Comment by herdcall | Hacker News Reader

Comment by herdcall | Hacker News Reader

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That seems like a non sequitur ("The optimal level of alcohol intake for health and longevity is zero"). All I see in the article you referred (or the original article above) are several (valid) questions about the J shaped association, like confounding factors and survival bias. But these aren't evidence that the optimal level is zero. Merely challenging/speculating about the opposite view is not evidence.

Also, as the paper itself admits, drinking small amounts of alcohol has low risks, and while it argues against causation, it doesn't even discuss possible causational factors. E.g., consider the fact that alcohol can reduce stress, which we know has detrimental effects on health. Couldn't small amounts of alcohol be causally responsible then in improving longevity?

Not to be cynical, but I feel the medical community finds this positive low-alcohol/longevity J association rather inconvenient and take every opportunity to debunk it. May be they're right, but if we're to discredit the massive epidemiological evidence, we need more direct evidence and be objective about it.

That 'alcohol reduces stress' is true short term, its not so much true long term. Think of those nasal sprays that reduce congestion. They absolutely do that, breathe that stuff in and it opens your airway real good, but at the same time it irritates those tissues so when the effect wears off, the airway becomes even more blocked than before because of the inflammation from the irritation. Alcohol does a similar thing for brain chemistry. It artificially slows things down (making you feel calmer), but the body's response is counter that effect so when the alcohol wears off, the stress levels can be higher than they were before - leading people to need another drink to relax.

Is there any evidence that alcohol does it that way? Sincere question.

There's a lot of research showing that yes, it does.

Here's a quote: "Long-term, heavy drinking can actually alter the brain’s chemistry, re-setting what is “normal.” It causes the release of higher amounts of cortisol and adrenocorticotropic hormone. When this hormonal balance is shifted, it impacts the way the body perceives stress and how it responds to it.21,22 For example, a long-term heavy drinker may experience higher levels of anxiety when faced with a stressful situation than someone who never drank or who drank only moderately" from https://pubs.niaaa.nih.gov/publications/AA85/AA85.htm

You can search for alcohol's impact on GABA, cortisol, or just stress in general and find plenty of science showing that there are significant negative impacts to how the body responds to stress or various key hormones due to damage from alcohol.

I did not encountered such sprays. The ones I used worked and once they were not needed I stopped - typically in few days.

You can just look up and verify it then

https://www.mayoclinic.org/diseases-conditions/allergies/exp...

Did you read the studies (cited in that review) that do Mendelian randomization? They seem fairly conclusive in favor of the view that the optimal alcohol intake is zero.

I looked at the paper but I don't understand how they got to that conclusion. There is still a J-shaped relationship between alcohol consumption and coronary heart disease outcomes. Not questioning the conclusion I just don't understand how you get to it from their data (due to my own ignorance).

Researchers are able to say that the J-shaped relationship is a result of factors correlated with alcohol use, instead of the effects of alcohol itself on the body, using a technique called Mendelian randomization.

Here's a summary for the lay reader [0]:

> One way to get around these limitations is through genetic studies. Some people carry a genetic variant that disrupts their ability to metabolize alcohol, causing them to develop skin flushing, irritation and other unpleasant symptoms when they drink alcohol. As a result, they tend to abstain or drink very little. If alcohol was good for heart health, these people should in theory have more heart disease compared to others. Instead, as one large analysis published in BMJ in 2014 found, they have “a more favorable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant.”

> The study concluded: “This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.”

(One fact not mentioned there is that for this technique to work and identify causality, the distribution of that genetic variant needs to be uncorrelated with all the other relevant variables. To my knowledge, this is true.)

[0] https://www.nytimes.com/2020/07/10/well/eat/should-we-be-dri...

Ah, I get it now. Thanks!

I think the alcohol -> reduced stress pathway is unclear, and the reduced stress -> longevity pathway is also unclear, despite your claims.

For any benefit alcohol gives (heart health, stress level, etc), there are healthier alternatives to accomplish the same or better results.

I'm sure that there are many alternatives that would be healthier than alcohol for any given individual, be it exercise, social and economic stability, CBT, vacation, improved diet, better sleep, etc. However, in societies where alcohol consumption is an engrained feature of ordinary life and social interactions, is it even feasible to encourage every person to implement whichever of the myriad of alternatives would be more effective for them?

I would argue that, at the public health level, focusing on a naïve "zero level" of alcohol in favour of the "better alternatives" would at best be ineffective, not the least because the better alternatives can be promoted regardless of alcohol consumption. At worst they could even be harmful, if the encouraged abstinence were to discourage the social events associated with non-excessive alcohol consumption.

On an individual level yes indeed, having 0 beers a week may be provably healthier than having 10 beers a week, all else being equal. And that's the crucial point—all else being equal. Those beers are not drunk in isolation or without context. The individual may enjoy trying craft beer with their partner at dinner, or they may meet some friends at the pub and enjoy some slightly disinhibited laughs together. Could this person enjoy trying herbal teas with their partner? Perhaps. Could their friends meet up for a game of volleyball instead? Maybe. Is it realistic to expect similar alternatives to alcohol in the overall population? Very probably not.

I worried about this a lot before I quit drinking.

Now I can tell you that my social life is exactly the same as before - but I’m drinking water or near-beer or something fizzy instead. I don’t care, my friends don’t care, and if they did, they wouldn’t count as friends anyway.

Now if you’re a frat member, maybe it’s different.

My other half never thought she would be able to date me, because she wanted someone to share a bottle of wine with. Turns out, she can have a lovely time drinking wine and having a designated driver to get her home :)

But I will say that being tee total has impacted my experience of social gatherings based around drinking. Sure, with good friends it couldn't matter less. But with work folks, acquaintances etc? Yeah, it matters

Another thing to keep in mind is that non-alcoholic drinks as a sector are growing rapidly. We might see a sea change here within a generation, like we saw with smoking, where it simply isn’t cool anymore.

For anyone interested, I followed Allen Carr's Easy Way to Control Alcohol. It was a totally painless process for me

As an individual body, there is no benefit that alcohol provides your system that cannot be achieved through healthier means (that I'm aware of - tell me if I'm wrong).

I'm not saying alcohol isn't effective, I'm saying that in all cases there are healthier ways (wiser ways) to achieve the positive effects.

I'm not saying alcohol isn't efficient, I'm saying the work required to implement the healthier methods for the same effects is worth the extra effort.

At the public health level, I don't think there's any harm in condemning alcohol. I'm not saying prohibition, and I enjoy a good tequila or whiskey or wine or beer - it's great stuff. But the least of our members of society - those with the worst problems - are often making their lives worse with alcohol not better. I see no issue in messaging that repeatedly. Responsible and irresponsible people will always drink, but messaging the harm it causes more often could not hurt American society. I don't think that's naive at all. You may be confusing messaging "zero level" with a legal prohibition, and I don't think that's a valid equivalency. Exercise is good for you, abstaining from alcohol is good for you too. Just like abstaining from fast food. It doesn't mean everyone will comply, nor should you expect that. But messaging that this stuff is not healthy seems wise to me. Instead you see a steady drip of "a drink a day may be good for your heart" crap, that is assuredly endorsed and promoted by the beverage industry, and not with the health of society in mind.

That is not standard we apply ... to pretty much anything else people consume. No single food or drink will make you live longer.

This is all just an attempt to create moral panic with pretension it is all concern about health. So people are free to point out that.

I'm not sure why you're morally panicked. Alcohol is a toxin. Drink it and have fun. Nobody's telling you what to do with your life by informing you that alcohol and fast food don't do you any good from a physical health standpoint and are poor choices for mental health as well. You can rationalize away the harm, and probably quite effectively for you alone - it's not my business.

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