Moderate drinking is good for the heart. Why won’t public health admit it?

A new study in the British Medical Journal has found that moderate drinkers have a lower risk of heart attack, angina and heart failure when compared to teetotallers. It found that lifelong non-drinkers have a 24 per cent higher mortality rate than moderate drinkers and that the death rate among former drinkers is even higher.

The authors, from Cambridge University and University College London, describe their research as ‘the most comprehensive study to date’ in this crowded field and with some justification. It involved nearly two million people, 62 per cent of whom claimed to drink within the old UK guidelines of 21 units for men and 14 units for women. The reduction in risk for heart disease was both clinically and statistically significant, and this is only the latest in a long line of studies stretching over five decades that have come to the same conclusion.

If moderate drinking was a pharmaceutical with the same weight of evidence behind it, doctors would be prescribing it. If it was a fruit, wellness gurus would be getting rich off it. But you will never hear anyone from the ‘public health’ lobby telling teetotallers to start drinking. You will seldom even hear them acknowledge the fact that teetotallers die younger. More likely, you will see them resorting to long-debunked arguments to cast doubt on the scientific evidence. They will do almost anything to avoid advising people to drink alcohol.

On the face of it, this is remarkable. We live in an age in which weak epidemiological associations are used to justify all manner of interventions in people’s lifestyles and yet here is a strong, proven link between the consumption of a product and substantially lower risks of both heart disease and overall mortality, and yet it is treated as a trivial factoid.

There are two reasons for this. Firstly, the ‘public health’ lobby fears that non-drinkers will become alcoholics if they are advised to have a glass of wine. Put simply, they don’t trust us. They don’t think we are responsible enough to drink moderately and they would sooner see a few thousand of us die of angina than give us accurate information. Second, a large number of ‘public health’ campaigners think that alcohol is the new smoking and want to co-opt the ‘no safe level’ slogan that has worked so well in the war on tobacco. There is a blueprint and they are going to follow it.

The new BMJ study is too strong to dismiss with the usual excuses about ‘sick quitters’ and so the strategy today has turned to presenting exercise and healthy eating as superior substitutes for moderate drinking. The subliminal message is that drinking probably isn’t much good for the heart and you should take up jogging instead.

For example, here’s how James Nicholls of Alcohol Research UK responded to the study:

‘There are better ways to strengthen the heart such as exercise and good diet. All things being equal — and given the increased risk of suffering other health conditions linked to any amount of alcohol consumption — if you drink within the existing guidelines it is unlikely that alcohol will either lengthen or shorten your life.’

And here’s how Rosanna O’Connor of Public Health England reacted:

‘Those who don’t drink should not consider taking up drinking to improve their heart health, but are better off stopping smoking, getting regular physical activity and eating a healthy diet.’

Healthy eating and physical activity are to be encouraged, but this line of argument is a false dichotomy. You should not be told to choose exercise or moderate drinking. They are complementary. The evidence shows that even if you exercise regularly, eat healthily and don’t smoke, moderate alcohol consumption offers additional benefits that teetotal health fanatics do not enjoy. This study from 2006, for example, concluded that: ‘Even in men already at low risk on the basis of body mass index, physical activity, smoking, and diet, moderate alcohol intake is associated with lower risk for MI.’ MI is myocardial infarction, otherwise known as a heart attack.

It could be argued that people who like alcohol do not drink for the health benefits. Likewise, people who hate the taste of alcohol are unlikely to start drinking even if it means they are more likely to have a heart attack. So what does it matter if ‘public health’ authorities downplay the benefits of drinking while exaggerating the risks?

It matters because we are being treated like children who cannot handle nuanced information. It is deeply patronising to assume that we will drink ourselves to death if Public Health England gives us permission to have a couple of bottles of wine every week. It is an insult to our intelligence for the scolds of ‘public health’ to speak to us as if the only message we can comprehend is ‘abstinence good, drinking bad’.

The benefits of drinking matter because the neo-temperance lobby thinks they matter. Drinkers do not need moderate alcohol consumption to be good for their health to justify their lifestyles, but the anti-drinkers desperately need to debunk the health benefits to justify their crusade.

These are people who see a world of black and white in which activities are healthy or unhealthy, good or bad, banned or compulsory. It is a world of zero-tolerance and ‘no safe levels’ — a world in which the most important thing is to ‘send a clear message’. When Sally Davies, the Chief Medical Officer, declared last year that there is ‘no safe level’ of alcohol and derided the benefits of moderate drinking as ‘an old wives’ tale’ she was dragging us into this cartoon parallel universe.

These are the slogans of a campaigner, not a scientist. The real world is more complex. In the real world, there are trade-offs to be made and the dose makes the poison. Science reflects the real world. Everything else is manipulation.


  • JLTrader

    To play devil’s advocate, aren’t those ratios (1.33, 1.12, and so on) all under 2 so therefore ‘noise’ ? “Relative risks of less than 2 [that is, a 100 percent increase] are considered small. . . . Such increases may be due to chance, statistical bias, or effects of confounding factors that are sometimes not evident.”

    • chrissnowdon

      That can be true when you’re dealing with small samples. It is also true that if you’re dealing with rare diseases, an increased risk of <2 probably isn't worth worrying about on a personal level. But when you're dealing with common diseases like heart disease and studying large numbers of people, relative risks of <2 can be taken more seriously and are more meaningful. And when you're dealing with all-cause morality, as this study is, an increased risk of 24% is definitely worth worrying about!

      • JLTrader

        Using insignificant ratios on large populations is how WHO and others come up with millions of smoking related deaths (including hundreds of thousands from passive smoking). It’s a minefield.

        • CommentTeleView

          Really? And how do you deduce that? The “insignificant ratios” you refer to…. what are these?

      • Peter

        Have a drink and don’t worry about it! 🙂

      • Appalled Tofer Gatfield

        “All-cause morality” is quite an apt Freudian slip.

  • modeluprightcitizen

    Public health can’t admit it because it’s nonsense. All of these observational studies have exactly zero weight when it comes to causality. These researchers should stop wasting time and public money on research methods that prove zilch.

    • TheImprover

      Good point. IMO, what is REALLY being measured here is self control: studies have shown that good self-control is associated with 10 years of extra life, and poor self control is associated with a 10 year reduction in life – for a total of 20 years difference between the well-controlled and the poorly-controlled. In choosing a group of people who drink moderately, you’re choosing people who have good self-control: if they didn’t, they’d lose control of their drinking.

      • CommentTeleView

        And your evidence is? How can you be so sure that there is no health benefit attached to a moderate intake of alcohol? The anecdotal and apparent evidence abounds, and when a study does corroborate those sources, you assume it’s flawed.

        I appreciate your point – self control may be the driver. But it seems unlikely. It doesn’t really explain the better health of moderate drinkers over zero drinkers – which of them do you suggest has better control, and how would you justify that position?

        • TheImprover

          Alcoholics are near the left end of the scale of self-control regarding drinking. When they receive expert help, they are taught to abstain – not to stop after a couple of pints. It seems likely to me that people who regularly have two pints and then stop are past the halfway mark on the scale. Therefore, I think that, for people for whom alcohol is easily available, abstaining from drinking requires less willpower than regularly drinking moderately. I also think that there is probably a positive correlation between control of drinking and general self-control.

          • CommentTeleView

            So your hypothesis, with no statistical basis to it, is that the general will-power of people who drink moderately is better than the will-power of non-drinkers (the overwhelming majority of whom aren’t reformed alcoholics, by the way!) Sufficiently better that their self-control gives them a longer life expectancy.

            My hypothesis (equally unsupported by research, I concede) would be the opposite – one should expect that those who eschew alcohol altogether also live more healthily in other respects, and are therefore likely to live longer than moderate drinkers (who are more likely to be moderate smokers, lazy exercisers, etc.). On that basis, the positive effects of moderate alcohol intake measured by this report are probably understated.

          • TheImprover

            I obviously didn’t explain myself clearly: lets divide the alcohol self-control scale into two halves: about 50% of the population have below-average drinking control, and about 50% have above-average drinking control. None of the people who regularly drink moderately will be so far down on the scale to be classified as alcoholics, and most of them will be in the top 50%.

            Therefore, it is reasonable to speculate that if you select a group of people who regularly drink moderately, you have a group of people whose alcohol self-control is mostly better than average – and certainly very few people from the bottom quarter of the alcohol self-control scale.

            The group of people who abstain will CERTAINLY contain many people who have very poor alcohol self-control, and many whose reasons for not drinking are in no way related to self-control at all.

            I am confident that if this “hypothesis” (your word, not mine) that people who are able to stop after two drinks on a daily basis mostly have an above average alcohol self-control score, it would be found to be correct.

            The only other thing that would need to be demonstrated is that there is a positive correlation between alcohol self-control and general self-control (which is associated with a greater increase in longevity than any other behaviour pattern). So while my “hypothesis” is not proven, it’s actually not far away from it – and if it is wrong, then something very unexpected about alcohol, self-control or human physiology would have to be true.

          • CommentTeleView

            Huh? The group who abstain from alcohol will have a large number of people with poor alcohol control? How do you deduce that? Is it just personal experience?
            I submit that the group who abstain are more likely to have levels of self control above those who drink, even moderately, than they are to have level of control below that average. You’re just taking a wild stab in the dark with your assumptions.

            No, I think you explained yourself just as well the first time.

          • TheImprover

            Most problem drinkers who regain control do so by abstinence. I’d happily bet my shirt on moderate regular drinkers getting higher average scores on an empirical test of alcohol self-control than abstainers. The fact that they’re able to stop at 2 every day all but proves they have good control.

            A good test of the article’s hypothesis would be to take heart function measurements of some abstainers, divide them into a “drink group” and a control group, have the “drink group” have 2 drinks per day and the control group have 2 placebos per day, and then re-measure everyone’s heart functions.

          • CommentTeleView

            We’re not discussing problems drinkers who abstain – I agree, they are a special group who may have self control or other mortality-signficant issues that spill out into other parts of life (and who in any case, may have done themselves severe damage before abstaining). Recovering alcoholics are a tiny percentage of people who don’t drink. I’d bet my shirt that most non-drinkers are likely to be more health-conscious and live healthier lifestyles in general, than those who drink.

            It seems to me that you disgaree with the conclusion of this study, and so you’re inventing a rather implausible scenario and asserting it as a fact, with zero evidence to support it. I’ve not looked at what controls the researchers had in place to correct for common-cause factors, but Occam’s Razor suggests that if moderate drinkers live longer than a control group of abstainers, moderate drinking might well be beneficial.

            As the article says, if a similarly statistically and clinically significant effect had been noted from eating a certain fruit, doctors would be telling us to eat it!

          • CommentTeleView

            I have gone back and looked at the actual paper in the BMJ. It’s very thorough. Their sample is around 2 million individuals, and they break the data down by several factors such as age and sex. They also split out former drinkers and measure them separately. And they test all the groups against various cardio-vascualr problems, as well as all-cause mortality.

    • Father Todd Unctious

      My grandad drank 50-60 units a week his whole adult life and lived to be 82.

  • toffeesturn

    How can the UK government admit it?
    This is a stupid question to ask under any circumstances, as drinking is forbidden in Islam, after all from what we foreigners are beginning to see from our foreign lands the United Kingdom is an Islamic State already today.
    Very soon “God Save the Queen” will be replaced by the Azan from the minarets of the thousands of mosques in the UK
    Britian will become known as Darul Jihad and all ladies will be forced to wear the Hijab.
    Allahu , Akbar, why that call was sounded around Westminster yesterday.
    “God really save the Queen.”

    • brett charlton

      I bet you’re that guy everyone tries to avoid in the pub.

  • Eric Smith

    Unless there are clearly stated medical reasons for the benefits of alcohol, this is meaningless.

    • CommentTeleView

      No, they might not understand the mechanism, but the numbers describe the facts.

    • Callipygian

      How about blood-thinning, for a start?

    • Simonjh

      Why?

  • Bill

    A bottle of Shiraz keeps the doctor at bay, quite simple really. Together with a good diet and some moderate outdoor exercise in the fresh air life is sweet. Your heart is more likely to be damaged by the continual intake of plasticiser fumes in the internal environment than much else.

  • Callipygian

    Hear hear!

  • WebberJ

    Nothing new on alcohol helping fight some disease causing things inside the body, not only for the heart. Anything too much always get people in trouble.

  • ֍ RationalOne ֎

    What is still missing in these studies is comparing the drinking of wine to the drinking of grape juice. The untested assumption being made is that it is the alcohol which is making the difference and not some other component of the wine. I’ve seen stories like this for years and have never yet seen that point being addressed.

    • CommentTeleView

      For one thing, the study covers alcoholic drinks in general, not just wine. But also, when they say “alcohol consumption”, they mean alcoholic drinks, complete with all their components. Maybe the time spent in pubs is what confers the benefit (although that’s easily corrected for), or the admiring glances of the opposite sex as one becomes better at dancing. But the point is that moderate drinking has a signifcant positive effect, and the rather moralising medical establishment and policy wonks seem over-anxious to down-play that information.

      • ֍ RationalOne ֎

        Actually the studies I’ve seen referenced only covered wine drinking and were “generalized” to other forms of drinking. Beer of course is already well known as a drink that provides good nutritional value as well as having long been used as a way to avoid drinking water that could contain deadly microbes so it has a “life extending” effect of it’s own but I’ve yet to see any study that can narrow the “life extending” effect they are claiming specifically to alcohol itself. Likewise wine has also been used in much the same way though it’s nutritional value is considerably less partly because wine is traditionally watered down when used that way to allow it to provide the needed liquid intake.

        The point is that the effect is not narrowed to alcohol yet, that doesn’t mean another study can’t eventually make that connection, only that crediting alcohol as the agent right now is simply premature.

        • CommentTeleView

          I can’t answer for studies you’ve seen and I haven’t, but the one actually under discussion studied drinking alcoholic drinks in general, not just wine. You might want to actually read the paper – it makes for interesting reading. Nor does the study attempt to specifically credit ethanol as the agent, although their controls are rigorous enough that it’s hard to see any credible alternatives.

          But you seem anxious to avoid the point that there is a measurable benefit to drinking alcoholic drinks moderately, compared to not doing so. Unless you have positively identified a specific common factor, the most rational advice is to simply drink alcoholic drinks moderately. If statisticians said that consuming pineapple juice conferred a benefit, we should advise drinking pineapple juice, even if we don’t know why. If one day we identified the secret ingredient (or circumstance) that made pineapple juice beneficial, that would maybe open up new options with even better benefits, but in the meantime, let’s not ignore the immediate win.

          • ֍ RationalOne ֎

            There were studies touting the benefits of anti-oxidants too but subsequent studies have shown negligible effects. Meanwhile an industry grew around selling things that have high anti-oxidant content.

            The one thing I have most liked about these studies that has remained a constant is their insistence on moderation which is a rarity, in this case it is well known how detrimental over-consumption can be while still noting a benefit for moderate consumption.

            There is a large percentage of people who fall into the “if a little is good then more should be better” camp who will always overindulge in anything they perceive as being good so stressing moderation is a welcome change.

            I see that this study was not focused on just wine consumption as many of the past studies have been and in fact does no breakdown of the kinds of alcohol and the frequency of consumption of each type at all which is odd since even if it is only alcohol providing the effect information about dosage amounts and rates for effectiveness could be derived.

            I remain skeptical mainly because I have seen a multitude of “this is good for you” studies come and go as better information has come along and shown the original study or studies to be flawed.

            This study is good and helps inform but since it’s based on self reporting of consumption (considering the subject, the number of participants and the time frames involved it would have been impossible to use a better methodology though) it still remains subject to the flaws of self reporting. I may be asking too much though because over the term of the study some participants patterns may have changed (such as a young person who used to drink beer with their meals moving to drinking some wine instead) and recording that additional data would make statistical analysis exponentially more difficult so I guess it may be better to try additional follow on studies of various types of drinkers by category instead of trying to get it all in one single study.

          • CommentTeleView

            It seems to me that you disagree with the conclusion, and on that basis, you are rather desperately seeking flaws in the study’s methodology. This is only one of many studies that show similar benefits. This one is not some “Scientists have discovered that bacon fat is good for you” headline, reported by the Pig Fat Association. This is a heavyweight study in a heavyweight journal, with findings that have been borne out by many similar studies. If you want to pick holes in it, you’re going to have to do so with actual evidence, not some musings based on, “I’m skeptical”!

          • ֍ RationalOne ֎

            You seem to read a lot into what you perceive me saying instead of actually reading what I did say.

          • CommentTeleView

            Well, feel free to correct my perception. So far, you’ve yet to identify any evidence that actually contradicts the study – you’ve simply rejected it on the basis that some other unrelated studies later turned out to be wrong. Which is a bit ironic, given that the article was actually focusing on precisely that kind of response to the very idea that alcohol might have beneficial effects.