Sick Quitters: Have We Been Misled on the Health Benefits of Alcohol?

Oh boy, do I need a drink.

I would guess that many people reading this may have said that before. Maybe it was after a long day, or in the middle of an even longer one, that you may have looked forward to unwinding with a strong cocktail or a cold beer. It is, without a doubt, one of the most socially acceptable ways to decompress, but we're instructed to not do it too often. But why?

We've been told that alcohol can be bad for you, but moderation is key. According to some studies from the 1980s and 1990s, a glass of wine of day may not necessarily keep the doctor away, but it certainly wouldn't harm you. For the better part of 40 years we pointed to these studies as evidence that the drinks we had each day could in fact be good for us, but recent analyses on the health benefits of alcohol have changed what we were told to believe.

What did those studies on alcohol say?

One of the studies that became frequently cited was conducted in 1992, but we should look at something a year before that helped spark the topic.

In 1991, the show 60 Minutes had a broadcast that looked at "The French Paradox" which claimed that French people seemed to have lower rates of heart disease despite their diet being higher in saturated fat when compared to other parts of the world. During this broadcast, one of the researchers in the aforementioned study was interviewed and essentially previewed some of the early findings of their work.

In the study, called "Wine, alcohol, platelets, and the French paradox for coronary heart disease," the researchers were trying to explain the so-called paradox; in virtually every other community, diets high in fat would typically lead to heart disease and increase the risk of death, but this did not seem to be the case in France despite having a similar diet. In their study, they concluded that this seemingly lower rate of heart disease and death in their population was due to their high consumption of wine, determining that 20-30 grams of alcohol (which is between about one to three glasses of wine) per day would be a protective factor against heart disease. This was just one of many studies around that time which seemed to prove that alcohol consumption could be healthy.

What was the problem with this study or the other ones?

To start, the amount of alcohol they determined was beneficial to health is actually a significant number of drinks. Following that guideline, you would be consuming enough alcohol to be considered to moderate drinker (one drink per day for women, two drinks per day for men), possibly well on the way to becoming a heavy user.

Secondly, the researchers used what's called an ecologic design for the study, meaning they analyzed data on the French population as a whole to describe trends between alcohol consumption and heart disease. The problem here is that ecologic studies merely look at the data, which is valuable, but is not the most reliable way to find a definite conclusion. For example, the data showed that French people tended to consume large amounts of saturated fats and alcohol, and also that the rates of deaths from heart disease were low. Without determining if there is actually relationship between those, we can't really conclusively say that their diet is the reason deaths are low. This is also similar to the claim that because wine has tannins that wine itself is healthy, when it's only the tannins that have provable health benefits and can be found in multiple whole foods and non-alcoholic beverages.

Lastly, the study looked at data that was skewed to make a moderate drinking habit look healthy. To explain, some studies might suffer from the problem of using what's called a "sick population." Let's say a study is looking to compare the health of moderate drinkers versus non-drinkers; we could assume that the people in the moderate drinker group would be one to two drinks daily and the non-drinker group are people who currently don't drink any may not have ever drank. However, what's known as the sick quitter bias occurs when the researchers also include former drinkers who have quit due to illness caused by alcohol, and classify them as non-drinkers. Because of this misclassification, the non-drinker group can look unhealthy compared to the moderate drinker group because a significant number of those people are already unhealthy even though they do not currently drink. The researchers, in part, drew their conclusions by reinterpreting previous studies which unfortunately suffered from this bias.

What do researchers think about these studies now?

That specific study was not the only one that looked at the potential health benefits of alcohol, but it did get a lot of exposure due to that 60 Minutes segment. In fact, these studies were already being scrutinized at that time due to their design and classification of participants, other issues outside of the sick quitter bias. But, the conclusions were what the public wanted to hear; it's not bad for you to have those drinks.

Some meta-analyses on the effects of alcohol reanalyzed data by excluding those sick quitters, which made that protective quality of alcohol essentially disappear. Some evidence also suggests that the researchers in the French paradox study looked at data which underreported the occurrence of heart disease and fatalities, further muddying the waters.

Conclusion

So, should you have that drink after a long day? That's a decision for you to ultimately make, but just know the facts before you start thinking that it won't really hurt. The current data has partly come from reevaluating all of those positive health claims, and the consensus is that alcohol is not nearly as healthy as we've been led to believe.

References:

CBS News - How Morley Safer convinced Americans to drink more wine, https://www.cbsnews.com/news/how-morley-safer-convinced-americans-to-drink-more-wine/

The Lancet (accessed from https://www.sciencedirect.com/) - Wine, alcohol, platelets, and the French paradox for coronary heart disease, https://www.sciencedirect.com/science/article/pii/014067369291277F

National Institute on Alcohol Abuse and Alcoholism - The Basics: Defining How Much Alcohol is Too Much, https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/basics-defining-how-much-alcohol-too-much#pub-toc1

International Journal of Epidemiology (accessed from https://academic.oup.com/) - The French paradox and other ecological fallacies, https://academic.oup.com/ije/article-abstract/40/6/1486/801211?redirectedFrom=fulltext

Journal of Studies on Alcohol and Drugs (accessed from https://pmc.ncbi.nlm.nih.gov/) Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality, https://pmc.ncbi.nlm.nih.gov/articles/PMC4803651/

Assessed and Endorsed by the MedReport Medical Review Board