Even moderate drinking could harm the brain
cbsnews.com
cbsnews.com
> Principal findings
> The relation was dose dependent, and increased odds of hippocampal atrophy were found even in moderate drinkers (14-<21 units/week in men).
That seems like a big range.
> Strengths and limitations
> The hippocampal atrophy associations we found in the total sample were replicated in men alone but not in women. This could reflect a lower power to detect an effect in women, in part because the sample was dominated by men (a reflection of the sex disparity in the civil service in the 1980s) and in part because few of the included women drank heavily.
That seems like it should be mentioned in the CBS article.
~~~
I wish more studies accounted for how drinking is done. It is worth wondering if drinking 2 drinks a day, 3 days a week is better for you than drinking 1 drink 6 days in a row.
Moderate drinking some days but not others, perhaps your liver/brain do better because they get "total rest days", whereas light/moderate drinking every day may put them in a constant state of irritation or stress. Just like with workouts.
Indeed. From what my own innards tell me, drinking almost any amount just before sleeping feels particularly disruptive to the various housekeeping activities said innards are entrusted with. The same amount in the afternoon (or well before nocturnal drowsiness sets in), rather less so.
It would also be nice to know to what extent the various damages detailed in the article compare with those of, say, loss of sleep or poor nutrition - or even (seriously now) social isolation, stress, or watching too much TV. And to what extent the body and brain may be able to repair these damages, over time.
The point is that lumping everyone who has 14-20 drinks in a week into one category makes for a large variation in behaviors and possible interactions.
> That seems like a big range.
Previous English advice was that men should drink less than 21 units per week. Current advice is less than 14 units per week.
Some people were asking what the evidence base was to reduce the limits, and papers like this address that.
> It is worth wondering if drinking 2 drinks a day, 3 days a week is better for you than drinking 1 drink 6 days in a row.
We know that it's better to leave some days drink free, and this is current alcohol advice in the UK and has been for some time now. (At least the past 20 years, I think.) This is because the liver needs time to recover.
I feel like there's a lack of knowledge about alcohol, considering how ubiquitous it is.
Drinking more than 14 units but leaving some days drink free is going to be better for your liver, but increase the risks of other alcohol related illness (including all the alcohol related cancers).
It's hard to say which is worse partly because genetic factors are important, and other stuff you do is important too.
We know a reasonable amount about alcohol, but there's a multi-billion dollar multi-national industry keen to keep people unaware.
Also less likely to become dependent.
This is basically an epidemiology paper, and the apparent statistician is an epidemiologist. As an interesting aside, I recently sat down for lunch with biostatistics grad students, and apparently they consider the epidemiology students/faculty/field to be incompetent wielders of "statistics-lite". I took it with a big grain of salt, but it does seem epidemiology is harder-hit by the replication crisis than most other biology fields.
> Moderate drinking some days but not others, perhaps your liver/brain do better because they get "total rest days", whereas light/moderate drinking every day may put them in a constant state of irritation or stress. Just like with workouts.
Actually my understanding is that the harm of drinking to the brain mostly does not occur during the drinking itself, but the withdrawal period after the depressant is cleared causes excitotoxicity for neurons. This is why quitting heavy drinking cold-turkey may not be best health-wise (but may be easier to do psychologically). Also, cycles of binging and abstinence cause your neurons to be increasingly vulnerable to damage via some kind of priming mechanism.
Personally, I've been trying to cut back, and I'm much more worried about my brain than my liver. It may be that the optimal pattern may vary by organ.
(just under) 3 units/day _on_average_ is moderate now? I thought that would be 2 drinks a day, at most (2 drinks puts you close to, if not over, the limit for driving in many countries)
You can find the unit content by multiplying the serving size in liters by the ABV value.
175 ml of wine at 12% = 0.175 * 12 = 2.1 units.
Given how xenobiotic metabolism ("drug tolerance") works, I would expect the opposite: that your liver would be perfectly fine with a sustained stress exactly under the threshold at which it is capable of dealing with it, and this state would be indistinguishable from consuming no alcohol at all. But go one hair more, and now you'll have a chronic but mild stress-state on the liver, with the formation of dangerous side-products (like NAPQI in tylenol metabolism) but only in tiny amounts, such that the small amounts of damage done by the side-products will be noticed and repaired, and the chemicals themselves flushed out by the excretory system before more damage can happen.
On the other hand, single, monstrously large doses ("binge drinking") will tend to lead to the formation of large amounts of such side-products, which will be highly available to react with other organic chemicals nearby and thus cause large amounts of long-term damage—weakening the body in ways that make repair harder—before they can be removed.
In Mediterranean countries it's pretty common to have a glass with some/most meals, but the regular weekend binging is a relatively new practice. Perhaps that explains overall population health differences with Anglo countries.
Is this true?
But people incorrectly think you can just spread out the drinks over a week and be fine, Drinking one glass (275 ml, not that big) of wine (12%, not that strong) every day is something like 23 units. We know that's increasing risks of a range of harm.
EDIT: I got my mls wrong! (Thanks mattmanser for pointing this out).
175 * 12 = just over 2 units.
UK standard measures are 125ml small, 175ml medium, 250ml large.
175ml is a normal glass of wine and is 2.3 units, or 16 units a week. 23 units is 2 and a bit bottles of wine.
You've got your units wrong.
https://www.gov.uk/weights-measures-and-packaging-the-law/sp...
https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think...
It's important to inspect the effects of drinking, even at doses perceived as low. This isn't about college kids killing their brain cells by partying. It's about long term health effects.
Three beers a day, spaced out over 16 hours, as one per meal, will still ruin your liver over decades. It's bad for you. This is pretty common information, and is important to understand, since people tend to find this counter-intuitive. Three beers a day, evenly spaced, sounds like moderation and good behavior.
The new information here says that even one unit a day is still bad for you, even if one unit of a specific type of alcohol (perhaps wine) might provide for a trade of hazards versus benefits.
Almost certainly not.
"Of all chronic heavy drinkers, only 15–20% develop hepatitis or cirrhosis, which can occur concomitantly or in succession."[1]
Not only do many chronic, heavy drinkers not ruin their livers, but further "three beers a day" would not even come close to any definition of chronic, heavy drinking.
I certainly think it's a bad idea and not something I, myself, would practice - simply because of the effects on athletic output and exercise regimes, etc. However, you very badly mischaracterize the behavior you've given an example of.
Quantity of alcohol taken: Consumption of 60–80g per
day (14g is considered one standard drink in the USA;
drinking a six-pack of beer daily would be at the top
of the range) for 20 years or more in men, or 20g/day
(about 25 mL/day) for women significantly increases the
risk of hepatitis and fibrosis by 7% to 47%
Pattern of drinking: Drinking outside of meal times
increases up to 3 times the risk of alcoholic liver
disease.
But, in conversation, people still roll their eyes at those numbers, because they still sound like low numbers.
Regardless, this new evidence claims that ONE UNIT DAILY results in measurable health problems.
That's a weird thing to say.
Assume a 330 ml bottle of beer at 5%. That's 1.65 units per bottle; 4.95 units per day. If we only do 6 days, and have one day drink free we get 29 units, which is double the recommended level of 14 units a week.
You're certainly increasing your risk of a wide range of disease, including a number of cancers, by drinking this much.
Perhaps. Neither the op nor I were discussing that.
He specifically mentioned "ruin(ing) your liver". I believed that to be inaccurate. Wikipedia ensued.
Weekend binging is more excessive for younger people, but I don't see people my age drinking in working hours, only older men.
Cheers!
PDF: http://www.bmj.com/content/bmj/357/bmj.j2353.full.pdf
Criticism by Frank Harrell:
> A very high-profile paper was published in BMJ on 2017-06-06: Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study by Anya Topiwala et al.
> The authors had a golden opportunity to estimate the dose-response relationship between amount of alcohol consumed and quantitative brain changes. Instead the authors squandered the data by doing analyzes that either assumed that responses are linear in alcohol consumption or worse, by splitting consumption into 6 heterogeneous intervals when in fact consumption was shown in their Figure 3 to have a nice continuous distribution.
> How much more informative (and statistically powerful) it would have been to fit a quadratic or a restricted cubic spline function to consumption to estimate the continuous dose-response curve.
Article: http://www.fharrell.com/2017/04/statistical-errors-in-medica....
My father and mother and step-father all smash it hard on weekends. Like passing-out-hard. Most friends as well. It's absolutely ridiculous. There's way more interesting things to do in life.
Drinking to the point of passing out is alcoholism no matter how you look at it. Try to get them help if you value them.
In a medical context, alcoholism is said to exist when two or more of the following conditions is present: a person drinks large amounts over a long time period, has difficulty cutting down, acquiring and drinking alcohol takes up a great deal of time, alcohol is strongly desired, usage results in not fulfilling responsibilities, usage results in social problems, usage results in health problems, usage results in risky situations, withdrawal occurs when stopping, and alcohol tolerance has occurred with use
So yes it's not a stretch to consider just drinking to the point of (almost) passing out alcoholism (ignoring whether or not the person drinks outside of these episodes). Doing that like twice in a year doesn't feel like alcoholism though. More like one of the many means to satisfying my constant urge and craving to 'go hard'.
For example, I drink 5-7 drinks a week on average. Every now and then, I have a bad reaction to some alcohol. I haven't completely identified it, but IPAs seem to trigger it the worst, and drinking while already sleep-deprived, which I am more often than I'd like to be, also is more likely to result in a bad reaction. The bad reaction typically manifests most notably as an extreme flushing in my face (probably rosacea - https://en.wikipedia.org/wiki/Rosacea), and sometimes flatulence or stomach discomfort.
So "large amounts over a long time period" is pretty vague, but I'd wager the 365 drinks that I might have over the course of a year could satisfy that description.
So is it fair to say that I'm an alcoholic due to those criteria? I think most people would agree that I'm not, but based on the medical definition alone it wouldn't be far-fetched to label me one.
Alcoholic hasn't been an appropriate medical term for some time now. It's been split into alcohol abuse and alcohol dependency.
The medical definition, posed elsewhere in the thread from the DSM definition, declares fuzzier criteria than numbers. There isn't a number. 50 drinks a year might quality someone as alcohol abuse if they only consume four times a year and 500 a year might be normal if no other criteria than tolerance exists.
The whole thing is a mess though. You have a problem when you have a problem. This is compounded by the definition its self allows people to justify their intake in many ways.
Listen to yourself, your body, and input from others. If you want to then talk to your GP doctor and seek an actual evidence based treatment. 12 Step programs are not, and shouldn't be, anyone's only option.
Depends on who 'most people' is I guess. In my book, I'd rather describe your situation (sounds like almost daily drinking to me, i.e. a proper addiction, and trust me I know those) as alcoholism then my current situation (once or twice a year I'll totally overdo it, but for the rest it averages out to like 1 drink a month).
There is harmful drinking, and you possibly fall into that range, depending how strong the drinks are and how large the serving size is.
If you drink 5 glasses of wine, and the glasses are 150 ml, and the wine is 12.5% you're drinking a bit over 9 units per week so that's ok. But if the glasses are 175 ml and you drink 7 of them a week you're drinking 15 unit a week, and that's a little bit over the recommended level.
There's a dose dependant response, so the more you drink the more harm is caused. There are also genetic factors for some of the harms. And increasing a low risk might not be something you're worried about.
But then there's also dependant drinking. That has a few markers: are you preoccupied with alcohol? Do you seek alcohol if you don't have any? Have you built up a tolerance to alcohol? Do you continue to drink alcohol even though you know it's causing you harm?
https://www.nice.org.uk/guidance/cg115/chapter/Introduction
> Harmful drinking is defined as a pattern of alcohol consumption causing health problems directly related to alcohol. This could include psychological problems such as depression, alcohol-related accidents or physical illness such as acute pancreatitis. In the longer term, harmful drinkers may go on to develop high blood pressure, cirrhosis, heart disease and some types of cancer, such as mouth, liver, bowel or breast cancer.
> Alcohol dependence is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of harmful consequences (for example, liver disease or depression caused by drinking). Alcohol dependence is also associated with increased criminal activity and domestic violence, and an increased rate of significant mental and physical disorders. Although alcohol dependence is defined in ICD-10 and DSM-IV in categorical terms for diagnostic and statistical purposes as being either present or absent, in reality dependence exists on a continuum of severity. However, it is helpful from a clinical perspective to subdivide dependence into categories of mild, moderate and severe.
I don't usually get people questioning my lack of drinking, but then again I am in older social circles now.
You can also just say you're on a diet and don't want the extra calories, that's an easy way to deflect it.
There was this one girl I dated that was completely baffled by this, though. She only got one night a week completely to herself (single mother, had a babysitter), so she didn't want to waste it and would drink harder than most people I've hung out with, even when I was in college. At the time I went along with it and drank a lot more than I really wanted to. I'm glad I'm not still in that situation, though.
What is the baseline rate? 3x more likely has wildly different outcomes if the base rate of atrophy is 0.1% versus 10%.
--
I gestured at my litre of fizzy red wine. “Want a drop of this?” I asked him.
"No thanks. I try not to drink at lunchtime.”
"So do I. But I never quite make it.”
"I feel like shit all day if I drink at lunchtime.”
"Me too. But I feel like shit all lunchtime if I don’t.”
"Yes, well it all comes down to choices, doesn’t it?” he said. "It’s the same in the evenings. Do you want to feel good at night or do you want to feel good in the morning? It’s the same with life. Do you want to feel good young or do you want to feel good old? One or the other, not both.”
"Isn’t it a tragedy?”
In an accompanying editorial, Killian Welch, consultant neuropsychiatrist at the Royal Edinburgh Hospital, says the findings "strengthen the argument that drinking habits many regard as normal have adverse consequences for health."
"This is important," he writes. "We all use rationalizations to justify persistence with behaviors not in our long term interest. With publication of this paper, justification of 'moderate' drinking on the grounds of brain health becomes a little harder."
---
In company with Ioannidis's article "Why Most Published Research Findings Are False"[1], I believe the rationalization effect is big in such studies. People want to believe that the things they already do are virtuous, thus there's a bias toward finding that chocolate, wine, etc., are all actually good for you. Not to mention respective industries that would benefit from such findings.
1: http://faculty.dbmi.pitt.edu/day/Bioinf2118/Bioinf-2118-2013...
Sci-Am is one thing, CBS News really is another...
I'm sure the scientists who performed this 30-year study knew about all this, are there things they did (or could have done) in this study to isolate the effects due to alcohol?
While I didn't personally vote you down, I can absolutely make a guess why. You posted a URL (a Twitter one, no less) with absolutely zero context at all. You didn't say "Here's what [well known statistician] has to say about this study." You also pointed to the Tweet, rather than the article (or in this case, more specifically, the recent update to an already existing article) that the statistician Tweeted about. You left all the work up to the reader (two clicks and a bunch of reading before they know why you posted a nondescript URL).
Why should anyone click on a URL to a Tweet without context? They shouldn't, which means that the URL adds no value to the conversation, which means the comment gets voted down.
IOW, don’t be lazy with your comments.
> The authors had a golden opportunity to estimate the dose-response relationship between amount of alcohol consumed and quantitative brain changes. Instead the authors squandered the data by doing analyzes that either assumed that responses are linear in alcohol consumption or worse, by splitting consumption into 6 heterogeneous intervals when in fact consumption was shown in their Figure 3 to have a nice continuous distribution.
> How much more informative (and statistically powerful) it would have been to fit a quadratic or a restricted cubic spline function to consumption to estimate the continuous dose-response curve.
Article: http://www.fharrell.com/2017/04/statistical-errors-in-medica...
Does abstinence correlate with lower scores? I don't understand the three different starting points. I was expecting a normalized score (~20) with several different levels of decline.