Is bad 2 beers a day

Two beers a day isn't too much!


By Thilo Spahl

If you drink a certain amount of alcohol, you die earlier, according to a new study. A critical look reveals the warnings from the German Cancer Research Center and the media as hysterical.

In April, a study on the risks of alcohol consumption published in The Lancet generated considerable media coverage. The headlines read: "Even small amounts of alcohol shorten your life" (Spiegel Online), "Every 2nd glass of wine shortens your life by 30 minutes!" (Photo), "Just one glass too much alcohol already shortens your life" (RTL ), "Alcohol: Just not more than one beer a day!" (Zeit Online) etc.

The local science also seconded. The German Cancer Research Center (DKFZ) announced: “Regular consumption of more than 100 grams of alcohol per week shortens life considerably [...]. Anyone who consistently consumes more than two liters of beer or a bottle of wine per week risks more strokes, fatal aneurysms and heart failure as well as an overall higher overall mortality. "

Voices quickly became loud that the guideline values ​​(140 grams for men and 70 for women) should be adjusted. And since the population traditionally showed little interest in such reference values, ideas also emerged as to how the care of those concerned about public health could reach the man in the pub and the woman in front of the television - or vice versa - even better. Cornelia Lange, head of the health behavior department at the Robert Koch Institute (RKI) in Berlin, stated that deterring stickers based on the tobacco keg pictures on beer and wine bottles or clear information on how many glasses are "allowed" (only one at a time), Would "help enormously".

"There is no question of an early death due to a few beers too many."

The comparison of desired and real drinking behavior shows that there is a strong need for action from the point of view of health promoters. Because the average German over the age of 16 does not consume 100 grams today, but 167 grams per week (as of 2014). That is considerably less than the 258 grams that our parents indulged in in 1976, but it is still easy to calculate 67 percent too much! According to the RKI, the average German is clearly a drunkard with just under 24 grams a day. And only significantly below average drinkers do not show any “risky drinking behavior”.

Before I rush to drink just one beer and a sip of wine a day, I'll take a closer look at the evidence. And it shows what was to be expected: there is no question of an early death due to a few beers too many. If you drink two or maybe three times as much as recommended, you don't need to worry too much. (At least by and large, each individual case is of course different here, and for some people, even moderate amounts of alcohol actually have a clearly negative effect.)

The Lancet study was a statistical analysis of 83 studies, all of which had collected figures on alcohol consumption and cardiovascular disease, as well as general mortality. It emerged that the risk of cardiovascular diseases above 100 grams / week increases with increasing consumption and that life expectancy decreases somewhat. By 6 months for those who were between 100 and 200 grams / week, 1 to 2 years for the group with 200–350 grams and 4 to 5 years for those who weighed over 350 grams. If I put myself in the 200–350 category, two large beers or half a bottle of wine a day are easy enough. Instead of 85, I'll maybe only be 83 or 84 years old - and I can say to myself relatively calmly: quantity isn't everything.

"So the results of the studies do not support the demand for a low alcohol limit as clearly as it appeared in the media."

It is also reassuring to take a closer look at the 100–200 gram group. The authors suggest that 100 grams or more becomes unhealthy and that too much beer should be avoided. However, their own data show that the risk of cardiovascular disease only rises slightly above that of the non-drinker at over 200 grams (right graphic) and is reduced before that. Mortality is also only significantly increased from 200 grams (left graphic).

Illustration 1: Angela M. Wood et al .: "Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies" in: The Lancet 10129, pp. 1513-1523 (see above)

The following graphic shows what was also not to be read in the newspapers. The risk of suffering a heart attack is significantly reduced for all groups. And the risk of coronary heart disease without a heart attack also does not increase significantly from 100 grams, but only at just under 200, and then decreases again.

Figure 2: Wood et al., See Figure 1

It is now clear why the announcement from the German Cancer Research Center only spoke of "strokes, fatal aneurysms and heart failure". Because there has been a decrease in heart attacks. And overall they are more common than strokes and much more common than aneurysms and heart failure. The heart attacks are mentioned further down in the text, but only with the note that it has been shown again that "moderate alcohol consumption resulted in fewer heart attacks" (Should I infer from this that 400 grams per week is still moderate for the DKFZ? )

The results of the studies therefore do not support the demand for a low limit for alcohol consumption as clearly as it appeared in the media. But that's not the whole problem. It is also questionable how reliable the results are.

"A lifestyle is a complex matter."

It is known that such studies have a fundamental problem. People who hardly ever drink a second, third or fourth beer differ from those who do it more often, often in very many ways. Those who drink more may also ski more, have more sex, maybe eat a lot of pretzel sticks with their beer, like to grill, eat less vegetables, are more often unmarried, sleep less often with the window open, etc., etc. Maybe. We do not know it. But we know that there can be tons of differences in health. It is therefore always daring to claim that their slightly earlier demise must be due to the extra beers. Of course, the scientists try to take other factors out of the equation, but a lifestyle is such a complex matter that it can only be seen as an attempt that sometimes works better, sometimes less. So we can rightly say: Maybe it's not the alcohol at all.

So we shouldn't be surprised that other studies come to different conclusions. A Korean study published in the journal Stroke in January 2018 with over 200,000 participants shows that the overall risk of heart attack and stroke (cardio-cerebrovascular disease - CCVD) does not increase, but even decreases it slightly, even when consuming more than 400 grams per week is (red line). And the general mortality (blue line) only rises here above 400 grams. And to get to 400 grams, you have to be quite hard-drinking.

Figure 3: Do Yeon Kim et al .: "Alcohol Consumption: Benefit versus Harm in Vascular Events and Overall Mortality" in: Stroke, January 2018 (see above)

Another known problem is that when asked about their alcohol consumption, most people tend to report less than they actually drink. And the more warnings are given about the dangers of drinking, the more pronounced this effect is likely to be. As a result, correlation studies associate negative health findings with lower consumption levels than are actually available. So maybe people in the 100-200 gram group are actually drinking 150-250 grams.

"Let us refrain from warning notices and even more so from disgusting images!"

One way to avoid this bias is not to rely on questioning but, for example, to investigate the connection between clinically diagnosed alcoholism and cardiovascular diseases. This was done in an American study with a total of almost 15 million patients. Here the results were very clear: Among other things, the risk of heart attack in alcoholics was increased by almost 50 percent. However, alcoholics were not classified here as people who occasionally drink more than one beer a day, i.e. the majority of the population, but rather those who have a real alcohol problem, which according to the study is the case for 10 to 15 million Americans. So we can assume that the three to five percent of the heaviest drinkers definitely have a significantly increased risk of cardiovascular disease. Maybe a few more, but not 50 or 60 percent. Here, too, we must also note that alcoholics often have a whole host of other problems that also have an unfavorable effect on the risk of the disease.

Conclusion: We can safely forget the 100 grams. Let us refrain from warning notices and even more so from disgusting images! But I already suspect: That will not prevent the "Enlightenment" from repeating their demands with vigor and perseverance. The first to suffer are the brewery workers. Because the old custom of home drinking still prevails there. According to the FAZ, every employee in Bavaria, for example, receives 18 liters of beer per week, as determined by collective bargaining agreements and tax-free. That's 18 halves for the employee and another 18 for the spouse. Per week. If they are lucky, there is still a little relatives to be provided for, who can help ensure that life does not become too short.

Strangely enough, what is never calculated is the joie de vivre-enhancing effect of alcohol. Because the "risky cell poison" is known to have an anxiolytic, relaxing and stimulating effect. Most of us like to drink and in moderation (even if not in the officially desired low proportions). Which means nothing else than that it gives us joy. Most likely because it promotes interpersonal relationships. And interpersonal relationships are probably not the least of the beautiful and important things in life!


Read more from Thilo Spahl (and on the subject of alcohol, among others) in this book: