Health benefits of alcohol debunked...

Why are you four times more likely to suffer from ischaemic heart disease in the United Kingdom than in France? Researchers tell us that the major risk factors are no less present over the Channel than in these islands. The higher consumption of alcohol in France has been identified as the explanation of the soi-disant "French Paradox" and red wine has been favourite in the health stakes. For quite a few years the drink industry publicity machine has made sure that everyone knows that a steady intake of Chateau Margaux, as recommended by Dr Stuttaford of The Times, will keep heart disease at bay. Large sums of money have been poured into research by the producers of alcoholic drink. Recently the Scotch Whisky Association paid for a study which indicated that the occasional dram could be as effective as red wine in averting a stroke. There is no doubt that the medical research carried out was done so in good faith and the results were certainly plausible. It seemed that men of about 50 years of age were protected from cardiovascular misfortune by a moderate consumption of red wine and possibly a glass of Glenmorangie.

Health campaigners and those working in the field of alcohol policy were justifiably alarmed that the message received by the public would be one of encouragement to drink. Whatever caveats accompanied the assertions of the researchers, it was argued, the idea would be implanted that drinking was a healthy activity.

The picture may be changing, however, and important new research has cast doubt on the protective effects of alcohol. Two studies recently published in The British Medical Journal (BMJ) have opened up the whole question. In the first* the red wine explanation of the French Paradox is shown to be no longer an established fact. Professor Nicholas Wald and Malcolm Law, of the Wolfson Institute of Preventive Medicine at St Bartholemew's in London, suggest that the disparity in the incidence of heart disease is accounted for by their "time lag" hypothesis.

"We propose," say the authors "that the difference is due to the time lag between increases in consumption of animal fat and serum cholesterol concentrations and the resulting increase in mortality from heart disease similar to the recognised time lag between smoking and lung cancer. Consumption of animal fat and serum cholesterol concentrations increased only recently in France but did so decades ago in Britain."

The hypothesis put forward by Dr Law and Professor Wald is based on the fact that there has only been a similarity in the consumption of animal fat and serum cholesterol in France and the United Kingdom for the last fifteen years. "There must be a time lag between the increase in serum cholesterol concentration and the full effect of the resulting increase in coronary artery atheroma and risk of death from ischaemic heart disease."

It is true that in the higher wine consuming countries there is a lower mortality rate from ischaemic heart disease. However, the countries where there is a high level of wine drinking (France, Italy, and Spain, for example) are those where saturated fat consumption was previously low but now increased to levels comparable to places like the UK. "The low mortality from ischaemic heart disease," say Law and Wald, "reflects the earlier low levels of saturated fat consumption, for which wine is simply an indirect marker or confounding factor."

Dr Law and Professor Wald further point out that not all French heart disease deaths were classified as such which in itself could account for about 20 per cent of the difference between Britain and France. In addition, they say that all alcoholic drinks, not simply red wine, protect against harm from cholesterol but that there was no evidence of this making any great difference.

In the second study** a research team led by George Davey Smith, Professor of Clinical Epidemiology at Bristol, has cast further doubt on the claims for alcohol's protective effect against heart disease. Their research drew on the data provided by a large cohort of men (almost 6,000) from western Scotland who were 35-64 when first screened between the years 1970 and 1973.

It has been argued that the relation between mortality and heart disease is best represented by a J shaped curve. This indicates that the greatest risk is found among heavy drinkers, the least among moderate drinkers, and that non-drinkers face a risk somewhere between the two. The suggestion has been made that non-drinkers include those who may avoid alcohol because of ill health or as a result of having been a former abuser of the substance. Professor Davey Smith's study shows that "there was no relation between mortality from coronary heart disease and alcohol consumption once adjustments were made for potential confounding factors". As opposed to some other studies, the researchers found no strong evidence that alcohol consumption reduced all cause mortality for light and moderate drinkers.

Other key findings were that drinkers of over 35 units a week had double the risk of mortality compared with non-drinkers and that risk of all cause mortality was higher in men drinking 22 or more units a week. It is worth pointing out that the old "sensible" drinking limit, scrapped by the previous government, had a maximum of 21 units a week.

The researchers say that "the overall association between alcohol consumption and mortality is unfavourable for men drinking over 22 units a week and does not support the promotion of increased drinking for reasons of health."

It may be the end of the road for the drink industry's argument for the health benefits of alcohol. The debate over the alleged benefits of red wine drinking will no doubt become more vigorous now that there are other explanations for the French paradox, but the French government, at least, appears to be convinced that alcohol is a major health problem. Lionel Jospin, the Prime Minister, is reported to be about to classify alcohol and tobacco as dangerous drugs. The French Health Ministry confirmed that Jospin was about to include both substances in the remit of an inter-ministerial commission charged with dealing with drug abuse. It is estimated that the two legal drugs account for more than 120,000 deaths a year in France. Recent reports indicated that seven million French people were excessive or dependent drinkers. One quarter of all hospital admissions in France, say Law and Wald, are a result of alcohol consumption. The drink industry is very powerful in France and has managed to ensure that measures to combat the problems related to alcohol have been kept to a minimum. It is outraged at the prospect of its products being put in the same category as heroin. The United Kingdom government takes a more sanguine view than its French counterpart and continues to promote the health benefits of alcohol. Perhaps these studies published by the BMJ will give the Public Health Minister and her advisers pause.

*Why heart disease mortality is low in France: the time lag explanation, Dr Malcolm Law and Professor Nicholas Wald, Wolfson Institute of Preventive Medicine, St Bartholomew's and The Royal London School of Medicine and Dentistry, British Medical Journal, vol 318, 1999.

** Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up. Professor George Davey Smith et al., British Medical Journal, vol.318, 1999.