Saturday, April 05, 2008

A Bit About Booze

smirnoff tarik!

...And we grant you nourishment from the fruit of date-palms and vines: from it you derive intoxicants as well as wholesome sustenance -in this there is a message indeed for people who use their reason. (Q.16:67)

It started with wine...
The wine industry rejoiced when studies showed that drinking wine was good for the heart. It single handedly increased wine consumption globally, and all of a sudden everyone was doing studies on the benefits of alcohol.

A few years of marketing bliss later...
Follow up studies showed that substances previously though to be beneficial in wine werent really beneficial at all, or were present in levels too low to have any effect on cardiovascular function. This was a bad thing for the wine industry, but few people ever learnt about it because the wine industry spends alot of money in advertisements. Later it was discovered that the active ingredient in wine was alcohol itself.

The epidemiological grapevine...
Alcohol is a very tricky stubstance to research. No ethics committee would approve a randomized controlled trial where half of the participants are given a fixed dose of alcohol while another half were given a placebo. Even if they did, how would you design a placebo for alcohol? Hence, most studies are based on evidence from the field epidemiology (statistics). Statistically at least, people who dont drink at all die earlier than people who drink moderately. People who drink alot die much earlier than people who dont drink at all.

The problem with the statistics...
Early studies grouped lifelong abstainers with people who have quit drinking for up to six months. That was a problem because people who quit drinking usually did so because they had some kind of disease (caused by too much alcohol, such as cirrhosis) and were more likely to die young anyway. This statistical problem, along with a few others, were corrected and adjusted for in further studies. The results are clear now.

So what does research really say about alcohol?
Alcohol literally kills your heart in large doses and you can drop dead from sudden death brought on by death of heart muscle. In small doses, alcohol appears to be good for the heart after all. However, research has only proven this to be true in men over 45 years of age. Early research also shows that people who drink one standard drink a day are 30% less likely to get type 2 diabetes (1). It also increases the proportion of "good" HDL cholesterol and reduces the amount of clot inducing "bad" LDL cholesterol in the bloodstream.

A bit about culture..
Here in australia, it is culturally acceptable, and even "cool" amongst youth to get drunk. An hour's of work at the supermarket pay about AUD16. Four litres of cheap low proof wine (30 std drinks) costs only AUD8. Ok, that's really vile stuff, but for AUD16 you could get five bottles of premium beer, each containing 1.3 standard drinks. The human body only eliminates about one standard drink an hour. Five standard drinks is enough to make a person drunk. Since one standard drink is not very much, it is really easy to drink too much. It is much less than what people typically consume in one sitting. A can of mid strength beer is about 1.3 standard drinks. 30ml of 38% spirit is considered one standard drink. How many people take only one beer at the pub?

My pseudo-opinion: Positive effect of low risk drinking ( less than 1.5 std drinks a day)
It is quite clear that people who drink moderately do derive health benefits from alcohol. The human body is incredibly complex and researchers are still unsure how alcohol does the things it does. Cardiovascular disease is essentially an inflammatory disease whereby the linings of the cardiac vessels dont function properly. Stress naturally causes the production of hormones that function to help a person get through a period of stress. Blood clotting factors are primed for use and the body is put into a state of tension. In the good ol caveman days, that was a good thing. Your body has to be ready to run away from the sabertooth tiger, and you had to stay awake at night if you sensed a predator in the bushes. In modern times, the same stress responses that once provided the human body with an edge in survival are now activated frequently by things such as work deadlines and lack of sleep. Alcohol helps dull that stress response and makes people more relaxed. That alone could be one of the reasons behind the health benefits of alcohol. A nip of whiskey before bed calms a persons nerves and makes him/her less anxious/stressed. It is not surprising that some cultures, such as the french, have successfully integrated alcohol into their lifestyles. Moderate consumption at the dinner table is a good thing.

The BIG picture.

Alcohol is bad for society. Period. The Australian Medical Association plainly states that alcohol leads to "an unacceptably high level of sickness and social disruption". It is estimated that in Australia, roughly 80,000 life years were lost as a result of drinking in 2001. This was contrasted to the estimated 61,000 life years gained as a result of moderate low risk drinking. The bottom line is that alcohol consumption costs taxpayers about AUD500k (RM1.5mil) a day in healthcare, emergency services and motor accidents.

They will ask you about intoxicants and games of chance. Say: "In both there is great evil* as well as some benefit for man; but the evil which they cause is greater than the benefit which they bring." (Q.2:219)

(1) Koppes LL, Dekker JM, Hendriks HF, Bouter LM, Heine RJ: Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies. Diabetes Care 28:719–725, 2005. -and- Howard AA, Arnsten JH, Gourevitch MN: Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med 140:211–219, 2004.