In recent months , the Minister of Agriculture, Food Sovereignty and Forestry Francesco Lollobrigida has on several occasions defended the consumption of alcohol, and of wine in particular, criticising the Irish government’s decision to introduce labels on alcoholic beverages with warnings about their harmful effects on health, as is already the case on cigarette packets. Lollobrigida argued, for example, that in Ireland wine ‘they do not even know how to consume it in moderation as it is right to do’ and that a label indicating serious dangers to health ‘tells a distorted story’, despite the fact that all major health institutions starting with the World Health Organisation have long said that ‘no amount of alcohol consumption is safe for health’.

This is happening, moreover, in the very days in which the government is speaking out in various ways against the consumption of other drugs, those we normally refer to as drugs: a controversial institutional spot, financed by the Department for Anti-Drug Policies, has just come out, in which the coach of the men’s national football team, Roberto Mancini, repeats numerous times that ‘all drugs are bad’. Neither in this nor in similar communications, however, is alcohol almost ever explicitly included, despite the fact that several recognised studies indicate it to be much more dangerous than most, if not all, of the substances we normally understand when referring to drugs. A similar discussion has developed around Transport Minister Matteo Salvini’s proposed reform of the highway code, which contains some still unclear measures that seem to stiffen the approach towards users of psychotropic substances, including marijuana.

The Irish law requires the implementation of health warnings within two years on all alcoholic products sold in the country, including beer, the main alcoholic beverage drunk in the country – and a very important element of the national economy – and is therefore not aimed exclusively at wines. In the case of Italy, the debate over Ireland’s choice focused on wine simply because our country produces and exports a lot of it, more than other alcohol-based drinks. Something similar has occurred in Spain and France, other countries that produce and export a lot of wine, with trade associations and politicians accusing the Irish government of ‘terrorising’ wine consumption.

There was talk of demonisation and prohibition, despite the fact that Ireland has not banned the consumption of wine and other alcoholic beverages in any way. As the Irish government explained, the health warning labels are intended to make alcohol consumers more aware of the risks in a context of heavy drinking, with many social and public health implications. Drinking alcohol is a choice like many others that is up to individuals, based on their preferences and tastes, which is why it is important to know what implications it may have.

Alcohol
Ethanol (or ethyl alcohol, what we commonly call ‘alcohol’) is a substance produced through the fermentation of sugars and starches by yeasts. In beers, it is usually present in concentrations of less than 10 per cent, while in wines it can be as high as 20 per cent; higher percentages are mainly found in liqueurs and spirits, where the alcohol portion of the drink can be as high as 70 per cent. With the same portion size, the short-term effects of a beer are naturally different from those of a spirit, simply because less alcohol is consumed, but health risks are present in both cases because there is no threshold within which alcohol consumption can be defined as ‘safe’.

When we drink a glass of wine, a beer or a cocktail, the alcohol contained in the drink is absorbed very quickly by the stomach and small intestine: it is distributed throughout the body and the task of disposing of it falls to the liver in particular, which converts ethanol into acetaldehyde and then into acetic acid. It is an intense activity and the liver can only dispose of a certain amount of alcohol over a certain period of time: an adult person of average weight (around 70 kilograms) can dispose of about 8 grams of alcohol per hour. In an average glass of wine there are about 10-12 grams of ethanol, so the time to dispose of it for that person is just over an hour. If several glasses or drinks with a higher alcohol content are drunk, the time to dispose of the ethanol increases greatly.

Very intensive work for the liver can lead to inflammation and thickening of tissues, with the formation of lesions and scarring (cirrhosis), which generally reduce the liver’s ability to perform its very important metabolic functions. Alcohol consumption reduces the activity of the immune system and can affect the cardiovascular system. Alcohol depresses certain activities of neurons and is toxic to the central nervous system, with reduced cognitive capacity and damage that may become permanent. Alcohol is also a causal factor in about 200 diseases and types of injuries.

Cancer and alcohol
The International Agency for Research on Cancer (IARC) of the United Nations has long since placed alcoholic beverages in ‘Group 1’ of carcinogenic substances. This group includes substances for which there is sufficient data to show that they unequivocally increase the risk of cancer occurrence. This does not mean that if you consume alcohol then you will definitely get cancer: the classification serves to indicate a substance which, if consumed, can increase your lifetime risk of getting a certain type of cancer. Similarly, not consuming alcohol does not give you the certainty of not falling ill with a particular cancer, but is a behaviour that exposes you to a different risk.

In its correct usage, as used by the IARC, the word ‘carcinogen’ means something that causes a certain type of cancer, in essence: a substance is either carcinogenic or it is not. The IARC classification, which has various groups, does not indicate which substances are ‘more’ or ‘less’ carcinogenic, but simply expresses how sure one is that a substance is indeed carcinogenic. For substances in ‘Group 1’, that of alcohol, the certainty is well established, for those in ‘Group 2A’ the level of certainty is lower, and so on. As new studies and knowledge accumulate, things may change, with some substances being moved from one group to another (those in ‘Group 1’ are unlikely to be reclassified, given the level of certainty about their effects).

Each carcinogen acts differently and this also determines the effects on the body. In ‘Group 1’, in addition to alcohol, there are sausages and smoking, for example, the consumption of which has different effects and is the possible cause of particular types of cancer.

Alcohol consumption can cause at least seven different types of cancer, even if only small amounts are consumed. The areas most affected are the mouth and throat, larynx, oesophagus, colorectum, liver and breast (in women). Effects on other organs are not necessarily related to cancer, but risks and damage to the brain, heart, lungs, stomach, pancreas, gallbladder, kidneys, bladder and reproductive systemhave been established.

The risks of consuming several carcinogens can add up, as is the case with drinking alcohol and smoking. It has been found that people who drink and smoke have a higher risk of developing cancers such as those of the oral cavity, larynx and oesophagus than people who either smoke or consume alcohol.

The famous glass of red wine a day
As studies and scientific institutions, including the WHO, point out, the myth that ‘a glass of red wine a day is good for the heart’ has no convincing scientific evidence. The research that has hypothesised this has mostly been based on observational experiences (where research groups simply observe phenomena) without taking pre-existing health conditions into account.

Even if there were benefits, these would still not outweigh the harm that alcohol consumption causes. The consensus in the scientific literature is that any amount of alcohol consumed increases health risks. “The debate about the possible and so-called ‘protective effects’ of alcohol diverts attention away from the larger context of the harms caused by alcohol; for example, although it is now clear that alcohol can cause cancer, this fact is still not widely known by people in most countries,” says WHO.

A world of alcohol
There is a perception among many that most people consume alcohol, but in reality it is estimated that 57 per cent of the world’s population does not. This majority is almost always under-represented, both because of massive advertising campaigns inviting people to drink and because of the presence of alcohol in numerous cultural products (TV series, films, books, comics, to name a few). There is also a certain social pressure on those who do not drink alcohol or would like to try to stop, which is often overlooked and underestimated.

The idea that moderate alcohol consumption carries little risk often stems from laws, for example those imposing a maximum blood-alcohol limit for driving, or from advertisements by alcoholic beverage manufacturers reminding people to ‘drink responsibly’. Such signs and messages do not highlight the health risks, and especially their existence regardless of the amount of alcohol consumed.

The law in Ireland with warnings about the risks and harm caused by alcohol is a first attempt in the direction indicated by health institutions to make consumers of alcoholic beverages more aware of the risks and danger of certain behaviours. Research conducted in the Yukon, north-west Canada, found that the addition of warning labels reduced alcohol sales by 7 per cent compared to areas of the country where warnings on packaging are not used. Larger, more structured studies on the effectiveness of this approach are lacking, however, although there are more reliable data on the positive effects of introducing labels on tobacco products in many countries.

Alcohol and other drugs
Precisely because each substance acts differently on our bodies, and even differently from person to person (we are all made differently and behave differently), it is very difficult to establish which drugs have possible negative health effects more than others. One study that is often cited dates back to 2007 and was published in the medical journal The Lancet, when a research team tried to estimate the negative effects in terms of both addiction and physical harm of several substances we usually call ‘drugs’, including alcohol. The study found that some anabolic drugs, cannabis, LSD and ecstasy may have fewer negative effects than alcohol.

An assessment of the relative dangerousness of drugs carried out in the European Union in 2015 reported that in general the most harmful substance was alcohol with a score of 72 out of 100 on the dangerousness scale. Alcohol was ahead of heroin (55) and crack (50). The other 17 substances considered had a score of 38 or less, the score assigned to cocaine. Tobacco scored higher than cannabis, and even lower were the scores for MDMA and LSD. It is worth remembering, however, that the more different the substances, the more difficult it is to compare them and to assess their risk factors.

Costs
Just as there is a tendency to think that there are more alcohol drinkers than abstainers, there is also a rather widespread perception that the harm caused by alcohol is due to a minority group of heavy drinkers. In reality, the main negative effects of alcohol (cancer, injuries and violence) are widely distributed in the population, even among those who consume relatively low doses of alcohol, as the Swiss National Institute of Health explains:

‘Although heavy drinkers are undoubtedly at high risk of alcohol-related harm, they contribute only a small part to the total number of alcohol victims but still represent for the industry the target group of consumers from whom they derive most of their profit. Consequently, even the reduction of at-risk and harmful consumers is not a goal that is realistically supported or supportable by an approach aimed at making maximum profit from product marketing. In this ‘paradox of prevention’, most alcohol-related harm occurs among low to moderate risk drinkers simply because they are more numerous in the population.

Italy
According to the latest report on alcohol consumption conducted in 2020 by ISTAT with data from the previous year, 66.8 per cent of the population aged 11 years and over consumed at least one alcoholic beverage per year. The amount of regular alcohol consumers (at least one portion per day) is 20.2 per cent, down from ten years earlier when it was 27 per cent. In contrast, the share of people who occasionally consume alcohol increased from 41.5 per cent in 2009 to 46.6 per cent in 2019.

It has been calculated that on average 800 people die every day in Europe from causes related to alcohol consumption. In Italy, an average of 48 people die every day from alcohol, about 17,000 every year.

Read also : Cancer, alcohol associated with over 740,000 cases a year. And this very recent study in the New York Times gives further confirmation to the headline : Even light alcohol consumption was associated with an increase in cancer deaths among the elderly, according to a study, adding to a growing body of evidence.