Whether You Have One or Two Shots of Whiskey Occasionally, It Affects Your Health

by
Bill Haskell
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The latest news? Do not drink.

A shot of anything is generally 1.50 fluid ounces, which is 41.7 grams. Whiskey can range in proof, starting at 80 proof. Simple math and using 80 proof whisky (40% alcohol) yields 16.68 grams of alcohol. I am going to guess Bourbon is similar.

I got tired of reading the NYT article which is also on Yahoo and printed twice in the same column. I do not have leeway to current NYT articles. This JAMA Network Open study which also includes author Tim Stockwell is similar to what the NYT article is. It is stating the same thing. If you drink any form of liquid being whiskey or wine there is a of risk all-cause mortality. An increased health risk among female drinkers who drank 25 or more grams per day and among male drinkers who drank 45 or more grams of ethanol per day. It does not matter if you have one shot or two shots. You are at risk.

This is not the complete study. I narrowed it down to the main points leaving behind some of the information leading to their conclusions.

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The Study: Association Between Daily Alcohol Intake and Risk of All-Cause Mortality

by Jinhui Zhao, Tim Stockwell, and Tim Naimi

JAMA Network Open March 2023

This systematic review and meta-analysis of 107 cohort studies involving more than 4.8 million participants found no significant reductions in risk of all-cause mortality for drinkers who drank less than 25 g of ethanol per day (about 2 Canadian standard drinks compared with lifetime nondrinkers) after adjustment for key study characteristics such as median age and sex of study cohorts. The study showed there is a significantly increased risk of all-cause mortality among female drinkers who drank 25 or more grams per day and among male drinkers who drank 45 or more grams per day.

Meaning:  Low-volume alcohol drinking was not associated with protection against death from all causes.

Introduction

The proposition that low-dose alcohol use protects against all-cause mortality in general populations continues to be controversial.¹ Observational studies tend to show that people classified as “moderate drinkers” have longer life expectancy and are less likely to die from heart disease than those classified as abstainers.² Systematic reviews and meta-analyses of this literature³ confirm J-shaped risk curves (protective associations at low doses with increasing risk at higher doses).

However, mounting evidence suggests these associations might be due to systematic biases that affect many studies. For example, light and moderate drinkers are systematically healthier than current abstainers on a range of health indicators unlikely to be associated with alcohol use eg, dental hygiene, exercise routines, diet, weight, income⁴; and lifetime abstainers may be systematically biased toward poorer health⁵.

Studies fail to control for biases in the abstainer reference group, in particular failing to remove “sick quitters” or former drinkers. Many of whom cut down or stop for health reasons²; and most studies have nonrepresentative samples leading to an overrepresentation of older White men. Adjustment of cohort samples to make them more representative has been shown to eliminate apparent protective associations.⁶ Mendelian randomization studies controlling for the confounding effects of socio-demographic and environmental factors find no evidence of cardioprotection.⁷

The present study updates our earlier systematic review and meta-analysis for all-cause mortality and alcohol use,⁸ including studies published up to July 2021 (ie, 6.5 years of additional publications). The study also investigated the risk of all-cause mortality for alcohol consumption according to:

(1) median ages of the study populations (younger than 56 years or 56 years and older), replicating the methods of Zhao et al⁹;

(2) the sex distribution of the study populations, and

(3) studies of cohorts recruited before a median age of 51 years of age and followed up in health records until a median age of at least 60 years (ie, with stricter rules to further minimize lifetime selection biases).

Because younger cohorts followed up to an age at which they may experience heart disease are less likely to be affected by lifetime selection biases,⁹ we hypothesized that such studies would be less likely to show reduced mortality risks for low-volume drinkers. Finally, we reran the analyses using occasional drinkers (<1 drink per week) as the reference, for whom physiological health benefits are unlikely. Occasional drinkers are a more appropriate reference group, given evidence demonstrating that lifetime abstainers may be biased toward ill health.¹⁰

Discussion

In fully adjusted, prespecified models that accounted for effects of sampling, between-study variation, and potential confounding from former drinker bias and other study-level covariates, our meta-analysis of 107 studies found:

(1) no significant protective associations of occasional or low-volume drinking (moderate drinking) with all-cause mortality; and

(2) an increased risk of all-cause mortality for drinkers who drank 25 g or more and a significantly increased risk when drinking 45 g or more per day.

Several meta-analytic strategies were used to explore the role of abstainer reference group biases caused by drinker misclassification errors and also the potential confounding effects of other study-level quality covariates in studies.² Drinker misclassification errors were common. Of 107 studies identified, 86 included former drinkers and/or occasional drinkers in the abstainer reference group, and only 21 were free of both these abstainer biases. The importance of controlling for former drinker bias/misclassification is highlighted once more in our results which are consistent with prior studies showing that former drinkers have significantly elevated mortality risks compared with lifetime abstainers.

In addition to presenting our fully adjusted models, a strength of the study was the examination of the differences in relative risks according to unadjusted and partially adjusted models, including the effect of removing individual covariates from the fully adjusted model. We found evidence that abstainer biases and other study characteristics changed the shape of the risk relationship between mortality and rising alcohol consumption, and that most study-level controls increased the observed risks from alcohol, or attenuated protective associations at low levels of consumption such that they were no longer significant. The reduced RR estimates for occasional or moderate drinkers observed without adjustment may be due to the misclassification of former and occasional drinkers into the reference group, a possibility which is more likely to have occurred in studies of older cohorts which use current abstainers as the reference group. This study also demonstrates the degree to which observed associations between consumption and mortality are highly dependent on the modeling strategy used and the degree to which efforts are made to minimize confounding and other threats to validity.

It also examined risk estimates when using occasional drinkers rather than lifetime abstainers as the reference group. The occasional drinker reference group avoids the issue of former drinker misclassification that can affect the abstainer reference group, and may reduce confounding to the extent that occasional drinkers are more like low-volume drinkers than are lifetime abstainers.^2,8,132 In the unadjusted and partially adjusted analyses, using occasional drinkers as the reference group resulted in nonsignificant protective associations and lower point estimates for low-volume drinkers compared with significant protective associations and higher point estimates when using lifetime nondrinkers as the reference group. In the fully adjusted models, there were nonsignificant protective associations for low-volume drinkers whether using lifetime abstainers or occasional drinkers as the reference group, though this was only a RR of 0.97 for the latter.

Across all studies, there were few differences in risk for studies when stratified by median age of enrollment above or below age 56 years in the fully adjusted analyses. However, in the subset of studies who enrolled participants aged 50 years or younger who were followed for at least 10 years, occasional drinkers and medium-volume drinkers had significantly increased risk of mortality and substantially higher risk estimates for high- and higher-volume consumption compared with results from all studies. This is consistent with our previous meta-analysis for CHD,9 in which younger cohorts followed up to older age did not show a significantly beneficial association of low-volume consumption, while older cohorts, with more opportunity for lifetime selection bias, showed marked, significant protective associations.

Our study also found sex differences in the risk of all-cause mortality. A larger risk of all-cause mortality for women than men was observed when drinking 25 or more grams per day, including a significant increase in risk for medium-level consumption for women that was not observed for men. However, mortality risk for mean consumption up to 25 g per day were very similar for both sexes.

Footnotes and references can be found at the article’s References.

Drinking a Little Alcohol Won’t Kill You Before Someone Who Never Drank, WSJ

Quantifying Alcohol’s Death Risk; NDAs Hide Docs’ Mistakes; H5N1 Pandemic Prep, MedPage Today