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Do Wine and Health Go Together? In Conversation with Prof. David Nutt

Professor David Nutt is an English psychiatrist and neuro-psychopharmacologist specialising in the research of drugs that affect the brain and conditions such as addiction, anxiety, and sleep. He is the chairman of Drug Science, a non-profit which he founded in 2010 to provide independent, evidence-based information on drugs, and author of Drink? The New Science of Alcohol and Health (2020), among other books. In 2013 won the John Maddox Prize for Standing Up for Science.

Whether we admit it or not, fine wine is alcohol. And with this simple statement come a lot of very important conversation around the future of our industry. In December last year the European Commission approved the conclusion of a report from BECA – the European Parliament’s Special Committee on Beating Cancer – which stated that “there is no alcohol consumption without health risks.”

The European parliament will vote in a few days on whether or not they agree. EU members could face a series of restrictions, from alcohol pricing to restrictions in funding related to alcohol production.

Do Wine and Health Go Together? Conversation recorded on February 7th, 2022

Following is a shortened and lightly edited version of the conversation. The whole discussion is available on the podcast.

ARENI

My first question is really simple: according to the BECA statement, there is no alcohol consumption without health risk. Is that true?

Professor David Nutt

Well, the risks are different for different organ systems. It’s become clear that alcohol’s associated with eight cancers. The reality is, there is no safe level of alcohol that doesn’t increase your risk of cancer. So if you look very objectively, the threshold for alcohol consumption per year to have zero risk of cancer from alcohol would be one glass of wine a year. If you look at something like alcoholic liver cirrhosis, then [the risk is] much less; you’re down to one glass of wine a day. The risk for the different harms of alcohol varies quite a lot, but the truth is if the risks of cancer is increased by even a glass of wine a year, or two glasses of wine a year, then you really are in a situation where you can say there is no absolutely safe limit.

However, the important thing is not simply to say there is an increased risk, but how does that compare with other things you do? How does the risk of cancer from alcohol compare to, say, the risk of cancer from smoking or obesity or something? And then the second thing, and this is perhaps the most important issue to discuss, is are there benefits?

ARENI

Can we go back a bit and, and can explain quite briefly – you’ve written a book of 300 pages on the topic – what makes alcohol at any level of consumption so risky? What happens in our body?

Professor David Nutt

Alcohol itself is toxic. We preserve fruits in alcohol because the alcohol kills the bugs. We put alcohol on our skin to stop infections, so we know that alcohol is toxic to living cells. And that in itself is a risk for cancer, because if you damage cells, they’re more likely to become cancerous. So that’s the first thing. But the second thing is alcohol is inevitably metabolized from ethanol to acetaldehyde and that is an even more dangerous substance, because acetaldehyde can get into cells and disrupt the DNA, the genetic material of cells, and make them more likely to go malignant.

Alcohol is inevitably metabolized from ethanol to acetaldehyde and that is an even more dangerous substance, because acetaldehyde can get into cells and disrupt the DNA, the genetic material of cells, and make them more likely to go malignant.

Prof. David Nutt

The third thing, of course, is that alcohol changes behaviour. Classically, a lot of people smoke when they’re drinking. And of course tobacco smoke is very carcinogenic.

ARENI

What I understood from your book and from what you also explained briefly is the intake of alcohol increase the risk of developing some cancers, and that’s where it becomes complex because we are not equal in the face of risk and how much alcohol consumption increases our risk of developing cancer.

Professor David Nutt

We’ve known that for a very long time from tobacco smoking. There are some people who don’t get lung cancer from smoking tobacco. We don’t know why. We presume their DNA is more resistant to damage for some reason than other people. So yes, it’s very likely there will be genetic variations. It may be that alcohol is adding to a genetic vulnerability. I should also say, the risks from alcohol aren’t enormous. I mean, they might double the risk, but that still means that the risk is very low.

ARENI

One of the problems that our industry has with the statement is the no consumption of alcohol without risk. But event then, it’s not that much of a risk on the individual level.

Professor David Nutt

Indeed, that’s a fair point. So let’s just look at it in a little bit more detail. At one extreme, because alcohol is so widely used, it clearly contributes a significant burden to cancer. I think the estimates are maybe 5% or 6% of all cancers might be due to alcohol. But on the other hand, that’s hundreds of millions of people drinking.

ARENI

When we discuss this now famous statement, that there is no alcohol consumption of without risks, we always end up hearing the same argument, that this is based on bad science or incomplete science, because there is evidence that moderate consumption of wine can be good for your health. And people refer to the J curve.  

Professor David Nutt

The J curve is almost certainly an artefact of living in southern France and having a much better diet. It’s pretty difficult to show that the J curve really exists independent of other factors. If you live in a nice place with plenty of sunlight, you get high vitamin of D, high quality food, lots of Omega-3 fatty acids in your diet. Those together protect against heart disease. Where people have looked at alcohol intake in other cultures where you don’t have all those other factors, then it’s pretty hard to show that alcohol is beneficial. Could it be that red wine is protective? Possibly, but the evidence is getting less and less strong.

The J curve is almost certainly an artefact of living in southern France and having a much better diet. It’s pretty difficult to show that the J curve really exists independent of other factors.

Prof. David Nutt

The health benefits, if they exist, only exist for red wine. And if they exist for red wine, the effect is very small and probably only in men. And if you want to maximize your health benefits from red wine on your cardiovascular system, if you are a 65-year-old man, then it’s about half a glass of wine a day.

ARENI

One of the things we hear is yes, people drink too much alcohol. They should cut some spirits or they should cut some beer, but wine is different because it’s not consumed the same way. It shouldn’t be treated same way as beer and spirits. Is that true? Can we really claim an exception for wine?

Professor David Nutt

Not really, no. That wine drinkers have better health than spirit drinkers and often beer drinkers, although that’s questionable, depends on the country. It’s probably because wine drinkers are better off and more middle class. Alcohol is toxic, regardless of whether it comes in the form  beer, wine, or spirits; however spirits are particularly problematic if people drink them very quickly. In countries like Russia, where vodka is the normative drink, there are towns where half of all the men die from alcohol, probably of alcohol poisoning. So you’re more likely to die of alcohol poisoning.

There are two factors. You know, if you drink a whole bottle [of vodka], you might just die. Whereas it’s unlikely you’re going to die if you drink a whole bottle of wine. And the second thing is that wine drinking with food is almost certainly less harmful than wine drinking without any food. Food is protective in two ways. Firstly, it slows the absorption, so the speed of rise of alcohol is less and that means you get less intoxication. And also food contains things like vitamins, which you need to keep alive. People who focus their drinking on spirits often do it at the cost of food, and so they end up with more harm from their vitamin deficiencies.

There is one thing that’s important to say here: drinking to intoxication is more dangerous, particularly for the heart and for the brain. Binge drinking of wine is more harmful than the drinking of wine with meals that we tend to see in places like France.

ARENI

Could wine be seen as part of a healthy diet?

Professor David Nutt

Well, you would never say part of a healthy diet, but you could say drinking wine with a diet is better than just drinking wine alone. There’s a big study in London of civil servant showing that even moderate alcohol intake did have negative effects on brain in the elderly. So the elderly population are likely to be, if anything, more vulnerable to alcohol than the young.

ARENI

I’ve also read study that says that red wine in particular is contributing to the fact that women have less Alzheimer’s disease and less degenerative disease.

Professor David Nutt

They’re all associations. No one’s ever done a controlled trial. There was this attempt in America about 10 years ago to get the drinks industry to fund an enormous study of thousands of people, either drinking or not drinking, to look at cardiovascular risk. In the end, the media hysteria stopped it. So we will never have absolute objective science. We will never do an experiment where we take one country and we give them wine, another one where we don’t give them wine and see how long they all live. That will never happen. So all our assessments are correlative rather than positive.

We will never have absolute objective science. We will never do an experiment where we take one country and we give them wine, another one where we don’t give them wine and see how long they all live. That will never happen. So all our assessments are correlative rather than positive.

Prof. David Nutt

So you can’t say that wine is protective and I can’t prove that wine does contribute to cancer. We don’t really have a mechanism to understand why it might be protective other than the antioxidants in red wine, which have been tested separately to in cardiovascular health and not shown to do very much.

ARENI

There’s a part of me that thinks that it doesn’t really matter. Wine shouldn’t be promoted as something healthy, or with health benefits. There so much more to say! And when you read the BECA statement, which there is no alcohol consumption without health risks, to me it sounds the same as saying that every time you cross the street, you have a higher risk of being involved in a road accident. All we have to do is educate our kids and teach them to cross the street and minimize their risk.

Professor David Nutt

Exactly. We all know there’s a risk of driving a car, but have a car because it improves our quality of life in terms of doing things.

ARENI

One of the things that you say in your book that also really resonated with me is that when we say “Drink Responsibly” on the label, the alcohol industry is actually transferring its health responsibility to the drinkers. Let’s say that I’m a wine bar owner that’s genuinely concerned about the long-term wellbeing of my staff and my clients, or a winemaker who understands that ensuring long term wellbeing is part of my sustainability crusade. What should I do?

Professor David Nutt

About 20 or 25 years ago, Pierre-Hugues Roche, a professor in France, conducted a really major assessment of drug and drug harms in France. And he concluded that alcohol was the most harmful drug in France, but he also included the fact that something like 30% of French people were employed one way or the other in the drinks industry. And he made a few suggestions. The first thing he said was, let’s get rid of cheap wine. And that was brilliant because one thing for sure is the more expensive the wine, the less people drink.

But the second thing is there’s more profit, so that the French wine industry is now more profitable because each bottle is making more money because it’s better quality. The second thing is he reduced the drink driving limit, and that massively reduced deaths on the road. And then he had this campaign to get pregnant women to cut drinking to significantly reduce the dangers to children, fetal alcohol syndrome. And they succeeded there. And then the fourth thing was to get rid of alcohol advertising. You now have lower levels of cirrhosis in France than we have in England and Scotland. It was one of the greatest social health innovations. It’s fantastic.

ARENI

There is a lot of socioeconomic discussion around alcohol and in France there’s a way of saying that poor people drink a lot of cheap things and those are the alcoholics. But alcoholism and health problems are something that we see through all classes.

Professor David Nutt

There’s one thing I need to say about the rich versus poor argument, because it’s true across the world. Rich people get a lot less harm from alcohol than poor people. And that’s a fact, but that’s nothing to do with even the same amount of alcohol, it’s because they’ve got protective factors. They get looked after better, they have better diets. Usually, they have better healthcare, they have less stress in their lives. The rich are always going to do better.

ARENI

As you’ve mentioned, you do not improve your health by drinking wine. But in your book, there’s research that shows that people who drink socially tend to have more friends, a key source of mental wealth. I find that an interesting paradox. We can say there is no benefit for our physical health, but if we control the consumption, then it can be a benefit for our mental health.

Professor David Nutt

I drink wine. Alcohol is my favorite legal drug. A world without alcohol would be a considerably less interesting and amusing and interactive place. Alcohol is the great giver of comity. It breaks down social barriers, particularly when drunk socially in bars, restaurants, clubs, et cetera. I’m a bit against drinking at home. I think one of the problems we have in Britain with a big rise in alcohol problems is a lot of people just sit in front of the TV and swill alcohol without getting the social benefits.

But in social situations, alcohol is just an amazing drug. I think the social benefits of alcohol are enormous and that’s why I’m not campaigning to ban alcohol. That would be absurd. I think the benefits socially completely outweigh the health risks for small amounts of alcohol. If you drink within the limits, the benefits outweigh the risks.


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