The impact of alcohol consumption on cancer risk and overall health

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. Yeah, 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 Mendelian 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 feel very comfortable saying that there is no dose of alcohol that is healthy, but you know, at a very low dose, I get 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 so I, I, I'm, I'm, I'm comfortable saying that. 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, you know, like, can you have your weekend, you know, glasses of wine? Like, 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 increase. Like to me, it's like you can't, you can't measure it. 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, twice, 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. It's not a linear like that. Yeah. No, no, no. I mean, I mean, it's, it's, it, but, 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 80 year 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 zero 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 hedonic pleasure. That's not good for me, but it's enjoyable. That's enjoyable. What, how do you feel about ApoE4 carriers and alcohol consumption? Our view in the practice is that they are indeed more susceptible, um, to the deleterious effects of alcohol. Um, and also I would say they're just more susceptible in general to the deleterious 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 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 so, so through that lens, I would just say, you know, if we have, we have lots of patients with E4 in our practice, including a number of E4 E4s, we just, you know, even though those patients represent only 2% of the population, they're probably about seven or 8% of our patient population. And, um, again, we say, look, unless this really means the world to you, it's probably not worth the 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.