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Comment by nuclearnice1 | Hacker News Reader

To point 1. In the brief I find at the red download link [1] contains the line “ Based on recent evidence, it has been concluded that there is “no safe level of alcohol consumption”(5).”

The reference points to an article from The Lancet [2]

[1] https://world-heart-federation.org/wp-content/uploads/WHF-Po...

[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

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“Based on recent evidence, it has been concluded that there is “no safe level of alcohol consumption”(5)

Which definitely takes artistic license with what the cited article actually said, which was:

   Our results show that the safest level of drinking is none.

Which is exactly like saying "The safest level of poppy seed consumption is none". Which of course completely dodges the question you'd really want to ask which is: "How many poppy seeds can you eat per day with either no or negligible negative health effects?" And in any case nowhere near equivalent to saying:

   It has been concluded that "there is no save level of poppy seed consumption".

Moral of the story being -- the byline quote at the top of the article:

"The evidence is clear: any level of alcohol consumption can lead to loss of healthy life"

Is not only supported by the research it cites -- but irresponsibly alarmist.

I don't think that misstates the lancet article, and i also think this information in the lancet article is useful.

There is a long belief that e.g. red wine is good for the heart, or in many places there are some herb liquors that old people drink thinking it will bring them benefits. Here the lancet unequivocally states that to our best evidence no alcohol is best. You're from now on not drinking red wine for your heart but for pleasure.

Here the lancet unequivocally states that to our best evidence no alcohol is best.

The thing is this proscription is essentially useless. It's like saying "to our best evidence no sugar is best".

So should you eat that piece of chocolate cake or should you not?

You're from now on not drinking red wine for your heart but for pleasure.

We knew that already. But it still doesn't tell us whether drinking, say, 3 or fewer glasses of wine per week has a significant negative health impact or not. For any actual measure of "significant".

Maybe figure 4 from the Lancet article [1] mentioned above is helpful here. It is titled “Relative risk curves for selected conditions by number of standard drinks consumed daily.”

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Interesting graphs.

What's interesting in particular is that for several categories (such as ischemic heart disease) the relative risk does seem to go down rather decisively for up to 6(!) standard drinks per day (which they note is "offset" by the increased risk in other categories -- including cancer).

So going by their own combined/weighted risk in Figure 5 - we see a curve that is essentially flat in the region between 0 and 1 - that is, showing negligible risk (asymptotically zero) at 1 drink per day, rising to more concerning levels starting at 2 or 3 per day.

And that's the decisive issue here: "Is having an average of 1 drink per day really any more risky than 0 per day?" The only take-way I can get from the article is that there's essentially no difference in risk level in this interval.

Another article from The Lancet from around the same time reported a whopping... 6 months of life expectancy reduction when consuming 100-200g of alcohol a week versus 0-100g of alcohol a week. [1, Figure 4] A drink is 14 grams of alcohol, so that means that your risk from consuming 150 grams, or over 10 drinks a week, is still relatively low in terms of all-cause mortality. Figure 1 also shows that consumption of 0-100g per week has virtually no consequence on all-cause mortality.

[1] https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736...

so Japanese people would live even longer than everyone else than they already do if they didn't drink so much

Japanese people don't drink a lot. They're 17th out of the 17 "high income countries" shown by default here:

https://ourworldindata.org/alcohol-consumption

They do smoke like chimneys though, which makes for some pretty surprising stats vis-a-vis lung cancer (lower rates than the US) and life expectancy (significantly higher).

For comparaison, smoking is ~10 years of life expectancy reduction https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal....

Surprisingly obesity seems to only replace some of your last years with years with diabetes, without decreasing your longevity https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4951120/. I think I didn't read that study correctly, or didn't find a good one.

Air pollution might be around 1 to 3 years: https://dynomight.net/air/

A reduction of 6 months is also more than what you can expect to gain by taking statins: https://dynomight.net/statins/.

> obesity seems to only replace some of your last years with years with diabetes, without decreasing your longevity

That's probably only because we can generally manage diabetes pretty well, though it does impose a lot of cost on society to do so.

> we can generally manage diabetes pretty well

We can but it requires the patient to manage their blood sugar very, very carefully and a lot of them can't do it 100% of the time. Whenever they don't, the damage happens and it accrues. I see a guy in the 'hood who's had much of his foot amputated as a result of diabetes.

Or so I've heard. I'm not diabetic myself.

"Nevertheless, men with obesity aged 55 y and older lived 2.8 (95% CI −6.1 to −0.1) fewer y without diabetes than normal weight individuals, whereas, for women, the difference between obese and normal weight counterparts was 4.7 (95% CI −9.0 to −0.6) y. Men and women with obesity lived 2.8 (95% CI 0.6 to 6.2) and 5.3 (95% CI 1.6 to 9.3) y longer with diabetes, respectively, compared to their normal weight counterparts."

Is this study suggesting that obese people with diabetes lived longer than obese people without diabetes? I suppose that diabetes as a condition is not harmful in and of itself and perhaps leads to a healthier lifestyle?

My (uninformed) guess would be that people with diabetes are followed more closely than people without. Your point about healthier lifestyle is a good one too.

Diabetes is extremely harmful unless perfectly controlled which it almost never is. The damage accumulates very slowly.

Severe obesity significantly decreases longevity.

https://jamanetwork.com/journals/jama/fullarticle/195748

That effect has been magnified by the current COVID-19 pandemic. Obesity directly causes more severe symptoms in infected patients.

https://www.wfae.org/health/2021-09-30/novant-says-9-of-10-c...

https://cardiologyres.org/index.php/Cardiologyres/article/vi...

https://reason.com/2022/01/03/cdc-covid-19-children-hospital...

So severe obesity would be indeed "almost as bad as smoking" according to your article, which is more in line with what I've heard before. Thanks for the sources.

> Surprisingly obesity seems to only replace some of your last years with years with diabetes

That can't possibly be right. Obesity is a negative prognostic factor in almost every disease.

I'd say quality of life is a way better measure - but its so subjective it makes it difficult.

I'm a sociable person, and in my(western) experience there are more good times when alcohol is involved, even with people who does not drink often. I get that it may have an adverse effect on health and longevity. But in the end, we are all going to die - to grow old just to be old doesn't sit right either.

There's a metric know an "Disability-adjusted life year", or DALY, that tries to quantify this: https://en.wikipedia.org/wiki/Disability-adjusted_life_year.

And your point about social alcohol is well taken. I have the luck of being a lightweight with drinking, so usually a glass of cider is enough for me, and with the right people it's always a good time. On the other hand, lots of people my age (young adults) tends to drink multiple pints of beer multiple times a week. They should at least be aware of the tradeoff they're making.

Queue the Winston Churchill quote "I've taken more out of alcohol than alcohol has taken out of me". I believe he died at age 91. Although it seems crazy that we could have ever believed alcohol is healthy in any way.

Anecdotal accounts could be one offs. We need data for a full picture and even than the data could be biased.

It may very well be Churchill could have survived longer were it not for alcohol.

This recent post seems to imply that they now have more accurate and more unbiased data leading them to this new conclusion. I think a lot of people at the WHF drink some amount of alcohol as do most people in the world. However, despite this, their conclusions and announcements must be based off data which is exactly the right thing to do and exactly what they are doing here.

There's some data on scholar, for instance a suggested health difference between wine vs beers or spirits, based on ~28k participants monitored over 2-19 years[0].

From my understanding the narrative of moderate alcohol consumption (specifically wine, via resveritrol) being beneficial comes from epidemiological studies of people living in the Mediterranean, an area with relatively long median life spans[1]

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31093/

[1] https://www.ingentaconnect.com/content/ben/emiddt/2014/00000...

Other than this being an anecdote and doesn't mean everyone who drinks heavily will leave to their 90s, the quality of those 90 years matters too!

Though he became Prime Minister for the last time at the young age of 76 in 1951, he was plagued by health problems. He suffered many minor strokes and at least one that left him partially paralyzed for some time. He only stayed on as PM as long as he did because his successor was sick as well (Anthony Eden).

Don't know about you, but I would rather live a healthy 70 years than live 90 years but where the last 20 years are plagued with illness and thus lower quality. In that light, I try to minimize the bad habits that may result in poorer health and thus lower quality life in my later years. Not saying I'm a saint, but I don't need to drink every day or even every week. Currently I'm mostly dry. Saves a lot of money too!

It is absolutely acceptable to knowingly exchange damage to body for healing to mind, and vice versa as well. But I still appreciate that science is gradually making clear that alcohol is not perfectly harmless, and that a large-scale health foundation is finally admitting that.

The mind is part of the body

Also contrary to popular belief, alcohol does not heal or help the mind unless perhaps you have methanol poisoning or are in the middle of a panic attack

> The mind is part of the body

is it...?

Yes, the mind is an emergent property of the networks of the brain.

Or maybe you have a soul.

The soul is an emergent property of the mind and body interacting with the world.

Citation needed. Please don't invoke magic

How could it possibly not be?

if the mind is a state of consciousness, and damage to the brain damages said consciousness, the mind must be part of the body.

going further, alcohol is interesting in that, in appropriate amounts, it can improve the state of consciousness through a better quality of social interactions, and at the same time, can damage the state of consciousness through poisoning

Absolutely, and not only in a strictly physical sense (i.e. it's contained within it). Mental acuity into old age is strengthened by continued exercise and fitness - damaging the body so that it is less able to physically operate damages the potential of the mind.

Even if you want to step into the realm of the philosophy of mind[1] - there still are rather clear portions of the mind that are physically linked and a pretty wide consensus on the feedback of bodily strength to a healthy mind. Modern dualism accepts that a lot of mental functions are either enabled or assisted by our physical brain goop and classical dualism still assumed the definition of some crossover point where the metaphysical abstract expression of thought was translated into physical signals that triggered actions in the body - the existence of pain reactions necessitates a fair amount of our mental processing having the direct involvement of physical systems.

1. https://en.wikipedia.org/wiki/Philosophy_of_mind

> alcohol does not heal or help the mind

Is it not possible that some people find alcohol in reasonable doses to be a net positive mentally and mood-wise?

What people experience as positive does not need to be that. Using alcohol to not/postpone/avoid solving an underlying problem for unhappiness would be an example.

It's been basically 2 years since I've had a drink.

Before then, I drank socially-- a couple times per year I'd get buzzed with friends. Not all my social outings were buzzed.

But those hazy memories of being buzzed withe friends are little treasures that bring me smiles even long removed from them. My life is richer, and my mental health better, by virtue of hanging out with people this way and I miss it (this is a casualty of COVID).

Many memories of sober moments with friends bring joy, too. But they're qualitatively different things. I want both.

Preface: I say this as someone who has been sober from alcohol for almost 5 years.

Something can be a "net positive mentally and mood-wise" without also being something that is "not/[postponing]/[avoiding] solving an underlying problem for unhappiness".

The sibling posts make the right point: lots of things are objectively bad for your body, but your emotions are part of it, too. If alcohol or whatever makes you happier, then it's "good for you." Until you have so much that it's not good for you anymore.

It's the same for sweet desserts: why TF should you deprive yourself of all of them? Just keep it in moderation.

We could imagine a very different society with much less consumption of alcohol but people still being equally happy. If someone is made to feel unhappy when they don't drink because everyone around them is doing so, the fact that then consuming alcohol makes them happier shouldn't be pointed to as evidence the person is making a good trade off between bodily harm and happiness.

This post is kind of involved.

No, you shouldn't be made to feel unhappy; or rather, you should push back harder against anyone who tries to effectuate that. Being sorta Stoic here: no one can "make" you feel anything.

It's none of their business, after all.

People are notoriously bad at observing/examining their own behavior and mental states, although it is possible. But those people would probably be better served with a pharmacological anxiety treatment or therapy

Alcohol can be part of having a fun time, and having a fun time occasionally is good for your mental health (as opposed to the physical health of your brain, which appears to be what you're talking about).

This is certainly an opinion, but I think there are plenty of alternatives out there that can do a better job at enabling fun having without causing nearly as much bodily damage or functional impairment. We have a variety of choices in both the natural and pharmaceutical realms.

Okay, fine. It’s acceptable to damage the body to heal the body.

For example, exercise, where you damaging muscle fibers to heal, maintain, and/or improve the body.

Also for example, intoxication, by virtually every vector known to exist, often damaging the body in order to maintain the body.

Being alive is about tradeoffs, not about minmaxing. You can max out any statistic, but only at the cost of the others — sanity included. Alternately, being alive is about the exquisite joy of minmaxing, being able to hyper focus on one specific body goal at the cost of everything else in your life, including sanity (if you’re not careful).

“I’m sane without intoxicants”: so no nature, no music, no games, no social joy, then.

For example, this is either a description of an acid trip or of someone listening to orchestral music on the radio:

“It was so amazing. I’ve never felt so alive. It was, like, there was a train running through the mountains, and my room was one of the train cars, and I could see it right there, and I just stared at the wall for like half an hour and enjoyed the ride.”

I find it simpler to discuss mind and body in separate terms since people have trouble seeing transcendent experiences as intoxicants, but I hope this use of your terms helps clarify my viewpoint.

This is a dangerous statement! Alcohol is not good for the mind, even in small amounts. I feel like a cloud has been lifted since I stopped drinking.

I strongly recommend everyone read Allen Carr's Stop Drinking Now (https://www.amazon.co.uk/Stop-Drinking-Now-Allen-Carrs/dp/18...) - a fantastic book in which the author logically argues why every perceived positive of drinking is actually a negative.

This is an interesting study, and I'm not 100% sure it supports their conclusion. For example on Figure 1 the hazard ratio for all cause morality isn't much higher than 1 until you get into the 200g+ groups, and the hazard ratio for cardiovascular disease is less than 1 until you get over 200g. This would seem to support studies that find a benefit for moderate drinking on heart health. Most of this benefit seems to come from lowering the incidence of MI based on Figure 2.

This also seems to support my initial hypothesis from reading your comment which is I wonder how much of the difference in all cause mortality is due to the effects of binge drinking or drunk driving. The fact that the hazard ratio on all cause mortality isn't really above one until you get over 200g would seem to support the idea that that is where most of the increased mortality comes from.

When I read stats like that I also think about quality of life. These results don't rule out people living pretty much the same length of time, but with an assortment of ailments caused by the alcohol that make life pretty miserable, as another comment in this thread says about obesity and diabetes.

I wish we'd stop using shallow metrics life longevity over quality - it causes the layperson (who hasn't developed their critical thinking enough yet, or perhaps not capable to) to skim over that "lifespan" doesn't take into account all kinds of qualitative variables - including alcohol being a depressant, literally you're depressing how sharp your nervous system can be; yes, which people often self-medicate with because they have energies they haven't yet figured out how to regulate and are too intense, so the alcohol becomes an escape. I'm not against alcohol, I'm just for informed consent - understanding the full scope of what you're doing.

Maybe you have a different point in mind, but I am skeptical that there are any consumers of alcohol that are not aware that it is partially a depressant. This is both obvious to any consumer of it, and taught in every school that does any sort of substance (ab)use education.

Do you know if they teach that it causes cancer too?

You've uncovered the fundamental issue with numerous public health studies: the effect size is irrelevant.

You don't get attention for being modest.

Yes but "The Lancet"

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