Alcohol: How Much is Too Much?
by Dr. Natalie Hutchins
Osler Health International
I recently gave up drinking for 3 months and I must admit, I felt so good! But as the final month of sobriety came to an end, I started wondering whether it was possible to mindfully reintroduce alcohol in a way that wouldn’t have negative effects on my health, and indeed might actually be beneficial in small amounts? If you haven’t seen it yet, the Blue Zones program on Netflix is a great little watch; you see centenarians drinking wine and still enjoying a long and healthy lifespan, so surely it can’t be all bad? Perhaps it is something about the way we drink or what we drink in the rest of the Western world that causes the problems
So, what does the evidence say?
The truth is that the trial evidence on alcohol consumption and its effect on health is conflicting and we don’t have all the answers yet. We know for sure that drinking too much in the long-term is associated with so many health problems; heart disease, liver disease, mental health problems, cancer, dementia and many more. But some evidence seems to suggest that moderate drinkers have less risk of dying than those who drink nothing at all.
How can that be?
Well, some interpret that to mean the healthiest approach to life is to be a moderate drinker, but I would caution against any teetotalers taking up drinking based on this evidence. People that completely abstain from alcohol tend to include lots of people that don’t drink because they already have health conditions, which in themselves put them at higher risk of dying. Actually, the studies that compare moderate drinkers to occasional drinkers (instead of non-drinkers) show no benefit to low alcohol consumption on the risk of dying; the more you drink at any level, the greater the risk to your health.
As such, the Singapore health promotion board recommend women drink no more than a standard unit of alcohol per day; and that’s only half a glass of wine!
Sounds like being teetotal is best then?
If you want to follow the best available trial evidence, then yes, I would agree. And if you have a personal or strong family history of a medical condition that might be negatively impacted by alcohol use, then even more so. But the trial evidence isn’t perfect and may never be. There might be key variables not captured in a trial and that may be the reason for the conflicting results we see; like what type of alcohol you drink, whether you drink with meals, whether you drink with other people or alone, how much alcohol is in the alcohol you drink and so on.
Do what the blue- zoners do……
If being teetotal isn’t for you, then maybe we need to also look to the anecdotal evidence of the blue zoners for guidance on how to drink whilst minimizing known risks and potentially reaping any rewards that may exist (until some better trials are published):
They tend to:
Drink red wine: Red wine has the highest polyphenol content (a plant compound with antioxidant properties found to be beneficial to health), followed by white wine, then beer, with spirits at the bottom.
Drink with meals, in the company of family and friends: Strong social connections and being part of a community are integral to living a healthy life.
Drink young wines: Younger wines have higher polyphenol contents than older, more coveted (and expensive) wines.
Drink natural wines: These tend to have a lower alcohol content than some commercially produced wine, so it may be this (rather than the absence of additives) that negates the risks of drinking on the blue zoners’ health.
Drink small amounts, spread over separate sittings: In essence, don’t binge drink. Aside from the anecdotal evidence provided by the blue zoners, there is also trial evidence that drinking all your units in one go at the weekend, is worse for your health than somebody that spreads the same number out over the week.
Dr Natalie Hutchins
MBBS (London, UK), MRCGP (UK), MRCOG (UK)
Osler Health International
Dr Natalie Hutchins is a British GP based at Osler Health’s Star Vista clinic. Dr Natalie has a background in obstetrics and gynaecology and has many years practising in a busy international clinic in Hong Kong. If you would like a safe-space to discuss your alcohol consumption, Dr Natalie is a good place to start. The team at Osler Health are non-judgemental and your consultations are entirely confidential.
Osler Health International is a GP medical clinic offering personalised healthcare for the whole family with two practices in Singapore (Raffles Hotel Arcade in the CBD and Star Vista off Holland Road). As a boutique clinic offering, the practice is perfectly positioned to get to know you and your loved ones. www.osler-health.com