9 ms·

> Nearly every patient in the developed world is aware that all three of these are bad Smoking, yes, we seem to have broad support for that one (way beyond wha

> Nearly every patient in the developed world is aware that all three of these are bad Smoking, yes, we seem to have broad support for that one (way beyond what the facts support, even, but that's probably for the best). But the other two? I don't think so. There's a lot of confusion out there about alcohol use. Most people still think small amounts are basically fine (maybe even good!), even though more recent studies [0] suggest that isn't true. And we're trending the wrong way on obesity, too. [1] [0] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... [1] https://www.scientificamerican.com/article/can-you-be-healthy-at-any-size/ https://www.scientificamerican.com/article/can-you-be-health...

TaupeRanger 4y ago
The article you linked (and in fact , no study exists) to support your claims about small amounts of alcohol. In fact plenty of evidence exists to the contrary.
- dionidium 4y ago
  There's reason to believe those earlier studies used flawed methodologies: > But there was a problem with many of these studies: They compared drinkers to non-drinkers, instead of comparing only lighter drinkers to heavier drinkers. And people who don’t drink are pretty fundamentally different from drinkers in ways that are hard to control for in a study. Their lives probably look dissimilar. > Most importantly, they may be sicker at baseline (perhaps they quit drinking because of alcoholism, or because of a health issue like cancer). And something in these differences — not their avoidance of alcohol — may have caused them to look like they were in poorer health than the moderate drinkers. (This became known as the “sick quitter” problem in the world of alcohol research.) > Lately, researchers have been trying to overcome that problem by comparing lighter drinkers with heavier drinkers. And the benefits of modest amounts of alcohol wash away. And that even moderate amounts of alcohol are harmful: > Their findings were stark: Drinking more than 100 grams of alcohol — about seven standard glasses of wine or beer — per week was associated with an increased in risk of death for all causes, they concluded. In the US, the government suggests men can drink double that amount — up to two drinks per day — but advise women who are not pregnant to drink up to one drink per day. > A person’s risk of death shot up as they drank more. The researchers used a mathematical model to estimate that people who consumed between seven and 14 drinks per week had a lower life expectancy at age 40 of about six months; people who drank between 14 and 24 drinks per week had one to two years shaved off their lives; and people who imbibed more than 24 drinks a week had a lower life expectancy of four to five years. My sort of baseline here is that nobody would think twice about this if they weren't motivated to justify continued consumption. It's fairly obvious that it's bad for you. Source: https://www.vox.com/2018/4/24/17242720/alcohol-health-risks-facts https://www.vox.com/2018/4/24/17242720/alcohol-health-risks-...
  - TaupeRanger 4y ago
    But those weren't problems at all with many such studies. For example, this one showed light drinking reduces risk of leukemia by 10%: https://pubmed.ncbi.nlm.nih.gov/24986108/#:~:text=Compared%20with%20nondrinkers%2C%20the%20relative,day)%20alcohol%20drinking%2C%20respectively https://pubmed.ncbi.nlm.nih.gov/24986108/#:~:text=Compared%2....
    - lupire 4y ago
      Come on > the relative risks (RRs) for all leukemia were > 0.94 0.85-1.03 "any" > 0.90 0.80-1.01 "light" > 0.91 0.81-1.02 "moderate to heavy" There is no signal there.
  - MichaelCollins 4y ago
    > between seven and 14 drinks per week That's already heavy drinking in my book; drinking every day of the week, or binge drinking at least once every week? Somebody drinking that much already has a clear habit and is probably developing an alcohol tolerance, a major step towards alcoholism. To me, a light drinker is somebody who has a drink on special occasions but not otherwise. One drink a week or less, so they're going several days if not weeks between drinking. I suspect the long-term harm from that is next to immeasurable.
- jnovek 4y ago
  “The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.” Seems pretty clear. It’s likely that the risk of,(e.g.) one drink per month is also very low. What’s not here is the inflection point where alcohol consumption goes from a (subjective) minimal risk to an elevated risk.
  - dionidium 4y ago
    I would just note here that the CDC is unequivocal on this point with respect to cigarettes, saying always that there is "no safe level of consumption." I think that sort of language is basically absurd, but the message it sends is crystal clear: this thing is bad for you, even in small amounts, and you're doing harm when you use it. I think the CDC could easily settle on the same language with respect to alcohol, if there weren't socio-cultural reasons not to. Another aspect of this is that we discourage even light cigarette use because of the fear that users might become addicted and escalate their usage. [0] It's interesting how rarely you hear that kind of an argument against drinking alcohol, and yet, unlike with smoking, increased usage can actually be ruinous. On the day you take your first sip of alcohol you're accepting a 1 in x risk that you'll end up a problem drinker (where x is anywhere from 3 or 4 to 20, depending on what definition of "problem drinker" you're willing to accept). [0] I remember many years ago when I was a very light smoker trying to find statistics online about moderate cigarette use and it was basically impossible, because every single statement about cigarettes was of the form, "you won't be able to only smoke a little, so don't even bother trying."
    - sarchertech 4y ago
      I know plenty of people who have 1 drink a day, I know absolutely no one who smokes 1 cigarette per day. I’m sure they exist, but not in my n of several hundred, so I’d bet that’s it’s pretty rare. Smoking is also much more obnoxious and directly harms anyone near. This is a first order effect, not a 2nd order effect like increased risk of car accidents.
      - dionidium 4y ago
Scoundreller 4y ago
> Most people still think small amounts are basically fine (maybe even good!) Legalize safer alternatives now!
- deleted 4y ago
  [deleted]
Izkata 4y ago
> But the other two? I don't think so. IIRC the argument about obesity is simply more cells = more chances for something to go wrong that turns into cancer.
- makeitdouble 4y ago
  That argument would go against growing muscle and getting taller in general. It might be true, but real world impact of that higher probability of some cancer seem to be negligeable.
- oaktrout 4y ago
  Obesity also contributes to inflammation,fat cells release pro-inflammatory adipokines.
- copperx 4y ago
  Does cancer ever start in adipose tissue?
  - pessimizer 4y ago
    Yes, but fat people also have more muscle and skin.
- lupire 4y ago
  Also, more food => morr oxidation => more damage.
mattmaroon 4y ago
It's practically impossible to to do a controlled study on any of these, so we'll likely never know for sure. If you were tasked with creating a study to determine, for any reasonable definition of "certainty", whether small amounts of alcohol increase or decrease one's lifespan, you'd never be able to come up with anything that passed any sort of moral or practical sniff test. So what you are left with is trying to tease causation out of relatively loose correlation, which is and always will be so problematic as to be near useless. The results will always just support the researchers' pre-conceived notions. Smoking is only so obvious because the rates of lung cancer there are an order of magnitude more. 80-90% of lung cancer is in smokers, while only 12% of Americans smoke. No other health issue is so clear, people who are moderate drinkers only have very slightly elevated risks of almost everything, so it could be confounded.
- Cthulhu_ 4y ago
  Drinking is the kind of thing where non-obvious long-term effects can only really be determined if any other cause of issues is ruled out. It doesn't seem to have a measurable effect on maximum lifespan (assuming it's not alcoholism), so I'd rate it rather low in the list of priorities.
dijonman2 4y ago
Alcohol is enjoyable and I prioritize happiness and satisfaction. I’ll gladly trade in some risk for a delicious beverage and a buzz every once in awhile.
- gambiting 4y ago
  Smoking is also enjoyable and gives people happiness and satisfaction. That isn't the point. The point is that cancers caused by drinking/smoking/being obese are preventable by behavioural changes.
  - deleted 4y ago
    [deleted]
  - pantalaimon 4y ago
    Smoking has a pretty bad risk/reward ratio. It’s better with alcohol and that is already not an ideal drug in that regard
    - Handytinge 4y ago
      Does it, in the same quantities? Is one cigarette a day better or worse for you that one standard drink?
  - mr_toad 4y ago
    I’ve seen estimates of the increased risk of cancer from drinking at about 10%. But it’s really hard to find actual estimates, most web searches just turn up the same ‘all drinking is bad’ message. I suspect the effect is small enough to be difficult to quantify. Whereas some research puts the risk increase for getting lung cancer from heavy smoking at 2000%, or more. Twenty times the rate of non-smokers.
pessimizer 4y ago
> And we're trending the wrong way on obesity, too. It's absolutely creepy how there's a constituency of people who are upset by any scientific possibility that fat people could be relatively healthy, or be made relatively healthy, without losing weight. The desire for fat people to conform or be punished, damn the science, is fetishistic. That's the only motivation I can think of for being upset by the exploration of the precise effects that being fat has on health. I'm nowhere near fat right now, but if there were an injection that saved fat people from insulin resistance and inflammation, the farthest thing from my mind would be to get upset about it. If you believe that gluttony is a mortal sin, no need to be upset if the only ways fat people are punished on earth are cardiovascularly, through their knees, and through the aggression of bullies; your deity can punish them after death for not eating as moderately as you would have preferred.
- ravenstine 4y ago
  I don't necessarily disagree, because yeah, having lots of adipose tissue doesn't necessarily mean anything is wrong at the moment. In my experience, the perpetually healthy fat person is a rarity. The possibility of being fat and otherwise healthy is used as an excuse the vast majority of the time to not actually address one's own health. If someone is fat, it would really be a good idea to get a DEXA scan to confirm that they don't have too much visceral fat. As any one who's pro-fat or body positive if they know what their level of visceral fat is and chances are they couldn't tell you what visceral fat is. There should be a reasonable medium where fat people aren't outright shamed for being towards one end of the bell curve but red flags for unhealth aren't ignored for the sake of other's feelings. America and now many parts of the west are facing various health crises to such an extent that I don't think obesity should be brushed off as perhipheral to other problems. Being fat has many comorbidities, and just focusing on losing fat is usually the best way to address those issues. > I'm nowhere near fat right now, but if there were an injection that saved fat people from insulin resistance and inflammation, the farthest thing from my mind would be to get upset about it. I agree, and there kinda sorta are medications currently available that would tremendously help. Off the top of my head, I don't know what it's called, but I know some people who've been on next-generation medications for obesity that target the ghrelin-leptin balance, basically correcting one's sense of hunger and satiety. Having seen the results myself, it works insanely well. On the other hand, solving obesity with a pill still has some moral issues. If everyone could just consume anything they want in massive amounts and not get fat, I don't think that's really good for a person's psychology in a similar sense that giving someone a bunch of money often doesn't end well. It's not a scientific argument, but a philosophical one; I know. Such drugs may also give someone the idea that they can just eat whatever they want because they don't gain weight, but just because you don't get fat doesn't mean there aren't other consequences to eating lots of sugar, carbs, odixated oils, etc. The question should be why we are so fat now. But that would mean believing that experts can be compromised and that a century of nutrition policy has been a failure, which many people aren't ready for. Just my opinion.

TaupeRanger 4y ago

The article you linked (and in fact , no study exists) to support your claims about small amounts of alcohol. In fact plenty of evidence exists to the contrary.

dionidium 4y ago
There's reason to believe those earlier studies used flawed methodologies: > But there was a problem with many of these studies: They compared drinkers to non-drinkers, instead of comparing only lighter drinkers to heavier drinkers. And people who don’t drink are pretty fundamentally different from drinkers in ways that are hard to control for in a study. Their lives probably look dissimilar. > Most importantly, they may be sicker at baseline (perhaps they quit drinking because of alcoholism, or because of a health issue like cancer). And something in these differences — not their avoidance of alcohol — may have caused them to look like they were in poorer health than the moderate drinkers. (This became known as the “sick quitter” problem in the world of alcohol research.) > Lately, researchers have been trying to overcome that problem by comparing lighter drinkers with heavier drinkers. And the benefits of modest amounts of alcohol wash away. And that even moderate amounts of alcohol are harmful: > Their findings were stark: Drinking more than 100 grams of alcohol — about seven standard glasses of wine or beer — per week was associated with an increased in risk of death for all causes, they concluded. In the US, the government suggests men can drink double that amount — up to two drinks per day — but advise women who are not pregnant to drink up to one drink per day. > A person’s risk of death shot up as they drank more. The researchers used a mathematical model to estimate that people who consumed between seven and 14 drinks per week had a lower life expectancy at age 40 of about six months; people who drank between 14 and 24 drinks per week had one to two years shaved off their lives; and people who imbibed more than 24 drinks a week had a lower life expectancy of four to five years. My sort of baseline here is that nobody would think twice about this if they weren't motivated to justify continued consumption. It's fairly obvious that it's bad for you. Source: https://www.vox.com/2018/4/24/17242720/alcohol-health-risks-facts https://www.vox.com/2018/4/24/17242720/alcohol-health-risks-...
- TaupeRanger 4y ago
  But those weren't problems at all with many such studies. For example, this one showed light drinking reduces risk of leukemia by 10%: https://pubmed.ncbi.nlm.nih.gov/24986108/#:~:text=Compared%20with%20nondrinkers%2C%20the%20relative,day)%20alcohol%20drinking%2C%20respectively https://pubmed.ncbi.nlm.nih.gov/24986108/#:~:text=Compared%2....
  - lupire 4y ago
    Come on > the relative risks (RRs) for all leukemia were > 0.94 0.85-1.03 "any" > 0.90 0.80-1.01 "light" > 0.91 0.81-1.02 "moderate to heavy" There is no signal there.
- MichaelCollins 4y ago
  > between seven and 14 drinks per week That's already heavy drinking in my book; drinking every day of the week, or binge drinking at least once every week? Somebody drinking that much already has a clear habit and is probably developing an alcohol tolerance, a major step towards alcoholism. To me, a light drinker is somebody who has a drink on special occasions but not otherwise. One drink a week or less, so they're going several days if not weeks between drinking. I suspect the long-term harm from that is next to immeasurable.
jnovek 4y ago
“The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.” Seems pretty clear. It’s likely that the risk of,(e.g.) one drink per month is also very low. What’s not here is the inflection point where alcohol consumption goes from a (subjective) minimal risk to an elevated risk.
- dionidium 4y ago
  I would just note here that the CDC is unequivocal on this point with respect to cigarettes, saying always that there is "no safe level of consumption." I think that sort of language is basically absurd, but the message it sends is crystal clear: this thing is bad for you, even in small amounts, and you're doing harm when you use it. I think the CDC could easily settle on the same language with respect to alcohol, if there weren't socio-cultural reasons not to. Another aspect of this is that we discourage even light cigarette use because of the fear that users might become addicted and escalate their usage. [0] It's interesting how rarely you hear that kind of an argument against drinking alcohol, and yet, unlike with smoking, increased usage can actually be ruinous. On the day you take your first sip of alcohol you're accepting a 1 in x risk that you'll end up a problem drinker (where x is anywhere from 3 or 4 to 20, depending on what definition of "problem drinker" you're willing to accept). [0] I remember many years ago when I was a very light smoker trying to find statistics online about moderate cigarette use and it was basically impossible, because every single statement about cigarettes was of the form, "you won't be able to only smoke a little, so don't even bother trying."
  - sarchertech 4y ago
    I know plenty of people who have 1 drink a day, I know absolutely no one who smokes 1 cigarette per day. I’m sure they exist, but not in my n of several hundred, so I’d bet that’s it’s pretty rare. Smoking is also much more obnoxious and directly harms anyone near. This is a first order effect, not a 2nd order effect like increased risk of car accidents.
    - dionidium 4y ago

Scoundreller 4y ago

> Most people still think small amounts are basically fine (maybe even good!) Legalize safer alternatives now!

deleted 4y ago
[deleted]

Izkata 4y ago

> But the other two? I don't think so. IIRC the argument about obesity is simply more cells = more chances for something to go wrong that turns into cancer.

makeitdouble 4y ago
That argument would go against growing muscle and getting taller in general. It might be true, but real world impact of that higher probability of some cancer seem to be negligeable.
oaktrout 4y ago
Obesity also contributes to inflammation,fat cells release pro-inflammatory adipokines.
copperx 4y ago
Does cancer ever start in adipose tissue?
- pessimizer 4y ago
  Yes, but fat people also have more muscle and skin.
lupire 4y ago
Also, more food => morr oxidation => more damage.

mattmaroon 4y ago

It's practically impossible to to do a controlled study on any of these, so we'll likely never know for sure. If you were tasked with creating a study to determine, for any reasonable definition of "certainty", whether small amounts of alcohol increase or decrease one's lifespan, you'd never be able to come up with anything that passed any sort of moral or practical sniff test. So what you are left with is trying to tease causation out of relatively loose correlation, which is and always will be so problematic as to be near useless. The results will always just support the researchers' pre-conceived notions. Smoking is only so obvious because the rates of lung cancer there are an order of magnitude more. 80-90% of lung cancer is in smokers, while only 12% of Americans smoke. No other health issue is so clear, people who are moderate drinkers only have very slightly elevated risks of almost everything, so it could be confounded.

Cthulhu_ 4y ago
Drinking is the kind of thing where non-obvious long-term effects can only really be determined if any other cause of issues is ruled out. It doesn't seem to have a measurable effect on maximum lifespan (assuming it's not alcoholism), so I'd rate it rather low in the list of priorities.

dijonman2 4y ago

Alcohol is enjoyable and I prioritize happiness and satisfaction. I’ll gladly trade in some risk for a delicious beverage and a buzz every once in awhile.

gambiting 4y ago
Smoking is also enjoyable and gives people happiness and satisfaction. That isn't the point. The point is that cancers caused by drinking/smoking/being obese are preventable by behavioural changes.
- deleted 4y ago
  [deleted]
- pantalaimon 4y ago
  Smoking has a pretty bad risk/reward ratio. It’s better with alcohol and that is already not an ideal drug in that regard
  - Handytinge 4y ago
    Does it, in the same quantities? Is one cigarette a day better or worse for you that one standard drink?
- mr_toad 4y ago
  I’ve seen estimates of the increased risk of cancer from drinking at about 10%. But it’s really hard to find actual estimates, most web searches just turn up the same ‘all drinking is bad’ message. I suspect the effect is small enough to be difficult to quantify. Whereas some research puts the risk increase for getting lung cancer from heavy smoking at 2000%, or more. Twenty times the rate of non-smokers.

pessimizer 4y ago

> And we're trending the wrong way on obesity, too. It's absolutely creepy how there's a constituency of people who are upset by any scientific possibility that fat people could be relatively healthy, or be made relatively healthy, without losing weight. The desire for fat people to conform or be punished, damn the science, is fetishistic. That's the only motivation I can think of for being upset by the exploration of the precise effects that being fat has on health. I'm nowhere near fat right now, but if there were an injection that saved fat people from insulin resistance and inflammation, the farthest thing from my mind would be to get upset about it. If you believe that gluttony is a mortal sin, no need to be upset if the only ways fat people are punished on earth are cardiovascularly, through their knees, and through the aggression of bullies; your deity can punish them after death for not eating as moderately as you would have preferred.

ravenstine 4y ago
I don't necessarily disagree, because yeah, having lots of adipose tissue doesn't necessarily mean anything is wrong at the moment. In my experience, the perpetually healthy fat person is a rarity. The possibility of being fat and otherwise healthy is used as an excuse the vast majority of the time to not actually address one's own health. If someone is fat, it would really be a good idea to get a DEXA scan to confirm that they don't have too much visceral fat. As any one who's pro-fat or body positive if they know what their level of visceral fat is and chances are they couldn't tell you what visceral fat is. There should be a reasonable medium where fat people aren't outright shamed for being towards one end of the bell curve but red flags for unhealth aren't ignored for the sake of other's feelings. America and now many parts of the west are facing various health crises to such an extent that I don't think obesity should be brushed off as perhipheral to other problems. Being fat has many comorbidities, and just focusing on losing fat is usually the best way to address those issues. > I'm nowhere near fat right now, but if there were an injection that saved fat people from insulin resistance and inflammation, the farthest thing from my mind would be to get upset about it. I agree, and there kinda sorta are medications currently available that would tremendously help. Off the top of my head, I don't know what it's called, but I know some people who've been on next-generation medications for obesity that target the ghrelin-leptin balance, basically correcting one's sense of hunger and satiety. Having seen the results myself, it works insanely well. On the other hand, solving obesity with a pill still has some moral issues. If everyone could just consume anything they want in massive amounts and not get fat, I don't think that's really good for a person's psychology in a similar sense that giving someone a bunch of money often doesn't end well. It's not a scientific argument, but a philosophical one; I know. Such drugs may also give someone the idea that they can just eat whatever they want because they don't gain weight, but just because you don't get fat doesn't mean there aren't other consequences to eating lots of sugar, carbs, odixated oils, etc. The question should be why we are so fat now. But that would mean believing that experts can be compromised and that a century of nutrition policy has been a failure, which many people aren't ready for. Just my opinion.