No Grey Area?
It doesn’t take a genius to know that alcohol abuse can cause serious health problems. However, over the past 10-15 years the benefits, especially cardiovasculr of “responsible drinking” (e.g. one glass of red-wine per day) has received a lot of attention and has generally been accepted throughout society. Well, it looks like the only benefits that alcohol provide come from not consuming it. At least that what the 2014 World Cancer Report (WCR), created annually by the Agency for Research on Cancer (IARC), an agency that is part of the World Health Organization (WHO).
Ok, time for some educated speculation in the face of science. I’m not the booze police, and don’t frown on drinking in moderation for those who can actually drink in moderation. Personally, I’ve seen the devastation that alcohol can cause to individuals, families, innocent bystanders, etc., that for those who choose to abstain, all the power to you. That said, I’m not sure I believe that moderate drinking causes cancer, like the report says. Please allow me to elaborate, starting with a simple question; How many people who drink too much don’t minimize the truth to not only doctors, law enforcement, family members, but perhaps most of all to THEMSELVES?
Isn’t There A River in Egypt Related to this Topic:
Denial is more powerful than alcohol and for centuries has played a huge part in the drinking habits of millions of people. So maybe it’s a question of what the actual consumption is, not only in terms of quantity, but frequency as well (including days between drinks). The report indicates that the risk is “dose dependent” meaning the more one drinks, the higher the risks. Would it not be fair to then consider that the identified correlations between alcohol and certain cancers are seen in patients who actually consume more than reported?
Serious Science & Statements of Certainty:
Many are surprised to learn that alcohol was declared a carcinogen by the IARC in 1988 and is considered to be causually related to several cancers for certain, and speculated to be causally related to several others (IARC Working Group, 1988).
Cancers Caused By Alcohol:
According to Jürgen Rehm, PhD, WCR contributor on alcohol consumption, and Senior Scientist at the Centre for Addictions and Mental Health in Toronto, causal relationship exists between alcohol consumption and cancers of the mouth, pharynx, larynx, esophagus, colon-rectum, liver, and female breast. The report also states that there is a significant relationship existent between alcohol consumption and pancreatic cancer. Dr. Rehm states that the IARC is absolutely certain that alcohol causes these cancers.
There have been established connections between alcohol consumption and leukemia; multiple myeloma; and cancers of the cervix, vulva, vagina, lungs, kidneys, and skin, but admittadly, more research is needed. For other cancers such as bladder, lung, and stomach cancers, the evidence for an alcohol-cancer relationship is conflicting (Rehm & Shield, 2013).
Circling Back to Denial and Under-Reporting Drinking:
I emphasize the importance of knowing real numbers, even in the face of a meta-analysis of 222 studies regarding “light drinking” where the combined sampled populations were comprised of 92,000 “light drinkers” and 60,000 non-drinkers. Supporting the 2014 report, this meta-analysis concluded that light drinking was associated with risk for oropharyngeal cancer, esophageal squamous cell carcinoma, and female breast cancer (Bagnardi, et al., 2013).
The Practical Bottom Line:
Just as one needs to be honest with themselves about how much they drink, they also need to remember the evidence for the harmful effects of alcohol is stronger than the evidence for its beneficial effects. Viewing drinking as engaging in a healthy activity is really a justification. Sure, as Renaud and de Lorgeril illustrated (1992), there is evidence which shows lower risks for diabetes mellitus, stroke, heart failure, and total mortality, but lowered risks are minimal compared to the increased negative risks associated with excessive alcohol consumption. Again, we’re talking excessive consumption.
To really benefit from light drinking, one needs to follow a consistent pattern of daily low-intake of alcohol (preferably redwine), before or during the evening meal, which is associated with the strongest reduction in adverse cardiovascular outcomes. The key being low-intake as heavy alcohol use causes hypertension, atrial fibrillation, ischemic and hemorrhagic stroke, and nonischemic dilated cardiomyopathy Renaud & de Lorgeril (1992).
The evidence for the harmful effects of alcohol is stronger than the evidence for its beneficial effects.
We haven’t even discussed the consequences unrelated to health (accidents, social problems, violence, etc) nor underage drinking. Those are the main reasons why alcohol abuse is the leading risk factor for premature death among males ages 15-59 (O’Keefe, et al., 2014).
Basically, as Dr. Rehm explains, “We still don’t know what causes 60% of cancers, but people can lower their risk by reducing their intake of alcohol.”
It seems that Dr. Pekka Puska, former Director General of the National Institute for Health and Welfare of Finland and contributor to the WCR, has the most realistic and practical advise regarding drinking. He states that, “I would not be concerned about the use of alcohol in every patient. Clinicians should inquire about alcohol use and inform patients about the health risks. For most patients, especially the elderly, if they consume alcohol in moderation, I would not pressure them to stop alcohol altogether. In patients who have health problems related to alcohol, however, clinicians should be very firm in advising them to stop using alcohol and recommend specific cessation services.”
So, if you drink, like most things, do so in moderation and be honest with yourself. However, if moderation is a problem for you in areas of your life (think “too much of a good thing”) abstinance is the only sure fire way to avoid an alcohol related problem. I’ve said it before and I’ll say it again, if you think you have a problem with alcohol, then you probably do. The good news is there is an abidance of ways to get help. Behavior change and positive effects have been observed in adolescents, adults, older adults, and pregnant women following alcohol screening and brief interventions aimed at reducing alcohol intake.
Feel free to comment or contact me individually should you or someone you care about possibly have a problem with alcohol or substance abuse and desire some professional guidance.
Bagnardi, V., Rota, M., Botteri, E, et al (2013). Light alcohol drinking and cancer: a meta-analysis. Annals of Oncology.;24,301- 308.
IARC Working Group, Lyon (1988). Alcohol drinking. IARC Monograph Evaluating Carcinogenic Risks in Humans,44,1-378.
O’Keefe, JH, Bhatti, SK, Bajwa, A, DiNicolantonio, JJ, and Lavie, CJ (2014). Alcohol and cardiovascular health: the dose makes the poison…or the remedy. Mayo Clin Proc.,89,382-393.
Rehm, J, and Shield, K (2014). Alcohol consumption. (In Stewart BW, Wild CB, eds. World Cancer Report 2014. Lyon, France: International Agency for Research on Cancer; 2014.
Renaud, S, de Lorgeril M. (1992). Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet,1992,339,1523-1526.