Revisited: just how bad is alcohol for us?
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This is The Guardian. Hi, Madeleine here. We're on a break at Science Weekly. We'll be back with some new episodes for you next week. But for now, we're going back to some of our favourites from 2024. Now, I don't want to dampen your New Year's Eve plans, but today we're returning to an episode which, I have to say, taught me a lot about how alcohol impacts our health. I hope you enjoy it.

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Humans' relationship with alcohol goes back a long, long way. 7,000 years ago, I think there's evidence from Syria of remains of equipment used to make beer. Over the centuries, it's helped us bond and celebrate. It's been used in rituals, as an antiseptic and even as an ancient form of payment.

Throughout all that time, we've also been aware of the dangers of drinking. There's quite early accounts, for example, in Egypt of problems being experienced of people becoming addicted to alcohol, experiencing health issues. This double-sided personality of alcohol has had a split.

There's a nice quote from ancient Greece, I think it's Pliny the Elder, who wrote that medical opinion is divided as to whether alcohol benefits more people than it harms, or words to that effect. And modern science hasn't made the picture clearer. Just as we're told by experts that drinking can cause cancer, heart and liver disease,

A pile of studies show that moderate drinking and knocking back a glass of wine a night can actually be beneficial. I think it's driving people mad because they probably say, well, get it together, what's going on here? We hear one thing one day and one the other. But now researchers have gone back into the data, carefully scrutinising it, and have found that despite what many of us, including myself here, would like to believe...

There is no rosy message when it comes to drinking. So today on Science Weekly, we're asking, why did scientists think boozing could be good for us? Where were the studies going wrong? And how should we understand the risks of drinking alcohol? From The Guardian, I'm Madeleine Finlay, and this is Science Weekly.

I just want to fill up my glass of water because this is going to take a little while and it's hot here. Ten seconds, hang on. Tim Stockwell is a scientist at the Canadian Institute for Substance Use Research at the University of Victoria, which he was previously director of for 16 years.

Tim has been involved in developing and assessing alcohol guidance in the UK and Canada. And so, glass of water at the ready, he explained to me how alcohol regulations and our understanding of its harms have evolved.

The first licensing laws, liquor licensing laws, apparently came at the end of the War of the Roses because the troops were getting a bit unruly. There's a lot of disorder and fighting when people got drunk. And so this idea of licensing taverns, which would be more capable of controlling behaviour and having a particular place where alcohol was permitted, came about. The first

restriction on liquor licensing in Australia was you could have a liquor license until somebody died on your premises. That was the only way you could have your license revoked. So it goes back a long way, but sort of formal study of it, apart from clinical observations and descriptions, which go back 100 plus, 200 years,

the sort of more epidemiological population-wide formal study is probably about 50, 60 years old. So Tim, as we know, over the past few decades, the link between alcohol and adverse health effects has been established.

It's been known to be carcinogenic to humans for a good while now. But then along comes this saving grace. In the 1970s, evidence begins to emerge that at moderate amounts, about one to two drinks a day, alcohol actually seems to have health benefits. And this becomes famous through something known as the J-curve. Tell me about that. Yeah.

Yeah, well, the J-curve really relates to studies that looked at deaths from all causes. So I guess sort of 60, 70 years ago, we see the beginning of these big population studies. So simply, you get a group of people, ask them how much they drink, and whether they're abstaining at the moment, or they're a moderate drinker or a heavy drinker, and then you follow up and see what the likelihood is of dying.

And the people who are moderate drinkers have a lower risk in almost every time you do this. So it looks compelling on face value. Hundreds of studies finding that moderate drinkers live longer than abstainers. You think QED, forget it, what's the fuss? Alcohol is good for you. We should all be drinking it. So the J is this shape of graph you described where the risk dips at moderate amounts of alcohol and then upticks as consumption goes up.

Were there any theories put forward as to why drinking a moderate amount might be beneficial? Yes. Well, one of the big theories that exploded on the world in the early 1990s was the Mediterranean diet or the French paradox. It was relating to the fact that people in France and Mediterranean countries generally have lower rates of heart disease than northern Europeans.

And the theory was that wine, particularly red wine, was capable of unclogging your arteries, cleaning them out and reducing risks of heart disease. And that was the principal driving factor. And there's been some other studies, laboratory studies,

suggesting that alcohol can have some minor physiological short-term benefits that might relate to heart disease. For example, good and bad cholesterol. There's some studies suggesting positive impacts there.

And were you convinced at the time? How convinced was the field? And were there people saying, hold on, this does seem too good to be true? I was convinced. I think most people were convinced. I wrote a piece that likened people who doubted it with all the evidence I just described as

members of the Flat Earth Society or people who didn't believe that people had landed on the moon. I think 25 years ago, mainstream opinion was fairly solid that there were therapeutic benefits. There was articles in the BMJ, the British Medical Journal, 2011,

which presented a big meta-analysis of all the impacts, these observational epidemiological studies, and then another companion piece looking at laboratory studies of physiological benefits. So you put the two together, you got the observations, some laboratory evidence, and it seems a cast iron case. And the conclusion was, well, actually, you may as well be advising people, if you want to live longer, drink a little bit every day.

But Tim, this takes us on to your work because you began to delve into all these studies and you found a very different picture. So what have you discovered? So I was approached by an American medical sociologist called Kay Fillmore. I was working in Australia. We came at this from an opposite point of view. She was a doubter and I was a believer. We thought, how interesting, let's do this work.

We did a systematic review to get all the relevant studies and a meta-analysis. Our first paper in 2006, we found, I think it was just five studies that were high enough quality. And there was no significant benefit. That made newspaper headlines to our great surprise all over the world. It became a big news story.

And it's gone back and forth since then. My groups revisited the data, looked at specific conditions, but deaths from all causes. You know, we've just published two papers in the last 18 months with 107 studies now available. We've been able to look at this in the greatest detail to date, we think. And we find that as we predicted, we made our predictions before we looked at the data, we predicted a particular kind of study

would not show benefits and another kind of study that's full of bias would show lots of benefit and that's exactly what we found. Let's talk through these biases. Where were these studies showing benefits of drinking going wrong? Why did they all find this jacob? One of the problems with this literature is that

The typical way of doing this is using what's known as a food frequency questionnaire. So these are health researchers interested in a myriad of health risks and behaviours, quite rightly, because we're very complex beings. And there's only room for two or three questions. So you ask how many times and when you drink, what's a typical serve size? And they don't go beyond the last year.

And so you get tens of thousands of people interviewed about their habits, but in most of the studies, you don't get a perspective of their lifetime habits. And the problem here is that a lot of these studies are done on older populations. If you're trying to find what people are going to die from, you haven't got time to wait 50 years if you're an ambitious researcher. So the older populations, and many of them have given up or cut right down on their drinking for health reasons.

and they get compared as abstainers with this healthy, robust surviving group who continue to drink. The unhealthy abstainers make these robust surviving drinkers look really healthy. And drinking alcohol is a sign of good health, not a cause of it. I see. So the abstainers were a less healthy group, not because they weren't drinking, but because they were

already unhealthy or ill and that's why they're given up on their drinking so the cause and effect are reversed and without taking that into account it looks as if the alcohol is having this benefit for the moderate drinkers when in fact they're just a healthier group of people

But Tim, for people like me who enjoy a tipple, this isn't great news. Do you think this is why the idea that some amount of alcohol is beneficial has persisted? Because it's not really something that we want to give up. No, it's a lovely idea. I mean, most people in Western societies drink alcohol. It's our favourite recreational drug still. It's got a bit of competition these days, but it's still our favourite substance.

And there's still divided opinion out there. So people are getting mixed messages and majority opinion. I've seen opinion polls of this in the States that more than half the population believe alcohol in moderate doses has no health benefits.

effect, it's not positive or negative. There used to be about 40% of people believed it actually was good for you. That's gone down to about 10%. So there's been quite a decline in the last 10 years in public opinion. And an increasing number of people are aware of small health risks for low volume drinking.

Well, this leads me to the question that I've wanted to ask. How should we understand the risks of drinking? Because relatively recently, the World Health Organization and other experts have said there is no safe level of alcohol consumption. But plenty of people like to have a glass of something and...

Want to know how risky that actually is? OK. Trouble is, the drinking guidelines use vague words like 'low risk'. You know, this is low risk drinking. What on earth does that mean? So, you can look at the relative risk of a drink of alcohol, like a unit of alcohol, with a tobacco cigarette. And it's actually a one-to-one mortality risk.

So if you take one cigarette a day, it's the same mortality risk as one drink of alcohol. And that equivalence gets worse for alcohol the more you drink. If it's two, three, four drinks a day, it's more like 10 to 15 cigarettes a day. So maybe we're unduly afraid of tobacco at low levels. I mean, at low levels, it's a low risk. At low levels of drinking, it's a low risk.

Another one is to look at the net effect on life expectancy, drinking at different levels. And in the Canadian guideline estimates, one drink a day would, for the average person, shave three months off their life expectancy. You might be unlucky and die tomorrow or this afternoon or whenever, or you might live to 120. But for the average person across the whole population, it's living three months less.

That comparison between an alcoholic drink and a cigarette, I find very surprising. I think perhaps because the messaging for cigarettes is so familiar.

But has doing all this research and learning these sort of comparative risks changed how you drink? I thought you might ask me that. It has a bit. I think I drink more cautiously and carefully. I believe it's at low levels, it's a tiny risk.

and I take greater risks, I think, when I get on my bicycle and cycle around the busy city I live in, I think it's just important to realize that this substance has been sanitized and glamorized. And the governments have not put warning labels. It's a carcinogen at low levels. And we're not told. No other product would get this protection. So the

I think it's important we just bear that in mind, that this product's rooted lobbying and industry influence. It's the advertising that affects our beliefs and attitudes about it rather than the facts and the science. Then again, Tim, there is this changing culture around alcohol. Young people around the world are drinking less and not drinking has become perfectly acceptable.

That must be nice for you to see. Actually, it is. I used to, by the start of my career, working with people with really severe drink problems in London and the West Country as well. And it's so devastating. It's a sad, sad story. You see on the one hand, people enthusiastically embracing alcohol. And then if you work in a clinic, you see the really sad, shattered lives and people's health and mental health being ruined. So

So I do take a lot of encouragement from that. What I really hope is that governments will publicly acknowledge and I think we get health warning labels on alcohol containers so we can tell the truth about the risks. Thanks again to Tim Stockwell.

The Science Weekly team is planning an episode all about how to get healthy in 2025. And for that, we need you to send us your questions. It can be anything you're curious about, from whether there's anything in the keto diet, how much strength training is needed to keep your muscles, to how to stave off the winter blues as January and February drag on.

We'll choose our favourites and bring you answers backed up by science. Just email scienceweekly at theguardian.com. And that's it for today. This episode was produced by me, Madeline Finlay. It was sound designed by Josh and Chana. And the executive producer is Ellie Burey. We'll be back on Thursday. See you then. This is The Guardian. The Guardian.

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