Hi, I’m WZ and this is Science Vs from Gimlet. We are back for a new season! It’s good to be here… we missed you!! And we’re kicking off the season by pitting facts against old fashioneds. Today: Alcohol. Is it good for you or not?

For decades we’ve been hearing that… drinking a glass or two…is practically a health food…

<<There is ground breaking research on the benefits of drinking alcohol moderately. >>

Many studies have shown…heart disease AD, and cancers.

1 or 2 glasses of something a day might be good for you>>

But while many of us were drinking this news up… things changed…  if you turn on the telly last year …  you were hearing a very different story.

<<We hate to be the ones to break some sobering news to you but a major new study found that no amount of alcohol is good for your overall health.>>

So what's going on? Is science now saying boo to booze?

 <<Even that one glass of wine at dinner does more harm than good.>>

<<No amount of alcohol is good for you not even a little bit.>>

Is this thing that we love doing after a stressful day at work…. really killing… us?

Well it turns out … what we thought was a fairly simple question.... Took us down this rabbit hole where things got curiouser and curiouser… and it became almost impossible to know what to think…

We even surveyed around 50 experts[1] about their thoughts on alcohol…and they couldn’t give us a clear answer either. So we might as well give up, right? Never! Here at Science Vs, there’s no question too confusing, no research quagmire too sticky.

Strap on your beer goggles and get yourself ready… through a peer-reviewed adventure to find out once and for all… is alcohol is good for us or not?  

When it comes to alcohol there’s a lot of opinions… but then there’s science

 <SFX: beer opening>

AHHHH

Science Vs Alcohol, coming up… just after the break. Cheers!

<SFX: clink>

<PRE-ROLL>

Welcome back. Today we are finding out if that cheeky beer is killing us. We all know that drinking a lot - like four drinks a day [2]- can be bad for us. It increases our risk of all kinds of diseases, like liver disease[3] and it makes it more likely that we’ll get into serious accidents… but where it’s confusing is when it comes to drinking in “moderation”... y’know cracking open a cold one or two…   Because It’s seems like everyday we hear something different: some say it’s good… some say it’s bad. And all I want to know is … can I have a beer?

To start our journey in answering the question we want to take you to a time … where basically no one was seriously arguing that alcohol was good for you.

<<Alcohol is a violent narcotic…. almost as if its aim in life was to transform man into an animal.

This is a PSA.. from 1952.

All it takes is 5 drops of alcohol for every 1000 drops of blood and brother, you’re a dead duck>>

Things changed for alcohol in the 1970s though, when a very curious study came out: showing that alcohol might actually be good for you. It found that people who drank had far fewer heart attacks[4]   … than people who didn’t drink. This caused a huge stir[5].. …heart disease kills hundreds of thousands of Americans each year… it’s the biggest killer around[6]. If this finding was true…  no longer were drinkers dead ducks … but they might be majestic eagles, soaring to health.

Other scientists immediately bellied up to the bar …  and wanted to find out … could this be true? Could alcohol really be good for you?

ER I was surprised that there was something that seems so simplistic. It really was just really just gee--  really having a couple glasses of wine with dinner can have that strong of an impact

Eric Rimm[7] is a professor of epidemiology and nutrition at Harvard and one of his first big studies was checking to see if that 1970s paper was right… after all: the idea that alcohol could help your heart - sounded too good to be true.

ER Yeah I think people were skeptical anecdotally alcohol was bad people who showed up in hospitals had too much and therefore if too much was bad then you know a moderate amount was bad too. 

So in the 1980s… Eric tried to get to the bottom of the glass[8] He got more than 40,000 men to tell him how much they drank, their medical history… and…  he also asked the men what they ate. To see if maybe… it wasn’t the alcohol - but something drinkers happened to be eating that was protecting their heart.

ER maybe we can sift out . Is it the alcohol or is it the diet. So…we had four pages where we asked them about their diet and it was a list of about 130 foods.[9] So you'd go through and tell us how many sweet potatoes you ate on average over the last year. How much red meat you ate.

To make sure that he could trust that people were accurately filling out his survey…. Eric’s team later made sure that what people said they ate lined up with what was actually in their bodies[10]. They’d look for specific chemicals - found in certain foods.

ER So if you eat a lot of carrots that means you should have a lot of beta carotene in your blood and sure enough people that reported more carrots had much higher levels of beta carotene and people that reported more tuna had more mercury in their toenails which we would expect because there's mercury in tuna.

WZ  So you actually went and measured the mercury in people's toenails to make sure that they were reporting that you know consumption correctly.

ER Yeah We have one of the world's largest collections of toenails.Yeah you don't like to brag about that but that comes up at parties. hahaha

Yeah sounds like a real rager. Ok back to Eric’s first study. So, as the late 80s were rolling into the 90s… Eric starts plugging all the info about what people drank, ate and whether they got a heart attack into a computer… which was very fancy for the time…

ER you hit the enter key. In this case you know I had to wait eight hours for it to churn through because the computers were pretty slow at that time.

And when the results popped up, Eric found… that alcohol really was good for the men’s hearts.  Any amount of drinking lowered their risk of heart diseases -- and generally speaking, the more they drank. The stronger the effect. And the benefit from booze was huge. Like, men who drank three glasses a day?[11] They had a 35 percent lower risk of getting a heart attack[12][13]than those who drank nothing. And this was after you considered what they ate.

ER And I look at the result going Nah can't be that strong. It can't be that strong that there really is a 35 percent reduction.

Eric’s like… hardly anything you do makes that big of a difference.

ER So the absolute risk reduction is very similar to actually exercising regularly[14] 

WZ Wow.

Eric found that drinking booze…  lowered the men’s risk of a heart attack as much as exercising regularly…  Which is bonkers!. And if you’re into your liquor, the news for booze was about to get even better. [15] [16] [17] 

ER it didn’t make a difference what you drank that if you liked vodka or if you like beer or if you liked white wine you had the same benefit as red wine.

Other studies have come out backing this up too:[18] [19]  beer, gin, whiskey, tequila…  all of them… were found to be good for your heart. And while Eric's first study was only in men, other research has found it worked for women too! Their risk of coronary heart disease dropped if they only they had one or two glasses a day.[20] [21] And as all this research on alcohol came out, scientists immediately started wondering ... why?

When researchers did some digging, they found a few things going on that might explain this. For example, alcohol may raise your good cholesterol...keeping plaque from building up in your arteries. It also might prevent blood clots[22][23][24][25] . All good stuff for preventing future heart attacks. It seemed like case...of wine...closed[26] 

 

ER I daresay there's a few people at my institution who have toasted me for 30 years since my initial publication.  

W Z haha

ER Yeah it is not just my friends it is my colleagues as the dean of our school

So drinks all round! I cracked open a cold one… and I’m taking a sip..

<<Wendy sips>> 

Well… before I down this… you have to know… that not everyone is toasting this idea that alcohol is good for your heart.

TS hang on a minute this is so flawed this is so fundamentally flawed. 

This is Tim Stockwell. He’s a professor of psychology at the University of Victoria in Canada[27]. And Tim? He’s battling team booze… he’s part of team… boooos. That’s going to be confusing.

So before we jump to the conclusion it's the alcohol which is such a nice conclusion. It's no it's more complicated than that.  

Scientists in Tim’s camp, they were the ones who threw a wrench into all this intoxicating booze research. But Tim wasn’t always a party pooper… in fact he used to think that alcohol was good for your heart. Then he met a sociologist called: Kaye Fillmore.  

TS Wasn’t until I met Kaye Fillmore and got to know her and her work that I began to seriously question the scientific evidence.  

WZ Tell me about Kaye.

TS She was quite. She was one feisty woman. She is about five foot nothing.  A heavy smoker. She liked her Scotch  And oh my God she was she would give it to anybody in large public meetings. 

And was about to start giving it to scientists like Eric. She died several years ago[28], but Tim told us that Kaye started thinking there was something fishy about all these alcohol studiesso she phoned Tim.

TS and yeah I get this call this gravelly voice she was smoking away puffing on a cigarette: Tim, can you help me?

Tim said yes. So Kaye’s like: ok all these studies are showing that those who drink have less heart disease than those who don’t well have you ever thought…  who are these non-drinkers in these studies? Like… what kind of person doesn’t drink anything?  It might seem like people who don’t drink would be those healthy types, ya know “my body is a temple”. But Kaye suspected that wasn’t true.

She started looking into the studies that had been done on people who don’t drink and found something kind of shocking. Generally speaking, they were more likely to be unhealthy. [29] [30] [31].[32] Many of them used to drink, but then had to stop for some medical reason. And so the team figured if you want to know if alcohol is good for you… then it’s a bad idea to be comparing drinkers to these sick teetotallers.  

TS you know they're unhealthy. So they make the moderate drinkers look good by comparison.

The people - who did drink… and then stopped… some scientists call them “sick quitters[33] [34]... Sounds like a bad burn, but basically means they didn't stop drinking because they were running a triathlon, but because they weren’t well.[35].

So Tim and Kaye thought… let’s only look at the studies we trust, like those that don’t have this problem with the sick quittersAnd when they did that… and ran the numbers… all of a sudden… alcohol wasn't good for your heart anymore. Tim remembers the moment the team figured it out.

TS And I remember some being stuck in there in a snowstorm and talking with her on the phone and working over the data Yeah. It was pretty clear that the significance fell away.

Significance fell away? That’s the dorky way of saying… his paper couldn’t find evidence that beer that is good for my heart.  

WZ so are you someone that people want to invite to parties based on your research.
TS Oh oh. I was invited round to dinner friends last night so I'm not a complete pariah. I do occasionally leave my house.

And when Tim and Kaye published their study in 2006,[36] ...it got a lot of media attention making headlines across the US[37] [38] [39] [40] saying: that alcohol might not be good for us anymore [41]… …and it set the stage for the confusion that’s still mixing us up today.[42]  ..

<<Even that one glass of wine at dinner does more harm than good.>>

<<One day it’ll kill you the next day it’ll save your life,>>

For Eric? Tim’s research was like a shot of vodka across the bow… Eric says he’s taken these sick quitters into account in these studies, and he still finds that alcohol is good for our heart[43][44]. But Tim has other problems with this research… and it basically centers around this idea that it’s just really hard to account for everything that might be different about people who drink and those who don’t… And so if you’re finding drinkers have lower rates of heart disease, it’s hard to know that  alcohol is the reason why.

TS. This is a very complex issues these are hugely complicated things to resolve. 

And so … the two sides have gone round and round on this. With no end in sight.

The fact that no one has put a cork in this yet… made us wonder if maybe -- other than these nerdy gripes -- could this be about the alcohol industry? Like, are they brewing up their own research? I mean, a big National Institutes of Health study just got canceled because of worries about interference from Big Alcohol[45],[46].

Our producer Meryl Horn asked Tim about it.

MH Do you think it explains this debate why there are some researchers that are so convinced that alcohol is good for your heart

TS Oh the industry funding? No I think it's just a small part of it.  Most of these studies are not funded by the alcohol industry.[47]

And full disclosure - we have alcohol advertising on Science Vs.

Away from industry funding though… Eric actually has a totally different complaint for us…

ER I am concerned that by doing this story you’re doing a disservice….  by giving equal weight to both sides you've essentially said well this is what it feels like when you go to a conference so be equal people on both sides of the aisle. This is not like a wedding with an equal number of people on the bride's side and the groom's side.

After talking to Eric, we really weren’t sure what to think. And so we reached to HUNDREDS of scientists to find out what was going on here: is this booze battle for real? And it turns out a bunch of scientists are now questioning if alcohol is good for your heart.  So we heard back from around 50 experts …  and they were split. Half agreed with Eric… and the other half either didn’t think alcohol helped your heart… or they said they didn’t know…  So clearly, this is still a spirited debate. [48].

Ultimately where did we land?…Well, last year two big reviews came out[49] pulling together work from this entire field …  And these newer studies tend to show: that Eric is right. Alcohol seems to be good for your heart…  But there’s a couple of caveats. Now that more studies are being more careful with things like the sick quitter effect, they’re finding some things that are different to what Eric found. For one: men and women gets a benefit to their heart after about one drink a day[50]. It’s not the more you drink the stronger the effect.  Also, more sobering news -- alcohol isn’t as good at protecting your heart as that early research found …. [51] [52] [53] [54] [55] [56] [57] 

Conclusion: It does look like alcohol can protect us against heart disease - which is the biggest killer in the US. But it’s not the life-saver those earlier studies found. So bottom line, I’m taking a sip. <<SIP>> But I’m a little less excited about it.

Now while the heart is getting all this attention...there's something else going on with alcohol and your body. Something else that might make you think twice before picking up that glass.

when I go home and I go to take a beer from the fridge I'm now going to be thinking of what you just said.  

SG Good.  

WZ Not for me!   

And we're going to tell you about it after the break.

BREAK

BEAT 4: CANCER

Welcome back. So for years, as we’ve been hearing that some alcohol is good for us, the conversation has basically centered around your heart. You could say it’s the heart of the issue! But something’s been bobbing under the surface this whole time, like the olive at the bottom of a martini glass. And this thing might overshadow any of the potential benefits that alcohol is giving to our heart. And it’s cancer….  [58]

 Susan Gapstur at the American Cancer Society[59] is looking into this… which she says can make for some awkward conversation over cocktails.

 

SG of course you get the original,  oh my gosh don't show her my drink.

WZ really?

SG But you know then then people are curious.  They want to know  

Yeah, and we wanted to know

WZ when it comes to cancer how much alcohol is safe to drink?

SG So the most recent evidence has shown that when it comes to cancer there is no safe amount

No safe amount. What Susan is saying is that even that cheeky glass or two of wine every day is bad news when it comes to many different types of cancers.[60] [61] [62] [63] [64] 

SG even at low amounts of consumption. Drinking alcohol increases the risk of mouth and throat cancers cancers of the esophagus which is that tube in the body just beyond your throat.

Another big one, for women, is breast cancer - light drinking bumps up your chances of getting it. The research suggests it’s even riskier if you binge.[65] [66] The news gets worse the more you drink -- then your risk of getting all kinds of cancers goes up. [67].[68] 

So how is alcohol doing this? How is it causing cancer? Here’s one way it can happen… Susan told us that after you have one drink, the alcohol is broken down into something called acet-aldehyde.[69] 

SG The acetaldehyde reacts with DNA and with proteins to basically glob onto them. 

Acetaldehyde sticks to DNA, and[70] it can squish itself right in the middle of the double helix, getting all up in our DNA’s business. [71] And all this can trigger mutations in our DNA… leading to cancer cells.

SG And that's just one mechanism. There are others. Acetaldehyde can prevent those cells that are damaged from dying.

This is a problem because our body has a way to clean up damaged cells so they don't stick around and grow into tumours... ... but acetaldehyde mucks this up too... And when those dud cells with messed up DNA don’t die, we can get cancer.

SG We want damaged cells to die and acetaldehyde can help inhibit that death

WZ I mean I'm imagining myself now when I go home and I go to take a beer from the fridge which I know is currently sitting in the fridge. I'm now going to be thinking of what you just said.  

SG Good.  

WZ Not for me!  

So… alcohol increases our risk of getting cancer… but…. I mean … doesn’t basically everything give us cancer... what we wanted to know is how bad is it? Like is alcohol a liquid cigarette?

Well we all know that when it comes to cancer ciggie’s are the worst[72] 

About 19 percent of cancers in the population can be attributed to smoking.. [73]

Susan told us that almost 6 percent of cancers in the US are caused by alcohol. [74] 6 percent. So not as bad ciggies… but still not great.

And if you’ve got a cold one sitting next to you -- what does all this mean? Like how much will that drink increase your risk of getting cancer?

 

To give you an example… one of the cancers that you’re most likely to get from having a drink each day is breast cancer, that’s for women anyway.  So let’s zoom in on this. Susan told us that the average woman's lifetime risk of getting breast cancer is a little more than 12 percent, but if she’s drinking about 5 drinks a week her risk jumps up to little more than 13%. [75] [76][77][78] . Now it can be hard to know how to feel about a stat like that… so here’s how Susan thinks about it.

SG this is something you can do if you're worried about your cancer risk if you are a woman and you are worried about your breast cancer risk you know minimizing your consumption if you are a two drink a day drinker you know starting to reduce that is something you can do 

Currently, the national guidelines in the US [79][80][81][82] recommend that women shouldn’t drink more than one drink a day and men should keep it to 2. When we dug into these recommendations… we realised there wasn’t clear science as to why the cut off is like this.[83] It’s now looking like everyone’s risk for cancer goes up if they have just one glass a day[84] … and as we mentioned… the newest research is showing that the benefit to everyone’s heart, on average, comes from one drink too.[85][86]

So when it comes to alcohol, should we raise a glass?

  1. Does alcohol help our heart? Yes, probably. While there is some nerdy argy bargy going on - overall, the research does show that it can reduce your risk of getting heart disease. And that’s the No. 1 killer in the U.S.!
  2. Does alcohol increase our risk of cancer? Yes, even if you don’t drink very much…  And the more you drink, the greater the risk. And by the way, cancer - this is the second biggest killer in the U.S[87].

So, alcohol -  good for the heart bad for the cancer... ?[88] [89] [90]  Should I drink this beer or not? We asked all of our experts where they personally stood on drinking … and while none of them were big boozers, none of them had cut out alcohol completely.

ER I am a red wine fan mostly although a good Chardonnay from California’s great..

TS Well look I I like a glass of wine or a beer and I these days I never drink more than two I think.   

SG  I love buttery chardonnays! hah

For me… I’ll finish this beer… but I won’t crack open another one.  So, cheers?

That’s Science Vs Alcohol.

FINAL CITATIONS

And we are now on instagram! Yeah - you can see behind the scene photos… just generally us being nerds. Find us on instagram science_vs.

This episode was produced by Meryl Horn with help from Wendy Zukerman as well as Rose Rimler and Michelle Dang. Our senior producer is Kaitlyn Sawrey. We’re edited by Blythe Terrell. Editing help from Caitlin Kenney. Fact checking by Michelle Harris and Michelle Dang. Mix and sound design by Peter Leonard. Music by Peter Leonard, Emma Munger and Bobby Lord. Thanks especially to Michelle Dang for her all her research help on this episode. A huge thanks to all the researchers we got in touch with for this episode including Dr. Arthur Klatsky, Dr. William Kerr, Dr. Tim Niami, Professor William Ghali, Dr. Wendy Chen, Max Griswold and many others. Recording help from Andrew Stelzer, Susanna Capelouto, Katie Sage, and Joseph Fridman. Also thanks to Lynn Levy, the Zukerman Family and Joseph Lavelle Wilson.  

Next week… we’ll take you to an ugly and long forgotten chapter in America’s science history… and ask: what went wrong?

We were putting poison on people’s backs… and at the time I thought it was the most interesting thing. I got caught up in it

I’m Wendy Zukerman, fact you next week.


[1] https://docs.google.com/spreadsheets/d/e/2PACX-1vRvZ3xwb5yyl_tnsmaTbDt_M37nH_YKrpY3UAcEdZUATZN7O07KittUbJ42-pEkfatEpkJg3YATfZ_A/pubhtml?gid=1218956013&single=true 

[2] http://sci-hub.tw/10.1001/archinte.166.22.2437 show an overall benefit to all cause mortality from light drinking (up to 4 for men) but flips to negative at around 4 drinks (see figure 1). Many of the newer meta-analyses see an increased health risk at levels much lower than this though (e.g. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2 )

[3]http://sci-hub.tw/10.1016/j.ypmed.2003.11.027 at 50 grams a day, the increased risk ratio for many diseases is up (see table 1 for numbers), and the disease increased the most is liver cirrhosis

[4]http://sci-hub.tw/10.7326/0003-4819-81-3-294 

[5]https://www.newspapers.com/image/311935809/?terms=alcohol%2Bheart%2Battack

https://www.newspapers.com/image/48725281/?terms=alcohol%2Bheart%2Battack https://www.newspapers.com/image/123759645/?terms=alcohol%2Bheart%2Battack australia!

https://www.newspapers.com/image/67115364/?terms=alcohol%2Bdrinking%2B%22heart%2Battack%22 canada!

https://www.newspapers.com/image/260603498/?terms=alcohol%2Bdrinking%2B%22heart%2Battack%22 england

[6] https://sci-hub.tw/10.1001/jama.294.10.1255 (PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16160134)

[7] https://www.hsph.harvard.edu/eric-rimm/ 

[8]https://sci-hub.tw/https://doi.org/10.1016/0140-6736(91)90542-W 

[9] The 131-item semiquantitative food frequency questionnaire included questions about average consumption during the past year of beer, white wine, red wine, and spirits.

[10] http://cebp.aacrjournals.org/content/cebp/6/12/1043.full.pdf These results illustrate the potential use of empirically derived weights for foods in estimating toenail levels of selected heavy metals and support the validity of published food residue data that are used to estimate mercury consumption.

[11]  https://sci-hub.tw/https://doi.org/10.1016/0140-6736(91)90542-W table II- at 30 grams and more, see “Multivariate RR” for myocardial infarction

[12] The most common type of heart disease is coronary heart disease… Coronary heart disease is often referred to simply as “heart disease,” although it’s not the only type of heart disease. Another term for it is coronary artery disease.

[13] Relative risks of alcohol consumption and coronary artery disease among men from the Health Professionals Follow-up Study. (see graph on page 467)

[14] https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.115.015853 ... well, define "regularly" ... but yes high levels of physical activity can achieve similar risk reduction "we observed a linear dose response for HF risk with a marked reduction in risk at very high doses of PA (≈35% risk reduction at 2000 MET-min/wk)."

[15] https://sci-hub.tw/10.1056/NEJMoa022095 No single type of beverage conferred additional benefit,

[16] https://sci-hub.tw/10.1016/j.ypmed.2003.11.027 Meta-analysis which finds J shaped curve for heart disease: max benefit around 20g/day (figure 2)

[17] https://sci-hub.tw/10.1016/0009-8981(96)06227-4 There is a considerable body of evidence indicating that moderate alcohol intake is associated with a reduced incidence of, and mortality from, coronary heart disease (CHD)...  Further, all major beverage types have been found to be associated with lower CHD risk, suggesting that it is the alcohol itself that provides much of the protection against CHD.

[18] https://www.bmj.com/content/312/7033/731.long   Results from observational studies, where alcohol consumption can be linked directly to an individual's risk of coronary heart disease, provide strong evidence that all alcoholic drinks are linked with lower risk. Thus, a substantial portion of the benefit is from alcohol rather than other components of each type of drink.

[19] https://www.ncbi.nlm.nih.gov/pubmed/10554677 Small doses (1-4 drinks a day) of wine, beer, and spirits are equally beneficial.

[20] https://sci-hub.tw/10.1111/j.1360-0443.2012.03780.x figure 2, c and d

[21] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2 figure page 1024

[22]  https://www.bmj.com/content/312/7033/731.long Several short term experimental studies have shown that alcohol (not specific to drink type) increases the serum concentration of high density lipoprotein cholesterol….Other potential mechanisms include an effect of alcohol on platelet function and on tissue plasminogen activator and other components of clotting and fibrinolysis.

[23] Recent analyses suggest that approximately 50% of the protective effect of alcohol is mediated through increased levels of HDL cholesterol https://www.ahajournals.org/doi/full/10.1161/01.CIR.94.11.3023 

[24] The discussion here has focused on ethanol’s benefits in reducing arteriosclerotic plaques, reducing blood clotting, and protecting cardiac myocytes, thereby reducing the risk for CHD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887499/ 

[25]  A 2017 rundown of factors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513687/#b23-arcr-38-2-219

[26] . Studies using different methodologies have shown that low-to-moderate alcohol consumption decreases platelet activation and aggregation in certain cases—for example, in response to certain physiologic stimuli such as adenosine 5′-diphosphate (Salem and Laposata 2005). On the other hand, significant daily alcohol consumption increases platelet aggregation and reactivity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513687/#b23-arcr-38-2-219

[27] https://www.uvic.ca/socialsciences/psychology/people/faculty-directory/stockwelltimothy.php

[28] http://www.roizen.com/ron/Roizen-Fillmore-tribute-2013.pdf

[29] http://sci-hub.tw/10.15288/jsa.1999.60.725  Light or moderate drinkers had not only lower mortality but other health burdens were lower than for either abstainers or heavier drinker… Compared with abstainers, all drinking categories were observed to be significantly less likely to report perceived

general health as less than good and to report more than three health complaints or more than three chronic conditions. For the subscales of the Nottingham Health Profile of mobility, isolation and complaints of lack of energy, statistically significant differences between abstainers and light and moderate drinkers were observed.

[30] http://sci-hub.tw/10.15288/jsa.2001.62.501 Hospitalization and onset of a chronic

condition were associated with decreased drinking levels.

[31] https://sci-hub.tw/10.1046/j.1360-0443.1999.9433858.x Table 4 shows that health problems were more frequent among subjects who stopped drinking compared with the reference group

[32] http://sci-hub.tw/10.1136/bmj.h4238 Abstainers or heavy drinkers were less likely than light and moderate drinkers to have had a regular physical exam and be screened for colorectal, prostate, or breast cancer (table 1). They also engaged in fewer physical activities and had lower AHEI 2010 dietary scores. 

[33] https://pubs.niaaa.nih.gov/publications/arh25-4/255-261.htm 

“The first of these concerns, also called the "sick quitter" hypothesis, was proposed by Shaper and colleagues (1988) in the United Kingdom. It states that the pool of abstainers includes many former drinkers who quit drinking because of illness or because alcohol interacts with prescription drugs they are taking."

[34] sci-hub.tw/10.1016/s0140-6736(88)92890-5 (Shaper et al., 1988)

“The data suggest that the observed alcohol-mortality relationships are produced by pre-existing disease and by the movement of men with such disease into non-drinking or occasional-drinking categories.”

[35] https://sci-hub.tw/10.1080/16066350500497983 This left a total of 54 all cause mortality studies and 35 CHD mortality studies (studies and study characteristics appended). Reference group current abstainers. Studies containing Former Drinker Misclassification Error Only (41 results from 8 studies) (8/35)

[36] https://sci-hub.tw/10.1080/16066350500497983 

[37] Tim and Kaye’s original finding in 2006 https://www.newspapers.com/image/273625305/?terms=alcohol%2Bkaye%2Bfillmore  Hawaii

https://www.newspapers.com/image/505748370/?terms=alcohol%2Bkaye%2Bfillmore Canada

https://www.newspapers.com/image/131662282/?terms=alcohol%2Bkaye%2Bfillmore Iowa

https://www.sfgate.com/health/article/UCSF-points-out-flaw-in-studies-tying-alcohol-to-2500729.php  San Francisco

[38] https://www.nytimes.com/2009/06/16/health/16alco.html?mtrref=www.google.com&gwh=A837EC1C73D12C60E3A419CDE4283582&gwt=pay “Alcohol’s Good for You? Some Scientists Doubt It” Quote Kaye, Tim Niami (the other big Boooos camp Tim) and Arthur Klatsky FROM 2009

[39] https://www.motherjones.com/politics/2018/04/did-drinking-give-me-breast-cancer/ this article talks about Kaye’s research. FROM 2018

[40]

[41] These are all from another “team booooos” paper , from Tim Niami, around the same time as Tim and Kaye’s research  https://www.newspapers.com/image/102772436/?terms=%22American%2BJournal%2Bof%2BPreventive%2BMedicine%22%2Balcohol%2Bheart

“Study says alcohol might not prevent heart attacks, strokes” from 2005

https://www.newspapers.com/image/211007086/?terms=%22American%2BJournal%2Bof%2BPreventive%2BMedicine%22%2Balcohol%2Bheart

“A few drinks a day may not help heart” 2005 -

https://www.newspapers.com/image/490102930/?terms=%22American%2BJournal%2Bof%2BPreventive%2BMedicine%22%2Balcohol%2Bheart

Don’t drink to your health, Government says

[42] E.g. Additionally, some research suggests that low levels of alcohol consumption can have a protective effect on ischaemic heart disease, diabetes, and several other outcomes.4–6 This finding remains an open question, and recent studies have challenged this view by use of mendelian randomisation and meta-analyses.7–10" and cite it as #8

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2

[43] https://sci-hub.tw/https://doi.org/10.1016/0140-6736(91)90542-W original study- did a post-hoc analysis removing ex-drinkers and still saw a big effect: https://sci-hub.tw/10.1016/j.annepidem.2007.01.002 

[44] “Good for the heart”- OK: in original study he looks at “coronary disease”, and “The most common type of heart disease is coronary heart disease. In fact, when people talk about “heart disease” they often mean coronary heart disease.” Eric’s follow up 2006 paper which also looks at whether this effect could be due to “sick quitters” is also about “Coronary Heart Disease”

[45] https://www.nytimes.com/2018/06/15/health/alcohol-nih-drinking.html?module=inline 

[46] https://acd.od.nih.gov/documents/presentations/06152018Tabak.pdf 

[47] https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12826 “there is no known precedent in alcohol industry funding of research” - however note, this paper calls for more investigation given the NIH scandal

[48] https://www.bmj.com/content/349/bmj.g4164 Meta-analysis of 56 epidemiological studies: Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.

[49] Referring to these papers which came out 2011, 2016, and 2 from 2018 (see below)

[50] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2 For ischaemic heart disease, we found a minimum relative risk of 0·86 (0·80–0·96) for men and 0·82 (0·72–0·95) for women, occurring at 0·83 standard drinks daily for men and 0·92 standard drinks daily for women.

[51] Next 6 citations are all meta-analyses which try to take sick quitters into account. They all find the effect is smaller than what Eric found (35%). For the 3 which compared before and after they  tried to account for the “sick quitter” hypothesis, 2 of them found the effect got smaller: https://sci-hub.tw/10.1046/j.1360-0443.2000.951015056.x “The studies with highest quality score, those reporting RRs adjusted for the main risk indicators, those considering life-time abstainers as referents, those excluding subjects with pre-existing disease at baseline and those performed with a cohort design, showed lower protective effect of alcohol….By pooling the 28 cohort studies with good qualitative characteristics (model 7), the function was decreasing up to 20 g/day RR= .8

[52] https://sci-hub.tw/10.1093/oxfordjournals.epirev.a036124 Weighted regression of low-dose data from five studies (23, 27, 35, 38, 42) that separated ex-drinkers from long-standing nondrinkers gave an estimated relative risk of 0.83…  Excluding nondrinkers altogether and using occasional drinkers as the reference group in five other studies (28, 29, 46- 48), it was possible to estimate an incremental relative risk of 0.88 (95 percent CI 0.81- 0.96) for approximately one drink per day relative to less-than-daily drinking:

[53] https://www.bmj.com/content/bmj/342/bmj.d671.full.pdf  (full paper) This meta-analyses did NOT find that the coronary heart disease protection got smaller after removing ex-drinkers- (see table 2 : Coronary heart disease rates in “Active drinkers v lifetime abstainers” are .73 and .75, compared to “Active drinkers v non-drinkers” 0.73 and 0.80, pretty similar results. These results (~25%) are still lower than Eric’s original finding.

[54] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2 tried to account for ex-drinkers vs lifelong abstainers and found an effect of “0·86 (0·80–0·96) for men and

0·82 (0·72–0·95) for women”... Females, particularly in high SDI locations, experienced some protective effects for ischaemic heart disease and diabetes beyond 60 years of age. For males, only high SDI and low SDI locations had noticeable protective effects for ischaemic heart disease, but the effect was small compared with the total attributable burden in those locations.

[55] https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3026-9 tried to account for ex-drinkers vs lifelong abstainers, found an effect of about 20% for men (IHD) less than 20% for women [this is by eye can’t find RR in numbers just the graph in figures 1 and 2...MH]

[56] https://sci-hub.tw/10.1016/S0140-6736(18)30134-X accounted for ex-drinkers vs lifelong abstainers by just removing all non drinkers. myocardial maximum effect looks like a little more than 20%, CHD less than 20% - for myocardial infarction, could see max benefit at 100g/week (figure 2) for men vs women, doesn’t say it’s different amounts which lead to this benefit, but they do compare the benefits at 100g for both and it’s similar: https://www.thelancet.com/cms/10.1016/S0140-6736(18)30134-X/attachment/5b9e9977-5741-4caf-9ab1-ab873eef63fc/mmc1.pdf  supplemental info for that paper: page 18: myocardial infarction for 100g/week: benefit was 0.95 for men, 0.87  for women.

[57] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2 max benefit for Ischaemic heart disease:  for women, occurring at 0·83 standard drinks daily for men and 0·92 standard drinks daily for women.

[58] https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm 

[59] https://www.cancer.org/research/acs-researchers/susan-gapstur-bio.html National Cancer Institute Cancer Prevention Postdoctoral Fellow, University of Arizona, 1993-1994

[60] https://www.wcrf.org/sites/default/files/alcoholic-drinks.pdf 

[61] http://sci-hub.tw/10.1093/annonc/mds337 Bagnardi 2013 meta-analysis- says light drinking (defined as less than one drink per day) increases the risk of cancer of oral cavity and pharynx, esophagus and female breast, but not colorectum, liver and larynx tumors at this amount.

[62] http://sci-hub.tw/10.1016/j.ypmed.2003.11.027  finds no “threshold” under which drinking is fine: “Some of the findings from this meta-analysis are innovative and of specific relevance, including the absence of a threshold effect for any of the seven cancer sites considered...” Strongly associated: oral cavity, esophagus and larynx. “. Less strong direct relations were observed for cancers of the colon, rectum, liver, and breast. For all these conditions, significant increased risks were also found for ethanol intake of 25 g per day”

[63] http://sci-hub.tw/10.1136/bmj.h4238  However, for women who have never smoked, risk of alcohol related cancers (mainly breast cancer) increases even within the range of up to one alcoholic drink a day.  [also says for men, : For men who have never smoked, risk of alcohol related cancers is not appreciably increased for light and moderate drinking (up to two drinks per day), but other studies control for smoking and do see an increased risk of these cancers- eg. this paper)

[64] http://sci-hub.tw/10.1093/jnci/djn514 but with every increase in drink per day, the risk goes up for: oral cavity and pharynx, esophagus, larynx, rectum, breast (in women)

[65] http://sci-hub.tw/10.1001/jama.2011.1590 After controlling for cumulative average intake, we observed a modest association with binge drinking but not frequency of drinking.”

[66] http://sci-hub.tw/10.1093/eurpub/ckm036 Binge drinking of 4–5 drinks the latest weekday increased risk with 55%, compared with consumption of one drink. ...Binge drinking was adjusted for the approximate total amount of alcohol consumed (weekend versus weekday, respectively).

[67] https://www.wcrf.org/sites/default/files/alcoholic-drinks.pdf 

[68] http://sci-hub.tw/10.1016/j.ypmed.2003.11.027  “Less strong direct relations were observed for cancers of the colon, rectum, liver, and breast. For all these conditions, significant increased risks were also found for ethanol intake of 25 g per day”

[69] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618592/ Based on extensive epidemiological evidence, the International Agency for Research on Cancer defined acetaldehyde associated with the consumption of alcoholic beverages as a “group 1 carcinogen” (definite carcinogen) for the esophagus and/or head and neck.

[70] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618592/ Acetaldehyde is a highly reactive compound that causes various forms of damage to DNA, including DNA adducts, single- and/or double-strand breaks (DSBs), point mutations, sister chromatid exchanges (SCEs), and DNA–DNA cross-links.

[71] https://pubs.acs.org/doi/abs/10.1021/tx000118t  In this study, we identified three new types of stable acetaldehyde DNA adducts, including an interstrand cross-link. ... DNA Adducts Induce Severe DNA Damage2-Et-dG blocks DNA synthesis and induces DNA mutations [60,61,62,63]. Moreover, N2-Et-dG inhibits translesion DNA synthesis (TLS), which leads to a majority of frameshift deletions and a minority of G:C > T:A transversions in human cells [62].

[72] https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21440 Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively).

[73] https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21440 Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively).

[74] https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21440 Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively).

[75] In the U.S., the average lifetime risk of a woman developing breast cancer is about 12.4%. This means that consuming about 5 extra drinks a week would be expected to increase the average woman’s lifetime risk of ever developing breast cancer from *12.4% to about 13.3%.*  [source]

[76] http://sci-hub.tw/10.1016/j.ypmed.2003.11.027 this paper gives stats for 25g a day, which is more like 2 drinks, but shows similar relative risk ratios for breast cancer as other types of cancers (esophagus and larynx)

[77] https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/causes-risks-prevention/risk-factors.html "Our metaanalysis provided sufficient evidence that alcohol, even at low intakes, significantly increases the risk of oropharyngeal cancer, esophageal SCC and breast cancer. Albeit small in absolute terms, the estimated effects might be important at the population level because of the high prevalence of light drinkers"

[78] http://sci-hub.tw/10.1093/annonc/mds337

[79] CDC: https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm up to one drink per day for women and two drinks per day for men

[80] USDA: https://health.gov/dietaryguidelines/2015/guidelines/appendix-9/ up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.

[81] NIH:  https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men. 

[82] foundations also have these guidelines: http://www.aicr.org/reduce-your-cancer-risk/diet/alcohol-and-cancer-risk.html https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/alcohol-and-heart-health

[83] I emailed the CDC, and they responded “Thank you for your interest in this topic.  The CDC Moderate Drinking Fact Sheet (https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm ) is based on a number of the scientific studies (see references at bottom of link) [these studies didn’t actually separate risks for men vs. women, except one which said it’s beneficial to have several drinks a day, so seemed to be contradicting the more recent evidence- MH]. Drinking at levels above the moderate drinking guidelines (1 drink a day for women and 2 drinks a day for men) significantly increases the risk of short-term harms, such as injuries, as well as the risk of long-term chronic health problems, such as some types of cancer (e.g., breast cancer) [but for other types of cancer, like stomach cancer, the increased risk is only significant for men but not women- MH] and liver disease. For information on the process to develop the dietary guidelines: https://health.gov/dietaryguidelines/2015/qanda.asp.” Was not clear from that why the limit is at women at 1 drink a day but not men… I asked “What exactly is the scientific justification behind these recommendations?” and then they referred me to the USDA, who never got back to me. Interestingly, other countries have different national recommendations, e.g. https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/ “men and women are advised not to drink more than 14 units a week on a regular basis”

[84] https://www.wcrf.org/sites/default/files/alcoholic-drinks.pdf women: page 47, postmenopause breast cancer, page 54 premenopausal breast cancer, both statistically significant increased risk per 10 grams consumed per day. Men: (also see citation 48)

[85] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931310-2 separated men and women, found both had the max benefit at a little under 1 standard drink

[86] http://sci-hub.tw/https://doi.org/10.1016/S0140-6736(18)30134-X didn’t separate men and women for heart benefit, (though it looks like max benefit is reached at about 1 drink a week for both) but stated that “For all-cause mortality... Associations were similar for men and women (appendix p 26)”

[87] https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

[88] https://sci-hub.tw/10.1016/S0140-6736(18)30134-X 

[89] https://sci-hub.tw/10.1001/archinte.166.22.2437 all cause mortality is lowered. They do try to control for “sick quitters” and still find significant effects. Weirdly, effect was much stronger for europeans

[90] https://www.bmj.com/content/342/bmj.d671.long Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)).