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The Good News About Booze
A businessman goes to his GP. 'My hands hurt, I get a bit of a pain in my chest sometimes, and I'm beginning to forget things,' he complains. The doctor examines him and says: 'You've got a touch of arthritis, possibly mild heart disease, and you may be in the first stages of dementia. How much are you drinking?' 'Never touch a drop, doctor,' says the patient proudly.
'Ah, that explains it,' says the GP, wagging an admonishing finger. 'Here's a prescription for red wine - a quarter of a litre a day.'
Ridiculous? Absurd? A story from the Bumper Book of Jokes for Alcoholics? Absolutely not.
Let me tell you this: if GPs fail to recommend alcohol to at least some of their patients, they should be had up for medical negligence.
That, at least, is the logical conclusion I've drawn from an in-depth study of around half-a-million scientific papers about alcohol. To my surprise, they contained findings that would make any pharmaceutical company uncork the champagne. Except they never will, of course, because alcohol can't be patented as a drug.
Most of the evidence suggests that if red wine, in particular - and to a lesser degree white wine, beer, lager and spirits - were used as a preventive and therapeutic medicine, disease rates would fall substantially. Not only that, but lives would be saved - with huge benefits to the economy.
In fact, red wine may well be one of the most effective 'medications' in history. Like other drugs, it has side-effects. It has a minimum and maximum therapeutic dose — take too little and it won't work; take too much and it may make you ill.
And it has a daily treatment regime: ideally, you should take wine once a day with the evening meal.
Yes, daily. I know that the medical profession urges us to stop drinking at least two or three days a week, but this isn't borne out by scientific studies. These consistently show that daily moderate drinking is the best for health.
OK, but what is a moderate amount? Unfortunately, that's where it gets a bit more complicated, because the prevention and treatment of different diseases seem to require differing amounts - varying from a small to a large glass a day, but sometimes more.
Of course, most people already know red wine is supposed to be good for your heart. But, that aside, the endlessly repeated public message is that alcohol is Bad News.
Now, I'd be foolish to deny that over-indulging in booze can be harmful to society. You need only think of alcohol-fuelled crime, road deaths, city centre mayhem, domestic violence, and costs to the NHS.
But to show only one side of the picture, as government and medical authorities inevitably do, is simply bad medicine. It prevents people making sensible decisions about their own health.
Why haven't doctors ever come clean about all this? The reason is fairly obvious: they don't trust us.
One shining exception is Professor Karol Sikora, the UK-based consultant oncologist who's written the foreword to my new book about the benefits of alcohol. Too much booze, he warns, not only kills but 'ruins lives, destroys families, ends successful careers, causes untold physical and mental illness and has a huge adverse impact on society'.
However, he continues: 'If you don't drink at all, you have a defined risk of developing all sorts of medical problems in your heart, joints, brain, blood sugar levels, and kidneys - indeed all round your body. 'As you begin to drink, there seems to be evidence of benefit. As you drink more, that gradually disappears and the damaging effects kick in.'
But let's be clear here: I'm not recommending anything personally. I'm just an averagely intelligent science journalist who's done what anyone else can if they have the time: I've looked at the scientific and medical data published in top-flight journals, and collated the evidence.
So, readers should consult knowledgeable health professionals before acting upon anything they read below. The trouble is, most doctors know very little about this area, because they, like you, have been largely kept in the dark.
Here, though, is some of the evidence I found - and it's more than a little surprising.
From the Nineties, experts at Harvard University monitored 12,000 men with high blood pressure for nearly 13 years.
All the men were doctors, and some were drinking far more than the accepted alcohol limits. In the UK, these are 16 grams a day for women - the alcohol in just over a medium glass of wine - and 32 grams for men, roughly half a bottle of red wine.
So what happened in the Harvard study? The more these men drank, the less chance they had of a heart attack.
Drinking 10 to 15 grams (up to a medium glass of wine) a day reduced risk by nearly 40 per cent. But at over 50 grams (two-thirds of a bottle of wine), the risk went down even further - by nearly 60 per cent.
Similar results were found in a 13-year Oxford University study of British doctors, some of whom also drank over the guidelines. 'The consumption of alcohol appeared to reduce the risk of ischaemic heart disease, largely irrespective of amount,' the Oxford researchers reported.
In fact, the evidence from over half a century's research seems to be overwhelming: alcohol is associated with a reduced risk of all forms of heart disease. And alcohol can also help people with existing heart disease; in other words, it acts just like a pharmaceutical medication.
A huge nine-year study of nearly half a million Americans revealed that alcohol 'significantly' prolonged the lives of people already suffering from heart disease - and this applied even to people who drank more than 56 grams of alcohol (two-thirds of a bottle of wine) a day.
Drug companies have spent billions trying to find a way of preventing colds, and failed. However, the answer has been staring us in the face all along, because astonishingly, both wine and alcohol in general help prevent the common cold - and very effectively, according to a joint research venture between Harvard and Spanish universities in 2002. The results were astounding: up to a 60 per cent reduction in the risk of catching a cold among red wine drinkers, and a staggering 88% reduction in white wine drinkers.
This finding was reinforced by an earlier placebo-controlled clinical trial in Britain's Common Cold Unit in 1993, when 400 regular drinkers and a smattering of teetotallers were deliberately infected with a cold virus.
Remarkably, it was the teetotallers who were most susceptible to getting a cold. And the effect of alcohol was huge: people who drank 20 grams (just over one large glass of wine) of alcohol a day had almost ten times fewer cold symptoms than teetotallers.
No drug, herb or medical intervention can come close to offering that level of protection.
In 2008, a study was done on about 1,500 women in Southern France who'd developed breast cancer in the previous two years. Their lifestyles were then analysed in detail, including the types of alcohol they drank, how much and how often. A matched 'control group' of healthy women was also surveyed.
The findings were dramatic. First, none of the breast cancer cases appeared to have any association with alcohol intake -no matter how much the women usually drank. Second, drinking up to 15 grams of alcohol a day of wine (a medium glass) actually reduced the risk of breast cancer - by a remarkable 42%. Third, the greatest protection occurred among the women who drank wine every day; there was no benefit whatever if they drank sporadically. So the researchers had no option but to conclude: 'Low and regular consumption of wine reduces the risk of breast cancer.'
Two years later, those French findings were bolstered by a University of Ottawa study on women at risk of one particular breast cancer type - the BRCA1 genetic mutation. 'Compared with non-drinkers,' it said, 'exclusive consumption of wine was associated with a significant reduction in the risk of breast cancer.'
In 2012, the Cedars-Sinai Medical Centre in Los Angeles reported that red wine specifically has beneficial effects on some of the hormones implicated in breast cancer.
Meanwhile, at least two studies on mice have shown that the natural ingredients of red wine can reduce breast cancer tumours.
However, we should be cautious. Although four population studies have found that wine doesn't cause breast cancer, about four disagree. And Cancer Research UK is adamant that drinking alcohol has been shown to increase the risk.
Certainly, the evidence is fairly clear that alcohol in general isn't good news for breast cancer, with roughly a 10% increase in risk for every tot of spirits or half pint of beer you drink.
In 2009, researchers at Canada's Centre for Addiction and Mental Health analysed more than 1,500 studies on the link between alcohol and diabetes.
They concluded that drinkers have a 13% lower risk of contracting it than teetotallers.
An earlier Dutch analysis looked at data on nearly 370,000 people whose health had been tracked for 12 years. If you drank between six grams of alcohol (half a small glass of wine) and 48 grams (two large glasses) of alcohol a day, you reduced your diabetes risk by about 30%, it concluded.
Interestingly, there's some evidence that moderate female drinkers benefit from almost double the reduction in diabetes risk as men.
'Currently, rheumatoid arthritis cannot be prevented,' says Britain's official NHS website tersely. But that's a porkie.
Because, according to a wide variety of studies, RA can be prevented - by alcohol.
Two separate Scandinavian studies in 2009, involving 3,000 women, revealed that teetotallers had 40% more risk of contracting RA, while the heaviest drinkers had 45% less risk.
Since those studies, more evidence has come along, showing that the most effective RA-preventing dose is about 10 grams (just under a small glass of wine) a day. But risks actually increase if you drink more than 30 grams daily (two medium glasses).
Does alcohol help if you've already got the disease? In 2010, Sheffield University doctors studied the drinking habits of over 800 RA patients, and found that regular drinkers have significantly less severe symptoms than non-drinkers.
Drinking for up to 10 days a month reduced pain by about 25%, and more frequent drinking by 30%. And this was no temporary anaesthetic effect: X-rays showed there was less damage to joints, blood tests revealed lower levels of inflammation, and there was less joint pain and swelling.
In 2012, U.S. researchers at Oregon State University studied a group of people very prone to bone loss: post-menopausal women. All were regular moderate drinkers, and they were persuaded to give up alcohol for two weeks. At the end of this period, super-sophisticated X-ray technology discovered that their bone turnover (the body's continuing replacement of new bone for old) had deteriorated markedly.
The women were then allowed to resume drinking - and their bone turnover went back to its original level within 24 hours.
Large-scale studies have confirmed these findings, showing that regular drinking significantly improves bone density in not just older women but men, too.
Optimum dose? For a 5% improvement in bone density, people had to drink more than 28 grams (slightly more than a large glass of wine) of alcohol a day.
Five per cent may not sound much but it's roughly on a par with the most commonly prescribed anti-osteoporosis drugs.
However, it's not a good idea to self-medicate with alcohol if you're already a bit unsteady on your feet. Heavy drinkers get more hip fractures - simply because they're more likely to fall over.
From 1964 to 1992, Danish researchers tracked the drinking habits of nearly 30,000 people to check their stomach cancer rates, and found that wine - both red and white - was protective. Seventy-five grams (roughly a bottle) a week resulted in a 24% reduction in risk.
A 2005 study of red wine and prostate cancer risk among 1,500 Americans reported that: 'Each additional glass of red wine consumed per week showed a statistically significant 6% decrease in relative risk of prostate cancer.' The risk of prostate cancer appeared to be halved by drinking a mere four glasses (or more) of red wine in a week. And for the most aggressive cancer type, the risk was reduced by 60%. However, not all studies agree, so there's still a bit of a hung jury.
Towards the end of the Nineties, University of Washington DC ophthalmologists decided to cast a beady eye over the drinking habits of their patients. They fully expected to find that the demon drink would be a major risk factor when it came to failing eyesight, but the opposite was true. 'Moderate wine consumption,' their report stated, 'is associated with decreased odds of developing age-related macular degeneration.'
In a 2009 study, the University of Florence asked 800 women aged between 18 and 50 to answer a standard questionnaire on 'female sexual function'.
What did they discover? Teetotallers scored 68% on sexual satisfaction, those who regularly drank a single glass of red wine 72%, and those who often drank two glasses 76%.
Ah, but is this a causal relationship or just a correlation? In other words, does red wine marginally improve a woman's sex life, or do the kind of women who choose to drink it also have a good sex life?
We don't know.
Male wine-drinkers haven't yet had their sex lives investigated. The only data I can find is that a constituent of red wine increases the effectiveness of the erectile dysfunction drug, Levitra - but only if you're a rat.
One huge UK-based study in 2010 analysed the medical data from over 150,000 British drinkers and non-drinkers, and could find no 'statistically significant' connection between alcohol and bowel cancer whatsoever.
Moreover, there's some evidence that one type of alcohol - yes, red wine - may actually protect against it. In 2009, Cambridge University researchers reported on an 11-year study of almost 25,000 people in Norfolk. They discovered that drinking wine actually seemed to reduce the risk of bowel cancer by almost half. Two American surveys have also found a similar protective effect from wine.
But beware not to drink too much. The consensus seems to be that drinking more than 50 grams of alcohol (more than half a bottle of wine) a day may raise the risk of this cancer.
But what about the liver?
If there's one organ that doctors tell drinkers that alcohol is bad for, it's the liver. But what does the evidence really say?
Even here, it turns out that we're only given a partial view of the true picture. The catch-all term for liver problems thought to be caused by alcohol is Alcohol Liver Disease (ALD). And the facts are that ALD is not nearly as widespread as doctors like to make out.
In the Eighties, Danish researchers decided to track the health of more than 13,000 people over a 12-year period, specifically looking for a connection between alcohol and ALD. As expected, they found that, above an intake of about 35 grams a day (roughly two pints of beer), there was indeed a risk of ALD.
But, crucially, this risk only applied to a relatively few people. Fully 93% of the drinkers had no sign of cirrhosis whatever, even at alcohol intakes above 120 grams a day - almost two bottles of wine.
Italian doctors found very much the same thing in a celebrated study called 'Dionysos' in 1997. This was an intensive long-term study of the inhabitants of two towns in northern Italy. Evidently, some of these 7,000 Italian townsfolk were pretty heavy drinkers, with more than a hundred of them downing the equivalent of more than a bottle and a half of wine a day - and yet the vast majority of these heavy boozers had no ALD symptoms at all.
Why not? Some experts believe the answer lies in people's genetic make-up - a special study of the heavy drinkers in the Dionysos population found that cirrhosis tended to occur in the people who had particularly unusual variants of the two genes responsible for detoxifying alcohol in the liver. In other words, if you're unlucky enough to have the wrong genes, you might get ALD almost no matter how little you drink. With the right genes, however, you'll probably never get liver disease.
What doctors also don't tell you is that some kinds of liver disease might actually be prevented by alcohol - for example, a condition called Fatty Liver Disease (steatohepatatis).
A huge U.S.-wide survey in 2012 found alcohol is of real benefit for this fairly common liver problem.
'Our study showed that people with modest alcohol intake - up to 36 grams of alcohol daily [roughly half a bottle of wine] had half the risk of developing steatohepatitis than people who drank no alcohol,' reported lead author Professor Jeffrey Schwimmer of UC San Diego.
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Anyone who's ever gone on a diet is told to lay off the booze because it's high in calories.
And that, of course, must make it very fattening indeed.
Go onto the NHS Direct website, and you'll be told a glass of wine contains as many calories as a slice of cake.
Or if you prefer beer, the British Nutrition Foundation reminds you two pints are roughly the equivalent in calories to a full glass of single cream.
So you may be surprised to learn that there's no scientific evidence whatsoever to support the idea that alcohol makes you put on weight. That's hugely counter-intuitive, I know, because alcohol certainly is said to contain lots of calories.
But the curious fact remains that alcohol isn't fattening.
Here's just some of the evidence. Professor Charles S. Lieber of Harvard University, who died in 2009, was probably the greatest expert on alcohol and health the world has ever seen. In the Seventies, he founded the first scientific journal on alcohol, and was also the first to establish a link between alcohol and liver disease. So he was no friend of alcohol.
Yet in 1991 he firmly rejected the notion that alcohol has any significant effect on weight. Lieber, however, was relying mainly on evidence drawn from studies that were looking at alcohol's other effects. It wasn't until later that anyone actually decided to examine this conundrum directly.
In the Nineties, researchers at Harvard embarked on a survey of almost 20,000 middle-aged women, whose drinking habits and weight were tracked for almost 13 years. At the start, the women were all roughly UK dress sizes 8 to 12. By the end, about 9,000 had put on significant amounts of weight, and some had become clinically obese. All other things being equal, you'd expect the fatties to be the drinkers. But they weren't.
In fact, the fatties were the women who didn't drink, and the skinnies were the heaviest drinkers. The women who drank five grams of alcohol a day reduced their risk of being overweight by 4%. Those who drank 15 grams (roughly one medium glass of wine) a day reduced their risk of piling on the pounds by 14%.
The figures were even more striking when it came to obesity.
Drinking 30 grams (two medium glasses of wine) a day or more gave the women an incredible 70% reduction in obesity risk.
So it was the non-drinkers who turned into size 18s or more.
In other words, this study showed that alcohol is not only non-fattening, but actually helps prevent weight gain.
A rogue result? Well, this was certainly no tin-pot study. The researchers made full allowances for obvious lifestyle differences that might have skewed the results, such as exercise, food intake and smoking habits.
Indeed, if the study had been a 13-year trial of a new slimming pill, the drug company involved would have been laughing all the way to the bank.
However, this was just one piece of research.
In the world of science, to stand a chance of anyone believing such startling evidence, the results need to be independently replicated. Which means other researchers have to find pretty much the same thing.
And they have - in spades. Here are just three of the studies conducted in the past 25 years which demonstrate that alcohol doesn't cause weight gain:
A six-year study of 43,500 people by the University of Denmark. Key findings: teetotallers and infrequent drinkers ended up with the biggest waistlines, daily drinkers had the smallest.
An eight-year study of 49,300 women by University College Medical School, London. Key findings: women who drank below 30 grams a day (around two medium glasses of wine) were up to 24% less likely to put on weight than teetotallers.
A ten-year study of 7,230 people by the U.S. National Center for Disease Control. Key findings: drinkers gained less weight than non-drinkers. Alcohol intake did not increase the risk of obesity.
And there are at least a dozen more studies on alcohol and weight which, by and large, confirm these results. So why isn't the medical world rejoicing?
Given the obesity epidemic in the Western world, you'd expect doctors to be rushing to prescribe two glasses of wine a day for overweight patients. Well, science doesn't quite work like that. Although data shows people who drank alcohol didn't put on weight it doesn't actually prove that beyond any doubt.
Yes, the studies made adjustments for other factors - such as a person's social class, fitness and education - what if they'd missed something?
On the other hand, it's highly unlikely that so many studies were wrong. And the methods used are certainly widely accepted as proof when it comes to, say, evaluating new vaccines.
Even so, it can take decades to challenge long-held scientific theories successfully.
So we're back to where we started: nutritionists remain adamant that because alcohol is high in calories, drinking must therefore put on weight.
To think otherwise is tantamount to heresy.
Fortunately, in the past ten years, a few nutritionists have had the courage to question this dogma.
One of the simplest studies was done in 1997 by U.S. sports scientists who wanted to find out if drinking a couple of glasses of wine a day puts on weight or not. A total of 14 men were studied for 12 weeks, during which they either drank a third of a bottle of red wine a day for six weeks, then abstained for the next six weeks, or vice-versa. The result? The addition of two glasses of red wine to the evening meal had no effect on the men's weight.
But that still didn't convince sceptical nutritionists. If taking in extra calories from alcohol doesn't put on weight, they argued, it must mean alcohol somehow makes people eat less.
So in 1999, Swiss physiologists tested 52 people to see if the sceptics were right.
Predictably, they weren't: alcohol, they found, actually made people want to eat more. What a surprise.
Next, they tested other theories. Was alcohol causing the body to heat up? Was it affecting fat metabolism? Again the answer was no: the team was stumped.
In fact, if you search the literature, you'll find no one has any explanation for why alcohol calories don't seem to count.
So where do we go from here? I have two theories. The first centres on glucose, which it's now widely accepted is what makes us gain weight. Could alcohol - which is known to increase the body's supply of insulin - be reducing glucose levels at the same time, thus helping to keep weight down?
My second, more radical, suggestion has to do with the theory of food calories itself. To explain this, I'm going to have to take you back to when calories were first 'invented'. In the 1880s, an American agricultural chemist called Wilbur O. Atwater decided to see how much 'energy' different types of foods contained - to help people choose what to eat so as not to starve. To measure the energy, he decided to treat different foods just like coal - i.e., burn them to ash in a furnace and measure how much heat (or 'calories') each one produced.Then he gave a numerical value to the calories produced by each food. He measured nine calories per gram coming off high-fat foods, and about four calories per gram from carbohydrates and proteins.
This is still the system we're using 150 years on, but in my view it's seriously flawed. Atwater's mistake was to assume that the body would assimilate the energy (i.e., calories) in food in the same way as a furnace. It doesn't.
Here are just a couple of food types that demonstrate the loopiness of the calorie theory.
As any calorie chart will tell you, nuts are among the top ten most calorific foods. Yet study after study has consistently shown they don't cause weight gain.
Nutritionists have tried to argue that nuts make you feel full, which makes you eat less food in general.
But at least two studies have shown this can't be the whole answer: when people are given diets with identical calories, they put on less weight when the diets contain nuts.
An even more stunning strike against the calorie theory is fatty foods.
For decades, the message has been that fat is fattening and low-fat is slimming. But experimental science says that this is almost 100% wrong.
I'll give you just one example out of many clinical trials that prove the point. In 2003, a U.S. university team of nutritionists tested two slimming diets - each amounting to the same number of calories - on a group of overweight women.
One diet was very low-fat and relatively high in carbohydrate. The other was high in fat but low in carbohydrate. What do you think happened?
The low-fat dieters lost 3.9kg (almost 9lb), but the high-fat dieters lost more than twice that: 8.5kg (almost 19lb).
Why does this seem so unbelievable? Because we've been repeatedly told fat is more fattening than carbohydrate. And who gave us that idea? Our 19th-century friend Wilbur Atwater.
Now let's look at alcohol. Significantly, Atwater was a leading member of the Temperance movement, forerunner of the alcohol Prohibitionists in the Twenties and Thirties. One day, he thought he might try to dish some dirt on the demon drink.
Alcohol, of course, is highly combustible. So when he tested it in his crude food furnace, it burned like a firecracker, giving off huge amounts of heat - or 'calories'.
And that's why, even in 2013, we're told alcohol puts on weight - because it supposedly contains lots of calories.
But that makes about as much sense as saying that because coal burns ten times hotter than alcohol, you'd put on loads of weight if you were to eat it. The reason you don't put on weight from coal or alcohol because your body can't assimilate the energy within either of them.
That's my theory, anyway. And it's backed up by some incontrovertible scientific evidence.
Take this 2004 study by nutritionists at Brazil's Fluminense Federal University, who did a series of highly controlled experiments with young laboratory rats. They found the more alcohol the rats were given to drink, the more weight they lost — even though their total calorie intake remained stable.
A more recent study on mice in 2008 at the University of Austin, Texas, found much the same thing. Two groups of mice were given either plain water or water containing 20% alcohol. To the researchers' surprise, although both groups of mice at the same amount of food, the alcohol-drinking mice put on no extra weight. In other words, the alcohol calories were not assimilated.
Convinced? Even if you are, there's probably one big question lurking at the back of your mind.
What about men's beer bellies? We don't just see them in every bar, but in literature, too - in the rotund form of characters such as Dickens' Mr Pickwick, and Shakespeare's Falstaff and Sir Toby Belch.
Beer makes up 43% of the alcohol drunk in Britain, with 30% wine and a 21% spirits. And the beer belly isn't just a British phenomenon - scientists from different countries have confirmed that heavy beer drinking does seem to have some connection with big bellies. Could there be calories in beer?
Yes, there are - but (leaving aside calories supposedly associated with the alcohol content) only about 50 carbohydrate calories per pint. Now, anyone familiar with conventional slimming diets will know that 50 calories - even five times that - aren't enough to turn your belly into a balloon. So the answer has to lie elsewhere.
The scientist who worked it out is an English nutritionist called David Jenkins. In the Eighties, he started assessing how much glucose was created by every food containing carbohydrates, and then scored each food out of 100. The result was the Glycaemic Index, which tells us that potato crisps, for example score high at 95, while green vegetables score a low ten.
Interestingly, nuts score only between 15 and 20 because they produce so little glucose.
But what's that got to do with weight? In the Eighties, a French scientist called Michel Montignac put two and two together.
In his pioneering book on the GI Diet, he argued that, because fat is deposited in the body as a result of excess glucose, the way to lose weight is to choose foods that produce the least glucose.
Initially, nutritionists scoffed at Montignac's theories, mainly because he largely ignored calories. But numerous subsequent studies have confirmed that he was right.
The bad news for beer drinkers is that their favourite swig scores very highly on the GI chart. Because one of its components is maltose, or malt sugar, which is formed by two units of glucose coming together, Montignac gave beer a figure of 110 - higher than glucose itself. Which means it's very fattening.
Naturally, the brewing industry argues that beer contains only small amounts of maltose. But a group of Finnish researchers weren't so sure. In 2011, they found the GI of beer wasn't 110 - it was a staggering 119.What about wine and spirits? You've worked it out, I'm sure. Both register a big fat zero. Which is why - whatever other reasons there may be to watch your intake - they won't make you put on weight.
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