Drinking is an intrinsic part of Australian culture. Introduced during colonisation, our tumultuous consumption patterns have gone from excess to restraint and back. Binge drinking has declined in recent times: however, moderate alcohol consumption has increased. Previously, research has suggested that moderate wine consumption may be beneficial for heart health. But a recent study has found that even moderate drinking can increase risk of death from stroke, aneurysm and heart failure, indicating that the threshold for avoiding health risks may be lower than previously thought.
Our relationship with alcohol – it’s complicated
Australians have had a somewhat complicated relationship with alcohol. A culture of heavy drinking was introduced during colonisation and by the 1830s consumption had reached a high of more than 13 litres of pure alcohol per person each year. Meanwhile, church-affiliated Temperance organisations were advocating for moderation and eventually prohibition. Liquor restrictions and the implementation of prohibition in some states failed to solve the problem: although consumption did decline during the 1890s and the Great Depression, it increased again after World War II. We’ve since developed more ‘civilised’ drinking habits; however, binge drinking has become prevalent in the last few decades.
But red wine is healthy, isn’t it?
Around the 1970s, research began to report links between alcohol and reduced risk of heart disease. Mild to moderate red wine consumption was associated with increased HDL cholesterol and reduced LDL cholesterol, inflammation and atherosclerosis. This effect was attributed to both alcohol itself and polyphenol antioxidants, particularly reservatrol and proanthocyanidin.Bertelli AA, Das DK. Grapes, wines, resveratrol, and heart health. Journal of Cardiovascular Pharmacology. 2009;54(6):468-76 Some, however, believe the connection between red wine and heart health may have stemmed from “The French Paradox”, or perhaps due to wine featuring in the Mediterranean Diet. This diet also includes other heart-healthy foods such as olive oil, oily fish and a high intake of vegetables, making it difficult to confirm causality, especially as most research around wine and heart health is observational.
The alcohol-heart disease relationship is complex: studies have reported that both abstinence and drinking too much are linked to increased risk. At the same time, moderate drinking is also associated with health risks including liver cirrhosis, sudden cardiac death, alcoholic cardiomyopathies and cardiac rhythm disorders.
Alcohol has been identified as a group-one carcinogen and the World Cancer Research Fund cites strong evidence that drinking increases the risk of colorectal, breast, mouth and throat, oesophageal, liver and stomach cancers, with risk increasing at even low consumption levels. A new study has emphasised the risks of drinking, finding that health risks may exist even at consumption levels recommended by official guidelines. Despite an association between moderate drinking and slightly lower rates of non-fatal heart attack, researchers found an increased risk of stroke, heart disease, heart failure, fatal hypertensive disease and fatal aneurysm, with risk increasing with each additional drink. Life expectancy was reduced by 6 months at 40 years of age at a consumption level of 100 grams of alcohol per week (around 10 standard drinks), with life expectancy further decreasing as consumption increased.Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. The Lancet. 2018;391(10129):1513–23
It’s not just binge drinkers at risk
Drinking is an element of many Australian celebrations and social gatherings and although evidence does indicate a general decline in drinking over recent years, many are still consuming alcohol at harmful levels. A comparison of drinking habits between 2007 and 2017 revealed a decrease in those drinking to excess; however, this habit is still prevalent in younger drinkers, particularly those aged 18 to 24 years. And even though excessive drinking is on the decline overall, there has been an increase in those that drink up to two standard drinks per day, particularly for men aged 34 years and above and women 40 years and over. Around 20% of those who reported drinking more responded that this was due to life stressors. Also of concern is that 36% of current drinkers did not recognise any health risks from drinking: these were mainly females aged 55 years and over that reported moderate consumption.
Time to reassess the guidelines?
The National Health and Medical Research Council are currently reviewing their guidelines for alcohol consumption, which presently advise that both men and women should consume a maximum of 2 standard drinks per day and no more than 4 drinks in any one occasion. They also mention that any potential health benefits from alcohol may have been overestimated and that there is no level of alcohol intake that can be considered completely safe. This echoes the findings in the recent study, which concluded that despite a slight reduction in risk of non-fatal heart attack, the increased risk of other serious conditions outweigh any benefit. In light of this, as well as current consumption trends, perhaps it’s time to challenge Australia’s relationship with alcohol once and for all.
References [ + ]
|1.||⇪||Bertelli AA, Das DK. Grapes, wines, resveratrol, and heart health. Journal of Cardiovascular Pharmacology. 2009;54(6):468-76|
|2.||⇪||Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. The Lancet. 2018;391(10129):1513–23|