Alcohol Dose and Mortality (Remedy or Poison?)

Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006 Dec 11-25;166(22):2437-45. Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. [FREE FULL TEXT]

Abstract
BACKGROUND:
Moderate consumption of alcohol is inversely related with coronary disease, but its association with mortality is controversial. We performed a meta-analysis of prospective studies on alcohol dosing and total mortality.

METHODS:
We searched PubMed for articles available until December 2005, supplemented by references from the selected articles. Thirty-four studies on men and women, for a total of 1 015 835 subjects and 94 533 deaths, were selected. Data were pooled with a weighed regression analysis of fractional polynomials.

RESULTS:
A J-shaped relationship between alcohol and total mortality was confirmed in adjusted studies, in both men and women. Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality, maximum protection being 18% in women (99% confidence interval, 13%-22%) and 17% in men (99% confidence interval, 15%-19%). Higher doses of alcohol were associated with increased mortality. The inverse association in women disappeared at doses lower than in men. When adjusted and unadjusted data were compared, the maximum protection was only reduced from 19% to 16%. The degree of association in men was lower in the United States than in Europe.

CONCLUSIONS:
Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women. Our findings, while confirming the hazards of excess drinking, indicate potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival.

My last blog on the effects of drinking alcohol and the prevention of obesity results, in women, were were highest in the 15-30 (~1-2 drinks) grams per day and  >30 grams (>2 drinks) per day group. This amount was higher than what I recall as the general recommendations of one drink a day for a woman and two per day for a man being the ideal amount for overall health benefits and longevity, from when I researched it for my own health back in college. At the time, I was exploiting the French paradox to counteract the high calorie diet was I using to gain weight for weightlifting. In my recent blog I also mentioned that I had read recommendations that were higher than the 1-2 drink recommendations.  I think such recommendations come from the abstract of the above paper, which I don’t feel is the best interpretation of the findings.

Reading the paper, it looks like women are indeed healthier with up to two drinks per day, and men are so with up to four drinks per day. Even so, when you get into the details at the upper limits of two and four drinks respectively, people aren’t much healthier. When you read the details in the paper itself, it seems that ‘healthier’ and ‘healthiest’ are not quite the same thing. The big thing with alcohol and health is what’s being called a “J-curve.” The J-curve being a meaningful curve downward slope in mortality with moderate drinking, and then follows an onward and upwards turn in health risks when drinking becomes heavy. With moderate drinking, the cited benefits include increased HDL cholesterol, increased fibrinolysis, decreased platelet aggregation and coagulation factors, improved endothelial function, and reduced inflammation. With heavy or binge drinking, the problems become severe including increases in cardiovascular disease, cirrhosis, various cancers, violence, and accidents which the World Health Organization says kills ~2.5 million people per year.

The reversion point (the upper limit for which the protection of alcohol was no longer statistically significant)  for women was 18 grams of alcohol per day, which is towards the lower end on what was found reasonably effective in preventing obesity, while in men it was found to be 38 grams. However, at the bottom of the J, the healthiest point was right at about 5 grams per day, which is less than half of a standard 14 gram USA drink per day. The health benefits were still pretty good at 10-15 grams which gives you your 5 oz glass of wine, and by 20-30 grams the reduced risk of mortality was used up. Anything beyond that amount, the health risks started to increase relative to not drinking at all. The numbers are all a bit fuzzy because they were based on a number of studies with varying numbers of additional factors included or adjusted for, but the overall gist was consistent. For men, the bottom of the J-curve was in the range of 5-15 grams (one drink region), which was still better than not drinking at two drinks per day, but above 30-60 grams per day the health consequences started to increase. The range for men was also pretty wide and varied by country, which might have to do with differences in drinking habits, genetics, or lifestyle.

So all that reading and it just brings me back to what my research on the topic found years ago, probably a small to a full drink per day is best for women, ans 1-2 per day for men. Pushing the drinks up to two per day for women and four per day for men isn’t bad, but is moving into the point where the remedy starts to become a poison, which is a bit of a buzzkill, haha.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

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