Talk:Long-term effects of alcohol

Better title for page, "Moderate drinking controversy" -> "Alcohol consumption and health"

I suggest a different name for this page. Controversy shouldn't be part of the title. The title should describe the information in this page. Controversy is inherent in the description of all sides of the issue. Here are some options for a name change:

• Health benefits of alcohol
• Benefits and risks of alcohol
• Moderate consumption of alcohol

Some of these titles require modifying the information on this page to contain more information about, say, the risks of alcohol.User:nereocystis 06:41, 8 Feb 2005 (UTC).

I like the third choice. I will move the page if there are no objections in the next few days.

Acegikmo1 23:03, 4 Feb 2005 (UTC)

After thinking about this a bit further, I suggest that this page change direction slightly and discuss all health aspects of alcohol consumption, regardless of the quantity. It would mention a few items:

1. Health benefits and risks of moderate consumption of alcohol, as it is today.
2. Health risks of higher consumption, including any benefits of high consumption.
3. Health risks of low alcohol consumption.

The reason I want to move in this direction is that the range of moderate consumption to high consumption is a continuum, not an absolute separation with, say, 2 drinks being moderate consumption with an entirely different set of risks for high consumption which is 3 drinks or more. I want to include cirrhosis, and drunk driving, even though the risk is lower with moderate consumption. Perhaps the title could be "health and alcohol consumption".Nereocystis 06:45, 8 Feb 2005 (UTC)

This seems quite reasonable. I think the title you propose is appropriate. Would you like to move the page there? Acegikmo1 05:40, 15 Feb 2005 (UTC)

I'll give it a few more days for comments, then move it if there aren't any objects. However, I'll give one last variation "Alcohol consumption and health", to give alcohol the first reference. Nereocystis 22:29, 17 Feb 2005 (UTC)

Done. "Moderate drinking controversy" moved to "Alcohol consumption and health". Nereocystis 01:13, 3 Mar 2005 (UTC)

"Moderate drinking"

I find it bizarre that consuming 30g/day of alcohol can be considered "moderate drinking". I rarely drink that much in a month! Still, good news for the brewers... wonder which one funded the research?

There's a difference between taking 30g/day and taking 210g in one weekend.

Exactly what constitutes moderate (or sensible) drinking) varies widely from country to country. What is Moderate Drinking or Alcohol Consumption? In addition, it depends on who is asked. A member of the WCTU would say that any consumption is excessive, whereas an alcohol-dependent person would likely say that consuming a quart of 80 proof whiskey each day is moderate. And yes, the pattern of consumption is important.

NPOV

I added an NPOV tag to this article since I found this at the external link section: [1]

There's been quite some research recently testing the claims about moderate drinking, and the Center for Disease Control's findings need to be mentioned. Namely, the CDC claims that the existing findings were corrupted by massive supressed variable biases, such as much higher incidence of poverty amongst nondrinkers, and that these things could explain the measured positive effect. Scott Ritchie 04:51, 16 February 2006 (UTC)

More on NPOV

Hi Scott- I think the CDC suggests that the relationship between moderate drinking and health benefits *may* have been influenced by uncontrolled variables and that therefore the benefits of moderate drinking may have been exaggerated. This hypothesis (which is a very reasonable one) was first proposed by Shaper in 1988. However, at an international conference a few years ago, he acknowledged, as I recall, that his hypothesis had not been supported by subsequent research that addressed the issue. Since then, the evidence against his hypothesis has continued to grow. Nevertheless,

"Some controversy persists about the apparent higher CAD (Coronary Artery Disease) risk among abstainers. For example, a much publicized hypothesis (Shaper et al. 1988) suggests that the group of abstainers studied may have included persons with pre-existing alcohol-related health problems who were already at high CAD risk (i.e., "sick quitters"). However, studies that differentiate between lifelong abstainers and past drinkers suggest that both of these types of nondrinkers are at higher risk of CAD than are current drinkers (Renaud et al. 1993; Maclure 1993; Klatsky 1994). In addition, a prospective Kaiser Permanente study of alcohol habits and CAD hospitalizations (Klatsky et al. 1986b) showed that former drinkers and infrequent drinkers (i.e., those who consumed less than one drink per month) were at similar CAD risk as lifelong abstainers. All other subjects had a lower CAD risk independent of a number of potential indirect explanations (i.e., confounders), including beverage choice (see the section, "The Role of Beverage Choice," p. 19) and baseline CAD risk (i.e., pre-existing CAD risk as evaluated at the patient's initial examination). In a prospective study of total CVD mortality (Klatsky et al. 1990a), former drinkers had higher age-adjusted CAD and overall CVD mortality risk than lifelong abstainers, but the difference disappeared when adjusted for other traits. Among current drinkers, lighter drinkers had the lowest risk for both total CVD deaths and CAD deaths, yielding U-shaped mortality curves with lowest risk at one to two drinks per day and at three to five drinks per day, respectively. Mortality curves were not influenced by differences in patients' baseline CAD risk or by the occurrence of pre-existing CAD."(“Moderate drinking reduced risk of heart disease,” Alcohol Research & Health, 1999).

Since this article was published, other research has found that lifelong abstainers and heavy drinkers both have higher mortality rates than do moderate drinkers. Such studies include:

Cleophas TJ. Wine, beer and spirits and the risk of myocardial infarction: a systematic review. Biomed Pharmacother 1999;53:417–23.

Dawson, D. A. Alcohol consumption, alcohol dependence, and all-cause mortality. Alcoholism: Clinical and Experimental Research, 2000, 24, 72-81.

Green, C. A.., and Polen, M. P. the health behaviors of people who do not drink alcohol. American Journal of Preventive Medicine, 2001, 21(4), 298-305.

Klatsky, A. L., et al. Wine, liquor, beer, and mortality. American Journal of Epidemiology, 2003, 158, 585-595.

Paoletti R, Klatsky AL, Poli A, Zakhari S (eds). Moderate Alcohol Consumption and Cardiovascular Disease. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2000.

Poikolainen, K., et al. Alcohol and coronary heart disease -- is there an unknown confounder? Addiction, 2005, 100(8), 1150-1157.

Theobald, H., et al. A moderte intake of wine is associated with reduced total mortality and reduced mortality from cardiovascular disease, 2001, 61, 652-656.

The consensus among medical researchers today is that moderate drinking is associated with better health and greater longevity than is either abstaining or heavy drinking. That consensus is based not only on epidemiological evidence but also on the biological and chemical mechanisms whereby alcohol improves cardiovascular health.David Justin 03:15, 17 February 2006 (UTC)

The date on the CDC study is not 1988, it is April 19, 2005. That's more recent than most of that stuff. Scott Ritchie 05:10, 17 February 2006 (UTC)

Hi Scott- Looks like we both misspoke. The CDC is making no assertions regarding the relationship between moderate alcohol consumption and health. One of the many studies it funds each year has called into question the validity of that relationship. A summary of the study in question follows:

______________________________________________________________________________

Article: Naimi TS, Brown DW, Brewer RD, Giles WH, Mensah G, Serdula MK, Mokdad AH, Hungerford DW, Lando J, Naimi S, Stroup DF. Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. Am J Prev Med 2005;28:369-373.

Summary: The authors state that studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking

The authors used data from the 2003 Behavioral Risk Factor Surveillance System, a population–based telephone survey of U.S. adults, to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day. After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results.

The authors conclude that their findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States.

Comments: Epidemiologists are only too aware of confounding in interpreting their results of observational studies among humans. It has long been known that social status, education, income, and many other factors modify the relation of alcohol to health and disease outcomes, and there is methodology available (and still being developed) to help adjust for confounding and to judge the impact of residual confounding in a study. None of this is discussed in the present paper. Using the best available techniques to adjust for confounding, almost every epidemiologic paper published has found that for a given age, gender, race, educational and smoking status, etc., moderate drinkers are less likely to die from coronary disease. Further, interventional studies in humans and extensive animal studies show dramatic reductions in most cardiovascular risk factors when alcohol is given in an experimental situation; this is also not commented upon by the authors.

Overall, this paper does not add any real insight into potentially confounding variables that we all deal with daily. Further, the risk of some of the factors they list such as diabetes and even obesity have now been shown in animal studies and limited interventional studies in humans to be reduced by moderate intake of alcohol. Hence, it would be expected that such risk factors would be more common among nondrinkers, as some of them (perhaps even a more favorable “general health status”) may be the result of alcohol intake. The implication of this paper that previous studies showing protection against CVD from moderate alcohol consumption have largely ignored many such factors is erroneous.

A number of statements throughout the paper cannot be supported by data. For example, by stating that “moderate drinking has a relatively small effect size relative to other risk factors,” the authors ignore a large amount of recent data showing much greater effects on HDL-cholesterol from alcohol than for any other lifestyle factor, more decrease in platelet aggregation from alcohol than other factors, much greater effects from moderate alcohol use on risk of death from CVD among diabetics than from other approaches for lowering risk. There are also a number of problems in the analyses done for this paper. Simply giving each factor one point and adding the number of factors together to get a “CVD Risk Score” is naïve, as very detailed equations have been worked out by the Framingham Heart Study and others that give proper weight for each component of a risk score. In fact, the authors of this paper do not even discuss the degree of impact on heart disease risk of the factors they list.

The authors end by stating that we should not consider alcohol use as a way of reducing heart disease risk as “there are safe and effective strategies to decrease CVD mortality.” They do not comment, however, on how often individuals are successful in losing weight and keeping it off, on the great difficulties many addicted smokers have in trying to stop smoking, or on the cost and potential side effects of the medications they suggest as alternative ways to reduce CVD risk.

No one is urging individuals to drink more (as very small amounts on a regular basis are not only the safest but most effective way of reducing cardiovascular risk), and no one is urging everyone to drink alcohol, as there are many conditions (previous problems with abuse, certain health conditions, against religious or ethical beliefs, etc.) that serve as contraindications to alcohol intake. Nevertheless, it is incumbent among all of us to provide balanced and scientifically sound information for physicians to use in advising individual patients about alcohol use or non-use. A paper such as the present one does not help in getting balanced information across to the public or the health profession.

Lay Summary: This paper points out that nondrinkers in the U.S. tend to have many unhealthy lifestyle and physiologic factors that may increase their risk of heart disease. The authors suggest that some of the purported reduction in risk of heart disease from alcohol intake may be due to these factors. Epidemiologists always strive to adjust for those factors that can be measured and comment upon those that cannot be measured or adjusted for when evaluating the effects of alcohol intake on heart disease risk. The current paper does not add much to our understanding of this ongoing challenge.

 					R. Curtis Ellison, MD

Best regardsDavid Justin 19:38, 17 February 2006 (UTC)

Here's an older article I just found, discussing what may have been a much better paper in the British Medical Journal: BBC link

They explained that earlier studies may have shown improved health among moderate drinkers simply through a statistical quirk. Many of the previous studies had shown results in the form of a U graph, with moderate drinkers having the lowest death rates, while heavy and non-drinkers had the highest. However, such figures could be skewed because sick people are more likely to be non-drinkers - they do not drink because they are ill, rather than being ill because they do not drink.

As it stands, the current article isn't terribly complete, since it doesn't really convey the controversy that this has gone through in the literature over the years. I'm too lazy to edit it myself, though. Scott Ritchie 07:04, 1 March 2006 (UTC)

Article is NPOV

I think that Article gives misleading picture of the discussion. It is definitely not true that all the studies show that alcohol is beneficial. See the following article for example: [2] --128.214.200.176 10:01, 6 March 2006 (UTC)

The article doesn't say that all studies demonstrate health benefits of drinking sensibly. I don't know of any area of medical research in which *all* studies report the same or consistent findings. However, as this article says, there is *consensus* among medical researchers regarding the relationship. That's not a point of view but a fact.

No study can prove a health benefits of drinking. It can show (or not) that moderate drinkers live longer or are healthier than non drinkers. --Spacey 20:33, 17 April 2006 (UTC)

International Study Questions Health Benefits Of Moderate Drinking

There is a Metastudy by Kaye Fillmore et al of the University of California saying the majority of studies suggesting that "moderate" drinking helps prevent heart disease may be flawed.

[3] "Our research suggests light drinking is a sign of good health, not necessarily its cause." --Spacey 20:24, 17 April 2006 (UTC)

This article and Effects of alcohol on the body

27 May 2006: There seems to be a lot of overlap between this article and Effects of alcohol on the body, which takes a broader view. If this is to remain a separate article, we need to work out what the demarcation between the two is.

Bias in "Comparison with health benefits of exercise and diet" section

The whole section is biased. It tries to make eating moderately and exercising seem like a very hard thing. Weasel words, like "demanding" and "diet", are used. It also attempts to argue that eating moderately and exercising is a complicated process by increasing the number of things one can do in their contrived list of things to do ("eating a very low-fat diet, vigorously exercising regularly, eliminating salt from the diet, and losing weight") by adding unneccesary statments - "eliminating salt from the diet" and "losing weight". The "eliminating salt" statement is not factual because sodium is a vital mineral required for vital bodily functions [4]. The "losing weight" statement is obviously there to make their list seem longer - losing weight is a result of exercising and does not need to be stated. In addition, "Vigorously exercising" and "very low-fat" are weasel statements.

This section should be removed. This kind of misleading content does not belong in an encylopedia. You alcohol-industry beneficiaries need to take your propoganda elsewhere.

-Usernamefortonyd

False/exaggerated health benefits of alcohol

Many of the studies used as sources do not disclose or consider proxy variables (unapparent variables that significantly affect the outcome than the claimed causative variables of the study), so many of the "facts" are incorrect. For example, many studies put ex-drinkers and lifetime abstainers into one group, which makes the "abstainer" group less healthy overall.

Much more info at Alcohol -- Health Benefit or Hazard?. -Usernamefortonyd

What kind of "authority" is this?!

Your "authority" is a Ben Best, who reports that throughout much of his life he was a "professional student", taxi-driver, Teamster, computer operator and "whatever other work I could find" [5].

Best is a self-described "raw foodist" and his daily exercise and diet regimens are described in detail on his website. The exact daily content, weight and calculated caloric value of two months of his diet are also archived there [6].

He writes that he "aggressively participated" in EST and various other human potential movements. He describes many of his activities as designed to help him overcome fear of women and various anxieties. [7] [8].

Currently, he operates a cryogenics company that stores dead bodies of people ("patients") he expects will be thawed back to life in the future.CRANdieter 03:04, 29 June 2006 (UTC)