Much has been made of recent mega-studies reporting that any level of drinking is bad, and that if there ever was a J-shaped curve for wine & health, it has disappeared. “We can’t even pretend that drinking is good for us anymore” trumpeted one headline, while another lamented: “Myth: Red wine is good for heart health.” If you have read Wine & Health you will understand that these conclusions are highly debatable, even flatly misleading, but they persist. So we shall persist as well in our quest to provide another perspective. Rather than highlight one or two large studies, let’s look at a meta-analysis of all of them, no holds barred, all comers welcome.
Fortunately the heavy lifting has been done for us already, and you can see the summary here.*
Source: International Coalition for Responsible Drinking
The inclusion criteria were as follows:
▶ Study design: meta-analysis or pooled cohort
▶ Study population: must include a general population cohort, rather than a subpopulation
with an existing condition or diagnosis (for example, diabetes or hypertension patients)
▶ Exposure: must include total alcohol consumption (rather than beverage specific results only) and provide multiple estimates for different levels of alcohol consumption (rather than a single binary variable or a single dose- response estimate)
▶ Outcome: all-cause mortality
▶ Analysis: must contain a comparison of drinkers with non-drinkers
▶ Publication date: 2000 to April 2023
What immediately jumps out is that every study meeting these broad inclusion criteria shows light-to-moderate drinkers have a similar or lower risk as non-drinkers. None of them find a dose-response relationship suggesting that moderate drinking is harmful. The second big takeaway is that all but three find a J-shaped curve. The third column addresses the issue of lumping “sick quitters” together with lifetime nondrinkers, which could skew the comparison. Here the picture is more uneven. We have debated this before, and there are a number of confounders at play with this topic.
A weakness of this review is that it does not separate out wine drinkers, who form the basis of the French Paradox. We have seen plenty of data demonstrating that wine drinkers are indeed a unique subset of the population of drinkers, especially where integrated into a lifestyle of regular moderate drinking with meals. It also seems that the J-curve was less likely to be seen where an effort was made to separate former drinkers from lifetime teetotalers, though again this was inconsistent.
*A note about the IARD: This is a Washington DC based advocacy group funded by beer, wine, and spirits companies. Their stated goals include reducing the harmful use of alcohol and combating harmful drinking. However, as an industry-funded organization the potential for a conflict of interest must be acknowledged. It should also be noted that the table published above does not come with commentary or a suggested interpretation; it’s simply a summary of peer-reviewed published studies. In the spirit of disclosure, it should also be pointed out that the Zhao and Stockwell studies, which failed to find a J-shaped curve, were underwritten by the Centre for Addictions Research of British Columbia at the University of Victoria (now the Canadian Centre on Substance use and Addiction). This organization views alcohol consumption through a lens focusing on alcohol abuse, and as I pointed out in Wine & Health they excluded studies that were contradictory to their message. The IARD table has no notable exclusions. Further, the 2006 Fillmore article – the only other one that failed to find a J-shaped curve – was not actually new data, but a skeptical reinterpretation of earlier studies (Stockwell was a co-author on this article BTW.) My own take is we should be more skeptical of the only 3 studies in the whole lot that don’t see a J-curve.
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