Alcohol and brain function in old age

Let’s get this out of the way at the start. It is clear that alcohol misuse is a leading cause of morbidity and mortality. As an example, binge drinking has been shown to lead to a higher risk of cardiovascular disease.

But what about lower level alcohol consumption?

Some previous studies have reported that low to moderate alcohol consumption show benefits to cognitive function. However, others have found no, minimal, or even adverse effects associated with alcohol consumption.

So what to believe?

Association studies are difficult to interpret correctly as most effects studied are multifactorial and vary over time. In particular, a one time measurement can easily be misleading as the time factor is disregarded.

To overcome this challenge, a study published in June 2020 by researchers from the University of Georgia used repeated measurements of health and lifestyle, including questions on drinking habits, in a group of almost 20,000 middle-aged and older participants over a ten-year period.

The participants had their cognitive function measured in a series of tests looking at their overall mental status, word recall and vocabulary. The test results were combined to form a total cognitive score.

And the good news – light to moderate drinking may preserve brain function in older age.

Compared to nondrinkers, those who had a drink or two a day tended to perform better on cognitive tests over time. The optimal amount of drinks per week was between 10 and 14 drinks.

Even when other important factors known to impact cognition such as age, smoking or education level were controlled for, they saw a pattern of light drinking associated with better cognitive function.

The debate will continue

The debate is clearly not over about potential benefits of moderate alcohol consumption. We have written about the balance of the good and bad of alcohol consumption before.

For a while it looked like the fact that regular, moderate alcohol consumption had been shown to promote heart health was settled. And then came another review of previously published research questioning this conclusion.

Several studies pointed to similar protective benefits of moderate alcohol consumption for brain health. And then a systematic review of existing literature on alcohol consumption concluded that there seemed to be no safe level of drinking alcohol.

Believe what you will, but at my age I will cling to the latest findings as it seems to be a solid design of the study.

Spoiling the fun – no booze!

beer_glass_(Tim_Dobson)“Hygge” is a Danish word for describing a feeling of wellness and contentment, possibly after consuming a beer or two as Denmark is top of the list in the number of drinkers in a country at over 95%. But, there is also a Swedish secret to a balanced and happy life and that is described by the word “lagom”, not too little, not too much, but just right. Applied to alcohol consumption it would mean drinking in moderation.

Up to now there has been numerous studies showing that drinking in moderation can actually be good for you. We have previously described potential health effects of consuming beer, wine or liquor while acknowledging the downside of excessive drinking.

Now a new study is attempting to spoil the fun.

New study claims no safe level of alcohol consumption

A systematic review of the existing literature on alcohol consumption published in August 2018 concludes that there seems to be no safe level of drinking alcohol. The study, part of the annual Global Burden of Disease, assesses alcohol-related health outcomes and patterns between 1990 and 2016 for 195 countries and territories and by age and sex. It does not distinguish between beer, wine, and liquor consumption due to a lack of evidence when estimating the disease burden. Instead, researchers used data on all alcohol-related deaths generally and related health outcomes to determine their conclusions.

First, the researchers explored 694 data sources on individual and population-level alcohol consumption. Not surprisingly they found that alcohol use patterns varied widely by country and by sex, the average consumption per drinker, and the attributable disease burden. Globally, more than 2 billion people were current drinkers in 2016.

Second, the study reviewed 592 prospective and retrospective studies on the risk of alcohol use. Based on this vast range of data sources they built a large and complex statistical model to estimate the relative risk for 23 health outcomes associated with alcohol use.

As a result of the modelling the researchers claim that in 2016, nearly 3 million deaths globally were attributed to alcohol use, including 12% of deaths in males between the ages of 15 and 49. They conclude that while moderate alcohol consumption may be preventive for some conditions such as ischaemic heart disease and diabetes, when combined with increasing risk of cancers and other outcomes there is a steadily increasing harm from alcohol consumption. This leads them to argue that there is ‘no safe level’ of alcohol consumption.

This is a rather bleak conclusion if true. Gone are the purported health effects of moderate drinking found in many other studies.

Is this as important as the authors claim?

The first consideration should be: Are the finding of significance in a real life situation and not just from a statistical point of view? To be able to gauge this the findings should be presented as absolute values rather than relative changes. If you notice above the study only presented relative risk outcomes. Thus, readers couldn’t tell how dangerous drinking alcohol really was for them.

However, this was remedied by the press office of the Lancet journal, in which the study was published. Thus, Lancet clarified that when comparing no drinks with one drink a day for 15–95 year olds, there was a 0.5% higher risk of developing one of the 23 alcohol-related health problems. This meant that the 914 in 100,000 that would develop a health condition in one year if they did not drink, would increase to 918 people in 100,000 who drank one alcoholic drink a day.

That is a difference of 4 people per 100,000 in a year.

People who drank two drinks a day had a 7% higher risk of alcohol related health problems or a difference of 63 per 100,000 in a year and people who drank five drinks every day had a 37% higher risk or a difference of 348 per 100,000 in a year.

A drink or two should be fine

Alcohol drinksIt is clear that heavy drinking has its toll on health and should be avoided, but to claim that abstention is the only solution is barely supported by the facts presented.

Presumably people who choose to drink alcohol moderately get some pleasure from it, and any risk needs to be traded off against this enjoyment, as expressed by David Spiegelhalter of the Winton Centre for Risk and Evidence Communication, Cambridge University.

I suggest that you will feel “hygge” by sticking to “lagom” when consuming alcohol and most of us will be fine.