Unexplainable – “Is a little alcohol bad for you?”

Date: September 8, 2025
Host: Bird Pinkerton & Dylan Scott
Guests: Dr. Ken Mukamal, Dr. Tim Naimi

Overview:

This episode takes on the pervasive question: “Is moderate alcohol consumption actually good (or bad) for your health?” Host Bird Pinkerton and co-host Dylan Scott investigate the conflicting evidence, interviewing scientists on both sides of the debate, and exploring why it’s so hard to get a definitive answer. The episode ultimately demonstrates how tricky it is to study the health effects of common lifestyle choices.

Key Discussion Points & Insights

1. The Confusion Around Alcohol’s Health Effects

• Mixed Messages:
  • Society is flooded with contradictory headlines: one day alcohol is a health risk, the next it’s beneficial.
    • “It feels like every week you read the news and there’s a new study about alcohol and it’s saying the exact opposite of the study you were reading about last week.” (Bird Pinkerton, [01:26])
• Heavy Drinking Clarity:
  • Scientific consensus: heavy drinking is bad for you (neurological damage, liver disease, heart/cancer risk).
    • “If you’re drinking more than that limit each day, the researchers that I talked to were in agreement that that’s going to be a problem.” (Bird Pinkerton, [04:29])
• Definitions and Surprises:
  • The gap between public and medical definitions of “a lot” is considerable; even one drink per day can be considered “heavy” by researchers.
    • “Even one can of beer, if it has really high alcohol content, can be more than one drink.” (Bird Pinkerton, [04:10])

2. The Case for Possible Benefits: Dr. Ken Mukamal

• Background:

  • Dr. Ken Mukamal is a primary care physician and researcher with a history of studying alcohol’s health effects (under some controversy).
    • “Although a sizable part of my research career has been related to alcohol, we hardly drank at all in my house.” (Ken Mukamal, [06:02])

• Rationale for Interest:

  • Mukamal wondered whether alcohol, due to mild blood thinning properties, could mimic the heart-protective effects seen with baby aspirin.
    • “If that data from the early 1980s was right… why aren’t we washing down that aspirin with a little bit of alcohol?” (Ken Mukamal, [07:44])

• Research Methodology:

  • Relies on large, long-term cohort studies — tracking thousands of people’s self-reported alcohol consumption and health outcomes.
    • “These are not experiments… These are just you chose to drink or you didn’t chose to drink. And I’m going to follow along and see what happens.” (Ken Mukamal, [09:08])

• Findings & Caveats:

  • Some evidence for modest benefits (mainly for heart disease or diabetes) but not strong or definitive.
    • “Where we see, well, I’ll call 'benefits' of alcohol… it’s predominantly for things like diabetes and heart disease.” (Ken Mukamal, [10:26])
    • “If there’s any benefit, there's benefits from drinking small amounts frequently. And in fact, binge drinking for the most part obliterates any of the benefits…” (Ken Mukamal, [10:54])
  • Mukamal is explicit that the observational data is not strong enough to draw definitive, causal conclusions.
    • “This is not high quality evidence in the same way that you would want, say, to have a new drug approved. It's just not.” (Ken Mukamal, [11:45])

3. The ‘Anti-Health Halo’ Argument: Dr. Tim Naimi

• Position:
  • Tim Naimi, director of the Canadian Institute for Substance Use Research: firmly skeptical of any health benefit from alcohol.
    • “The science is very consistent for 40 years that, like, when it comes to alcohol, that less is better.” (Tim Naimi, [16:10])
    • “At no level of consumption was there a significant protective effect.” (Tim Naimi, [16:45])
• Data Quality Problems:
  • The same weaknesses Mukamal pointed to:
    • Studies are observational, not designed for alcohol research.
    • Drinkers are asked about habits only at study onset; frequency and patterns are not well-captured.
    • “Typically they’re only asking people at one point, like at the beginning of the study... And then from that they calculate an average consumption.” (Tim Naimi, [17:47])
• Moderate Drinker Bias:
  • Moderate drinkers in studies tend to be more affluent and otherwise healthy, which skews data (confounding from socioeconomic status and associated healthy behaviors).
    • “The problem is the so-called moderate drinkers, especially in developed countries, tend to be very socially advantaged… This is a big problem, right?” (Tim Naimi, [19:49])
  • Non-drinker category usually includes ‘former drinkers’ who may have quit due to health problems, skewing comparisons.
    • “Those people are actually... former drinkers. Former drinkers we know are very unhealthy.” (Tim Naimi, [20:54])

4. Why It’s So Hard to Answer the Question

• No Randomized Trials:
  • Logistically and ethically impossible to randomize people’s drinking over their lifetimes.
    • “That’s not realistic in the world we live in.” (Dylan Scott, [14:34])
• Complex Confounders:
  • Cultural norms, self-reporting errors, life changes, and the “healthy user” bias all complicate analysis.
  • Researchers try to control for these biases in meta-analyses, but it’s not an exact science.
    • “There’s an art to doing that kind of work. You know, different people could choose to weigh different variables to different degrees…” (Bird Pinkerton, [23:05])

5. The Way Forward & What to Do

• New Methods:
  • Genetics and mechanistic studies may produce more reliable data in the future, but big questions remain.
    • “There are researchers who are trying to use things like genetics to improve the data we have.” (Bird Pinkerton, [23:27])
• Pragmatic Conclusion:
  • Heavy drinking = clearly harmful.
  • Small amounts: no strong evidence for benefit, but moderate consumption likely not disastrous for most people.
    • “I don’t think anybody would say, you know, you should start drinking because it’s going to be good for your health. But I don’t think anybody we talk to would say... everybody should stop drinking.” (Bird Pinkerton, [25:57])
  • Final message: Make informed choices, enjoy responsibly.
    • “I am approaching 40 now. I write about healthcare. I do try to moderate my drinking even more these days because I am aware of all this stuff, but I still get to enjoy that glass of wine with dinner or have a beer when we’re grilling out... It’s really, I think, about just informed consumption.” (Bird Pinkerton, [26:30])

Notable Quotes & Memorable Moments

• On frustration with imperfect evidence:

  • “At least for me, the fact that something is hard is not a reason not to do it... How is it that we don’t know exactly what the hell this stuff does if half of Americans are doing it?”
    — Ken Mukamal ([24:31])

• On illusion of moderate drinking benefits:

  • “It makes it appear like, oh, moderate drinking gives you straight teeth and it gives you a good job and it gives you a BMW, but in fact, it’s the BMW and the nice job…”
    — Tim Naimi ([20:31])

• Overarching theme:

  • “We’ve run into this problem again and again where it’s really hard to set up a proper randomized trial that would really give us the answers that we want. And so instead, we’re left with this imperfect observational data that leaves us a little bit uncertain...”
    — Bird Pinkerton ([25:12])

Timestamps for Key Segments

| Timestamp | Segment Description | |-----------|--------------------| | [01:26] | Setting up the conflicting headlines around alcohol’s health effects | | [03:25] | Clarifying the strong harms of heavy drinking, confusion around definitions | | [05:13] | Dr. Ken Mukamal introduces the potential for small benefits & his reasoning | | [09:08] | Cohort study methodology and limits; the challenge of drawing causality | | [10:26] | Mukamal summarizes where slight benefits appear (heart, diabetes) and major caveats | | [13:41] | Dr. Tim Naimi counters: less alcohol is always healthier, “health halo” is overblown | | [17:47] | Weaknesses of observational data, moderate drinker bias explained | | [20:54] | Problems with using ‘former drinkers’ as the comparison group | | [23:27] | New research approaches: genetics, mechanistic studies | | [25:57] | Final takeaways for individuals: “informed consumption” |

Tone, Style, and Flow

Throughout, the hosts use a light, conversational, and self-aware tone—acknowledging both the frustration and the humor in chasing something “unexplainable.” Both guest experts present their positions clearly, with humility about the limits of available data rather than dogmatic certainty. The takeaway is both sobering and realistic: definitive answers are elusive, but moderation and informed choices remain wise.

For Listeners Who Missed the Episode

This episode walks you through the main scientific debate about moderate alcohol consumption and health. It reveals why the evidence is so inconclusive and why confident claims in headlines are often unwarranted. If you want to be a savvy consumer of alcohol (and health news about it!), knowing the limits of current research is its own kind of wisdom—until, perhaps, truly definitive studies emerge.