Gifford: UK drinking limits – toxic advice?

Britain's chief medical officer, Dame Sally Davies, unleashed a torpedo on the country's drinkers in the first week of 2016. Or has she already done so? Let's examine the facts.

The debate revolves around the advice given to alcohol users by the UK's four chief medical officers (Davies is the UK's chief marketing officer – the equivalent of the Surgeon General in the USA – but there are also separate CMOs in Wales, Scotland and Northern Ireland). Davies suggests reducing the current guidelines of 21 units of alcohol per week for men and 14 units per week for women to 14 units for everyone. One bottle of 13.5% wine is equivalent to 10,125 units of alcohol – so the advice is that drinking 'minimal risk' is equivalent to a quarter of a bottle of wine in five days plus two days off (with an extra glass of wine somewhere in between). Line). Vacation days are important – and pregnant women should not drink alcohol at all.

It's just a suggestion; The consultation closes at the end of March, and wine merchants and others are welcome to respond to the proposal before then. Of course this is just advice; We are all free to ignore it. The advice is almost unchanged for women; The main change affects male drinking.

You can see the full list of supporting evidence used by top marketers here, and you can also download all the evidence yourself. The centerpiece of the research is a report titled “Mortality and morbidity risks from alcohol consumption in the United Kingdom” prepared by the University of Sheffield, which in turn is based on guideline thresholds in Canada and Australia. After reading every word of this, I see three major changes from similar documents in the past. The first I have no objection to. The second is the puzzle. The third is toxic.

The first change is that research data on the risks from alcohol consumption are treated with greater precision than in the past, and the Sheffield document has in many respects become more important to medical statisticians and epidemiologists than to medical practitioners. This can be summarized by saying that if the previous advice was cautious, the new advice is very cautious.

To put this in context, we'd say that almost all of us will do riskier things in our lives than modestly exceed the new safe drinking limits (no more than, say, doubling them in any given week). However, the UK Government does not provide advice on those other risks.

Examples? I regularly walk around my village without wearing a crash helmet, get into cars driven by strangers, and try to change light bulbs while standing on a rickety chair. There's no advice from Mrs. Sally about standing on rickety chairs, so I don't worry about that. Sometimes I don't have the option of being led by others (who may be about to have a heart attack, nursing their eyeballs or just half asleep), while I know I'm an idiot for not wearing a crash helmet on a bike for short trips as well as long ones.

However, most people will not relate every item on their risk list in this way, so they may end up worrying too much about the risks associated with alcohol.

What about identical consumption levels for men and women? It is counterintuitive to think that a regular glass of wine would have the same health effect on a rugby player or a sumo wrestler as it does on a ballerina. The puzzle is that most of the data in the Sheffield document suggests that the risks associated with alcohol are actually lower for women than for men per unit consumed, rather than higher, although small. (The volume differences mean that women have higher blood alcohol levels than men at a given level of consumption.)

But note that the study is about morbidity and mortality rates, and remember that males tend to adopt more risky behavior patterns (such as wrestling or playing rugby – or making disease-inducing lifestyle choices at fast food restaurants) than women. It has always been this way: this is one of the reasons why more boys are born than girls. Again, alcohol consumption should be viewed as part of a larger overall risk picture.

So what is toxic?

Those who heard Dame Sally Davies make her proposals noted her disdain for the idea that moderate consumption of alcohol, especially red wine, could have beneficial consequences; She even described the general heart-protecting effects of a glass of red wine as an “old wives' tale” on BBC Radio 4's influential Today program (although she made a reluctant exception for women over 55). It is worth noting that the British government – and Britain has a small wine sector but a large beer sector and a huge whiskey and gin sector – flatly refuses to distinguish between different forms of alcohol in relation to health.

The seven authors of the University of Sheffield report admit that many of their graphs do show a hockey stick curve or J curve, suggesting that there are benefits to moderate consumption of all alcoholic beverages (the base of the graph is underlined (the “J” on the left of the graph) before The negative consequences as consumption rises appear on the right of the graph, but they constantly distort interpretations of the data that indicate this. If you choose to read this report, go to Section 5.4.1.2 on pages 58-60 for a summary of “the authors’ strong reasons for concluding[the benefits]are, at the very least, overestimated within the framework of standard epidemiological analyses.” However, it provides no counter-evidence; They are just asking for explanations.

Among their suggestions (which are also being made in the United States at present) is that the relative health of moderate wine drinkers is due to a combination of decisions about exercise and diet rather than to the wine itself. In other words, wine is a symptom of a healthy lifestyle, but not a cause. It is also claimed that wine-friendly studies include among the group of non-drinkers those who have given up alcohol after heavy use and thus who already suffer from alcohol-related poor health.

Of course there have been many studies showing the benefits of consuming red wine, especially since the findings of French researcher Serge Renaud were broadcast on the American television program Sixty Minutes (on November 17, 1991), and the idea that “a little red wine” is beneficial Yours” led to the expansion of wine consumption around the world.

Watch the original sixty-minute show from 1991 below (Reno's wine comments start from 3:30 onwards):

The apparent healthfulness of red wine is one of the main reasons why wine has boomed in China in recent years, and a major reason why red wine sales have comprehensively outperformed white wine sales there.

A useful summary of the health benefits of red wines, especially those (such as Madeiran, Cahors, serious Bordeaux, Nebbiolo-based wines such as Barolo and Barbaresco, and other “tannic” Italian wines such as Sagrantino di Montefalco) that are high in wine content. In skin-derived phenols, anthocyanins, and tubule-derived procyanidins, they can be found in Roger Corder's carefully researched and discussed book The Red Wine Diet. Corder is professor of experimental therapy at the William Harvey Research Institute in London. Corder's signature suggestion is not simply that “red wine is heart-protective,” but that certain types of red (such as those mentioned above) are both highly heart-protective and may be linked to increased longevity in some populations.

I asked Corder for his response to the latter piece of advice, and to the Sheffield study referenced above. “My general comments, based on studying the literature for many years, are that the University of Sheffield report presents an overly negative opinion by using a biased presentation of the literature to support the authors’ view, rather than employing a wider range of studies,” he wrote. literature to arrive at a balanced opinion on which future guidelines can be based. Failure to examine data from different types of alcoholic beverages also greatly reduces the value of any conclusions about specific drinking behaviors.

He also suggested that Davies' observations about the cardio-protective effects of red wine as an “old wives' tale” were based on a major study (ref. 14 in the University of Sheffield report) with flawed sampling. “This study does not separate alcoholic beverages into different types, the study is aimed at women (less than 30% men), and includes a limited number of men from traditional red wine drinking countries (8% of the total group from Greece, Italy and Spain). The study does not include i.e. men from France).The idea that red wine is not heart-protective cannot be based on a population where red wine is not the primary beverage of the population.

If the chief medical officer of one of the world's leading wine-consuming countries is going to claim that research findings suggesting a heart-protective effect of red wine are somehow fictitious, we need to see better evidence than that presented in the proposed new guidelines. It will be up to wine merchants and wine producers to lobby for this, since the Portman Group (the UK's main alcohol lobbying organization) and the UK Wine and Spirit Trade Association would never make any kind of case in favor of a wine exception; The institutional power of UK spirits companies and breweries will not support this.

However, someone needs to. If the idea that all wines may be bad for health gains traction (there is no “safe level” of alcohol consumption, as Sally Davies said on the Today programme, in addition to discrediting red wine's heart-protective effect), millions of cases would be lost. of global consumption every year. This would be a tragedy not only for wine producers, but also for moderate wine consumers whose health might otherwise benefit from a near-daily glass of red wine. It's time to act.

Updated 19 January 2016: Current UK guidelines are 14 units per week for women and 21 units for men.

More on Gifford on Monday: