake (1974)(Percent deaths over 24 years in Men)
response of officials at nih
Response of Officials at NIH

“Refer to only 3 major risk factors, and

remove all references to alcohol.

With all the abuse in this country, we

must not say alcohol prevents CHD.”

“If you must comment on alcohol, say it

has no effect.”

Seltzer CC. “Conflicts of Interest and Political Science,” J ClinEpidem 1997

slide64

Comments from an “Alcohol Expert”

October, 2013

“Deaths from alcohol dwarf any small number of people who may derive benefit from low-dose alcohol.

“Among all people who start drinking, 5 – 10 times as many die from it as are benefited by it.”

slide66

Does Heavy Drinking by Adults Respond to Higher Alcohol Prices and Taxes? A Survey and Assessment

(JP Nelson, Dept of Economics, Pennsylvania State Univ, 2013)

Higher alcohol prices and taxes are frequently proposed as a policy tool to deal with abusive consumption

A review of 19 individual-based studies that examine price responses by heavy-drinking adults finds only 2 studies with a significant negative price response among heavy drinkers.

Many studies show that moderate-drinking adults have significant and substantial price/tax elasticities

slide67

The Impact of a Large Reduction in Alcohol Prices in Finland on Mortality Herttua et al, Int J Epidemiol, 2010

Markedly lowering the price of alcohol in Finland increased the number of alcohol-related deaths by 14-40% = 0 to 2.9 excess deaths each month, by age group

Lowering the price decreased by up to 24% the number of deaths from cardiovascular disease = 0 to 24.8 excess deaths each month, by age group

For all-cause mortality, 42 to 69 fewer monthly deaths

slide68

The Moral Bases for Public Health Interventions.

(Cole P, Epidemiology 1995;6:78–83)

“Policy should be based not on paternalism (‘We professionals know what is best’) but on education and the assumption that ‘informed people make healthful choices.”

Cole adds, ‘‘Health education should be education and not propaganda; it becomes the latter when only one side of an issue is presented to the public.’’

slide69

Lionel Tiger on Alcohol Guidelines

“We have seen the rise of what he calls ‘concernocrats,’ people who are motivated by well-meaning concern for the welfare of others and are prepared, therefore, to exert their power over the behavior and disposition of others.

‘‘It is a very tempting thing for well-meaning people to make statements about other people’s health and welfare because the population is primed for quasi-religious advice from the druids, the priests who advise us.”

slide70

Lionel Tiger on Alcohol Guidelines

“Those of us in the comment business need to be extremely careful about what we say, not because people may drink too much, or too little, but because we may nominate ourselves as ‘gurus’ of everyone’s destiny and inspect their behaviors too carefully.”

slide71

Klatsky has clearly stated that advice regarding alcohol depends on the individual’s age, sex, past alcohol

use experience, cardiovascular risk, and other factors.

We can apply similar approaches in giving population advice, as well. He added that most people know very well what the difference is between light to moderate drinking and binge or excessive drinking. While some patients may rationalize their heavy drinking because of its purported health effects, he has yet to find someone who had developed alcohol abuse because of messages about the health effects of moderate drinking. Medical practitioners, in his view, have a ‘‘solemn duty’’ to tell the truth about alcohol consumption, as they understand it, to all of their patients.

Alcohol & Health

Responses of Jackrabbit Johanssen, a cross-country skier aged 101, on his advice for a long and healthy life:

“Don’t smoke,

Get lots of exercise,

Don’t drink too much.”

slide72

Klatsky has clearly stated that advice regarding alcohol depends on the individual’s age, sex, past alcohol

use experience, cardiovascular risk, and other factors.

We can apply similar approaches in giving population advice, as well. He added that most people know very well what the difference is between light to moderate drinking and binge or excessive drinking. While some patients may rationalize their heavy drinking because of its purported health effects, he has yet to find someone who had developed alcohol abuse because of messages about the health effects of moderate drinking. Medical practitioners, in his view, have a ‘‘solemn duty’’ to tell the truth about alcohol consumption, as they understand it, to all of their patients.

Alcohol & Health

Responses of Jackrabbit Johanssen, a cross-country skier aged 101, on his advice for a long and healthy life:

“Don’t smoke,

Get lots of exercise,

Don’t drink too much.

Then, again, don’t drink too little either”

slide73

Klatsky has clearly stated that advice regarding alcohol depends on the individual’s age, sex, past alcohol

use experience, cardiovascular risk, and other factors.

We can apply similar approaches in giving population advice, as well. He added that most people know very well what the difference is between light to moderate drinking and binge or excessive drinking. While some patients may rationalize their heavy drinking because of its purported health effects, he has yet to find someone who had developed alcohol abuse because of messages about the health effects of moderate drinking. Medical practitioners, in his view, have a ‘‘solemn duty’’ to tell the truth about alcohol consumption, as they understand it, to all of their patients.

current challenges
Current Challenges

For middle-aged and older adults who have no contraindications to alcohol we can encourage regular, moderate drinking as a component of a healthy lifestyle.

Make drunkenness socially unacceptable

alcohol intake chd mortality among non diabetics diabetics physicians health study ajani et al 2000
Alcohol Intake & CHD Mortality Among Non-Diabetics & DiabeticsPhysicians’ Health Study, Ajani et al, 2000
moderate alcohol use and c ognitive function a mendelian randomization design study march 2012
Moderate Alcohol Use and Cognitive Function(A Mendelian Randomization Design Study) March 2012

Headlines

  • Mendelian randomization is the “Gold Standard” for studying alcohol and disease
  • Moderate alcohol use is unlikely to lower risk of dementia
moderate alcohol use and c ognitive function a mendelian randomization design study march 20121
Moderate Alcohol Use and Cognitive Function(A Mendelian Randomization Design Study) March 2012

Comments

  • Mendelian randomization based only on ALDH2 (but explains < 3% of alcohol intake)
  • Ignored patterns of drinking, environmental factors affecting alcohol use
alcohol and obesity 2011 2013
Alcohol and Obesity 2011-2013

Sayon-Orea et al reviewed publications on alcohol and obesity. They concluded: “It is possible that heavy drinkers may increase their risk of obesity.

“Light-to-moderate alcohol intake, especially wine intake, may be more likely to protect against weight gain, whereas consumption of spirits has been positively associated with weight gain.”

alcohol body mass index by quintiles of frequency of drinking breslow ra et al am j epidemiol 2005

Alcohol & Body Mass Index(by quintiles of frequency of drinking)Breslow RA et al – Am J Epidemiol2005

the international scientific forum on alcohol research1
The International Scientific Forum on Alcohol Research

The Forum was established in 2010, to provide critical and balanced reviews of emerging papers related to alcohol and health, published on www.bu.edu/alcohol-forum

The Forum consists of an international group of 40 invited physicians and scientists who are specialists in their fields and volunteer their services

the intenational scientific forum on alcohol research
The Intenational Scientific Forum on Alcohol Research

The Institute on Lifestyle & Health at Boston University serves as the scientific center of the Forum; the Institute is supported completely by donations

Since 2010, more than 120 critiques have been published by the Forum on its web-site (www.bu.edu/alcohol-forum).

Brief summaries of each critique are distributed widely by a team in the UK headed by Helena Conibear

alcohol cardiovascular disease
Alcohol & Cardiovascular Disease

Ecologic studies, such as those describing the “French Paradox,” compare populations in the aggregate, but do not contain individual data. May generate hypotheses, not test them.

For the latter, clinical trials are best; but we often have to rely on prospective epidemiologic studies that are adequately adjusted for confounders.

quotation from abraham lincoln
Quotation from Abraham Lincoln

"It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing."

Lincoln A. Talk to Washington Temperance Society of Springfield, Illinois, February 22, 1842

slide95

Coronary Atherosclerosis, by Type of Alcohol Consumed (Rabbits)

Type of Beverage% of Coronaries with lesions

Water 100%

Beer 100

Whiskey 83

White wine 67

Red wine 40

Klurfeld & Kritchevsky, 1981

in determining alcohol policy we must avoid publications with
In Determining Alcohol Policy, We Must Avoid Publications With

Bias: An inclination, a propensity, a predisposition, (towards); prejudice

Ignorance: Lack of knowledge (general or particular)

Pseudoscience: Pretended or spurious science; a collection of beliefs about the world mistakenly regarded as being based on scientific method or as having the status of scientific truth

Misinformation: Wrong or misleading information

slide98

Klatsky has clearly stated that advice regarding alcohol depends on the individual’s age, sex, past alcohol

use experience, cardiovascular risk, and other factors.

We can apply similar approaches in giving population advice, as well. He added that most people know very well what the difference is between light to moderate drinking and binge or excessive drinking. While some patients may rationalize their heavy drinking because of its purported health effects, he has yet to find someone who had developed alcohol abuse because of messages about the health effects of moderate drinking. Medical practitioners, in his view, have a ‘‘solemn duty’’ to tell the truth about alcohol consumption, as they understand it, to all of their patients.

Sin Taxes: Do Heterogenous Responses Undercut Their Value?

Ayyagari et al, National Burerau of Econommic Research, 2009

“Only a subgroup responds significantly to price. Importantly, the unresponsive group drinks more heavily, suggesting that a higher price could fail to curb drinking by those most likely to cause negative externalities.

“In contrast, those least likely to impose costs on others are more responsive, thus suffering greater deadweight loss yet with less prevention of negative externalities.”