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I wish more studies accounted for how drinking is done.

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.

> 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.

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.

"even in moderate drinkers (14-<21 units/week in men)"

(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)

One English unit is 10 ml of pure alcohol.

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.

>> 14-<21 units/week in men).

> 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.

14 units per week is still, if I understand correctly, two units per day. That's pretty moderate drinking, so that seems ok to me. Honestly, I drink a bunch less than that, so it doesn't seem difficult to do.

Is there any research on which is worse? In other words, how does it compare to drink under 14 per week but without any rest days, versus drinking more than 14 per week but only during three days of the week.

I feel like there's a lack of knowledge about alcohol, considering how ubiquitous it is.

Drinking everyday is going to be worse for your liver.

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.

Care to share some layman's reading on effects of alcohol (that isn't "fire and brimstone")?

>This is because the liver needs time to recover

Also less likely to become dependent.

Yes... the statistics in this article are annoying (par for the course for BMJ, NEJM, and other medical journals). They use mixed-effects models and a lot of potential covariates (good) but then bin the variable of interest (BAD). I've seen a lot worse, but it's not optimal IMO.

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.

The study says that it is dose dependent with atrophy seen at moderate drinking levels. So total amount of alcohol consumed per week.

That's the point. If they see atrophy in people who drink 14-20 units per week, that leaves room to wonder whether there's a significant difference between people within that group depending on whether they drink 2-3 units every day or drink 4-7 units three days a week with four rest days. You could then go further and see if it is different to have four consecutive rest days and three consecutive drinking days versus having each drinking day spaced with at least one rest day. Etc.

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.

It doesn't matter. Total accumulated, not per drinking session. You can assume a mix of behaviors. Even then it may not matter.