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Sunday, July 13, 2008

The Impact of Alcohol on Health

The effect alcohol, including in the form of beer, might have on the overall state of healthfulness of the body. What harm might it do and might it actually do some good? And let us start from a baseline statement that alcohol is relatively non-toxic, with an oral LD50 for the rat of 13.7 g/kg (i.e. the amount of ethanol which will kill half of the animals in an experimental population) (Bakalinsky and Penner 2003) Increasingly the evidence is that there appear to be bene ts in drinking beer (and other types of alcoholic beverage). Guallar-Castillon et al. (2001) concluded that the consumption of total alcohol (wine and beer) was associated with a lower prevalence of sub- optimal health. Hospitalisation is less acute for daily moderate drinkers (Longnecker & McMahon 1988), especially for women who had consumed between 29 and 42 alcoholic beverages in the fortnight prior to lling in the questionnaire. Artalejo et al.
(2000) found that moderate drinkers in Spain were less likely than abstainers to use healthcare services. Meanwhile Wiley and Camacho (1980) showed that moderate alcohol consumption (17–45 drinks per month) was associated with the most favourable adjusted health scores.
Beer drinkers were shown by Richman and Warren (1985) to have signi cantly lower rates of morbidity (sickness) than expected – one drink per day giving 15% less disability than was the case for the general population. There will be those reading this who will not be able to countenance such ndings.
If these people nd it hard to swallow that drinkers, imbibing in moderation, could be less ill, then they might note that they have certainly not been shown to be more sick. However, we must stress always that many of these studies are dealing with correlation, not necessarily causality. Some will argue that there may be other confounding factors not explored in the studies, and that those who tend to drink in moderation may have other lifestyle attributes that are the true reason for their enhanced healthiness. However, the sheer frequency of studies that have demonstrated the bene ts of restricted alcohol intake, weigh heavily in support of the merits of sensible drinking.
In the mid-1990s, the Department of Health within the British government addressed the matter of recommended safe limits for drinking. After (we presume) careful consideration of the scienti c and medical evidence available up to that stage, they increased the recommended limit for men from 21 units to 28 units per week, with the advice to
women being to drink no more than 21 units per week (previously it had been 14). They stressed that the daily maximum should be 4 units and that binge drinking (the equivalent of taking all of the weekly allocation at one sitting) is absolutely undesirable.
Individuals differ substantially in their bodily response to alcohol. Various factors will play a role, including body weight, general state of health, amount of activity, and whether the alcohol is being consumed on its own or alongside food. The UK guidelines are precisely that: blueprints to give some guidance to people to judge sensibly what is and what is not an advisable amount of alcohol to consume. They are not recommendations to drink: they are certainly not instructions. Rather they are a common-sense judgement on what is likely to be healthful for a sensible and healthy adult. And the fact that the levels were increased is testimony to the burgeoning evidence that there is real merit in moderate consumption of alcohol.
The author of a newspaper article in California once highlighted the number of times I had invoked the word ‘moderation’ when she interviewed me. I make no apology for using the word again here (particularly as a glance at the thesaurus in my computer offers the word temperance as a suggested alternative!). As the reader should surmise from what follows, there is more than ample evidence for the harmful effects of sustained, heavy intake of alcohol in all its forms. However, it will be noted that the serious ailments are primarily associated with extreme alcoholism, and a consequence of vastly more alcohol ingestion than is the norm for the great majority of adults.