Moderate Drinking: The Debate Continues

New study says it’s the lifestyle, not the alcohol.

Ever since the first studies showed modest statistical health benefits for people who drank a light to moderate amount of alcohol, the debate has bounced back and forth among researchers. Now an Italian study of more than 3,000 older adults, published in the Journal of the American Geriatrics Society, claims that it is the moderate lifestyle of drinkers, and not the alcohol itself, which helps prevent functional decline as we age.

After controlling for body weight, level of physical activity, education, and income, Cinzia Maraldi and coworkers in the Department of Clinical and Experimental Internal Medicine at the University of Ferrara pointed the finger at lifestyle characteristics—primarily weight control and exercise.

The researchers did not dispute the finding that moderate levels of alcohol intake can lower the risk of cardiovascular disease--but lead author Maraldi said in a press release that “the benefit of alcohol intake on other health-related outcomes is less convincing.”

Maraldi said the positive effects of moderate alcohol on physical aging and cognitive impairment in the elderly may be only apparent, “because life-style related characteristics seem to be the real determinant of the reported association.”

The research follows earlier U.S. studies suggesting much the same thing. A finding that had become common folk wisdom—with perhaps a little nudge from the alcoholic beverage industry--is now openly disputed by scientists.

“The moderate drinkers tend to do everything right,” said sociologist Kaye Middleton Fillmore, in a New York Times article by Roni Caryn Rabin. “They exercise, they don’t smoke, they eat right and they drink moderately.” In the same article, an Oakland cardiologist said: “It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative.”

In the New York Times article, Dr. Tim Naimi of the Centers for Disease Control and Prevention said: “The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study—the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country.”

Photo Credit: Rhodes University


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Gimme a Drink--But Hold the Acetaldehyde

Another look at alcohol and cancer.

If beverage alcohol were a new drug, it would face an uphill battle to make it through the Food and Drug Administration (FDA) pipeline. Why? Because the amount of acetaldehyde in alcoholic drinks—combined with acetaldehyde from other sources—might be too carcinogenic to pass muster under existing regulations.

When drinkers drink, the first thing that happens is that enzymes convert the alcohol into acetaldehyde. Previous research has shown that this common organic chemical is implicated in certain cancers, particularly cancers of the digestive tract. Studies at the National Institutes of Health (NIH) showed that the concentration of acetaldehyde measured in human saliva during drinking episodes was sufficient to produce the kind of damage to DNA that can result in cancer.

In a study published recently in the journal Addiction, researchers from Canada and Germany showed that heavy drinkers ingest enough acetaldehyde to raise their lifetime cancer risk to as high as 1 in 1,000. The study concludes: “The life-time cancer risks from acetaldehyde from alcoholic beverages greatly exceed the usual limits for cancer risks from the environment.”

The real problem comes when alcohol is used in combination with acetaldehyde from other sources, such as tobacco, food flavorings, pesticides, and perfume. Heavy drinkers “face a magnitude of risk requiring intervention.” According to Dr. Jurgen Rehm at Canada’s Centre for Addiction and Mental Health (CAMH), quoted in Science Daily: “Most risk assessments to date were based on one source of exposure only. This has led to a negligence of the overall risk.”

According to the Science Daily article, “Alone, the risks associated with surpassing limits of acetaldehyde from the air may not yet be alarming, but for heavy drinkers and smokers, it adds to the acetaldehyde levels already received from these sources. This overall risk then surpasses established safety limits.” To make matters worse, acetaldehyde is a common substance in tobacco smoke—and alcoholics are often heavy cigarette smokers.

A Finnish drug company is currently conducting clinical trials of a time-release capsule of the amino acid cysteine, which can bind with acetaldehyde and render it inactive.

In a related development, a study in PLoS Medicine appeared to demonstrate that people who suffer from the so-called alcohol flush reaction—primarily Japanese, Chinese, and Koreans—are at increased risk for throat cancer. The culprit? An excess of acetaldehyde.

Photo Credit: National Institute of Standards and Technology

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