Alcohol consumption-none is better than alittle.

Abstract

Alcohol is socially accepted and widely consumed as arecreational beverage. Furthermore, it is used as adisinfectant for medicinal purposes and as acultural asset it is also part of religious rituals. However, it is also an intoxicant and an addictive substance. The deleterious side of alcohol is reflected in the fact that around 3million people worldwide die every year as adirect or indirect result of alcohol consumption. For several decades, epidemiological studies suggested that drinking alcohol in moderate quantities was beneficial. This was referred to as the "French paradox," which described differences in mortality between France and Finland mainly, but also other countries, that were found in epidemiological studies. The difference in the levels of alcohol consumption was found to explain the differences in mortality in view of the otherwise similar risk factors. When alcoholic drinks per day were plotted against all-cause mortality this led to aJ-shaped curve. This finding represented awindow of benefit for moderate alcohol consumption. However, the recent publication by Zhao etal. in 2023 revisited the relationship between the quantity of alcohol consumed and mortality risk and led to aparadigm change, which has influenced not only the recommendations of Canada's Guidance on Alcohol and Health but also the recommendations and guidelines of major health organizations: "No alcohol is better than alittle." The J‑shaped curve as an explanation of the French paradox became alinear relationship between the amount of alcohol consumption and the increasing mortality from tumors and cardiovascular diseases. The renewed review of several control groups in previous epidemiological studies revealed arecruitment error due to the inclusion of abstinent ex-drinkers. Taking this bias into account, the alcohol-friendly view of small amounts of alcohol being cardioprotective had to be revised. The combined misuse of alcohol and other risk factors for carcinogenesis and heart diseases still needs further attention. The misuse of both alcohol and cocaine led to the conclusion that when the two risky substances are consumed together, it is even more detrimental than the mere sum of the two.