DOCTORS / scientists how bad is alcohol?

[RalphyWard]

Really interested in the opinions of doctors / health scientists on this! I stumbled across a study saying for women one bottle of wine equals 10 cigarettes (will link study at end). I didn’t really like this study as I don’t think it’s great to compare one thing to another. You could do it for anything . E.g. living in a polluted area / eating a cheeseburger / never walking places = X amount of cigarettes.

It’s a catchy title but IMO they could have just said it affects cancer risk by X percent. Also what about individual risk (some people more likely to cancers than others due to genetics / diet / where they live ), and type of alcohol? I’ve read for instance wine is good for you in sensible amounts.

I’m quite mindful of my drinking as I’m a biologist working in the area of evaluating products for human health risks, so cancer and disease is forefront on my mind, plus there are some alcoholics in my family. I have a bottle of wine spread over the weekend so was horrified at the title. 🤣

I think the title is misleading and whilst alcohol can be bad there are some benefits and also genetics and lifestyle influence a lot so it’s swings and a roundabouts.

Interested to hear your thoughts.

Study: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6576-9

IMO they could have just said it affects cancer risk by X percent.

They could, but it would meaningless to the majority of people.
The dangers of smoking, and smoking related cancers, have been aware to people for decades now so that is something people do understand. By comparing the two, there may be a chance of getting more people to understand the risks.
Not a Dr but I do health checks. I’ve seen people who drink 50/60/70 units of alcohol per week. They think they are healthy because they go to the gym twice a week. Even when I try to explain the increased risks, not only of cancer but hypertension/CVD, they still say ‘I’m fine, I wouldn’t be able to exercise if there was anything wrong with me’.

@MadAboutIt thank you for your response. I completely understand what you’re saying.

Based on your experience is it ok for health if people stick to the NHS recommended units per week, or better to hardly drink at all / not drink at all?

My job is to evaluate medical evidence.

Very Short answer: Meh.

Long answer: I don't have any problem accepting that any alcohol intake is more harmful than not. I'm pretty skeptical about supposed benefits, btw, although it's nice as a social lubricant or (my case) to make me relax and gain perspective.

It's a modelling study, they have to make a lot of assumptions, attributable risk fractions is fairly fiddley to calculate. But even if the equivalence calculation is valid (I'm not saying either way, I'm done PARs & PAFs but am not an expert)

10 cigarettes is actually not that bad for you... and keep in mind the time denominator. Most smokers are having 10-20/day but no "moderate" drinker persistently has a 750ml bottle a day. Authors talk a lot in that article about the different types of cancer that can be linked to cigs/booze. That matters because you can do a lot to reduce risk of developing the cancer they most linked to alcohol (breast cancer). Are you already doing all those things? They also note that survival rates for (say) breast cancer are much better than survival after diagnosed lung cancer, in other words, they are only predicting cancer incidence not cig/booze-linked mortality/net harms. "Cancer deaths are a fraction of the total number of deaths associated with smoking and alcohol and this study is not a comparison of the overall mortality of smoking versus alcohol."

"We must first be absolutely clear that this study is not saying that drinking alcohol in moderation is in any way equivalent to smoking." is the author's own statement.

Alcohol has been consumed since the delights of wine were discovered. Amphorae of wines were consumed to excess by the Greeks and they revered Dionysus, same for Bacchus by the Romans - the enjoyment of alcohol has continued to this day.

Air pollution is a bigger threat to our health now.

Of course it's better not to drink it than to drink it in any capacity. If you want to be sure that it's not affecting you, don't drink it.

It's up to you to read the information and do a basic risk assessment based on your own circumstances.

The message when you've had a small stage one breast cancer is diet is non consequential; alcohol is.

I don't drink much anyway though so it's not a big issue for me. If I do I'll savour a tiny good red wine.

Alcohol is ethanol. You only have to look at what ethanol can be used for to realise that it’s not good to drink.

Huberman lab has an excellent podcast on alcohol. It's episode 86. He goes through all the research and talks about a number of issues including cancer. It's not preachy or with an agenda, he chooses different topics each week and goes through all the research and data etc and puts into context.

Listen and decide what you think but I've barely drunk since I listened to it three months ago and I used to enjoy a drink, so that gives you an idea!

And many, many years ago people drank alcohol because it was safer than drinking the water. It doesn’t mean that alcohol is safe.

If I do I'll savour a tiny good red wine.

In an egg cup 😂 I kid you not!

Alcohol is a toxin so will always cause some.degree of damage. Red wines also contain polyphenol which are are also linked with some health benefits (it should be noted that cigarettes contain nothing beneficial). These polyphenol can also be gained from an abundance of other foods without the health risks. Alcohol is also linked with conditions such as hypertension and some cancers.
On the other hand, a glass or two of wine every now and again offers a relaxing and enjoyable moment in the day and is often accompanied by social interaction which has massive health benefits (these social benefits can also be obtained via other means).
Overall, as a I approach middle age I am.extremely cautious about not overdoing my alcohol intake. I'll enjoy a couple of glasses of wine a week...more on holiday. This seems balanced. At the moment for me personally, my excess weight is of greater concern for my liver and other conditions.

Since my cancer diagnosis I found Liz O Riordan, tbe breast surgeon who's now sadly got a third reoccurrence.

We are a similar age and I knew loads of medics at uni. The amount of drinking gen x did was horrific. She has reflected a lot on how very much of a fish she was with alchohol. Nothing can be done now but I do think making that message clearer is helpful.

I did drink but could never keep up with everyone else. I've barely been drunk in the last decade due to kids not allowing it. I don't seem to have a good tolerance at all for it. In a way it's nice to have an excuse as peer pressure has always been in the background!

The ease of accessing alcohol when I was in my 20s was ridiculous (10 p shots Ffs) and I do worry many of my peers will find themselves in similar situations.

Don't get me wrong, I love sharing bottles of Prosecco and g and ts with friends. That's social though. At the same time I can enjoy their company without. I only actually appreciate a really nice red wine taste wise. I know some who don't seem to be able to do company without alchohol, including DH, which concerns me.

*obviously Liz's drinking didn't necessarily lead to cancer but the evidence is that it increases risk .

Cancer can be genetic or sheer fucking bad luck.

Actually, I personally am more concerned about my bone density than cancer; alcohol doesn't help that either and for me maintaining that is important, though I could have done more about it in recent years.

That could be a more reasonable common concern for women tbh. Because we can't spend our lives worrying about getting cancer. And if we do unfortunately get a diagnosis, bone density is really important there.

Apologies for going quiet, busy weekend.

Thank you for all your replies, some really interesting food for thought. I had heard of the Huberman lab episode, I’ll have to listen. Very interesting about Gen X - I am a millennial.

I’ve never been huge drinker bar a couple of years in my teens and a year or two in my 20s (partying and fun times). I can have a good time without a drink. I get migraines which were triggered by even a glass of alcohol.

Recently my migraines have improved and alcohol doesn’t trigger them all the time so I’ve been enjoying a bottle of wine over the weekend as I love red wine. I don’t want to go silly with it though as I don’t want to undo years of good work. After reading these responses perhaps I’ll go down to once a month or something.

I often wonder if any research/sampling has been undertaken on the populations of countries where alcohol is banned. Say Saudi for example and there are many others. Do their populations have a far lower occurrence of cancer (and other illnesses) than those that have few restrictions?

Such a mega-challenge trying to compare.
For instance kingdom of SA, they may have a female obesity prevalence of ... 69%. Yes really. Move aside Mexico, there's a fatter country than you. I just picked on obesity because it's a risk factor for breast cancer. And so is whether someone breastfed their children; I bet breastfeeding rates are higher in Saudi than in many 'western' countries.

Meantime, anyway, age-adjusted breast cancer incidence in KSA seems to be 22.7/100k persons. European countries have age standardised rates of 85-205. So the European rate seems emphatically much much higher, but other factors (like breastfeeding rates, genetics, family size, smoking history, age when 1st give birth, use of hormonal contraception or HRT, could be part of picture).

@MedSchoolRat Oh thank you very much for all that + the link. It's interesting isn't it?

I also wonder about males and cancer in alcohol free societies. Their cancer incidence must surely be lower if the hypothesis is that alcohol is a significant risk factor. I know they can get BC also, but presumably without the female hormone risk factors.

I don't know much about statistics and research I'll be honest, it is just something I have wondered about.

I avoided hormonal contraception and bf for 7.5 years. Breast cancer at 46. I did take hrt but only for a year, so I was probably going to get it at some point later on. I am on thyroxine for hypothyroidism though and have been more than half my life. I think there are some increased links there, either the disease from a genetic pov, the actual disease or the issues with managing it (I've found it harder to get the right dose with fluctuating hormones after pregnancy and during peri etc.)

Statistics can only give over arching trends. There's an interesting radio 4 program at the moment on cancer (looking at it as a disease in all animals, barely anything in naked mole rats but lots in mice) and they simply don't really know why it happens and often just seems bad luck.

I've also never been over weight and sometimes have to actively eat more! It's a fucker!