Glad to see my advice fits in with all three of y’all. I have these same discussions with people. John, you said, “I’m not a preacher”. Funny you mention that, bc I am actually a deacon at my church and find that patients quite frequently want to discuss spiritual issues with me…including the spiritual issues of drinking. I have sort incorporated my advice to them (which can be supported by the Bible) into all my alcohol talks. I tell my patients, “If it’s alcohol that ‘powers the sails of your life’, you need to regain self control. If it’s a moderated and controlled adjunct to the joy of your life that God has graciously bestowed upon you, cheers!”
Admittedly, I am a drinker. While a young man I drank a lot of beer. Now as a 67 year old I drink on average a couple glasses of wine 3-4 nights a week (occasionally exchange wine for good rum). Every year I change my diet for 6 weeks and forego alcohol along with eating a low fat diet. I lose 20 lbs in that time. With that bias, I figured a napkin math problem using the cancer/alcohol connection from the surgeon general's stats. Looked like at worst I have a .8% chance of dying from getting cancer from drinking(this includes alcoholics in the stats that drink much more than me) and if I get those cancers would lose less than 4 years of my life. My father with a similar set of genes and similar drinking habits died at 99. My mother who drank very little died of breast cancer at 73. I think I am not impressed with the WHO and surgeon general's pronouncements. No change in drinking habits for me.
The one thing that has proven to provide good health over many, many studies is regular exercise. I swim 2-3 times a week (mile and a half), x-country ski during the winter, walk, and have started to work out in the gym for weight bearing exercise purposes. Now I might not live a long life, but I am currently living a very pleasant one. Living forever has never been a goal and even less now as I have watched the way my parents and my wife's parents died and lived their last few years (all but my mom in their late 80s or 90s).
Doctors work best when they treat problems using the best science and stay away from morality issues. Public health has taken a black eye recently, maybe two, and needs to gain the trust of the public again. This didn't help.
I somehow recall that beverage alcohol inhibits a particular enzyme (or set of enzymes) that are crucially involved in mobilizing body fat for use as an energy source when calorie intake is restricted purposely for weight reduction. I no longer drink wine or other alcoholic beverages (and Vinay, I agree that wine is damned good with dinner) because my sleep quality thereby improved greatly as a result. I have found also that I'm able to fairly easily shed 5-7 pounds every spring with modest calorie restriction plus my daily 4-mile walk that usually takes just over 60 minutes. The zero booze program means in my case: Sleep quality great, belly girth tamed, and probably most importantly an obvious risk factor for developing AF is not in play. As an active 81 year-old licensed skydiver and wind tunnel flyer, l'm absolutely screwed if I need to be anti-coagulated.
Having said that n=1. Having any amount of wine affects my sleep quality. I struggle with enjoying life and extending my time here. I enjoy wine. I enjoy ice cream. I am of the mind now that I would prefer a shorter quality life to a longer life consisting of doctor visits and medication.
Excellent discussion. My advice probably aligns most with John's, as I see mostly patients with atrial fibrillation - suggest 2-3 drinks/week or less for them. For other cardiovascular patients I generally discourage daily habitual drinking but not too forcefully unless patients are above the 7-14 drink/week threshold or have signs/symptoms of alcohol use disorder.
I read a report that any amount of alcohol shrinks ones brain. Then I read a story of a US scientist who joined a French research team and the one hour lunches that obviously included a glass of wine. A ha, that’s the French paradox! Being 87 with afib, I’ve stopped alcohol — no physics team to join. However, a former student worker at the University is the wine maker at his parents’ Napa winery. (His brother cares the vines.) He’s invited me agin, so I’ll enjoy a convivial glass. It’ll be from one of the few I’ve saved from the case his sister delivered while I was lab manager, and Chris was one of my student workers. (Previous century)
My patient population is easy. I get the ones whose needle tipped to the addiction side, which I define by the “two fisted method!” Fist one - drinking. Fist two - threatening or adverse consequences. If both are filled I do my part to help them find a lifestyle that will help them get well, for now they are dealing with a chronic, progressive, and fatal illness. That being said, I manage my disease quite well and would happily bring a bottle of wine to Vinay’s party for all to enjoy! I refuse to make my problem others’ responsibility - my statement to some crybaby comments seen on Vinay’s post…
Sadly, after the scales fell from my eyes over the last few years, I find myself unable to blindly trust pronouncements from public health officials. If this topic was important to me I would have to start reviewing the literature.
No doubt it would be messy and full of contradictions. Probably because the signals are small enough that they are hard to isolate and see clearly.
Sadly if I drink after dinner time my sleep is horrible, and for some reason it's socially unacceptable to have a couple of whiskys in the middle of the day :)
I tell my patients that the only RCTs of diet to show reduction in CV outcomes (in primary- PREDIMED - and secondary - Lyon Heart -prevention) pertain to the Mediterranean diet. And those folks do consume alcohol. So there’s no reason NOT to do it, in moderation.
But I also tell them NOT to drink expressly for health benefits.
Finally, if I’m seeing them for AF, I tell them there is RCT data (ALCOHOL-AF) that cutting back from moderate use will reduce their AF burden.
Wow, those are some big glasses. Usually get 5 glasses out of a bottle of wine.. So 2 glasses = 40% or 300ML. 225 calories. Not nothing, but a lot less than your calculation.
That’s where asking about the dose is important! Because “generous” is highly subjective. My typical glass is 187ml or 1/4 bottle but I am sure that the vast majority of people have not actually weighed their wine.
Yep, my comes from experience. 5 glasses is average for every bottle I open. I think my red wine glasses would be filled close to the top with more than half a bottle in them which defeats the purpose of having red wine glasses.
IIRC red wine is 10-12% abv so in 500ml there’s probably 50-60g of alcohol which means 350-420 calories from alcohol. The rest would be carbs, so at most 25g in those 2 generous glasses. If I’m tracking macros though, I usually enter my calories from alcohol as carbs…because it’s surely not fat and definitely not protein!
Glad to see my advice fits in with all three of y’all. I have these same discussions with people. John, you said, “I’m not a preacher”. Funny you mention that, bc I am actually a deacon at my church and find that patients quite frequently want to discuss spiritual issues with me…including the spiritual issues of drinking. I have sort incorporated my advice to them (which can be supported by the Bible) into all my alcohol talks. I tell my patients, “If it’s alcohol that ‘powers the sails of your life’, you need to regain self control. If it’s a moderated and controlled adjunct to the joy of your life that God has graciously bestowed upon you, cheers!”
So well said.
Admittedly, I am a drinker. While a young man I drank a lot of beer. Now as a 67 year old I drink on average a couple glasses of wine 3-4 nights a week (occasionally exchange wine for good rum). Every year I change my diet for 6 weeks and forego alcohol along with eating a low fat diet. I lose 20 lbs in that time. With that bias, I figured a napkin math problem using the cancer/alcohol connection from the surgeon general's stats. Looked like at worst I have a .8% chance of dying from getting cancer from drinking(this includes alcoholics in the stats that drink much more than me) and if I get those cancers would lose less than 4 years of my life. My father with a similar set of genes and similar drinking habits died at 99. My mother who drank very little died of breast cancer at 73. I think I am not impressed with the WHO and surgeon general's pronouncements. No change in drinking habits for me.
The one thing that has proven to provide good health over many, many studies is regular exercise. I swim 2-3 times a week (mile and a half), x-country ski during the winter, walk, and have started to work out in the gym for weight bearing exercise purposes. Now I might not live a long life, but I am currently living a very pleasant one. Living forever has never been a goal and even less now as I have watched the way my parents and my wife's parents died and lived their last few years (all but my mom in their late 80s or 90s).
Doctors work best when they treat problems using the best science and stay away from morality issues. Public health has taken a black eye recently, maybe two, and needs to gain the trust of the public again. This didn't help.
I somehow recall that beverage alcohol inhibits a particular enzyme (or set of enzymes) that are crucially involved in mobilizing body fat for use as an energy source when calorie intake is restricted purposely for weight reduction. I no longer drink wine or other alcoholic beverages (and Vinay, I agree that wine is damned good with dinner) because my sleep quality thereby improved greatly as a result. I have found also that I'm able to fairly easily shed 5-7 pounds every spring with modest calorie restriction plus my daily 4-mile walk that usually takes just over 60 minutes. The zero booze program means in my case: Sleep quality great, belly girth tamed, and probably most importantly an obvious risk factor for developing AF is not in play. As an active 81 year-old licensed skydiver and wind tunnel flyer, l'm absolutely screwed if I need to be anti-coagulated.
Thanks for the great Substack. This post tipped the balance for me -- and I'm now a paid subscriber, rather than a freeloader! :)
Thank you Jon. (Though we appreciate the free loaders too!)
Having said that n=1. Having any amount of wine affects my sleep quality. I struggle with enjoying life and extending my time here. I enjoy wine. I enjoy ice cream. I am of the mind now that I would prefer a shorter quality life to a longer life consisting of doctor visits and medication.
Excellent discussion. My advice probably aligns most with John's, as I see mostly patients with atrial fibrillation - suggest 2-3 drinks/week or less for them. For other cardiovascular patients I generally discourage daily habitual drinking but not too forcefully unless patients are above the 7-14 drink/week threshold or have signs/symptoms of alcohol use disorder.
I read a report that any amount of alcohol shrinks ones brain. Then I read a story of a US scientist who joined a French research team and the one hour lunches that obviously included a glass of wine. A ha, that’s the French paradox! Being 87 with afib, I’ve stopped alcohol — no physics team to join. However, a former student worker at the University is the wine maker at his parents’ Napa winery. (His brother cares the vines.) He’s invited me agin, so I’ll enjoy a convivial glass. It’ll be from one of the few I’ve saved from the case his sister delivered while I was lab manager, and Chris was one of my student workers. (Previous century)
As long as it follows the Reinheitsgebot or is a red. Try a Carmenere or a good Rioja. A good Chianti. Arriba, abajo, al centro, Pa’dentro 😂
My patient population is easy. I get the ones whose needle tipped to the addiction side, which I define by the “two fisted method!” Fist one - drinking. Fist two - threatening or adverse consequences. If both are filled I do my part to help them find a lifestyle that will help them get well, for now they are dealing with a chronic, progressive, and fatal illness. That being said, I manage my disease quite well and would happily bring a bottle of wine to Vinay’s party for all to enjoy! I refuse to make my problem others’ responsibility - my statement to some crybaby comments seen on Vinay’s post…
Sadly, after the scales fell from my eyes over the last few years, I find myself unable to blindly trust pronouncements from public health officials. If this topic was important to me I would have to start reviewing the literature.
No doubt it would be messy and full of contradictions. Probably because the signals are small enough that they are hard to isolate and see clearly.
Sadly if I drink after dinner time my sleep is horrible, and for some reason it's socially unacceptable to have a couple of whiskys in the middle of the day :)
I tell my patients that the only RCTs of diet to show reduction in CV outcomes (in primary- PREDIMED - and secondary - Lyon Heart -prevention) pertain to the Mediterranean diet. And those folks do consume alcohol. So there’s no reason NOT to do it, in moderation.
But I also tell them NOT to drink expressly for health benefits.
Finally, if I’m seeing them for AF, I tell them there is RCT data (ALCOHOL-AF) that cutting back from moderate use will reduce their AF burden.
I’d be delighted to be a guest at your dinner party Vinay and will bring a wonderful bottle of red to share and enjoy!
Wine isnt loaded with carbohydrates tho, is it ?
2 generous glasses of red wine is probably 2/3 of a bottle or 500mL which is probably anywhere from 400-450 calories.
So, if somebody is trying to lose body fat, cutting that out would probably cut about 1lb/week.
Wow, those are some big glasses. Usually get 5 glasses out of a bottle of wine.. So 2 glasses = 40% or 300ML. 225 calories. Not nothing, but a lot less than your calculation.
That’s where asking about the dose is important! Because “generous” is highly subjective. My typical glass is 187ml or 1/4 bottle but I am sure that the vast majority of people have not actually weighed their wine.
Yep, my comes from experience. 5 glasses is average for every bottle I open. I think my red wine glasses would be filled close to the top with more than half a bottle in them which defeats the purpose of having red wine glasses.
Ha! Well I’m an uncultured swine who drinks wine from pint glasses I’ve accumulated from various breweries over my adult life. 😂
sorry, I meant carbohydrates
IIRC red wine is 10-12% abv so in 500ml there’s probably 50-60g of alcohol which means 350-420 calories from alcohol. The rest would be carbs, so at most 25g in those 2 generous glasses. If I’m tracking macros though, I usually enter my calories from alcohol as carbs…because it’s surely not fat and definitely not protein!