Reviews of previous data have shown a strong positive relationship
between moderate alcohol consumption and longevity, with moderate
drinkers (< 30g a day) recording between a 20% and 50% reduction
in mortality due ,largely, to a reduction in coronary heart disease.
The aim of the study by Professor Leon Simons (Associate Professor
of Medicine , University of New South Wales and head of Blood
Lipid Research Department, Vincents Hospital, Sydney) was to examine
the relationship between alcohol intake and survival in elderly
people. Since 1988 a team of researchers lead by Professor Simons
have been conducting an ongoing prospective study in Dubbo, a
rural town in central New South Wales with a population of 34,000.
Included in the study were all non-institutionalised people aged
> 60 years (1,235 men and 1,570 women).
Reported in the Medical Journal of Australia on 7th August 2000
(Vol. 17.3 pages 121-124) was the latest review of the data after
116 months (nearly 10 years). This review again showed a similar
result with the studys conclusion stating "moderate alcohol intake
in the elderly appears to be associated with significantly longer
survival in men 60-74 years and in all elderly woman". Regardless
as to whether beer, wine or spirits were consumed, the protection
effect observed was basically similar. The only separation of
drinking behaviour noted in the trial was into beer and other
(i.e. wine and spirits), because most Australian men > 60 years
and living in rural areas would drink beer.
A "threshold benefit effect" was shown by the Dubbo study as alcohol
intake was significantly associated with reduced all cause mortality
in both sexes even in the minimum consumption category of 1-7
drinks/week compared with abstainers. In terms of future health
strategies and recommendations about the question of suggesting
whether abstainers should begin to consume alcohol or not the
threshold benefit effect is very important.
In the Dubbo study the quantity of alcohol intake was highly correlated
with HDL (High Density Lipoprotein) or good cholesterol levels.
HDL takes LDL (Low Density Lipoprotein) or bad cholesterol from
atheromatous plaques in vessel walls back to the liver to be metabolised,
therefore it is not necessarily ones total cholesterol that is
so significant anymore, but how high ones HDL level is in preventing
Other mechanisms that explain the health benefits of drinkers
include favourable effects of alcohol on clotting mechanisms,
reduced insulin resistance and improved function of the endothelium
(inner lining of vessel walls) through increased nitric oxide
production. Nitric oxide makes microscopic vessels within larger
walls dilate thus improving blood flow within larger vessel walls
to make them healthier and with healthier vessel walls and enothelium
less atheroma develops.
Excess alcoholic intake is known to be toxic to the central nervous
system but the Dubbo study showed a moderate intake of alcohol
reduced the risk of dementia. The hospitalisation rate for dementia
in abstainers during the 116 months of follow up of the Dubbo
study was 4.3 per 100 people while in drinkers it was only 2.5
per 100 people. This could be due to better blood flow within
cerebral vessels, both large and small microscopic, as well as
the role of antioxidants in protecting nerve cells from the harmful
effects of toxins such as free radicals and other toxic chemicals.
Findings from other studies
In 1997 in Professor Orgogozos Bordeaux study, the relative hospitalisation
rate for dementia was 4.9/100 for abstainers and 3.9/100 for drinkers.These
findings correlate with research from a team led by Dr Jorge Cervilla
at the Institute of Psychiatry in London. Reported in the British
Journal of Psychiatry (August 2000) was research by Dr Cervilla
et al that moderate drinking could reduce the impact of ageing
on the brain. The report stated that "moderate alcohol intake
could protect against cognitive deterioration in late life".
Over 12 years the mental ability of 400 people aged 65-74 years
was tested. Lower rates of mental decline was seen in those who
indulged in moderate alcohol consumption, whereas teetotallers
whilst under 60 showed some of the highest losses of mental agility
as they aged. A similar relative rapid loss of cognitive function
was seen in abusers of alcohol.
Doctors should no longer be afraid to recommend a drink a day
to abstainers, (unless for religious or other health reasons).There
is an increasingly strong case to recommend drinking alcohol in
moderation to improve the quality of life and health of the elderly,
as well as its role in preventing vascular disease amongst all
Dr Philip Norrie is a General Practitioner, author of Wine and
Health and a member of the AIM Editorial Board.