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Aug 16 2013

Should I start drinking?

I don’t drink alcohol. There are several reasons for it. One is that I just never developed the taste for it and find it unpleasant. Another is that Sri Lanka has a real drinking problem with many people drinking far too much too often and I had considerable first-hand awareness of the negative effects on them and their families and careers, which turned me off at an early age. The third is that on the solitary occasion where I had several drinks, I noticed that I was losing control of what I said and did, and it was not a pleasant feeling. As a result, I only drink wine on very rare occasions when offering a toast or something and have a beer once or twice a year at events where there is no alternative.

But recently there has been a lot of media chatter about the health benefits of moderate drinking, with studies suggesting that abstemious people have higher mortality rates than light drinkers, making me wonder if I should start to drink more.

But a new paper that was published online in the June 2013 issue of Population Research and Policy Review (vol.32: p. 325–352) by Richard G. Rogers, Patrick M. Krueger, Richard Miech, Elizabeth M. Lawrence, and Robert Kemp suggests that it is not that simple and that heterogeneity among nondrinkers plays an important role because mortality rates may also depend on the reasons for not drinking. Their data came from the 1988–2006 National Health Interview Survey Linked Mortality File (N=41,076) of individuals age 21 and above. (The paper is by subscription only but you can read an article based on it here.)

As the authors say in their paper (citations removed):

Alcohol consumption has a well-documented U-shaped relationship with mortality. The risk of death is lowest among light-to-moderate drinkers, slightly higher among abstainers and former drinkers, and much higher among heavy drinkers. Several studies find that the lowest mortality risk occurs among current drinkers who consume on average one drink or less per day. This U-shaped relationship suggests a perplexing question: why do nondrinkers have higher risks of death than light or moderate drinkers? If their elevated mortality results solely from not drinking, then public health policies and clinical guidelines could acknowledge the disadvantages of nondrinking and perhaps even recommend that nondrinkers begin drinking in moderation (in addition to suggesting that heavy drinkers curtail their excesses).

So should nondrinkers like me start drinking? Not so fast, they say. After their statistical analysis, they arrive at the following conclusions.

The commonly reported U-shaped relationship between alcohol consumption and mortality is an oversimplification.

Among abstainers and light drinkers the risk of mortality is the same as light drinkers for a subgroup who report that they do not drink because of their family upbringing, and moral/religious reasons. In contrast, the risk of mortality is higher than light drinkers for former drinkers who cite health problems or who report problematic drinking behaviors.

The heterogeneous mortality experiences among nondrinkers also accounts for the elevated risks of death for former drinkers who quit drinking for health reasons, because they have family members who have problematic drinking behaviors, or because they are problem drinkers. Thus, the nondrinkers who have the highest risks of death relative to light drinkers might have even higher risks of death if they resumed their drinking.

Relatively low levels of education and income also partially explain the elevated mortality among nondrinkers. [I thought it interesting that drinking increases with income and education, something that went counter to my intuition. - MS]

Our results also demonstrate heterogeneous mortality risks when examining detailed causes of death. Compared to light drinkers, family prosocial lifetime abstainers have similar mortality risk for most of the causes of death we examined but 34 % lower risk from cancer mortality.

Perhaps most important, the oft-touted benefits of light alcohol consumption can easily vanish if consumption levels increase.

In summary, the risk that nondrinkers may miss slight potential benefits of drinking must be offset against the risk that light drinkers may increase their consumption levels and thus their overall and cause-specific mortality. Rose (2008) cautions that prevention strategies should consider both the middle and the extremes of distributions. Our results indicate that social policies aimed at reducing mortality can credibly point to the benefits of abstention. Substantial and diverse evidence demonstrates that many nondrinkers have quite positive mortality prospects, on par with those of light drinkers, if not better.

So it looks like I may not need to start drinking after all. That’s a relief because, as I said, I just don’t like the taste and it would be like taking medicine for me.

27 comments

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  1. 1
    michaeld

    “I thought it interesting that drinking increases with income”

    Not surprising to me at all. I don’t know about where you live but in Canada alcohol is expensive so you can’t drink it if you can’t buy it.

  2. 2
    physicsphdstu

    “I thought it interesting that drinking increases with income”

    I think this depends on the local culture and this data probably pertains to the west. In India for example, it is considered a taboo in the middle class to drink. Drinking is mostly by the extremely rich and the poor.

  3. 3
    Mano Singham

    I thought that it was due to a couple of reasons, the main being that when one is poor one has fewer avenues for relaxation and drinking with one’s peers is one of them. The second is that alcohol can dull the pain of life’s stresses.

    Aren’t cheaper forms of alcohol available in the west? In Sri Lanka the poor drank a form of illegal distilled alcohol known as kasippu that was potent but cheap and made of dubious ingredients that caused damage to people’s bodies. It was a social menace.

  4. 4
    Zain

    Red wine is the only drink I enjoy. It can be interesting to drink a glass and then put on a good album and listen to details you might otherwise not notice in a normal state.

  5. 5
    left0ver1under

    I would be (and am for myself) more concerned about physical fitness, about blood pressure and body fat percentage (re: heart disease, diabetes, et al). Being fit and having a good diet will do far more good (short and long term) than the minimal positive effects that come from alcohol.

  6. 6
    sailor1031

    Aren’t cheaper forms of alcohol available in the west?

    Rarely, given the amount of effort ATF and other police agencies put into eradicating illegal liquor and the general government monopolies on sale of branded beverages.

    If you don’t like it, don’t drink. Theer are other ways to be healthy…..

  7. 7
    invivoMark

    I’m a beer geek and a homebrewer, so I definitely drink. I enjoy it quite a lot. I think drinking beer is a great social activity, and I love the complexity and variety of flavors and aromas beer can have. I could extol the virtues of drinking beer endlessly. That’s why it’s my hobby.

    Of course, moderation is important. For me, that isn’t a problem – I drink constantly, but rarely do I have enough to get drunk (and then, it’s always because I know I’m in a friendly environment, I have a way to get home without driving, etc.). But for some people, it could be a problem, and so I definitely understand if someone refuses to drink. I think that the flavors of beer and other alcohols are varied enough that it shouldn’t be dismissed on grounds of taste alone, and I’ll encourage my non-beer-drinking friends to try various beers if that’s their reason for avoiding it.

    Drinking for health reasons is silly. Alcohol definitely isn’t healthy in most regards (though there are far unhealthier vices).

    The intelligence correlation doesn’t surprise me, though. I’m a graduate student, and most of my friends drink like fish. Having a few drinks at the end of the day is the best way to finish a long day of intellectually-challenging work. I also wonder if there might be a religiosity connection, as well. Religiosity correlates slightly negatively with intelligence, and many religions forbid alcohol (after all, it’s for “moral purity” that the Prohibition ever existed).

  8. 8
    Henry Gale

    I guess that depends on how you define ‘cheap.’

    Trader Joe’s sells Charles Shaw wine which is commonly referred to as ‘two buck Chuck.’ Odd since it costs more than $2 in some areas due to state laws. It’s supposed to be very good.

    http://abcnews.go.com/2020/story?id=124332&page=1

    “After two hours of tasting, and scoring each wine for color, clarity, bouquet and finish, the results were in. When stacked up against the competition — red or white — “Two Buck Chuck” held its own, even inching ahead of the $50 Chardonnay. ”

    If there is no Trader Joe’s around there is always Boone’s Farm. Many a teenage night was spent under the influence of Boonies.

    http://en.wikipedia.org/wiki/Boone%27s_Farm#Wine_brands

    And I’m not sure if they are still sold, but when I was younger I remember seeing older men buying bottles of MD 20/20 and Thunderbird.

    I think all of the above would be considered inexpensive coming in at less than $6 a bottle.

  9. 9
    Rob Grigjanis

    Balance in all things, including moderation. At least three intense cardio workouts per week, (sort of) balanced diet, getting slightly pissed no more than twice a week, and smoking no more than 15 cigarettes a day. Works for me, and my doctor doesn’t seem too concerned, except for the smoking.

  10. 10
    mudskipper

    I recently started monitoring my blood sugar levels after meals as a result of an A1C blood test that indicated my blood sugar levels had been in prediabetic ranges over the previous three months.

    The most surprising thing I learned by doing so was the effect of alcohol on my blood sugar levels. If you had asked me before I started monitoring what the effect of alcoholic drink would be on my blood sugar levels, I would have replied, “Oh, it would spike them, for sure. Duh!”.

    But the opposite has proven to be true. If I eat a heavy carbohydrate meal, I can blunt the effect on my after-meal blood sugar by having a drink with the meal. In fact, sometimes my blood sugar will be LOWER after a meal with a drink than it was before. And the effect lasts for hours.

    One explanation I have read for this is that the liver is so preoccupied with dealing with the alcohol that it reduces the amount of glucose it produces.

    This might explain the paradoxical health effects of alcohol. An increasing body of research suggests that after-meal blood sugar spikes cause cardiovascular damage, and that the blood sugar levels at which this damage occurs is far lower than what is currently considered normal and healthy. To the extent that alcohol curbs these spikes, it might be cardio protective.

    Of course, I suspect that for ideal health, you are best off curbing those spikes by watching what you eat and not drinking alcohol.

  11. 11
    2up2down2furious

    Regarding poor people drinking less in the United States, I wonder how much of that is regional. A portion of the rural poor in the South are clustered in dry counties where it is illegal to sell alcohol. This means that in addition to having money to purchase alcohol, one must also have transportation and gas money to go a county where alcohol is available.

    I would be interested to see a comparison between rural, suburban, and urban poor, as well as a comparison between some rural wet counties and rural dry counties with similar income levels.

  12. 12
    Donovan

    I’m also a home brewer. I love beer and the seemingly endless variety. But I think beer geek life style enhances health. One reason can be seen on the side of any street in the US. You’d be hard pressed to fine a Sam Smith or Woodstock Inn bottle as litter. That says something about the drinkers. A second reason is that, in my case, learning to enjoy beer without excess has spilled into other areas of my life. I can eat one cookie.

    But I don’t drink to enjoy good health. I keep healthy so I can enjoy good drink.

  13. 13
    invivoMark

    Yep, alcohol has long been known to cause hypoglycemia (link: http://www.medicalnewstoday.com/releases/93141.php – the mechanism has to do with overstimulating insulin release from the pancreas). That’s a substantial part of what gives you a hangover!

  14. 14
    invivoMark

    I like your last line! I absolutely do the same!

  15. 15
    schmeer

    As home brewer #3 I agree with all that you’ve both stated, but I’d like to add:
    One of my best friends is an abstainer, as Mano is, whenever he asks we drinkers tell him not to bother starting now.
    If you like alcohol I’ll talk your ear off about why you should try some beer you’ve never had, but if you have a reason for not liking it, don’t worry about drinking.

  16. 16
    Jockaira

    I haven’t yet seen a dry county where you couldn’t get wet for a ten-spot and thirty minutes worth of walking round trip. In most of these places home delivery is available for a small surcharge. The only net effect of dry laws is to make imbibing less public.

  17. 17
    MNb

    “and find it unpleasant”
    That’s reason enough (and i drink myself). As for the health benefits: they are long term so I’m pretty sure you’re too old to enjoy them. What’s more you should ask yourself if these benefits are more valuable than the cost of consuming you don’t like. Or is it your goal to become as old as possible, no matter what? Then remember that the last years on ones life are usually not the best ones anyway in terms of health. It’s vanity to assume you will be the exception.

  18. 18
    Charles Sullivan

    There are times when altering one’s consciousness can change one’s atheistic experiences, and make the aesthetic (creative) act itself enjoyable in a fun way. Try spliffing (inna Jamaica stylee) and then play a drum or fingerpaint. Drink some wine or beer with friends, and then have a sing-a-long to a sea-shanty or a Pete Seeger song.

    Of course one need not alter one’s consciousness (via ingesting chemical compounds) in order to have fun participating in such activities. But sometimes the compounds reduce inhibition just enough to start the ball rolling.

  19. 19
    Mano Singham

    I agree. But I guess I have never felt the need to reduce my inhibitions more than what I currently do without alcohol. But maybe I don’t now what I am missing!

  20. 20
    Charles Sullivan

    You mean you’ve never dropped acid or done mushrooms and then listened to the album ‘Close to the Edge’, by the band ‘Yes’? Yeah, you don’t know what you’re missing.

    As I get older I find myself less concerned with what other people think of me and my beliefs and actions (with the exception of genuine moral matters). It’s as though getting older has lessened some of my inhibitions.

  21. 21
    Charles Sullivan

    With Bill Bruford on drums on that album, dude: concise and precise.

  22. 22
    Mano Singham

    Nope, I have never done any of those things. I have lived a remarkably boring life.

  23. 23
    Rob Grigjanis

    Great, but even better with King Crimson IMO. Example, Asbury Park.

  24. 24
    Rob Grigjanis

    Oops. Didn’t know it would do that. Sorry.

  25. 25
    oldymoldy

    me either. i think i’ll go take a nap! snore….

  26. 26
    Drewzilla

    To the good professor, I would suggest a joint and his favourite album (whatever that may be). Just once. And I mean that in the very best way that I can express it. Alcohol is (and this is coming from an alcoholic who can’t stop drinking) a coarse drug and the high it gives you is fraught with stupidity. If it’s at all possible within your circumstances, I genuinely would suggest having a two hour alone time (or perhaps time with someone trusted who knows what’s going on) with a stick of weed and a few good albums/blogs/movies to listen/read/watch. It’s a genuinely different experience, something that is whimsically intertwined with noticing things otherwise unnoticed. I don’t think you’ll have any sort of genuinely life changing experience if you ever decide to do it, but it should give you an awareness of this ‘other’ mental space you can go to to think about things differently.

  27. 27
    Mano Singham

    Actually, I have considered that option but never tried it.

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