My doctors’ office now asks that I self report my weight if I feel comfortable doing so. 
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Ugh, I feel for the docs. But I get why they are changing their behavior.
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This article and many others seem to spin the surgeon general’s report to suit the author’s own personal desires and fit their own personal circumstances. Such rationalizations seem more about one’s devotion to social drinking rather than about an honest assessment of the risk or an attempt to understand the risk of alcohol to those not similarly situated.
For example, the author takes comfort in the fact that every drink only takes five minutes off of a hypothetical/average life and rationalizes that this can be balanced with a bit of exercise, which adds five minutes. It is presented as a wash, but that isn’t really the way our bodies and chronic disease work, is it? Isn’t it more accurate to say that if you are one of the unlucky ones who ends up getting cancer, a stroke, etc. then not only will your life expectancy be drastically cut, but your quality of the rest of your life will also be drastically impacted.
In other words, it seems more like a longer term and more subtle version of Russian roulette, albeit with many more empty chambers in the gun. For most people, drinking will not impact their lifespan even 5 minutes a drink. For an unlucky few, drinking may drastically curtail lifespan and quality of life. And those who have other pre-existing risk factors for cancer, heart disease, addiction, strokes, heart failure, etc, have fewer empty chambers to begin with. How much joy would you have to expect to play Russian roulette with a revolver with one bullet in a 199 empty chambers (0.5% risk). What if your revolver already had bullets in 5 chambers? Would you add a few more? (Obviously not a perfect metaphor because the danger is immediate, rather than down the road.)
Even looking at it this way, it still may be that a healthy person with few risk factor will decide that the minuscule future risk of one of these extreme results doesn’t outweigh the immediate joy they receive from drinking. (Were it not for certain risk factors, this would be my choice.) But it also may be that a person with heightened risk factors who never considered that drinking increased the risk further will see a warning label and think twice about playing.
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Lying to your doctor? Wow. I had to google the % of people who lie to their doctor. This kinda sorta boggles my mind. And the range is 60-80% with the four (4) most common lies being diet, exercise, alcohol consumption and sexual activity.
I’d like to think I’d be totally honest with my doctor. And my doctor to be totally honest with me. 
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It’s also easy to unintentionally mislead yourself; for example, my Dad pours wine into a standard wineglass until it’s about 1/2-3/4" from the top of the wine glass, as one would fill a water glass. To him, that’s “a glass of wine,” but it’s actually just a hair under two glasses of wine according to how different types of alcohol are measured. Then when he got stemless wine glasses with a broader bowl, one of his glasses (the way he pours it) is now fully double “one glass of wine.”
So when he tells his doctor that he has “one and a half to two glasses of wine a day,” he really needs to be telling them he’s having 3-4 glasses of wine a day. It’s not a gotcha, but it’s information his doctor should have so that his doctor can properly provide guidance on medication, treatment, and health.
I have tried gently to have this talk with my Dad—not from a standpoint about changing his drinking—but about updating his doctor at his next checkup “just so he can tweak any of your medications to be right for you.”
My Dad thinks I’m being persnickety, that I’m exaggerating that it’s two glasses instead of one, and the amount doesn’t really matter anyway. (Not only was I in the wine business for years, so yes, I do know what a glass pour is, but I’ve also measured the volume of these glasses at different fill levels.)
With the health conditions he has, it does matter. And at some point I’d like to figure out how to let his doctors know the accurate information so that they can provide accurate treatment. Yes, I already have healthcare POA, and I’ve even sat in on calls with his neurologist, and have access to his portal. But as all communication runs through the portal, I can’t communicate confidentially with his doctor without my Dad seeing it, and the fall out from doing that would be a real issue.
So for now, it’s encouraging him to let them know himself, and hoping that he has another tele-doc appointment I could join in the future (rather than the in person ones that I don’t) where I could segue naturally to asking about alcohol, conditions, and medication in a totally natural way.
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This exactly!
I see this all the time with my patients as well as my loved ones. People with health issues (or habits that tend to be unhealthy) tend to overestimate their exercise/activity level and underestimate habits related to excess/unhealthy eating, overuse of alcohol or medications/drugs and smoking.
In my opinion it is not exactly intentional, but more of a defense mechanism because it feels painful to be questioned or lectured about it. Which is why it is so challenging to address as a health care provider.
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House: "everybody lies:
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This is my mil. I know she isn’t forthcoming with her doctor about how much wine she drinks. I also think she deceives herself about how much she has consumed. It’s honestly one reason I prefer a mixed drink to wine. Wine has the problem of, “topping off,” at least when one is at home.
In addition to the overall health risks, I worry about increased fall risks as well.
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I’ve seen a lot of topped-off gin and tonics where after a while it all gin.
With wine at least one can keep track of the bottles. 5 standard servings to a bottle, so if Dad or mil is drinking a bottle of wine, that is 5 drinks, not 2 and a half. It gets harder if they switch to boxes of wine.
Yes and mixed drinks often contain a lot of sugar and sodium, depending on what you’re drinking. Give me a glass of red 
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I wrote the doctor’s nurse and asked her to make sure the doctor saw my note before my mom’s appointment that week.
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I agree.
Take my SIL, for example. She was in this…phase…for about 10 years where she’d say that she had “a couple of glasses of wine” each day. But in reality, she was polishing off an entire bottle all on her own every day. I saw it happen several times. And she’d developed a large enough tolerance that she acted completely unphased by it.
Another time, over a 3-day weekend, she & BIL polished off an entire gallon of wine + a couple of 12 packs of beer + a bunch of those vodka spritzer canned drinks. It was pretty eye opening.
She’s since cut back a lot.
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Some points:
Nobody thinks that lots of alcohol is good, but there are legitimate questions about small amounts,” … “The biggest frustration for me…is the implication that the science is settled so clearly and securely that we don’t actually need to get the right answer to this.”
…
That study, published in the Lancet in 1991, suggested that alcohol consumption alone—not diet or other factors—was responsible for about a 30 percent lower risk of heart attack. In the decades since, further studies have confirmed that light drinking can increase levels of high-density lipoprotein, HDL (the so-called “good” cholesterol), and reduce blood sugar and insulin levels, lowering diabetes risk.
…
The colleagues are closely watching a randomized trial on alcohol consumption now under way in Spain, hoping it may help answer some of their unresolved questions. In the meantime, they advise following current U.S. guidance. “You don’t have to drink,” Mukamal points out, “but if you would like to, don’t ever have more than one in a day if you’re a woman, or two in a day if you’re a man. Full stop.”
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FWIW I think this 34 year old study and similar studies have been largely refuted or at least seriously called into question. Some studies have found the opposite.
(One study’s) conclusion: There is no level of drinking that does not confer heart disease risk. The risk is small if people have an average of seven drinks a week when compared with none. But it increases quickly as the level of alcohol consumption rises.
. . .
Some researchers have reported that drinking modestly protects the heart because moderate drinkers as a group have less heart disease than those who drink heavily or those who abstain. Dr. Aragam and his colleagues also saw that effect. But the reason, they report, is not that alcohol protects the heart. It is that light to moderate drinkers — those who consume up to 14 drinks a week — tend to have other characteristics that decrease their risk, like smoking less, exercising more and weighing less than those who drink more heavily and those who do not drink.
. . .
The actual risks to an individual depend on whether the person has other conditions, like diabetes or obesity. But, Dr. Aragam said, extrapolating from the results of the study, a typical middle-aged person in the study who did not drink had an estimated 9 percent chance of having coronary heart disease. A person who had one drink a day had an estimated 10.5 percent chance, which is small. After that, though, the risk increases quickly. https://www.nytimes.com/2022/03/29/health/alcohol-drinking-heart.html
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This, and that’s the problem. If it was clear…it would be clear. Want to go down the rabbit hole? Look at egg research.
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Or caffeine!
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Or unprocessed red meat and dementia…
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I actually put my wine glass on the scale which lives on my kitchen counter and pour until it reaches 180 ml.
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But it is clear for all but moderate drinkers. Alcohol consumption poses health risks, and the more you drink the higher the risks. And for people with certain existing conditions (AFib, for example) there is significant additional risk even at moderate levels of consumption.
The alcohol industry has duped many of us into believing that alcohol consumption is good for us, or that we just don’t know one way or another. And we’ve been willing dupes because who doesn’t enjoy a drink or so? But let’s not kid ourselves. We do know there are significant risks associated with alcohol use, and for certain groups of people certain conditions or characteristics, the risks may be worth considering.
From an article linked in the podcast you posted above, from the Dr. in the podcast . . .
Researchers have long known that excessive alcohol use is hazardous to one’s health. In the United States, alcohol-associated liver disease is the top reason people need liver transplants. Heavy alcohol use has been linked to high blood pressure, strokes, heart failure and multiple cancers. The surgeon general’s advisory notes that 20,000 cancer deathsannually are related to alcohol consumption. Alcohol is the third-leading preventable cause of cancer, behind smoking and obesity. Based on this information alone, I believe it is reasonable to add cancer to the warning label of alcoholic beverages.
I also agree with the surgeon general that people should be aware of emerging research that links moderate alcohol use to some cancers. For instance, his advisory cites a study showing that the risk of a woman developing breast cancer in her lifetime is 11 out of 100 if she doesn’t drink or drinks infrequently. If she has one drink a day on average, that risk goes up to 13 out of 100. At two drinks a day, it’s 15. For men who consume less than one drink a day, the risk of developing any alcohol-related cancer in their lifetimes is 10 out of 100. It increases to 11 at one a day and to 13 at two a day.
Some people will look at this data and shrug. After all, many other factors increase cancer risk, which individuals can manage by exercising, cutting ultra-processed foods, staying at a healthy weight and not smoking. In addition, people engage in many pleasurable behaviors that carry risk. How to evaluate these risks will differ from person to person.
Others, however, will change their drinking behavior because of this data. A woman with a significant family history of breast cancer who has already taken other steps to reduce her cancer risk might want to reduce alcohol consumption. And people who have a glass of wine every night because they think it’s good for their health should know that whatever benefit they derive from heart protection (which itself is a point of contention) is probably outweighed by the increased cancer risk. They might choose to cut down because, from a purely a physical health perspective, less alcohol is better.
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Is it though? We used to be just as certain that eggs were bad. There were even calculators that showed a direct relationship between number of eggs consumed and reduction in days of longevity. We were certain fat was bad. I could go on, but certainty based on epidemiological data is anything but.
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