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To be teetotal or not

In summary, any form and any amount of alcohol consumption is unhealthy for the brain.

Photo by Hush Naidoo on Unsplash

He was only 64 when his daughter noticed that his forgetfulness had started to impact on his ability to function independently. Her father had forgotten to pay the gas and electricity bill and social services had contacted her as next of kin to find out why. It was clear that years of excessive alcohol was having an impact on his memory.

The scenario above is one that is played out across society thousands of times if not hundreds of thousands of times. This is why the study below from the UK biobank is so worrying; when it comes to brain volume, a crude measure of the brain's neuronal and cognitive reserve, there is no safe alcohol consumption limit.

Importantly, comorbidities such as high blood pressure and obesity interacted with alcohol consumption to reduce brain health. Not surprisingly binging on alcohol made things worse and this was over and above the volume of alcohol consumed.

For those who think some forms of alcohol consumption can be part of a brain health diet think again. There is also no evidence for a differential effect between wine, beer or spirits, which on a personal level I find rather disappointing as wine is my favourite tipple.  

Topiwala et al. No safe level of alcohol consumption for brain health: observational cohort study of 25,378 UK Biobank participants. medRxiv doi: https://doi.org/10.1101/2021.05.10.21256931

Objectives: To estimate the relationship between moderate alcohol consumption and brain health, determining the threshold intake for harm and identifying whether population subgroups are at differential risk.

Design: Observational cohort study. Alcohol consumption was determined at baseline assessment visit using touchscreen questionnaire (2016-10). Multi-modal MRI brain and cognitive testing were performed subsequently (2014-20). Clinical data was extracted from linked Hospital Episode Statistics.

Setting UK Biobank study: Brain imaging was performed on identical scanners with identical protocols at three UK centres (2014-20).

Participants: 25,378 participants (mean age 54.9±7.4 years).

Main outcome measures: Brain health as defined by structural and functional MRI brain measures.

Results: Alcohol consumption was negatively linearly associated with global brain grey matter volume (beta= -0.1, 95%CI= -0.11 to -0.09, p<2×10−16). The association with alcohol was stronger than other modifiable factor tested and robust to unobserved confounding. Widespread negative associations were observed with white matter microstructure (beta= -0.08, 95%CI= -0.09 to -0.06, p<2×10−16) and positive correlations with functional connectivity. Higher blood pressure and body mass index increased risk of alcohol-related harm (SBP*alcohol: beta= - 0.01, 95%CI = -0.02 to -0.004, p=0.005; BMI*alcohol: beta= -0.01, 95%CI = -0.02 to -0.002, p=0.02). Binging on alcohol had additive negative effects on brain structure on top of the absolute volume consumed (daily compared to never binging: beta= -0.19, 95%CI= -0.30 to -0.08, p<0.01). No evidence was found for differential effects of drinking wine, beer or spirits.

Conclusions: No safe dose of alcohol for the brain was found. Moderate consumption is associated with more widespread adverse effects on the brain than previously recognised. Individuals who binge drink or with high blood pressure and BMI may be more susceptible. Detrimental effects of drinking appear to be greater than other modifiable factors. Current ‘low risk’ drinking guidelines should be revisited to take account of brain effects.

Conflicts of Interest
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Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not reflect the position of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust.
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Comments

  1. Tom26 May 2021 at 08:32

    Problem is many will lose their drinking buddies.

    ReplyDelete

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