The Case for Drinking Alcohol

Disclaimer: Look, if you have problems with alcohol, I get it. Alcoholism is a real thing and destroys lives. I'm going to be discussing moderate, controlled, social drinking in this piece. This is not a recommendation to begin or resume drinking if you have a problem with it. 

The Case for Alcohol

I have always enjoyed alcohol, but never to excess. For at least the last 20 years, I have had one or two glasses of wine almost every night with dinner. It always made the food taste better and frankly made dinner more enjoyable. The classic steak plus red wine plus excellent dinner conversation is an unparalleled combination.

About 10 years ago, I noticed that drinking wine had begun to ruin my sleep. I would have a glass or two and, without fail, wake up once or twice throughout the night and feel groggy in the morning. So I did an alcohol free experiment for the better part of the year. Sure enough, my sleep was restored.

I had no issues giving it up and while I missed having wine with dinner, I didn’t feel any physiological compulsion to drink. Sleep is more important than that. Then I got a note from a guy named Todd White, who was starting something called Dry Farm Wines, a subscription box that delivered only natural wines. Natural wines are raised with organic standards and dry farmed, meaning they don’t use artificial irrigation, only rainfall. The result is a wine that is complex, interesting, lower alcohol (10 to 12.5 percent) and with zero sugar. Natural wines tend to be much higher in polyphenols because the grapes aren’t protected by modern fertilizer and pesticide systems. They have to produce more polyphenols to defend themselves. The grapes have more “grapeness.” Todd said, Mark, try some of these and see if they make a difference.

The difference was remarkable and instantaneous. My one or two glasses a night of natural wine no longer affected my sleep. If anything, they improved the quality.

So when I see people avoiding all alcohol because it is incontrovertibly, entirely, uncontroversially an absolute poison with no benefits, I have to push back. I think the health gurus out there telling you that the only healthy amount of alcohol is none are selling you short. They’re not giving you the full picture.

The Problem With How Alcohol Science Is Done

As is the case with almost every dietary study, the bulk of evidence for the idea of there being no safe amount of alcohol is observational data. They take large swaths of the population, see how much they drink, and then track their health. Then they come up with a single number that shows the so called risk of drinking various levels of alcohol for diseases like cancer, heart disease, and early mortality.

They plug thousands of people’s individual experiences with alcohol into a single number that purports to capture the effect of alcohol for all of humanity, and certainly for the average human being, and certainly for you.

Part of it is an inherent limitation of how we conduct studies and how we try to encompass the experiences of tens of thousands of people into a single data point or risk ratio. Turning all those experiences into a single number doesn’t negate the actual life stories of the individuals that make up the study.

These studies invariably ignore the real world examples and trials we have of certain types of alcohol and certain modes of intake improving specific health markers and having beneficial physiological effects.

The Brain Atrophy Argument

What about brain atrophy? Probably the most cited objection to alcohol intake is that it reduces brain volume. That is the thrust of what Rhonda Patrick and Andrew Huberman say as a big reason for not drinking. The crux of their argument rests on the results of a giant study: the UK Biobank study. It was over 36,000 adults living in Britain and it measured their brain matter volume (both gray and white matter). It found that any amount of alcohol, even just one or two drinks a day, was linked to lower brain volumes.

It sounds scary, but it’s a little more nuanced than that. For one, other studies show different results. A paper looking at a multiethnic population of adults in New York found that light to moderate drinking (1-2 drinks per day) was associated with greater brain volumes. Wine had an even stronger relationship than other alcoholic drinks. Another study found that Danish men who drank small amounts of wine (8-14 drinks per week) or spirits (1-7 per week) had lower cognitive decline than men who abstained. Beer, however, had no protective effect.

Secondly, the absolute effect was very small. When you controlled for all the variables that they identified, alcohol could only explain 0.4 percent of global brain volume changes and 0.1 percent of white matter changes. At the individual level that is exceedingly small, especially compared to other established risk factors and determinants of brain volume.

For instance, one of the biggest correlates for total brain volume variance is aerobic fitness. The more fit you are the bigger your brain and the better it works. And interventions where they put older adults on exercise programs find that just six to twelve months of training can actually increase brain growth by one to 2 percent and it can even reverse brain shrinkage (and increase memory).

Strength training is another big lever. Resistance training in older adults prevented age-related brain atrophy in one paper. Now that is an intervention study where they actually measured changes caused by the training, not just an observational analysis. As for brain volume, one study found that the lean mass of the thigh muscles predicted brain volume in older adults. Another found that total neck muscle volume predicted 17% of the total brain volume variance. A strong case for training neck.

This shouldn’t come as a surprise; muscle is an endocrine organ that releases IGF-1, which is vital for neurogenesis and neuron maintenance.

Another one is social isolation. People who are lonely, who are socially isolated, tend to have lower brain volumes than people who are not lonely. Perceived loneliness even seems to predict the onset of dementia, and this relationship is mediated by reductions in gray matter volume. My honest opinion? The social and brain volume effects of having that glass of wine at happy hour or drinking a couple beers with your buddies on the weekend might outweigh any potential knocks on brain volume or function. It is very likely that it is better for your brain to have a drink with a friend than to abstain entirely and not see that friend.

Sleep might be the biggest lever. Sleeping less than five hours a night is linked to lower brain volume versus sleeping 7 to 8 hours. And that’s using the same dataset as the alcohol study: the UK Biobank. It is highly likely that a great many of the people in the UK Biobank study who had worsening brain volumes due to alcohol were drinking late at night, going to bed still inebriated, and ruining their sleep. Keep reading for more on how important timing is when you drink alcohol.

And finally, if you go to the study and look at the scatterplot, there is a trend line, but the trend is pretty meager and there are many tens of thousands of people above and below it. What that means is that there are plenty of people who have never had a drop in their lives who have low brain volumes, and there are many thousands of people who have moderate amounts of alcohol every day and have normal brain volumes. What this shows is that individual variance is huge, and that there are many other factors that play a larger role in determining brain volume than just whether you have a glass of wine.

Remember, you are not the trend line. You can have a glass of wine with dinner and you can get together with your friends, maintain your social connections, train hard in the gym, maintain good muscle mass and cardiorespiratory fitness. These things can all exist together and pulling on those larger levers is going to make a bigger impact on your brain health than whether or not you drink a glass of wine or have a beer.

Mendelian Randomization and “Alcohol Intake”

Much is made of the supposed links between even moderate drinking and brain health. Most of those links are established through something called Mendelian Randomization, which looks at genes that appear to predict behaviors related to alcohol intake. They’re not actually looking at intake. They’re looking at whether a person who carries certain alcohol related genes has a higher risk of dementia.

Mendelian Randomization doesn’t study actual drinking. It studies genes presumed to predict drinking, and then infers the rest.

It is “being genetically predisposed to drink more alcohol is linked to Alzheimer’s.”

It is not “drinking red wine at 5 PM with a New York strip and friends causes Alzheimer’s.”

These are interesting, but they aren’t looking at actual behaviors.

Look Who Is Telling You Not To Drink

Another big problem is who is telling you not to drink. A lot of health influencers and longevity experts who say alcohol is poison are the same guys who are eating once a day. Guys who are eating 1000 calories a day and taking handfuls of supplements in order to wring out a few extra years of life at the end of their mortal coil. Guys who are deep into ketosis. Ketogenesis operates along the same pathways that we use to metabolize and detoxify alcohol, so if you’re deep into ketosis you may have a poor response. I’m a big fan of targeted ketosis and using it as a tool to help reach metabolic flexibility or to treat specific health conditions, but it’s not necessarily the ideal end state for the average person. But that kind of diet does not work very well with alcohol. And I also think that is why a lot of these health influencers have trouble with alcohol.

And then there’s the nocebo effect.

If you have the preconceived notion drilled into your head from podcasts telling you how dangerous alcohol is, you might have an outsized negative response to alcohol. Remember, placebo goes both ways. 

But, worst of all, you’ve got the guys who live and die by the last study they read.

Guys who have spent so many hours digging through the weeds of observational data linking alcohol intake to certain maladies that they are convinced of, and now go looking for, the slightest perturbation to their subjective health homeostasis to confirm what they have been researching are bound to “feel bad” when they have a glass of Malbec.

Okay, so maybe the danger of alcohol to the brain has been overstated. Are there actual benefits to drinking?

There are.

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