Why drinking the Mediterranean way is healthier

A recent letter in the British Medical Journal suggests that how alcohol is consumed should be given more emphasis when advising on alcohol limits. The British government recently reduced its recommended limit to 14 units per week for both men and women (previously 21 units for men), and justified this decision by stating that for some cancers, such as those of the mouth, throat and breast, “risk increases with any amount you drink”. Some drawbacks in making this general recommendation are discussed in the letter.

The authors point out that the traditional Mediterranean diet is one of the healthiest in the world despite including low to moderate alcohol consumption. Many studies have demonstrated the cardioprotective effects of moderate drinking, especially as part of a Mediterranean diet, and there is increasing evidence linking the Mediterranean diet with a decreased risk of dementia. And the stress-reducing benefits that a drink or two bring to many people should not be dismissed.

The more contentious issue is the relationship between low alcohol consumption and cancer risk. Here, drinking as part of a Mediterranean diet may be particularly important. For example, a study – part of the respected Predimed study – found that women who ate a Mediterranean diet had a reduced risk of breast cancer, even though almost half were drinking up to two units of alcohol (a 175 ml glass of wine) a day. This contrasts with studies showing that women consuming even low amounts of alcohol as part of a western-style diet were at increased risk of breast cancer. One explanation may be that foods in the Mediterranean diet, including vegetables, pulses, whole grains and olive oil, contain protective substances that help counter alcohol’s harmful effects. For example, extra virgin olive oil contains various anti-oestrogens that block the carcinogenic actions of oestrogens. Also, a large European study found that folates – present in large quantities in green leafy vegetables and pulses – protect against the effects of alcohol. However, it is still the case that women with a family history of breast cancer are advised to avoid drinking. The Mediterranean diet has also been found to reduce the risk of mouth and throat cancers even when low to moderate alcohol is consumed, again contrasting with the generalised government guidelines that the risk of these cancers increases “for any amount you drink”.

The Mediterranean way of drinking – moderate alcohol intake spread out over the week, a preference for red wine drunk with meals, little intake of spirits, and an avoidance of binge drinking – is also key. In the Million Women Study there was no increased risk of these cancers for women drinking up to two units a day, so long as they were non-smokers. So if most drinking occurs during a meal then the hazards from smoking become less likely, since most people do not also smoke while eating. Food in the stomach is also well known to reduce dangerous spikes in blood alcohol levels that are linked to high blood pressure and strokes.

Eating guidelines now recognise that the health benefits of diets are best explained by considering diets in their totality, rather than by isolating individual foods or nutrients such as sugar or saturated fat. And there is good reason to apply the same thinking when weighing up the risks and benefits of drinking alcohol. There is little doubt that heavy drinking increases the risk of various cancers, and even low alcohol consumption may do so with certain diets such as those high in processed foods. But the evidence suggests that the Mediterranean diet – even one including low to moderate alcohol consumption – is beneficial to overall health.

Richard Hoffman
University of Hertfordshire, Hatfield AL10 9AB, UK

 

Publication

Alcohol consumption-the importance of context.
Hoffman RM, Gerber M
BMJ. 2016 Feb 4

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