What’s New?

The widespread criticism of alcohol often misses a vital point: how these health risks pertain to you personally.

Why It Matters

In the discourse surrounding alcohol, both proponents and critics aim to sway your opinion in their favor rather than allow you to form an independent judgment. To achieve that independence, it's essential to recognize how statistics can be manipulated to induce unnecessary worry.

What’s Next?

This article serves as your initiation into informed dissent—not just against the extreme anti-alcohol stance but possibly against my own perspective as someone who enjoys Spanish Reds. The goal is to promote a new approach of Responsible Reassurance that health advocates should incorporate into their messaging.

This Post’s “Aperitif”

“Even a single glass of red wine at dinner is carcinogenic.” This statement comes from oncologist Dr. Waqqas Tai on his popular TikTok channel, which quickly gained substantial attention.

Health advocates often prioritize spreading concern over providing reassurance. The former is perceived as knowledgeable, while the latter is seen as naive. Unfortunately, this anxiety-driven narrative contributes to a health misinformation crisis fueled by attention-seeking figures on social media. Thus, a new ethical approach of responsible reassurance is urgently needed.

This article aims to provide that framework.

It is not about taking sides in the “to drink or not to drink” debate akin to Hamlet’s soliloquy. Instead, it focuses on revealing the statistics related to alcohol's links with cancer and cardiovascular disease, empowering you to determine how much weight to give to the concept of abstinence.

As someone who has a deep appreciation for Spanish Reds, remaining neutral is a personal challenge. However, rather than engage in endless debates about what is best for readers, I advocate for informed dissent. I present information, and you can decide whether to agree with my stance or that of Dr. Waqqas and others.

Focusing on alcohol's relationship with cancer and cardiovascular disease—two primary causes of disability and mortality—is essential.

I’ll help clarify the statistics and demonstrate how authorities often twist them to advocate for complete abstinence.

By the end of this article, you will have the tools to either agree or disagree with the information presented, but more importantly, you'll know how to base your decisions on data rather than ideology. You will not only grasp the statistics I share but also learn how to interpret them when faced with future lifestyle choices.

Alcohol and Cancer

What is a Carcinogen?

Dr. Waqqas referred to alcohol as carcinogenic. Here’s what the U.S. National Institutes of Health (NIH) states:

1. "A carcinogen is any substance that can cause cancer."
2. "Exposure to a carcinogen does not necessarily mean you will get cancer."

The National Toxicology Program lists 256 substances recognized as definitive, probable, or possible carcinogens. Alcohol is one of 64 definitive agents, alongside ultraviolet sunlight and tamoxifen, a breast cancer medication.

Unlike a vampire, few would advise avoiding sunlight entirely. Similarly, oncologists do not deny tamoxifen treatment to breast cancer patients, as its benefits in combating cancer far outweigh the risks of inducing another type of cancer. This concept is known as relative risk (RR), which is crucial to understand.

How Cancer Risk is Communicated

The U.S. National Cancer Institute (NCI) states:

"Moderate to heavy alcohol consumption is associated with a 1.2 to 1.5 times increased risk of cancers of the colon and rectum compared to non-drinkers."

This translates to a 20% to 50% increase in risk, based on a 2015 meta-analysis that categorized alcohol consumption as follows:

• Light: ?12.5 g/d (about one can of beer)
• Moderate: 12.5–50 g/d (approximately half a liter of wine)
• Heavy: >50 g/d

According to the Breast Cancer Research Foundation:

“Women who consume one drink a day have a 7–10% increased risk compared to non-drinkers, while those drinking 2 to 3 drinks daily have about a 20% higher risk.”

While these percentages may sound alarming, it’s important to consider them in context. The baseline for comparison is the rate of cancer incidents among non-drinkers, who also develop cancer.

Cancer Risk Put in Perspective

To emphasize the importance of the baseline, consider a 2021 cohort study involving 11.7 million adults aged 40 and older who underwent health examinations in 2009/2010 and were followed for an average of 6.5 years until they either developed gastrointestinal (GI) cancer or the study concluded in 2017.

Participants were categorized based on their alcohol consumption levels: non-drinkers, mild, moderate, or heavy drinkers, with relatable beer equivalents:

• Nondrinkers: (0 g/week)
• Mild drinkers: (0–104 g/week) = 1 glass of beer/day
• Moderate drinkers: (105–209 g/week) = 2 glasses of beer/day
• Heavy drinkers: (?210 g/week)

Compared to non-drinkers, moderate drinking raised the risk of GI cancer by 23%. One might quickly conclude that this is significant enough to reconsider drinking habits.

However, examining the absolute numbers reveals a different story. Among non-drinkers, 2.6% developed cancer, while 3.2% of moderate drinkers did.

Visualize this: out of 100 non-drinkers, nearly 3 (2.6) develop cancer, while slightly more than 3 (3.2) moderate drinkers do. This is the reality behind the 23% increase.

Your Basis for Decision-Making

Here’s the critical question in your decision-making process:

How many moderate drinkers need to stop drinking to prevent just one case of cancer? This figure is known as the number needed to treat (NNT), which is easily calculated:

NNT = 1/ARR

Where ARR = absolute risk reduction; in this case, it is 3.2% - 2.6% = 0.6%.

Thus, NNT = 1/ARR = 1/0.006 = 167.

This means that if 167 moderate drinkers quit alcohol, one would avoid developing GI cancer. The remaining 166 would give up drinking without any cancer benefit, as they wouldn’t get GI cancer even if they continued.

Put another way, the odds against developing cancer while remaining a moderate drinker are 166:1.

I extrapolated this study's findings over a period of 10 years, which aligns more closely with typical risk-prediction tools used in clinical settings. Even after a decade, the NNT remains at 115.

With these statistics, you can make an informed decision by weighing the absolute risk reduction and NNT against the enjoyment you derive from moderate drinking. You do not have to blindly accept recommendations from Dr. Waqqas or myself.

An Illustrative Example

To understand how absolute risk impacts perception, consider this hypothetical scenario: if the disease risk among non-drinkers is 10% instead of 2.6%, with the same relative risk of 23%, moderate drinkers would then have an absolute risk of 12.3%. The NNT would drop from 167 to 43, and the odds would shift from 166:1 to 42:1.

This demonstrates how absolute risk can significantly alter the perception of relative risk. Relative risk loses its weight when viewed through the lens of absolute risk.

Your First Two Takeaways: - The smaller the absolute risk, the less compelling the relative risk. - The smaller the absolute risk reduction, the larger the NNT.

Alcohol and Cardiovascular Disease

Let’s examine the numbers from a 2015 analysis of the Prospective Urban Rural Epidemiological (PURE) study, which included 114,970 participants aged 35–70 years.

This study assessed the correlation between various alcohol consumption levels and cardiovascular disease outcomes over an average follow-up of 4.3 years.

Current drinkers faced a 24% increased risk of any cardiovascular event (such as heart attack or stroke) compared to non-drinkers.

As with the cancer data, I extrapolated these findings to a 10-year period.

The absolute 10-year risk for non-drinkers was 5.17%; for current drinkers, it was 5.55%.

This results in an ARR of 0.38% and an NNT of 263, meaning the odds of avoiding a cardiovascular event over the next decade while continuing to drink are 262:1.

What Do Genetic Studies Tell Us?

The observational studies discussed earlier indicate associations between drinking habits and disease occurrences but do not confirm causation.

To establish causation, randomized controlled trials (RCTs) would be necessary, but ethical considerations prevent such studies. It is impractical to instruct individuals to abstain from alcohol or to drink varying amounts over several years just to track disease outcomes.

Fortunately, genetic variants offer an alternative method to conduct this type of analysis.

If certain genetic variants lead individuals to consume more alcohol, and if these individuals have a higher incidence of cancer or cardiovascular disease, then alcohol could indeed be a contributing factor.

Such studies are termed Mendelian Randomization (MR) studies. For a causation conclusion to be valid, three criteria must be met:

1. There must be a strong association between the variant and alcohol consumption.
2. The variant must not be linked to any other confounding genetic variant affecting disease outcomes.
3. It should only impact the outcome through its association with exposure (i.e., alcohol).

A study utilizing data from 368,000 individuals in the UK Biobank investigated the relationship between alcohol consumption and cancer.

The findings challenged prevailing health narratives:

“We found no evidence supporting a relationship between alcohol consumption and overall cancer risk.”

However, this does not invalidate all observational research.

The Problems with Genetic Studies

MR studies exploring the alcohol-cancer and alcohol-CVD associations face inherent challenges.

First, the genetic variants associated with alcohol consumption significantly influence intake in Asian populations, but not in Europeans. This is due to a gene affecting an enzyme related to alcohol metabolism—specifically, acetaldehyde, which is carcinogenic, not alcohol itself.

Carriers of a variant of this gene experience flushing reactions and less enjoyable drinking experiences, leading them to abstain or consume less alcohol. This variant is notably more common among North Asians than Europeans, which complicates the first criterion.

Second, while researchers included additional genes potentially linked to drinking, it remains uncertain whether these genes are tied to other confounding factors, violating the second criterion.

Thus, MR studies demonstrate a lack of evidence for alcohol-cancer causation, but lack of evidence does not equate to evidence of absence.

If you encounter someone referencing this MR study to assert that alcohol does not cause cancer, be skeptical, just as you would with Dr. Waqqas’s claims.

Conclusion

How does Dr. Waqqas’s assertion that “even one glass of red wine is carcinogenic” resonate with you now?

His medical education should have equipped him with an understanding of the absolute versus relative risk distinction. If it didn’t, his oversight isn't entirely his fault; he has likely been influenced by health authorities aiming to obscure this issue.

Their focus is on public health metrics rather than individual patient concerns. The more individuals they can deter from responsible drinking, the better their metrics appear. They often disregard the enjoyment that moderate drinkers have derived from alcohol throughout history.

The World Health Organization is a primary player in this narrative.

"Risks start from the first drop."

Conversely, the inability of MR studies to link alcohol consumption with disease should not encourage irresponsible drinking habits.

Your best approach is to evaluate the statistics I presented. If they lead you to abstain from wine, beer, and spirits, that is perfectly acceptable. If they don’t, that is equally valid.

The goal here is responsible reassurance, which I aimed to provide through this article.

Responsible reassurance supports your informed dissent—whether that be with Dr. Waqqas’s viewpoint or my own lifestyle choices.

What I Do

If you have perused some of my previous writings, you may have noted my fondness for a daily glass of Spanish Red and an occasional beer after a day of cycling. I wouldn’t want to miss these experiences, as I identify as a moderate drinker.

For me, the data presented do not warrant sacrificing these pleasures. My informed dissent lies with health absolutists who attempt to strip away enjoyment from life.

Now, I turn the discussion to you. I’m eager to know your stance on alcohol and whether my article has influenced your perspective.

Cited References

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