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Healthy habits add up to 10 disease-free years to your life, study reveals (nhs.uk)
200 points by open-source-ux on Jan 13, 2020 | hide | past | favorite | 169 comments

Living a long and healthy life is simple, but it isn't easy.

Which is to say almost everybody knows this, very few people live it. The toughest battle isn't yet again telling people that 1+1=2, but rather figuring out ways to make it more accessible to people (read: cheap, low time commitment) and more sustainable as a lifestyle.

That's why ideas like HIIT[0] and IM[1] are interesting, not because they're superior to getting doctor recommended levels of exercise and eating the recommended nutrition but because people actually do them and stick to them, and they're "less bad" then doing nothing.

"Perfect is the enemy of good" is the enemy of people's health too, and the medical profession obsessed over what the Greek God tier lifestyle should look like while ignoring "easy wins."

[0] https://en.wikipedia.org/wiki/High-intensity_interval_traini...

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

> because people actually do them and stick to them

Do you have data to back this up? I would have thought the exact opposite. That HIIT and IM are techniques that people try after having seen a Ted talk or something like that and don't make a life discipline out of them.

I also think plenty of people have some "common sense discipline" such as cycling/walking to work, and not eating junk food and sodas, and trying to eat fruits and vegetables. I feel this is very sustainable with a high ratio benefit/cost.

Appreciate this is a sample size of one, but IM has worked reasonably well for me. I lost nearly 3 stone, my weight's up a little since then but I'm still within a pound or two of my lowest fat mass over a year on.

All it really is to me is skipping breakfast and not snacking after my evening meal. I only ever had breakfast because people told me it wasn't healthy to skip it. Not so sure they were right now. I still pig out at lunch, dinner and in between times.


How did you measure fat mass?

The graph is from an app that comes with Withings smart scales and it's that I've used. (So take the absolute values with a pinch of salt, but I suspect they're in the right ballpark).

Withings smart scales are garbage for body fat measurement. I have the Body+ model and it fluctuates by ±4.3% day to day which is obviously not physically possible. And even the highest readings are still about 1.5% lower than my most recent DXA scan, which is far more accurate. (Yes I did try the scale's "athlete mode" but that was even less accurate.)

In general electric measurements of body composition are just toys and not to be relied upon.

> Do you have data to back this up?

Yes e.g.:

Fasting: https://academic.oup.com/ajcn/article/90/5/1138/4598070

Intermittent exercise: https://www.nature.com/articles/0800533

> I also think plenty of people have some "common sense discipline" such as cycling/walking to work, and not eating junk food and sodas, and trying to eat fruits and vegetables. I feel this is very sustainable with a high ratio benefit/cost.

I agree. Those are also examples of "easy wins." We need more of exactly that, maybe even with support (e.g. cataloguing your life and looking for such wins). IM and HIIT are only as good as their adherence rates, but anything that people will stick to is worth serious evaluation and promotion.

Aren't your two links not showing your earlier claims? The claim was that they stick to it, the outcome/benefits of sticking to it weren't disputed. I am asking because I also can't believe that people stick to IM or HIIT long term.

Both of my links very specifically look at adherence rates.

> Results: Dietary adherence remained high throughout the controlled food intake phase (days adherent: 86%) and the self-selected food intake phase (days adherent: 89%).


> For both groups, moderate intensity, intermittent exercise showed excellent adherence and this may be a useful model for future research studies.

So I'm not sure, having read both links, you came to the conclusion that it "doesn't prove my claims." They both very directly do.

Both of your links have nothing to do with general population adherence rate though. They are adherence rates within a pre-selected group of people for a specific study (apologies if i am reading this wrong).

I was actually surprised by the low adherence rate. The studies were done on small sets of folks for a very short period of time (2/8months) with little effort to adhere and yet the participants couldn't even do that. I figured adherence rates for this would actually be 100%. After all, the researchers asked for 6 minutes a day, 5 days a week.

The question I was interested in is roughly: If i randomly select 1000 people from the population and introduce them to HIIT, how many will do it 3-5 times a week 6/12/18/24 months after the introduction without any reporting and supervision?

Again, sorry if i am totally misunderstanding the links.

> They are adherence rates within a pre-selected group of people for a specific study (apologies if i am reading this wrong).

Yes, that's generally how studies work.

> The studies were done on small sets of folks for a very short period of time (2/8months) with little effort to adhere and yet the participants couldn't even do that.

You have to view it in context, diet and exercise changes have a very low adherence rate historically. It may be "low" but even that is a marked improvement over a lot of the alternatives.

You asked for data that showed these strategies had good adherence rates, which I provided. I could find additional studies, but those too would have a scope and would therefore be dismissed just as readily. I don't have a population-level study to link.

> That HIIT and IM are techniques that people try after having seen a Ted talk or something like that and don't make a life discipline out of them.

I don't HIIT because I think it's more for runners (and I cycle), but Intermittent Fasting has been the easiest adoptable technique for me to keep my calorie intake in check. Just count the hours, really. I try to push a little bit more fasting hours than the typical 16:8, more like 18:6, and stick to a low carb, high fat sorta diet. I've been doing this for eight years and I don't see me stopping that soon, it's so simple to follow. There's no TED talk (not that I have seen one on IF) that can convince me more than direct first hand experience.

I love the example of HIIT. I discovered it inadvertently 10 years ago when I switched to recreational sprinting as a primary form of exercise. It results in excellent physical conditioning with a minimal time investment (about one hour per week total).

Establishing habits is difficult and complex. Finding highly efficient (in time, energy, drudgery, money, etc) ways to achieve a desired outcome is a critically important cornerstone of that process, in my experience.

Any way for lazy people to get started with HIIT without going to a gym?

Yes! One set of jump squats as high and as rapidly as you can do them without pause, until fatigued. Rest two to three days afterwards. Once you get into a habit where you hate to miss a workout, switch to doing burpees instead. You can do this anywhere, including a hotel room, so it minimizes reasons to skip. It is surprising how much this works your cardio as well as strength. You can get super-fit doing this one thing and you only need to do one set per workout. In each workout, focus on doing a few reps more and doing them a bit faster than the previous workout. Just be sure to start slow (maybe 6 reps on your first workout) and never increase by more than 10% of what you did on the previous workout. Never do this two days in a row. You get stronger on your rest days, not your workout days. For high intensity workouts, I find that two days of rest is better than one.

The guests in the room below would appreciate it if you utilized the hotel fitness center instead of doing burpees in your room.

This is a valid issue. If you aren't in a fitness center, you can exercise near a load-bearing wall or pillar to attenuate the floor impact harmonics, which always seems to work well for me.

There is so much information available these days!

Try this on—all you need is a little space: https://www.youtube.com/watch?v=q20pLhdoEoY

I find the biggest barrier to doing anything like this is the laziness itself. Thinking clearly about the choices I'm (not) making, and the trade offs I'm choosing helps me decide what I'd prefer to do. Reminding myself that activity makes me feel much better helps a lot too.

I hate gyms as well (I see them as a necessary evil these days). Personally I grab my bike and go mountain biking a lot. Not HIIT per-se, but very spikey bursts of effort.

You could accomplish some high quality interval work with a simple road bike (a hill helps) and a good attitude. The benefit to this being far less impact compared to sprints.

Just be a little careful starting with high intensity stuff - you want to slowly ramp this up over a handful of weeks or more. True high intensity work with insufficient muscle conditioning is a quick way to get injured (think ham/glute/calf pulls, tears, etc), and you do need to be careful when ramping up the cardio side - heart issues aren't fun.

Depending on how lazy you are, you could try running in place with the Tabata protocol.

For me, one beautiful thing about sprinting is that you can do it anywhere you have a sufficiently lengthy stretch of open, flat ground. You can also shorten the sprint and do more of them to accommodate less permissive situations. I've even done wind sprints in my basement!

I've been playing Ring Fit Adventures on the nintendo switch, which takes you through a lot of different short exercise routines. I'm not sure if it technically counts as HIIT, but I do about 20 minutes every couple of days and work up a massive sweat in the process. Also because its a game I can play from my own lounge room, I'm finding I keep it up much more regularly than I have with a gym membership.

I'd check out YouTube, there are tons of HIIT "classes" that you can do at home for zero or minimal cost.

But there are also more specialised classes if you have some equipment or are a certain body composition (e.g. easier on the knees).

There is an app by the people who invented it, afaik. And other apps, too. (7 Minute Workout, I think that's the same thing?)

because people actually do them and stick to them

The same can be said of any beneficial practice while it's trendy. HIIT and intermittent fasting are trendy right now. Nothing can stop the wheel of fashion from turning, so let's wait and see if they still stand out as "something people actually do" when they're passé.

This is nonsense. Even if you do everything right, you can have bad luck. Illness can happen to anyone.

Of course you can improve your odds, but acting like sickness is some sort of personal failing is a bad mentality, and one of the reasons American health care is so messed up.

Do Japanese women do HIIT?

Surprising: one of the healthy habits mentioned is drinking alcohol only in moderation (defined in this study as just under 2 units for women and 4 units for men daily). If I drank any alcohol on a daily basis, I would be scared that it would go downhill from there. Habits are hard to change, so better do not pick up bad ones at all. I'm convinced that just avoiding to do stupid things is half the battle already.

The reported BMJ study does not recommend teetotalers take up drinking; it only suggests moderation for individuals who already consume alcohol.

"We observed a relatively small difference in life expectancies across different levels of alcohol consumption compared with other individual lifestyle factors. The cardiovascular benefits of moderate alcohol consumption have been consistently observed in large cohort studies, but alcohol consumption and risk of cancer showed a dose-response relation. Thus, current guidelines do not encourage a non-alcohol drinker to start drinking just for the benefit of preventing cardiovascular disease."

My mistake, I should have been more precise in my formulations. I was rather surprised that daily alcohol consumption still counted as moderate.

This seems to be a cultural UK/US difference which I've noticed moving to the US. In the UK a glass of wine with food every night would be seen as part of a healthy mediterranean diet and health advice on alcohol was refocussed to discourage binge drinking, emphasizing daily rather than weekly consumption limits.

In the US daily drinking seems to be seen as bad (perhaps a legacy of prohibition?) while binge drinking once a week doesn't seem to be seen as particularly problematic.

In the US its a pretty skewed distribution. 30% don't drink at all. Another 30% less than once per week. The top 10% drinks a crazy amount.


The data is also an unbelievable mess.

We can work towards drinking from two directions: self report consumption and alcohol sales ought to lead to the same number. Not perfectly of course - drinks get thrown away, saved as gifts, used to cook, and so on. But last I looked, the ratio of drinks sold to drinking reported in the US was two to one. (I'd love to see the same data for other countries.)

So either people understating their drinking by a huge amount, or the studies are undersampling groups that do a lot of drinking. Probably both. We can make some good guesses: minors probably don't admit to their drinking, teetotalers probably self-report more accurately than occasional drinkers, and so on. But it's a gap so big that it's hard to talk confidently about what people here are doing.

> In the UK a glass of wine with food every night would be seen as part of a healthy mediterranean diet and health advice on alcohol was refocussed to discourage binge drinking,

I don't understand what you mean.

Public Health advice on alcohol in the UK has been pretty consistent for many years. There are 3 changes: the limits for men went from 21 units a week to 14 units a week; the advice to pregnant women to avoid all alcohol became stronger; and the advice about not allowing under 18s to drink alcohol became stronger.

In 1987 the advice was pretty close to what it is today.


We don't know if there's a safe limit

men should drink no more than 21 units per week

women should drink no more than 14 units per week

both men and women should have 2 to 3 days drink free

the total number of weekly units should not be drunk in 1 or 2 bouts.

It must have been the 1995 change:

> The most significant change to the Government guidelines was the move from weekly limits to daily limits.


Obligatory BBC public service announcement on safe drinking levels: https://www.youtube.com/watch?v=z-ZVdHnOqd8

"A glass of wine with food" is fairly rare culturally outside of Europe I believe; and even in Europe, it's uncommon in beer countries (UK, Belgium, …).

"Drinking every night" = "[at least] 1 beer / night" in the minds of people who associate drinking with beer. There's no such thing as consuming a small glass of beer as it's not really a beverage you savour.

Small (8 oz./235 ml) servings of beer that are very much meant to be savored are very common in bars in the U.S.!

In Netherlands or Belgium 8-12 oz servings of beer compensate by it having higher ABV (8-10%), so the amount you consume is actually pretty much the same as with 16oz lager or pilsner.

Yes, it's the same in the U.S. (though much of the beer is less worthy of savoring). But the point stands that "there's no such thing as consuming a small glass of beer as it's not really a beverage you savour" is wildly inaccurate.

You're right, I should have qualified that statement with "for most people…".

I doubt your claim that this sort of beer savouring is "common in US bars" (or if it is commonly available, I doubt that it is commonly ordered).

To put it another way, compare the amount of alcohol ingested on an average evening where beer was the primary beverage vs. an average evening where wine was the primary beverage.

I don't have data to back this up and it's not like I drink heavily myself, but my instinct and experience tells me alcohol-for-wine consumption is much lower than beer's, and so it is in most people's minds.

They are not recommending that you drink 4 drinks every day, but right now guidelines come in two forms:

1. Drinks per week, eg 14 drinks/week

2. Average drinks per day, eg 4 drinks/day

If you drink your entire drinks per week in a day, that's really bad. If you drink your average drinks per day, every day, that's also bad.

For others who might be reading this: You should have some days (ideally a majority) in which you don't drink at all, some days in which you drink at or below the daily guideline, and you probably aren't all the worse off if you occasionally exceed the daily average guideline.

Not only that, but these articles always say the "what" and not the "why". Daily consumption of alcohol for example, depletes glutathione. The more you drink, the more that is depleted. Once your reserves are gone, the liver will still protect you, at the cost of itself. It essentially slowly self destructs to neutralize the alcohol once the glutathione is gone. People will always give examples of someone they knew that lived to 100 and had a shot of whiskey every day. Makes sense, they were replenishing their glutathione reserves faster than depleting it. It's obviously much more complicated of a process than what I described, but people don't have a way to measure it. The liver will try to detox people until it hits something like 5% capacity and then the symptoms are really obvious. By then, it is too late.

Quite surprising for me too. Or rather, I don't understand the unit they mention. From the article linked:

also collected alcoholic beverage consumption, including red and white wine separately (4 ounces, increasing to 5 ounces in 2006), beer (one glass, can, or bottle), and liquor (one drink or shot). We multiplied the amount of alcohol in grams per specified portion size by servings per day, determined the midpoint of the frequency category, and summed across all beverages to estimate the average alcohol consumption (g/day). We defined moderate alcohol consumption as 5-15 g/day for women and 5-30 g/day for men

Surely it cannot be 4 bottles of beer daily (or 4*7 bottles on weekend).

This left me confused as well. This NHS article on alcohol abuse cleared it up, though: https://www.nhs.uk/conditions/alcohol-misuse/

> A unit of alcohol is 8g or 10ml of pure alcohol, which is about:

> half a pint of lower to normal-strength lager/beer/cider (ABV 3.6%) > a single small shot measure (25ml) of spirits (25ml, ABV 40%)

So a 12oz bottle (.75 pint) of 3.6% beer would be 1.5 NHS units. A bottle of 7.2% stout would be 3 units. A full 4 units per day would require a bottle of strong 9.6% beer, or two bottles of a 4.8%.

While less eye-popping than four bottles a day, that still seems like a lot of drinking to me, especially if concentrated around a few days. That's 14 bottles of 4.8% beer per week, so imagine four beers on a Wednesday, seven on Friday night, and another three over the weekend after the hangover's worn off – week after week. That seems like it would have to have a health impact, and it's surprising to see it as the limit for "moderate" drinking.

It is a lot. Recent advice (2016) cut the limits for men down to 14 units a week. The advice has always included recommendations to have some days drink free, and not to save the units up to drink more on one day.

Ah. A USA "drink" is 15ml, so 1.5 UK units.

That still seems like a lot to me. I've always heard that 2 "drinks" is the limit for being able to drive, and it seems that drinking "during the day" (before dinner) is culturally frowned upon, so taking the advice of 2-3 "drinks"/day would mean you're at the limit every evening. If you have one or more sober days, you'd be over the limit every non-sober day if you do it in one sitting.

That being said, I don't drink, so I don't know for certainly what is culturally acceptable, I'm just going based on observations (lunches and dinners with coworkers and whatnot). However, this seems like it could be used to justify poor behavior, especially for health conscious individuals who like to check off boxes.

A bottle of beer (say 500ml) at 5% strength would be 2.5 units, so not as much as 4 bottles a day [1]. Also worth noting that alcohol you buy in shops in the UK has the number of units printed on the label, so it's fairly easy to keep track of.

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

A standard bottle of beer is 330ml to 375 ml. 500ml is closer to an imperial pint @ ~17 oz. That's roughly the size of an American "pint"

Here in Europese standard bottle /can sizes are 250, 300/330 and 500ml. The former are more common west of the Rhine, the 500ml is the standard East of it

A unit is 10ml of pure alcohol, roughly half a pint of 4% beer or half a glass of wine. This unit value is printed clearly on pretty much all alcohol containers. (In the US it seems incredibly difficult to find the ABV % for the drinks you buy.)

A bottle of beer is usually 330ml so 1.3 units, so moderate drinking would be defined as up to 2 pints or 3 bottles of 4% beer daily.

I believe ABV is printed on every alcohol label in the US (I suspect there is a regulation mandating it)

While most does, at least the box of Heineken in my fridge (don't judge me, left over from a party!) doesn't have the ABV on the box, though does on the cans inside.

To find the units you multiply the serving size in litres by the number for the ABV.

So, a 250 ml glass of wine at 12% ABV is 0.25 * 12 = 3 units.

In the past when units were created wine was about 8% ABV, and a serving size was about 125 ml, which gives 0.125 * 8 = 1 unit per glass. When you see advice saying "one small glass of wine is about 1 unit" it's a bit misleading, because currently in the UK one small glass is going to be about 175 ml, and the ABV is going to be about 12%, which gives about 2 units per glass.

Also have to factor in the opportunity cost of drinking...going for a drink after work instead of the gym? What comes next? Bar food with your beer and maybe a pizza?

I'd rather have the work out, good meal, hydrate, and get good sleep. It's obvious that good habits snowball into more good habits, while bad habits snowball into more bad habits.

haha, this reads like some abstinence only sex education argument or something. don't let that one beer turn in to a good time!

i think it's funny that having a good (if not optimally healthy) time would be so ridiculed, but maybe that's just me. FWIW i know a lot of people who work out at 4:30am in order to gain that time for after work social activities which often include alcohol, so not mutually exclusive.

Not the commenter you replied to, but I feel like you both have valid points.

> Bar food with your beer and maybe a pizza?

> don't let that one beer turn in to a good time!

Personally, I prefer to enjoy the social benefits of going out without the consequences of alcohol or "bar food." I accept people's drug habits - it's fine to consume drugs responsibly (alcohol included). For me, I am able to have a good time and "let loose" without being under the influence of drugs.

There's nothing wrong with being sober. You can still participate in the local economy, engage in social events, and live a healthy life without fitting the routine you described of going to the bar and hitting the gym.

Anyways, my point of saying this is that I wonder if alcohol for most people increases their life expectancy because it lets them socialize more. In the same way that people buy essential oils and it has a placebo effect on the that make them feel better, I think the bar scene has the same effect on many Americans.

My social experience is that people are mentally unable to "let loose" and socialize without the aide of drugs.

Exactly. Personally I don't like drinking. I see the fun of getting drunk with friends and all..experienced it in my college years...but I don't like the unspoken pressure/expectation that you have to be on something to have a good time.

I'm one of those people. Rather, it's gym at 5:30/6:00 AM so that I don't have to go later. Then I can have a pizza day and not feel guilty. Life's too short to live so puritanically, if you ask me. Some of the biggest eaters and drinkers I've known were also some of the highest performing athletes. I'm not fond of the habit of isolating each of these habits as if each of them are as statistically effective as they are in a vacuum.

A pizza a day, or a slice of pizza a day?

The secret of junk foot is that junk food makes your mouth feel good for 20mminutes, but healthy food makes your body feel good all day, and gives you an energy level to live more actively.

It sounds like "a pizza day", probably meaning once a week.

am I ridiculing having a good time? If I'm not drinking at a bar every night I'm boring? Sounds like a Budweiser ad to me...

I'm simply saying there's a real opportunity cost which is directly in context with the comment I'm replying to. Sorry you interpreted it differently.

Simply put, if you're out drinking, you're not in the gym or doing another activity that has more health benefits. Don't let that stop you from 'having a good time', but it's something to keep in mind when we talk about the health effects of having a couple drinks everyday.

Drinkers actually exercise more. So maybe they don't quite snowball.


More accurate to say drinkers "self report that they exercise about 10-15% more than non drinkers do."

It's possible drinking impacts their self reports :-)

Bear in mind that the study looked at the combined impact of multiple factors: working out, eating healthy food, and not being overweight were specifically studied. So by definition, this "10 more years" population were the people for whom drinking didn't snowball.

That said, the individual-factor breakdown really did find that at low doses, rising alcohol consumption correlated with improved health. Undoubtedly some healthy-user bias between no and light drinking, but it's a pretty smooth curve through moderate consumption.

I'm surprised this was mentioned at all. There's even newer research that basically shows any amount of alcohol regularly is bad for you.

The idea that any amount of alcohol is bad for you is about as surprising of a concept to me as vaping actually being bad for you. Drinking poison or filling your lungs with anything that isn't air is not healthy.

"What can we say? We know alcohol's a toxin. We'll never believe alcohol can be good for you. This is America, for chrissake! We're willing to die for our true beliefs!" https://www.psychologytoday.com/us/blog/addiction-in-society...

Presumably you are not including any mental benefits? Or consider 'stress' of any sorts as a non-health issue?

Or social benefits, depending on which country you live in. Way too broad to say that any alcohol is "bad for you".

And social benefits can have massive physical repercussions. Happiness breeds healthiness, loneliness the opposite.

Of course I'm not implying that alcohol is in any way healthy, but it's probably healthier to have great drunk moments with your friends once in a while than it is to be lonely and not drink. It's important to note that you certainly can be social without alcohol though.

Of course stress is a problem, but the thought that you have to drink to solve that problem is a terrible thought to me. It is unfortunate if this is what society thinks.

Also, air can often be unhealthy. Even places where the air is 'clean.'

That's mighty convincing evidence you have right there.

Here's one: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

From the conclusion: "Our results show that the safest level of drinking is none."

That one doesn't make any sense to me. Alcohol is basically poison. Perhaps small amounts of it won't do any harm to you, but how could it possibly have a positive effect on your health?

The study actually does show small positive effects to alcohol, but it's also trying to differentiate alcohol (minimal impact at low doses) from smoking (strong and strictly negative impact at all doses). You can see the study's alcohol results by dose here: https://www.bmj.com/content/bmj/368/bmj.l6669/F2.large.jpg

From the study text:

> We observed a relatively small difference in life expectancies across different levels of alcohol consumption compared with other individual lifestyle factors. The cardiovascular benefits of moderate alcohol consumption have been consistently observed in large cohort studies, but alcohol consumption and risk of cancer showed a dose-response relation. Thus, current guidelines do not encourage a non-alcohol drinker to start drinking just for the benefit of preventing cardiovascular disease.

Female life expectancy peaks in the two lowest non-zero ranges, and disease-free expectancy at the second-lowest specifically; male life expectancy rises all the way to the top of "moderate" consumption, and disease-free peaks at the top two "moderate" doses. Presumably that's partly from men being larger and metabolizing alcohol faster, and partly from men being at higher risk of heart disease.

(There's probably a healthy-user bias here too, since there are conditions and medications which weren't checked for that would make people unable to tolerate alcohol, but that's less relevant when comparing different doses.)

Well, historically it did by sterilizing water. Also degrading alcohol gives you energy and may make you socialize more which might be good for your mental health. Directly benefitial? Probably not.

Maybe it can have a positive affect on your mental health, in moderation?

Sharing a bottle of wine or champagne with my wife can be one of the most enjoyable experiences to us.. going out to the pub having some beer with family & friends is great.

An argument could be "you can have just as much fun doing something else", but I don't know.. that's not really my experience. A moderate amount of drinking usually makes things even more fun.

In a business regard, people are usually perfectly understanding of a cost/benefit analysis—but when it comes to something like alcohol you hear a lot more absolutism. It surprises me a little bit.

Absolutely this. Hypothetically you could have fun with no alcohol, in practice the people that don’t drink are the most boring and as a result don’t get laid as much. You will die anyway maybe ten years later but if you don’t reproduce you’ve lost the gene game and the future population will be of those that drank. Which maybe explains why we still drink despite health reasons to the contrary.

one the upstream replies is telling: it says, basically, you might hang out and socialize if you get a drink after work, whereas it'd be "healthier" to just eat a salad or something and go to bed early; presumably, he'd forsake any potential social stuff for all of that healthy stuff.

it may be that the act of consuming alcohol is a confounding variable in the underlying correlation of social interaction/un-stressing or something.

Look up "hormesis". As they say, the dose makes the poison, and for a lot of "bad" things, small amounts are actually beneficial.

(Incredibly to me, even small doses of radiation can be protective against larger doses later.)

I've always assumed it was one of two things:

1. The social benefit. There's research showing that if you have a rich social life and friend network, you live longer. The assumption being that the drink is likely to be with other people.

2. The stress management benefit. It's not healthy to be stressed out. The alcohol's mitigating effect on stress may be greater than the alcohol's poisonous effect, in the right dose, for the right person.

It’s also a stress-reliever, and is frequently consumed in the company of others, so it has social benefits as well.

The key word is definitely "only".

I don't agree. Even if you "only" drank in moderation forever and never drank too much for your liver to deal with it isn't helping anything. At the absolute best it simply isn't hurting anything.

Which I'm really not convinced that is even true.

I didn’t read that advice to mean you should drink daily. Rather that if you do drink, it should be limited to a certain amount per day.

I think the research papers claiming that were already debunked: they simply did not control for age, so abistinents group was actually 7-10 years older that moderate drinkers.

Or, to put a cynical spin on it: noone becomes an abstinent by choice, usually people stop drinking once their doctor tells them they should, so obviously they will have worse overall health than moderate drinkers.

I get drunk and act like an absolute idiot, but I also don't really care. it's like the ying to my yang of trying really hard and being serious/ pretending to be serious about things. Hedonism is just as valid as a lifestyle choice as the other options (prove me wrong!)

The one thing I don't like about drinking is that it's basically a cheat code. It makes mundane stuff fun, if it were removed as an option, then maybe I would try other stuff and live a more interesting life.

> Surprising: one of the healthy habits mentioned is drinking alcohol only in moderation (defined in this study as just under 2 units for women and 4 units for men daily).

These figures are not absolute. Other studies consider someone an alcoholic as soon as there is a craving for alcohol. The risk is higher for someone who drinks daily.

Standards of what is acceptable also vary from country to country.

no. you need to start drinking 4 units per day if you want to live longer /s

This is one of the best general-audience presentations of a study I've seen. The "What kind of research was this?" section, with a quick explainer on cohort studies, is by itself a lot more context than many media outlets offer, and the other sections add up to an accessible primer on how this type of study is performed, no scientific background required. Excellent science communication from the NHS.

NHS's online communication is almost always excellent.

This is an example of a thing they do where they make a point of responding to things that get media buzz, so if you see something elsewhere it is usually worth googling to see if they have a response.

> drinking alcohol only in moderation (defined in this study as just under 2 units for women and 4 units for men daily)

This part Of “stay healthy” advice has always puzzled me - it looks like full blown alcoholism. Am I way off?

Is alcoholism not actual dependency on alcohol? As in not being able to leave it from one day to the next? If people drink 15 beers/day it is unhealthy but if they can quit tomorrow for months (or ever), it is not alcoholism right? Many people know it's unhealthy to consume enormous amounts during december (I know plenty who do a few bottles of wine per day per person) and then just quit 2nd of January. As far as I can see on the definition of alcoholism, that is not alcoholism... There is no dependency; they just like to be drunk for a month... And stuff themselves with fat. A lot of people all over the world (if they can afford it) do.

And 4 units/day (which is not 4 beers in many cases, it is less, but let's say it is) is something a lot of people do; they are, again, not dependent on it.

Doing damage is something else. I think no alcohol (at all) (+no/little refined sugar, processed food, stress laden work, too much fat, smoking anything, living in smog infested cities, driving motorcycles etc etc) are better, but that's just a feeling; the 'advice' seems to change every few years. One year wine is good for your cardiovascular system, one year it's bad. And the amounts vary too. Etc.

Ok, so it doesn't apply to your friends then? I am talking about daily drinking - the topic article promulgates it as "healthy".

Someone who "could stop drinking any time" and yet drinks every day year-round is de-facto addicted - among all the possible things they could do in the evening they always chose to do the same exact thing. Many addicts are high-functioning, but they are still addicts.

FWIW the rest of the recommendation by the NIAAA (National Institute of Alcohol Abuse and Alcoholism) is no more than 14 drinks per week for men and 7 drinks per week for women. So, they are not advising that 4 drinks per day every day for a week is safe.

The article does not mention the weekly limit though, which is typical - 4 units per day is mentioned often and the second limit is hardly mentioned at all.

I think the idea is that full-blown alcoholism is what really destroys your body. That being said, the link is definitely inconclusive - this is the article I always think of when thinking about alcohol [1].

[1] https://www.bbc.com/news/health-45283401

> This part Of “stay healthy” advice has always puzzled me - it looks like full blown alcoholism. Am I way off?

Yes, probably because you are mistaking a not-more-on-any-day-than level for a constant-consumption-every-day level.

Oh, and also confusing addiction with level of consumption.

There's slow low key buzz in afternoon/evening, evening and there's overloading your liver binging.

Also those numbers are not adjusted for body size. Some non-obese people weigh 100lb and some weigh 260lb.

4 units is not 4 beers.

A single 7% beer bottle is 3 units.

9 beers a week is... Not quite full-blown alcoholism. But I can see why the study picked that as a threshold.

A 25ml (.8oz) shot of 40% proof is 1 unit. 4 of those per day is one hell of a “healthy habit”.

I don’t know how large beer bottles are in the US, but 330ml (11.2oz) at 7% is 2.3 units.

(These are all European measurements, if that makes a difference. The NHS is in the U.K., though, where 1 unit = 10 ml of pure alcohol).

Alcoholism is a compulsion to drink alcohol, not a count of how much alcohol a person consumes in a given time period.

To be honest, I've never head of health issues caused by alcohol beyond the possibility of your liver failing. So I suspect, if you stay within liver failure bounds, you're good to go in terms of health.

I'm ignoring here the fact that drinking more might cause a cascading effect of bad habits, like eating more, exercising less, sleeping less, etc. Here I assume that you'd drink, but not degenerate your other habits as a consequence.

It's pretty conclusively bad for brain health; alcoholics hands aren't shaking from weak liver function...


Had never heard of that before. Thanks for the link. So its probably that brain damage also only happens at levels that put the liver at risk, and maybe that's why this isn't observed in the OP study?

There are studies that show even moderate alcohol usage can have a damaging effect. And any amount of alcohol has been shown to raise risk of cancer.


The consensus is slowly moving towards there not being a healthy amount of alcohol consumption.


Beyond liver failure excessive alcohol use causes throat and mouth cancer as well as pancreatitis at the very least.

I see, had also never heard of this. I'd guess then that we're talking in the same level of excess that make you at risk of liver damage? And that might be why these don't seem to impact OP's study?

Leaving sex out of the equation was an unfortunate oversight.

STDs cause a lot of grief and arguably as much or more damage than diet. AIDS speaks for itself; herpes is implicated in Alzheimer's, heart disease and other ailments and is just a general curse without the modern antivirals (although many persons are naturally immune); gonorrhea and syphilis continue to mutate to new drug-resistant forms.

You can have sex without getting STDs - either by sticking with one/few monogamous relationships, or just using protection.

On the other hand, sex has been found to have lots of benefits (I'm at work so I don't want to be looking up citations, but intuitively a few minutes of cardio can't be a bad thing).

"You can have sex without getting STDs" also means it's a pain to study. Almost all mortality is statistical - you can smoke your whole life without getting lung cancer - but STDs are an even more random risk factor. There's no cumulative damage across events, detection and treatment are massively influential, and different populations have completely different risk profiles.

These findings are backed by two cohort studies, one on female nurses in the UK and one on male health professionals in the US. There's really not much chance their STD outcomes correspond to the general population.

It is an unfortunate drawback, but I don't think it's an oversight.

This data comes from cohort studies on nurses and other healthcare workers, so it wouldn't generalize well at all. We can assume eating veggies and smoking cigarettes affect them similarly to other people. They might be more likely to recognize problems and seek treatment, but they're not actually getting more or less nutrition out of kale.

When it comes to sex though, doctors and nurses are likely to have very different risk factors than the population average, in ways that are hard to rigorously study. Even beyond using protection or getting tested, they probably don't have the same protection error rates, partner pools, etc., as the general public.

Not to mention having children, which if my experience is any indication is the #1 reason parents use for being overweight and unfit, not having time and/or energy to properly care for themselves now that they have kids.

Ironically the best way to care for their kids is to set a good example by eating and living healthily.

When was the last time you saw healthy parents with an obese child or obese parents with a healthy child vs. how often you see healthy parents with healthy children and obese parents with obese children?

My mom was in extremely good shape with obese children. She was a homemaker who did hours of exercise everyday. As such she could basically eat potato chips and donuts and stay in great shape. For people who had to do things like study or work, it didn’t work out.

'Obese' implies 'unhealthy' but 'not obese' doesn't imply 'healthy'.

>AIDS speaks for itself

HIV does not significantly reduce life expectancy for patients who consistently take retroviral therapy.


Leaving sex out of the equation was an unfortunate oversight.

Maybe it's covered under "vigorous exercise?"

Also celibacy causes a lot of unhealthy stress and unbalanced hormones.

Does anyone have a link to the AHEI-2010 (the 2010 version of the Alternative Healthy Eating Index)? I can't find it easily anywhere on the Internet.

Hmm, the list of habits wasn't even that bad:

Don't smoke, drink little, keep a BMI of 18.5 to 24.9, exercise 30min per day, have a diet in the top 40-percentile most healthy.

These seems like feasible habits. Sure if you're overweight, smoking or drinking a lot changing the status isn't easy.

But you don't have to go vegan :)

I agree, you don't have to go vegan, but you could go mostly vegan, so that instead of meat and dairy being the default they become the exception.

Once you start it's a slippery slope to full on vegan. You will look at meat and dairy not as food but as liabilities to you and your earth.

Then it's just kinda depressing. Here you are in an alternate universe with hope and love and beauty while your friends and family stuff buttered bred muscle into their mouth and complain about all their health issues brought about by eating meat and dairy. These same friends look at you with concern for your life decision to not eat meat or dairy while you look at them with concern for their decision to eat meat and dairy.

You research it and realize the meat and dairy industries lobby and get our money for their ad campaigns. got milk beef. its whats for dinner pork. the other white meat

For the last 70 years they have been programming us that this is how food should be three times a day, every day. We will look back on the cruelty it takes to buy meat on foam wrapped with cellophane and our grandkids will ask us how we disassociated ourselves enough to take part in it all. Why didn't we shout from the rooftops that we are destroying ourselves, our world, our dear sentient animals?

But go vegan. It's easy!

I don't expect anyone to rehash the usual debates over this, but I have a question I've never found answered convincingly...

How the heck do vegans eat high-protein diets? I don't mean "get enough protein to avoid deficiency", there are lots of recipes for that. But practically every vegan food I see described as "high protein" is well under 1/3 protein, which is a pretty unremarkable target if you want to build muscle.

Eggs are a really easy way to fix that: you can eat a lot of them, you get a pretty good range of micronutrients, and their macros are majority-protein so you have "budget" for other foods. Is the vegan fix just getting really good at cooking seitan with green vegetables? That's (with tempeh and tofu) the only option I've found that's even in the right ballpark.

I think the keys are 1) don't be soy-phobic (eat tofu/tempeh, yes, but also soy milk -- esp. the fortified, unsweetened kinds, they demolish most other vegan milks nutritionally), 2) eat lots of pulses (so peanuts, lentils, beans, peas, chickpeas, and the like), 3) eat nuts and nut butters, and 4) choose high protein grains (e.g. oatmeal, whole wheat breads with seeds, whole grain pastas, etc). It all adds up -- I actually found I was getting something like 50% over my recommended protein intake without thinking about it.

Lots of beans, lentils, tofu, soy mince, fake meats... You could always buy some vegan protein powder if you are concerned about it.

I eat mostly vegetarian (I'm not a principled vegetarian so I'll eat meat in some circumstances, just way less than most people) and that's pretty easy, but milk is really cheap & convenient (chemically) for so much cooking, eggs are like a nutrition-on-a-budget cheat code and also chemically useful in lots of cooking, and I love cheese. Going vegan would hurt.

[EDIT] if there's one modification I'd really like to make to my diet, it'd be to add fish once or so per week, ideally the fatty, oily, low-on-the-food-chain sort that're supposed to be so heatlhy. I need some kind of guide for how to work up to enjoying fish when you didn't grow up eating it. I can tolerate larger fish when cooked & seasoned very well, but don't really enjoy it at all, and have no understanding of what even to do with the smaller, healthier sorts that isn't stomach-turning (to me) to even consider. Though for some reason I love sushi and calamari, so, go figure.

The drink units are weird in this article. Most people (in the US) think of a drink as closer to a 1.5oz 80 proof shot or 12oz of 5% abv beer, which works out to 17.75ml of ethanol. The article defines a drink as 10ml of ethanol. So the guidline for men would be on a bit over 2 budweisers per day.

It's explicitly not "a drink" that's defined as such, but a "unit of alcohol". It's a standard measure in the UK for actual alcohol content in drinks.

The fact that it was health care professionals studied leads to the possible confounding factor that people who had unhealthy lifestyles were very aware of their choice to be unhealthy, meaning a possible placebo effect

If I actually live longer I don’t care if it was the placebo effect or not.

As an added benefit, being annoyingly healthy and so proud to announce your superiority to the world will make you smarts smell so fine, you will capture them in a sniffing glass, just to savor your good habits

> having a healthy diet score in the top 40% of people in the study

Correlation does not equal causation. It's obvious from this statement that the relationship is not (necessarily) causal. Yeah "top 10% of the people in study live longer" isn't really revolutionary.

Yeah, that's a funny way for them to phrase it. I think the point is that you don't need a nearly-unachievable "top 5% diet" to be a healthy person - you just need to put in a little effort.

The first of the good habits is a good diet. The first medicine is food.

I'd actually say that the most impactful first habit is regular exercise. Especially a few hours of strength training and a few hours of aerobic exercise per week.

You can have a mediocre diet and still see huge health benefits. The opposite is not true: a sedentary lifestyle will kill you and the last years will be miserable with little in the way of physical autonomy.

Does < 10 cigarettes a month count as smoking?

How big are the cigarettes, how deep do you inhale, how strong are the cigarettes you smoke, type of filter... So many factors.

But no simple X is safe and X+n is bad formular to appease any concerns. Everybody is different and all these Recommended Daily limits are all based on an average that none of us fully fit into.

I will say though that anything in moderation is the only rule of thumb that still carries, after all - stress does kill and if by not having a few cig's you increase your stress then you may find that your reducing your health even more due to the stress.

Moral being, be happy and if you have to question it, then you already know the answer that's best for you.

I don't think "smoking in moderation" is the best answer for anyone for any reason. Stress can be dealt with in many many ways that are better for your health than tobacco.

The study has a per-factor breakdown here: https://www.bmj.com/content/368/bmj.l6669

"Ever smoking" looks like "smoked any amount but doesn't presently" rather than "occasional smoker through present", and the lowest bucket for current smokers is 1-14 cigarettes per day. <10 is, I suppose, 1/3 of a cigarette per day.

"Ever" and "1-14" show clear and substantial health effects, which isn't promising, but <10/month looks to be below any of the actual measured brackets.

The problem with cigarettes is that it is incredibly difficult to stick to a very low count overtime. I smoked for 20 years, roughly 20 cigarettes every 2 days in the end. I managed to quit thanks to vaping.

Just don't start smoking, even small in quantities. It might not have significant drawbacks when you are young, but it absolutely will take a toll on your health eventually, just like drinking.

No, smoking is usually defined as smoking daily. But there's so few people that smoke less-than-daily that they aren't usually included in these sort of studies so it's harder to say what sort of effect it has.

Seems pretty common in my experience, pretty much always "I only smoke when I drink" folks.

Is there really that few people? I know several people that only smoke occasionally.

How can I have a top40% healthy diet score? w

They didn't list this, but most things I've heard (eg, "How Not to Die" by Dr. Michael Greger who reads a lot of studies) is to eat a whole food, plant based diet. Might not have to give up meat completely, but the less you eat, the healthier you will tend to be.

This isn't an exact answer, but the article links here:


That page has some dietary recommendations:

- Eat more fibre (at least 30g a day)

- Cut down on saturated fat

- Get your 5 A Day (servings of fruit and vegetables)

- Cut down on salt (no more than 6 grams a day)

- Eat fish (at least twice a week)

If you live 10 years longer, you're almost guaranteed to have top 10% healthy diet score.

be rich. eat organic. cut sugar consumption

It's funny...I don't drink, never smoked, and don't eat meat or sugar, but I'm not really hoping to live until some crazy age.

Four drinks per day is "moderate"?

Four units = two pints of lager = less than half a bottle of red wine.


> not smoking

It's a pet peeve of mine, but I really wish smoking weren't presented as a binary choice in medicine and science.

I know a lot of people who smoke socially but only socially. They probably have an average of somewhere between half to maybe five or six cigarettes a week -- less than one a day, universally.

(For comparison, it's believed that addiction only starts to kick it at around 5 cigarettes per day.)

It would be nice if studies used granularity for smoking akin to that used for alcohol.

Part of this is the cultural failure of western medicine to recognize all drugs as sacraments. It's also a failure of justice systems to ban discrimination based on drug use.

So for example, I wrote that I was a smoker once on an insurance application (at the time as a 2-3 per day, 1 pack per week social smoker) and my insurance went up almost $100 per month. But the risk of not being truthful would be possible denied coverage down the road if I ever did develop respiratory problems. So insurance effectively encourages lying as a financial incentive (since the vast majority of people don't develop problems social smoking) as well as a racket (a loophole that corporations can use to deny coverage).

But there's no way to talk about something like this in polite society, because people effectively lose their minds. For example, I hate that my parents smoke, and often wish that tobacco never existed. Yet I treasure my memories of social smoking at parties, and consider counterculture stuff like that to be part of my ethos.

IMHO the only solution is to be vigilant in denying corporate control over our liberty and justice. Which is increasingly difficult in these times. I'm hopeful that the 2020s will unwind some of the oppression that's happened since 2001 though.

I find this (seemingly uniquely American) idea that it's wrong to discriminate in insurance quite strange. I'd love to understand your thought process behind it.

The whole point of insurance, as I see it, is that you pay based on your risk. Of course whether you smoke changes your risk of having health issues! Of course whether you're rich or poor, or male or female, affects your health risks.

For example, it's no surprise to me that my car insurance premiums are more expensive than my sister's, even though she's a year younger than me. Young men are much much more likely to be involved in car accidents than young women. But I've seen many Americans claiming this should be considered illegal discrimination. Isn't this discrimination the whole point of insurance?

The problem isn't that they factor in whether you smoke. The problem is that it's binary. You should find an insurance company that will let you specify how much you smoke. The insurance company should be delighted with that information: it allows them to model your risk more accurately and offer you more competitive prices!

This isn't 'corporate control over our liberty and justice' and it certainly isn't 'oppression'.

While what you're saying has a truthful ring to it, I fundamentally disagree with your hypothesis. The theory behind insurance is that everyone pays a flat rate so that there is enough money in the pool to cover statistically rare events. It works for fire, flood, life insurance, anything really. And the great thing about it is that the premiums are generally substantially lower than people expect. There's enough room there to charge enough for insurance companies to make a profit and still have affordable premiums.

This has gone haywire in recent decades due to corruption. In their never-ending quest for more profit, insurance company lobbyists have bribed politicians to change the laws so that they can create new brackets. Now car insurance costs more for young drivers. Now people in the south find they have no flood insurance or that their coverage wasn't good enough to replace their home or that there is so much red tape that they have to sue their own insurance company to get paid. Or the company simply doesn't pay, and the US government has to bail everyone out.

The fact that smoking is the single biggest discriminator in insurance premiums after age is a huge red flag that corruption is afoot. Here are a few things statistically more dangerous than smoking:

* Texting while driving

* Not eating right or exercising

* Working a blue collar job

Corruption just shifts costs onto the poor in the name of efficiency.

> While what you're saying has a truthful ring to it, I fundamentally disagree with your hypothesis. The theory behind insurance is that everyone pays a flat rate so that there is enough money in the pool to cover statistically rare events. It works for fire, flood, life insurance, anything really. And the great thing about it is that the premiums are generally substantially lower than people expect. There's enough room there to charge enough for insurance companies to make a profit and still have affordable premiums.

The point is that you amortise your risk. You pay small affordable amounts because that's more reliable than a small chance of having to pay extraordinary amounts.

The point is not that everyone pays the same rate, or that people pay what they can afford. If that's what you want, you introduce a tax and a government program: government healthcare, government fire insurance, government flood insurance, etc. Most places effectively have this at the edges: any large scale event there will be significant government assistance, and insurance ends up only having to cover small incidents.

Fire insurance should be more expensive in Queensland than in Oslo. Flood insurance should be more expensive in New Orleans than in Qatar. Insurance is amortisation of risk, not a wealth redistribution service.

>This has gone haywire in recent decades due to corruption. In their never-ending quest for more profit, insurance company lobbyists have bribed politicians to change the laws so that they can create new brackets. Now car insurance costs more for young drivers. Now people in the south find they have no flood insurance or that their coverage wasn't good enough to replace their home or that there is so much red tape that they have to sue their own insurance company to get paid. Or the company simply doesn't pay, and the US government has to bail everyone out.

What are you even talking about? You don't need a law change to be 'allowed' to make premiums higher for younger drivers or people with houses that are prone to flooding. The default situation is that you can provide insurance to people at whatever price you feel like giving them, based on whatever factors you have calculated affect their risk. It's a free market.

If you live in an area that's basically guaranteed to flood in the next 10 years, of course you're going to have difficulty getting flooding insurance! They're basically guaranteed to lose money unless you're paying 20% of the value of your house in premiums every year.

I suspect you literally don't understand the concept of risk.

>The fact that smoking is the single biggest discriminator in insurance premiums after age is a huge red flag that corruption is afoot. Here are a few things statistically more dangerous than smoking:

How do you measure whether someone texts while driving? How do you measure whether someone gets enough exercise or has a healthy diet?

What do you even mean by 'corruption' anyway? This is how insurance works everywhere, in every country, every jurisdiction, universally. It's how insurance works as a very basic concept. The entire point is that you pay based on risk, and higher risk = higher premiums.

Working in a blue collar job already is factored into health insurance premiums. Go ask employers what their insurance premiums are for their employees in the United States. Obviously places with significantly dangerous jobs will have expensive health insurance premiums because that just makes logical sense for the health insurers.

>Corruption just shifts costs onto the poor in the name of efficiency.

It literally makes no logical sense for this to happen. Insurance is a very competitive market. If they are overcharging people relative to their actual risk, then someone that can measure that risk more accurately and charge you less while still making a reliable profit should exist.

And in fact that is exactly what happens.

I can't argue with any of your points specifically, in fact I agree with most of them.

I wonder if what's happening in the US though is that nearly all markets with inelastic demand curves have come to be dominated by a handful of companies (duopolies). So if I need an operation that I simply must have, or health insurance or internet service, I have a couple of companies to choose from that both charge roughly the same price, which is usually quite a bit more than what I'd like to pay.

The principle here is that markets with inelastic demand curves form natural monopolies:


But in the US, there has been no move to break up monopolies or transfer them into the public sector as utilities (like for water and electricity) since the Reagan era:


So the controversy you see in the media here about whether to have single payer healthcare, for example, stems from the fact that these natural monopolies are run by private sector corporations which have formed rackets within the government through the use of lobbying (a form of bribery). Their disinformation and smear campaigns across the major media outlets (themselves usually duopolies like CNN and Fox News) distract the populace so that basic economic principles take a back seat to political ideology. This keeps everyone divided in order to maintain the status quo of duopoly protection.

If the US were to move to public healthcare, the price would fall to a rate base (a legally determined profit margin above base cost) which must be determined through regulation since the free market can't find a fair price between supplier and consumer since the price is inelastic and/or there as an information or power imbalance which makes it a non-free market:



Looking to other countries as examples, this would lower the price to roughly 1/2 to 1/3 what it is now:


All of this is why when I see smoking singled out on health insurance applications, I tend to see corruption rather than market efficiency. Which is outrageous, because my vote would be to move health insurance into the public sector anyway. It feels like being kicked when I'm down.

I think what might be going on here is that you're thinking microeconomics while I'm thinking macroeconomics, but we can both be right.

I have to disagree with you here. Even social smoking puts you at a higher risk for developing certain diseases than non-smokers. If insurance companies didn’t charge smokers $100 then they would charge everyone $50. That certainly doesn’t seem fair.

I’m also having a hard time with the idea that insurance companies are using this policy as a way to get out of paying future claims. Is it really possible to prove that a condition is due to smoking? Also any time I’ve had to fill out that information on an insurance form and I’ve only ever seen it ask if I am currently a smoker. What’s to say I wasn’t a smoker before I was covered by that insurance company?

I think the reported intended to differentiate "drinking in moderation" from "not smoking" because the drinking results are actually ambiguous at low doses. There are a lot of possible confounders, but a few drinks a week actually correlate with better outcomes. As far these findings, and all others I've seen, smoking is strictly negative.

But jumping from "never" to "1-14 per day" does seem like a pretty massive gap, and one that makes these results harder to use for a lot of people. I've known plenty of social smokers, as well as people who almost quit smoking but didn't kick a final 1/day habit. It certainly seems useful for a 10/day smoker to know what their risk profile would be like at 1/day or lower, which isn't available here.

(I wonder if it's a data limitation here, though? Most of the social smokers are I know are 20-somethings who smoke when they're drinking with friends, or something similar. These cohort studies were on middle aged doctors and nurses, so there may not be many people falling between "nonsmoker" and "addicted"?)

Smoking causes other things besides the things that happen near the end of your life. It also affects your immune system; injuries take longer to heal. You don't have to be a pack-a-day person to experience these effects... i know!

Studies already do that, it's called pack-years. If your friends do 1/12 a pack per day for 12 years, that'd mean 1 pack year of smoking.

I'm analyzing data for an epidemiological study now, we have such a binary smoking status indicator that you critique. Our issue is the data source has immense complexity, 3500 plain text entries on smoking status questions, it would take weeks of painstaking effort to develop the measure you speak of...whereas the current measure took us a morning to implement as someone had already done the legwork for 0/1 smoking or not.

It seems that even social smoking has a sognificantly negative impact on your health. I’m not sure the same is true with alcohol.


From a public health standpoint it sounds like your pet peeve is that people don't tolerate "smoking in moderation".

Not at all.

It's that if light smokers self-identify as smokers in research, then it can mask the greater damage done in heavy smokers.

While if light smokers self-identify as non-smokers, it may reduce the overall difference between true non-smokers and heavy smokers.

Either way, it leads to the same kind of dangerous misinterpretation of data you'd have if there were only two categories "never drink" and "blackout drunk nightly".

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