Alcohol and heart disease Drinking advice inconsistent and unscientific

EDITOR, - John Kemm claims that advice about drinking to individual members of the public has been fairly consistent over the past decade.1 This is surprising.

In 1979 a special committee of the Royal College of Psychiatrists stated that the absolute upper weekly limit was about 56 units of alcohol.2 In 1981, however, the Department of Health and Social Security stated that these weekly limits were in fact quite high but declined to give precise advice because this was not necessarily appropriate in view of variations in both drinkers and drinking circumstances.3

Thus at the beginning of the decade no good medical guidance was available and so various bodies framed their own. For instance, in 1984 the Health Education Council stated that 21-36 units a week for men, and 14-24 units a week for women, was unlikely to damage health.4 At around the same time the Scottish Health Education Group advised that 35 and 20 units a week were the maximum upper limits for men and women respectively.5

In 1986-7 the Royal Colleges of Psychiatrists, General Practitioners, and Physicians all issued guidelines on safe consumption. Although some confusion was caused by the use of the words levels and limits at various places in the text, they seemed to be fixing 21 units a week for men and 14 for women as sensible levels/limits, but they did not offer scientific justification for them.

Better Living, Better Life was published under the auspices of the Department of Health and the Royal College of General Practitioners last year.6 It gives inconsistent advice but at one point defines sensible drinking as about two units a day because at this level there is a possible beneficial effect on the heart. But it then muddles this advice by saying that these effects are outweighed by the risk of other diseases and events such a child abuse and divorce.

I therefore suggest that the advice has been far from consistent. The only consistency is that it has become progressively more conservative, with no supporting scientific justification. Indeed, what has been consistent over the past decade is accumulating evidence that about 28 units a week for men and and probably somewhat less for women not only is unlikely to be harmful but may be beneficial to health.