Does alcohol reduce mortality or does it increase? Why scientists argue and who is right

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Does alcohol reduce mortality or does it increase? Why scientists argue and who is right
Does alcohol reduce mortality or does it increase? Why scientists argue and who is right
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For a decade, some studies have been saying that alcohol is an absolute evil. Others find it reduces mortality from mass disease. The authors of those and other works use similar scientific methods, but come to opposite conclusions. Let's try to figure out which of this is true.

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Problems began only when one looked closely at the specific reasons for the victims of ethanol. It turns out that the leading cause of "alcoholic" death is tuberculosis (1.4% of all deaths at the age of 15-49). Yes, we must admit: there is scientific evidence on the relationship between alcohol and the likelihood of tuberculosis. For example, those who drink more than 40 grams of alcohol per day (100 grams of vodka or less than half a bottle of wine) fall ill with it 2, 94 times more often than non-drinkers.

The fact is that alcohol is not just a depressant, but also a compound that suppresses immunity with prolonged abundant use. Most of us come into contact with the bacteria that cause tuberculosis at least once in our lives, but few develop the disease. Drinkers have impaired mobilization of macrophages - cells that devour "tuberculosis" bacteria - so everything is logical here.

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The second cause of deaths from alcohol is death in road traffic accidents (1.2% of deaths at the age of 15-49). Here, too, everything seems to be clear. True, questions immediately arise: in Australia they drink a lot, but in Pakistan, as the article in The Lancet rightly notes, very little, almost the least of all in the world (Islam). But an insignificant number of people die from road accidents in Australia - 5, 6 cases per 100 thousand population per year. And in Pakistan - 14, 2 cases per 100 thousand. In Oman, too, Islam, they also drink a little, but the death rate from road accidents is more than 25 cases per 100 thousand. It is completely incomprehensible in Denmark. The largest share of the world's population regularly drinks here: 97% of men and 95% of women (in Russia, for example, the numbers are noticeably lower). However, the death rate from road accidents is 3.4 cases per 100 thousand per year.

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Why does the "most drinking" country in the world have road traffic deaths four to seven times lower than the most teetotal? In general, any experienced traveler can answer this question: Pakistan has a terrible driving culture, in Oman they love to drive (and we put it mildly). And in Australia there are cameras on every corner and monstrous fines. In Denmark, besides this, drivers are still quite calm. In Russia, they drink radically more than in Pakistan, but the mortality rate is 11.6 per 100 thousand - although 10-15 years ago it was 25, as in Oman. We did not drink less or less often: our driving culture has changed, cameras have appeared, and natural selection has gradually reduced the number of people least adapted to road traffic.

As soon as we figured it out, the understanding immediately comes: the connection "alcohol causes death in road accidents" is correct, but does not take into account cultural characteristics. And this creates the risk that, linking death from road traffic accidents with alcohol in one country, we cannot correctly compare it with the same relationship "road accident - alcohol" in another.

Loans or Vodka: What Really Leads to TB Epidemics?

Immediately there is a desire to check: maybe it is the same with tuberculosis? And here we are also awaited by the surprising: India accounts for 26% of cases of tuberculosis in the world, and China - 8%. Only now the consumption of alcohol per capita among Indians is 21% lower than among the Chinese. Moreover, the number of Indians is somewhat less than the number of Chinese. But for some reason, tuberculosis is there 3, 3 times more often. A similar paradox in Pakistan: 5.7% of all cases of tuberculosis on the planet. That is, per capita it is there much more often than in the world as a whole, although they drink in Pakistan the least.The frequency of tuberculosis is also abnormal in Muslim Bangladesh (practically a non-drinking state).

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Anyone interested in tuberculosis will immediately answer what the matter is: it is "the disease of the poor." Tuberculosis in Russia, almost crushed by the end of the Soviet era, jumped sharply in the nineties. And such a picture was not only with us.

In 2008, researchers from the University of Cambridge found that Eastern European countries that received IMF loans quickly showed a surge in tuberculosis - but if the borrower was different, then there was no surge, or it was more moderate. In total, according to their calculations, the IMF loans in the mentioned region led to the death of more than one hundred thousand people with “tuberculosis”. That much more losses to Russia in all (combined) wars after World War II. The point is, scientists note, that the IMF loans are accompanied by macroeconomic requirements leading to the compression of health care, and it plays a crucial role in the prevention of tuberculosis.

It is clear from this one example that any attempt to link TB to alcohol is difficult. It is well known that after 1991, alcohol consumption rose sharply throughout the former USSR. But how can we separate its impact on tuberculosis from the impact of IMF loans on tuberculosis? This is especially difficult to do also because in the 2000s, when Russia finished taking loans from this organization, its per capita consumption of alcohol began to decrease in parallel. How can we reliably find out what exactly dropped tuberculosis mortality: moderation in alcohol or refusal to follow the specific requirements of the IMF?

By the way, the authors of the original work in The Lancet did not take into account the IMF factor in any way. Their data is not cleared from it. Meanwhile, the countries most affected by tuberculosis are still recipients of IMF loans. And low-drinker, but extremely tuberculous Pakistan is one of the largest borrowers (like India in the past). This is understandable: the Ministry of Finance in Pakistan has hardly read the articles of Cambridge scientists. To summarize: it is unlikely that without clearing "tuberculosis" mortality from the impact of IMF loans (not to mention other threats posed by poverty), one can seriously assess the specific causes. Until such consideration is given, the claims of this connection from The Lancet may be somewhat exaggerated.

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Conclusions: unambiguous attempts to call any dose of alcohol hazardous to health have not yet been supported by works, the results of which could be relied on with full confidence.

Of course, this is not the fault of the authors of the work at The Lancet. Such is the situation in the world today: scientists studying the effect of alcohol on health are not normally aware of the impact on health of the same IMF loans. They simply took the frequency of alcohol-related death categories and averaged them across 195 points in the world. Why not - they didn’t know that loans and poverty can lead to tuberculosis deaths as well as alcohol? A similar situation - ignorance of the full picture of the causes of road traffic deaths - led to the link between alcohol and road deaths.

Specialization is one of the key problems of modern civilization, and scientific knowledge is one of the areas where this problem manifests itself most clearly.

Let us emphasize: all this does not mean at all that even moderate alcohol consumption is harmless. We only noted that unambiguous connections of this kind have not yet been proven within the framework of scientific works that would take into account all the factors of this issue.

Does ethanol reduce cardiovascular mortality?

And now a new work is published on the same topic - and also in the very authoritative journal BMC Medicine. Its authors note that from earlier works it follows that those who consume small doses of alcohol are less likely to suffer from cardiovascular diseases. But, scientists note, it is unclear what happens when alcohol is consumed in moderation by those who already have cardiovascular disease. To clarify the situation, they studied data on 48 thousand Britons with a history of heart attack, stroke or angina pectoris.Statistics on them were taken for, on average, 8, 7 years after such a diagnosis was made.

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It turned out that mortality from all causes among moderate drinkers with such diagnoses was less than among non-drinkers. The lowest overall mortality rate was among those who drank an average of 7 grams of ethyl alcohol per day. This is a very moderate dose - about half a bottle of wine or a liter of beer per week. Those participants in the study who consumed it, died during the observation period 21% less often than those who did not drink at all.

If we take only deaths from cardiovascular diseases, then for them the minimum mortality occurred at a dose of 8 grams of ethanol per day, which is only slightly more. Such people died from these diseases 27% less often than non-drinkers. Interestingly, the reduced mortality from both general causes and cardiovascular problems remained largely unchanged, even if those who stopped drinking were excluded from the group of non-drinkers.

This is important: earlier, a number of researchers assumed that the mortality rate of non-drinkers looks worse than the mortality rate of low-drinkers because there are dropouts among the non-drinkers. It is clear that those who have had significant health problems against this background often quit drinking. They, some argued, "spoil" the statistics of non-drinkers. The new work shows that if such "spoilage" does occur, then the final conclusion is not affected: mortality among moderate drinkers is still lower.

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How does it work? Where is tuberculosis, road accidents and the like? It's pretty simple: the authors of the study use data from one country, not 195 points. There are no IMF loans in the UK. Tuberculosis is spread there moderately and cannot influence the situation in any way. They drink decently there, but the mortality rate from road accidents is low - which is why it also cannot affect the mortality rate per unit of time for drinkers and non-drinkers so that for the latter it was at least the same as for drinkers.

It is easy to see that the new work carries practically useful information. If her findings are correct - a big if - a glass of wine once a day will not increase, if not reduce, your chances of dying.

The work received this practically useful information precisely due to the refusal to analyze the populations scattered in different countries. The “white noise” from the fact that people in Pakistan “fly” even sober or suffer from tuberculosis without any suppression of the immune system by alcohol does not interfere with new work - therefore it does not receive false signals “alcohol raises mortality”.

But the authors of the article from the first part acted differently - but, due to their narrow specialization and a narrow view of the issue, they did not take into account the fact that tuberculosis feels best not in those countries where they drink more, but where there is poverty and IMF loans. …

Having come to this conclusion, we will inevitably ponder further. If neglecting poverty and the associated death threats, such as, for example, an IMF loan, unsanitary conditions, etc., can lead to false conclusions about the dangers of alcohol, can it happen the other way around? Could it be that a new job that does not take into account poverty exaggerates the benefits of alcohol?

Let's check this assumption.

Is poverty and alcohol different from wealth and alcohol?

Obviously, we need to find work that shows whether the effect of alcohol on mortality is not different for the poor and the rich. Unfortunately, there are very few such works: only one is quite suitable. This is normal: for such works to exist, it is necessary that someone would like to check the same assumption before us. As is clear from the discussion above, the hypothesis that the poor and the rich may have different effects from drinking is not widely accepted. Otherwise, the authors from The Lancet would not have counted tuberculosis for the "consequences of alcohol" so indiscriminately - ignoring the fact that this disease is most often found in low-drinking countries.

Yet in 2018, a group of Norwegian researchers tested the “poverty hypothesis”. They took data from 207,000 Norwegians and compared the effects of alcohol on cardiovascular mortality among the poor and the rich.It turned out that those who drank alcohol two to three times a week, during the observation period, died 22% less often than those who drank less than once a month. Note that there was no estimate of the amount of alcohol consumed in this work: the line between moderate drinkers and those who drink excessively was drawn according to the frequency of drinking (the critical threshold was three times a week).

But here's the caveat: among those who held a high socio-economic position, this decline rose to 34%. And those who occupied the middle position - only 13%. Those who belonged to the lowest layer - by 21%. Among those who drank excessively, the risk was 58% higher. But the danger of excessive drinking is so self-evident that there is probably no need to expand on it.

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It turns out, judging by scientific data, moderate alcohol consumption reduces the risk of cardiovascular mortality in all categories of the population, but really strongly - only in the rich.

This begs the question: how exactly might well-being affect the health effects of alcohol? There can be many answers. For example, the poor are known to communicate less with their children. We know from other studies that people release oxytocin when looking at pictures of their children. It is possible that the same happens when they communicate with them. It is known from another body of scientific papers that the level of oxytocin can affect the performance of a person's immune system and his level of stress. The latter seriously affects the risk of death from cardiovascular disease.

It is important to understand that Norway is an exceptionally rich country. Thanks to its vast natural resources, it is richer than other Scandinavian countries, not to mention the world in general. Therefore, the local poor are people who are relatively well off against the world background. It cannot be ruled out that in other countries, even moderate alcohol consumption among the poor does not lead to a decrease in cardiovascular diseases.

Most likely, half a bottle of wine a week reduces the risk of death (at least from cardiovascular diseases) and in our country - at least for the rich and middle strata of the population.

A relevant scientific study here could finally clarify the impact of small doses of alcohol on the poor in Russia. However, experience suggests that no one will undertake it. Therefore, the question “Does moderate alcohol consumption reduce the chances of premature death?” Each of us will have to answer on our own. One thing is good: thanks to Western scientists, there is at least a starting point for reflection.

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