The benefit of alcohol is being questioned

Text: Fredrik Hedlund, first published in the magazine Medicinsk Vetenskap, number 3, 2015.

Is alcohol good for you? This notion is now being questioned by Sven Andréasson, Professor of Social Medicine at Karolinska Institutet, who has worked with researchers from Australia, Canada and the USA to go through the extensive research done on the subject.

“The support for a possible beneficial effect is very weak,” he says.

The reason is that all the studies that have looked at the benefits of alcohol are so called observation studies, in which the researchers ask people about their current or past drinking habits and see how they have fared. The problem is that these studies have many built-in weaknesses that make them less reliable.

In most cases, they are therefore followed by other studies that are more expensive and more time-consuming, in which the researchers select different subjects at random to different levels of consumption or placebo and then monitor them. But it is both practically and ethically impossible to randomly assign people a certain level of alcohol consumption over a lifetime to see what happens. The studies that do exist show that the people who say they do not drink any alcohol at all are at a higher risk of suffering cardiovascular illnesses than those who say they drink moderately.

But Sven Andréasson and his international research colleagues believe that this is wrong, despite a great number of studies all indicating the same thing.

“Our point is that if you conduct 100 studies with the same incorrect methodology, then you will have 100 studies with the same incorrect results,” he says.

Their first objection relates to how it would be possible.

“How could alcohol, which is toxic to most biological tissues, be healthy?” he asks.

THEY LOOKED AT PROPOSED mechanisms, such as impact on the “good” cholesterol, blood pressure and vascular sclerosis. But it turned out that the good cholesterol is no longer considered to influence cardiovascular morbidity; the amounts of alcohol that are considered to provide protection increased the risk of high blood pressure, rather than the opposite; and a brand new study from Finland, in which researchers measured the development of the vessel walls in young people from before they first had alcohol and on, was unable to show any protective effect.

“Meaning that the more alcohol they had, from zero and up, the more negative effects they had on the vessel walls,” says Sven Andréasson.

Another important argument is that the beneficial effects of alcohol cannot be seen in cultures where drinking alcohol is not the norm, but something that a minority does. Only in modern, Western, industrialised societies can the beneficial effects be seen. This could explain why those who do not drink alcohol end up with a higher level of risk in the studies according to Sven Andréasson.

“Our conclusion is that those who drink alcohol in our culture are part of the majority. They are ‘normal’ people who socialise and have good relationships, which means sometimes meeting up and having a few drinks with a good meal. Those who do not engage in such activities are outsiders, a bit lonely, odd or mentally ill. And outsiders generally have a higher risk of everything you could think of,” he explains.

HOWEVER, SVEN ANDRÉASSON’S conclusions have been criticised in Läkartidningen by other persons well versed in the subject, such as the former head of Swedish Council on Health Technology Assessment (SBU), Måns Rosén, and the chair of the SBU Scientific Advisory Committee, Kjell Asplund, who think that his arguments are not sufficiently substantiated, and that the overall research would still indicate a beneficial effect.

hey also feel that it is irresponsible to worry people about a moderate alcohol consumption in middle age. But Sven Andréasson and his research colleagues have never intended to cause alarm. Nor are they of the opinion that it is dangerous to drink a little alcohol; what they are questioning is whether it is beneficial.

“Can you improve your health by drinking a small amount of alcohol? That's what we are sceptical about,” he says. That means that the limits of risky drinking remain exactly the same.

“So far, I think the levels we have described are okay. Somewhere along those lines you will see moderate increases in risk,” he says.

And he has not changed his own approach to alcohol due to these new findings.

“No. I drink the same way as those around me. There’s nothing dramatic about it for me personally,” he says.

Text: Fredrik Hedlund, first published in the magazine Medicinsk Vetenskap, number 3, 2015.