Latest / Hardiness with Dr Paul Taylor / The Alcohol & Health Story Isn’t as Simple as You Think: Wisdom Wednesdays
Transcript
- 0:06Speaker 1: Hey everybody, welcome to another edition of Wisdom Wednesdays. Now,
- 0:09Speaker 1: unless you've been living under a rock, you'll have noticed
- 0:12Speaker 1: that the message around alcohol has changed quite dramatically over
- 0:17Speaker 1: the last decade or so. We used to hear a
- 0:20Speaker 1: lot about the possible benefits of a glass of red
- 0:22Speaker 1: wine in particular, things like the French paradox, cardiovascular protection,
- 0:28Speaker 1: resveratrol and all that stuff. And these days, the message
- 0:32Speaker 1: is much more straightforward. Alcohol is bad for you, And increasingly,
- 0:37Speaker 1: we're told that there is no safe level of alcohol consumption. Now,
- 0:42Speaker 1: from a purely physical health perspective, there's actually plenty of
- 0:46Speaker 1: evidence behind that shift. Alcohol is known as a group
- 0:49Speaker 1: one carcinogen, and it's associated with a number of different cancers.
- 0:54Speaker 1: And although the absolute risk from an occasional drink may
- 0:58Speaker 1: be very small, there doesn't appear to be a magical
- 1:02Speaker 1: threshold below which the cancer risk in particular disappears completely.
- 1:07Speaker 1: And then in 2018, we had the huge global burden
- 1:12Speaker 1: of disease study published in the journal The Lancet. It
- 1:16Speaker 1: looked at alcohol consumption across 195 countries and territories and
- 1:20Speaker 1: examined 23 different alcohol-related health outcomes. And the headline conclusion
- 1:26Speaker 1: was pretty stark. When all of those outcomes were considered together,
- 1:31Speaker 1: the level of alcohol associated with the lowest overall health
- 1:35Speaker 1: risk was essentially zero. And in the same paper, alcohol
- 1:39Speaker 1: was also named as the seventh leading risk factor for
- 1:43Speaker 1: death and disability globally. And among people aged 15 to 49,
- 1:48Speaker 1: it was actually the leading risk factor. So the old
- 1:51Speaker 1: thinking that one or two glasses of wine a night
- 1:54Speaker 1: is a longevity intervention has pretty much been torpedoed by science.
- 1:59Speaker 1: But here's where I think the conversation needs a little
- 2:02Speaker 1: more nuance, because the idea alcohol isn't good for you
- 2:07Speaker 1: and every drink causes a meaningful amount of harm are
- 2:11Speaker 1: not quite the same statement. And a really interesting meta-analysis
- 2:15Speaker 1: published by Azao and colleagues in JAMA Network Open in
- 2:19Speaker 1: 2023 looked at 107 cohort studies in involving just under
- 2:26Speaker 1: 5 million people. And there were more than 425,000 deaths
- 2:32Speaker 1: in this cohort. And the researchers were particularly interested in
- 2:35Speaker 1: something called the former drinker bias, sometimes known as the
- 2:41Speaker 1: sick quitter effect. And here's the problem. In quite a
- 2:45Speaker 1: lot of older alcohol research where we found that alcohol
- 2:49Speaker 1: are small amounts were good for you, the non-drinking group
- 2:53Speaker 1: also included not only people who had never drunk alcohol,
- 2:56Speaker 1: but also people who had stopped drinking. And it turns
- 2:59Speaker 1: out that some of those people had stopped drinking precisely
- 3:02Speaker 1: because they were getting older or had become unwell, or
- 3:06Speaker 1: they had problematic alcohol consumption and really had to stop.
- 3:11Speaker 1: And if you put those former drinkers into the abstainer group,
- 3:15Speaker 1: the abstainers suddenly looked less healthy and the people having
- 3:18Speaker 1: a glass or two of wine can appear healthier by comparison.
- 3:22Speaker 1: even if the alcohol itself isn't providing any benefit. So
- 3:26Speaker 1: when the researchers adjusted for this and some other issues
- 3:30Speaker 1: they found, that supposed longevity advantage of moderate drinking largely disappeared,
- 3:36Speaker 1: which is supportive of the Lancet study I mentioned earlier.
- 3:39Speaker 1: But there was another part of the result that I
- 3:41Speaker 1: think gets less attention. They also didn't find a statistically
- 3:46Speaker 1: significant increase in all-cause mortality at lower levels of consumption.
- 3:52Speaker 1: It turns out in their analysis of almost 5 million
- 3:55Speaker 1: people that occasional drinkers and people consuming up to 24
- 3:59Speaker 1: grams of alcohol a day were not significantly different in
- 4:04Speaker 1: their all-cause mortality risk from lifetime abstainers. And even the
- 4:10Speaker 1: group consuming 25 to 44 grams per day had a
- 4:14Speaker 1: small increase that wasn't statistically significant. Now I talk about
- 4:18Speaker 1: grams because It's different, a standard drink is different in
- 4:22Speaker 1: different countries. 24 grams is about 1.7 standard drinks in
- 4:27Speaker 1: the US, but 2.4 standard drinks here in Australia, which
- 4:32Speaker 1: is why we use grams to kind of have that
- 4:35Speaker 1: overall effect. Now, it was at 45 to 64 grams
- 4:41Speaker 1: per day, which is three to four and a half
- 4:44Speaker 1: standard US drinks or four and a half to six
- 4:46Speaker 1: and a half standard Australian drinks. that the mortality signal,
- 4:51Speaker 1: all-cause mortality, became really clear, about 19% higher. And above
- 4:57Speaker 1: 65 grams a day, it was about 35% higher, which
- 5:00Speaker 1: is pretty whopping. So we're not talking about a very
- 5:04Speaker 1: clear cutoff here where alcohol suddenly becomes harmless. We're talking
- 5:08Speaker 1: about a dose-response relationship where the measurable risk becomes much
- 5:13Speaker 1: more obvious as consumption increases. There's also good evidence that
- 5:17Speaker 1: the old idea of alcohol being protective for the heart
- 5:20Speaker 1: was probably exaggerated. And a 2022 JAMA Network open study
- 5:26Speaker 1: involving more than 371,000 people from the UK Biobank found
- 5:31Speaker 1: that light and moderate drinkers tended to have healthier lifestyles
- 5:35Speaker 1: in general. They exercised more, smoked less, had lower BMI
- 5:39Speaker 1: and ate more vegetables. Now, once some of those differences
- 5:43Speaker 1: were taken into account, much of the apparent cardiovascular protection
- 5:46Speaker 1: for moderate alcohol consumption completely disappeared. Their genetic analysis pointed
- 5:52Speaker 1: in the same direction. Alcohol intake was associated with increasing
- 5:57Speaker 1: cardiovascular risks, although importantly, The increase was relatively small at
- 6:03Speaker 1: low intakes and became much steeper with heavier drinking. Now,
- 6:07Speaker 1: even the global burden of disease group that I talked
- 6:10Speaker 1: about earlier, they subsequently added some nuance to their original message.
- 6:15Speaker 1: Their 2022 analysis found that alcohol risk varied considerably depending
- 6:21Speaker 1: on age and background disease patterns. For people aged 15
- 6:25Speaker 1: to 39, the level associated with minimal overall risk was
- 6:29Speaker 1: generally zero or very close to zero. But in adults
- 6:31Speaker 1: over 40, the aggregated risk curves were often J-shaped because
- 6:36Speaker 1: small amounts of alcohol may lower the risk of certain
- 6:39Speaker 1: cardiovascular outcomes while simultaneously increasing other risks. So their conclusion
- 6:47Speaker 1: wasn't that middle-aged people should start drinking. but that the
- 6:50Speaker 1: relationship between alcohol and total health risk isn't identical for
- 6:54Speaker 1: everyone and the waters are a bit murky. Now, when
- 6:58Speaker 1: we take all of this together, I think the reasonable
- 7:01Speaker 1: interpretation is this. The old story that a couple of
- 7:04Speaker 1: drinks every night will make you live longer hasn't held
- 7:06Speaker 1: up particularly well, but neither should we pretend that having
- 7:10Speaker 1: one or two glasses of wine carries anything remotely resembling
- 7:14Speaker 1: the risk of regularly having four or six. Dose clearly matters.
- 7:19Speaker 1: And there's another piece of biological evidence that's emerged very recently.
- 7:24Speaker 1: In June, 2026, there was a review published in pharmacological
- 7:30Speaker 1: reports looking specifically at relationship between alcohol and serotonin. Now serotonin,
- 7:36Speaker 1: as you know, is involved in mood, but also stress,
- 7:38Speaker 1: impulse control and aggression and relationship with alcohol appears to
- 7:42Speaker 1: work in both directions. So disrupted serotonergic function may increase
- 7:48Speaker 1: vulnerability to some forms of alcohol use disorder, while chronic
- 7:52Speaker 1: alcohol exposure itself changes the serotonin system, including serotonin production,
- 7:59Speaker 1: serotonin transport, and serotonin receptors. And those adaptations may then
- 8:05Speaker 1: contribute during withdrawal to anxiety, low mood, craving, and relapse.
- 8:10Speaker 1: Now that's important because we have to be precise about
- 8:13Speaker 1: what the paper actually studied. It's largely a review of
- 8:17Speaker 1: chronic alcohol use and alcohol use disorder. And a lot
- 8:21Speaker 1: of the mechanistic evidence comes from animal models. So we
- 8:24Speaker 1: shouldn't take it and claim that somebody having two glasses
- 8:27Speaker 1: of wine over a long dinner is wrecking their serotonin
- 8:30Speaker 1: system because that's not what the evidence shows. What it
- 8:34Speaker 1: does reinforce is that chronic and heavy alcohol exposure is
- 8:38Speaker 1: can substantially alter brain chemistry. And once again, pattern and
- 8:43Speaker 1: dose matter enormously. And I think everyone is aware of
- 8:48Speaker 1: the societal problems of alcohol misuse disorder on both social
- 8:52Speaker 1: and domestic violence and general bad behavior. So if we
- 8:57Speaker 1: stop there, we'd have a perfectly reasonable Wisdom Wednesday. about
- 9:02Speaker 1: why drinking less or abstaining completely is probably the best
- 9:06Speaker 1: for your physical and mental health. And that is what
- 9:10Speaker 1: the physiology said. But I'm a psychophysiologist and we have
- 9:14Speaker 1: to talk about the psychology because I came across another
- 9:18Speaker 1: paper recently that made me think that there's another side
- 9:21Speaker 1: to this conversation that many people who drink alcohol will recognize.
- 9:25Speaker 1: Not another side to whether alcohol causes cancer and not
- 9:29Speaker 1: some clever argument that alcohol is secretly good for your arteries.
- 9:33Speaker 1: I'm talking about another side to being human. So in 2025,
- 9:38Speaker 1: James Nichols and Geoffrey Hunt published a paper in the
- 9:42Speaker 1: journal Addiction with the cool title, Taking Pleasure Seriously. Should
- 9:48Speaker 1: Alcohol Research Say More About Fun? Their basic point was
- 9:53Speaker 1: pretty simple. Public health alcohol research has become incredibly good
- 9:59Speaker 1: at measuring hormones. think cancer liver disease cardiovascular disease addiction
- 10:04Speaker 1: accidents violence mortality but if you're actually trying to understand
- 10:08Speaker 1: why human beings drink alcohol there's something rather obvious missing
- 10:13Speaker 1: from that list lots of people me included enjoy a
- 10:17Speaker 1: drink especially in social settings Now, Nichols and Hunt argue
- 10:21Speaker 1: that this matters for three reasons. Scientifically, if pleasure is
- 10:27Speaker 1: one of the major reasons people drink, you can't properly
- 10:31Speaker 1: understand drinking behavior while excluding pleasure from your research. Ethically,
- 10:37Speaker 1: they argue that it's not self-evident that maximizing long-term physical
- 10:42Speaker 1: health should be the only things that human beings value.
- 10:45Speaker 1: And practically, If health authorities describe drinking in a way
- 10:49Speaker 1: that bears absolutely no resemblance to people's lived experience, there's
- 10:54Speaker 1: a danger that people simply stop listening to the message altogether.
- 10:59Speaker 1: I think that's a really important point because none of
- 11:03Speaker 1: us actually live our lives according to the principle of
- 11:06Speaker 1: eliminating every possible risk. If we did, life would be
- 11:11Speaker 1: pretty damn dull. We eat desserts, we ski, we surf,
- 11:16Speaker 1: we ride motorbikes, we do risky sports, we stay up
- 11:20Speaker 1: until one in the morning talking to someone we haven't
- 11:22Speaker 1: seen for years, we fly halfway around the world to
- 11:25Speaker 1: go traveling, we sit around a table eating and drinking
- 11:29Speaker 1: for three hours when from a purely metabolic point of view,
- 11:33Speaker 1: we'd be much better off eating salmon and broccoli at
- 11:36Speaker 1: six o'clock and being tucked up in bed by 10.
- 11:39Speaker 1: Human beings constantly make trade-offs between longevity and pleasure, experience, relationships,
- 11:46Speaker 1: and meaning. And that's not irrational, that is called living.
- 11:50Speaker 1: And at the risk of glorifying alcohol, which is not
- 11:53Speaker 1: what I want to do, some of the most memorable occasions,
- 11:56Speaker 1: which I will remember until my 90s, that I've ever had,
- 12:00Speaker 1: have involved alcohol. And admittedly, some pretty stupid but hilarious antics.
- 12:06Speaker 1: I seriously don't remember anything ever catching up with old
- 12:11Speaker 1: Navy or uni mates and saying, hey, do you remember
- 12:13Speaker 1: that time we went for a coffee? What a legendary
- 12:17Speaker 1: time that was. I personally, and you may as well,
- 12:21Speaker 1: have a long list of stories that I'll dine out
- 12:24Speaker 1: on for years, and not one of them involves sitting
- 12:28Speaker 1: around having avocado on toast. And that takes us to
- 12:32Speaker 1: research of Oxford evolutionary psychologist Robin Dunbar. Now, Dunbar and
- 12:38Speaker 1: colleagues published a fascinating paper in 2017 called Functional Benefits
- 12:44Speaker 1: of Modest Alcohol Consumption. They started with a very different question.
- 12:49Speaker 1: Alcohol has been part of human social life for thousands
- 12:54Speaker 1: of years and appears in one form or another in
- 12:57Speaker 1: cultures all over the world. So why has it been
- 13:00Speaker 1: so persistent? Their work combined three different studies, including a
- 13:05Speaker 1: nationally representative UK survey of 2,200-odd adults, along with questionnaire
- 13:13Speaker 1: and observational studies in pubs. And what they found was
- 13:17Speaker 1: that social drinkers tended to report having more people they
- 13:22Speaker 1: could turn to for emotional and practical support, greater trust
- 13:26Speaker 1: in other people, and a stronger sense of connection to
- 13:30Speaker 1: their local community. People who had a regular local pub
- 13:34Speaker 1: tended to be particularly socially connected. Now, obviously, I don't
- 13:39Speaker 1: want you to interpret that as beer creates friendships. These
- 13:42Speaker 1: are observational relationships. And it could be that naturally sociable
- 13:48Speaker 1: people are more likely to go to the pub in
- 13:50Speaker 1: the first place. Dunbar and his colleagues were very clear
- 13:53Speaker 1: about those limitations in their study. But they also proposed
- 13:57Speaker 1: a very interesting biological mechanism. Alcohol can stimulate the endogenous
- 14:03Speaker 1: opioid system, what we call the endorphin system. And that
- 14:07Speaker 1: system plays a really important role in social bonding. And
- 14:11Speaker 1: what else activates that system? Laughing together, singing, dancing, storytelling.
- 14:16Speaker 1: These are things human beings have been doing socially for
- 14:20Speaker 1: an extremely long time. Dunbar's suggestion is that moderate alcohol
- 14:24Speaker 1: consumption in a social environment may amplify the same bonding
- 14:29Speaker 1: processes involved in those other social rituals. And I think
- 14:34Speaker 1: many of us who do consume alcohol will realize you
- 14:37Speaker 1: don't need a PhD to come up with that idea.
- 14:40Speaker 1: And there's also pretty interesting experimental evidence suggesting that something
- 14:46Speaker 1: real is happening here. Michelle Syatt and colleagues at the
- 14:50Speaker 1: University of Pittsburgh carried out one of the largest alcohol
- 14:53Speaker 1: administration studies of its kind. So what they did is
- 14:56Speaker 1: they recruited 720 social drinkers, put complete strangers into groups
- 15:01Speaker 1: of three, and randomly gave them either an alcoholic drink,
- 15:06Speaker 1: a placebo drink, or a non-alcoholic controlled drink. They then
- 15:10Speaker 1: recorded their interactions and painstakingly analysed facial expressions, smiling, speech,
- 15:17Speaker 1: and other behaviours. The people who received alcohol showed more
- 15:21Speaker 1: behaviors associated with positive emotion, fewer behaviors associated with negative emotion,
- 15:27Speaker 1: and reported greater bonding with the other members of the group.
- 15:32Speaker 1: In other words, under those controlled conditions of just a drink,
- 15:35Speaker 1: this wasn't like six drinks, alcohol did appear to facilitate
- 15:39Speaker 1: social bonding during the formation of a new group. Now,
- 15:44Speaker 1: that doesn't mean that we need alcohol to connect. Clearly,
- 15:47Speaker 1: we don't. Laughing, exercise, music, singing, dancing, sport, shared meals,
- 15:52Speaker 1: and storytelling can all create social connection without alcohol being
- 15:57Speaker 1: involved at all. But it does mean that when someone says,
- 16:01Speaker 1: I enjoy having a drink with my mates or friends
- 16:03Speaker 1: because it helps us relax and have a laugh, science
- 16:06Speaker 1: shouldn't respond by pretending they're imagining the entire experience and
- 16:11Speaker 1: taking them off because they're damaging their health. And here's
- 16:14Speaker 1: what I think becomes even more interesting because social connection
- 16:18Speaker 1: itself is incredibly important for health. And in my latest book,
- 16:24Speaker 1: The Hardiness Effect, I discussed the research where Julianne Holt-Lunstad
- 16:29Speaker 1: and colleagues, they published a landmark meta-analysis in the journal
- 16:34Speaker 1: PLOS Medicine involving 148 studies and more than 308,000 people.
- 16:40Speaker 1: And across those studies, people with stronger social relationships had
- 16:45Speaker 1: around a 50% greater likelihood of survival during the follow-up
- 16:49Speaker 1: period compared to people with weaker social relationships. Now, before
- 16:55Speaker 1: anybody edits this into a reel saying Paul Taylor says
- 16:59Speaker 1: drinking gives you a 50% survival advantage, that's not what
- 17:03Speaker 1: I'm saying. The Health Association is with Social Connection, not
- 17:07Speaker 1: with alcohol, but alcohol can help facilitate it, right, on occasion.
- 17:13Speaker 1: This is exactly why I think the discussion becomes more
- 17:16Speaker 1: interesting once you zoom out from a single molecule. If
- 17:21Speaker 1: you look only at the alcohol and the physiological pathways
- 17:25Speaker 1: in the body, you see cautionogenic effects, you see cardiovascular effects,
- 17:29Speaker 1: you see liver disease, and you see neurobiological effects. Now,
- 17:33Speaker 1: they are real and important, but if you zoom out
- 17:36Speaker 1: and look at the person sitting around a table laughing
- 17:39Speaker 1: with five people they love, there is another set of
- 17:41Speaker 1: things happening as well. Health doesn't just happen inside your
- 17:45Speaker 1: liver or your coronary arteries. It happens inside a life,
- 17:49Speaker 1: and that life includes relationships, friendships, pleasure, ritual, celebration, and belonging. Now,
- 17:55Speaker 1: there was a response to Nicholson Hunt's paper in the
- 17:59Speaker 1: same issue of addiction from psychologists James Morris and Emma Davies,
- 18:03Speaker 1: who argued that public health messaging needs to grapple with
- 18:08Speaker 1: exactly this problem. If the message essentially becomes there is
- 18:13Speaker 1: nothing whatsoever positive about drinking and we should all stop,
- 18:18Speaker 1: while people's own lived experience tells them that there sometimes
- 18:21Speaker 1: is something positive, then that health message completely loses its
- 18:27Speaker 1: credibility or is at significant risk of losing its credibility
- 18:31Speaker 1: with a large subset of the population. And I think
- 18:34Speaker 1: that's right. If somebody loves sitting down on a Friday
- 18:38Speaker 1: night with their partner and sharing a bottle of wine
- 18:40Speaker 1: over dinner, and you tell them there's absolutely nothing positive
- 18:45Speaker 1: occurring in that experience, they're probably going to think, well,
- 18:47Speaker 1: that's clearly bollocks. And once you've lost them there, maybe
- 18:52Speaker 1: they pay less attention when you're telling them something genuinely
- 18:56Speaker 1: important about cancer risk dependence, or drinking five bottles of
- 19:00Speaker 1: wine a week. I also think, as many of you will,
- 19:04Speaker 1: that there's a big difference between drinking with someone and
- 19:07Speaker 1: drinking because of something. Sitting alone at home pouring glass
- 19:13Speaker 1: after glass of wine or having a truckload of beers
- 19:16Speaker 1: because you've had a really stressful day or week or
- 19:20Speaker 1: you're in a shit relationship and you want to numb
- 19:23Speaker 1: yourself is psychologically very different from sitting around a table
- 19:27Speaker 1: drinking with mates or people you love sharing a meal,
- 19:30Speaker 1: laughing and having a couple of drinks. The ethanol molecule
- 19:34Speaker 1: might be identical, but the behaviour, motive and social context
- 19:38Speaker 1: are completely different. And perhaps that's where parts of modern
- 19:43Speaker 1: health culture occasionally get themselves tied up in knots. We've
- 19:47Speaker 1: become very good at asking what increases my risk of disease? Now,
- 19:51Speaker 1: that's an important question and we should ask it, but
- 19:54Speaker 1: it's not the only question worth asking. We should also ask,
- 19:59Speaker 1: what makes my life enjoyable, meaningful and connected? Sometimes those
- 20:04Speaker 1: two questions point in exactly the same direction. Exercise is
- 20:08Speaker 1: great for you and can be enormously enjoyable. Good relationships
- 20:12Speaker 1: are both pleasurable and associated with better health. But sometimes
- 20:15Speaker 1: there's a trade-off. And that's why I don't think the
- 20:19Speaker 1: lesson from any of these papers is that alcohol is
- 20:23Speaker 1: good for you. It isn't a health food. And if
- 20:25Speaker 1: you don't drink, there's absolutely no health reason to start drinking.
- 20:29Speaker 1: If you're drinking heavily, however, using alcohol as your primary
- 20:33Speaker 1: coping mechanism, losing control of your consumption or your life
- 20:37Speaker 1: or finding it's affecting your sleep, relationships, mood or health,
- 20:41Speaker 1: none of this social bonding research cancels those harms out.
- 20:45Speaker 1: What the evidence is suggesting to me is something a
- 20:48Speaker 1: bit more grown up than either alcohol is good for
- 20:52Speaker 1: you or every sip is poisoning you. Dose matters, frequency matters,
- 20:57Speaker 1: patterns matters, motive matters and context matters. Perhaps the most
- 21:02Speaker 1: interesting lesson from Dunbar's work is that the alcohol may
- 21:07Speaker 1: not even be the most important ingredient in the situations
- 21:10Speaker 1: we value. Maybe the really powerful ingredients are the people,
- 21:14Speaker 1: the ritual, the shared meal, the laughter, the stories, and
- 21:17Speaker 1: that feeling that you're part of something. And if a
- 21:20Speaker 1: little bit of alcohol can help facilitate or enhance those things,
- 21:24Speaker 1: then maybe that offsets a big chunk of the risk.
- 21:28Speaker 1: Because health isn't simply about adding years to your life,
- 21:31Speaker 1: it's also about what you put into those years. Sometimes
- 21:35Speaker 1: that's an early night, a hard training session and a
- 21:37Speaker 1: green smoothie. And sometimes it's sitting around a table with
- 21:41Speaker 1: people you love, eating great food and talking absolute shit
- 21:45Speaker 1: over a glass of wine or a few beers. Both
- 21:49Speaker 1: things can be true. That's it for this week, folks.
- 21:52Speaker 1: Catch you next time.