Of all the drugs that alter our minds, nothing compares to alcohol.  No drug is used by more people, no drug has been used for longer in history.  In fact, alcohol is popular with animals, insects flock around leaves that have fermented nectar from rain drops lasting long enough.

Another unique quality to alcohol is that it is the only drug that is also a food.  No other drug has calories, but as we all know, alcohol does.

Not unique to alcohol, but more widespread than for other drugs, is the fact that many cultures have a role for alcohol in cultural habits and religious rituals.  Think of kiddush in Judaism, communion in Christianity, toasts across so many cultures, college, and football.

And so it comes as no surprise that from time to time, we look for evidence from medical science that somehow alcohol is OK to use.  Sometimes we even find clues to suggest it’s not just OK, but confers some benefits.

A new study reported in the Times gives us new information on the health impacts of even low level uses of alcohol. Unfortunately, this latest information is more worrisome than reassuring.

Here is the actual study.

This is a big study.   It examines trends in health outcomes, related to alcohol use across 195 countries and 26 years.

The scale of this enormous undertaking allows us to see the impact of drinking, and not drinking, alcohol on health.

Patterns of how Humanity Uses Alcohol

The first surprise is that most people do not drink alcohol.  For this study, a drinker is someone who had at least one drink of alcohol, a year.  A non-drinker had no drinks over the course of a year.  The numbers are surprising.  In 2016, about two-thirds of all humanity did not drink, at all.  The actual number was 32.5% of all people were current drinkers in 2016, again a drinker is a drinker with only one drink that year.  More men than women had drinks.  In 2016, 25% of females had at least one drink, and 39% of males.

This trend disappears when a nation becomes wealthy.  In the wealthiest nations, 72% of females and 83% of males had at least one drink in one year.

Again, in the wealthy nations of the world women averaged 1.9 drinks a day, and men averaged 2.9 drinks a day, among drinkers in 2016.

Across the world, in every category- place, age, wealth, men drank more alcohol than women.

Another interesting trend had to do with place, which may simply reflect wealth.  Drinking is heaviest in the nations of Western Europe, and the countries colonized by England- western Canada, the US, Australia.  In addition, the areas of western South America, Greece, and the former Yugoslavia are also heavy drinking areas.

Impact of Alcohol Use on Mortality

The first question the study asked about health was if there were any patterns of alcohol use and dying at a younger than expected age.

We know that about 58.7 million people died every year across the planet in 2016, and this study finds about 2.8 million people died from alcohol in 2016, or about 4.8% of all deaths on the planet.  That proportion rises sharply for people in the age range of 15-49 years old, where 12.2% of all male, and 3.8% of all female, deaths were caused by alcohol use.  This makes alcohol the #1 reason that people ages 15-49 die early or get disabled.

Impact of Alcohol on Health 

Across populations of millions of people, for men and women, across all ages, not using alcohol at all is the best choice across a broad range of health possibilities.

Drinking led to more of many various health problems, including more:

Cancer: 8 types- lip and mouth, throat, pharynx, larynx, esophagus, colon, liver, breast).  Note that 6 of the 8 alcohol related cancers are where the alcohol touches our body, the mouth, throat, and gut.

Chronic diseases such as diabetes.

Infections such as tuberculosis.

Accidents.

Suicide.

In wealthy countries, drinking does offer some protection from heart attacks, but only after age 60, with that level of protection getting pronounced only by age 75 or 80.

In nations where wealth is not great, but somewhere in the middle, even the protection from heart attacks seen after age 60 is nearly absent, only to appear again in very poor countries.

Everywhere, alcohol’s possible protection against heart attacks vanishes if you drink more than 4 drinks a day.  A drink is one bottle of beer, one glass of wine, or one shot of liquor.

The trend line for breast cancer shows an increased rate of risk of breast cancer going from 0 drinks per day average to even 1.

Overall, across the entire world, for all genders, at all ages, the risk of dying from drinking alcohol goes up starting at going from an average of 1 drink per day to 2 drinks per day.

BOTTOM LINES

1. The study discussed here is an enormous review of the medical literature that includes consideration of millions of people in 195 countries over a 26 year period.
2. The findings are epidemiologic.   This simply means the authors are describing what they observe when they count drinks and diseases.  Epidemiologic studies such as this can find real trends but cannot prove causes.  Causes can only be proven, in the case of alcohol, by exposing a large group of people to the drug, then removing the exposure, and seeing the actual difference in the various diseases of concern.
3. Even so, the evidence is compelling that the action of drinking alcohol causes an enormous amount of disease and death.  We know in the United States that of the 2 million Americans who die each year, 100,000 die from alcohol use.  And, that 50% of all deaths by car are due to the influence of alcohol.  And that suicide occurs more often when under the influence of alcohol.
4. This study suggests that even mild use of alcohol makes 8 different cancers more likely to happen, as well as strokes, high blood pressure, pancreatitis.
5. There may be some protection for heart attacks, even diabetes with use of alcohol, but that benefit is countered by the possible increased harm from the diseases listed above.  If one reaches an older age, the use of alcohol appears to offer an overall benefit from reducing heart attacks, but only at levels of 5-6 drinks per day, and in either very wealthy or very poor countries.

As we gather efforts to stamp out the use of opioids and the rise of fentanyl, and try to stop the addiction of our children to nicotine, it remains important to be aware that alcohol, the most accepted of all mind-altering drugs (with the exception of caffeine), is not really a safe chemical to be exposed to.

To your health,
Dr. Arthur Lavin