Mediterranean diet and consumption of alcoholic beverages

Two scientists, Richard M Hoffman (University of Hertfordshire, UK) and Mariette Gerber (French Food, Environment and Work Safety Agency, ANSES, France), exploring the health effects of the Mediterranean diet, recently published an important comment in the British Medical Journal that should be embraced by committees formulating drinking guidelines (8):

“The new drinking guidelines do not adequately account for the complex interactions of alcohol with other factors in the diet (1). For example, low to moderate alcohol consumption during a meal is an integral part of the Mediterranean diet, one of the healthiest diets in the world, which protects against cancer mortality even in the presence of alcohol (2). There is no evidence of increased breast cancer with a Mediterranean diet, and this may, at least in part, be linked to the protective effects against alcohol of folates in the diet (3). In addition, a Mediterranean diet with low to moderate alcohol consumption reduced the incidence of cancers of the upper aerodigestive tract (4) and low alcohol consumption was not a risk factor for these cancers in non-smokers in the Million Women Study (5).

The Mediterranean diet is renowned for its cardioprotective effects, and alcohol seems to be an important part of this (6). Recent epidemiological studies support the cardioprotective effects of low to moderate alcohol consumption and have compensated for possible confounding by heterogeneity among non-drinkers (7).

Many epidemiological studies on alcohol do not take drinking patterns into consideration. Failing to adequately emphasise the importance of the context of alcohol consumption, risks unnecessarily stigmatising responsible drinking with a healthy meal, an activity that brings pleasure and stress relief for many people.”

1. Wise J. Cut drinking to reduce risk of cancer, says new guidance. BMJ 2016;352:i109.26747831.
2. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008;337:a1344.
3. de Batlle J, Ferrari P, Chajes V, et al. Dietary folate intake and breast cancer risk: European prospective investigation into cancer and nutrition. J Natl Cancer Inst 2014;107:dju367.
4. Samoli E, Lagiou A, Nikolopoulos E, et al. Mediterranean diet and upper aerodigestive tract cancer: the Greek segment of the Alcohol-Related Cancers and Genetic Susceptibility in Europe study. Br J Nutr 2010;104:1369-74.
5. Allen NE, Beral V, Casabonne D, et al. Million Women Study Collaborators. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst 2009;101:296-305.
6. D’Alessandro A, De Pergola G. Mediterranean Diet and cardiovascular disease: a critical evaluation of a priori dietary indexes. Nutrients 2015;7:7863-88.
7. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption  with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011;342:d671.
8. Hoffman RM, Gerber M. Alcohol consumption-the importance of context. BMJ. 2016 Feb 4;352:i580. doi: 10.1136/bmj.i580. http://www.bmj.com/content/352/bmj.i580.long