Great analysis of an ongoing question, “Is a glass of red wine healthy or harmful for me?” That depends…on so many factors, as you pointed out.
It’s similar to the coffee debate that folks my age might remember well. Except, you’re not likely to end up in substance abuse hell for overindulging in a few cups of hot, black Joes. And, while there’s no such thing as Coffeeholics Anonymous, too much of anything, regardless of how good it is, can be a dangerous thing.
Moderation is the key for me, with most things, but if I had a history of alcohol use disorder (AUD), total abstinence would be the only thing that made any sense for both biological and psychological reasons. After one has crossed the threshold between desire and dependency, the neural pathway changes. So, an individual with a history of AUD can go sober, for years, then take a single drink and pick up where they left off, only with intensified dependency and diminished tolerance. It’s a dangerous game.
As the country song goes, for those who suffer from AUD, “One drink is way too many, but a thousand is never enough.”
I am not a health professional, but I am interested in the subject. First "excuse" for drinking is Resveratrol. I must admit that I am a social drinker. But my opinion is that if you drink, you should do it with knowledge. You know the truth, you decide.
You hit on one of the key reasons drinking doesn't automatically make anyone healthier: We might not get beneficial amounts of resveratrol unless we're drinking gallons of red wine per day, for instance. The other issue is that data on the health benefits of resveratrol are mixed at best. Supplements are available, but I don't see strong evidence that most of us should be taking them.
This article made me revisit Kari Poikolainen's output.
From a recent study of his, totally out of context, of course: "Former drinkers scored worst on most measures, even in comparison to the highest drinking decile."
At first glance that looks like good news for a boozer of any age (we're outperforming folks who quit, so let's not quit!), but in the end it says nothing about the risks of any level of consumption. Poikolainen and the Helsinki group helped show that it's important to not simply compare drinkers to non-drinkers, but to also differentiate the latter group into former drinkers vs. lifelong abstainers. Some former drinkers quit because of serious health problems, and those problems continue to impair their performance on all sorts of measures. On the other hand, I'll bet you a dollar that lifelong abstainers, on average, outperform the highest drinking decile on a lot of measures (as of a decade ago, the highest decile for the U.S. was > 74 drinks a week!).
Of course I don't go for that bet. I know I have forfeited something with my drinking. I'm just considering what I have to gain by quitting now, being fit and healthy for my age. My father drank heavier but less regularly than me and started to become demented in his late eighties and could still ride a bicycle and play the trumpet (not simultaneously) after his mental capacity had pretty much deteriorated. I wouldn't complain about such a perspective.
Apart from quitting, you might also consider whether to cut back. I'm not trying to persuade you of anything, but in tomorrow's post I'll be explaining why the more a person currently drinks, the more they'll benefit from a slight reduction (in terms of health risks).
Of course you're right. That's what I'm doing in a way. Not drinking more than necessary most days. Much fitness training, work, prayer and a few days of sobriety now and then.
The Zhang article is very strange. With a large sample and adjustments for now-abstainers who have been harmed by alcohol, they show that the relative risk for occasional drinkers is 0.96 with CI 0.86 to 1.06, and for "low-volume" drinkers is 0.93 with CI not reported. So on average, "light" drinking seems to reduce the risk of death compared to not drinking, but this is a small effect and might be due to chance. So far, solid.
However, instead of framing this as "light drinking doesn't seem to harm people", they say "there is no protective effect from light drinking". It's like they care more about refuting late-20th century memes about a French paradox or resveratrol than actually providing useful conclusions. It's not surprising that reporting on this has been so badly done.
The curve plotting excess risk against consumption is what we care about. This paper indicates that the excess risk curve hovers at 0 up to 24g of alcohol per day, and only then does it show increasing harm as the dose increases. (The exact threshold where the risk starts increasing is not clear from this analysis, but seems to be in the range 20-30g per day.) The curve does not go through the origin and the WHO statement is misrepresenting the evidence. A line through the origin would show that any amount of alcohol is harmful, but the paper does not show that. The paper says that up to 24g per day, alcohol does not seem to be harmful.
It's galling that people have managed to spin the voluminous evidence showing light alcohol consumption is a non-issue into a grand anti-alcohol narrative by using antagonistic framing. The real story is: most people eliminate small amounts of alcohol without any ill effects, drinking more than one's individual genetics or health conditions can eliminate is bad, your personal threshold is probably less than has been culturally accepted. Or even simpler: alcohol is generally bad for you but one drink a day is fine for most people.
You raise some good points here about how the RRs are framed.
1. I think that Zhang et al. talked about "no protective effects" because they were responding to the language used in earlier studies showing J-curve effects, where the researchers were literally saying that light drinking offers protective effects against cardiovascular disease etc. So I take Zhang et al.'s choice of words as not only intended to refute the memes, as you said, but also as an attempt to refute what other researchers had been arguing.
2. I agree with you that in this particular meta-analysis, we don't see harm at that lowest level of consumption (0-24g/day). There's other evidence of harm at low levels that I'll be discussing in my next post on 10/31, and some of that data looks solid, but in the end I will also agree with you that (a) there has been some anti-alcohol spin in the literature that's not justified by the data, and (b) sufficiently low levels of consumption probably don't increase the risk of health problems among people who meet certain criteria (e.g., no history of AUD or other contraindications).
The original J-curve findings were odd too, it never made sense to me that people were reporting the uptick in risk for abstainers as a real thing without controlling for reasons for abstinence. It looks like the left part of the J can be ignored, but the WHO should not instead overcorrect and pretend that the whole curve has mysteriously shifted over to cross the origin.
I would also like to see better stratification, because it's possible most of the risk is from people with a genetic disposition to alcoholism who usually don't drink but occasionally drink to excess, those without ADH who are inadvertently exposed to alcohol, or similar non-obvious causative factors. It might well be that real harm to some people is being hidden in a large average lack of effect, and it would be valuable to understand that (and you might well do that next time, looking forward to it).
Thank you. I'm glad you've found that zero works for you. I think we each need to figure out what's best for us, individually, and in many cases science can't be the only source of guidance. Even if studies showed that literally everyone benefits from light drinking, I don't think I could do it every day, because alcoholism runs in my family. I would have to pass on the benefits.
Great analysis of an ongoing question, “Is a glass of red wine healthy or harmful for me?” That depends…on so many factors, as you pointed out.
It’s similar to the coffee debate that folks my age might remember well. Except, you’re not likely to end up in substance abuse hell for overindulging in a few cups of hot, black Joes. And, while there’s no such thing as Coffeeholics Anonymous, too much of anything, regardless of how good it is, can be a dangerous thing.
Moderation is the key for me, with most things, but if I had a history of alcohol use disorder (AUD), total abstinence would be the only thing that made any sense for both biological and psychological reasons. After one has crossed the threshold between desire and dependency, the neural pathway changes. So, an individual with a history of AUD can go sober, for years, then take a single drink and pick up where they left off, only with intensified dependency and diminished tolerance. It’s a dangerous game.
As the country song goes, for those who suffer from AUD, “One drink is way too many, but a thousand is never enough.”
Thanks you! Glad you've discovered what works for you (i.e., moderation)!
I am not a health professional, but I am interested in the subject. First "excuse" for drinking is Resveratrol. I must admit that I am a social drinker. But my opinion is that if you drink, you should do it with knowledge. You know the truth, you decide.
About resveratrol.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4942868/
Article states the quantity of several products to get the DAILY dose. In case of wine is:
Red: 505 to 2762 Litres
Rose: 3448 Litres
White: 2564 to 17544 Litres...
More than a glass...
And the problem with wine is... Ethanol. Wine is an alcoholic beverage.
You hit on one of the key reasons drinking doesn't automatically make anyone healthier: We might not get beneficial amounts of resveratrol unless we're drinking gallons of red wine per day, for instance. The other issue is that data on the health benefits of resveratrol are mixed at best. Supplements are available, but I don't see strong evidence that most of us should be taking them.
This article made me revisit Kari Poikolainen's output.
From a recent study of his, totally out of context, of course: "Former drinkers scored worst on most measures, even in comparison to the highest drinking decile."
What's an old boozer gonna make of that?
At first glance that looks like good news for a boozer of any age (we're outperforming folks who quit, so let's not quit!), but in the end it says nothing about the risks of any level of consumption. Poikolainen and the Helsinki group helped show that it's important to not simply compare drinkers to non-drinkers, but to also differentiate the latter group into former drinkers vs. lifelong abstainers. Some former drinkers quit because of serious health problems, and those problems continue to impair their performance on all sorts of measures. On the other hand, I'll bet you a dollar that lifelong abstainers, on average, outperform the highest drinking decile on a lot of measures (as of a decade ago, the highest decile for the U.S. was > 74 drinks a week!).
Of course I don't go for that bet. I know I have forfeited something with my drinking. I'm just considering what I have to gain by quitting now, being fit and healthy for my age. My father drank heavier but less regularly than me and started to become demented in his late eighties and could still ride a bicycle and play the trumpet (not simultaneously) after his mental capacity had pretty much deteriorated. I wouldn't complain about such a perspective.
Apart from quitting, you might also consider whether to cut back. I'm not trying to persuade you of anything, but in tomorrow's post I'll be explaining why the more a person currently drinks, the more they'll benefit from a slight reduction (in terms of health risks).
Of course you're right. That's what I'm doing in a way. Not drinking more than necessary most days. Much fitness training, work, prayer and a few days of sobriety now and then.
I wish you all the best with that!!
Thank you for revisiting this issue.
The Zhang article is very strange. With a large sample and adjustments for now-abstainers who have been harmed by alcohol, they show that the relative risk for occasional drinkers is 0.96 with CI 0.86 to 1.06, and for "low-volume" drinkers is 0.93 with CI not reported. So on average, "light" drinking seems to reduce the risk of death compared to not drinking, but this is a small effect and might be due to chance. So far, solid.
However, instead of framing this as "light drinking doesn't seem to harm people", they say "there is no protective effect from light drinking". It's like they care more about refuting late-20th century memes about a French paradox or resveratrol than actually providing useful conclusions. It's not surprising that reporting on this has been so badly done.
The curve plotting excess risk against consumption is what we care about. This paper indicates that the excess risk curve hovers at 0 up to 24g of alcohol per day, and only then does it show increasing harm as the dose increases. (The exact threshold where the risk starts increasing is not clear from this analysis, but seems to be in the range 20-30g per day.) The curve does not go through the origin and the WHO statement is misrepresenting the evidence. A line through the origin would show that any amount of alcohol is harmful, but the paper does not show that. The paper says that up to 24g per day, alcohol does not seem to be harmful.
It's galling that people have managed to spin the voluminous evidence showing light alcohol consumption is a non-issue into a grand anti-alcohol narrative by using antagonistic framing. The real story is: most people eliminate small amounts of alcohol without any ill effects, drinking more than one's individual genetics or health conditions can eliminate is bad, your personal threshold is probably less than has been culturally accepted. Or even simpler: alcohol is generally bad for you but one drink a day is fine for most people.
You raise some good points here about how the RRs are framed.
1. I think that Zhang et al. talked about "no protective effects" because they were responding to the language used in earlier studies showing J-curve effects, where the researchers were literally saying that light drinking offers protective effects against cardiovascular disease etc. So I take Zhang et al.'s choice of words as not only intended to refute the memes, as you said, but also as an attempt to refute what other researchers had been arguing.
2. I agree with you that in this particular meta-analysis, we don't see harm at that lowest level of consumption (0-24g/day). There's other evidence of harm at low levels that I'll be discussing in my next post on 10/31, and some of that data looks solid, but in the end I will also agree with you that (a) there has been some anti-alcohol spin in the literature that's not justified by the data, and (b) sufficiently low levels of consumption probably don't increase the risk of health problems among people who meet certain criteria (e.g., no history of AUD or other contraindications).
The original J-curve findings were odd too, it never made sense to me that people were reporting the uptick in risk for abstainers as a real thing without controlling for reasons for abstinence. It looks like the left part of the J can be ignored, but the WHO should not instead overcorrect and pretend that the whole curve has mysteriously shifted over to cross the origin.
I would also like to see better stratification, because it's possible most of the risk is from people with a genetic disposition to alcoholism who usually don't drink but occasionally drink to excess, those without ADH who are inadvertently exposed to alcohol, or similar non-obvious causative factors. It might well be that real harm to some people is being hidden in a large average lack of effect, and it would be valuable to understand that (and you might well do that next time, looking forward to it).
Interesting read. I have stopped drinking alcohol and don’t think I want to be a light drinker. Happier at zero!
Thank you. I'm glad you've found that zero works for you. I think we each need to figure out what's best for us, individually, and in many cases science can't be the only source of guidance. Even if studies showed that literally everyone benefits from light drinking, I don't think I could do it every day, because alcoholism runs in my family. I would have to pass on the benefits.
It runs in mine, too. Hence the zero approach!
thank you ken. we liked your "sober" look at whether drinking can be good for you