There is no safe limit for drinking alcohol. Alcohol at any level is injurious to health. This loud and clear message emerges from a global burden of disease (GBD) study published on August 23. It estimates the levels of alcohol use and health effects in 195 countries between 1990 to 2016.
The humongous study provided robust estimates of alcohol consumption and related risks based on 694 data sources on individual and population-level alcohol consumption, along with 592 studies on the risk of alcohol use. More than 500 GBD collaborators, such as researchers, academics and others from more than 40 nations contributed to it.
Worldwide, alcohol is associated with 2.8 million deaths each year. The study itself highlighted the following chilling facts (quoted verbatim):
- Globally, one in three people drink alcohol (equivalent to 2.4 billion people), and 2.2% of women and 6.8% of men die from alcohol-related health problems each year.
- Alcohol use was ranked as the seventh leading risk factor for premature death and disability worldwide in 2016, and was the leading cause for people aged 15-49 years old. In this age group, it is associated with tuberculosis, road injuries, and self-harm.
- For people aged 50 years and older, cancers were a leading cause of alcohol-related death, constituting 27.1% of deaths in women and 18.9% of deaths in men.
The most important conclusion is that the study suggests that there is no safe level of alcohol as the adverse effects on other areas of health, particularly cancers, outweighs beneficial effects against ischaemic heart disease.
There are significant variations in drinking patterns globally. In Denmark, 95.3% of women and 97.1% of men consume alcohol. Romania has the heaviest drinkers for men (8.2 drinks a day), and Ukraine, for women (4.2 drinks a day). The fewest drinkers were found in Pakistan, for men (0.8%), and Bangladesh, for women (0.3%).
For India: A report based on the fourth edition of the National Family Health Survey, 2015-2016, found that only 37% of all men consume alcohol in Kerala – a state popularly perceived as being fond of drinking – behind Arunachal Pradesh (59%), Tripura (57%) and Andhra Pradesh (54%).
Though a drinking habit is very common, what people consider a standard drink to be varies widely. The important factor is the actual alcohol content in the drink.
In the present study, “average consumption” referred to a standard drink defined as 10 grams of pure alcohol, consumed by a person daily. This is about the equivalent of (quoted verbatim):
- A small glass of red wine (100 ml or 3.4 fluid ounces) at 13% alcohol by volume;
- A can or bottle of beer (375 ml or 12 fluid ounces) at 3.5% alcohol by volume; or
- A shot of whiskey or other spirits (30 ml or 1.0 fluid ounce) at 40% alcohol by volume
The researchers noted that in the UK, a standard drink is 8 g of alcohol whereas in Australia, the US and Japan, it is 10 g, 14 g and 20 g, respectively.
The paper stated that people who had one drink a day had a 0.5% risk of alcohol-related harm. The ‘progression’ from there is remarkably non-linear: at two drinks a day, the risk jumps to 7% and at five, to 37%.
According to the researchers, alcohol consumption affects health through several mechanisms. Cumulative consumption may lead to adverse effects on organs and tissues. Acute intoxication may lead to severe injuries. Drinking dependence may cause impairments, potentially self-harm or violence. Both volume of consumption and pattern of drinking influence these effects.
“Alcohol poses dire ramifications for future population health in the absence of policy action today,” a press release quoted one of the authors, Emmanuela Gakidou, of the Institute for Health Metrics and Evaluation, University of Washington, quoted as saying. “Our results indicate that alcohol use and its harmful effects on health could become a growing challenge as countries become more developed and enacting or maintaining strong alcohol control policies will be vital.”
She added that officials would have to revisit their respective national “alcohol control policies and health programmes” and that this could show as higher taxation, access to alcohol and sale hours and, of course, in advertising. “Any of these policy actions would contribute to reductions in population-level consumption, a vital step toward decreasing the health loss associated with alcohol use,” she said.
However, David Spiegelhalter, professor for the public understanding of risk at the University of Cambridge, disagreed. Given that the study’s conclusions rest on how risk is communicated, he said abstention is not warranted because there could be some pleasure associated with drinking that would need to be factored in.
He wrote, “According to data provided by the authors but not published in the paper, to suffer one extra alcohol-related health problem, around 1,600 people would need to drink two drinks totalling 20 g of alcohol a day for a year. This is equivalent to around 32 standard 70-cl bottles of gin over a year, so a total of 50,000 bottles of gin among these 1,600 people is associated with one extra health problem.” This, he said, indicated “a very low level of harm” in people who drank moderate amounts and that the UK guidelines “of an average of 16 g a day are very low-risk indeed.”
To drive his point further home, Spiegelhalter argued, “There is no safe level of driving, but government does not recommend that people avoid driving. Come to think of it, there is no safe level of living, but nobody would recommend abstention.”
Nonetheless, Gakidou asserted that “The myth that one or two drinks a day are good for you is just that – a myth.”
K.S. Parthasarathy is a former secretary of the Atomic Energy Regulatory Board.