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World’s Drunkest Countries

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An online article today on Business Insider examines the World Health Organization’s most recent Global status report on alcohol and health 2014. Entitled Here Are The Drunkest Countries In The World, it gives the highlights of the WHO report. Unfortunately, in my experience WHO tends to lean on the side of prohibitionists in their approach to alcohol, highlighting primarily the bad aspects while ignoring the positive. As a result, WHO tends to be all doom and gloom about alcohol in the world. It’s a somewhat odd position. At any rate, they use the map below, showing per capita alcohol consumption by country, as of 2010 (but it’s the same data in the 2014 report).

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See the chart full size.

One thing to notice is that despite the hue and cry from U.S.-based anti-alcohol groups, American consumption has been flat or down since its 1980 high point, and worldwide we’re pretty much in the middle of the consumption scale, not the lowest or the highest, as they’d have us believe. Canada drinks more than we do. So does Australia and most of Europe, especially Eastern Europe and Russia.

But even with WHO’s very conservative view of drinking alcohol, American patterns of risky drinking is even lower than average, squarely in the second-lowest category. For example, Mexico may drink less than Americans per capita, but still manages to drink in a more risky manner, and Canada and us are the same, despite out-drinking Americans. Likewise, Western Europe, which drinks more than most, engages in the least risky behavior, at least as WHO defines it.

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See the chart full size.

So if we accept the way WHO comes up with that statistic — stated as by considering “the usual quantity of alcohol consumed per occasion, proportion of drinking events when drinkers get drunk, proportion of drinkers who drink daily or nearly daily, festive drinking, drinking with meals, and drinking in public places — then overall there’s a lot less risky drinking in the world than the first chart would have us believe. While per capita consumption seems to follow the expected bell curve, risky behavior does not, with far less dark spots. The riskiest countries are concentrated in just a few nations, and looks even larger than it really is because one of the countries is geographically very big. The countries in the second-riskiest tier looks to be less than ten nations, suggesting that a majority of places to do not engage in a great deal of risky drinking, which is frankly what I’d expect. Either way, I’m not sure hardly any deserve the title “drunkest countries.”

The Unintended Consequences Of Prohibitionist Propaganda

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So I know this is one of those thorny issues that tends to fire people up and argue from an emotional point of view. That being said, the issue of a woman drinking when pregnant is a tough one, especially because the science is not exactly as settled as people believe. My understanding is that it’s not clear how drinking effects an unborn fetus, though a significant amount of drinking has been shown to have potentially disastrous consequences. Generally speaking, a modest amount of drinking probably won’t do any lasting damage, especially in the very early stages of pregnancy. But since when and how much are fairly unknown with any precision, doctors, and the medical community as a whole, have tended to recommend that a woman abstain from drinking during pregnancy. And that seems almost reasonable, except for the fact that prohibitionist and anti-alcohol groups have taken that advice as sacrosanct without really examining the science behind it and have done their best to shame women who might have an occasional drink and make them feel as guilty as humanly possible.

For example, WebMd says. “For decades, researchers have known that heavy drinking during pregnancy can cause birth defects. But the potential effects of small amounts of alcohol on a developing baby are not well understood. Because there are so many unknowns, the CDC, the U.S. Surgeon General, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics advise pregnant women not to drink alcohol at all.” But again, that’s just because they don’t really know, not because it’s proven that any amount of alcohol is harmful. If you do a quick search, you’ll find that a lot of websites claim that pregnant women should never drink because, as most of them put it, “[t]here is no known safe amount of alcohol that you can consume if you are pregnant.” But that’s misleading. It’s not so much that no amount is safe so much as the amount that is safe is not known with precision, and for every person. I know that sounds like I’m splitting hairs, but I think it’s an important distinction. There are safe levels of drinking alcohol that would have no effect on a woman’s pregnancy, and for any given woman that amount would differ, but so far we don’t know how to calculate that amount, so instead doctors recommend abstaining. But that’s very different from hounding women who might have the occasional drink or acting as if they’re actively or willfully harming their unborn fetus.

It’s quite easy to find this scaremongering in all sorts of places. Not surprisingly, Alcohol Justice, who is a leading propagandist, regularly tweets “Save Babies From Birth Defects: Don’t Drink While Pregnant,” with a link to International Fetal Alcohol Spectrum Disorders Awareness Day Aims To Help Save Babies From Birth Defects: Don’t Drink While You’re Pregnant. Which would be reasonable, except for the fact that the Medical Daily piece is littered with exactly the sort of absolutist misinformation I’m talking about.

There’s a common misconception that it’s safe to drink during certain points in the pregnancy, or that one glass of wine or beer is harmless. It has been almost 30 years since the medical community recognized mothers who drank alcohol while pregnant could result in a wide range of physical and mental disabilities, but still, one in 13 pregnant women reports drinking in the past 30 days and one in six reports binge drinking. Fetal alcohol syndrome can be devastating, which is why a day [September 9] has been dedicated to spreading the awareness and clearing up the truth for mothers to understand that anything they eat and drink affects the baby.

The NIH’s Alcohol Abuse and Alcoholism branch has supported years of research to reveal the dangers and understand when developmental problems within the womb begin. Babies who are born with fetal alcohol syndrome have been born small and premature, develop problems eating, sleeping, seeing, hearing, learning, paying attention in school, controlling their behavior, and may even need medical care through their life. The severity of drinking alcohol while pregnant cannot be underplayed because of the profound confirmed health effects that could follow a child throughout their life.

Every pregnancy is different and unique to the mother’s health, genetic composition, and the baby. According to the NIH, drinking alcohol the first or second month of pregnancy can hurt the baby with irreversible health consequences. The Centers for Disease Control and Prevention backs up the NIH by saying there is no safe level of alcohol to use during pregnancy. If drinking continues throughout the pregnancy, babies are likely to develop fetal alcohol syndrome with characteristic facial features such as a wide set of eyes, smooth ride on the upper lip, and a thin upper lip border. But that’s only the surface, because within the brain lies the possibility of intellectual disabilities, speech and language delays, and poor social skills.

Unfortunately, the “truth” as they put it is not exactly the whole truth, nor is it the same advice given universally by the medical community, despite the fact that both the NIH and the CDC take the absolutist point of view just to be safe. That these government agencies here, and in other places, take this position without actually explaining why, or even how they arrived at it and the uncertainty about it, seems to me a condescending way to treat people. I know, or hope, they mean well, and the goal is to bring healthy babies into the world. Everyone agrees that frequent drinking or drinking large quantities of alcohol while pregnant is a terrible idea, but not giving women all of the facts is yet another example of the medical community talking down to people and treating them with condescension. And it’s taking its toll on some women in unexpected ways, as I’ll explain later.

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More recent studies are beginning to show that in fact the occasional drink is not only harmless, but in some cases beneficial. For example, a 2013 study at Harvard found “no connection between drinking alcohol early in pregnancy and birth problems” and at the University College London, they found “Light drinking in pregnancy not bad for children.” Others found A Drink A Day While Pregnant Is OK and Moms Who Drink Wine While Pregnant Have Better Behaved Kids. Yet another recent New study shows no harm from moderate drinking in pregnancy. Likewise, Moderate drinking during pregnancy may not harm baby’s neurodevelopment and the Parenting Squad says that Yes, You Can Drink While Pregnant.

In Is It OK to Drink While Pregnant? Why Scientists Really Don’t Know, the author details why it is that the science is so difficult to pin down, and as such many doctors advise abstaining altogether. One of the problems with this contrary advice is that some people who are convinced that any alcohol represents a danger to an unborn fetus and they make life difficult for anyone who’s received different advice, or who has looked at the issue and come to a different conclusion. Despite it being unsettled, some states have, or are considering, passing laws to punish women who have the temerity to have a drink while pregnant. Both of my wife’s baby doctors advised her the occasional drink was not a problem, and even told her that if it helped her relax was a positive. She tended to have a drink only every so often, rarely even, and I certainly enjoyed the months of having a designated driver. But many other women report having been publicly shamed, ridiculed and punished for drinking while pregnant in public. At least one person reports being accosted for simply buying alcohol (it was for a party and she had no intention of drinking it) and I suspect that’s not an isolated incident. The clerk at the liquor store acted like it was against the law for her to simply purchase it.

Many have written about their experiences with alcohol during pregnancy and are worth reading. See, for example, Take Back Your Pregnancy, by an economist writing for the Wall Street Journal. And for Slate, Emily Oster explains herself in “I Wrote That It’s OK to Drink While Pregnant. Everyone Freaked Out. Here’s Why I’m Right.” In addition, Dr. Peggy Drexler, a research psychologist and gender scholar, examined the history and psychology of shaming such women in A Loaded Question: On Drinking While Pregnant. Not surprisingly, it’s only been since 1981 that the U.S. Surgeon General’s took the official position pregnant women should completely abstain from drinking alcohol. And for a while, drinking among pregnant women declined, but since 2002 has been on the rise again, though it’s the “‘every now and then’ glass of wine or two” rather than binge drinking and the biggest demographic to see this increase is “college-educated women between 35 and 44.” Her answer to why “as a whole we continue to judge women who opt to have that occasional glass of wine,” is that “[w]e’re so fully entrenched in the age of over-parenting — having opinions, and voicing them, about how other people raise their kids — that, it seems, we can’t help but start in before the baby is actually born.”

Similarly, in a lengthy piece for Boston Magazine, Pregnant Pause?, author Alyssa Giacobbe details this explanation.

“As soon as you’re pregnant, or have a baby, it’s like all bets are off,” says Kara Baskin, a 33-year-old mother of a two-year-old boy. “People can say whatever they want, touch whatever they want, make whatever comments they want.” A few years back, she was at a Starbucks when the barista asked her, “Are you supposed to be having any caffeine when you’re pregnant?” She wasn’t pregnant — it was just the shirt — but of course that didn’t matter. She ran out crying.

Of course, it wasn’t always that way. My mother drank, and most likely smoked, while she was pregnant with me. If you’re close to my age, or older, your Mom probably did, too. Entire generations did, and while it would be hard to argue that children today aren’t better off thanks to their mothers watching what they consumed or what they did while pregnant, our species made it pretty far before 1981 just by being sensible.

But back to Dr. Drexler, who concluded with these words of wisdom.

This is not a call to drink while pregnant, or to be careless in any way. We know much more now than our own mothers did, and that’s an advantage. But years of experience studying gender and working with families have shown me, time and again, that mothers get a bad rap. This can create needless fear, anxiety, and self-doubt. Perhaps it’s time to rethink the tendency to assign blame, constantly monitor, and voice our every opinion about the choices other mothers make. After all, isn’t the prospect of having a baby daunting enough?

Indeed, I think we can all agree that over-indulging during pregnancy is not a good idea. But making hard and fast rules, giving people a hard time about it, or even punishing them socially, or legally, is going too far. Which brings me back to my statement earlier that this is “taking its toll on some women in unexpected ways.” An article last week in London’s Telegraph, Pre-pregnancy test binge-drinking: 5 myths busted, detailed the darker side of humiliating pregnant women with the abstinence only propaganda so commonly employed by prohibitionist groups.

Most women try and follow the existing guidelines, or avoid alcohol altogether.

But what about those who don’t know they’re pregnant? What about the women who have spent the first few weeks of their pregnancy binge drinking, because they had no idea they were unexpectedly expecting?

Today, the British Pregnancy Advisory Service (BPAS) said that many women are so shocked to discover they’ve been binge drinking through the early stages of pregnancy, that they consider having an abortion.

The organisation reports an increase in women who are so worried about having unknowingly harmed their baby that they’re enquiring about ending what would otherwise have been a wanted pregnancy. BPAS is now trying to reassure pregnant women that this is not necessary.

That’s right, some women have been so traumatized by the scaremongering propaganda out there about binge drinking that they’re considering terminating their pregnancy, that is having an abortion rather than risk giving birth. The BPAS is now scrambling to reassure women that they don’t need to go to such extreme measures, and author Radhika Sanghani takes on five common myths which lead women to consider an abortion, and in the process contradicts much of the absolutist rhetoric and rationale for advising women to completely abstain from alcohol during pregnancy.

What struck me about this story is that it’s a real example of harm being perpetrated on women — not to mention their unborn children — through prohibitionist propaganda. I want to believe that the healthcare community has been giving the abstaining advice in an abundance of caution and with a greatest good sort of mentality to protect women and children. But I have no such illusions about the motives of prohibitionists, who have shown they’ll use any tactic to promote their agenda, and will exaggerate any claim that shows alcohol in a negative light. This is what can happen when propaganda goes unchecked. This suggests that there may be children who were terminated and not given a chance to live full lives thanks to exaggerated propaganda by prohibitionist groups and other anti-alcohol organizations. As my British colleague Pete Brown tweeted when this article first appeared; “Proud of yourselves, Alcohol Concern? These are the, hopefully, unintended consequences of prohibitionist propaganda.

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All Hopped Up For The Cure 2014

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Last night, Russian River Brewing kicked off their annual month-long All Hopped Up For the Cure charity event, raising money for the local Sutter Medical Services in Santa Rosa and specifically their Breast Care Center. They do it every October, in conjunction with Breast Cancer Awareness Month, a cause owners Vinnie and Natalie Cilurzo feel quite deeply about. It’s a big one for me, too. I lost my mother to breast cancer when I was only 21, when she was just 42. More than two dozen Summit doctors and breast cancer survivors were on hand to show their support. While this year’s efforts just began, there’s plenty of time to stop by the brewpub and help this very important cause in a variety of ways. As they do each year, there are three big items that are being auctioned, and raffle tickets are available until the drawing takes place, on October 30th, 2014 during their annual Halloween Bash. You need not be present to win, but you do have to answer your phone when Natalie calls from the stage. Here’s what you can win:

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Raffle tickets can be bought at the pub and placed in lucite boxes at the front of the brewpub. You can also purchase raffle tickets without visiting the pub by contacting Aura Helwick at info@russianriverbrewing.com.

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The big prize is a brand new White Vespa Primavera 150cc with “All Hopped Up for the Cure” decals. The winner is responsible for claiming their prize in person at Revolution Moto in Santa Rosa! Must be 18 to win. Must answer the phone if/when I call at around 10pm on Oct. 30 to be eligible to win! Raffle tickets are $10 each or 3 for $25.

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There’s also a Pink Electra Amersterdam Joyride bicycle, graciously donated by The Bike Peddler in Santa Rosa! Raffle tickets are $5 each or 5 for $20.

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And lastly for the big raffle items, a very cool Custom Built Guitar, a pink accoustic guitar hand-made by Timmy Lovold and friends! Raffle tickets are $10 each or 3 for $25.

Brewmaster Vinnie Cilurzo also created a special beer for the events, Framboise For A Cure, which will be available on draft and in 375ml bottles available, but only at the brewpub. FFAC is a sour barrel-aged blonde ale with 31 pounds per barrel of fresh raspberries, giving it a beautiful reddish/pink hue. Each year, it’s only around until it runs out, though they’re setting aside a set number of bottles to sell each day so it’s not gone too soon, and 100% of proceeds from sales of this beer will be donated to Sutter. I had some last night, and it’s really tasty, with big fruit flavors, not too sour but just enough jammy, puckering goodness to keep sipping.

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And finally, Russian River creates a new graphic each year for the event, and this year’s logo is really cool, as far as I’m concerned.

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The logo is available on Men’s T-Shirts, a Men’s Workshirt and a Ladies T-Shirts. All three are available online or at the pub, with 100% of proceeds donated to Summit, as well.

Give generously this year to help make breast cancer a thing of the past, or at least increase the odds that more children don’t lose their mothers, husbands their wives or friends their friends to breast cancer.

Beer And Good Health, Circa 1907

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Here’s another interesting historical artifact on beer and good health. This is from the Tennessee State Fair Official Souvenir Program and Guide, from 1907, advertising a talk by a German professor, Dr. P. Bauer, “demonstrating the effect of beer on the health.” It looks like his appearance was sponsored by the William Gerst Brewing Co. of Nashville, Tennessee. One insight he could be expected to give: “Solid foods often remain in the stomach a long time and retard digestion. Liquid foods, like GERST Beer, are an aid to digestion.” Oh, and there’s this subtitle. “People Who Drink Plenty of Beer Are Always Strong and Healthy.” The ad then ends with this branded tagline: “There is Good Health in every bottle of Gerst Beer.”

Good-Health-1907

Beer In Ads #1328: What Products, Besides Beer, Come From The Brewing Industry?

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Monday’s ad is another one from the United States Brewers Foundation, from 1951. This a series of ads they did in 1951 using a Q&A format aimed at highlighting different positive aspects of beer and the brewing industry.

Q
What products, besides beer, come from the Brewing Industry?

A
Vitamins, yeast and cattle feeds are important industry by-products.

Apparently brewing yeast is the best source of B vitamins every found, and it even may have rid the world of pellagra, “the dread diet-deficiency disease” that I’ve never heard of, although it persists in Africa, Indonesia, North Korea and China. Then there’s also spent grain given as feed for livestock, as common then as now.

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The ALS Ice Bucket Challenge: Brookston & Porter

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So you’ve probably noticed that one of the latest internet memes is the ALS Ice Bucket Challenge to raise awareness and money for Amyotrophic lateral sclerosis, better known as Lou Gehrig’s Disease. The idea involves “dumping a bucket of ice water on someone’s head to promote awareness of the disease amyotrophic lateral sclerosis (ALS) and encourage donations to research.” Also, the “challenge dares nominated participants to be filmed having a bucket of ice water poured on their heads and challenging others to do the same.” I was challenged by my friend and colleague, Tom Dalldorf, publisher of the Celebrator Beer News, who also tapped Stephen Beaumont and Tom McCormick, executive director of the California Craft Brewers Association. So here’s my video, with my son Porter, who decided he wanted to join me.

You can find out more about how to donate at the ALS Association or the MDA.

THE ALS ASSOCIATION

I also challenged three friends:

  1. Fal Allen, brewmaster, Anderson Valley Brewing
  2. Justin Crossley, founder, The Brewing Network
  3. John Holl, Editor, All About Beer magazine

Now it’s their turn. No thanks necessary.

The Heart & Health & Beer

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I can’t tell you how sick I am of the unscrupulous tactics of prohibitionists; the way they bend the truth to suit their agenda, the way they play so fast and loose with the truth and the way they demonize those of us in the alcohol industry. I find their hypocrisy more than a little unsettling, especially when they claim to be “watchdogs,” keeping the alcohol industry honest, while being so dishonest in the process. Why they continue to receive positive press is bewildering to me. Here’s the latest example of this, from one of the most egregious of the bunch, Alcohol Justice. Here’s what they’ve recently added to their daily tweetings.

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Oh, Alcohol Justice, how do I hate thee, let me count the ways.

  1. Alcohol no benefit to the heart, even light use: You probably won’t be too surprised to learn that clicking on the subsequent link takes you to a story that says roughly the same thing, but that the study’s conclusion requires a great leap from one conclusion to another, with no obvious causation or relation of one to the other, as you’ll see below. AJ happily picks up on bad and sloppy reporting, and an apparently agenda promoting press release without ever noticing that the basis for all of it does not support the headline.
  2. Refutes bogus industry claims: Okay, this one really pisses me off. The claims about how moderate alcohol consumption can benefit heart health are not “industry claims,” but comes from numerous scientific studies, and dismissing them all as “bogus” with a wave of the hand over one so-called study, even if right on point, is so mindbogglingly disingenuous and dishonest to make them utterly fundamentalist prohibitionist wingnuts with absolutely no regard for honesty or truth whatsoever.

Unfortunately they’re lead down this rabbit hole partly by one media outlet, a press release by one of the universities involved in the study and even a weird, untrue statement by one of the researchers.

So let’s start with the news media report. Alcohol does not benefit the heart, claims new study is on the website Medical News Today, which in the past has also used misleading headlines and twisted analysis of studies to misrepresent the results. The article is written by a Catharine Paddock, who apparently has a PhD and despite writing numerous times about medical and health topics, has a background as a “technical writer in the computer and electronics industry.” She also “enjoys keeping fit, yoga, reading, [and] walking,” so she’s obviously qualified to write about complex medical studies. But to be fair, she pretty much uncritically reports and reworks the press release on the study. Despite Medical New Today helpfully providing links to both the press release and the original study, she appears not to have read or looked at the study itself, otherwise she might have noticed that the two don’t really agree.

Next, let’s look at the “news release” from Penn Medicine, titled New Study Shows Drinking Alcohol, Even Light-to-Moderate Amounts, Provides No Heart Health Benefit, subtitled “Results Call into Question Previous Studies Suggesting One Drink Per Day May Promote Cardiovascular Health,” so it’s obvious that’s where the mischaracterizations begin. Curiously, they don’t even provide a link to the study that’s the subject of their news release. But given that they’re pushing this study to toot their own horn, to promote the work of their own Perelman School of Medicine at the University of Pennsylvania, it’s not too surprising that they’d oversell its accomplishments. It’s slightly more surprising that the mainstream news media would not critically question it, but it’s still troubling and more than a little annoying given that most people expect that a news story has been vetted and checked for accuracy. But more often what happens is overworked journalists simply rework a press release into a story and often don’t bother investigating its veracity or interview anyone with a contrary opinion or even someone simply outside or not involved in the organization who put out the press release itself.

But let’s go first to the study itself, titled simply Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. Here’s the abstract:

Objective To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease.

Design Mendelian randomisation meta-analysis of 56 epidemiological studies.

Participants 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers.

Main outcome measures Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption.

Results Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (−0.88 (−1.19 to −0.56) mm Hg), interleukin-6 levels (−5.2% (−7.8 to −2.4%)), waist circumference (−0.3 (−0.6 to −0.1) cm), and body mass index (−0.17 (−0.24 to −0.10) kg/m2). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)).

Conclusions Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.

So in this case, after all the scary headlines and statements like “[t]he latest findings call into question previous studies which suggest that consuming light-to-moderate amounts of alcohol (0.6-0.8 fluid ounces/day) may have a protective effect on cardiovascular health” they finally get to the truth, of sorts, well after many people probably stopped reading. Here it is: “Researchers found that individuals who carry a specific gene which typically leads to lower alcohol consumption over time have, on average, superior cardiovascular health records. Specifically, the results show that individuals who consume 17 percent less alcohol per week have on average a 10 percent reduced risk of coronary heart disease, lower blood pressure and a lower Body Mass Index.” That’s right, the conclusion is about people with a specific gene.

In the study’s abstract conclusion, they go from stating that those people who have the specific genetic variant drink less and also had “a reduced risk of coronary heart disease than those without the genetic variant” to a conclusion that therefore “reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.” But that makes no sense whatsoever.

But perhaps more annoying is a comment by one of the researchers at Penn, Co-lead author Michael Holmes, who essentially dismisses every study before his own as worthless as he arrogantly mansplains that those were all observational studies, just mere “observations,” unlike his study. His tone is clearer when you watch the video, but essentially it’s this, from the media report:

He explains how for some time, observational studies have suggested only heavy drinking is bad for the heart, and that light drinking might even provide some benefit, and this has led some people to believe moderate consumption is good for their health, even lowering their risk of heart disease.

And from the press release:

“These new results are critically important to our understanding of how alcohol affects heart disease. Contrary to what earlier reports have shown, it now appears that any exposure to alcohol has a negative impact upon heart health,” says co-lead author Michael Holmes, MD, PhD, research assistant professor in the department of Transplant Surgery at the Perelman School of Medicine at the University of Pennsylvania. “For some time, observational studies have suggested that only heavy drinking was detrimental to cardiovascular health, and that light consumption may actually be beneficial. This has led some people to drink moderately based on the belief that it would lower their risk of heart disease. However, what we’re seeing with this new study, which uses an investigative approach similar to a randomized clinical trial, is that reduced consumption of alcohol, even for light-to-moderate drinkers, may lead to improved cardiovascular health.”

In addition, his statement that people have been taking up drinking alcohol because previous studies showed a positive association between moderate drinking and heart health is utterly obnoxious. I’ve read a lot of these studies and every single one is overly careful to make sure nobody should ever take their study’s conclusion as a catalyst to start drinking. Between that and the incessant chorus in our society about the dangers of drinking or the idea that drinking’s a sin, this statement, I think, tells us more about his own personal issues with alcohol than any objective reality.

But despite the dismissive tone, waving aside every other study on this topic, suggesting this one study somehow supersedes and replaces them all, there have been perhaps hundreds, or more, studies around the world on the association between alcohol consumption and heart health. I have a hard time accepting that every one of them was “observational” or that they’re all now meaningless now that he’s done this one.

Cardiovascular disease is the number one cause of death in U.S., but moderate drinking can reduce risks 40-60% [Journal, Alcoholism, 2004] and the benefits of alcohol on the heart has been known since 1904 [Journal of the AMA, 1904].

The Director of the National Institute on Alcohol Abuse and Alcoholism wrote that “Numerous well-designed studies have concluded that moderate drinking is associated with improved cardiovascular health” and a Nutrition Committee of the American Heart Association reported that “the lowest mortality occurs in those who consume one or two drinks per day.” On top of that, the World Health Organization Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease could no longer be doubted. [AIM Digest (Supplement), June 1997].

And here’s just a sample of previous studies, taken from Alcohol Problems and Solutions. And none of them are bogus industry claims, either.

Heart Health

Medical research has demonstrated a strong relationship between moderate alcohol consumption and reduction in cardiovascular disease in general and coronary artery disease in particular. [Moore, R., and Pearson, T. Moderate alcohol consumption and coronary artery disease. Medicine, 1986, 65 (4), 242-267.]

The National Institute on Alcohol Abuse and Alcoholism found that moderate drinking is beneficial to heart health, resulting in a sharp decrease in heart disease risk (40%-60%). [Highlights of the NIAAA position paper on moderate alcohol consumption. Press release from the journal, Alcoholism: Clinical & Experimental Research, June 14, 2004; Berman, Jessica. Moderate alcohol consumption benefits heart, U.S. government says. Voice of America News, June 16, 2004.] This is important because cardiovascular disease is the number one cause of death in the United States and heart disease kills about one million Americans each and every year. [American Heart Association web site.]

The Director of the National Institute on Alcohol Abuse and Alcoholism wrote that “Numerous well-designed studies have concluded that moderate drinking is associated with improved cardiovascular health,” and the Nutrition Committee of the American Heart Association reported that “The lowest mortality occurs in those who consume one or two drinks per day.” [Pearson, T.A. (for the American Heart Association). Alcohol and heart disease. Circulation, 1996, 94, 3023-3025.] A World Health Organization Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease can no longer be doubted. [Wilkie, S. Global overview of drinking recommendations and guidelines. AIM Digest (Supplement), June, 1997, 2-4, 4.]

  • Researchers studied volunteers in seven European countries and found that people who have a daily drink of beer, wine or distilled spirits (whiskey, rum, tequila, etc.) have significantly better arterial elasticity, a strong indicator of of heart health and cardiovascular health, than nondrinkers. Moderate drinkers also had significantly better pulse rates than those of abstainers from alcohol.
  • A study of 1,795 subjects found that “the risk of extensive coronary calcification was 50% lower in individuals who consumed one to two alcoholic drinks per day than in nondrinkers.” [Vliegenthart, R., et al. Alcohol consumption and coronary calcification in a general population. Archives of Internal Medicine, 2004 (November 22), 164, 2355-2360.]
  • Research demonstrates that moderate alcohol consumption is associated with better endothelial function, which contributes to better heart health and lowers risk of atherosclerosis and cardiovascular disease. [Suzuki, K., et al. Moderate alcohol consumption is associated with better endothelial function: a cross sectional study. BMC Cardiovasc. Discord., 2009, 9, 8.]
  • A study of over 3,000 men and women found that those who never drank alcohol were at a greater risk of having high levels of CRP and IL-6 (excellent predictors of heart attack) than were those who consumed alcoholic beverages in moderation. [Price, J.H. Light drinking lowers bad proteins. The Washington Times, February 11, 2004.]

Moderate Drinkers are Less Likely to Suffer Coronary Heart Disease and Heart Attacks (Acute Myocardial Infarctions) than are Abstainers or Heavy Drinkers.

  • A National Institute on Alcohol Abuse and Alcoholism review of research studies from at least 20 countries around the world demonstrate a 20- to 40-percent lower coronary heart disease (CHD) incidence among drinkers compared to nondrinkers. It asserts that “The totality of evidence on moderate alcohol and CHD supports a judgment of a cause-effect relationship… there are cardioprotective benefits associated with responsible, moderate alcohol intake.” [Hennekens, C. H. Alcohol and Risk of Coronary Events. In: National Institute on Alcohol Abuse and Alcoholism. Alcohol and the Cardiovascular System. Washington, DC: U.S. Department of Health and Human Services, 1996.]
  • Harvard researchers have identified the moderate consumption of alcohol as a proven way to reduce coronary heart disease risk.[Manson, J. E., et al. The primary prevention of myocardial infarction. The New England Journal of Medicine, 1992, 326(21), 1406-1416.]
  • A study of 18,455 males from the Physicians Health Study revealed that those originally consuming one drink per week or less who increased their consumption up to to six drinks per week had a 29% reduction in CVD risk compared to those who did not increase their consumption. Men originally consuming 1-6 drinks per week who increased their consumption moderately had an additional 15% decrease in CVD risk. [Sesso, H.D., et al. Seven -year changes in alcohol consumption and subsequent risk of cardiovascular disease in men. Archives of Internal Medicine, 2001, 160, 2505-2612.]
  • The Harvard Health Professionals Follow-Up Study of over 44,000 men found moderate alcohol consumption to be associated with a 37% reduction in coronary disease. [Rimm, E., et al. Prospective study of alcohol consumption and risk of coronary disease in men. The Lancet. 1991, 338, 464-468.]
  • A British study of women found moderate consumption of alcohol to be associated with lower levels of cardiovascular risk factors. [Razay, G., et al. Alcohol consumption and its relation to cardiovascular risk factors in British women. British Medical Journal, 1992, 304, 80-83.]
  • A study of over 5,000 women with type 2 diabetes mellitus found that coronary heart disease rates “were significantly lower in women who reported moderate alcohol intake than in those who reported drinking no alcohol.” Women who drank more than 5 grams (about one-third glass) a day reduced their risk of CHD (fatal or nonfatal) by more than half. [Solomon, C. G., et al. Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation, 2000, 102, 494-499.]
  • In a study of nearly 88,000 men, researchers found that drinking reduced risk of coronary heart disease risk among both diabetics and non-diabetics. Weekly consumption of alcohol reduced CHD risk by one-third (33%) while daily consumption reduced the risk by over half (58%) among diabetics. For non-diabetics, weekly consumption reduced CHD risk by 18% while daily consumption reduced the risk by 39%. [Ajani, U. A., et al. Alcohol consumption and risk of coronary heart disease by diabetic status. Circulation, 2000, 102, 500.]
  • Light to moderate consumption of alcohol appears to reduce the risk of coronary heart disease by as much as 80% among individuals with older-onset diabetes, according to a study published in the Journal of the American Medical Association. [Valmidrid, C. T., et al. Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. Journal of the American Medical Association, 1999, 282(3), 239-246.]
  • The Honolulu Heart Study found a 49% reduction in coronary heart disease among men who drank alcohol in moderation. [Blackwelder, W. C., et al. Alcohol and mortality. The Honolulu Heart Study. American Journal of Medicine, 1980, 68(2), 164-169.]
  • Harvard researchers concluded about coronary heart disease that “Consumption of one or two drinks of beer, wine, or liquor per day has corresponded to a reduction in risk of approximately 20-40%.” [Manson, J. E., et al. Prevention of Myocardial Infarction. New York: Oxford University Press, 1996.]
  • At a scientific conference, researchers from Korea, Italy, Germany, Poland, the Netherlands, and the United States reported finding striking reductions in death among moderate drinkers, with heart disease and total mortality rates about one half or less compared to non-drinkers. [Trevisan, M., et al. Drinking pattern and mortality: a longitudinal study; Gaziano, J. M., et al. A prospective cohort study of moderate alcohol consumption and sudden death in the Physicians’ Health Study; Keil, U., et al. The relation of alcohol to coronary heart disease and total mortality in a beer drinking population in Southern Germany; Waskiewicz, A., et al. Alcohol consumption and l l-year total and CVD mortality among men in Pol-MONICA study; Grobbee, D. E., et al. Alcohol and cardiovascular risk in the elderly. All presented at the 4th International Conference on Preventive Cardiology, Montreal, Canada, June 29-July 3, 1997, and published in Abstracts from the 4th International Conference on Preventive Cardiology. The Canadian Journal of Cardiology, June, 1997, volume 13, Supplement B.]
  • After over 6,000 participants in the Framingham Heart Study were followed for a period of six to ten years, researchers found that “when consumed in moderation, alcohol appears to protect against congestive heart failure.” [Walsh, C. R., et al. Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study. Annals of Internal Medicine, 2002, 136(3), 181-191.]
  • The American Heart Association, based on the research evidence, concludes that the “Consumption of one or two drinks per day is associated with a [CHD] reduction in risk of approximately 30% to 50%.” [Pearson, Thomas A. (for the American Heart Association). Alcohol and heart disease. Circulation, 1996, 94, 3023-3025.]
  • After reviewing the research, Dr. David Whitten reported that “The studies that have been done show pretty clearly that the chances of suffering cardiac death are dramatically reduced by drinking” one or two drinks a day and asserted that “We don’t have any drugs that are as good as alcohol.” [Whitten, D. Wine Institute Seminar. San Francisco, CA: 1987. Quoted in Ford, G. The French Paradox and Drinking for Health. San Francisco, CA: Wine Appreciation Guild, 1993. Pp. 26-27.]
  • Based on the medical evidence, noted investigator Dr. Curtis Ellison asserted that “abstinence from alcohol is a major risk factor for coronary heart disease.” [Vin, sante & societe. AIM, 1995, 4(2), 7-10, p. 9.]

The Moderate Consumption of Alcohol Increases the Survivability of Heart Attacks

  • Drinking alcohol in moderation throughout the year before a heart attack or acute myocardial infarction (AMI) has been found to reduce the risk of dying afterward. Moderate drinkers had the lowest mortality rate, reducing their risk by 32%, compared to abstainers. The health benefits were virtually identical for beer, distilled spirits, and wine. [Mulcamel, K.J., et al. Alcohol consumption after myocardial infarction. Journal of the American Medical Association, 2001, 285(15), 1965-1970; Alcohol and AMI: Benefits from beer, wine, and liquor. American Journal of Nursing, 2001, 101(8), 18.]
  • Men who consume two to four drinks of alcohol after a heart attack are less likely to experience a second heart attack than are abstainers, according to a study of 353 male heart attack survivors. Researchers found that men who consumed an average of two drinks of alcohol per day were 59% less likely than non-drinkers to have another heart attack. Those who drank an average of four drinks per day experienced a risk reduction of 52% compared to abstainers. [de Lorgeril, M., et al. Wine drinking and risks of cardiovascular complications after recent acute myocardial infarction. Circulation: Journal of the American Heart Association, 2002, 106, 1465-1469.]
  • Research at the University of Missouri-Columbia found that drinking alcohol (beer, wine, or distilled spirits) in moderation reduced the damage to effected tissue following a heart attack. [Dayton C, DC Gute, P Carter, and RJ Korthuis. Antecedent ethanol prevents postischemic P-selectin expression in murine small intestine. Microcirculation, 2004, 11, 709-718.]
  • A study for a five year period of over 85,000 men who had suffered previous heart attacks found that “moderate alcohol intake was associated with a significant decrease in total mortality” compared to nondrinkers. [Gaziano, J., et al. Potential mortality benefits for drinkers with previous heart attacks. The Lancet, 1998, 352, M 1882-1885.]

Alcohol Abstainers Who Begin Drinking Reduce Their Risk of Cardiovascular Disease

  • During a ten year study of 7,697 non-drinkers, investigators found that 6% began consuming alcohol in moderation. After four years of follow-up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did those who continued abstaining. Even after adjusting for physical activity, Body Mass Index (BMI), demographic and cardiac risk factors, this difference persisted.
      
    This study is important because it provides additional strong evidence that the reduced risk of cardiovascular disease among moderate drinkers is a result of the alcohol itself rather than any differences in lifestyle, genetics, or other factors. [King, Dana E., Mainous, III, Arch G. and Geesey, Mark E. Adopting moderate alcohol consumption in middle-age: Subsequent cardiovascular events. American Journal of Medicine, 2008 (March), 121(3).]
  • A study of men with high blood pressure found that those who averaged one to six drinks per week has a 39% lower risk of death from cardiovascular causes than were abstainers. Those who averaged more (one or two drinks each day) were 44% less likely to experience such death. [Malinski, M.K., Sesso, H.D., Lopez-Jimenez, F., Buring, J.E., and Gaziano, M. Alcohol consumption and cardiovascular disease mortality in hypertensive men. Archives of Internal Medicine, 2004, 164(6), 623.]
  • Frequent Drinkers Enjoy Greater Heart-Health Benefits than Those Who Drink Less Often
    In a study of nearly 88,000 men, researchers found reductions in coronary heart disease risk with increasing frequency of drinking alcohol for both diabetics and non-diabetics. Weekly consumption of alcohol reduced CHD risk by one-third (33%) while daily consumption reduced the risk by over half (58%) among diabetics. For non-diabetics, weekly consumption reduced CHD risk by 18% while daily consumption reduced the risk by 39%. [Anani, U. A., et al. Alcohol consumption and risk of coronary heart disease by diabetes status. Circulation, 2000, 102, 500-505.]

And that’s just a sample, obviously. While this new study is interesting, and I’m looking forward to learning more about the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B), it’s seems more than a little premature to throw out everything that’s come before it. But back to ADH1B. How many people have that gene variant. How can people know if they have it? Although curiously, it’s mentioned in passing that people with the gene variant are also slightly more likely to smoke. Doesn’t it seem at least as likely that the while the gene variant may have a positive effect on heart health, that not having ADH1B isn’t automatically a negative, but the norm? Without knowing the percentage of the population that has this gene variant, it seems odd to me that the conclusion is that the rest of us are somehow negatively impacted by not having what’s by definition a mutation. If having it is good for your heart, can it be synthesized?

Also, in their conclusions, they found that people with the ADH1B gene variant, in addition to drinking less, also “exhibited lower levels of blood pressure, inflammatory biomarkers, adiposity measures, and non-HDL cholesterol,” which could also be contributing to their heart health, couldn’t they? The most confounding conclusion, that simply because they used mendelian randomisation “that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health” I confess I don’t fully understand. Not being a scientist, and not having come across mendelian randomisation before, I don’t fully understand how it can provide results that are so certain, despite it apparently being prone to misleading conclusions from “linkage disequilibrium, genetic heterogeneity, pleiotropy, or population stratification” or any of the biases or problems that you’d have with any study. Almost every preliminary study, or whenever one is the first of its kind, the researchers are always careful not to make too much of their results. They always caution people from drawing too many conclusions and usually state that further research is necessary to confirm or invalidate their findings. That’s how the scientific method is supposed to work, I always thought. But in this instance, one study is being touted as the be all, end all in understanding the relationship between alcohol and your heart. That seems very strange to me. Maybe that’s my ignorance, but neither the press release nor the news report on the study has done anything to clear it up. Considering that those are aimed at the general public, that seems like a big failure. But it certainly makes it easier for Alcohol Justice to jump in and claim victory that alcohol is now completely bad for everyone, no exceptions, despite society having endured quite well since the dawn of time with alcohol playing a fairly prominent role.

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Beer In Ads #1236: A Doctor’s Reasons

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Saturday’s ad is for Schlitz, from 1904. It’s an unthinkable ad in today’s world, where health claims are strictly forbidden in beer advertising, even if they’re true. In a fictional, or hypothetical at best, conversation between a doctor and his patient, the physician unequivocally endorses Schlitz beer because it’s so pure. How does he know? Because he’s seen it being brewed, which of course makes no sense. But my favorite advice the doc gives is about why pure beer is good for you. “The hops form a tonic; the barley a food. The trifle of alcohol os an aid to digestion. And the custom of drinking beer supplies the body with fluid to wash out the waste. People who don’t drink beer seldom drink enough fluid of any kind. A great deal of ill-health is caused by the lack of it.” And no, it doesn’t cause biliousness, which is a “term used in the 18th and 19th centuries pertaining to bad digestion, stomach pains, constipation, and excessive flatulence.” Whew, dodged a bullet there.

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Pints For Prostates Urges Men To Get Checked During Men’s Health Week

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Today is the first day of Men’s Health Week, which is an international effort “to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys.” In the week leading up to Father’s Day, health organizations around the world celebrate International Men’s Health Week, including our our own CDC.

Rick Lyke’s wonderful Pints for Prostates has been “Reaching Men Through the Universal Language of Beer” since 2008, when Rick launched it after he was “diagnosed and successfully treated for prostate cancer.”

Pints for Prostates is using the occasion of “Men’s Health Week,” and the observance of Father’s Day, to ask people to focus on Dad and how he is taking care of himself. At the events they attend they regularly meet men in high risk groups that still do not know that they need to get tested. In addition to funding their awareness mission, they put donations to work providing free men’s health screenings in partnership with the Prostate Conditions Education Council and they help fund the support groups for men and families fighting prostate cancer through a partnership with the Us TOO International Prostate Cancer Education and Support Network.

Most people do not realize that 1 in 6 men will develop prostate cancer and that this number is 33% higher than the 1 in 8 women who will face breast cancer. Last year we lost 30,000 men in America to a disease that is nearly 100% survivable when detected early and appropriately treated. Every week about 4,500 men in America hear the words “You have prostate cancer.” The nation’s leading prostate cancer organizations urge men to get screened starting at 40 years old, or at 35 if you have a family history of the disease or are African American.

Pints for Prostates is focused on getting men to take charge of their health. Their message to guys is simple:

  1. Get Tested
  2. Live Longer
  3. Drink More Beer

For more details, check out their website at PintsForProstates.com or their Facebook page.

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The Mythical Monolith Of Big Alcohol

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Since the end of February, Alcohol Justice (AJ) has been tweeting the following:

Big Alcohol will never admit #3 http://bit.ly/1mFY39E Alcohol classified carcinogenic 25 years ago

It’s part of their new series of things that “Big Alcohol will never admit.” I think somebody forgot to tell AJ that there’s no actual organization “Big Alcohol,” no single entity that speaks with one voice on all matters alcoholic.

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The mythical monolith of “Big Alcohol” that doesn’t actually exist, but which Alcohol Justice believes should respond to their propaganda demands.

But let’s take a look at what we’re accused of this time. According to AJ, 25 years ago Alcohol was classified as a “carcinogenic.” That tidbit comes from their Alcohol and Cancer Risk “fact sheet” which states. “The International Agency for Research on Cancer (IARC) has classified beverage alcohol as a Group 1 (cancerous to humans) carcinogen since 1988.” That statement is footnoted by two studies. The first is the IARC Monographs on the Evaluation of Carcinogenic Risks to Humans VOLUME 96 Alcohol Consumption and Ethyl Carbamate and the second is Volume 100E A Review of Human Carcinogens: Personal Habits and Indoor Combustions (2012). And those two documents do indeed state that they “concluded that there was sufficient evidence of carcinogenicity for cancers of the oral cavity, pharynx, larynx, oesophagus and liver.” But is that the whole story? Hardly. Since that time, they’ve added colorectal and female breast cancer for a total of seven types of cancer, out of how many different types? Dozens? Hundreds? And for at least a few of those, moderate alcohol consumption reduces risk and for most of the rest is neutral, meaning there’s little or no effect. But AJ also claims that “Big Alcohol” has been somehow denying this for the past 26 years. How exactly has anyone been denying it?

But another questionable exaggeration is this, from AJ’s press release of February 26 of this year, where they attempt to take a position that the moderate consumption of alcohol is also unsafe.

While heavy drinking presents the greatest risk, daily alcohol consumption of as little as 1.5 drinks accounts for up to 35% of alcohol-attributable cancer deaths in the United States. Added [Director of Research Sarah] Mart, “The research is clear: There is no determined safe limit for alcohol consumption with regard to cancer risk.”

But that’s at least a little misleading. That claim comes from a 2013 study in the American Journal of Public Health entitled Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States. Here’s the relevant bit from the results, in the abstract.

Alcohol consumption resulted in an estimated 18,200 to 21,300 cancer deaths, or 3.2% to 3.7% of all US cancer deaths. The majority of alcohol-attributable female cancer deaths were from breast cancer (56% to 66%), whereas upper airway and esophageal cancer deaths were more common among men (53% to 71%). Alcohol-attributable cancers resulted in 17.0 to 19.1 YPLL for each death. Daily consumption of up to 20 grams of alcohol (≤ 1.5 drinks) accounted for 26% to 35% of alcohol-attributable cancer deaths.

Although they exaggerated the findings by saying “Up to 35%” instead of “26% to 35%,” which is a typical propaganda tactic, what that one study really found is that 26% to 35% of 3.2% to 3.7% of all US cancer deaths may have come from moderate drinking. Put another way, 0.83% to 1.295% of all U.S. cancers may be attributable to people who drank moderately. From that, AJ concludes that “The research is clear: There is no determined safe limit for alcohol consumption with regard to cancer risk.” If you think that’s clear, keep making those donations, because it makes no logical sense. Less than 1% of all cancer deaths up to as many as 1.3% may be attributable to moderate alcohol consumption, and that constitutes clear causation, ignoring all other factors, such as genetics, environment, and lifestyle.

The study itself claims that there’s “no safe threshold for alcohol and cancer risk” despite it representing only around one percent of all cancers in the United States. Not to mention, when you dig deeper into the data, that particular study is only examining six types of cancer. They ignore all other cancers, while still making sweeping pronouncements about cancer, and ignoring any mitigating benefits of moderate alcohol consumption, including the rather hard-to-ignore total mortality.

Here’s what I don’t understand about calling alcohol a carcinogen. If indeed it increases the risk for certain types of cancers, but not others, it seems to me it would have to increase the risk to all persons (or even most) for all cancers to be considered to show “sufficient evidence in humans for the carcinogenicity of alcohol consumption.” My sense in reading through WHO literature over the years is that their mission is more about stopping people from drinking because as an organization they’re convinced that alcohol is always bad and has no positive aspects or benefits. When you only look for negative consequences, that’s all you find.

What AJ, WHO and many of these studies do is start with a premise and try to prove it, ending up cherry-picking the studies that support it and ignoring any that don’t. That creates a powerful propaganda tool but rarely stands up to any scrutiny. Luckily, as prohibitionist groups are well aware, few subject their propaganda masquerading as press releases to much, if any, scrutiny whatsoever. So their incentive to be more truthful is practically nil. So they can just make up whatever they want, like the mythical monolith of Big Alcohol, and then wonder why they won’t admit whatever prohibitionists says, no matter how twisted or distorted.