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Alcohol and your health: Is none better than a little?

September 20, 2018

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio
View all posts by Robert H. Shmerling, MD


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November 15, 2018

How does one have .09 drink a day? Is that wine or brandy, scotch or vodka?

Stephen C Row
October 10, 2018

Robert – You know me as you lived right above me in Winthrop. You also know me as a member of the championship crew (1974) and two-time Olympic camp draftee. What you don’t know is I lived through a horrific childhood with an alcoholic mother who was emotionally and physically abusive to all of us. My sisters probably had the worse end, and both died in the past ten years from complications resulting from alcohol use, abuse and pills. My mom died from alcoholism 33 years ago. My childhood was one long saga of DT’s, hallucinations, convulsions, being driven around in the back seat of a car while mom went bar hopping with a drinking buddy. I never talked about this at Harvard and to be quite honest, had a few good years when my mother was in recovery, albeit shaky and littered with serious relapses. She was tremendously supportive of my Harvard education and though I wanted to go to Stanford, where I was also accepted. she encouraged me to go to Harvard and row on the crew team. I stopped drinking 33 years ago and believe I have the “gene” for alcohol addiction. I don’t drink at all and despite the possible health benefits of an occasional glass of red wine. have no desire to experiment. I watched one Christmas as mom drank a glass of red wine and said she could drink like the rest of us. The result was a horrific Christmas which ended with my brother and dad taking her to detox. I spent Xmas eve at a friends and came home to a house filled with shattered glass, the Christmas tree in the front yard, and a family in shock.

Robert Shmerling
September 26, 2018

I agree with the comments/replies here – yes, “association is not causation” – that’s a valid concern but to get a more definitive answer, you’d need a long-term, controlled trial with a large number of people randomized to different amounts of alcohol intake while keeping as many other variables as possible constant – that’s not a trial happening anytime soon! And, as mentioned, many of the outcomes (drunk-driving deaths) are likely causal.

As for confounders, no, they did not control for diet, exercise and a myriad of other potentially relevant factors. It’s certainly possible that some of the findings are tainted by confounding (e.g., the heaviest drinkers probably smoke more) but the size of the study and the magnitude of the “dose effect” between alcohol and health outcomes argues that alcohol consumption matters.

Manuel Pena
September 25, 2018

I think Dr. Shmerling’s article is quite sensible, particularly his view that when it comes to alcohol, there probably isn’t a “one-size-fits- all” conclusion. I particularly wonder whether the large studies took into account possible confounders that might enter into the good-bad discussion. For example, in determining death rates among drinkers and teetotalers, did the researchers take regular exercise into account? Diet? Sleep patterns? Differences in individuals’ stress levels? It seems to me that we cannot isolate alcohol consumption from all of these other variables in determining what’s healthful and what’s harmful.

Ian Graham
September 25, 2018

@AlanLeger – could it be that the majority of teetotalers do not drink for religious reasons? and are likely to be no more or less health-conscious than the rest of the population?
Statistics by association are questionable, but there is nothing to suggest these are simply statistics by association – the links between alcohol and deaths in these studies are causative. The outcomes and findings of well designed studies are more likely to be valid than not; and alternative explanations of the outcomes based on no evidence at all are very much less credible.

Alain Leger
September 24, 2018

Could it be that complete teetotallers are likely to be more health
conscious than other people, and therefore more likely to outlive even moderate drinkers ?
Statistics by association are always questionable

AF Leger
September 24, 2018

Could it be that complete teetotallers are likely to be more health
conscious than other people, and therefore more likely to outlive even moderate drinkers ?
Statistics by association are always questionable

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