I am making plans…and this “Day” I am planning a little lunch, at an outside table on a quiet Oakland sidewalk, at my favorite Italian restaurant, with a truffle infused pasta dish, AND a glass of good Italian wine, and I will watch the people passing by, with babies, and dogs, enjoying a moment in the California sunshine, as a precursor to “coping” with the next 4 years. I enjoy wine, and always have. I have a passion for Italian wines, enjoy the varietals as well as the great Barolos. At 87 I heed my doctor and drink in moderation, perhaps a small glass 2 or 3 times a week. I understand the risks. But I also recall when eggs were bad for you…..butter was bad for you…..fat is bad for you…..I will stick with my Scots grandmother’s admonition: “Moderation in all things!” But thank you Ryan, for your ever insightful posts.
Such a fun moment you painted here, Mary, I wish I could join you for that lunch with a glass of white for me, and watch the world go by. It reminds me of a legendary William Osler quotation:
"Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the commonplace, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs.”
I've always been a proponent of moderation in all things -- which includes trying not to be obsessive about risks. I'm lucky when it comes to genetics and lifestyle choices -- I have never been overweight, have never smoked, and my family tends to live well into their 80s and 90s. If I gave up working with horses I'm sure I could lessen my risk of dying before my maximum possible lifespan by a considerable amount, but hell will freeze over before I give that up. If I gave up the occasional piece of chocolate cake I could probably extend my life a bit more, and removing my 3 small glasses of wine per week might add a year or two to the total, but I won't be doing that either.
The bottom line? We all have an expiration date. My goal in life is quality, not quantity, and if having a glass of wine over dinner a few nights a week, or enjoying a fabulous dessert now and then might give me fewer days on the planet, that's a risk I'm willing to take. The anxiety of trying to avoid every possible risk isn't good for me either.
Thank you for continuing to be a voice of reason in a sea of misinformation and outrage-mongering.
Thank you CBA, and your commentary is how I feel, too. Watching the passion in MLK's voice, the knowledge that he would soon be assassinated somehow, it just gives me chills. Those 40 odd years were worth 10,000 spent selfishly chasing 100 in a haze of narcissism and self-preservation. that being said it's good to play the long game, but not at the expense of missing the whole joy of the game.
My older patients would certainly agree that the golden years are not always golden, so seize the day.
Again thanks! Perfect post for an absolutely horrible day (for our country and frankly the world). I am *fine* thanks for asking! At least it is sunny here in Seattle (if freezing) and I am taking care of the song birds in my yard. I will not be watching the speech and I also will not be drinking any alcohol. I do drink but over the past 3 years I have dropped my alcohol intake by quite a bit (75% less alcohol in 2024 over 2022 but I did not drink daily at that point). Why? I sleep like sh*t when I drink any alcohol and I prioritize sleep over everything else. That said, having a drink with friends or while on vacation does have benefits -- social connection is so important. So I save up my alcohol intake for those occasions. My father drank more than was good for him but lived to be 93 and was fairly intact when he passed. His two brothers died of alcohol-related illnesses in their 40s. I have taken care of 28 year olds in the ICU as they died of alcohol related illness so I am aware some of it is genetics and good luck. Anyway, if I used alcohol to cope with the next 4 years I would be drunk all the time!
So true Donna! I agree that sleeping like sh*t is not worth it as I too get older and less able to stitch a full 7 hours together anymore. Darn glutamate upregulation or whatever! And the health inputs are in the millions, obsessing on a few might help, but like you've illustrated the wheel of fortune stops in unexpected places and times for us all.
I've been hearing a really common thread among friends, family, patients, (readers!) - doubling down on relationships, love, seeking beauty and purpose while tuning out what we must to survive. I really hope that recharges the batteries we will need to right the ship in the near future.
Hi Mick! A definite "no" to being poisoned for profit.
For me, the dose and the frequency still make the poison, and I'm glad you've pointed out this linear rather than J shaped correlation in this study.
The safest bet is not to drink at all, but there are pleasures in addition to the poison when consumed "in moderation."
While the authors acknowledge their study's methodological strengths, they don't claim it's definitively superior or more authoritative than all previous research. They note that their study:
Uses a newer analytical method (doubly-ranked approach) that overcomes certain limitations of previous nonlinear Mendelian randomization studies
Is the first to apply this specific method to examine multiple cause-specific mortality types
However, they also openly acknowledge their study's limitations, including potential biases, generalizability concerns, and the possibility that the true biological relationship between alcohol and mortality could be more complex than their analysis shows. This balanced presentation suggests they see their work as contributing to, rather than definitively settling, the ongoing scientific discussion.
That being said, the profiteering with the advertisements and addictive nature of alcohol for many is balatant.
Good job on the political portion of this post Ryan. A bad day for the country, made worse that the climate of the times led a majority of the country to vote for our new president. We are drowning in an ocean of misinformation and disinformation. We seem to have a relish for chaos and entertainment. Good government bores the law-abiding and vexes the law breakers. Dolorous times to be living in.
I appreciate this nuanced, thoughtful post, as always but maybe especially today. I'm avoiding the news this week but allowing myself certain substacks : )
My parents have provided me with powerful anecdotal testaments to the dangers of alcohol. While I have drank more during certain periods of life, now that I am well into middle age, I have cut way back on drinking, limiting it to occasional social situations. I watched my mom slowly kill herself with alcohol, dying of liver disease at age 70. I do not wish that for my children. All of her siblings have lived well into their late seventies and eighties, so it seems likely she was destined for a longer life/health span had she not become an alcoholic in her 20s. My dad just passed away at age 90 and never drank. He lived through myasthenia gravis in his 40s, a car accident-caused TBI in his 50s, two bouts of kidney cancer, an aortic aneurysm in his 60s, an abdominal aneurysm and two covid hospitalizations. I think avoiding alcohol contributed to robust enough health to get him through these numerous setbacks. That, and some good genetics and luck. He lived independently until just a few months before he died.
I don't think I'm alone in lamenting Trump's seemingly robust health. No doubt abstaining from alcohol has contributed to that (maybe offsetting the effects of McDonalds).
Anyway, cheers to you, Dr. McCormick, and thanks in advance for helping us get through the next four years.
Hi Danielle, and thanks for the honor of a read and visit today as I too am limiting my media time. Fascinating family story, and though the specifics are unique, the universal health struggles we all endure are so relatable, especially for those loved ones who reach old age.
My mom reminds me that health challenges and setbacks are the price we pay for living, and that it's hopefully always worth it.
I didn't really get into alcoholism (this post was already insufferably long at times), focusing instead on the "choice" to drink... but your kind story about your mom reminds us that for many there is "no choice", just dependence upon alcohol. Most of us know that well somewhere in our family trees.
Trump does not look healthy to me at all, so not sure his abstinence will make up for time, Covid, BMI, stress, rage, and the rest.
This is tangential , but your remark reminded me . History turns on a dime . I can still see that moment that DJT returned from his Covid hospitalization - the obvious labored breathing as he struck his defiant Mussolini like pose . And I realize that he came so close to death . Regeneron likely saved him.
So very true, so many ironies and hypocrisies when it comes to respecting the science and scientists and clinicians that saved his life… and so many others. As Biden said, you can’t just love your country when you win, so too you can’t just love science when it saves your damn life.
Thank-you. I was aware of most of the risks of alcohol and even some of the mechanisms thanks in no small part to my endocrinologist explaining some of the many pathways involved in type2 diabetes. She filled an entire exam table covered with paper. I actually followed up her 'course' at the NIH library.
When I think about risks I have to map them into other contexts for comparison. A youth spent attaching lead weights onto a fishing line using my teeth. Racing to keep up with the insect fogger truck on my bike. Using trichlorethelene on wide-band tape machine heads. Sleeping on top of a torpedo with who knows what propellant. Years of smoking. Too much sugar, Too many fats.
I'm glad that I've changed many of my behaviors. Thank goodness for the toughness of livers and kidneys ! But I'm not much intimidated by the risks from my current usage of alcohol. The sugars in the "alcohol-free" drinks emerging as replacements are pretty bad too.
I was struck by your note on the attractiveness of "the burn". That is a learned behavior much like smoking. Now I find some equivalent experience of it in cinnamon in my coffee and in hot peppers on almost everything. I expect that if I live long enough that cinnamon and capsaicin will be declared adverse. Coffee is already close to being on the list. But I expect to expire from something else long before then.
Hi John - I love the examining table paper white board, too! Awkward to rip that off and hand to patients after the discussion, so I've gotten away from it :)
Quite a list of risks and situations, most eye-popping was the sleeping on top of torpedoes. I'm guessing Navy!
The one time I tried inhaling cigarette smoke it was most unpleasant, and you are right, I bet a similar learned interpretation of that basic noxious experience leading to a nicotine fix changes the brain.
I won't write any posts casting shade on cinnamon, hot peppers, or coffee... so no worries about ruining all the good stuff here.
Thank you for this, Dr. McCormick. I agree that moderation is essential in almost everything. I received a bottle of single malt scotch in the summer of 2021. There is still about 6 ounces left in the bottle. Scotch has been my favorite alcoholic beverage for the past 70 years, although on occasion I like a cold lager. I am the oldest of four siblings, I will be 92 in March. A sister died in infancy. My two younger brothers 2 years and 7 years behind me are both dead. Both drank alcohol immoderately, like a bottle of wine everyday. So having read your article I guess I'm lucky. I don't dislike alcohol, but the older I've gotten the less I drink it and even in my youth I rarely drank to excess,
Hi Fay, thanks for stopping in! We are much the same, with hard liquors well past their expiration dates (if they have such a thing), but savored when they are consumed infrequently. A cold lager cannot be beat on a hot day, though proper hydration must be ensured in parallel. Here's to 92. Amazing.
I saw one of favorite patients this week who just turned 101. Sharp mind, body a bit slow, but still enjoying life. Likely you caught this one already:
You don't really get into the risks related to mental health beyond the physiological effects. I decided at the age of 17 that alcohol was never going to be an option for me. I had pretty wild mood swings and anxiety, even for a teenager. One thing I learned from the nascent Web at the time was that alcohol was not a good way to cope with these and likely would make things worse. Add in an extended family history of anxiety, depression, and alcohol abuse and it really seemed unwise for me.
2.5 decades later I still hold to this decision and I'm glad I have. I do have anxiety and depression as my 17 year old self suspected. It's a heavy "biological load" as my doctor calls it. I don't have a hard time socializing with friends and family (to the extent my introverted self prefers) and have no desires to add intoxicants to those interactions. I've seen more examples of people acting foolishly and not realizing it than people getting more comfortable or relating better in a real way. The times I wish I had something like alcohol is when I'm in a bad spot and probably also alone, and there's no upside to that. That's where I'm glad I never gave myself that option and instead resort to exercise, hobbies, meditation or talking to a friend rather than further disrupting my brain chemistry and putting my body under more stress. I'm not sure of studies about the role of alcohol in suicidal ideation, but I'm also thinking it can't be positive. I've seen how people dig their mental holes deeper with alcohol and even if it doesn't kill them, it does not actually improve their condition and likely makes it worse.
Hi Kate - very good point, and I pointed out above in another comment that there were certainly aspects of alcohol I did not address (this post got way too long, too!). Mental health, self-medication with alcohol really deserves another post someday. You've illustrated some of the big concerns and alternatives above, so thank you for that. Agree that drinking alone for anything but perhaps a little relaxation or pleasure can be a red flag.
An extremely nuanced post. Like so many who have commented, I believe in moderation of all things, including drinking and politics. I can’t get over the irony of Trump being inaugurated on Martin Luther King Day……….
Patti - we are going to need some serious comedic heroism to make any sense of the Roman salute from Elon Musk at the Presidential Podium under The Seal on MLK Day. tragic stuff. Here was a good highlight show:
Thank you for that thorough analysis of alcohol. What I have noticed, as a nurse practitioner in a relatively small town-is that the level of alcohol intake doubled during Covid and now there really does seem to be an effort to turn it around. Many of my patients say they do not like the taste anymore, or that they feel so badly the next day, even after a small glass of wine, that it is no longer worth it. As for health effects, one thing not mentioned and that I really think I see-is a phenomenon like microvascular dementia. Alcohol, for some people, can injure the brain on a microvascular level, and it is not reversible. Sorting the effects of alcohol out from high cholesterol, high blood pressure, impaired glucose tolerance and the like, would probably make this an impossible study.
Maybe someday there will be a genetic bluebook for each baby that makes more personalized recommendations, until then I agree with your reader and her Scots grandmother-Moderation in all things!
Such a fascinating thought, I agree that many are cutting back on alcohol, perhaps associating it with that pandemic they are trying to forget and revise in their memories. Just like clinicians and public health leaders are increasingly being thrown under the bus, masks + vaccines + any ventilation lessons learned now suffering scorn, maybe one good thing will be an aversion to excessive alcohol.
Also a good point about the neurotoxic effects of alcohol and the potential for microvascular damage... more apparent as we have accumulated more damage from all sources over the decades perhaps. Neuroplasticity is a thing, but less of a thing as we age, right?
Thanks for stopping by , cheers to moderation as a choice!
My long comment is that we don't seem to think of alcohol as a drug, as we often see/hear "drug and alcohol" as if these are separate things. It is an psychoactive drug and a CNS depression. The chemical name is ethanol. However, it is one of the ceremonial chemical used through out human history. I view that the line is really crossed when it becomes addictive. After all, one of the major college sports is binge drinking (see Animal House). Hell, we have examples in nature that animals imbibe once a year. https://youtu.be/Ru-dssakX8I
Did you ever see birds like cedar wax wings on the sidewalk? They are not dead but drunk, please put then in safe place. Probably wakes up wondering where , in heck, they are. Having said that, I haven't had any alcoholic beverages for some time. I remember though, vodka taste strange in a plastic bottle rather than the old glass ones. Not really interested in messing with my perfect brain waves.... (LOL)
Hi KB - it is hard to deny the historical use of alcohol, and it really is fascinating. Beerwine emerged as safer drinks than many others laden with bacteria, etc, right? And alcohol's mixed effects have certainly played a huge role in interpersonal negotiations and power sharing, from marriages to triumvirates!
Drunk animals are a thing. I think of monkeys with overripe fruit.
Keep those brain waves undisturbed, a good choice, too!
I could watch that 10 times in a row and not feel any less moved. Also listened to a speech he gave at a philly high school in 1967. Different audience, different tone, same mensch.
I learned about the acetaldehyde/ formaldehyde/poison connection at the University of Connecticut school of medicine back in 1977 and though I’d never been a drinker, I knew then as I have had reaffirmed today in reading your post, that alcohol is a poison and nothing I have ever felt inclined to need or want in my life. So while I hear it has social lubricant qualities that many prize, I remain a teetotaler and at 72 I’m not likely to change my mind about this.
An excellent choice, Phoebe. I missed that lecture as I was still in diapers then, but such a prescient idea. The dose makes the poison of course, and the liver is amazing at handling so many inputs... but congrats on 72 and why start now!
I am making plans…and this “Day” I am planning a little lunch, at an outside table on a quiet Oakland sidewalk, at my favorite Italian restaurant, with a truffle infused pasta dish, AND a glass of good Italian wine, and I will watch the people passing by, with babies, and dogs, enjoying a moment in the California sunshine, as a precursor to “coping” with the next 4 years. I enjoy wine, and always have. I have a passion for Italian wines, enjoy the varietals as well as the great Barolos. At 87 I heed my doctor and drink in moderation, perhaps a small glass 2 or 3 times a week. I understand the risks. But I also recall when eggs were bad for you…..butter was bad for you…..fat is bad for you…..I will stick with my Scots grandmother’s admonition: “Moderation in all things!” But thank you Ryan, for your ever insightful posts.
This was an inciteful post, and refreshing to read and learn.
What restaurant is this? My now adult daughter lives in Oakland as we visit often.
My all time favourite…Belotti, College Ave
Been there..it's a gem.
Thank you! I set a reminder to make a reservation for March 15th!
I had RAVIOLI LENTCCHIE, COTECHINO DI MODENA E TARTUFO NERO |$41.50
Our pasta version of the Iconic lenticchie e cotechino dish typical of the winter celebration period in North Italy, we stuffed our
egg pasta with cotechino di Modena, soft russet potatoes in a braised Umbrian lentils sauce topped with shaved Perigord black truffle.
It was pricey (truffles!!!) but so delicious, with a nice Barbaresco! And really helped navigate my "day"!
Yum!!
My mouth is literally watering....
Such a fun moment you painted here, Mary, I wish I could join you for that lunch with a glass of white for me, and watch the world go by. It reminds me of a legendary William Osler quotation:
"Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the commonplace, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs.”
https://stanfordmedicine25.stanford.edu/blog/archive/2014/10-Osler-isms-to-Remember-in-Your-Daily-Practice.html
Moderation in all things just keeps winning, doesn't it?!
Cheers to your health and longevity
I've always been a proponent of moderation in all things -- which includes trying not to be obsessive about risks. I'm lucky when it comes to genetics and lifestyle choices -- I have never been overweight, have never smoked, and my family tends to live well into their 80s and 90s. If I gave up working with horses I'm sure I could lessen my risk of dying before my maximum possible lifespan by a considerable amount, but hell will freeze over before I give that up. If I gave up the occasional piece of chocolate cake I could probably extend my life a bit more, and removing my 3 small glasses of wine per week might add a year or two to the total, but I won't be doing that either.
The bottom line? We all have an expiration date. My goal in life is quality, not quantity, and if having a glass of wine over dinner a few nights a week, or enjoying a fabulous dessert now and then might give me fewer days on the planet, that's a risk I'm willing to take. The anxiety of trying to avoid every possible risk isn't good for me either.
Thank you for continuing to be a voice of reason in a sea of misinformation and outrage-mongering.
Thank you CBA, and your commentary is how I feel, too. Watching the passion in MLK's voice, the knowledge that he would soon be assassinated somehow, it just gives me chills. Those 40 odd years were worth 10,000 spent selfishly chasing 100 in a haze of narcissism and self-preservation. that being said it's good to play the long game, but not at the expense of missing the whole joy of the game.
My older patients would certainly agree that the golden years are not always golden, so seize the day.
Again thanks! Perfect post for an absolutely horrible day (for our country and frankly the world). I am *fine* thanks for asking! At least it is sunny here in Seattle (if freezing) and I am taking care of the song birds in my yard. I will not be watching the speech and I also will not be drinking any alcohol. I do drink but over the past 3 years I have dropped my alcohol intake by quite a bit (75% less alcohol in 2024 over 2022 but I did not drink daily at that point). Why? I sleep like sh*t when I drink any alcohol and I prioritize sleep over everything else. That said, having a drink with friends or while on vacation does have benefits -- social connection is so important. So I save up my alcohol intake for those occasions. My father drank more than was good for him but lived to be 93 and was fairly intact when he passed. His two brothers died of alcohol-related illnesses in their 40s. I have taken care of 28 year olds in the ICU as they died of alcohol related illness so I am aware some of it is genetics and good luck. Anyway, if I used alcohol to cope with the next 4 years I would be drunk all the time!
So true Donna! I agree that sleeping like sh*t is not worth it as I too get older and less able to stitch a full 7 hours together anymore. Darn glutamate upregulation or whatever! And the health inputs are in the millions, obsessing on a few might help, but like you've illustrated the wheel of fortune stops in unexpected places and times for us all.
I've been hearing a really common thread among friends, family, patients, (readers!) - doubling down on relationships, love, seeking beauty and purpose while tuning out what we must to survive. I really hope that recharges the batteries we will need to right the ship in the near future.
This is the best study on drinking alcohol that we have so far:
Alcohol consumption and the risk of all-cause and cause-specific mortality—a linear and nonlinear Mendelian randomization study:
https://academic.oup.com/ije/article/53/2/dyae046/7632292
Should we keep being poisoned for profit, while we wait for more studies?
No is my answer!
Hi Mick! A definite "no" to being poisoned for profit.
For me, the dose and the frequency still make the poison, and I'm glad you've pointed out this linear rather than J shaped correlation in this study.
The safest bet is not to drink at all, but there are pleasures in addition to the poison when consumed "in moderation."
While the authors acknowledge their study's methodological strengths, they don't claim it's definitively superior or more authoritative than all previous research. They note that their study:
Uses a newer analytical method (doubly-ranked approach) that overcomes certain limitations of previous nonlinear Mendelian randomization studies
Is the first to apply this specific method to examine multiple cause-specific mortality types
However, they also openly acknowledge their study's limitations, including potential biases, generalizability concerns, and the possibility that the true biological relationship between alcohol and mortality could be more complex than their analysis shows. This balanced presentation suggests they see their work as contributing to, rather than definitively settling, the ongoing scientific discussion.
That being said, the profiteering with the advertisements and addictive nature of alcohol for many is balatant.
Well put, Ryan. Thank you!
Good job on the political portion of this post Ryan. A bad day for the country, made worse that the climate of the times led a majority of the country to vote for our new president. We are drowning in an ocean of misinformation and disinformation. We seem to have a relish for chaos and entertainment. Good government bores the law-abiding and vexes the law breakers. Dolorous times to be living in.
I often think of the Gladiator scene:
"Are you not entertained??" to a stunned crowd.
And then the crowd moves on from the shock and horror to chant "Maximus!"
Classic.
Not a perfect example, though, as Maximus was definitely a blue dog democrat and Emperor Commodus by definition the nasty autocrat ;)
I appreciate this nuanced, thoughtful post, as always but maybe especially today. I'm avoiding the news this week but allowing myself certain substacks : )
My parents have provided me with powerful anecdotal testaments to the dangers of alcohol. While I have drank more during certain periods of life, now that I am well into middle age, I have cut way back on drinking, limiting it to occasional social situations. I watched my mom slowly kill herself with alcohol, dying of liver disease at age 70. I do not wish that for my children. All of her siblings have lived well into their late seventies and eighties, so it seems likely she was destined for a longer life/health span had she not become an alcoholic in her 20s. My dad just passed away at age 90 and never drank. He lived through myasthenia gravis in his 40s, a car accident-caused TBI in his 50s, two bouts of kidney cancer, an aortic aneurysm in his 60s, an abdominal aneurysm and two covid hospitalizations. I think avoiding alcohol contributed to robust enough health to get him through these numerous setbacks. That, and some good genetics and luck. He lived independently until just a few months before he died.
I don't think I'm alone in lamenting Trump's seemingly robust health. No doubt abstaining from alcohol has contributed to that (maybe offsetting the effects of McDonalds).
Anyway, cheers to you, Dr. McCormick, and thanks in advance for helping us get through the next four years.
Hi Danielle, and thanks for the honor of a read and visit today as I too am limiting my media time. Fascinating family story, and though the specifics are unique, the universal health struggles we all endure are so relatable, especially for those loved ones who reach old age.
My mom reminds me that health challenges and setbacks are the price we pay for living, and that it's hopefully always worth it.
I didn't really get into alcoholism (this post was already insufferably long at times), focusing instead on the "choice" to drink... but your kind story about your mom reminds us that for many there is "no choice", just dependence upon alcohol. Most of us know that well somewhere in our family trees.
Trump does not look healthy to me at all, so not sure his abstinence will make up for time, Covid, BMI, stress, rage, and the rest.
Cheers back to you, keep in touch these next 4 ;)
This is tangential , but your remark reminded me . History turns on a dime . I can still see that moment that DJT returned from his Covid hospitalization - the obvious labored breathing as he struck his defiant Mussolini like pose . And I realize that he came so close to death . Regeneron likely saved him.
So very true, so many ironies and hypocrisies when it comes to respecting the science and scientists and clinicians that saved his life… and so many others. As Biden said, you can’t just love your country when you win, so too you can’t just love science when it saves your damn life.
Thank-you. I was aware of most of the risks of alcohol and even some of the mechanisms thanks in no small part to my endocrinologist explaining some of the many pathways involved in type2 diabetes. She filled an entire exam table covered with paper. I actually followed up her 'course' at the NIH library.
When I think about risks I have to map them into other contexts for comparison. A youth spent attaching lead weights onto a fishing line using my teeth. Racing to keep up with the insect fogger truck on my bike. Using trichlorethelene on wide-band tape machine heads. Sleeping on top of a torpedo with who knows what propellant. Years of smoking. Too much sugar, Too many fats.
I'm glad that I've changed many of my behaviors. Thank goodness for the toughness of livers and kidneys ! But I'm not much intimidated by the risks from my current usage of alcohol. The sugars in the "alcohol-free" drinks emerging as replacements are pretty bad too.
I was struck by your note on the attractiveness of "the burn". That is a learned behavior much like smoking. Now I find some equivalent experience of it in cinnamon in my coffee and in hot peppers on almost everything. I expect that if I live long enough that cinnamon and capsaicin will be declared adverse. Coffee is already close to being on the list. But I expect to expire from something else long before then.
Thanks for a nice post !
Hi John - I love the examining table paper white board, too! Awkward to rip that off and hand to patients after the discussion, so I've gotten away from it :)
Quite a list of risks and situations, most eye-popping was the sleeping on top of torpedoes. I'm guessing Navy!
The one time I tried inhaling cigarette smoke it was most unpleasant, and you are right, I bet a similar learned interpretation of that basic noxious experience leading to a nicotine fix changes the brain.
I won't write any posts casting shade on cinnamon, hot peppers, or coffee... so no worries about ruining all the good stuff here.
Thank you for this, Dr. McCormick. I agree that moderation is essential in almost everything. I received a bottle of single malt scotch in the summer of 2021. There is still about 6 ounces left in the bottle. Scotch has been my favorite alcoholic beverage for the past 70 years, although on occasion I like a cold lager. I am the oldest of four siblings, I will be 92 in March. A sister died in infancy. My two younger brothers 2 years and 7 years behind me are both dead. Both drank alcohol immoderately, like a bottle of wine everyday. So having read your article I guess I'm lucky. I don't dislike alcohol, but the older I've gotten the less I drink it and even in my youth I rarely drank to excess,
Hi Fay, thanks for stopping in! We are much the same, with hard liquors well past their expiration dates (if they have such a thing), but savored when they are consumed infrequently. A cold lager cannot be beat on a hot day, though proper hydration must be ensured in parallel. Here's to 92. Amazing.
I saw one of favorite patients this week who just turned 101. Sharp mind, body a bit slow, but still enjoying life. Likely you caught this one already:
https://mccormickmd.substack.com/p/one-hundred-long-years
I'm sorry that you are the last sibling. Bittersweet is longevity.
You don't really get into the risks related to mental health beyond the physiological effects. I decided at the age of 17 that alcohol was never going to be an option for me. I had pretty wild mood swings and anxiety, even for a teenager. One thing I learned from the nascent Web at the time was that alcohol was not a good way to cope with these and likely would make things worse. Add in an extended family history of anxiety, depression, and alcohol abuse and it really seemed unwise for me.
2.5 decades later I still hold to this decision and I'm glad I have. I do have anxiety and depression as my 17 year old self suspected. It's a heavy "biological load" as my doctor calls it. I don't have a hard time socializing with friends and family (to the extent my introverted self prefers) and have no desires to add intoxicants to those interactions. I've seen more examples of people acting foolishly and not realizing it than people getting more comfortable or relating better in a real way. The times I wish I had something like alcohol is when I'm in a bad spot and probably also alone, and there's no upside to that. That's where I'm glad I never gave myself that option and instead resort to exercise, hobbies, meditation or talking to a friend rather than further disrupting my brain chemistry and putting my body under more stress. I'm not sure of studies about the role of alcohol in suicidal ideation, but I'm also thinking it can't be positive. I've seen how people dig their mental holes deeper with alcohol and even if it doesn't kill them, it does not actually improve their condition and likely makes it worse.
Hi Kate - very good point, and I pointed out above in another comment that there were certainly aspects of alcohol I did not address (this post got way too long, too!). Mental health, self-medication with alcohol really deserves another post someday. You've illustrated some of the big concerns and alternatives above, so thank you for that. Agree that drinking alone for anything but perhaps a little relaxation or pleasure can be a red flag.
An extremely nuanced post. Like so many who have commented, I believe in moderation of all things, including drinking and politics. I can’t get over the irony of Trump being inaugurated on Martin Luther King Day……….
Patti - we are going to need some serious comedic heroism to make any sense of the Roman salute from Elon Musk at the Presidential Podium under The Seal on MLK Day. tragic stuff. Here was a good highlight show:
https://www.theguardian.com/culture/2025/jan/21/jon-stewart-trump-inauguration
Thank you for that thorough analysis of alcohol. What I have noticed, as a nurse practitioner in a relatively small town-is that the level of alcohol intake doubled during Covid and now there really does seem to be an effort to turn it around. Many of my patients say they do not like the taste anymore, or that they feel so badly the next day, even after a small glass of wine, that it is no longer worth it. As for health effects, one thing not mentioned and that I really think I see-is a phenomenon like microvascular dementia. Alcohol, for some people, can injure the brain on a microvascular level, and it is not reversible. Sorting the effects of alcohol out from high cholesterol, high blood pressure, impaired glucose tolerance and the like, would probably make this an impossible study.
Maybe someday there will be a genetic bluebook for each baby that makes more personalized recommendations, until then I agree with your reader and her Scots grandmother-Moderation in all things!
Such a fascinating thought, I agree that many are cutting back on alcohol, perhaps associating it with that pandemic they are trying to forget and revise in their memories. Just like clinicians and public health leaders are increasingly being thrown under the bus, masks + vaccines + any ventilation lessons learned now suffering scorn, maybe one good thing will be an aversion to excessive alcohol.
Also a good point about the neurotoxic effects of alcohol and the potential for microvascular damage... more apparent as we have accumulated more damage from all sources over the decades perhaps. Neuroplasticity is a thing, but less of a thing as we age, right?
Thanks for stopping by , cheers to moderation as a choice!
Excellent article and good information!!
Thank you Delores :)
My long comment is that we don't seem to think of alcohol as a drug, as we often see/hear "drug and alcohol" as if these are separate things. It is an psychoactive drug and a CNS depression. The chemical name is ethanol. However, it is one of the ceremonial chemical used through out human history. I view that the line is really crossed when it becomes addictive. After all, one of the major college sports is binge drinking (see Animal House). Hell, we have examples in nature that animals imbibe once a year. https://youtu.be/Ru-dssakX8I
Did you ever see birds like cedar wax wings on the sidewalk? They are not dead but drunk, please put then in safe place. Probably wakes up wondering where , in heck, they are. Having said that, I haven't had any alcoholic beverages for some time. I remember though, vodka taste strange in a plastic bottle rather than the old glass ones. Not really interested in messing with my perfect brain waves.... (LOL)
Hi KB - it is hard to deny the historical use of alcohol, and it really is fascinating. Beerwine emerged as safer drinks than many others laden with bacteria, etc, right? And alcohol's mixed effects have certainly played a huge role in interpersonal negotiations and power sharing, from marriages to triumvirates!
Drunk animals are a thing. I think of monkeys with overripe fruit.
Keep those brain waves undisturbed, a good choice, too!
That you closed with the marvelous gesture of Martin Luther King, Jr.’s speech says it all. Today is HIS day, and no one else’s.
I could watch that 10 times in a row and not feel any less moved. Also listened to a speech he gave at a philly high school in 1967. Different audience, different tone, same mensch.
I learned about the acetaldehyde/ formaldehyde/poison connection at the University of Connecticut school of medicine back in 1977 and though I’d never been a drinker, I knew then as I have had reaffirmed today in reading your post, that alcohol is a poison and nothing I have ever felt inclined to need or want in my life. So while I hear it has social lubricant qualities that many prize, I remain a teetotaler and at 72 I’m not likely to change my mind about this.
An excellent choice, Phoebe. I missed that lecture as I was still in diapers then, but such a prescient idea. The dose makes the poison of course, and the liver is amazing at handling so many inputs... but congrats on 72 and why start now!
Excellent article and very informative.