
Relation between alcohol consumption in midlife and dementia in late life - barking
https://www.bmj.com/content/362/bmj.k3164
======
newswriter99
>Abstainers were mainly women, had lower education and physical activity, were
obese, and had a higher prevalence of cardiometabolic risk factors, all
associated with an increased risk of dementia,11,12 which could explain the
differences; however, adjustment for confounding factors did not alter the
findings.

This is why interactive data visualization is so important. People need to be
able to adjust the results of data to fit them, otherwise the margin of error
and deviation from the "average" will be so great, findings are virtually
useless to an individual.

~~~
kazinator
> _however, adjustment for confounding factors did not alter the findings._

Let me guess: adjusting for confounding factors means throwing away most of
the data, so that all that remains is a small group of abstainers and non-
abstainers who are similar in all regards except for the abstinence.

Problem is, there may be more than one way to do that, with different results;
then it's possible to choose a way of reducing the data to fit the desired
hypothesis.

The only honest way to fix a confounding bias in the data is to re-do the
study with a properly randomized sample of subjects.

~~~
SubiculumCode
Are you seriously suggesting a study in which people are randomly assigned
people to drinking conditions for decades? That is perposterous.

Edit: To be clear, assignment to drinking conditions and following them over
decades is unrealistic, would have problems with participant compliance, and
is probably unethical.

~~~
jacobolus
I recently saw a study where adults were assigned to drink 1 drink per day or
0 drinks per day, for years, with the drinks subsidized.

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hyperpape
Can anyone tell if this study avoids the "sick quitter" problem?
([https://www.vox.com/2018/4/24/17242720/alcohol-health-
risks-...](https://www.vox.com/2018/4/24/17242720/alcohol-health-risks-facts))

~~~
throwaway183738
See also: “sick non-exerciser”. There’s never enough discussion of correlation
vs causation in these types of studies.

~~~
stakhanov
Also makes you wonder if some of those wine/none-wine-alcohol effects are
really female/male effects.

~~~
jdietrich
There are also class and ethnic biases - wine drinkers are disproportionately
college-educated and caucasian.

~~~
stakhanov
...reading the fulltext now. They were selected from among middle-aged civil
servants in London in the late 80s/early 90s so the sample is way more
homogeneous than the total population, certainly if the U.S. is what you're
thinking of.

~~~
safanycom
In London...

Polluted London, Leaded car fuel London

------
stakhanov
"Abstinence from alcohol in midlife, long term abstinence, and decrease in
consumption were associated with a significantly higher risk of dementia of
45%, 67%, and 50%, respectively, compared with consumption of 1-14 units/week,
but only among participants who reported abstinence from wine."

I don't get that sentence. Doesn't abstinence from alcohol always imply
abstinence from wine? Or is it saying that drinking 1-14 units/wk only lowers
your risk compared to being abstinent if some of that consumption comes in the
form of wine?

~~~
atwebb
The next paragraph follows up a bit, the phrasing is odd but it helps clear up
that the tenuous link is wine/wine components.

>The most intriguing finding from this study was the significantly increased
risk of dementia among abstainers, including long term abstainers and
participants who became abstainers, and that association was only present in
those who abstained from wine.

~~~
kazinator
Doesn't clear up anything. A person who does not abstain from wine is not an
alcohol abstainer.

Among alcohol abstainers, there is no special category of those who abstain
from wine; logically, they all must.

A: "I don't play sports"

B: "Which ones don't you play in particular?"

A: "Tennis."

B: "Ah too bad; the one I particularly don't play is soccer."

A: "I guess we won't be enjoying our non-play of sports together then. Your
avoidance of soccer requires the lack of a big field and complete absence of
half a dozen other players so that a team is not accidentally formed; whereas
my aversion toward tennis requires that there be no court or racquets."

~~~
GuiA
Jean-Paul Sartre is sitting at a French cafe, revising his draft of Being and
Nothingness. He says to the waitress, "I'd like a cup of coffee, please, with
no cream." The waitress replies, "I'm sorry, Monsieur, but we're out of cream.
How about with no milk?”

~~~
emmelaich
Descartes is sitting across the table. The waitress asks him if he would be
having some wine.

He replies. "I think, therefore I am."

------
yosito
> Abstainers were mainly women, had lower education and physical activity,
> were obese, and had a higher prevalence of cardiometabolic risk factors, all
> associated with an increased risk of dementia

Well, pretty hard to draw conclusions from this study then.

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barking
Zero and heavy alcohol consumption could both be side-effects of isolation.
Isolation is associated with dementia as a cause or an effect

------
jf-
My first thought is a relationship with glutamate excitotoxicity. Fronto-
temporal dementia is known to be related to glutamate. If that’s lumped in as
part of the dementia cohort that may help explain the result.

~~~
Herodotus38
Probably not a large factor because the prevalence of frontiers-temporal
dementia is very small compared to vascular, Alzheimer's, Parkinson's.
Anecdotally I see it in less than 1% of dementia patients.

Incidence of FTD is around 2.7-4.1 per 100,000 people.

Incidence for Alzheimer's is estimated to be roughly 10.5 per 1000

So although it's a good thought to have about the correlation, even if 100% of
FTD cases were caused by that mechanism I don't think you'd see the difference
they saw in the study.

Sources:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932112/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932112/)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405821/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405821/)

~~~
jf-
If I remember correctly, the mechanism underlying the glutamate toxicity is
mutant SOD, which is made as a response to oxidative stress. The glutamate is
simply an excitory stimulus that makes free radicals which need to be mopped
up by something. Could be that other proteinopathies are a similar reaction to
oxidative stress, and something that promotes GABA, such as alcohol, has a
beneficial effect. But of course I’m only speculating.

~~~
Herodotus38
I'm not knowledgeable enough about the biology to really add much to what you
said there either, even though I deal with the end results.

Systems biology is one of those areas where I think AI will make a huge
difference in the future. If you are interested in some thoughts on this
listen to the first hour and a half talk by Craig Mundie (you can skip first
20 minutes of intro by Collins) of this recent NIH videocast on AI in
medicine:

[https://videocast.nih.gov/summary.asp?live=28053&bhcp=1](https://videocast.nih.gov/summary.asp?live=28053&bhcp=1)

------
tiatia123
I post it again:

The Truth We Won’t Admit: Drinking Is Healthy

[https://psmag.com/social-justice/truth-wont-admit-
drinking-h...](https://psmag.com/social-justice/truth-wont-admit-drinking-
healthy-87891)

Super smart guy by the way.

I am not sure why this gets downvoted. You may look up who this guy actually
is:
[https://en.wikipedia.org/wiki/Stanton_Peele](https://en.wikipedia.org/wiki/Stanton_Peele)

~~~
hendiatris
In light of this piece I'm curious about how countries with large sober
populations (majority Muslim countries?) compare to others while accounting
for other factors

~~~
mschuster91
> countries with large sober populations (majority Muslim countries?)

Closet drinkers. Pay enough money and you can get alcohol everywhere,
including booze parties in the midst of Teheran. It has been covered e.g.
here: [https://www.independent.co.uk/news/world/middle-
east/drunk-i...](https://www.independent.co.uk/news/world/middle-east/drunk-
in-tehran-the-islamic-state-s-secret-party-scene-9217419.html)

~~~
tonysdg
Reminds me of an Iranian friend I had. We were talking once about weddings in
different cultures, and I asked her about Iranian weddings. She laughed and
told me that despite the ban on alcohol, every man at an Iranian wedding ended
up drunk "somehow".

------
stakhanov
One more thing that comes to mind: So they're comparing people who drink 14
units/week (one beer a day) versus people who drink more than one beer a day.
Are the differences in the effects observed really dominated by the presence
of people in that second group who drink a second beer and then stop their
drinking for the day, or by the presence in that group of really excessive
drinkers.

~~~
Lukman
14 units per week is two drinks a day.

~~~
Lukman
Oh, sorry, just saw explanation below. In the US these studies equate 1 unit =
1 glass of wine or 1 beer, I could swear.

~~~
bunderbunder
That's what a lot of sources in the US say, but, when they say, "drink", they
mean "standard drink", which is this quasi-mythological beverage that one
never encounters in real life.

I honestly think that it's negligent on the part of public health folks to
continue the practice. Saying "Drinking more than 2 drinks in X time will
cause you to be legally impaired" is actively encouraging people to
unwittingly drive drunk in a culture when a typical ABV for beer is about
twice what it was when those standard were originally calculated, and non-
highball cocktails typically contain at least two shots of liquor.

"Unit" is so much better a term.

~~~
cnasc
> when they say, "drink", they mean "standard drink", which is this quasi-
> mythological beverage that one never encounters in real life.

I encounter 12oz bottles and cans of 5% abv beer literally every day

~~~
eadmund
A 12 oz is .34 L, which at 5% would be 1.7 units of alcohol — rather different
than a single unit.

~~~
volkl48
In the US, "units of alcohol" are not a thing or part of the government
recommendations.

One standard drink in the US is tied to 12oz of 5% beer (or it's equivalents
in wine/spirits), _not_ the UK definition of a "unit" of alcohol.

When there are US health recommendations made, they are referring to standard
drinks.

------
francisofascii
Is this all related to sleep quality? Increased alcohol consumption decreases
sleep quality, decreased sleep quality increases dementia risk, therefore
increased alcohol consumption increases dementia risk.

~~~
jstr
The study is suggesting the opposite relationship - that decreased wine
consumption _increases_ the risk of developing dementia

~~~
emmelaich
It's suggesting both. Low and high consumption increase the risk. For the high
consumers, impaired sleep might be a thing.

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bhouston
Who funded this?

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karmakaze
I'd like to see the probability changes,not just as percent change but as
decimal values. The problem with reporting 17% this and 67% that is that even
with a 67% increase in one group it could still be less than the 17% of
another. This could help distinguishing things that are less bad vs being
positive depending on where it falls in the p-range.

------
pier25
So what corresponds to one unit of alcohol? A glass of wine?

~~~
stakhanov
It's a british thing. Drink manufacturers in the UK are obliged to declare the
total amount of alcohol that's in the bottle using a "units" system, where
half a litre of beer at 4% equates to roughly 2 units. So 14 units per week is
a bottle of beer a day.

[https://www.drinkaware.co.uk/alcohol-facts/alcoholic-
drinks-...](https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-
units/what-is-an-alcohol-unit/)

~~~
pier25
Thank for the link!

------
Shagadelic
Forfeiting beer and whiskey? No thanks. Total digression, but does anyone here
know of any drugs that cause neurogenesis? I speculate shrooms and acid might,
but maybe I'm just delusional..

~~~
mrsteveman1
> does anyone here know of any drugs that cause neurogenesis?

Tianeptine is fairly well known[1][2] for being able to prevent and/or reverse
changes like hippocampal volume loss, which is commonly seen in untreated
depression[3], chronic stress[4] and several other conditions.

7,8-Dihydroxyflavone[5] derivatives and/or prodrugs also look promising[6].

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/22047727](https://www.ncbi.nlm.nih.gov/pubmed/22047727)

[2]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034085/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034085/)

[3]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557684/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557684/)

[4]
[https://www.nature.com/articles/srep29127](https://www.nature.com/articles/srep29127)

[5]
[https://en.wikipedia.org/wiki/7,8-Dihydroxyflavone](https://en.wikipedia.org/wiki/7,8-Dihydroxyflavone)

[6]
[https://pubs.acs.org/doi/abs/10.1021/jm101206p](https://pubs.acs.org/doi/abs/10.1021/jm101206p)

------
kamalkishor1991
I wonder if these differences has something to do with the personality of
drinkers? People who are drinking might be more aggressive and might also be
phisically active or exercising more. Do we actually have any fundamental
reason to believe if moderate alcohol might be okay?

------
jl2718
As a non-drinker myself, I think this might have a lot to do with lack of
sleep.

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hprotagonist
“moderation in all things”, as usual, seems like sage advice.

~~~
S-E-P
maybe not all things... but most things :)

~~~
wry_discontent
My favorite phrasing of that is a quote that I think is from Oscar Wilde:
"moderation in all things, including moderation."

~~~
hprotagonist
and it’s even got the virtue of being true.

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lobo_tuerto
I'd like to see a study about the relation between Zen meditation and
dementia.

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polotics
TL;DR: Get polyphenols in your diet. Wine is an option for this but there are
others.

~~~
pluma
My grandfather, a wine drinker all his life, suffered severe dementia in his
final years. There is no magic bullet.

~~~
cheeko1234
Anecdotal data is not evidence.

My grandfather smoked 2 packs a day starting when he was 11 till he was 97 and
didn't get lung cancer.

~~~
SubiculumCode
It is evidence of N=1.

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TheSpiceIsLife
> consuming large amounts (>21-28 units/week) was associated with an increased
> risk of dementia compared with light to moderate (7-21 units/week)
> consumption.4

The idea that 21 units of alcohol per week is _moderate_ and also _heavy_
drinking is.... preposterous.

Consider: drinking alcohol (ethanol) is a Group 1 carcinogen.[1] There is _no
level of alcohol consumption that is safe_.

21 units of alcohol per week should always be considered _heavy drinking_.

1\. [https://www.cancer.org/cancer/cancer-causes/general-
info/kno...](https://www.cancer.org/cancer/cancer-causes/general-info/known-
and-probable-human-carcinogens.html)

~~~
Theodores
Alcohol is a solvent. It dissolves stuff. Sometimes that is helpful in the
workshop where you can see what you are doing. The same can't be said about
inside your own head even though our ancestors have been experimenting for
millennia.

Anyone done comparison studies with the Muslim world?

~~~
colek42
Water is a solvent as well. In fact, it dissolves more substances than any
other liquid on earth. What is your point?

~~~
emmelaich
Not only that, but water has the highest pH of any acid!

