It seems very difficult to get reliable information about what constitutes problem drinking.
I think the best answer might be “if it’s interfering with your life in ways that bother you, you have a problem.”
I am what my doctor would term a “heavy drinker” since I probably average 20 units (10g by weight) per week.
That’s two cocktails, or half a bottle of wine, or three beers, every night.
I would say maybe once every two months I will have an additional drink, so I am very consistent at that level. The last time I recall being drunk is probably 18 years ago. I’ve never enjoyed having an excess of alcohol in my system.
Some doctors respond to this level of drinking with shock and horror. Others act as if it’s slightly too much and suggest maybe two nights a week without drinking would solve the problem. Others seem to think that problem drinking is when you get most of your calories from alcohol. I literally had a doctor tell me that this is the definition of alcoholism, and that it always goes hand-in-hand with malnutrition.
The only thing I am certain about from what I have read is that the healthiest quantity of alcohol you can drink is zero. That’s right. The studies that say one glass a wine a day improves your health and longevity - well, they all seem to be flawed in one way or another.
Here’s the thing - I really don’t like feeling very tipsy - that’s why it’s so rare I have more than two cocktails. What I do like is the taste. Of beer, wine, cocktails, straight whisky. I only drink when I eat, and I find it hard to eat dinner without a drink because I like the bitter or sweet taste of the alcohol with the food.
If I need to stop for some reason, eg because of oral surgery, etc, I don’t find it difficult.
But I still wonder whether I am slowly pickling my liver and just need to cut back.
I used to need to have a drink with my meal too, dinner anyways. Having a cold beer or a cocktail with my food was just the best. For many reasons I’ve since stopped. I’d still have a drink with meals occasionally, especially if it’s a group event. But if I’m eating by myself or with my partner I almost never have a drink.
You know what? It hasn’t made a difference to my enjoyment of my meal. It did at first. Felt weird to have my food without a beer, but after the transition period it was just normal to not have one. This may be a part of the psychological dependency on alcohol.
I have a hard time thinking there's a problem here. I mean, if three beers a night will kill a person in the long run then the authorities need to be clear about that. It seems like that guideline is more due to the fact that alcohol is dangerous in excess -- excess meaning drunk -- and also addictive, which feeds into the danger, in excess.
I go months at a time without drinking, and generally stay between 2-4 drinks when I do, but as soon as I hit that 4th I want to keep going and have a hard time stopping. If I were to follow your program of 20 units per week it wouldn't be long before there would be trouble. That's problematic, IMO.
18 years without being drunk? You've got the best of both worlds.
I am now realizing when doing the math I misremembered and the US CDC unit of alcohol is 14g, so I am consuming 3 units/day whereas their guidelines are no more than 2 units/day.
The UK in contrast says a unit is 8g, and suggests no more than 2 units a day (so slightly more than half the US guideline).
Some countries call a unit 10g. If I recall correctly France suggests no more than 40g/day, so around 2/3rds of a bottle of wine (so 50% more than the US guideline).
So the suggested “healthy” limits for reasonable drinking vary considerably between countries and I am definitely exceeding the US guidelines, and even slightly exceeding the French guideline.
Interesting, perhaps some of the guidelines have been revised down in recent years. I distinctly remember both France and Italy having higher recommended daily limits and the only explanations I could find were that wine was part of the culture and thus the governments were reluctant to recommend substantially less than what people were actually drinking in practice.
there is pretty strong evidence that moderate drinking is beneficial, It isn't just one study, it's multiple studies done over many years in multiple countries.
Have you read the studies or the ones that disagree?
It’s been a few years now but I have. Time and time again the conclusion seems to be that the studies that say drinking is beneficial are screwing something up, eg the result is based on including very sick people who don’t drink because of their poor health, and these people die younger (and thus skew the results toward making it look like drinking increases longevity).
The studies that correct for this and other issues generally either conclude zero alcohol is best, or in one case I recall a study that concluded 5g (in other words a third of a shot, a third of a beer, or third of a glass of wine) had a minimal positive impact and by the time you got to 10g it was neutral and anything beyond 10g started reducing lifespan.
Sorry I don’t have any references. I looked into this in detail a while back and didn’t save any of what I found.
Doubtful that this is a valid objection. On the flip side, you would have to also exclude people who drink and drive because they skew mortality stats in ways that are not applicable to those who drink but don’t drive. Also, studies on benefits are not just about pure correlation with longevity but various beneficial effects.
Even excluding violent and chemical death, the third cause is cancer. Alcohol is classified as a carcinogen by IARC[1], the WHO[5] and the CDC[2]. I'm not well read on the subject - nor particularly well researched - but a cursory glance shows metabolic byproducts as the main culprit, though there are other factors.
As to "beneficial effects", keep in mind that the trace amounts of something healthy would pale in comparison to the negative effects of the alcohol, which is much less of a trace chemical.
Plus, other lifestyle choices could give a false positive[4]. Stuff like eating properly and exercising might not be properly controlled for, giving an unrealistically rosy picture.
The point about eating properly and exercising - that’s irrelevant since it’s not mutually exclusive with moderate drinking. You can drink moderately AND eat properly and exercise. The point about alcohol being a carcinogen is sort of irrelevant too since apparently it’s not enough of a carcinogen to affect longevity
I thought the latest studies hypothesized that there was a hidden variable - social interaction. Moderate drinkers were more likely to have consistent social interaction, which is strongly correlated with positive outcomes - enough to cancel out the negative health effects from drinking.
> Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.
This study uses an inscrutable statistical model to arrive at this conclusion. On the other hand I have yet to see an epidemiological study that shows abstaining results in a lower hazard ratio than moderate drinking.
I'm sure that similar issues exist with "Alcohol use and burden for 195 countries and territories" but the statistical model is too complicated to really see what's going on. I agree that at a population level alcohol is bad for longevity but at an individual level there seems to exist no evidence to suggest that moderate drinking is.
I addressed this elsewhere in this thread. Even this study finds benefits for heart disease and the all in mortality is affected by accidents, which doesn't apply to a moderate drinker who doesn't drink and drive. Also, this study inexplicably includes tuberculosis as the leading cause of death caused by alcohol. Perhaps this is the case in some countries, but seems irrelevant for those of us moderate drinkers who live in the developed world.
> Previous research has analysed all-cause risk due to alcohol use by either investigating all-cause risk in particular cohorts and survey series, or through meta-analyses of those studies.26,27 Past findings subsequently suggested a persistent protective effect for some low or moderate levels of alcohol consumption on all-cause mortality. However, these studies were limited by small sample sizes, inadequate control for confounders, and non-optimal choices of a reference category for calculating relative risks. More recent research, which has used methodologies such as mendelian randomisation, pooling cohort studies, and multivariable adjusted meta-analyses, increasingly shows either a non-significant or no protective effect of drinking on all-cause mortality or cardiovascular outcomes.7,14,28 Our results on the weighted attributable risk are consistent with this body of work. Taken together, these findings emphasise that alcohol use, regardless of amount, leads to health loss across populations. Although we found some protective effects for ischaemic heart disease and diabetes among women, these effects were offset when overall health risks were considered—especially because of the strong association between alcohol consumption and the risk of cancer, injuries, and communic-able disease. These findings stress the importance of assessing how alcohol use affects population health across the lifespan.
Yes, it’s very clear but people interpret it incorrectly nonetheless. For example, since population as a whole drinks and drives, alcohol would reduce longevity in population as a whole. Which has nothing to do with a personal decision to drink or not, since you can drink and not drive. The point about communicable diseases is simply irrelevant for most readers of this website.
My 2 cents is, if you can drink like that, and it makes you happy, just do! it’s not clear to me moderate drinking is actually bad for you. It might actually be good for you. Also is life a competition to live the longest? Is that the only definition of success?
Just if you find the pattern changing for the worse, stop.
You might also spontaneously stop when you’re older. Lots of people do.
I think the best answer might be “if it’s interfering with your life in ways that bother you, you have a problem.”
I am what my doctor would term a “heavy drinker” since I probably average 20 units (10g by weight) per week.
That’s two cocktails, or half a bottle of wine, or three beers, every night.
I would say maybe once every two months I will have an additional drink, so I am very consistent at that level. The last time I recall being drunk is probably 18 years ago. I’ve never enjoyed having an excess of alcohol in my system.
Some doctors respond to this level of drinking with shock and horror. Others act as if it’s slightly too much and suggest maybe two nights a week without drinking would solve the problem. Others seem to think that problem drinking is when you get most of your calories from alcohol. I literally had a doctor tell me that this is the definition of alcoholism, and that it always goes hand-in-hand with malnutrition.
The only thing I am certain about from what I have read is that the healthiest quantity of alcohol you can drink is zero. That’s right. The studies that say one glass a wine a day improves your health and longevity - well, they all seem to be flawed in one way or another.
Here’s the thing - I really don’t like feeling very tipsy - that’s why it’s so rare I have more than two cocktails. What I do like is the taste. Of beer, wine, cocktails, straight whisky. I only drink when I eat, and I find it hard to eat dinner without a drink because I like the bitter or sweet taste of the alcohol with the food.
If I need to stop for some reason, eg because of oral surgery, etc, I don’t find it difficult.
But I still wonder whether I am slowly pickling my liver and just need to cut back.
Can anyone relate?