Dr. Kenneth Mukamal
Appearances
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Well, it's a tough question to answer in a short time, but to kind of condense it down, we're looking at a whole bunch of different kinds of effects, right? Because alcohol can affect your heart, it can affect your liver, it can affect your brain. So there's all different kinds of effects. And one of the problems we're seeing where you get these sorts of messages is people
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
it's easy to dial down on one of these. And I'll give you an example. So we've known since the 1980s that even small amounts of alcohol probably increase a woman's risk of getting breast cancer, but by a small amount, by about a 10% increase over her otherwise medium risk.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Now, that sounds bad, but what they don't tell you is that there's other kinds of cancer that alcohol seems to reduce the risk of.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
So if all we're doing is picking and choosing specific endpoints, specific diseases, then it's easy to come up with dictates like that. When we look at this across the board, trying to integrate everything together, it more or less looks like limited alcohol consumption, right? So within the currently recommended limits, does not seem to have huge risks to health.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Whether it has benefits or not, I think is somewhat of a harder call. But it's interesting that the National Academy of Sciences, Engineering, and Medicine just came out in January with a very detailed report. And it showed that compared with not drinking, limited drinking, light drinking, was associated with lower risk of dying. So that goes exactly opposite.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
I can't speak to the whole vaccine question. That's not something I studied. But I can certainly say that in this case, the data actually hasn't changed very much. That's why this panel could come out and show that, in fact, using the most up-to-date data, the risk of dying overall seems to be a little bit lower if you drink a small amount of alcohol relative to none.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
But, you know, if you're eager to try to show that alcohol is entirely bad for you, there's ways to do that because you can cherry pick again. And that, I think, has sort of been where they've been so successful, that by choosing things like, say, breast cancer, it's easy to say, look, there's a risk from light drinking. That's true.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
There's also a risk of getting in a car accident if you get in your car. It doesn't mean that the risk outweighs the benefit, but it does mean that there's some risk. And I think that's sort of the misconception that we're seeing across the board here.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Which is crazy, right? Because even if we eliminated all alcohol, because the added risk of breast cancer from drinking is so small, even if we eliminated all alcohol in our studies, we would still have 96% of the breast cancer left. Really? Yeah. So this is just really not, it's not a huge contributor nationwide to breast cancer statistically.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
In contrast, right, it'd be important to have that same conversation with you about, say, your risk of diabetes. Because it turns out that if you drink with meals, and it's probably important to have that drinking with meals, that tends to lower blood sugar after a meal and probably lowers your risk of diabetes. Really?
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Well, if your doctor is only giving you half the story, then you're not a fully informed consumer.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Yeah, but it's certainly true that there's interest from existing temperance societies that grew out of, you know, the temperance societies from 100 years ago that were religiously based and tried to get everybody to drink no alcohol at all. And at least some of the people on the science side who have been most vocal about eliminating all drinking and alcohol
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
highlighting the fact that even a tiny bit of drinking might be ready to kill you, have at a minimum spoken to and collaborated with temperance societies.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
I wish I knew the answer to that, but it's funny that if you look back at what the concerns have been over the last 30, 40 years in this, it's all about how the alcohol industry must be secretly working with doctors to try to show that a little bit of drinking is good for you. And so the concern about conflict of interest has always come from that side.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Well, our research has never been funded by industry, not a single penny of it. And yet we've consistently shown, again, things like lower risk of diabetes and lower risk of heart disease associated with limited drinking.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
So I think part of it has been that physicians and researchers have been so primed to look for conflicts of interest from industry that they just totally miss the fact that there's a whole bunch of other kinds of conflict of interest. religious conflicts of interest, there's personal conflicts of interest. And, you know, in this case, you've got temperance societies taking advantage of it.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
You know, it's a great question. There are folks in the medical community, I think, trying to bring in this idea that at least some of the benefits of alcohol relate to social lubrication, right? This idea that that's, you know, we have an epidemic of loneliness in America. It's okay to... to acknowledge that at least part of social behavior in humans is related to alcohol.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
And at least from a health standpoint, we know that the healthiest way to drink is that kind of Mediterranean style, right? Sit down over a meal, have some wine, and enjoy company of people together. We know that the Mediterranean lifestyle helps people live the longest.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
Somehow we've managed to take some of the dietary pieces of that Mediterranean lifestyle and strip away all the other things, including the wine and including the social piece. I hope we'll get it back.
The Nerve with Maureen Callahan
Dirty Diddy Details Overload, Bogus Claims About Drinking Exposed, and Terrible Advice Columns
So hopefully the National Academy report that came out in January will help stimulate some of this discussion or at a minimum, I think, maybe try to reverse some of the trend we've seen toward just all alcohol is not just bad, but it's going to kill you tomorrow.