The right amount of alcohol is not always less

Changes in alcohol consumption should not be simply about cutting it, but about optimising it

DISMAY greeted last week's news that the "ideal" amount of alcohol for an adult to drink is just 5 grams a day - equivalent to roughly two standard glasses of wine or 3.5 units of alcohol each week. This is far less than the current guidance for safe drinking from the UK government, which suggests 21 units a week for men and 14 for women. Warnings of nanny statism duly flew, with reports suggesting that people would soon be "allowed" to drink only a quarter-pint of beer a day.

Leaving aside the question of whether or not the state has a duty to counsel its citizens against drinking themselves to death, this is an unhelpful reaction to helpful research. The point of the study behind the headlines was to find the average intake that would best balance the beneficial and deleterious long-term effects of alcohol. For years now, drinkers have received confusing messages about how much alcohol they should drink. For every study confirming that alcohol reduces heart disease, there seemed to be another attesting to drink-related liver disease or cancer.

The new research promises to bring some clarity by modelling the daily intake across the entire English population that would maximise the benefits, in terms of heart attacks avoided, and minimise the downsides, in terms of cirrhosis and cancer. "We were surprised it hadn't been done before," says Peter Scarborough at the University of Oxford, co-leader of the team whose results appear in BMJ Open (DOI: 10.1136/bmjopen-2012-000957).

The "Goldilocks" level of consumption turned out to be 5 grams per adult per day. At this level, the model predicted that about 840 more people would die every year from heart disease, because alcohol's beneficial effects kick in at higher intakes. But there would be 2670 fewer deaths from cancer and 2830 fewer deaths from liver disease - saving in the region of 4600 lives overall. But there were still net health benefits if average consumption was more than double this level - closer to the 13 grams per day that English drinkers actually averaged in 2006, when the study's underlying data was gathered.

The Goldilocks alcohol figure is not likely to be the same in all parts of the world, since disease burdens differ from place to place. For example, heart disease rates are already low in Japan, so it would be difficult to compensate for the negative effects of alcohol.

So while one might expect this result to inform government guidelines on drinking, those predicting a drastic curtailment are being over-dramatic. For one thing, many questions remain open, such as how other aspects of people's lifestyles affect the risks of disease from alcohol, including diet, smoking, exercise and, of course, medical histories. And the guidelines have much to do with lessening the impact on society of people whose drunkenness leads to accidents and violence.

So there is no clear mandate for a major decrease in target consumption. In fact, the study's findings on abstinence are among its most striking: less than 1 gram per day was associated with increased mortality, since teetotallers are at higher risk of heart attacks. Changes, then, should be driven not by the desire to simply cut alcohol intake, but to optimise it: to see the glass as half full, as well as half empty.

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