8. Looks Good, Tastes Good, and.

“So if we could only boost the level of thiamine, would you agree that beer is a fairly well-balanced foodstuff?”^[1]

Even for me that would be a fairly tall claim, but a renowned medic was sincerely suggesting it, having heard me discuss the composition of beer at a meeting dedicated to exploring the “Science Behind Health Benefits of Moderate Beer Consumption,” an event organized by the University of Maryland Center for Food, Nutrition, and Agriculture Policy in Washington, DC, in October 2006.

I think I replied to the good doctor that at least one would need to accompany the beer with a few pretzels. Tongue-in-cheek stuff, of course.

Count me, then, among the majority of people who take a beer for the simple pleasure quotient. Few people surely make conscious decisions about taking a beer (or any other alcoholic drink for that matter) on overtly nutritional or medicinal grounds. As my student Christine Wright^[2] showed, in decreasing order of importance in the decision-making process regarding purchase of alcoholic drinks we have

However, it is important that any drinker be aware of the relative positive and negative consequences of their choice. Too often people are prepared to accept that alcoholic beverages are thoroughly bad: a portal to doom, debauchery, and damnation, messages perpetrated by organizations of extreme religious or self-proclaimed moralistic fervor. On the other hand, there are those who ignore any cautionary words of the risks of intemperance.

Edgar Vincent D'Abernon (1857-1941), banker, erstwhile Conservative Member of Parliament for Exeter, director of the Lawn Tennis Association, and the first British Ambassador to Berlin after the Great War, chaired in 1918 the advisory committee on alcohol appointed by the British Medical Research Council, the aim of which was “to separate what is knowledge from what is surmise, conjecture, or popular belief, and, by this preliminary clarifying of the question, to prepare the way for further research.” In the preface to the resultant book titled Alcohol: Its Action on the Human Organism, Lord D'Abernon wrote

Alcohol is an ungrateful subject. Most people who are interested in the subject are already partisans on the one side or the other, and no body of impartial opinion exists which is ready to be guided by scientific inquiry. The majority of those who would give any attention to original work on the subject would do so less to gain knowledge than to find arms and argument to support their preconceived opinion.

In 1957, Chauncey D. Leake, professor of medicine at Ohio State University, said at a symposium titled “Alcoholism” held under the auspices of the American Association for the Advancement of Science

As better knowledge and understanding of the action of alcohol becomes available, more sensible attitudes regarding it are arising, [but] it is also interesting to observe how little the people wanted to learn about alcohol in a scientific way. They seemed much to prefer their violently differing emotional fantasies about it.”

For better or worse, the present author has been a member of the brewing industry since June 1978,^[3] either in a research, quality assurance, or academic role, and will undoubtedly therefore be condemned by the anti-alcohol lobby as partial and on the dollar of those who they would perceive as cynically pouring alcohol down the throats of the naïve and foolhardy. To my mind, such accusations would be no more nor less astonishing than to argue that a male judge would be incapable of recognizing crimes of a man against a woman (or indeed vice versa).

Lest the reader starts to believe that the author doth protest too much, let us consider with all due impartiality the current state of affairs with regard to beer and health. And let us start with the medical profession, trusting they are at arm’s length from funding drawn from the drinks business or (conversely) the anti-alcohol lobby, for the latter could be equally perceived as self-serving.

It is important to stress that the bulk of the conclusions concerning the impact of alcohol on health, whether positive or negative, are based on statistical correlations derived from the questioning of patients or at the very least from observations that are not free from confounding influences. As such they demand close scrutiny and critical appraisal before being set in the gospel tablets of either the pro- or anti-alcohol camp. So much of the data is generated from questionnaires, of the type: “how much alcohol do you drink per day?” The inherent tendency of patients is to underestimate their consumption, a phenomenon more readily described as “lying.”

Another highly pertinent problem is that of “secondary correlations.” Let’s look at a hypothetical example that has nothing to do with beer.

Think of sumo wrestlers. They are all very big blokes. The vast majority are Japanese. So there is a strong correlation between the total number of sumo wrestlers and the proportion of the population that are Japanese. There is also a stronger correlation, I would suggest, between the proportion of Japanese people and the tendency to worship at a Shinto shrine than there is for the general world population. However, this does not mean that to worship at a Shinto shrine will lead to your chances of developing a body fitting you for the sumo dohyo.^[4] Writ simply, the uninformed conclusion would be “pray at a Shinto temple and get fat.”

Taking a direct example, the World Health Organization reported various statistics purported to link alcohol consumption to violence (http://www.euro.who.int/Document/E87347. pdf). For example, 53 percent of the victims of assault in Norway claimed that their attacker had consumed alcohol before the crime. The data isn't reported, but I daresay approaching 100 percent of the criminals had eaten food before the assault. The naive would infer that to eat is to predispose one to aggression. Stupid? Of course. But so too, surely, is the assertion that alcohol per se causes violence.

When it comes to drawing correlations between health effects and the consumption of alcohol, therefore, we need to be careful. The benefit or the adverse impact may have nothing whatever to do with drinking. Rather it may have everything to do with other activities undertaken by the drinker—as we shall see.

Doyens in the field of alcohol research include Dr. Arthur Klatsky of the Kaiser Permanente Medical Center in Oakland, California; Dr. Norman Kaplan, Professor of Internal Medicine at the University of Texas Southwestern Medical Center in Dallas; and Dr Curtis Ellison, Professor of Medicine and Public Health at Boston University School of Medicine in Massachusetts. They have been particularly prominent in drawing attention to the realities, notably the concept of alcohol in moderation being actually good for you.

Ellison was one of the voices heard in 1991 on the television program 60 Minutes, in which moderate consumption of red wine was touted as the basis of the French Paradox phenomenon: It was the wine that was countering the blocking of arteries (atherosclerosis) by bad cholesterol arising from the fat-filled diet (and the French are rude about English food!^[5]). The red wine lobby has never felt obliged to be reluctant about these claims and point to a molecule from the grape called resveratrol as being the key component.

Evidence has been mounting that it is far from being this straightforward. The key studies on resveratrol were done in animal systems with relatively huge doses, equivalent to around 100 bottles of red wine every day. You would at the very least need to be exceedingly wealthy and also have the fortitude of a whale to consume that amount. Fortunately, one would not need to, for the simple reason that the growing realization is that the active ingredient is actually plain old ethanol; that is, alcohol. And it does not matter if it is red wine, white wine, beer, or another personal favorite of mine, Southern Comfort. They all, on a same-amount-of-alcohol basis, appear to confer a similar reduced risk of developing coronary heart disease. And it seems to me that a fair guideline to those reasonable quantities would be 26 units per week for a man or 21 units for a woman, with no more than 4 units in any one day, as laid down (so to speak) by the UK government.^[6] And that would need to be every day, as observed by Dr. Kenneth Mukamal and his colleagues at the Division of General Medicine and Primary Care of the Beth Israel Deaconess Medical Center in Boston, Massachusetts. Better to have one or two daily than one or two on just a couple of days per week. And no storing it up for the weekend—that is binge drinking.

Nevertheless, people say to me, you have only to look at those who drink wine to see that they are healthier than those consuming beer. To which I reply, “Of course. To buy wine at those ludicrous prices one has to be wealthy, and therefore you can also afford the best health care.” Just as tongue-in-cheek I would also say that folks who drink wine eat spinach and go to the gym, whereas those drinking beer sedentarily watch ball games while stuffing sausages and of course those inevitable pretzels. Dr. Morten Gronbaek from the National Institute of Public Health in Denmark studied what people were buying in Danish supermarkets. Those with wine in their baskets were buying more olives, fruit and vegetables, poultry, cooking oil, and low-fat cheese and milk than were beer buyers, while those toting six packs of beer were also hauling more ready-cooked dishes, sugar, cold cuts, chips, pork, butter or margarine, sausages, lamb, and soft drinks. I flippantly suggest that it is only the beer that is keeping these people alive.

I feel that brewers have much to do to convince those who now would automatically gravitate towards wine as their alcoholic beverage of choice to realize that in beer they have a drink of sophistication and genuine consistent quality. Furthermore, there is a vastly greater diversity in beer styles and choices than obtains in the world of grape-derived alcohol (see Appendix B, “Types of Beer”).

While they are at it, they might also like to remind the drinker that the evidence clearly weighs in favor of beer in regard to its nutritional merit.

Just the other day, a delightful young nutrition major on campus came to chat with me about class. Answering that she was loving it, she said, “I always smile when I think that if all that was left in this world to drink was water or beer, then it would be far wiser to drink the beer, because it has nutritive value.” It would also be free from pathogenic bacteria, which would unlikely be the case for much of the world’s water in such a doomsday scenario.

Under those circumstances, of course, the choice would indeed be a no-brainer (indeed, if there really was a global situation where there was nothing else to consume, then the beer sure would be welcome to drown the misery). No right-minded individual, of course, would ever argue in a normal society for overtly considering beer as a nutritive supplement. As we have seen, most of us would for the most part drink it on hedonic grounds. However, it is equally incorrect for the naysayers to suggest that beer is nothing more than empty calories.

Beer contains B vitamins. In one study, my colleagues Andy Clifford and Janel Owens from the Department of Nutrition and I compared the level of folic acid in beers and other beverages.^[7] Finding none in wines, we showed that beers differed significantly in their folate levels, with up to 6.1 percent of the recommended daily allowance.

Beer contains substantial levels of polysaccharides, especially the so-called arabinoxylans, which may comprise soluble fiber. Furthermore, we are questioning right now whether some of the molecules that are made in the malting and brewing processes by the breakdown of other complex polysaccharides (called beta-glucans) might be prebiotics, molecules that constitute substrates for beneficial organisms in the large intestine.^[8]

We and others have demonstrated the very significant levels of antioxidants in beers. Colleagues at Brewing Research International and Guy's Hospital showed that one of these antioxidants, ferulic acid,^[9] entered the body more efficiently from beer than from tomatoes. Alas, this is one of the few studies that have categorically shown the entry of antioxidants from any source into the body, and so there are very real doubts expressed by many about the merit of the very high antioxidant levels reported in products such as wine. It is all very well measuring phenomenal antioxidant potential in a product whether it be red wine, green tea, or even beer, but quite another to conclude that it has any merit. It is only if the stuff gets to the parts of the body that matter that there is any possible benefit. The polyphenols in red wine are very complex, relatively big molecules that don't only get snaffled by proteins in the mouth (think bitter and astringent) but also find it a challenge to get through membranes and into the cells of the body. At least in the guise of the much smaller fer-ulic acid we can contemplate some possibilities, and that is a molecule in substantially higher levels in beer than wine.

These arguments of course apply to all the components of any foodstuff, including beer. We must always make claims with caution, such as in the case of our relatively recent work on silica (see Chapter 6, “Despite the Odds: Anti-Alcohol Forces”). Casey and I found that beers could contain up to 56 mg/L silicate. There is no recommended silica intake, but the average consumption in the United States is 20-50 mg per day. So at the highest level we measured, a 12-ounce serving of the beer would contribute all of the daily intake at the lower consumption rate. Assuming, that is, it gets into the body. But it seems that the silica in beer is in its most accessible form, and indeed the esteemed British medical scientist, Dr. Jonathan Powell, has very clearly drawn a correlation from his research between beer consumption and reduced risk of osteoporosis. The caveats discussed earlier in this chapter naturally apply.

Osteoporosis is of course but one affliction associated with advancing years. And it is not the only one that has been claimed to be countered by moderate consumption of beer. It has been suggested that the risk of Alzheimer’s disease is lowered. It is indicated that cognitive function is improved.

Quite whether there is a direct causal link is uncertain. For example, there are those who believe that aluminum is associated with Alzheimer’s and that the sequestration of aluminum by silicate—such as that found in high levels in beer— helps counter the risk. Equally possible (or additional) causes are to do with relaxation. The mellowing impact of a daily drink, associated perhaps with convivial company, may have a major beneficial role. As Professor Robert Kastenbaum says

There is by now sufficient information available to indicate that moderate use of alcoholic beverages is pleasurable and beneficial for older adults. The lowerethanol beverages such as beer and wine may have their place in the lifestyles of some older adults.

Beer has been linked to the reduced instance of kidney stones and gallstones. Beer is rather more diuretic than is water, and fresh beer makes you pee more than does stale beer!

We have already peeked at atherosclerosis, the alcohol favorably affecting the balance of “good” versus “bad” cholesterol in the body, and also reducing the risk of blood clotting. Drinking has been linked to increased blood pressure, but the current belief is that the blood pressure of nondrinkers is in fact higher than in those consuming 10-20 g alcohol per day.^[10] Hypertension certainly increases the risk of stroke, but again it seems that there may be a lowered risk of stroke for moderate drinkers and only when drinking is heavy (more than six drinks per day) does the risk of stroke become significant.

There is now good evidence that stomach and duodenal ulcers are induced by a bacterium called Helicobacter pylori. This organism is inhibited by alcohol—so there are reports of reduced chance of ulcers through moderate drinking.

All is not rosy for drinkers. The risk of pancreatitis is increased in heavy drinkers. Some beers should be avoided by sufferers of gout because they can contain significant quantities of purines. Hangovers are likely caused by a buildup of acetaldehyde, a breakdown product of alcohol.

On the other hand, moderate drinking has been linked to reduced risk of developing diabetes.

Perhaps the most emotive discussions revolve around cancer. A quarter of all deaths in developed countries can be ascribed to cancer. Cancer occurs when cells divide uncontrollably, perhaps invading other tissues. The DNA becomes damaged, leading to mutations that cause those cells to escape from the control processes that keep them in check. Anything capable of mutating DNA can in theory at least lead to cancer.

Some claim that alcohol is a mutagen, but this is certainly not the case. But are the metabolic by-products of alcohol mutagenic? Or are there traces of other mutagenic components? There is no firm evidence one way or the other.

It is now generally accepted that obesity increases the risk of developing cancer. Is the link truly causal, or do people who overeat consume foods that contain carcinogenic substances? Taking the relationship at face value, anything that imparts calories will contribute to the risks if consumed to excess, including alcoholic beverages.

In many societies the beer drinker is also the smoker or, even if they are a nonsmoker, someone who frequents pubs where others are billowing out fumes. Uncritical evaluation might reveal a correlation between beer drinking and cancer, when in reality the causative agent is burning tobacco.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) draws attention to the tremendous inconsistency in data. They caution against abuse of alcohol, and also draw attention to the claims that alcohol potentiates the damaging impact of the prime carcinogen, notably tobacco.

Arimoto-Kobayashi from Okayama University discovered pseudouridine in beer, a substance capable of protecting against mutagens. Pseudouridine seems to account for only 3 percent of the antimutagenic complement of beer, which leaves quite a lot still to be discovered in this area. Perhaps some hop-derived compounds are important, of the type suggested by scientists at Oregon State University. It is always wise to be cautious in claims and aspirations, especially with such an emotive and potentially devastating issue such as cancer. It would be dreadful to lead those suffering from the ailment to false hope, just as it would be irresponsible to overplay the risks of alcoholic beverages for this disease.^[11] It really does appear that the drinking of beer within recommended limits (such as those recommended by the United States Department of Agriculture) will not manifestly increase the risk of contracting cancer. Despite the optimism that there may be ingredients of beer that may have anticarcinogenic value, we really must see where the accumulation of evidence takes us.

* * *

So I wrote to the author of the diet that had become all the rage a few years ago. I was incensed. He had written that beer was the worst thing you could put into your mouth, because it contains (or rather he said it contains) maltose, and maltose was the worst of all sugars for the glycemic index.^[12]1 asked him (politely) if he had ever heard of the interesting phenomenon known as fermentation. I pointed out that in this process maltose is converted into alcohol. Sure, alcohol is the major source of calories in any alcoholic beverage.^[13] But it isn't maltose. Now the diet says “due to recent research we can rescind the ban on beer.”

Bizarre. Nonetheless there remains the myth about the beer belly. The truth really is rather straightforward: It's a case of calories-in versus calories-out.^[14] There is nothing peculiar about the calories in beer: If they are counted among the daily calorie intake, provided the latter level is in balance with (or less than) the calories burned off, then there will be no body fat accumulation, in the belly or anywhere else for that matter. And if you compare a Bud at 150 calories with a slice of lemon meringue pie with at least twice that amount then it is a no-brainer!

Certain components of beer may induce symptoms in sensitive individuals—for example, proteins claimed to be deleterious for sufferers of celiac disease. Medical advice for such patients is to avoid foodstuffs derived from wheat and barley. Therefore there is interest in beers such as Redbridge that are brewed from sorghum and that do not contain sensitive proteins.

Some men have heard scary stories about hops being rich in phytoestrogens, but they should relax: The amounts getting into beer are minuscule.

Finally, let me make mention of the old adage that nursing moms should drink beer for good breast-feeding. This certainly has nothing to do with female hormones, some believe that there is a carbohydrate in beer coming from barley that promotes secretion of the hormone prolactin, which encourages milk production. It may be that the reality is that the beer is nothing more than a reward after a somewhat demanding experience. Just another example of beer’s role in a holistic lifestyle.