What don't we know about alcohol?

It sometimes seems, when working through the dozens of research papers devoted to alcohol each week, that there can be few stones left unturned in the field of alcohol and its effect on human health and behaviour. Some 60 studies have now reflected Arthur Klatsky’s J shaped curve - greeted with disbelief initially in 1974- which showed that those who drink between 12 and 30g of alcohol a day live longer than abstainers and heavy drinkers.

Several papers reviewed this quarter reveal that we still have much to learn: The New England Journal of Medicine calls for a study, with clinical trials, on the efficacy of alcohol in lowering the risk of heart attack among patients who already suffer from cardiovascular disease. This accompanied a paper ‘Should alcohol be used as a medication’.

A chapter by Merton Sandler on migraine, Wine — a Scientific Exploration, reveals that although it is indisputable that migraines exist, dietary links, for example to red wine are controversial, unproven and presumed by some as ‘a conditioned reflex’. In fact we have little idea of the effect of alcohol on the brain at all. To use Baroness Susan Greenfield’s words, ‘ the process of fermentation has been practised since the early agricultural civilisations. But even now, no-one really knows how alcohol exerts the effect it does’.

Why do individuals respond to alcohol differently? Why do a minority (2% of women and 6% of men in the UK) become dependent on alcohol, how much is a genetic predisposition?

Other questions which arise surround questions such as cirrhosis. Why does cirrhosis only affect 10% of alcoholics and how strong is the link between obesity and cirrhosis? Obese heavy drinkers are now being shown to be at much greater risk. Professor Oliver James called obesity ‘the epidemic of the 21st century’ with strong increased risk of fatty liver as well as type 11 diabetes at the IMAG conference last year.

What is a binge? In many studies it is defined as consuming more than six units of alcohol in an evening. This can be as little as two good glasses of wine at 13%, which if consumed over a convivial dinner certainly does not constitute a binge. Dr. Elisabeth Wheelan highlights this problem in her commentary on the JAMA ‘adult excessive drinking’ research which courted much controversy in the US.

AIM and the WSA’s joint conference on self regulation and social responsibility offered some firm solutions regarding the role of the industry and the government in tackling key issues such as underage drinking, anti social behaviour, binge drinking and drink-driving. The lack of accurate statistics were highlighted many times however due to several factors: The lack of an international definition of a unit means studies from around the world cannot be accurately compared and contrasted. A unit varies from 8g in Britain to 19.75g in Japan and 12g in the US. Even definitions of light or moderate drinking vary between studies, making meaningful comparisons between data difficult.

The cost of alcohol misuse to industry and the cost to the health service offered another dilemma - it can be argued that cost benefits should be factored in too. 65 million people in Europe have late onset diabetes for example as Creina Stockley paper explores on page 12, moderate drinking by the obese (constituting 20% of the Australian adult population) reduces the risk of developing type 2 diabetes considerably, plus reduces the risk of cardiovascular disease in those with type 11 diabetes, let alone those without.

So, it seems, we have much to learn, or to clarify at least, if alcohol’s effect is to be properly understood, either on the body or in a social context.