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Is moderate drinking really good for you?


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Answer: apparently not, because of methodological bias in most of the studies. The few studies not biased don't show the supposed beneficial J-curve of modest alcohol consumption.


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Is wine, red or otherwise, an exception? The study above does not address that question, but the odds against a wine benefit seem longer than they were before.


-Richard Schulman

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Hi Richard!


It's delightful seeing you posting to the Forums!


I currently drink about 3oz of red wine twice weekly -- once on Friday night, once on Saturday afternoon,

probably too little to be significant.


I began my modest drinking after seeing the evidence posted on the old CR List.


I hope to see you at CR IX!




-- Saul

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This isn't really news: there's never been any good evidence that total alcohol consumption at any level reduces total mortality at any dose. Rather, there is good evidence that low-dose wine intake (≤1 5 oz glass/day) does so, particularly if consumed at meals and in a regular pattern. And even for other outcomes and total alcohol, there are important distinctions to be drawn about both the nature of "abstention" and the pattern of drinking.


The authors' definitions are also a bit problematic, as they defined "a drink" as 10 g alcohol instead of ~14 g, and included everyone who drank anywhere from 1 such "drink" per week up to an average of two drinks per day as a light drinker; the low end seems to me to embrace people who are de facto abstainers in their "moderate drinking" category.


On the author's main point (disaggregating the abstainers): even just for coronary events, (1) finds that "After multivariate adjustment for classic cardiovascular risk factors and centre, the hazard ratio for hard coronary events [incident heart attack and coronary death] compared with regular drinkers was 1.97 (95% CI 1.21 to 3.22) for binge drinkers, 2.03 (95% CI 1.41 to 2.94) for never drinkers, and 1.57 (95% CI 1.11 to 2.21) for former drinkers for the entire cohort. The hazard ratio for hard coronary events in Belfast compared with in France was 1.76 (95% CI 1.37 to 2.67) before adjustment, and 1.09 (95% CI 0.79 to 1.50) after adjustment for alcohol patterns and wine drinking. Only wine drinking was associated with a lower risk of hard coronary events, irrespective of the country." Adjustment for CVD risk factors does tend to play down the benefits of alcohol consumption, as alcohol consumption increases HDL (which ought to be good for CVD, though recent years have substantially "problematized" simply reading HDL-C or particle number as it doesn't take into account HDL functionality) and seems to paradoxically lower the long-term risks of hypertension.


One partial exception is (2), which is unusual for being both "on the older side" for the study population and very long-term (20 years). It finds that "Controlling only for age and gender, compared to moderate drinkers [1-3 drinks/d (14 g to <42 g alcohol ⁄ d)], abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers [≤1 drink (0-13 g alcohol) ⁄ d] had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers."



1: Ruidavets JB, Ducimetière P, Evans A, Montaye M, Haas B, Bingham A, Yarnell J, Amouyel P, Arveiler D, Kee F, Bongard V, Ferrières J. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). BMJ. 2010 Nov 23;341:c6077. doi: 10.1136/bmj.c6077. PubMed PMID: 21098615; PubMed Central PMCID: PMC2990863.


2: Holahan CJ, Schutte KK, Brennan PL, Holahan CK, Moos BS, Moos RH. Late-life alcohol consumption and 20-year mortality. Alcohol Clin Exp Res. 2010 Nov;34(11):1961-71. doi: 10.1111/j.1530-0277.2010.01286.x. Epub 2010 Aug 24. PubMed PMID: 20735372.

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Sounds like a contradiction. You say there is no good evidence that

booze reduces mortality risk. But at the end of your post the study you cite says the opposite. Did I misread?


You seem to have missed the opening phrase: "One partial exception is (2) ..."

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