A fermented mood enhancer rich in antioxidants and fortified with protein, the Peruvian Pisco Sour is a cocktail of contradictions that might pass off as an undercover health tonic. Are some of our popular social lubricants just as bad as they seem?
When Health Is Wealth
In 1979 the government advised men to drink no more than 56 units of alcohol per week. This was later reduced to 36 units, then 28 units and then 21 units. By 2020 Sally Davies, the Chief Medical Officer, had reduced it to 14 units. She also asserted that there is no safe level of drinking and that the health benefits of moderate alcohol consumption were ‘an old wives tale’.
The WHO recommend drinking no more than 14 units of alcohol a week, spread across 3 days or more. That’s around 6 medium (175ml) glasses of wine, or 6 pints of 4% beer. Before answering the question of whether or not we can trust health advice we must first ask: ‘which health advice?’ As the statistics vary so much over time and between countries.
In a few commonly referenced epidemiological studies the relationship between alcohol consumption and mortality is ‘J shaped’. Meaning the risk of death declines substantially at low levels of alcohol consumption and then rises. However there are some studies that suggest it does not reach the level of a teetotaller until the person is consuming somewhere around 40 and 60 grams of alcohol a day, which is to say between 35 and 50 units a week.
What is a safe level of drinking? Sally Davies says there isn’t one. In so doing she is encouraging the public to believe that the only safe level is zero. But that is not what the epidemiology always shows. In some studies, it would appear that you can drink significantly more than 14 units a week, or two units a day, and have a lower mortality risk than a teetotaller.
Confounding factors and study limitations aside, statistics at a national level are just as much about politics as they are about health. For example it is our values and beliefs that dictate the ways in which we prioritise the opportunities and trade-offs involved in an analysis.
In behavioural economics, ‘anchoring’ is the strategy of putting a higher or lower target in mind than the one you hope people will realistically aim for. For example, telling guests to turn up to a dinner party at 6pm, because you know that in reality most people will aim for a culturally acceptable and ‘fashionable’ form of disorganised lateness.
Setting the standard of ‘the norm’ is what affects individual and collective perspectives of deviant behaviour. The issue with public health is that it often attempts to categorise a non-binary existence into either ‘good or bad’. The focus is also usually a ‘best on average’ approach over a ‘no one size fits all’ approach – efficiency over effectiveness.
The Good, The Bad and The Fugly
Not all alcohol is created equal – when it comes to health benefits and risks, factors such as the type, processing and strength of alcohol are just as important as how we use it. ‘Moderation’ is the favoured buzz word, but how much is too much?
This is where some of the fuzzier elements of what defines an addiction also come into play. A grey scale standard acknowledges that a pathological addiction is the pursuit of a behaviour or substance, despite consistently negative overall consequences (health, social and legal) on the quality of life.
While there are many factors that contribute to an addiction, including genetic and environmental influences, socioeconomic status, and pre-existing mental health conditions – most professionals within the field of addiction agree that there are four main stages of use: experimentation, regular use, high-risk use, and dependency.
Not everyone in the first two stages of this process will develop an addiction, but individuals within the third stage are extremely likely to progress into full-blown dependency. To some degree, this is also a matter of context.
A habitual cannabis user who takes cannabis recreationally on a day to day basis, or someone that relies on a few cups of coffee to make it through the day – might be considered addicted or dependent at the lower end of the spectrum. If that same person is prescribed medical cannabis in the clinical setting (for mood / sleep or other lifestyle factors), this is now considered a medicine.
An interesting narrative is emerging in the legal cannabis industry. When pressed about the nature of withdrawal from medication, many doctors have flipped the narrative, explaining that while the symptoms remain the same – they are now evidence of an abnormally under-active endocannabinoid system. This centres around a shift in what defines ‘the norm’ for an individual.
In some cases, there are elements of truth to this. For example there are studies emerging that demonstrate that a particular type of migraine may be associated with endocannabinoid system signalling. In medical treatment, the opportunities and trade-offs of taking any medication with side-effects are also tempered against the disadvantages of the underlying condition.
At the same time, there are also many reasons to consider recreation and pleasure as other forms of wellbeing – one that is not simply the absence of disease. Isolating alcohol, caffeine or cannabis as a substance that is ‘unhealthy’ is misleading and narrow.
As well as the social benefits, some alcohol has been shown to be able to balance blood sugar levels in some individuals, making them less prone to type 2 diabetes. In a similar way, vinegar – which is a combination of acetic acid and water made by a two-step fermentation process, is able to lower the glycemic index of many starchy foods. This may be where the tradition, or ‘old wives tale’ of sprinkling vinegar on your chips comes from.
A CockTale of Conclusions
There is no doubt that heavy drinking and cultural binge drinking takes a toll on society and the body, and appreciating the complexity that defines a truly holistic approach to health can often be a minefield. Especially when we lack crucial pieces of the puzzle such as any meaningful insights into our own genetic makeup.
Alcohol is one of the most popular psychoactive substances in the world and can have powerful transient effects on our mood, behaviour and mental state. Its consequences can range from a positive impact on our health and social wellbeing, to a complete catastrophe.
Either way, if you believe the notion that booze used to be safer to drink than tap water, then our reliance on the forbidden fermented fruit is part of the reason we are here to make these evaluations today.
A teacher once attempted to show a group of students how dangerous alcohol is by dropping a few worms into a glass of beer. The worms wriggled and quickly died. Prompting her class for the moral of the experiment, one student replied “if you drink alcohol – you won’t get worms”.