"Is It Better to Drink a Little Alcohol Than None at All?"
Why do we not see the corporate interests of the alcohol industry
as clearly as we see those of the tobacco industry?
Well, the alcohol industry has waged a sophisticated and successful campaign
over the last few decades, undermining perceptions of the extent
of alcohol-related harm to health
by framing the argument as a balance of benefits and harms.
Yes, alcohol may be an intoxicating carcinogen, increasing cancer risk,
but what about reducing heart disease risk?
Policymakers hesitate to introduce effective alcohol policies,
or even to support the addition of warning labels
for fear they might undermine or contradict any possible health benefits of alcohol use.
After all, alcohol consumption clearly raises HDL, the supposed "good" cholesterol.
But sadly, as I've already explored, HDL is no longer considered protective,
based in part on so-called Mendelian randomization studies,
where having a high HDL your whole life doesn't appear to help,
whereas a lifelong reduction of bad cholesterol, LDL,
just thanks to luck-of-the-draw genetics, does indeed decrease heart disease risk.
So the boost in HDL from alcohol may not matter,
and if you look at subclinical markers of atherosclerosis,
like the thickening of the wall of your carotid arteries in your neck,
those that abstain from alcohol completely seem to be at the lowest risk,
and the same with coronary calcium scores, where, in general,
the lower the alcohol consumption, the lower the risk.
And alcohol bumps our blood pressure up a bit as well,
which would be expected to raise, not lower, our cardiac risk.
So where do we get this idea that alcohol was good for us?
From the famous J curve. Check it out.
If you follow large populations of people over time, in general
the more people drink, the higher their risk of dying prematurely,
but the lowest risk, those who tend to live the longest,
were not those who drank zero, the abstainers,
but those who drank moderately, like one drink a day.
That's why you get some folks recommending that physicians should counsel
lifelong nondrinkers to take up the habit.
Sure, there are statin drugs, but alcoholic beverages don't require a prescription,
are far cheaper, and certainly more enjoyable.
Is moderate drinking really protective,
or is there just something about people who abstain completely from alcohol
that puts them in a higher risk category?
The reason we suspect something fishy is going on
is that abstainers seem to be at higher risk of a whole swath of diseases
including, ironically, liver cirrhosis.
Compared to lifelong abstainers, those who've never touched the stuff,
men and women drinking a little appear to have less liver cirrhosis.
Wait---what?
How could a little drinking be linked to lower rates of liver cirrhosis?
Well, let's think about it.
What makes more sense,
that drinking lead to less liver cirrhosis or liver cirrhosis lead to less drinking?
In other words, reverse causation, the so-called sick quitter effect.
If you look at studies of smokers, sometimes you see higher mortality rates
among those who quit smoking compared to those that continue smoking.
Why? Because the reason they quit smoking is because they got sick.
So, of course, sick people die more often than less sick people.
That's why when you classify someone as a non-smoker in a study,
you have to make sure they're a lifelong non-smoker
and not just a non-smoker--- since last Tuesday.
Yet, unbelievably, that's not what they do in most alcohol studies,
where instead they misclassify former drinkers as if they were lifelong abstainers.
And, look, individuals with poorer health are more likely to cut down
or stop drinking completely, thereby making current drinkers look good
in comparison to those who drink zero, because some of the abstainers
are just abstaining because they got sick and stopped.
OK. So, what if you went back to all those studies
and corrected the misclassifications,
separate out the former drinkers from the lifelong abstainers?
We didn't know until now.
They, indeed, found drinker misclassification errors all too common,
plaguing three quarters of the studies,
and when they controlled for that the J-shaped curve disappeared.
The death versus alcohol relationship became more consistent
with a straight line, linear dose response, meaning more alcohol, more death:
no protection at low levels of consumption.
So no apparent benefit of light to moderate drinking after all,
when you use better comparison groups.
Although these results are not what the majority of drinking
adults may desire to believe, the public deserves to hear
and to read in more complete and balanced detail
the ever-growing evidence
that drinking alcohol is very unlikely to improve their health.