Light drinking may be risky
CHICAGO – You eat your veggies, exercise at least a few times a week, gave up cigarettes and hormone-replacement pills, and have a glass of red wine every day, all because you care about your health.
But one of these things is not like the others.
While your attention has been elsewhere, scientists have amassed persuasive evidence that drinking alcohol – any form of alcohol, even in moderate amounts – can pose a serious threat to your health.
Researchers have known for nearly 20 years that drinking alcoholic beverages can cause cancer of the mouth, throat, esophagus and liver. But those diseases don’t get much publicity. This year, the International Agency for Research on Cancer added breast and colon cancer – two of the four major killer cancers – to the list of malignancies known to be fostered by alcohol.
The risk is “dose dependent,” meaning the more you drink the higher the risk.
According to comprehensive reviews of the scientific evidence, people who average just over one drink a day (100 grams of alcohol in a week’s time) increase their chances of developing colon cancer by about 15 percent. For those who consume about four drinks daily, the risk is 40 percent higher.
Women who have one to two drinks a day increase their breast cancer risk by 13 percent. With four drinks, the risk is 50 percent higher. That’s twice the increase in relative risk attributed to Prempro, the hormone pill tested in the Women’s Health Initiative, the well-known study that found the risks of hormone replacement outweigh the benefits.
Last month, yet another study reinforced the fact that even a glass or two of wine a day increases breast cancer risk. Yes, even red wine.
Drinking small amounts of alcohol – a shot of hard liquor or a glass of beer or wine – on a consistent daily basis does have a few proven health benefits.
Specifically, it reduces the risk of heart attacks and strokes caused by blocked arteries by 10 to 15 percent. That’s probably because alcohol increases good cholesterol and prevents blood platelets from clumping together.
“On the other hand, alcohol is detrimental for more than 60 diagnoses,” said Juergen Rehm, head of public health and regulatory policies at the Ontario Center for Addiction and Mental Health.
“That red wine stuff – how it was supposed to be protective – was hyped completely out of whack by the media,” Rehm said. “And whatever protective effect there is, is not about the red wine – it’s about the alcohol.”
According to data compiled by the Centers for Disease Control and Prevention, alcohol consumption is the third-biggest cause of preventable death in the U.S., after smoking and obesity. The centers estimate that in 2001, the most recent year for which data is available, drinking caused nearly 93,000 deaths.
That includes more than 12,000 cancer deaths, comparable to the 13,674 killed in alcohol-related traffic accidents.
The same data show that about 30,000 fatal heart attacks were prevented by moderate alcohol consumption, which is defined as fewer than two drinks a day for men and less than one drink a day for women. But Dr. Robert Brewer, head of the CDC alcohol team, said the evidence for alcohol preventing heart attacks is less reliable.
“We need to be cautious about interpreting the studies that suggest a benefit,” said Brewer. “People who drink moderately are different from people who don’t drink – they exercise more, they have better medical insurance, their body-mass index is lower.” In other words, they might have had fewer heart attacks because of factors other than alcohol intake.
Scientists don’t know exactly how alcohol changes the cancer picture. Some researchers are analyzing the influence of alcohol on estrogen levels, which can affect the risk of breast cancer. But alcohol also affects liver function, which could impair the body’s ability to get rid of potential cancer-causing agents.
The good news for worried drinkers, Rehm said, is that quitting seems to eventually reverse the added risk.
In a study published last month in the International Journal of Cancer, Rehm and his colleagues showed that the risk of head-and-neck and esophageal cancer decreased significantly within 10 years of giving up booze and was the same as that for non-drinkers after 20 years.
Some experts say society should take the public health risks of alcohol much more seriously and limit consumption.
Traci Toomey, an epidemiologist at the University of Minnesota, said several strategies have been shown to work, including restricting happy-hour and two-for-one promotions, training wait staff to make sure drinkers aren’t overserved, and increasing taxes.
“Taxes on alcohol haven’t kept up with inflation, so the real price is much lower than it used to be,” she said. “Excise taxes should be indexed to inflation.”
But that would involve taking on the alcohol industry. Jim Mosher, who studies alcohol policy at the Pacific Institute for Research and Evaluation, said “the power of the alcohol lobby” makes it almost impossible to raise state or federal taxes on alcoholic beverages.
“Where we get action,” he said, “is at the local level, where politicians are more accountable to their constituents and the lobby is less powerful.”
As a positive example, Mosher pointed to a program in Ventura County, Calif. The county trains bar and restaurant staff and limits the number of places that can sell alcohol. A dedicated law-enforcement officer works with the bars, “so if there continues to be overserving despite the educational efforts, they can move to revoke licenses,” he said.
Ventura County also has a “social host liability law” that fines parents and landlords if they allow underage drinking on their property.
According to the National Institute on Alcohol Abuse and Alcoholism, 18 states have mandatory server training laws, 21 have voluntary training programs, and 30 have laws requiring the registration of beer kegs sold to private citizens.
All but a handful of states have seen deep erosion of excise taxes.
Frank Coleman of the Distilled Spirits Council dismissed the notion that the industry was responsible for keeping alcohol taxes low.
“Our society has a general aversion to higher taxes, except for policy wonks who think they know what’s best for everybody else,” he said.
Coleman also noted that the so-called alcohol industry involves “lots of little people all over the country: waitresses, bartenders, busboys, people who run little shops, family farms – it’s a big chunk of the economy.”
In any case, he said, alcohol , “if used responsibly, in moderation, can be part of a normal healthy lifestyle.”
Dr. Arthur Klatsky, a researcher at Kaiser Permanente in Oakland, agrees with Coleman on that point.
Klatsky co-wrote the study released last month that found even one or two drinks a day raised a woman’s breast cancer risk. But there was no increased risk for those who reported having a few drinks a week.
“I don’t know where the threshold is,” said Klatsky, referring to the amount of alcohol above which breast cancer risk goes up. But “I don’t want women to fear they can’t have a glass of champagne at a wedding.”
Klatsky pointed out that the risk-benefit analysis will be different for each person.
“A middle-aged or older man who doesn’t have a drinking problem probably has a net benefit from one or two drinks a day because he’s at risk of heart disease,” Klatsky said. “But a younger woman with no cardiac risk and a family history of breast cancer would probably do better not to drink.”