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Wine, health, and the fool's gold of "zero risk"

Over the last year, there has been a steady drumbeat of anti-alcohol messaging percolating out into newspapers and magazines around the world. This messaging is due in large part to a coordinated campaign led by the World Health Organization (WHO), who published a news release in January titled No level of alcohol consumption is safe for our health and last week proposed that governments worldwide double their taxes on alcohol to drive down consumption. This is an important change from their last major initiative from 2010, which was designed to reduce the harmful use of alcohol

The negative health effects of the abuse of alcohol are well documented. But the data on light to moderate consumption of alcohol, and particularly wine, is much more equivocal. Low levels of alcohol consumption appear to have modest protective effect on cardiovascular disease and diabetes, and a small negative effect on certain cancers, most notably throat, breast, and colorectal cancer. There is a great article by Felicity Carter in Meininger's International that dives into the data. She points out that the same massive data set on which the WHO based its new recommendations was later analyzed by the Journal of the American College of Cardiology (JACC), which came to five main conclusions:

  • Regular moderate alcohol consumption protects against fatal and nonfatal CVD and all-cause mortality, both in healthy adults and in CVD patients.
  • The dose-effect relationship is characterized by a J-shaped curve.
  • For light-to-moderate levels of alcohol consumption, the risks of some cancers (breast, colorectal, oral) are relatively small and should be considered in the context of each individual global risk.
  • Lifelong alcohol abstainers should not start drinking for health reasons only, but should be encouraged to adopt healthy lifestyles (regular physical activity, no smoking, weight control, and dietary habits such as the Mediterranean diet).
  • Excessive or irregular (binge) alcohol use is detrimental to human organs and function and is a major public health and social problem.

I'll share the JACC's image of the J-shaped curve, which puts in graphical form the idea that the extremes (total abstention and high consumption) are both higher-risk than low-to-moderate consumption:

JACC J-shaped curve

This all matters because these sorts of stories drive consumer behavior. A recent Gallup poll showed sharp increases in the percentage of Americans who believe that moderate drinking is harmful:

2023 Gallup poll on alcohol perception
The increase in the perception that moderate alcohol consumption is bad for health was driven largely by younger Americans (age 18-34). This suggests there's good reason for the worry in the wine world that Millennials and Gen-Z may not pick up the baton in wine consumption as Boomers and Gen-X start to age out of their prime wine purchasing years. Not only is wine competing with other forms of alcohol -- not to mention cannabis, which was seen in the Gallup poll as less harmful -- but the changes in perception are driving the rise in movements like Dry January and sober-curious

If the data around moderate alcohol use and mortality is -- at worst -- equivocal, wine seems likely to be comparatively less harmful and more helpful than beer and spirits. After all, it's made from fruit (rather than grain or sugar), it includes heart-healthy compounds like resveratrol and other polyphenols, it's been linked to long lifespans in places like Gers, France, the home of Tannat, and it's more likely to be consumed with a meal instead of on its own, which slows the absorption of alcohol in the blood and seems likely to also have positive interactive effects as a part of the Mediterranean diet.

So why is the WHO taking such a strong stance against alcohol, collateral damage be damned? I'm sure it's hard for an organization tasked with optimizing health outcomes to roll out a nuanced policy on a product that is capable of causing such harm when misused. If they did, it would probably look something like this summary from the Harvard School of Public Health. It would look at whether you were by family history more predisposed toward cardiovascular disease or cancer. It would look at your age and drinking history. It would make recommendations on how you drink as well as how much.

Back to the WHO's press release. In one key paragraph, they say "To identify a “safe” level of alcohol consumption, valid scientific evidence would need to demonstrate that at and below a certain level, there is no risk of illness or injury associated with alcohol consumption." Whatever you think of their analysis of the data (and I think they're setting an impossible standard of evidence) my bigger question is this... is our decision tree about what to do supposed to be driven by zero risk? I do things every day that have non-zero risk. So do you. Some of the things I've done in the last week include driving (risk of accidents), road biking (risk of crash), hiking (risk of injury), and attending sporting events (risk of contagion). Our goal in life shouldn't be to eliminate risk. It should be to properly evaluate it and weigh that risk against any potential benefits.

Maybe the WHO has concluded that a broad-based attack on all alcohol is the only way to get at the problem drinkers and the personal and societal harm they cause. And it's important that we as a society and an industry wrestle with that challenge. But none of that changes the overall picture for the individual consumer. Moderate alcohol consumption is unlikely to either significantly increase or decrease your health outcomes. I'm suspecting that if you're reading this blog, you've already decided that it increases your pleasure.

Consider yourself a risk taker.