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The global burden of alcohol according to a recent World Health Organization report, and what it means for Canadians

By: Caine Meyers

Alcohol consumption is increasing worldwide along with the burden of consuming it Last year, The World Health Organization (WHO) released a global status report on alcohol and health. This was an extensive review on the current disease burden of alcohol worldwide, and how each country is responding to the issue.

Today, it is estimated that 2.3 billion people drink alcohol (WHO, 2018). Of this cohort, the average consumption daily consumption of alcohol is 33 grams of pure alcohol -- which is equivalent to 2 glasses of wine, one large bottle of beer, or two shots of a spirit per day. At first glance, this number may seem trivial; especially for alcohol enthusiasts and frequent drinkers. However, a comprehensive meta-analysis published in the Journal of Preventive Medicine reported that only one glass of alcohol per day can significantly increase your odds of cancer and liver disease (Corrao et al., 2004). This analysis is large in size, including more than 100,000 subjects across all studies, and it found that the risk of mouth, esophageal, and breast cancer increased with consumption of only 25g of alcohol per day. This same daily alcohol intake further raised the risk for violence, injury, and liver cirrhosis.

In their recent report, WHO estimated that harmful alcohol use accounted for 48% of all cases of liver cirrhosis in the world. Further, it was the cause of 26% of all mouth cancers, 26% of all incidences of pancreatitis, 20% of all cases of tuberculosis, and 18% of all suicides. A more exhaustive list can be found here.

Indeed, the risk for these diseases increases with increased consumption of alcohol. The following infographic is taken directly from Corrao and colleagues’ (2004) meta-analysis (See Figure 1). In short, as previously mentioned, the risk of developing certain diseases increases as alcohol consumption increases. The X-axis, or bottom line of each graph, is the amount of alcohol consumed. It increases by increments of 20g to the right. The Y-axis, or vertical lines, depicts the relative risk ratio associated (RR) and is dependent on the amount of alcohol consumed. RR refers to probability that an individual exposed to a certain substance will develop an outcome compared to an individual who is not exposed. In this instance, it is the likelihood that someone will develop a specific disease in relation to the amount of alcohol they consume.

As shown, the risk of developing fourteen different coronary and/or cancer related diseases increases with increased alcohol consumption. However, in some specific heart disease related incidences like ischemic stroke, we see a “J-curve.” This indicates that a specific dosage of alcohol may actually be protective against certain diseases. More on this later, as it is not that simple.

In their recent report, WHO predicted that the global average of alcohol consumption will increase, enlarging the burden of disease related to alcohol (WHO, 2018). This is especially alarming when the statistics reveal that more than a quarter of current drinkers are adolescents between the age of 15 and 19, and heavy episodic drinking (aka binge drinking) peaks in individuals between age of 20-24 (WHO, 2018). As it happens, this type of drinking behaviour is equally subject to the risks of consuming alcohol daily (Aberg et al., 2017; White et al., 2017; Piano et al., 2017). Given this, it is unsurprising that younger individuals are disproportionately affected by the harms of alcohol compared to older adults. 13.5% of all deaths related to alcohol occur between the ages of 20 and 39.

Does this mean we should completely abstain from alcohol? Well, it’s hard to definitively say yes or no. But, the risks need to be properly weighed against the benefits and young people especially ought to know how to drink responsibly.

As previously alluded to, Corao and colleagues (2004) found that certain amounts of alcohol may be protective against specific cardiovascular diseases, as reflected in the “J-curve” effect. However, this effect is not without its caveats, and the methodology of these studies have been heavily criticized. Tim Stockwell, a professor of Psychology at the University of Victoria (BC), told reporters of the renowned Science Vs Podcast that these studies are misleading. In short, the study compared drinkers to non-drinkers however there was no specific exclusion criteria for the study. In other words, the study did not account for the reasons that people did not drink. Tim Stockwell questioned what kind of people reported that they were non-drinkers or drinkers. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that more than half of the US population reported drinking in the last month and 70.1% of the population drank in the last year (NIAAA, 2019). Along with his colleague, Tim Stockwell found that the majority of these non-drinkers were what scientists refer to as “sick quitters.” These are people who must or choose to abstain from substances like alcohol due to pre-existing health conditions, and on average, these people are less healthy to begin with. When juxtaposed with drinkers, a group that includes a large amount of otherwise healthy people, it indeed would give the illusion that alcohol has a protective effect Tim and his colleagues re-examined the data and included studies that omitted “sick quitters.” Unsurprisingly, the protective effects against cardiovascular diseases between the two groups disappeared (Fillmore et al., 2006).

Fillmore and colleagues’ 2006 study stirred headlines. But, only a few years later, two high quality studies were recently published that once again claimed alcohol may be protective against cardiovascular disease (Rehm, Shield, Roerecke, & Gmel, 2016). This time, these studies did account for sick quitters. But, the effect was much smaller than previously reported by all studies. As it happened, this effect was only present when individuals drank just under one glass of alcohol per day and did not increase with the increased consumption of alcohol.

This begs the question of how all of this should be interpreted? Once again, the question remains, should we completely abstain from alcohol? The reality is that one glass of alcohol per day may protect you against cardiovascular disease but the same glass also increases your chances of developing cancer. In women, one glass increases the chance of having breast cancer by 5%. More than one glass increases the odds to 13% (Bagnarti et al., 2012; Corrao et al., 2004).

Overall, it is clear that the risks associated with drinking alcohol outweigh the benefits when you exceed more than one glass per day. Further, you are bargaining two possibilities that are not mutually exclusive. You may protect yourself against heart disease but the cost of doing so increases your odds for cancer. It is without question that the more you drink, the more at risk you are for all types of cancer (Corrao et al., 2004). Bare in mind that this includes binge drinking behaviour (i.e., those who drinks large amounts only on weekends; WHO, 2018).

Indeed, alcohol can be an important catalyst for social interactions, however, this may be a matter of cultural attitude and a new perspective on alcohol is merited. According to the Canadian Cancer Society (2018), 1 in 2 people will get cancer in Canada and 1 in 4 will die from it. In fact, cancer is now the leading cause of mortality in Canada. Rates are alarmingly high and any attempt to mitigate risk is a step in the right direction. Perhaps, it is worth mentioning that heart disease is only the third leading causing of death in Canada when weighing the risks and benefits. This is not to negate the fact that other modifiable lifestyle choices increase your odds for cancer such as smoking, poor diet, and excess weight (Islami et al., 2017).

If you or a loved one is struggling to use alcohol responsibly, please consider speaking to a counselor at Searidge today. We are happy to help: 1-866-777-9614.

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