Alcohol, calories, labels and disingenuity

The Royal Society for Public Health (RSPH) published a press release on 31st October 2014 calling on the drinks industry and the newly appointed EU Health Commissioner to introduce calorie labelling for alcoholic drinks. The RSPH claimed that there was strong public backing for this to happen and a general lack of awareness among consumers about the calorie content of alcoholic drinks.

The RSPH commissioned a polling company, Populus, who interviewed a random sample of 2,117 British adults, online, between 10-12th October 2014. The results were as follows (Please note – the press release claims “two thirds of the public”/”over 80% of the public”, but claims can only be made on behalf of those interviewed – not the Great British public):

–      Two thirds (67%) of those interviewed supported the addition of calorie labels on packaging of alcohol drinks (we don’t know how this was positioned in the survey);

–     Over 80% of those interviewed didn’t know, or guessed incorrectly, the calorie content of a large glass of wine (we don’t know what margin for error was allowed);

–      Almost 9% didn’t know, or incorrectly estimated, the calories in a pint of lager (ditto).

(As an aside, this blog, by the RSPH chair said that 80% of 500 people “didn’t know the calorie content of their favourite tipple”. 2,117 or 500? How many people were interviewed?)

The European Commission is due to make a decision by December 2014, about extending nutrition labelling (including calorie labelling) on alcohol. (Alcoholic drinks are currently not recognised as food and are therefore exempt from food labelling.)

The Chief Executive of RSPH, Shirley Cramer CBE, was quoted in the press release as saying:

Calorie labelling has been successfully introduced for a wide range of food products and there is now a clear public appetite for this information to be extended to alcohol to help individuals make informed choices.  With 2 in 3 adults overweight or obese and given that adults who drink get approximately 10 percent of their calories from alcohol, this move could make a major difference to waistlines of the nation.”

I’m familiar with the UK Family Food Survey, so the “10 percent of their calories from alcohol” didn’t sound right. (Check the 2012 document – Table 24.4, page 18 – and you can see that alcohol accounts for 58 calories out of 1,990 – 2.9% of calorie intake.)

I emailed the communications manager to ask for the source of the 10% claim and she replied by return to say that it was from p17 of this. Start on p16 and notice that averages (means) for all adults (or in a couple of cases children) are reported for: fruit and vegetables; oily fish; all energy; total fat; saturated fat; transfats; Non Milk Extrinsic Sugars; non-starch polysaccharides; vitamins and minerals. Only one intake is reported differently. Alcohol is not reported as a mean intake of all adults, but as an average of those who drank alcohol in a four-day recording period: “58% of adults aged 19 to 64 years and 52% of adults aged 65 years and over consumed alcohol during the four-day recording period. Adults aged 19 to 64 years who consumed alcohol during the four-day recording period obtained 9% of energy intake from alcohol; older adult consumers obtained 7%.”

That’s how Cramer manipulated the figures to make the ‘prize’ of alcohol calorie reduction look larger than it is. Even then, 7 and 9% became “approximately 10%.” This is disingenuous.

Alcohol and calories

As followers of this blog/recipients of this newsletter will know, there are fundamental issues with calories in general: thermodynamics not being about calories or weight; the calorie theory being unsourced and unproven, etc. There are additional issues with alcohol calories…

The assignment of calories to different foodstuffs is generally credited to Wilbur Atwater (1844-1907) and Max Rubner (1854-1932). Their work around the turn of the 19th-20th century developed the first calorimeter and this enabled them to estimate that carbohydrate, protein and fat had approximately 4.1, 4.1 and 9.3 calories per gram respectively.[i] (Rubner recorded the calorific value for olive oil as 9.4, so even his 9.3 was an average of four fats reviewed. This has never been a precise science).

Atwater was concerned about helping American working men to fuel their physical labour and he discovered that alcohol had approximately 7 calories per gram. This was much to the joy of the liquor industry, giving rationale for alcohol consumption for its calorie value. It’s ironic that, just over 100 years later, the powers-that-be are trying to curtail alcohol consumption for its calorie value.

Those who know about the thermic effect of nutrients and the work of Jequier,[ii] Feinman and Fine,[iii] know that macronutrient calories behave very differently within the human body. Alcohol calories even more so. The body sees alcohol as a toxin and wants to get rid of it. Some is got rid of as acetic acid. (When you drink, you wee – yes?) Alcohol digestion takes place mostly in the liver and the kidneys, not in the digestive system – big clue there. So alcohol calories don’t count in the same way as sugary drink calories. Those RSPH pictures claiming a glass of wine = a slice of pizza – also disingenuous.

Arguably, given that alcohol calories are not properly digested – the more Brits drink and the less they eat, the slimmer they will be!

Calorie labelling and choices

Let’s be honest – what is really going on here is that the Royal Society for Public Health is trying to stop people drinking alcohol. Frightening people with health scares hasn’t worked, so they are now trying the calorie angle to see if this will curb drinking instead. And it might. Women especially are more calorie aware/obsessed than men and may choose a lower calorie drink. But this won’t necessarily lower alcohol – which is the end in mind, is it not?

The RSPH web site accompanying the press release has a picture of a Pina Colada (scroll down), claiming that it has 450 cals. It has 2 units of alcohol. On the same web page, I can see that I could have 2.5 x 250ml glasses of wine with a total of 8.2 units of alcohol for the same 450 calories. The law of unintended consequences could take effect here. On the RSPH’s own video here (bottom one) a woman says she won’t drink less – she may choose lower calorie alcohol options.

Alcohol and weight

You can download the RSPH’s position paper on alcohol here.

Here is the paragraph on alcohol and weight in the position paper:

“There is evidence that heavy drinkers (drinking four or more drinks per day) are at a greater risk of obesity than moderate or non-drinkers. The odds of being overweight or obese are also significantly higher among binge drinkers than among those who consume the same amount of alcohol over multiple sessions. (Ref 14) Weight gain from drinking alcohol is also greater in individuals who are already overweight or obese and there are individual differences in the impact of alcohol consumption on weight. (Ref 15) Drinkers dependent on alcohol, however, due to the propensity to substitute alcohol for meals, may experience weight loss (Ref 16).”

Ref 14 can be seen in full here. This is the results section of the abstract:

“Current drinkers had lower odds of obesity (Adjusted odds ratio = 0.73, 95% CI: 0.55, 0.97) as compared to non-drinkers. The odds of overweight and obesity were significantly greater among binge drinkers and those consuming four or more drinks/day. However, those who reported drinking one or two drinks per day had 0.46 (95% CI: 0.34, 0.62) and 0.59 (95% CI: 0.41, 0.86) times the odds of obesity, respectively. Similarly, the odds of obesity were significantly lower among those who reported drinking frequently and consuming less than five drinks per week.”

Did you get that? Current drinkers had lower odds of obesity. Those drinking one or two drinks per day had approximately half the incidence of obesity compared to non drinkers. The odds of obesity were significantly lower for the frequent drinkers. Look at Table 2 in the paper to see that you do not want to be a non drinker, or even in the first quartile of drinking days per year. Those in the second, third and highest quartiles of drinking days all had a significantly lower incidence of obesity. The average drinks per week data shows that you want to be having more than 15 drinks a week (a drink was counted as a 12oz beer or 4oz wine), rather than 10-14 drinks a week. Although the only statistically significant findings on the drinks per week section was those drinking up to 5 drinks a week had significantly lower levels of obesity than teetotalers.

The only finding in favour of alcohol intake and obesity was the one quoted by the RSPH position paper. This is disingenuous.

Ref 15 (abstract) can be seen here. The paper title is: “Is alcohol consumption a risk factor for weight gain and obesity” and it opens by noting “Epidemiologic data showed a positive, negative, or no relationship between alcohol intake and body weight.” Again – only the circumstance in favour of the RSPH’s anti-alcohol position has been cited: “Weight gain from drinking alcohol is also greater in individuals who are already overweight or obese.”

What about those not overweight or obese? You can either buy the paper ($54) or assume that – had there been any more ammunition from this paper, the RSPH would have used it.

Ref 16 doesn’t try to offer evidence for an association between weight and alcohol intake – other than an inverse one. It admits that very heavy drinkers tend to drink rather than eat and therefore tend to experience weight loss. This is further evidence for the notion that replacing food calories with drink calories could actually aid weight loss. (I think it would, but I am not advising it as an overall health strategy).

And that’s it. So we don’t actually have evidence presented by the RSPH for the implication that reducing alcohol consumption will reduce calories will reduce weight. It’s all just inferred. So what is the evidence for alcohol and weight?

Here is where you should do yourself a favour and get this fab little read from amazon. Tony Edwards has gone through reams of evidence on alcohol and all important conditions, from weight to heart disease and cancer to diabetes, so that you don’t have to. There were a couple of summary articles at the time of publication. Try this or this.

In Chapter 7 of his book, Edwards runs through the major studies reviewing alcohol and weight over the past 25 years: Wang et al 2010 studied 19,220 women, their drinking habits and weight for almost 13 years. Approximately 9,000 gained significant weight over the study. The study concluded: “Compared with non-drinkers, initially normal-weight women that consumed light-to-moderate amount of alcohol experienced smaller weight gain and lower risk of becoming overweight and/or obese during 12.9 years of follow-up.”

Then there’s the findings of a 5-6 year long Danish study, involving 43,500 people, where daily drinkers had the smallest waistlines. Then there’s the 8 year long University College London study of nearly 50,000 women, which showed that women who drank 30 grams of alcohol daily were less likely to put on weight than teetotalers. Then there’s the 10 year study, of 7,000 US adults, showing that drinker gained less weight than non drinkers. And so on.

Please note that this is all still association, not causation; relative, not absolute risk. Nonsense on top of nonsense therefore but not even the underlying association is supporting the RSPH position.

Summary

Don’t forget in all of this that the unit guidelines were plucked from thin air. Although Richard Smith wasn’t popular with the Royal College of Physicians for saying so.

Has the RSPH proven that calorie labelling on alcohol would reduce alcohol consumption? No.

Has the RSPH proven that alcohol and weight are even positively associated? No.

Has the RSPH proven that labels would have any impact on any health condition that alcohol is claimed to be associated with? No.

There’s just been a lot of insinuation, inference and disingenuity. And a lot of media hot air. Talking of hot air…

Here’s a final thought for you…

Coal apparently has 7,000 calories (kcal) per kg. That’s 7 kcal per gram – the same as alcohol. Do you think that a gram of coal would make you fat?! Well then…

 

References

[i] Max Rubner, “Zeitschrift fur Biologie,” Festschrift zu Voit, (1901).

[ii] Eric Jequier, “Pathways to Obesity”, International Journal of Obesity, (2002).

[iii] Richard Feinman and Eugene Fine, “A calorie is a calorie violates the second law of thermodynamics”, Nutritional Journal, (2004).

 

21 thoughts on “Alcohol, calories, labels and disingenuity

  • March 27, 2015 at 7:31 pm
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    I notice you wrote in your article that the European Commission was due to make a decision on calorie labelling on alcohol by December 2014. Has a decision been reached? I’ve tried looking into this but haven’t found anything!

  • November 12, 2014 at 5:59 pm
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    I’m not sure where to put this question, it refers to your Post about Saturated Fats not causing heart disease. There was a study done in the UK in Word War 2 which looked at death rates from heart disease during the later years of the War, it found that the heart rate disease had halved during this period when meat, butter, cheese and also sugar was very much restricted. The study was mainly done to see if the higher rates of stress would cause higher rates of heart disease. The only resultant factor which appeared different was the type and amounts of food consumed. Love t hear what you think of this?

    • November 12, 2014 at 7:38 pm
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      Hi John
      As Dr Malcolm Kendrick says: “Although association cannot prove causation, a lack of association does disprove causation.”

      First – there needs to be association. Can you find the study you referred to? I had a quick search and found this instead (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1052486/) which undermines the suggestion that CHD changed, let alone halved…

      If association could be demonstrated, there were far too many things that changed for any one thing to be associated, let alone causation proven. Smoking fell, sugar fell (as you noted), weight fell, exercise increased and, crazy as this may sound, people had a purpose in life that they may not have previously had. The sense of belonging increased and the unified working towards a cause was prevalent. IF it can be shown that CHD halved and IF it can be shown that the classification arguments above were wrong, there’s still no association with any one thing, let alone causation.

      Best wishes – Zoe

      • November 13, 2014 at 6:17 pm
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        I like your answer! I wasn’t agreeing with the findings just a bit confused!

        Another question about cholesterol. I was surprised by your info about cholesterol as I had always prided myself on having a low overall cholesterol, high “good” C. low “bad” C. and low triglycerides readings. I don’t take any drugs for it, it’s just natural, I’m 68 and the readings have always been the same. Now I worry are my readings not good after all?

        John

        • November 13, 2014 at 8:40 pm
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          Hi John
          They are what they are. Leave the body to do what it’s designed to do – make the right amount of cholesterol for you, as and when needed. ‘Low’ might be a sign that you’ve been in sunshine and converted lots of cholesterol to vit D (that would be good). ‘Low’ may be a sign that your body doesn’t have much repair to do at the moment (that would also be good).

          All we know is that – from an all population review of association, especially in older people (and you’re heading there! ;-)) low cholesterol is not associated with longevity. High cholesterol is associated with longevity.

          Just don’t get it measured is my best tip! Then you stay out of the nonsense system :-)
          Best wishes – Zoe

  • November 10, 2014 at 9:13 pm
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    It’s risible!

    This stupid labelling idea, I mean – not your (very good) article!

    Scary too – especially having heard today’s headlines about even more bariatric surgery where they are looking at ‘cures’ (of a sort) and not prevention or non-under-the-knife cures.

    The news item I was referring to – and even on Radio 4 it seemed to be lauded :-( – http://www.bbc.co.uk/news/health-29984108

  • November 8, 2014 at 2:10 pm
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    The problem with too much alcohol isn’t just that it has to be metabolised as matter of priority (which prevents metabolism of other macronutrients), it also drops your blood glucose level, hence the munching on kebabs & pizza. Some alcohol is good and can blunt the post prandial glucose rise (one for the diabetics out there), so have a glass of wine with your meal. That boozy night out though? Save it for once in a while, rather than every week.
    I totally agree that calorie labelling is pretty pointless and that eating real food regulates satiety. I don’t however buy into the concept that you can eat unlimited quantities of “good” fats and not store them.

    • November 10, 2014 at 4:34 pm
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      Maybe everyone’s different? I cut down on carbohydrates; not drastically – just to around 200 g per day – no cakes, biscuits or cereal, less bread and not so many potatoes. The Government’s recommended protein, fat and total calorie intake imply, for men, a recommended carbohydrate consumption of 360 g per day. Eating less carbohydrate means eating more fat and/or protein, or be permanently hungry. I now eat a lot more fat, “good” and “bad” – 400g of cheese a week, 400g of peanut butter a week, full fat milk instead of semi skimmed, butter, nuts, fatty meat; but have lost two or three inches from my waist. Many thousands of people report the same effect. My advice to anyone with stubborn middle age spread which doesn’t respond to exercise, is just try it for a couple of months. If it doesn’t have the desired effect, then perhaps it’s not for you and no harm will have been done. Three years ago, I wouldn’t have believed it, but the proofs’s in the 32″ waist jeans, which I last comfortably fit into 20 years ago.

  • November 6, 2014 at 4:56 pm
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    Thanks very much for the information and links for how alcohol is digested. I’ve been curious about this since the 10% claim was made last week. I switched to red wine from beer and reckon, for the same amount of alcohol, it is less fattening as it contains less carbohydrate.

  • November 5, 2014 at 1:26 pm
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    And by 18th 19th century (Alcohol and calories), I assume you mean 19th 20th? :-)

    Sorry.

    Great article, though.

    • November 5, 2014 at 3:24 pm
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      Yes – thank you! Corrected – I clearly need to take a day off if I can’t remember what century we’re in!
      Best wishes – Zoe

  • November 3, 2014 at 8:49 pm
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    On the other hand, this would be great news for label printers; all the alcohol labels would need to be re-done.

  • November 3, 2014 at 5:17 pm
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    “Calorie labelling has been successfully introduced for a wide range of food products…”

    Which means exactly what?!? Calorie labelling has been introduced for a wide range of food products.. yes. Has it had a “successful” or even measurable impact on people’s food-buying choices? I don’t see any evidence to that effect.

    As you say, nothing but smoke and mirrors.

    But calorie labels DO help to shift the blame to all us “fatties” for making our poor choices.

    • November 4, 2014 at 9:12 am
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      Good point Frank! I thought about covering the ‘do the labels change behavior?’ angle, but that’s a whole thesis in itself!

      The alcohol site (http://www.rsph.org.uk/en/policy-and-projects/areas-of-work/alcohol-labelling.cfm) top video did their own ‘experiment’ – non-randomised, non-controlled, insufficiently powered etc. It looks like there are 10-12 different people and the claim was that the average calories drunk by the group without labels was 764 and the average cals drunk by the group with labels was 381. This is such a vast claim as to be literally unbelievable.

      I came across this report when I was thinking about covering this pathway (http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf406357) It describes the impact of labelling as “uncertain”, which is much more believable. This and other reports I found suggested that small trials show an impact on behaviour because, even if you try to make people think they are just playing jenga, they know they’re involved in a trial so behaviour changes no matter what (same happens in drug placebo arms – people feel better just because they’re getting attention). However, the evidence for what happens in the real world is ‘not much’.

      I was in Costa coffee over the summer and noticed calorie labels on the junk. I asked the assistant how long they’d been there and she said “ages – a year or so” I asked if it had made any difference to what people bought and she said “not at all”! I imagine if it had made any difference to the bottom line, Costa would have taken them off as fast as they put them on!

      Best wishes – Zoe

  • November 3, 2014 at 12:22 pm
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    O no not MORE calorie B.S ……AGAIN!!!

    2000 Calories is approximately equal to 8 Snickers bars OR 8 medium Avocado’s OR 285g of Coal (yes coal like 17% of pregnant women have been known to eat without harm)

    Now the questions are:-

    Which do you think would be the easiest to eat each day for a week?

    Which would be very very difficult to eat that many of each day BUT IF you could would make you lose weight and why?

    Which IF you could eat it at all would have zero impact on you metabolism despite still having 2000 Cal?

    Which of them would cause you to put weight on AND WHY?

    Its not about inorganic chemistry, physics or even engineering, its about physiology.
    If you eat more (good) fat you will be less hungry and so eat less over all.
    (Good quality) protein is proven to kill appetite so eat less over all.

    Carbs/sugars (same thing in the end) make you hunger for more food.[ clue…insulin]

    Think about it…..(and speaking of booze)…….what happens at the end of a night on the town (liquid carbs)????
    Answer…….Kebab or Pizza
    I rest my case…………………well almost.

    To liberate all the energy from our food requires that it be burnt to ash / carbon then how come I do not poop black ash and why if I stand in front of a roaring log fire the is radiating vast numbers of calories or therms or what ever measure of energy you choose to use, do I not get fat?

  • November 3, 2014 at 10:17 am
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    Drinking alcohol is one of the few things that has actually been shown to be good for you. We’ve all had some fantastic times whilst consuming alcohol. Great times are good for the soul at a fundemental level. You relax, your artery’s relax, your blood thins but there is always a but.

    The principle driver of the vast majority of illnesses we suffer these days is insulin resistance. The more i look the more i find things lead back to insulin. What causes insulin resistance? Visceral fat, not subcutaneous but visceral, abdominal, beer belly fat. What causes visceral fat? Too much sugar, stress, alcohol abuse, sedentary living, not enough sleep and a diet full of poor quality processed carbohydrates. How do you know you’ve got too much visceral fat? Your waist measurement or high triglycerides and low HDL. How do you get rid of visceral fat? You have to take the pressure of your liver, give it less to deal with, that means cutting out sugar/ sucrose and alcohol as both fructose and alcohol have to be processed by the liver. Eat real unprocessed quality food, learn to deal with stress, get some decent kip and get out for a walk. Do 3 minutes of HIT training every week or find a way of using up the glucogen in your muscles a few times a week.

    When or if your healthy, alcohol is an important part of a healthy, balanced, vibrant lifestyle.if you drink then drink often, enjoy what you drink, enjoy who you’re drinking with, don’t drink to get drunk.

    Total calories are irrelevant. It’s how and how fast the body metabolises those calories and how they affect insulin and your ability to use your insulin that is important.

    As a metabolically healthy adult male, i will be helping my wife celebrate her birthday this weekend with a bottle of Champagne and on Saturday i will be sharing a good few drinks with my friends and i will be blissfully uninterested in the calories that those drinks contain.

    Thanks Zoe.

  • November 2, 2014 at 9:34 pm
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    Allegedly evidence based medicine has become disingenuous, agenda driven medicine in turn establishing false protocols.

    Thanks for your continued efforts Zoe and for the link to the book by Tony Edwards, which I’ve ordered.

    • November 3, 2014 at 12:04 pm
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      I think you might mean that …….Instead of evidence-based medical decision making, we now have decision-based evidence making.
      Or in the case /opinion of “professor” Rory Collins/ aka the statinator……eminence based decision make.

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