I go out on the limb and I'm going to say it there is no amount of alcohol that is healthy um the J curve is a misnomer and what I think I would say is somewhere between zero and one there's probably that much there's not that much of an increase in Risk but there's not a reduction in Risk right so the for what for for for for mortality in general mortality yeah yeah yeah so in other words you know they talk about the sort of J curve where complete abstinence is a greater risk than you
know one drink a day uh but but I think both the mandelian randomization makes that not makes it clear that that's not true and then secondly when you look at all the confounders of the people who are drinking zero drinks and what confounds their mortality um I I feel very comfortable saying that there is no dose of alcohol that is healthy but you know at a very low dose again probably four to seven drinks per week it probably has immeasurable um pardon me not immeasurable you probably can't quite quantify the harm um that that would
be my take and and so I I I'm I'm I'm comfortable saying that I I really feel confident that that is the case um and that you know things like the French paradox have far better explanations as one example yeah I I I tend to think I mean there's the data is also a mess like you like I agree with you and um it does seem like like you know like can you have your weekend you know glasses of wine like absolutely I think you can and you know with respect to the cancer risk and
like that's that's considered you know it's mild I mean it's less than you're having less than one drink a day and the only evidence I've really seen against the the mild is on the National Cancer Institute site where they like it's one of those cancers where it's like one in 500 like it it it increases your risk of a cancer that you already have a lifetime risk of one in 500 and it's still less than 1% of an increased like to me it's like point you can't you can't measure you can't you can't measure it
yeah it's a classic example of the dose makes the poison but don't confuse that the poison is a poison right so another example would be cigarettes if you smoked a cigarette twice a week literally one cigarette Twi twice a week would your risk of cancer go up yes but you wouldn't be able to measure it that doesn't change the fact that cigarettes are harmful right to mention heart disease like that that is not a linear like that like yeah yeah yeah no no no I mean I mean it's it's it but even just focusing on
cancer right like it really comes down to kind of establishing causality right is tobacco causally related to disease yes it's it's it's a harmful thing to take but the dose matters right like again just being glib one cigarette a week is it's probably increasing risk but we don't live long enough to see that to see the separation of those Kaplan Meyer curves right maybe if we lived maybe if our natural lifespan was 500 one cigarette a week would be sufficient to see a spreading of those lines but at an 80e lifespan eh you have to
get up to 10 cigarettes a day before we can see where that is by the way I'm making that up I'm not advocating that one can smoke up to nine cigarettes a day but you know what I'm getting at right and I think that's my point with with alcohol it's it's it's simply just a question of of that but but I just want to make sure people aren't taking away from this that you know look I probably have anywhere from to four drinks a week but when I'm drinking those four drinks across two or three
days it's not going through my mind that this is healthy it's like yeah this is a honic pleasure that's not good for me but it's enjoyable it's enjoy what how do you feel about apil we4 carriers and alcohol consumption like our our view in the practice is that they are indeed more susceptible um to the dous effects of alcohol um and also I would say they're just more susceptible in general to the D delerious effects of poor sleep which is one of the ways that I think alcohol is disproportionately hurting the brain um you know
I think poor sleep is is causally driving Alzheimer's risk and cardiovascular disease risk I'm less clear on cancer but in as much as most people that are drinking alcohol are doing so in the evening and anybody who's used a sleep tracker you know you don't need to be Matt Walker to to very quickly do the experiment on yourself and compare a night of sleep with no alcohol a night of sleep with alcohol they're different um yeah and and so so through that lens I would just say you know we have we have lots of patients
with E4 in our practice including a number of E4 e4s we dispop you know even though those patients represent only 2% of the population they're probably about seven or eight% of our patient population and um again we say look unless this really means the world to you it's probably not worth a drink um and if you are going to have a drink here are some principles for how you might minimize the damage right in terms of the number you might have how long you might have it before bed that kind of thing [Music]
