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Low-levels of alcohol consumption may not lengthen our life expectancy after all, but two or even three drinks a day likely won't significantly shorten it either, according to new analysis. Familiar authors of a new study emphasized the former point, summarizing that "low-volume alcohol drinking was not associated with protection against death from all causes." But they also found that less than 2 drinks per day for women and as many as 3 for men does not significantly increase risk either. And that finding is hard to square with the increasingly loud assertion that there's "no safe level" of drinking, even if the first result supports it. Ref 1 Background: the "J-Shaped Curve" & "Sick Quitters" Published late last wk in the Journal of the American Medical Assn's free Network Open database, the study represents the latest attempt by an all-star cast of alcohol-focused public health researchers to flatten the so-called "J-shaped curve." Recall, dozens of studies over decades mostly focused on cardiovascular health and showed that light-moderate consumption had a "protective effect," or a lower risk of mortality than that of abstainers. As consumption went up from there, so did the risk. Plotting those results generates a curve that looks like a wide J.For many years, public health researcher-advocates fixated on the initial scoop of that J, which suggests a lower risk for light drinkers than for abstainers. They've worked hard to flatten the scoop by arguing that earlier studies baked in "drinker biases." The health of all "abstainers" is skewed negatively by including former drinkers, they showed with additional research. So to truly assess the impact of alcohol on overall mortality risk, studies must tease out these "sick quitters" from the baseline abstainer group, they asserted. That thinking drove a 2016 meta-analysis of 87 prior studies, which this new study updates by adding 20 more studies published between 2015 and 2021. All told, the 107 studies analyzed followed over 4.8 mil adults in numerous countries.The Significance of Insignificance Summarizing their results, authors have their cake and eat it too, emphasizing statistical significance only when it supports their hypothesis. As expected, they found "no significant protective associations of occasional or low volume drinking (moderate drinking) with all-cause mortality" (our emphasis). The study defines occasional drinking as less than 1.3 grams of pure alcohol per day or about 1 drink (14 g in the US) every 10-11 days. Low-volume drinking is under 25 g or a bit less than 2 drinks per day.But note how the acknowledgment of what's "significant" or not shifts in the next clause, summarizing the study's 2nd major takeaway: "an increased risk of all-cause mortality for drinkers who drank 25 g or more and significantly increased risk when drinking 45 g or more per day" (our emphasis). Numerous media outlets picked up that language, implying that the study asserts risks to mortality from drinking just under 2 drinks/day. But the study's data and author's language elsewhere undermines that claim. Indeed, "daily low or moderate alcohol intake was not significantly associated with all-cause mortality risk," the study's abstract reads plainly.Curve Still Slightly J-Like Here are the numbers backing up those summaries. Compared to the estimated average relative risk (RR) of all-cause mortality for lifetime nondrinkers (an RR of 1), risk dipped 4% for occasional drinkers (RR of 0.96) and 7% for low-volume drinkers (0.93). Medium-volume drinkers consuming at least 25 g and less than 45 g (2-3 US drinks) per day had a 5% greater risk (1.05) than lifetime nondrinkers.But none of those results are statistically significant. In other words, if the benefits or "protective effects" of light drinking aren't significant, neither are the risks of moderate drinking. A chart plotting these findings (and included in the study's supplemental materials) still resembles a J, just with a much smaller scoop compared to unadjusted data. Moving the Goalpost to Occasional Drinkers Researchers ran plenty of further analyses, too, including one important tweak to the above: setting "occasional" drinkers as the baseline instead of nondrinkers. That's appropriate because it "avoids the issue of former drinker misclassification," authors wrote. Plus, occasional drinkers are "unlikely" to enjoy any "physiological health benefits" from drinking. The above figure is also instructive, though. This new comparison limits the scale of the dip for low volume drinkers and increases the size of the rise for medium drinkers and beyond. Yet authors still acknowledged that "there were nonsignificant protective associations for low-volume drinkers whether using lifetime abstainers or occasional drinkers as the reference group."Age, Sex & Limitations Authors also worked to examine risk differences based on age and sex. The latter analysis revealed the consistent finding that risk begins at lower consumption levels for women than it does for men. Compared to abstainers, women identified as occasional or low-volume drinkers showed slightly lowered risk of all-cause mortality (RR of 0.99 for both). But risk jumped significantly for medium-volume drinking women (1.21). Risk for men who drank at that level was still very low (1.01), however. Meanwhile, the relatively few studies that followed folks for at least 10 yrs beginning before they turned 50 found "significantly increased risk of mortality" for even moderate drinkers.As always, analyzed research relied on notoriously unreliable self-reported consumption, leading to the study's "major limitation," in the authors' view. And it cuts a couple of ways. Authors emphasize that even folks who identify as "lifetime abstainers" are in fact former drinkers, which would lead to over-estimated risks for nondrinkers (and therefore underestimated relative risks for drinkers). They also acknowledge that "self-reported alcohol consumption is underreported in most epidemiological studies." But they don't point out the logical conclusion: if study subjects actually drank more than they reported, then the measured risks may not go up until even higher consumption levels.Press Coverage Highlights Ambivalence Ironically, while covering a study aiming to address the biases of previous research, various media outlets revealed their own biases. More left-leaning pubs tended to emphasize the anti-alcohol views of the public health researchers who conducted the study. "No, moderate drinking isn't good for your health," headlined the Washington Post, which gave much space to study authors Tim Stockwell and Tim Naimi (and only a brief courtesy rebuttal to DISCUS' science and health veep Amanda Berger). NY Times took the same tack and NBC News similarly emphasized that "Having an alcoholic drink or two per day is not healthier than abstaining."On the other hand, outlets that tilt more to the right were more likely to play up drinking positives or split the difference. Cheers rang out abroad. The UK's The Sun touted that "Drinking a pint of beer or glass of wine a day won't kill you," and Canada's national TV network alerted viewers that "A glass of wine or beer per day is fine for your health." The study, written by a team of mostly Canadian researchers, comes at a particularly awkward time there. Recall, the country's Centre on Substance Use and Addiction drastically lowered recommended drinking levels to no more than 1 drink per week. Again, the study found"nonsignificant protective association" with at least 1 drink per day, so less risk not more, as the government agency asserted.Some outlets in the US found more middle-ground. The NY Post's typical splashy style warned that "Your daily adult beverage won't kill you - but one more might." And the Wall Street Journal balanced the good and bad news with a little cliche, headlining that "A Little Alcohol Won't Kill You or Make You Stronger." And the ambivalent beat goes on.Cheers,References1 Zhao, J et al, "Association Between Daily Alcohol Intake and Risk of All-Cause Mortality," JAMA Network Open, March 2023, doi:10.1001/jamanetworkopen.2023.6185

Aiming to Flatten J-Shaped Curve, Researchers Confirm Low Risk of Moderate Drinking

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