More Data to Suggest that Moderate Alcohol Consumption Confers No Benefits
In recent years more careful consideration of epidemiological data has pointed to there being no health advantage to moderate alcohol consumption. Many past studies were looking at a form of alcohol consumption, such as moderate wine intake, that correlates with higher socioeconomic status. That in turn correlates with health and longevity, and the whole web of interlinked factors such as wealth, intelligence, education, and so forth.
The study here suggests another issue, in that groups who do not drink alcohol may have a higher proportion of people with risk factors for poor health and shorter life span than is the case in the general population. For example, people with a history of substance abuse, who do not drink at all as a necessary part of maintaining control over their lives. If one matches people who do not drink versus people who drink moderately, and ensure that other risk factors are the same on both sides, then the apparent advantage to drinking vanishes.
This is perhaps a similar situation to that arising in the epidemiology of excess fat tissue. Studies were showing a survival advantage to being moderately overweight in late life. That, however, is because the population of people who are thin at a given time in later life includes a sizable number who lost weight due to continuing ill health, and are thus at a higher risk of mortality going forward. People who remain thin throughout life have a survival advantage over their moderately overweight peers. There are many such cautionary tales in epidemiology regarding the interpretation of data.
Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study
Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later. A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018.
We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption.
The Cox proportional hazard ratio (HR) was 2.44 for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking.
The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.
It is very hard to teas out social and other factors. If you have friends to go for drinks and then hiking, apparently this is a good thing, unless you get wasted. Some use a drink for a better sleep. Alcohol can disinfect too. Not really relevant in modern times, but if you go on a resort drinking a virgin cocktail might be dangerous due to the local bacteria.
How about the French Paradox?
"This is perhaps a similar situation to that arising in the epidemiology of excess fat tissue. Studies were showing a survival advantage to being moderately overweight in late life. That, however, is because the population of people who are thin at a given time in later life includes a sizable number who lost weight due to continuing ill health, and are thus at a higher risk of mortality going forward. People who remain thin throughout life have a survival advantage over their moderately overweight peers. There are many such cautionary tales in epidemiology regarding the interpretation of data."
I wonder if the same is true with the U-shaped curve of cholesterol to mortality. People with blood cholesterol levels being around 220 have better mortality statistics than people with lower blood cholesterol of 150 or so...
Drinking Pure alcohol may not provide any benefits, but alcohol is often used to dissolve herbal medicines and dietary supplements - making these substances more bioavailable than water solutions.
So Fisetin, Piperlogumine, icariin dissolved in alcohol would be more beneficial than the same substances dissolved in water.
Drinking fisetin dissolved in alcohol is more fun.
As I did the tongue in cheek calculation to di solve the human equivalent dose of therapeutic dose takes about 750 ml off 40% alcohol. Or a bottle of vodka. That would go above the moderate drinking, though
It has always seemed somewhat fuzzy how drinking would confer the supposed health benefits. Ethanol is cytotoxic, albeit weakly so in low concentrations; its metabolite acetaldehyde is orders of magnitude more toxic.How regularly exposing yourself to a DNA damaging agent would somehow improve your health always seemed hard to explain and a bit too good to be true.
I don't know the answer to your cholesterol question about the U-shaped curved, but some researchers believe the U shape curve is a true curve and is not due to cofounding factors:
"Reverse causality has been suggested as an explanation of higher mortality associated with low cholesterol levels. However, a long term follow-up study in a Japanese-American population showed that individuals with low cholesterol levels maintained over a 20-year period had the worst all-cause mortality, and concluded that reverse causality was unlikely to account for the higher mortality associated with low cholesterol entirely"
Yi, SW., Yi, JJ. & Ohrr, H. Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults. Sci Rep 9, 1596 (2019). https://doi.org/10.1038/s41598-018-38461-y
Also it seems that researchers attempted to adjust for cofounding factors in this study:
"All participants were followed up until 2015 except those younger than 18 years old, after excluding those who died within three years of follow-up, a total of 1619 deaths among 19,034 people were included in the analysis. In the age-adjusted model (model 1), it was found that the lowest LDL-C group had a higher risk of all-cause mortality (HR 1.708 [1.432-2.037]) than LDL-C 100-129 mg/dL as a reference group. The crude-adjusted model (model 2) suggests that people with the lowest level of LDL-C had 1.600 (95% CI [1.325-1.932]) times the odds compared with the reference group, after adjusting for age, sex, race, marital status, education level, smoking status, body mass index (BMI). In the fully-adjusted model (model 3), people with the lowest level of LDL-C had 1.373 (95% CI [1.130-1.668]) times the odds compared with the reference group, after additionally adjusting for hypertension, diabetes, cardiovascular disease, cancer based on model 2. The results from restricted cubic spine (RCS) curve showed that when the LDL-C concentration (130 mg/dL) was used as the reference, there is a U-shaped relationship between LDL-C level and all-cause mortality. In conclusion, we found that low level of LDL-C is associated with higher risk of all-cause mortality. The observed association persisted after adjusting for potential confounders. Further studies are warranted to determine the causal relationship between LDL-C level and all-cause mortality."
Liu, Y., Liu, F., Zhang, L. et al. Association between low density lipoprotein cholesterol and all-cause mortality: results from the NHANES 1999-2014. Sci Rep 11, 22111 (2021). https://doi.org/10.1038/s41598-021-01738-w
@Brad Thank you for the LDL-C reference! I run my LDL levels very low, intentionally. I've heard several concerns about doing so, but they rarely seem to be well supported when I've dug below the surface.
I don't understand how one could publish that paper without any mention of HDL levels! While I run my LDL very low, my HDL is pretty high. I'm fastidious about diet and exercise with an occasional multi-day fasting mimicking episode thrown in for good measure.
Was the low LDL level risk also associated with a low HDL level? They should've answered that obvious question.
['French paradox'] I'm pretty sure they have not decorelated the latin / catholic work ethic (35 hour work week), climate, GDP, degree of (non-)industrialisaton (still) of food supply, racial mixity in couples, free higher education. We just need to give up TAP (The Acetaldehyde Precursor) and making babies when we shouldn't and we will be one huge blue zone :D !