When I wrote about alcohol on 01 Aug 2021, I said
“The Global Burden of Diseases paper  on alcohol use across 196 countries showed no benefit of alcohol consumption at any level. Alcohol is the 7th leading cause of death worldwide across all age groups and the 9th commonest cause of death in India in the 50-69 years age group. It is the third most important reversible cause of cancer.”
And then I ended with this,
“So what is your matka here? If you like drinking, you should drink really light, which would mean not more than 2-3 times a week and not more than 1 glass of red wine or equivalent. If you drink more (which I do sometimes as well), then do it without getting drunk and without binging. However, you cannot justify drinking alcohol from a health perspective…there is no evidence that drinking at any level helps us live longer, healthier. This is one of those situations where we have to balance a fun activity with what is good for our health in a practical and common sensical manner.“
So last month, when I came across a meta-analysis of alcohol intake and blood pressure by Federico S and colleagues  published in Hypertension saying there is no safe level of alcohol drinking when it comes to systolic and diastolic blood pressure, it made me pause. Should I completely stop drinking because any amount of alcohol causes a rise in blood pressure? I then read the fine print, which said that while there is no safe level, the actual increase in blood pressure with social drinking (up to one serving a day) is very very small.
There is a strong movement these days to devilize alcohol and often, guides like my Atmasvasth guide to live long healthy, seem like a list of Dos and Don’ts designed to rob us of any pleasure or fun or joy as John Steinbeck wrote about way back in 1963, in his book “Travels with Charley”.
“During the previous winter I had become rather seriously ill with one of those carefully named difficulties which are the whispers of approaching age. When I came out of it I received the usual lecture about slowing up, losing weight, limiting the cholesterol intake. It happens to many men, and I think doctors have memorized the litany. It had happened to so many of my friends. The lecture ends, “Slow down. You’re not as young as you once were.” And I had seen so many begin to pack their lives in cotton wool, smother their impulses, hood their passions, and gradually retire from their manhood into a kind of spiritual and physical semi-invalidism. In this they are encouraged by wives and relatives, and it’s such a sweet trap.
Who doesn’t like to be a center for concern? A kind of second childhood falls on so many men. They trade their violence for the promise of a small increase of life span. In effect, the head of the house becomes the youngest child. And I have searched myself for this possibility with a kind of horror. For I have always lived violently, drunk hugely, eaten too much or not at all, slept around the clock or missed two nights of sleeping, worked too hard and too long in glory, or slobbed for a time in utter laziness. I’ve lifted, pulled, chopped, climbed, made love with joy and taken my hangovers as a consequence, not as a punishment. I did not want to surrender fierceness for a small gain in yardage.“
Our focus on living long, healthy is not supposed to be at the expense of joy and pleasure. Ms. Emily Oster in a recent issue of The Atlantic called this attitude of denying ourselves the simple pleasures of life in our quest to live long, healthy, “pleasure agnosticism”.
Let’s come back to alcohol. Many of us feel good with a glass or two every now and then. Wine during lunch or dinner often enhances the meal. Conversations tend to become better after a pint or two of beer. Alcohol has been around in some form or the other for tens of thousands of years but now papers like the Global Burden of Diseases tell us that there is no safe level of alcohol drinking. Logically, if alcohol was that bad, would the practice have lasted so long?
A recent meta-analysis of cohort studies by Zhao J and colleagues  puts this in perspective. They found that occasional (up to 1.3 gm of ethanol per day) and low volume (1.3 to 24 g of ethanol per day) drinking did not increase (or improve) all-cause mortality. (1 standard drink or 14 gm of alcohol is 1 pint of beer, 1 glass of table wine or 1 1/2 peg of any distilled spirit). There was minimally increased all-cause mortality in those who drank between 25 to 44 gm of alcohol per day and a significantly increased mortality risk in those who drank more than 44 gm of alcohol equivalent per day.
So, while accepting that there is no health benefit to drinking and that if you don’t drink, you don’t need to start, there is no reason to feel guilty, if you drink socially.
The same can be extended to salt, sugar, fat and ultra-processed foods (UPFs). Yes, excess salt on a daily basis causes high blood pressure and increases all-cause mortality, excess sugar has its own set of problems and the use of UPFs consistently is associated with a reduced healthspan and lifespan. But does that mean we take all joy out of eating? If that tiramisu melts in your mouth, should you stop at one spoon? Or if you wolf down that box of Pringles once in a while, with all its salt and fat and additives, is that going to reduce your lifespan and healthspan?
The idea of Atmasvasth is to give ourselves a guide that allows us to live long, healthy. But that does not mean we have to be pleasure-agnostic and eschew everything that gives us joy because of the potential future downsides. The key is moderation and common sense. So, it makes sense not to shoot intravenous heroin even if it makes you feel good because of the high chance of getting addicted, but if you have to smoke a cigarette or a joint or a hookah once in a month or two with friends, the earth will not fall and you will not lose months or years of your life.
Joy itself adds to our healthspan and lifespan. Being part of a community, going out with friends, enjoying so-called “sinful’ activities, all go a long way in making our lives more fulfilled.
Most of us are going to live till the age of 80, many of us till 90 and it is a good idea to follow the Atmasvasth principles to ensure a long healthspan within that lifespan…but with joy and grace and fun. What is the point of living long, if we don’t enjoy that journey? After all, irrespective of all that talk about reincarnation and karma and rebirth, you really only live once, don’t you?
1. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018 Sep 22;392(10152):1015-1035.
2. Federico S et al. Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies. Hypertension 2023;80:00–00
3. Zhao J et al. Association Between Daily Alcohol Intake and Risk of All-Cause Mortality A Systematic Review and Meta-analyses. JAMA Network Open. 2023;6(3):e236185.
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