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 vascular disease.

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 ages.

Dr Philip Norrie is a General Practitioner, author of Wine and Health and a member of the AIM Editorial Board.