1. The best evidence that there is no safe amount of alcohol consumption is the Mendelian randomization (MR) by Holmes et al from 2014 [1]. I believe that the more recent paper making such claims is no better than the usual observational studies. But the MR paper is convincing to me. The risks for mild drinking appear to be low enough that I don't abstain, and I am happy to tell my patients about my thought process.
2. While we like to claim that a study randomizing people to alcohol wouldn't be ethical, pre-2014 I don't think that would have been true. I think there was enough equipoise. Post-2014, I would need to see some strong counter-evidence to make me think there is equipoise once again.
3. The environment changes. A trial came out last week showing that ASA may be harmful for older healthy people [2]. This probably reflects that our bloodstream is no longer nicotine-filled, etc., so the heart attack risk is low enough that the bleeding risk may outweigh it. There may be something about alcohol that was helpful in the 1950s that is no longer so today, due to these environmental changes.
Edit: disregard, seeing the updated link you posted.
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If I'm reading correctly, that 2015 MR paper establishes that LDL and triglycerides play a role in heart disease by filtering populations used in prior studies for genetic blood lipid factors. But it doesn't make any claims about alcohol. Is there already a well established link between alcohol and LDL / triglycerides?
My impression is that the relationship between LDL, HDL, and triglycerides and what we eat/drink is not well understood. But I'm not involved in biology or medicine, so maybe you can help me understand this better?
Thank you very much for that first link. It seems to be severely under-publicised considering the huge amount of exposure that the topic gets.
Do you happen to know if rs1229984 is linked to any particular group that could make this result problematic? I noticed that the paper mentions that "There was also some evidence for a difference in years of education, and, while the size of the effect was small, this requires further investigation." That sounds like a decent-sized red flag.
Take a look at the population frequencies on the right. While the minor allele is infrequent in Europeans, it is extremely common in East Asians, for example.
> Do you happen to know if rs1229984 is linked to any particular group that could make this result problematic?
It seems to me that we would not have to know about the link in order for the conclusions to be unfounded. These MR analyses rest on the assumption that the instrument is not linked to any potential confounders. This seems like a bold and unwarranted assumption when we are talking about an instrument linked to behavior, given the complexity of the chain of events (chemical, biological, and psychological) between gene expression and observable human behavior.
That education red flag involves just one possible confounder out of many that were never considered.
> 2. While we like to claim that a study randomizing people to alcohol wouldn't be ethical, pre-2014 I don't think that would have been true. I think there was enough equipoise. Post-2014, I would need to see some strong counter-evidence to make me think there is equipoise once again.
That's a very convenient way to socially forbid replication attempts. I don't buy it. The argument basically amounts to a claim that we answered the question definitively in 2014 and anyone questioning that result now is unethical. Today's scientific research, especially in any area pertaining to people, is too unreliable to blindly trust this way.
What's the line? If we found that some intervention group had 90% mortality with the control group having 10% mortality in some experiment, I think you would agree we shouldn't repeat that experiment with a lot of people as you would be randomizing to something likely to kill them. What about 20% mortality to 10%? What about 11% to 10%? What degree of certainty about the results do you need? Obviously there is a line somewhere. But, its not easy, so I wouldn't recommend dismissing such concerns glibly. Is that the same as claiming we answered the question definitively, or is that just ethical research?
We're not talking about administering arsenic to people just in case we're wrong about thousands of years of experience. We're talking about randomizing exposure to an activity that billions of people choose voluntarily, an activity that at worst has an effect of a few parts per 100,000. That's on the same order of risk as being struck by lightning. Unnecessary x-rays are likely worse. Why the outrage over this risk in particular?
Declaring this level of risk to be outside the bounds of permissible research is an attitude incompatible with scientific progress. It's elevating short-term harm prevention to an unjustifiable extreme that makes it impossible to determine whether we have an accurate model of the world.
Sure, you could run an alcohol intervention by an IRB and see what they say. If they think there is equipoise they might go for it. Just because I don't agree doesn't mean I feel strongly about it or would throw down some gauntlet.
I don't accept the legitimacy of IRB rulings; I hope to see a day when these bodies stop blocking research. Researchers are competent to be ethical on their own.
My reading (not just [1], although [1] is a lucid examination) suggests to me that IRBs are net detrimental to research. There's an incentive misalignment that pushes them too far in the "harm" prevention camp and that makes it too difficult to answer scientific questions.
If I am following your logic here, you're saying that because you read a blog post in which a practitioner was surprised at how much more ethically complex it is to conduct scientific research than it is to simply deliver the current state of the art to a patient, you've come to believe that biomedical research should be freed from institutional oversight?
You can express that opinion, but it sounds awfully like you don't understand what your source ("Scott Alexander") was saying, or perhaps that both you and your source don't understand (a) the distinction between practice and research and (b) the relative cultural fixity of institutional reviews in biomedical research versus talk therapy.
So I guess what I'd say is that it looks like the one thing you know about IRBs is that Scott from SlateStarCodex once had a run-in with them and generalized wildly from it.
If I've said something incorrect, refute it. Otherwise, stop it with the vague insinuations. You have no idea what I've read about IRBs and you haven't engaged with any specific arguments in anything I've linked. "It sounds like" is not an argument. It's putting words in someone's mouth.
I'm responding to the argument you actually made, not the variety of arguments you hypothetically could have made. My response has been substantive; I've clearly read the same article you did, as well as your citation. If you're unhappy with your own argument, don't blame me for it.
I think neither of will profit from continuing this discussion, though. You can safely sum up my point as "the problems people in psychology, and the social sciences in general, have with IRBs do not necessarily generalize to biomedical research". One of the basic complaints scientists have about IRBs is the "mission creep" from human medical research to the rest of the sciences. The premise of that argument doesn't line up with your argument here on this thread.
You are not in fact responding to any argument I've made.
My point is that IRBs have an incentive structure that encourages excessive risk aversion. My citation is an instance of this phenomenon in action. It has nothing to do with the particulars of psychology. You have not attempted to address this incentive alignment argument in any way. Blocking an attempt to replicate an alcohol study due to weak evidence for a very small negative effect is another example, albeit hypothetical, of this same excessive risk aversion. You have not made a similarly substantial argument. Instead, you've just asserted that institutional review is embedded in biomedical research. It is, but I think it shouldn't be.
> Also, SlateStarCodex is bad.
It's amazing that immediately after a paragraph in which you claim to be making a substantive argument, you make a bald and unsupported assertion that an influential and widely-read blog, one that Pinker has called "wonderful", is in fact "bad".
This is not the kind of intellectual conversation that HN was meant to host.
I am surprised that taking a baby aspirin every day may turn out to be harmful. It's been common wisdom for years, and now it may (or may not) be wrong. Like the advice that chocolate and red wine is good for you.
I remember reading a paper some time ago claiming a relationship between NSAID use and kidney cancer. And then one about Aspirin use and lower risk of colon cancer. The side effects of Aspirin are not just the risk of stomach bleeding as stated on the package.
"But if the same 100,000 people drank nothing at all, 914 would still have one of those same problems. That’s only 4 more people per year (per 100,000) who will have a problem that’s attributable to alcohol—that’s tiny. But it’s also not zero."
...and it's also far too little to be statistically significant.
Moreover, nutritional studies of any kind have been infamously bad at giving reliable information. The advice from one decade is almost routinely found in the next to be invalid, or even the opposite of the truth. That's for things like carbohydrates, about which there were few religious injunctions or political polarization. For a topic with as much emotional and political baggage as alcohol, I find it unlikely to be any better. Whatever your decision about alcohol, I think the reliability of the science (pro- or anti-) is just not sufficient to help you make your decision.
I have been reading for years about the numbers of studies being done (especially in the public health field) that can be whittled down to correlation without any strongly proven causality. Is this an issue with science, or with how the media reports on science? Is it really as bad as it seems?
I understand that it's difficult to control for various factors when doing large scale studies of health and behavior, but my perception as a layman is that there is some willful ignorance or absence of rigor. I realize this is perhaps too harsh a statement; I'm just trying get my point across.
Observational studies can be incredibly hard to do in a way where you can infer causality. But most of the data you can get your hands on are observational.
Does cataract surgery reduce mortality in older women? It sure looked like it, until it was recognized that the study suffered from a concept called "immortal time bias" [1]. Now the reverse "seems" to be true. (Unhelpfully, it's easy to make an "explanation" for either case. Surgery lowers mortality? Of course! Better vision keeps you safe. Surgery increases mortality? Of course! Failing vision is associated with other failing organs, and surgery itself poses risks.)
In cardiology, we like to refer to immortal time bias as the "cheetos" effect. An example: Let's look at people who had an event (heart attack) and try to estimate the benefit of a procedure done afterward (literally eating a bag of cheetos within 60 days after the heart attack). You will find that eating a bag of cheetos confers increased survival compared to not eating a bag of cheetos. The reason for this is that in order to have eaten the bag of cheetos, you necessarily lived long enough to eat the cheetos. If you died first, you count toward the non-cheetos group. So stacking things up, it will look like cheetos keeps you alive longer. (The solution to this problem is not to count the time before eating cheetos towards your survival time. If you do this with literal cheetos, which don't have a survival effect, then you will correctly see no difference between groups.)
This is just one of the numerous biases that exist and can be difficult to account for. In my opinion, this stuff is just hard. If you are interested, Judea Pearl is developing tools for causal inference [2].
Looking at the notice of retraction[1], "immortal time bias" seems to be a particular subset survivorship bias, in which there is a distinct delay between two events, and by definition one facet of the study only looked at those who survived that time period. In this case, the time period between diagnosis and the actual surgery.
> I understand that it's difficult to control for various factors when doing large scale studies of health and behavior, but my perception as a layman is that there is some willful ignorance or absence of rigor.
I perhaps understand the sentiment behind this, but if this is really what you think then probably you don't really 'understand' how difficult it is to do large scale studies of health and behavior. As a thought experiment, pretend you are the researcher studying a glass of wine a night and write the script you would pitch to potential research subjects. You have to try to convince them to be randomized to either completely abstain from alcohol for a period of 10-20 years OR to drink 1 glass of wine a night for that same period. Do you think you could get 10,000-50,000 people to participate and that those people would reliably stick to their randomized groups? How would you monitor compliance? How will you keep track of those people for 30-50 years to see differences in mortality or other outcomes?
The 'answer' may be here that it's simply best to acknowledge that we cannot realistically study some, and arguably many, things. I expect your response would be that at least trying to do the best with the resources we have is better than remaining blissfully ignorant. But the problem is that coming to wrong conclusions far more dangerous than simply acknowledging we do not yet have the resources to come to any conclusion. And science is built upon the shoulder of giants. But what happens when the shoulders you've built upon collapse? One mistake decades ago can end up destroying decades of further work that was built upon it.
Science is never 100% on practically anything. Even in physics there are keystone works that are mutually incompatible indicating errors in one or both. But there is a difference between models that are based on predictiveness, direct experimentation, and falsifiability - and models that are based on correlation. Newtonian mechanics is a good example. The equations that determine a body's position given a set of inputs and time could be shown to be 100% correct in every single scenario. Well at least until Mercury came along with it's 1/100degree per century orbital aberration. And that 1/100th aberration per century of a single body was enough to inform that something was wrong. With correlational studies, actual results don't really matter and entire views become practically impossible to falsify. And when they do provide predictions, rarely is it the case that the failure of that prediction to come true would falsify the study. That's just not science by any stretch of the imagination. It is the difference between astronomy and astrology.
I mostly agree with this. But part of it is scientific illiteracy on behalf of most people, who want these 100% answers, not grades of evidence and certainty. An observation study is definitely helpful, but should be taken as what it is, an observational study, not truth, which is often how it is reported and understood.
But I don't think that coming to wrong conclusions is necessarily 'far more dangerous'. People who drink 1 drink a night are not likely to have dramatically different outcomes than people who abstain. (perhaps unless it contributes to binge drinking, but science already says that is bad)
I guess what I mean is that the results of these types of studies are useful, but only in pointing where to look for a more direct mechanism. In other words, we found a correlation, now we can look more closely at the elements involved to find causality. Mostly it seems like the correlation is accepted and then untested theory is exposed as fact to explain it.
>correlation without any strongly proven causality
How would one really prove causality or does it even matter. When I think of science, I try to think of it like how I think of physics, where we create a model that best describes the evidence but which doesn't have any guarantee of being how things really work.
Take Newtonian gravity. It is a pretty good model that describes a lot of basic interactions. Given a state at a given moment in time, it lets us determine things going forward or backwards (though for more complex physics, backwards stops working because of assumptions and estimates in the model). But at the same time, it is wrong. More complex physics shows there is a model that fits even more experimental data which contradicts what we thought was happening in the Newtonian model. Mass doesn't attract mass. Mass bends space time and impacts objects traveling through it in such a way that it appears mass attracts mass (though even this may end up being wrong and something else entirely is at play).
So, is it really important to describe why a ball falls to the ground when I release it, or is it good enough to have a system that describes the interactions enough that I can apply it to problems? If I solve a problem, say what angle and what speed I need to throw a ball to get over fence, does it really matter if I think the ball falls back to earth because mass attracts mass or because mass bends spacetime? Or is it just important for my equations to be accurate enough that any error is less than what is innate in applying the solution to real life (measuring the exact height of the fence, throwing at an exact angle).
What does applying a similar mind set in something dealing with vastly more complicated systems, such as in medicine, looks like?
> So, is it really important to describe why a ball falls to the ground when I release it, or is it good enough to have a system that describes the interactions enough that I can apply it to problems?... does it really matter if I think the ball falls back to earth because mass attracts mass or because mass bends spacetime?
I think you answer this question in your own post. The answer depends entirely on your goals.
"All models are wrong, but some are useful".
If all we ever wanted to do was shoot cannon balls over/into walls accurately, then we probably would've never bothered inventing modern physics.
But we did want to do other things, so we built better models. It's worth noting that some of those things we wanted to do were more philosophical than others, e.g., engineering ("put satellites into orbit"), explaining empirical observations that seem important ("explain how electricity really works") and philosophical ("understand the nature of reality") are all answers to the question "what are you goals?" that have inspired progress toward better models in physics.
> What does applying a similar mind set in something dealing with vastly more complicated systems, such as in medicine, looks like?
It takes a certain amount of philosophical sophistication to realize that even the most perfect model is still a model and to then reason through what that entails -- epistemologically -- for less perfect models and for the entire scientific enterprise.
I'm personally a fan of the 'make a better model to have a better model and let someone else figure out the application' model, but that one is harder to get funding for.
It matters for decision-making. If A causes B then forcing A to happen artificially (without changing anything else) will make B happen too. If it's not a cause then it won't. The correlation might always happen in the original environment, but it doesn't survive intervention.
There's a big difference between knowing that A causes B and knowing how A causes B. For most purposes relating to health it's sufficient for a layperson to know just that A does cause B, no matter how. But if A is just correlated with B and doesn't cause it, that makes a world of difference.
But you can never really know if A causes B or not. You can only create models, some that have A causing B and others than only have them correlated, and get rid of models as you find contradicting data.
What actually causes a ball to drop to the ground when I release it? We don't know. The best model (that I know of) is the bending of space time, but that isn't the real answer and may one day be overturned just as the older idea of mass attracts mass.
I guess the question is, are we sure enough of our model to be able to trust the airplane isn't going to drop to the ground like the ball does, and how do we achieve equivalent certainty in the biological sciences.
I recommend reading Judea Pearl's _The Book Of Why_, which details why historically science has been restricted to correlational observations, and how causal calculus can shed light on causality.
The incentive structure in "science" is completely fucked, and it's a well-known dirty secret.
Of course there is great research being done. The problem is that the cognitive load of evaluating which research is useful has been shifted to the end "consumers" of that research.
I think it's little more than a sharp increase in bias. The physiological sciences are heavily driven by moneyed interests and the social sciences tend to be full of people who are extremely politically motivated, and homogeneous, in their 'research.' Bias is always bad, but at least when it's counter-balanced with bias in the opposite direction both sides can help bring each other closer towards the truth by remaining extremely critical of one another. But bias without any counter balance is particularly dangerous as it leads to a feedback resulting in even greater extremism and bias: social media in a nutshell, but it's not limited to just social media of course.
Compare science that's goal is to find a truth to science that's goal is to prove an assumed truth, and you'll see the standard of research sharply decline.
There are some systemic issues in play for sure. Publish or perish means researchers need to put out new publishable work, or find a new career. And that in turn also introduces a publication bias. Spend 5 months researching a hypothesis only to find that it's wrong? Well that's pretty much 5 months wasted because journals are not so fond of publishing negative results. Massage the numbers a bit to get that positive result though, and you're good to go. Pretty nasty incentive systems there. And now add into the fact far more people than ever before are pursuing postgraduate education. It's a mess.
I think it's an issue with studies funded by someone that has an interest in a certain result, and also a media that is happy to publish a story that is nearly written for them.
For me it works only after enabling JS and disabling adblocking, but the contents is appalling:
> To continue enjoying the free content made available to you on this website, you must indicate that you understand and accept Bonnier Corp.’s use of cookies by selecting the "Allow all cookies" button below.
What about the loss of quality of life from not drinking?
Are those things ever taken into account?
We could a nutritionally determined portion of specific foods every day, sit at home to avoid accidents outside, get out enough for the required sunlight, and exercise the optimal around.
While it's good to know whether a "glass of wine" is good or not, it bad when such research is used to cut off any bad-for-us enjoyment we get.
Besides, it's a bunch of factors which makes the whole "one glass of wine is harmful" a moot point if you can take care of the rest (and why not start with them?).
In the "blue zone" of Icaria for example, one of the places in the globe where people live the most, people regularly drink several glasses of wine per meal and have been doing so for millennia. Yet, there they are regularly at 90+ and 100+. Then again, they're stress free, sleep whenever they feel like (no really, they'll casually open their shops at 2pm or at 3am if they feel like it), and don't eat junk food.
Glass of wine in the night is a very bad habit and you don't need a large scale study to prove it. If you have a watch that can track your sleep cycle, you will see that your deep sleep doesn't start until much later if you consuming alcohol before going to sleep. In other words, a glass of wine might make you feel relaxed but it robes you from your deep sleep.
If you have a watch that can track your sleep cycle, you will see that your deep sleep doesn't start until much later if you consuming alcohol before going to sleep.
That seems ridiculous but indeed, we shouldn't make assumptions. We have to measure assumed negative effects, like impaired cognition. Or maybe that's good too.
That’s why I drink what I want and I eat what I want. I stopped caring about studies changing each year. Also, I’d very much prefer to die earlier from a heart attack than live longer and die from Alzheimer’s.
Alcohol consumption and our attitudes towards it, is pretty much the result of marketing, movies and shows. We are literally made consumers of literal poison. Has anyone paid attention to recent WHO report that 5% of all deaths are due to alcohol, number has high as 23% in 20 somethings.
Humans have been making alcohol since prehistory. There are plenty of breweries, distilleries, and vineyards in Europe and Asia that have been continuously active for centuries.
True and it was never mass consumed and celebrated to this extent. Current situation is that despite the facts and knowledge, social pressure makes people drink. Despite the facts.
The facts are overwhelming and we shouldn't just keep consuming alcohol because muah cultur. Many alcoholics end up causing traffic accidents and require lots of state support in other ways. Just walk into ED on any Saturday/Friday night. I have done that
People used to be drunk constantly - why do you think 19th century temperance movements were such a cultural force? Alcohol consumption was staggering in the past, to a degree we would consider insane today. Naval everyday rum rations alone would be well above the guidelines of being considered an alcoholic.
Alcohol was consumed en mass more than it is now. Little kids would regularly drink. Often alcohol was drank instead of water for sanitation reasons. It's been a huge part of nearly every culture for thousands of years.
You seem somewhat unperturbed that the entire crux of your original argument was faulty... maybe time for an update on your priors? Don't mean to sound unfriendly :)
Unperturbed because I know the endgame on this :). World without alcohol is a better world. The arguments about the past. I can list down counter arguments. But that’s not the point. People often respond with emotions about alcohol consumption. Media brainwashing has done its job well.
Alcohol consumption in the past was necessity because of cold climate and manual labor. Alcohol is made from ethanol is made from sugarcane and is extremely calories rich. 100 gm beer contains 43 calories. One can contains 154 calories
It was quite fine in the past as most of the calories were burned due to harsh living conditions.
Fast forward to 21st century. We are hardly exposed to extreme cold. We live in extremely protected environments. From temperature controlled office to car to home. But we haven’t changed our drinking habits to reflect that.
Add to that mass media consumption due to profits. We have an epedicmic which can easily be prevented. 5% of all deaths are due to alcohol.
Just visit ED of any hospital on Saturday night if you want to see the ills for yourself
No doubt alcoholism is bad and shouldn't be encouraged. But there's a huge difference between ending up in the ER and having a craft beer on a Friday after work (and everything in between).
You are discounting the positive psychological benefits that can be attributed to alcohol. Even if it really is bad to ever drink, ever, it's not like you're going to instantly keel over and die, it's a very subtle effect if it's there at all. People will weigh that risk against the benefits they get from drinking and act accordingly.
One could say that a lot of these "soft limits" are already in place due to humanity's long relationship with alcohol. It's already not seen as a good thing to get black out drunk for instance...
Don’t get me wrong. Personal choice precedes everything. I do think however that there’s lack of information spread. And profit seeking encourage drinking and discount the ill effects.
Facts weigh against alcohol consumption and I hope people choose their, societal and environmental health
There has been a rather disturbing post-2000 neo-puritan thing going on for a while now, shaming people for purely personal choices, such as eating meat, smoking, drinking alcohol, enjoying cannabis in various forms, and generally acting in ways that are "impure".
Sure, banning smoking in restaurants makes sense, as it actively ruins the experience for other people. But this whole vegan teetotaler thing is getting extremely aggravating.
Shaming people for enjoying alcohol responsibly is just as bad as shaming people for choosing to not drink. Both groups of shamers need to cut it the hell out.
You set a weekly limit and the app tells you when you're getting too close. Features Untappd integration, HealthKit calorie syncing, and various charts and stats of your drinking over the past year. Figured I'd build it after reading numerous articles like this and deciding that 100g/week was the optimal risk/reward point for my health.
That page was nearly unreadable in Chrome on my phone due to bizarre scrolling ads everywhere and eventually crashed and died. A pity, I was learning a lot.
Same on mobile Safari. On page load it immediately scrolled halfway down the article and covered up half the screen with a “trending articles” popover whose assets — including the dismiss button — failed to load.
Seriously, does anybody in publishing actually visit their own sites? I see UX like this and all I can think is, “gee, somebody got _paid_ to make this?”
Edit: I see from another comment that the scrolling was (partly) a result of the link being to an anchor tag. I stand by the rest of my point, though.
I've often felt that there was something sketchy about meta-analysis,...
"But as the headline-generating study in The Lancet notes, “Until recently, most meta-analyses of alcohol consumption have not controlled for the composition of the reference category,” and that “subsequently, assessments of harm relying on these studies have been biased.”"
...but overall systemic bias wasn't what I was thinking of.
Nah that’s an obvious one. Having unrelated health problems is a more important confunder (i.e. people with health problems, or old, or mentally ill, are mole likely to not drink).
People with health problems are told by their doctors to stop drinking alcohol.
From TFA:
"An analysis from 2007 by an international group of alcohol epidemiologists and addiction researchers, published in Annals of Epidemiology, notes that “as people progress into late middle and old age, their consumption of alcohol declines in tandem with ill health, frailty, dementia, and/or use of medications.” That decline means that, as people become less well—even if they’re not elderly—they will also tend to stop drinking."
I might have been too subtle since you TFA so nicely.
The article points to adverse health related events that cause abstainment. Clear and good the AoE-article works that out.
I however point out that it's pretty clear within the drinking categories you have effects that go in tandem with other illnesses as well (like self-medicating with alcohol for psychological issues).
So the whole argument they propose should at least be carried out to its full, working both ways. You've got illnesses moving people into abstainment and illnesses moving people into moderate or high alcohol usuage. The only way to control this is to use changes in comorbidity over time as a factor.
TBH the scientists in the underlying article write this down as an issue as well.
Right, I mis-summarized the article. A more accurate summary would be: non-drinkers are more likely to have pre-existing health problems than light-moderate drinkers.
Obviously I can't say anything about my own longevity, but over the past few years my alcohol consumption has decreased to virtually zero and I've never felt better. I was never a big drinker, but I would semi-regularly go out and drink a few pints of beer or have wine with dinner. I never intended to cut down on alcohol, but my lifestyle changed, I stopped going out so much, and the drinking went with it. I would still drink maybe once a month, but I've realised that it makes me feel bad every time, so I now completely abstain.
The interesting thing is how people react to it. For some reason you are expected to provide a reason for why you don't drink. I don't smoke either but nobody asks me why. I've noticed also that it makes people uncomfortable if you're not drinking. When I do go out now I drink diet soft drinks so that I don't get constantly asked why I don't have a drink.
I foresee a shift in cultural views towards alcohol much like the shift with respect to tobacco of last century. I wonder if the USA and UK will again lead the way with this leaving much of continental Europe behind.
Unless you were getting wasted it's quite unusual for a few drinks to make you feel bad.
Also, there is more and more a decent selection of <0.5% alcohol beers - I find this the easiest way to not get strange looks when at a drinking occasion.
But then again, maybe the point of drinking together is it provides some kind of bonding effect, being a shared vice. It makes it harder to lie and shows you value others more than your own health (relatively).
How do you define quite unusual? I’m not East Asian, but I most often get symptoms similar to Alcohol Flush Reaction with even only a single drink. I often find a single beer strong. I’ve never been able to figure out why sometimes I’ll get a headache after a single beer.
“Approximately 36% of East Asians (Chinese, Japanese, and Koreans) show characteristic physiological responses to drinking alcohol that includes facial flushing, nausea, headaches and a fast heart rate.”
Diabetes, poor liver and/or kidney function, similar genetic mutation, etc. There are a host of reasons, I would bring it up with your physician, as they may have more insight than a psudoanonymous commenter.
It could be some other cause too. A couple of years ago I started noticing that one or two beers would make me almost drunk and to feel terrible the next morning. I attributed it to aging (36) but I also noticed none of my friends had the same problem.
Later, I was diagnosed with sleep apnea and after daily treatment now drinking a few beers is completely ok.
I don't understand what the relationship between those two things are. I would have never imagined.
I noticed even a single normal ABV beer makes a noticeable impact on my workout the following morning (I workout 5 mornings per week). There's just an a edge I don't have if I had a drink the previous night, and it definitely doesn't require overindulging.
Have you ever abstained for a while from alcohol? I used to drink like a degenerate in college (easily 10+ drinks on a night out).
I cut out drinking altogether for about a year right after college. Since then, I drink maybe 6 times a year. If I drink anything more than two drinks I feel pretty horrible and can feel it the next day.
The places I've been to in the Bay Area has never served anything like <0.5% beer. I'd much rather drink something like ginger beer or kombucha anyway, which is what I do given the occasion.
When I was twenty pounds heavier, a few drinks had no effect on me. Now that I am healthy and running every day, I notice every drink has an effect on my performance. I think the extra fat just helped distribute the effects of alcohol.
> Unless you were getting wasted it's quite unusual for a few drinks to make you feel bad.
Is it, though? I know plenty of people who will just waste whole days away in front of the TV doing nothing because they don't feel like doing anything else. People are constantly telling me they're "tired". I used to be like that too. But now I work on my career or on my hobbies day in, day out. Barring seasonal illnesses I never have down days.
> Obviously I can't say anything about my own longevity, but over the past few years my alcohol consumption has decreased to virtually zero and I've never felt better. I was never a big drinker, but I would semi-regularly go out and drink a few pints of beer or have wine with dinner. I never intended to cut down on alcohol, but my lifestyle changed, I stopped going out so much, and the drinking went with it. I would still drink maybe once a month, but I've realised that it makes me feel bad every time, so I now completely abstain.
Same is happening to me.
And the last time I bought alcohol, I bought a pack of 0% alcohol beer by mistake at the supermarket. I would never do that intentionally, as I consider 0% alcohol beer a ridiculous idea and also never tried it. However, I finished the pack, and the first beer was special. It actually tastes like beer, without alcohol, it's mainly sugar with water.
Won't buy another pack ever again, but it was an interesting experience and opened my eyes about the taste of beers
I maintain that alcohol-free beer is one of the best post-workout drinks available. As I see it, the proper place of alcohol-free beer is not as a replacement for regular beer, but as a replacement for energy drinks and sodas.
> For some reason you are expected to provide a reason for why you don't drink
I grew up in a family that didn't drink - and this was always weird/uncomfortable to explain to friends.
I do drink now; but I've noticed over the years that it is becoming much more socially acceptable to not drink ..and people don't think it so strange; "I just don't like it", "religious beliefs", "trying to get healthier". So, yeah, people still ask "why?", but often out of genuine curiosity IMHO.
This is a good thing - frankly, I like to have a drink with friends, but its more about being with the friends - and if they're drinking soda I'm just as happy they're with us.
related: I wonder if there is an emerging market for craft non-alcoholic cocktails in bars similar to the emergence of low-alcohol craft beers (in the ~2% range).
It is called mocktails and every proper cocktail bar has at least as many as regular cocktails. If your cocktail bar does not, then you are overpaying for a spruced up dive bar experience.
> The interesting thing is how people react to it. For some reason you are expected to provide a reason for why you don't drink. I don't smoke either but nobody asks me why. I've noticed also that it makes people uncomfortable if you're not drinking. When I do go out now I drink diet soft drinks so that I don't get constantly asked why I don't have a drink.
I never drank aside from a few sips in past attempts to placate people bothering me about drinking. I used to be more annoyed by people who seem to really want to know why, but I've found that simply being firm about not drinking is usually enough to get people to drop the subject. I don't usually give a reason, as that seems to be an invitation for others to harass you. I also will refuse to even sip an alcoholic beverage for the same reason.
Some people seem to take the fact that you don't drink as personally offensive, as if you are judging others for drinking. But I really don't care that much about how much you drink any more than I care about how much ketchup you put on your fries. That is, I don't care much at all unless you're using obviously too much. The view that non-drinkers are judgmental seems to be caused by a combination of psychological projection and the drinker having mixed feelings about alcohol.
If I had to give a reason, it would be something like this: I never was convinced of any benefit from drinking, but I can see many risks. The main benefit to me is that many drinkers will socially exclude non-drinkers, but I think a better solution is to avoid people who don't like non-drinkers.
The reasons I've heard from people about why they drink or want to encourage me to drink vary a lot. One that comes to mind is "I want you to be happy", which don't find convincing because I am perfectly happy and don't think drinking would improve my happiness. The people who insist that I just haven't tried the right drink are getting tiring. If you didn't like ketchup and I said that you haven't tried the right ketchup and then insisted that you try small amounts of a half dozen ketchups, that would be considered fairly weird. But it happens to non-drinkers.
In France we were raised on water (school, home - surely tzp wzter in large quantities) then wine and beer (not that much soft drinks compared to US).
When you go to the restaurant, it is meal to order tap water (no matter the restaurant) and often you will find some people drinking water, some other wine. Yesterday (upscale restaurant) it was 50/50 at my table
In z bar people commonly take a juice when other take alcohol.
Nobody ever saw that as weird in my circle of friends (an average and quite random one)
> I've noticed also that it makes people uncomfortable if you're not drinking.
Last night I watched a video by Mel Robbins on friendship¹ in which she made the very cogent argument that when you mention you don't want to drink you remind others in your social circles of their own struggle to quit drinking, hence the negative feedback. Her solution is to accept that those people are part of an old chapter of your life, and although you don't dislike them in anyway, it's important to recognize that you will slowly develop new friendships with those that match the lifestyle you now choose to live.
The USA tried that once, and the results were so horrifically bad that I doubt we will try it again. It resulted in organized crime openly running the cities of Chicago and New York, because they outgunned the cops. It was much like what Columbia was like at the height of their troubles with cocaine druglords.
Now there has been a shift in regards to driving while intoxicated, but that happened about 20 years ago, and while it has continued, it shows no signs of leading to a movement to make alcohol illegal. On the other hand, marijuana legalization is gathering steam lately.
> but I've realised that it makes me feel bad every time.
Between not drinking alcohol at all and drinking so much that you feel bad the following day there is a middle ground of drinking moderately. If a low amount still makes you feel bad, drinking alcohol of a better quality can help (there is a huge difference in this regard between really cheap wines and more expensive ones).
It’s also possible that no such middle ground exists, and some people are just less attuned to the hangover effect. Or maybe some people do and some don’t suffer from heightened sensitivity. I don’t see how you can make a blanket assertion that moderate drinking with no ill effect is available to anyone.
In fact the topic article describes research suggesting that there is no “good” amount.
> blanket assertion that moderate drinking with no ill effect is available to anyone.
For me if you have ill effects it is no longer moderate drinking. Note that I am talking about short-term effects such as having an hangover, not the long-term issues that are the topic of the "good" amount in the article.
For sure according to my definition for some people such a level may be zero, and in that case they should refrain from drinking, but the person I replied too talked about "a few pints of beer" at a time, not exactly a minimal amount.
I agree with the observation that people expect a reason. At least in my experience in Australia, "no thanks, I'm driving" works well. It is somewhat socially unacceptable to convince a driver to drink, and bar staff are supportive generally.
If that was the extent of your drinking, I doubt that was the major factor in your improved health. I would look to the things you consumed while drinking, such as rich full-fat restaurant food in big portions, salty carb-heavy fatty snacks and second-hand smoke.
Cutting out alcohol completely is certainly not a bad thing health-wise, but I think it was much more significant that you stopped going out so much.
Nah, I still do eat rich full-fat, salty, and carb-heavy food. Trust me, it's the alcohol. The day after drinking used be completely wasted for me. Now every day can be very productive.
You didn't ask for this suggestion, but I'll say it anyway: evidence suggests that making a similar switch in your regular diet would have a material impact on your well-being beyond what you've experienced with alcohol. If you think back to your drinking days and think you would have gained more from quitting alcohol much earlier, just imagine how you would feel by improving your diet.
My diet is very well-controlled. I fast for 20 hours every day and have a perfectly balanced intake. But if I drink alcohol I will sleep badly and I will have a bad day tomorrow. Why do people refuse to believe this?
This comment thread just reinforces your argument (my belief as well) that people will go out of their way to try and normalize drinking, just like smoking used to be in the 60s.
I get constant questions as well unless I'm babying a random non-alcoholic beverage. I've found that the best non-follow up to "why don't you drink?" is "I used to drink a lot but my doctor told me to try and abstain for my health."
No, the issue is simply that the alcohol intake he describes should not have that big of an impact.
A few pints of beer or some wine with dinner should not completely wreck the day after, unless there is some medical condition that is worsening the effect.
Personally, I don't care of people drink or not, that's their choice. What I'm saying is that his intake was probably heavier than he claims, which would certainly account for his marked improvement in health when he cut out alcohol completely.
My intake was not heavier than I claimed. If you read my post again you'll see that I went for complete abstinence only after drinking became an occasional thing for me. When you drink a few pints of beer once after a month or more of no drinking it has a massive effect.
People disputing this have probably never gone more than a week without alcohol. I'm not prepared to maintain a tolerance to alcohol and it makes me feel bad when I drink occasionally.
All I'm claiming is that a literal poison has a negative effect on me that far outweighs any positive I get from the enjoyment of drinking. Yet people are jumping up in arms saying there must be something wrong with me because they drink regularly and feel fine. I think people could do with some careful introspection and maybe to reconsider what "fine" is.
I occasionally go a month or two without touching alcohol (an appropriate occasion simply doesn't come up for a while), and I simply can't recognize what you say about reduced tolerance and feeling better after a period of abstinence. I simply feel the same as always.
What you seem to be claiming is that we (who enjoy alcohol in moderation and on occasion) are lying to ourselves about how we feel.
In that case, if it truly wrecked the day after, you were drinking a lot more than just a couple of pints or some wine with dinner, and were probably in denial about it.
I can tell the difference, trust me. I've been there myself, and I still go there on occasion, in good company at a concert/festival, when I know I can waste a Saturday/Sunday after. A couple of pints will not do it.
That's not true. The more you drink the more you can drink. If you either gradually or cold turkey quit for a few months to reset, you would be amazed how less alcohol you would need to feel smashed. From my understanding it is basically training your liver and kidneys.
It is also quite funny: anesthesiologists always know who lies on the intake forms based on the answer to alcohol consumption question. The more the drink, the longer it takes to put them under.
That's not correct. The point is that with no tolerance for alcohol a few pints or a glass of wine with dinner can have an enormous effect for someone who in general eats very clean and does not drink/stopped drinking for a while.
It is a very observable thing in among the healthy living crowd: August and September are popular abstain from drinking months in these circles. Meeting these people for dinner in October pretty much means they would be visibly buzzed after a glass or two of wine.
Certainly not if you're talking a correctly-sized glass of wine, as you would get in a restaurant. A glass of wine does not mean "fill it to the edge".
What you're describing only happens on an empty stomach, which is a mistake anyone should be able to identify easily.
With all due respect as I do not know you what so ever, I suggest having a chat with one of the non-PC doctors. Real chat. Like "your time is valuable because you are really good at what you do. Like $500 an hour valueable... This is my lifestyle. Tell me what I'm doing wrong or pat me on a back if I'm doing it all right"
They increase urea, which lowers blood ammonia. I have never heard of using LOLA for alcohol, but seems possible. Got any links, and rurthermore, how this would be useful in this context?
because more people are becoming alcoholics and the penalties for a DWI are getting harsher. bottom line is... if you think you have a problem, you already have a problem. Get help and get help now before you hurt someone (you don't want this on your conscience... trust me). Go to AA, NA, a therapist, a doctor, rehab, a detox, doesn't matter, open up and tell someone you have a problem and get the help you need before you destroy your life or someone elses.
Do you have a source for this claim, which both does a good job of defining a measurement schema for alcoholism and also shows convincingly that it is on the incline?
Do you also have a source for the claim that this particular increase is the reason (or even a contributing factor) to the apparent decline in correlation between moderate wine consumption and positive health outcomes?
> if you think you have a problem, you already have a problem
Now this just seems like toxic thinking to me. Plenty of thoughtful, responsible people continually ask themselves whether they are experiencing various problems in life, and sometimes the answer really is "no."
> Go to AA, NA, a therapist, a doctor, rehab, a detox, doesn't matter
Really? It doesn't matter?
Your links at the end of your comment are only to AA and NA. Can you explain what aspects of these programs are preferable to you?
I hope that my comment isn't minimizing the issues of drug abuse (including alcoholism) in our culture - I totally respect that these are serious issues with many grave outcomes. I just want to be sure that we're discussing them in a way that is... well, sober.
Anyway, even if you don't have answers to the above questions, your perspective is welcome IMO.
"Is it a problem?" is always relative. The question would be better phrased, "is it a problem worthy of expending limited resources on fixing?" with the usual considerations of opportunity costs, etc.
So yes thinking about whether something is a problem worth addressing is totally healthy behavior for anyone with a modicum of self-awareness.
This study[1] purports that alcoholism doubled during the decade after the turn of the millenium. It also has a concrete criteria for what they consider alcoholism.
> Now this just seems like toxic thinking to me. Plenty of thoughtful, responsible people continually ask themselves whether they are experiencing various problems in life, and sometimes the answer really is "no."
To you it may seem like "toxic thinking", but to anyone with a problem who had the insight to ask themselves such a question, it can be a life changing moment.
If someone is at a point in their alcohol consumption career where they step back and have to ask, "Do I have a problem?", that insight usually stems from encountering a problem most people don't face.
The nature of alcoholism is to tell yourself everything is fine and normal, that there is no problem even though your life is falling apart.
To wish to portray as truly pivotal insight that an alcoholic would be lucky to have as "toxic thinking" is, IMO, minimizing the issues of drug abuse in our culture.
> Really? It doesn't matter?
When you're at the point where a substance controls your life, there's no saying when you might overdose or drink too much and plow your car into innocent people.
Finding someone who can direct you to help now is paramount.
> Your links at the end of your comment are only to AA and NA. Can you explain what aspects of these programs are preferable to you?
There are no months-long waitlists for AA or NA like there are for rehabs, detox clinics, therapists, psychiatrists and addiction specialists.
There is no pretense of requiring an in-network insurance provider that will cover the tens, if not hundreds, of thousands of dollars worth of treatment you might require.
As much as I disagree with some aspects of those programs, their existence is infinitely better than the alternative. Which, for most people with that problem, is the destruction of what is left of their life.
AA and other 12 step programs can be positive to some people but they can also be very harmful to others. AA teaches a lot of falsehoods. If AA was actually honest about what it was, I wouldn't dislike it so much.
Plus "just do anything" can lead you to the abusive profit seeking sketchy "rehab" industry, and that's probably going to leave you worse off. I think the worst offenders have been shut down recently though thanks to exposés.
Most people are able to reduce alcohol consumption to less harmful levels on their own. That's not saying you shouldn't seek help if you need it, just you may not need it. Everyone is different. If you wish to reduce your alcohol consumption don't assume you are "powerless" just because AA says you are.
>The 12 steps are so deeply ingrained in the United States that many people, including doctors and therapists, believe attending meetings, earning one’s sobriety chips, and never taking another sip of alcohol is the only way to get better. Hospitals, outpatient clinics, and rehab centers use the 12 steps as the basis for treatment. But although few people seem to realize it, there are alternatives, including prescription drugs and therapies that aim to help patients learn to drink in moderation. Unlike Alcoholics Anonymous, these methods are based on modern science and have been proved, in randomized, controlled studies, to work. For J.G., it took years of trying to “work the program,” pulling himself back onto the wagon only to fall off again, before he finally realized that Alcoholics Anonymous was not his only, or even his best, hope for recovery. But in a sense, he was lucky: many others never make that discovery at all.
>Whereas AA teaches that alcoholism is a progressive disease that follows an inevitable trajectory, data from a federally funded survey called the National Epidemiological Survey on Alcohol and Related Conditions show that nearly one-fifth of those who have had alcohol dependence go on to drink at low-risk levels with no symptoms of abuse. And a recent survey of nearly 140,000 adults by the Centers for Disease Control and Prevention found that nine out of 10 heavy drinkers are not dependent on alcohol and, with the help of a medical professional’s brief intervention, can change unhealthy habits.
>AA truisms have so infiltrated our culture that many people believe heavy drinkers cannot recover before they “hit bottom.” Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma. “You might as well tell a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack,’ ” Mark Willenbring, a psychiatrist in St. Paul and a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, told me. He threw up his hands. “Absurd.”
>But many in AA and the rehab industry insist the 12 steps are the only answer and frown on using the prescription drugs that have been shown to help people reduce their drinking.
>People with alcohol problems also suffer from higher-than-normal rates of mental-health issues, and research has shown that treating depression and anxiety with medication can reduce drinking. But AA is not equipped to address these issues—it is a support group whose leaders lack professional training—and some meetings are more accepting than others of the idea that members may need therapy and/or medication in addition to the group’s help
Because there isn’t sufficient funding to pay for non biased scientists who have the understanding of statistics and probability to perform the correct experiments and analysis. And there isn’t sufficient funding for the types of large scale control groups needed for studying health effects on a complex organism such as humans, especially when mechanisms of actions can’t directly be observed.
Yes, I was answering why it’s so hard to do legitimate research. I agree that it would be better if the garbage research didn’t exist at all. No info is better than bad info.
2. While we like to claim that a study randomizing people to alcohol wouldn't be ethical, pre-2014 I don't think that would have been true. I think there was enough equipoise. Post-2014, I would need to see some strong counter-evidence to make me think there is equipoise once again.
3. The environment changes. A trial came out last week showing that ASA may be harmful for older healthy people [2]. This probably reflects that our bloodstream is no longer nicotine-filled, etc., so the heart attack risk is low enough that the bleeding risk may outweigh it. There may be something about alcohol that was helpful in the 1950s that is no longer so today, due to these environmental changes.
1 = (Free full link): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091648/
2 = https://www.nejm.org/doi/full/10.1056/NEJMoa1800722?query=fe...