Even moderate drinking could harm the brain

http://www.cbsnews.com/news/even-moderate-drinking-could-harm-the-brain/

by obeone • 9 years ago

90 71 9 years ago

cbsnews.com

stuartd• 9 years ago

From Money by Martin Amis:

I gestured at my litre of fizzy red wine. “Want a drop of this?” I asked him.

"No thanks. I try not to drink at lunchtime.”

"So do I. But I never quite make it.”

"I feel like shit all day if I drink at lunchtime.”

"Me too. But I feel like shit all lunchtime if I don’t.”

"Yes, well it all comes down to choices, doesn’t it?” he said. "It’s the same in the evenings. Do you want to feel good at night or do you want to feel good in the morning? It’s the same with life. Do you want to feel good young or do you want to feel good old? One or the other, not both.”

"Isn’t it a tragedy?”

nicolashahn• 9 years ago

Until technology advances far enough to where hangovers are a thing of the past, or liver replacements get cheap, or we just live forever.

letitgo123452• 9 years ago

https://twitter.com/f2harrell/status/872496449241718787

letitgo123452• 9 years ago

Why the downvote? Guy is a well known statistician pointing out some statistical flaws in the study...

neogodless• 9 years ago

The first rule of Hacker News is that you don't talk about downvotes. But I'd like to educate you, so here goes.

While I didn't personally vote you down, I can absolutely make a guess why. You posted a URL (a Twitter one, no less) with absolutely zero context at all. You didn't say "Here's what [well known statistician] has to say about this study." You also pointed to the Tweet, rather than the article (or in this case, more specifically, the recent update to an already existing article) that the statistician Tweeted about. You left all the work up to the reader (two clicks and a bunch of reading before they know why you posted a nondescript URL).

Why should anyone click on a URL to a Tweet without context? They shouldn't, which means that the URL adds no value to the conversation, which means the comment gets voted down.

mikestew• 9 years ago

neogodless got it right. I didn’t downvote your particular comment, but I often downvote similar ones that effectively say, “I have no counter argument, so read this random link that’s probably some wackadoodle conspiracy theory, but I’ll give you absolutely no context to signal ‘wackadoodle’ from ‘reasonable argument’.” If you have something to say, say it. Don’t just barf up a link to $DEITY knows where.

IOW, don’t be lazy with your comments.

andai3• 9 years ago

A very high-profile paper was published in BMJ on 2017-06-06: Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study by Anya Topiwala et al.
The authors had a golden opportunity to estimate the dose-response relationship between amount of alcohol consumed and quantitative brain changes. Instead the authors squandered the data by doing analyzes that either assumed that responses are linear in alcohol consumption or worse, by splitting consumption into 6 heterogeneous intervals when in fact consumption was shown in their Figure 3 to have a nice continuous distribution.
How much more informative (and statistically powerful) it would have been to fit a quadratic or a restricted cubic spline function to consumption to estimate the continuous dose-response curve.

Article: http://www.fharrell.com/2017/04/statistical-errors-in-medica...

Study: http://www.bmj.com/content/357/bmj.j2353

PDF: http://www.bmj.com/content/bmj/357/bmj.j2353.full.pdf

ihaveajob• 9 years ago

I take issue with the way moderate drinking is defined in this and other studies. Drinking, like the article states, "about 5 to 7 beers or 6 to 8 glasses of wine" in one week is very different if you have one beer a day, or if you drink the same amount on a Saturday night outing.

In Mediterranean countries it's pretty common to have a glass with some/most meals, but the regular weekend binging is a relatively new practice. Perhaps that explains overall population health differences with Anglo countries.

pdexter• 9 years ago

"about 5 to 7 beers or 6 to 8 glasses of wine" in one week is very different if you have one beer a day, or if you drink the same amount on a Saturday night outing.

Is this true?

andai3• 9 years ago

Having done both, it certainly feels true. I can't speak for my liver, though.

DanBC6• 9 years ago

Binge drinking is more harmful, so don't binge.

But people incorrectly think you can just spread out the drinks over a week and be fine, Drinking one glass (275 ml, not that big) of wine (12%, not that strong) every day is something like 23 units. We know that's increasing risks of a range of harm.

EDIT: I got my mls wrong! (Thanks mattmanser for pointing this out).

175 * 12 = just over 2 units.

ovulator• 9 years ago

The articles "moderate" would actually be an increase in alcohol consumption for most Americans. As the vast majority of adults drink less than 3 drinks a week.

https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think...

pavement2• 9 years ago

Everyone takes issue with this definition, except the medical community, which has used this standard for decades, to account for how reasonable people consume drinks casually.

It's important to inspect the effects of drinking, even at doses perceived as low. This isn't about college kids killing their brain cells by partying. It's about long term health effects.

Three beers a day, spaced out over 16 hours, as one per meal, will still ruin your liver over decades. It's bad for you. This is pretty common information, and is important to understand, since people tend to find this counter-intuitive. Three beers a day, evenly spaced, sounds like moderation and good behavior.

The new information here says that even one unit a day is still bad for you, even if one unit of a specific type of alcohol (perhaps wine) might provide for a trade of hazards versus benefits.

rsync2• 9 years ago

"Three beers a day, spaced out over 16 hours, as one per meal, will still ruin your liver over decades."

Almost certainly not.

"Of all chronic heavy drinkers, only 15–20% develop hepatitis or cirrhosis, which can occur concomitantly or in succession."[1]

Not only do many chronic, heavy drinkers not ruin their livers, but further "three beers a day" would not even come close to any definition of chronic, heavy drinking.

I certainly think it's a bad idea and not something I, myself, would practice - simply because of the effects on athletic output and exercise regimes, etc. However, you very badly mischaracterize the behavior you've given an example of.

[1] https://en.wikipedia.org/wiki/Alcoholic_liver_disease

chicob2• 9 years ago

As a Mediterranean man, my perception (possibly biased, of course), is that 6 to 8 glasses of wine a week seem excessive as a standard for moderate consumption. I think I drink moderately, and in the last 3 weeks I had two, maybe three glasses of wine and maybe 5 beers.

Weekend binging is more excessive for younger people, but I don't see people my age drinking in working hours, only older men.

Cheers!

daxorid• 9 years ago

were three times more likely to have hippocampal atrophy compared with those who did not drink.

What is the baseline rate? 3x more likely has wildly different outcomes if the base rate of atrophy is 0.1% versus 10%.

atemerev• 9 years ago

Cheers!

sunstone• 9 years ago

Jeez, now you tell me.

likelynew• 9 years ago

I don't think I believe this. I know that it's associated with me and can be my bias purely. But for now I will refer to this well written article: https://www.vox.com/2015/3/23/8264355/research-study-hype (This is why you shouldn’t believe that exciting new medical study)

aaronchall• 9 years ago

I agree with your sentiment, I would appreciate it if we had an ongoing meta-analysis of pre-existing studies instead of hype - but non-hype doesn't get people to pay attention to the news, and if the news doesn't have everyone's attention, how can they sell advertising?

robg• 9 years ago

Uncontrolled common cause: Alcohol use, daily stress, and sleep quality. Stress and sleep affect "mental skills" more than any other, esp over a 30 year period.

edmanet• 9 years ago

Too late for me then

simonsarris• 9 years ago

From the study itself: http://www.bmj.com/content/357/bmj.j2353

Principal findings
The relation was dose dependent, and increased odds of hippocampal atrophy were found even in moderate drinkers (14-<21 units/week in men).

That seems like a big range.

Strengths and limitations
The hippocampal atrophy associations we found in the total sample were replicated in men alone but not in women. This could reflect a lower power to detect an effect in women, in part because the sample was dominated by men (a reflection of the sex disparity in the civil service in the 1980s) and in part because few of the included women drank heavily.

That seems like it should be mentioned in the CBS article.

~~~

I wish more studies accounted for how drinking is done. It is worth wondering if drinking 2 drinks a day, 3 days a week is better for you than drinking 1 drink 6 days in a row.

Moderate drinking some days but not others, perhaps your liver/brain do better because they get "total rest days", whereas light/moderate drinking every day may put them in a constant state of irritation or stress. Just like with workouts.

kafkaesq• 9 years ago

I wish more studies accounted for how drinking is done.

Indeed. From what my own innards tell me, drinking almost any amount just before sleeping feels particularly disruptive to the various housekeeping activities said innards are entrusted with. The same amount in the afternoon (or well before nocturnal drowsiness sets in), rather less so.

It would also be nice to know to what extent the various damages detailed in the article compare with those of, say, loss of sleep or poor nutrition - or even (seriously now) social isolation, stress, or watching too much TV. And to what extent the body and brain may be able to repair these damages, over time.

sjg0073• 9 years ago

The study says that it is dose dependent with atrophy seen at moderate drinking levels. So total amount of alcohol consumed per week.

bryondowd2• 9 years ago

That's the point. If they see atrophy in people who drink 14-20 units per week, that leaves room to wonder whether there's a significant difference between people within that group depending on whether they drink 2-3 units every day or drink 4-7 units three days a week with four rest days. You could then go further and see if it is different to have four consecutive rest days and three consecutive drinking days versus having each drinking day spaced with at least one rest day. Etc.

The point is that lumping everyone who has 14-20 drinks in a week into one category makes for a large variation in behaviors and possible interactions.

DanBC6• 9 years ago

> 14-<21 units/week in men).
That seems like a big range.

Previous English advice was that men should drink less than 21 units per week. Current advice is less than 14 units per week.

Some people were asking what the evidence base was to reduce the limits, and papers like this address that.

It is worth wondering if drinking 2 drinks a day, 3 days a week is better for you than drinking 1 drink 6 days in a row.

We know that it's better to leave some days drink free, and this is current alcohol advice in the UK and has been for some time now. (At least the past 20 years, I think.) This is because the liver needs time to recover.

bryondowd2• 9 years ago

Is there any research on which is worse? In other words, how does it compare to drink under 14 per week but without any rest days, versus drinking more than 14 per week but only during three days of the week.

I feel like there's a lack of knowledge about alcohol, considering how ubiquitous it is.

eli_gottlieb• 9 years ago

14 units per week is still, if I understand correctly, two units per day. That's pretty moderate drinking, so that seems ok to me. Honestly, I drink a bunch less than that, so it doesn't seem difficult to do.

wcummings• 9 years ago

This is because the liver needs time to recover

Also less likely to become dependent.

xaa• 9 years ago

Yes... the statistics in this article are annoying (par for the course for BMJ, NEJM, and other medical journals). They use mixed-effects models and a lot of potential covariates (good) but then bin the variable of interest (BAD). I've seen a lot worse, but it's not optimal IMO.

This is basically an epidemiology paper, and the apparent statistician is an epidemiologist. As an interesting aside, I recently sat down for lunch with biostatistics grad students, and apparently they consider the epidemiology students/faculty/field to be incompetent wielders of "statistics-lite". I took it with a big grain of salt, but it does seem epidemiology is harder-hit by the replication crisis than most other biology fields.

Moderate drinking some days but not others, perhaps your liver/brain do better because they get "total rest days", whereas light/moderate drinking every day may put them in a constant state of irritation or stress. Just like with workouts.

Actually my understanding is that the harm of drinking to the brain mostly does not occur during the drinking itself, but the withdrawal period after the depressant is cleared causes excitotoxicity for neurons. This is why quitting heavy drinking cold-turkey may not be best health-wise (but may be easier to do psychologically). Also, cycles of binging and abstinence cause your neurons to be increasingly vulnerable to damage via some kind of priming mechanism.

Personally, I've been trying to cut back, and I'm much more worried about my brain than my liver. It may be that the optimal pattern may vary by organ.

Someone• 9 years ago

"even in moderate drinkers (14-<21 units/week in men)"

(just under) 3 units/day _on_average_ is moderate now? I thought that would be 2 drinks a day, at most (2 drinks puts you close to, if not over, the limit for driving in many countries)

DanBC6• 9 years ago

One English unit is 10 ml of pure alcohol.

You can find the unit content by multiplying the serving size in liters by the ABV value.

175 ml of wine at 12% = 0.175 * 12 = 2.1 units.

derefr• 9 years ago

Moderate drinking some days but not others, perhaps your liver/brain do better because they get "total rest days", whereas light/moderate drinking every day may put them in a constant state of irritation or stress. Just like with workouts.

Given how xenobiotic metabolism ("drug tolerance") works, I would expect the opposite: that your liver would be perfectly fine with a sustained stress exactly under the threshold at which it is capable of dealing with it, and this state would be indistinguishable from consuming no alcohol at all. But go one hair more, and now you'll have a chronic but mild stress-state on the liver, with the formation of dangerous side-products (like NAPQI in tylenol metabolism) but only in tiny amounts, such that the small amounts of damage done by the side-products will be noticed and repaired, and the chemicals themselves flushed out by the excretory system before more damage can happen.

On the other hand, single, monstrously large doses ("binge drinking") will tend to lead to the formation of large amounts of such side-products, which will be highly available to react with other organic chemicals nearby and thus cause large amounts of long-term damage—weakening the body in ways that make repair harder—before they can be removed.

omginternets• 9 years ago

Given how terrible mainstream news outlets are at reporting scientific results, I strongly feel that we should discourage users from linking to such "stories". It lowers the quality of discourse.

Sci-Am is one thing, CBS News really is another...

pc2g4d• 9 years ago

This study seems small and with the effect being the opposite of that previously found it basically amounts to "What's going on here???" I did like this from the article, though:

In an accompanying editorial, Killian Welch, consultant neuropsychiatrist at the Royal Edinburgh Hospital, says the findings "strengthen the argument that drinking habits many regard as normal have adverse consequences for health."

"This is important," he writes. "We all use rationalizations to justify persistence with behaviors not in our long term interest. With publication of this paper, justification of 'moderate' drinking on the grounds of brain health becomes a little harder."

---

In company with Ioannidis's article "Why Most Published Research Findings Are False"[1], I believe the rationalization effect is big in such studies. People want to believe that the things they already do are virtuous, thus there's a bias toward finding that chocolate, wine, etc., are all actually good for you. Not to mention respective industries that would benefit from such findings.

1: http://faculty.dbmi.pitt.edu/day/Bioinf2118/Bioinf-2118-2013...

_RPM2• 9 years ago

I really dislike the culture of drinking at startups. I don't like to drink unless I'm with my girlfriend.

david-cako• 9 years ago

I don't like to drink unless I'm with her either.

Infernal• 9 years ago

Appreciate the subtle levity :)

_RPM2• 9 years ago

I didn't realize you were insulting me until I read the child comment. I thought you meant you don't like to drink unless you're with your own girlfriend.

digitalshankar• 9 years ago

I don't drink even if I'm with my gf, FYI I don't have gf.

akyu• 9 years ago

Quit drinking completely 6 months ago. Don't have any intention of picking it back up. Friends think I'm weird, but the mental clarity is worth it. Funny how alcohol is so ingrained in our culture that it's strange not to drink it.

stinos3• 9 years ago

Yeah, not really related to the study directly and being anecdotal, but I can attest that during periods in which I drank daily, and sometimes heavily, mental clarity was indeed the exact opposite of what I felt.

emerongi• 9 years ago

Recently I heard my mother utter something like (not about me): "Does so-and-so drink? He does? Ok, I was just afraid he is a weirdo."

My father and mother and step-father all smash it hard on weekends. Like passing-out-hard. Most friends as well. It's absolutely ridiculous. There's way more interesting things to do in life.

antisthenes• 9 years ago

That isn't normal.

Drinking to the point of passing out is alcoholism no matter how you look at it. Try to get them help if you value them.

sinap• 9 years ago

I've never drank and don't plan to. I just tell people I'm allergic to X in the alcohol. It's easier than trying to make up a reason for why I don't drink and people don't think I'm weird.

Obi_Juan_Kenobi• 9 years ago

While I do drink, I sympathize with you; there's a very unfair notion that abstaining is only the result of ignorance or backwards moral hangups, and given the derisive term teetotaling. Your decision is firmly your own.

2OEH8eoCRo• 9 years ago

As someone who started drinking from time to time later than most I don't know what clarity you're referring to. I've felt a much bigger change from quitting soda and sugary drinks rather than the occasional stiff drink. Completely anecdotal.

ashwinaj• 9 years ago

I concur. Small to moderate amount of drinking isn't as bad. Sugary drinks are the worst!

ivm• 9 years ago

Quit drinking 6 years ago. Mental clarity is definitely worth it.

cableshaft• 9 years ago

I can go that long in between drinks. I really don't enjoy the lingering effects of drinking heavily, so I usually only have one drink every once in awhile, like a single margarita or a beer or a rum and coke, usually no more than once a month.

I don't usually get people questioning my lack of drinking, but then again I am in older social circles now.

You can also just say you're on a diet and don't want the extra calories, that's an easy way to deflect it.

There was this one girl I dated that was completely baffled by this, though. She only got one night a week completely to herself (single mother, had a babysitter), so she didn't want to waste it and would drink harder than most people I've hung out with, even when I was in college. At the time I went along with it and drank a lot more than I really wanted to. I'm glad I'm not still in that situation, though.

openasocket• 9 years ago

Do they take into account diet? I don't know anything about hippocampal atrophy, but I know https://en.wikipedia.org/wiki/Korsakoff%27s_syndrome which is a form of severe memory loss is usually seen in very heavy drinkers, but isn't caused by the drinking, but rather thiamine deficiency (alcoholics tend do have poor diets). I'm wondering if moderate drinkers may have slightly worse diets and so you see the same effect on a much smaller scale. There's also other factors like sleep and daily stress that may also play a role.

I'm sure the scientists who performed this 30-year study knew about all this, are there things they did (or could have done) in this study to isolate the effects due to alcohol?

sjg0073• 9 years ago

Measure thiamine levels?

andai3• 9 years ago

Link to the study: http://www.bmj.com/content/357/bmj.j2353

PDF: http://www.bmj.com/content/bmj/357/bmj.j2353.full.pdf

Criticism by Frank Harrell:

A very high-profile paper was published in BMJ on 2017-06-06: Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study by Anya Topiwala et al.
The authors had a golden opportunity to estimate the dose-response relationship between amount of alcohol consumed and quantitative brain changes. Instead the authors squandered the data by doing analyzes that either assumed that responses are linear in alcohol consumption or worse, by splitting consumption into 6 heterogeneous intervals when in fact consumption was shown in their Figure 3 to have a nice continuous distribution.
How much more informative (and statistically powerful) it would have been to fit a quadratic or a restricted cubic spline function to consumption to estimate the continuous dose-response curve.

Article: http://www.fharrell.com/2017/04/statistical-errors-in-medica....

jacquesm• 9 years ago

Programmers that drink (hard) are like cooks blunting their knives. I knew a couple in my 20´s that went down this route, they are not programming today. The brain is a complex piece of machinery and damage that you do to it when you are young will come back to haunt you later in life, when the aging of the brain removes some of the reserves. It is really hard to see people that were whip smart lose their faculties, especially if they had a hand in the change themselves.

chicob2• 9 years ago

If I didn't know what the findings were, and if I looked merely at the graph in Fig. 6 of the BMJ article, I'd say that higher lexical scores in younger years correlate with higher declines in that same score.

Does abstinence correlate with lower scores? I don't understand the three different starting points. I was expecting a normalized score (~20) with several different levels of decline.

Even moderate drinking could harm the brain

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