In a previous blog article, we wrote about the health benefits of moderate drinking. That article, In Vino Veritas, focused on a large-scale Danish study of over 76,000 participants which found that drinking in moderation could combat diabetes while teetotalers had an increased risk for that disease. The survey looked at factors such as frequency, volume, and type of alcoholic beverage imbibed to come to its conclusions. Now a study in the medical journal Lancet, comes to an astonishing conclusion: that alcohol in any form and in any amount is hazardous to one’s health. In short, the best drink is no drink.
Co-written by 512 researchers from 243 institutions, the study was a summary of data (a metanalysis) of more than a thousand papers and data sources about alcohol as well as death and disability records from 195 countries between 1990 and 2016. They assessed the impact of alcohol on the risk for 23 health problems. Emmanuela Gakidou, a professor of global health at the University of Washington and the senior author of the report concluded that “People should no longer think that a drink or two a day is good for you. What’s best for you is to not drink at all.”
Well, that’s depressing especially for the two billion people in the world who have a drink or two with friends over dinner twice or three times a month. O la la! The French would be absolutely apoplectic! They advocate drinking red wine daily to help fight heart disease.
Yet according to the Lancet, the health risks of even moderate drinking offset and overwhelm any health benefits. Those risks include breast and laryngeal cancer, stroke, cirrhosis, tuberculosis, interpersonal violence, self-harm and motor vehicle accidents.
But if you read between the lines, once again it is volume and frequency that matter. Professor Gakidou notes “At one drink a day, a person’s risk of developing one of the 23 conditions associated with alcohol increases by 0.5% while with 2 glasses the increase is 7% and at 5 drinks a day, 37%. So, if you are an alcoholic or binge drinker—something bad is eventually going to happen to you. For example, if you go on a bender, you may pass out and die of the complications of a fall. If you are a decades-long heavy drinker, you may develop cirrhosis of the liver or fatal heart disease. Are these surprises to the average person? No, not really. Abusing alcohol means there will be a price to pay.
David Speigelhalter, a statistician who writes about evidence, risk, probability, chance, and uncertainty, etc., thinks the study provides no absolute risks or safe levels associated with drinking and is only statistical conjecture based on a possibly flawed model. For example, the study cites the following:
“Specifically, comparing no drinks with one drink a day the risk of developing one of the 23 alcohol-related health problems was 0.5% higher — meaning 914 in 100,000 15–95 year olds would develop a condition in one year if they did not drink, but 918 people in 100,000 who drank one alcoholic drink a day would develop an alcohol-related health problem in a year.“
Speigelhalter counters by looking at one drink a day (10g, 1.25 UK units) compared to none, for which the authors estimated an extra 4 (918–914) in 100,000 people who would experience a (serious) alcohol-related condition. He notes, “To experience one extra problem, 25,000 people need to drink 10g alcohol a day for a year, that’s 3,650g a year each.” To put this in proper context, a standard European 70cl bottle of gin contains 224 g of alcohol, so 3,650g a year is equivalent to around 16 bottles of gin per person.” (A U.S. equivalent unit for bottle size is slightly less than 750ml and over the course of a year, that’s about a bottle a month.) According to Speigelhalter, the results are very “low risk” and even at five drinks a day, still don’t warrant abstention.
Studies like these don’t serve the public well because they only serve to confuse rather than clarify. Statistics aren’t often uniform across the board from country to country and largely dependent on source credibility and can therefore, be flawed or incomplete. The 2015-2020 U.S. Dietary Guidelines for Americans recommends that if alcohol is consumed, it should be in moderation—up to one drink per day for women and two drinks per day for men. Bottom-line, know your limits and tolerance for alcohol. Always err on the side of caution, not consumption.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”
