"Heavy" Drinking and Cancer Risk

I saw a recent headline about alcohol consumption that concerned me a bit, and because so many editors skew research report findings to get more clicks, I thought I'd take a closer look.

The article in question is titled "Heavy drinking Europeans most prone to digestive cancers." The information itself isn't too extraordinary - if you consume excessive amounts of alcohol, there are bound to be issues, much like if you consume too much of anything.

However, what worried me are two things: 1) what is considered heavy drinking and 2) at the end of the article was a quote from Richard Gardner, who is the CEO of the British Society of Gastroenterology. He said "Fundamentally, there’s no such thing as no-risk drinking."

As a scientist, I know that there is very rarely anything that is black and white, and I have some interest in the area of wine consumption and health issues (having followed in my father's footsteps with research into resveratrol production by grapevines). I have posted on this subject before (see here) and my views on moderate wine consumption and health have not changed in the intervening years...

So the undefined statement about heavy drinking and that about all alcohol consumption being bad immediately rang some alarm bells and got me more interested.

For starters, to be completely pedantic, there is no such thing as no risk anything. Every time we walk out the door, our odds of being injured increase, not to mention all the potential dangers in the home itself! So everything we do is a calculated risk - we have to make the decision, does the risk of a bad thing happening outweigh the benefits of the activity?

For alcohol consumption, there are many examples of research reports that indicate possible health issues generated by excessive drinking, but the key there is "excessive." The article above uses the phrase "heavy drinking." I do not think anyone would argue that consuming too much alcohol is bad for your health - the real question is, in terms of understanding the article, how much is too much and also, and a bit separately, is less than that beneficial or not?

Let's drill down and do some investigative reading of the article....

The headline I saw was on The Drinks Business, and most of the article is fair, noting that there is a range of consumption across the different countries. However, "heavy drinking" is defined as having "more than four alcoholic drinks at least once a week." This can be a bit confusing, as it could be interpreted as more than four drinks per week, but also as more than four drinks a day at least once a week. Without clarity around this, it's difficult to know how to interpret the information.

Because there can be losses or alterations to information as it gets transmitted around (see Chinese Whispers), it would be a good idea to go direct to the source, rather than relying on someone else's interpretation of the information (a very important component of reviewing scientific information, too).

The Drinks Business got their information from Bloomberg, who published "Europeans are drinking themselves to death."

In reading this article, we see a bit more detailed information, with a focus on the average number of drinks per day people consume in various countries.They also report that drinking "heavily" means "more than four alcoholic drinks - at least once a week," which still doesn't help us in interpreting what the data actually mean.

So the next step is to go back to the original source, United European Gastroenterology. Their press release is "Alcohol consumption putting vast majority of Europeans at risk of digestive cancers, report reveals." There, "people that consume 4 or more drinks per day" are considered to be heavy drinkers. This clarifies what they are really talking about, and makes sense - with that much alcohol per day, it's no wonder there is a health impact!

But the original report's version of "heavy" drinking differs considerably from what the editors at Bloomberg used - there is a definite alteration to how people might interpret what "heavy" drinking is with the Bloomberg version.

Lesson: If you can, don't trust the reporting - go back to the source!

Getting back to Richard Gardner's statement, "Fundamentally, there’s no such thing as no-risk drinking," let's take a closer look at that...

Currently, the American Cancer Society (see "Colorectal Cancer Risk Factors") recommends avoiding "heavy alcohol use" and recommends "no more than 2 drinks a day for men and 1 drink a day for women," adding that this "could have many health benefits, including a lower risk of colorectal cancer" (note that the Bloomberg article also points this out).

They're not the only ones saying that moderate consumption of alcohol can be beneficial. The National Institute on Alcohol Abuse and Alcoholism says this "may protect healthy adults from developing coronary heart disease."

The Centre for Disease Control and Prevention has a nice summary of what is considered excessive consumption (here) as does the NIAAA (here)

Not all agencies have quite the same take. The National Health Service (England) suggests that new research shows that "evidence on a protective effect from moderate drinking is less strong than previously thought"(source here). They state that fewer than 14 units of alcohol per week puts you in a "low risk"category as "there is no safe drinking level."

And that brings us back to the risks versus benefits. Saying that "there is no safe drinking level" is misleading because it implies that people should not consume alcohol at all. The fact remains that there is no completely "safe" level of anything. Equally valid, but useless statements could be "there is no safe amount of driving" or "there is no safe amount of sugary drink consumption."

 As the saying goes, "health is simply the slowest possible way to die..." 

We all make choices that have an effect on our health - some are worse, but some can be better.

So for me, I'm happy being in the "low risk" group the National Health Service identifies because based on my reading of the research, there is support for both positive aspects of the risk and for negative ones. 

I believe the positives outweigh the negatives by a large margin, and not just from a health standpoint, but just as importantly from a lifestyle standpoint. Wine gives me so much pleasure in life! Wine is part of a meal - it is part of a discussion - it is part of intellectual stimulation. 

For some, alcohol in whatever form may be a means to get drunk, but that is not at all how I view alcohol - alcohol to me is a component of a beverage that (in wine, at least) is complex, varied, nuanced and something to be thought about, discussed and most of all, enjoyed.

Moderate wine consumption and health in the news, again!

The debate over whether or not moderate wine consumption is a beneficial or a detrimental thing continues. I suppose it will never end, but here is the latest campaign by some people who are against it.

An article published in The Age, from Melbourne in Australia, "Experts see red over wine 'myth'," details the new push by the Alcohol Policy Coalition to discourage the consumption of alcohol.

The Alcohol Policy Coalition is an Australian group made up of the Australian Drug Foundation, Cancer Council Victoria, Heart Foundation, Turning Point Alcohol and Drug Centre and VicHealth, who share "concern relating to the misuse of alcohol and its health/social impacts on the community."

The "report" they refer to in their press release is really a press release, also, or in their words, a "position statement," so not a report at all. In it, they summarise some information relating to alcohol consumption and its association with non-communicable diseases.


My main concern about this statement is that they use data that result from the misuse of alcohol to support their statements such as, "Every drinking occasion contributes to the life-time risk of harm from alcohol, therefore, any reduction in the dose - that is the amount and frequency of alcohol consumed - will reduce the annual and life-time risk of alcohol related harm."

This is an unsubstantiated remark and of no relation to the information they have presented.

In paragraph two of the statement they say this:

"In 2008, alcohol misuse was responsible for 2.3 million deaths (3.8 per cent) globally."

This is fair enough, however, the key word there is "misuse."

I would hope that the vast majority of people do not misuse alcohol, meaning they have chronic and excessive consumption. It is also worth noting that in the report they cite as the source of the information (World Health Organization Global status report on noncommunicable diseases 2010) that 80% of the deaths are in low to middle-income countries, and therefore only 20% in the high-income countries.

Per capita consumption of alcohol is listed in the WHO report and low-income countries have a value of about 4 litres per capita and high-income at just over 10 litres per capita. Since the consumption level is lower in the countries that have the highest percentage of deaths due to alcohol, I read this as meaning that binge drinking and other forms of alcohol abuse are the reason why so many people are dying there. With more affluent societies, alcohol (and wine in particular) is consumed more regularly, but also more responsibly.

So I'm not convinced by their argument that we should increase taxes on alcohol in places like New Zealand, Australia, or other higher-income countries. The real problem seems to be in other places, where perhaps more control over people's access to alcohol is warranted, or better yet, the institution of policies that educate about alcohol use.

The other thing that I am always cautious about with studies relating to alcohol consumption and disease incidence is whether or not it is a cause and effect, or if the disease incidence change is due to other factors that are associated with alcohol consumption. We've already mentioned that higher income countries have more alcohol consumption, so you can draw relationships between such things as the number of television sets per household in a country and the level of alcohol consumption. So does that mean that to curb alcohol consumption we should limit the number of televisions?


A bit of an absurd example, but it makes the point - sometimes you can get correlations between factors, but they are not direct cause and effect. You need to look at the information and see exactly what it is they're testing, and make sure that they do have evidence that backs up their claims.

I, personally, am an advocate of moderate wine consumption. However, this is not from the health point of view, but mostly because I find it a fascinating beverage, and that it accompanies food so well. I would never recommend to anyone to start drinking wine because it will make you healthier, but I would recommend people try it and see if they like it.

What I'm not keen on is a tax-grab on alcohol, and wine in particular, under the pretext that we are being saved from ourselves.