An ambitious new study has prompted a flurry of sensational headlines suggesting that people under 40 should avoid alcohol entirely, while people over 40 may benefit from modest alcohol consumption. But the research, which examined health data for 30 years from multiple nations, presents a complex picture: On one hand, the researchers found that people under 40 who drink are more likely to engage in risky behavior, which raises their risk of accidents, injury and death. But for people over 40, whose major health risks are heart disease, stroke and diabetes, moderate drinking provided benefits.
The study was conducted by dozens of researchers through the Institute for Health Metrics and Evaluation. Their work was funded by the Bill & Melinda Gates Foundation and published in July in the medical journal the Lancet. The researchers analyzed data from the 2020 Global Burden of Diseases, Injuries and Risk Factors Study (GBD). The GBD's large scope allowed researchers to analyze alcohol-related causes of death for people ages 15 to 95 in 21 geographic regions from 1990 to 2020.
A previous Lancet study that looked at the 2016 GBD concluded that no amount of alcohol consumption is safe. That prompted a backlash, as other researchers pointed to studies that have established links between moderate consumption of alcohol, particularly wine, and improved health.
The new GBD study differs from the earlier one by focusing on "background rates of disease." The health effects of alcohol on a given population depend on how healthy, or unhealthy, that population already is—and that depends, in turn, on the population's age (older people are more prone to cardiovascular disease, for instance) and location (people in certain regions are more prone to diseases such as tuberculosis).
That focus informs the study's main findings: Younger people are most prone to alcohol-related death by injuries, which include car accidents, interpersonal violence, accidental injury and self-harm. Because of young people's elevated risk of injury while using alcohol, their "non-drinker equivalence"—the amount of alcohol consumption at which a drinker's risk equals that of a non-drinker—is close to zero, the authors found.
Older people, on the other hand, are much less likely to suffer alcohol-related injuries, but they are more prone to heart disease, stroke and type 2 diabetes. Since evidence suggests moderate alcohol consumption provides some protection against those diseases, people over 40 who drink moderate amounts of alcohol have better overall health than non-drinkers.
In the U.S., current guidelines recommend that women limit alcohol consumption to one drink or less per day and that men limit it to two drinks or less per day. The guidelines define one standard drink as 14 grams of alcohol, which is the equivalent of a 5-ounce glass of wine (assuming that wine is 12 percent alcohol by volume). The study, however, found that people under 40 can drink just over one 5-ounce glass of wine per week before their risk goes up compared to non-drinkers. There was no statistically significant difference in risk between men and women; therefore, the researchers suggest that public health officials should emphasize age, rather than sex, when issuing guidelines.
The new study doesn't contradict prior research linking moderate alcohol consumption to certain health benefits. Rather, it emphasizes that the risks and benefits of alcohol are different depending on a person's age and location. Dr. Emmanuela Gakidou, the senior author of the study and a professor of health metrics sciences at the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine, told Wine Spectator, "In the age groups where [heart disease, stroke and type II diabetes] are primarily prevalent, we see the benefit of alcohol consumption." In young people, the relatively high risk of alcohol-related injury resulted in an extremely low threshold for non-dangerous levels of alcohol consumption.
Dr. Gakidou admits that changing individual behavior, especially among young people, is exceedingly difficult. "Encouraging moderate consumption, or small levels of consumption, might be more realistic," she said.
But getting young people to drastically curb their alcohol consumption isn't necessarily needed to improve health outcomes in a substantial way. "There's definitely some evidence … that if you can prevent the injuries and accidents from happening, a lot of the harm associated with alcohol in the younger ages will go away." Dr. Gakidou points to countries like Australia, which enacted strict laws against drunk driving that have dramatically reduced accident-related deaths. In another case, the mayor of a city in Colombia noticed that homicides spiked on paydays; he forced bars to close early on paydays and achieved a notable decrease in deaths.
To many wine lovers, especially those under 40, the results may sound like cause for alarm. But the researchers clearly state that the study should not be directly applied to individual choices around alcohol consumption. They hope to influence policymakers and public health officials, but they aren't here to tell you whether or not to cut back on Cabernet.
Dr. Gakidou is quick to point out that the GBD data is extensive, but doesn't show many other factors. "We don't have much evidence about cumulative drinking," she says, that is, whether or not consistent moderate consumption over a lifetime provides enhanced protection against certain diseases in old age. She also emphasized that the researchers didn't have enough data to differentiate between the health effects of different kinds of alcohol—an especially important point since studies have found that wine drinkers tend to be healthier than beer and spirits drinkers.
Overall, Dr. Gakidou said, "we tried to steer away from making recommendations for individuals because each individual has their own health profile, [including] potentially other underlying conditions that may complicate … recommendations to drink or not to drink. Individuals should really just consult with their doctor when it comes to their own consumption."
She also emphasized that "particularly for older adults," moderate alcohol consumption "absolutely" can be part of a healthy, balanced lifestyle. She advises young people who choose to drink to "consume [alcohol] in moderation and never engage in … binge drinking. If we can't bring consumption down to zero, that's fine, but if we can avoid binge drinking and excessive consumption, I think we will reap a lot of health benefits."
Some older drinkers may even find cause to rejoice in the study. Dr. Gakidou says that of all the papers she has published, "this [one] has made my mom the happiest." Though she stresses that certain older people should avoid alcohol due to particular conditions or medications, her general message to older drinkers is simple: "If you want to have a drink or two, or even three [depending on] your age group, don't feel guilty about it." She says "there's no evidence that it will hurt you to the point that you should avoid it and be made to feel guilty about … having a glass of wine."
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