喝一点酒比滴酒不沾更好吗？
前言：本视频是 Michael Greger 医生制作，于2018年4月4号刚刚发布的，是在NutritionFacts.org的YouTube频道发布的，NutritionFacts.org网站上暂时还没有。
摘要：即使酒精会导致癌症，并且没有“法国悖论”，那么著名的J型曲线是怎么回事？那个曲线表明，过量饮酒是不好的，但是轻度饮酒者实际上死亡率低于从不喝酒者吗？
https://v.qq.com/txp/iframe/player.html?vid=a06364pndxm&width=500&height=375&auto=0
（注：由于视频背景颜色的关系，白色字幕与背景颜色接近，所以字幕颜色上篇文章用的红色，这次用的黄色，请在后台留言哪种颜色更好。谢谢反馈！）
为什么我们不能像了解烟草业的企业利益一样清楚地看到酒精行业的企业利益呢？
Why do we not see the corporate interests of the alcohol industry as clearly as we see those of the tobacco industry?
酒精行业已经在过去的几十年里发起了一场高端而成功的运动，通过构建利弊平衡的观点削弱了人们对酒精危害身体健康的严重性的看法。
Well, the alcohol industry has waged a sophisticated and successful campaign over the last few decades, undermining perceptions of the extent of alcohol-related harm to health by framing the argument as a balance of benefits and harms.
没错，酒精也许会成为令人上瘾的致癌物增加癌症的患病风险，那么在降低心脏病风险上呢？
Yes, alcohol may be an intoxicating carcinogen, increasing cancer risk, but what about reducing heart disease risk?
政策制定者在推出有效的酒精政策方面犹豫不决，甚至犹豫是否该支持在产品上增加警告标签，因为担心这样会驳斥到使用酒精所带来的任何潜在健康益处。
Policy makers hesitate to introduce effective alcohol policies, or even to support the addition of warning labels for fear they might undermine or contradict any possible health benefits of alcohol use.
毕竟摄入酒精将明显提高HDL，即“好”胆固醇。但遗憾的是，正如我研究过的一样，HDL已不再被认为具有保护作用，其部分是因为所谓的孟德尔随机研究，表明终生都拥有高水平的HDL实在益处寥寥，而因纯靠运气得到的好基因带来的终生低水平LDL，才真正会降低心脏病风险。
After all, alcohol consumption clearly raises HDL, the supposed “good” cholesterol. But sadly, as I've already explored, HDL is no longer considered protective, based in part on so-called Mendelian randomization studies, where having a high HDL your whole life doesn't appear to help, whereas a lifelong reduction of bad cholesterol, LDL, just thanks to luck-of-the-draw genetics, does indeed decrease heart disease risk.
所以通过摄入酒精来提高HDL的方式或许没有作用，如果你关注动脉粥样硬化的亚临床标志，比如颈动脉血管壁的增厚程度，你会发现那些完全戒酒的人似乎患病风险最低，这在冠状动脉钙化评分上也一样，一般摄入酒精越少，患病风险即越低。
So the boost in HDL from alcohol may not matter, and if you look at subclinical markers of atherosclerosis, like the thickening of the wall of your carotid arteries in your neck, those that abstain from alcohol completely seem to be at the lowest risk, and the same with coronary calcium scores, where, in general, the lower the alcohol consumption, the lower the risk.
酒精还会些许提升我们的血压，而预计这将会增加，而不是降低我们的心脏风险。那么我们是从哪儿得到酒精有益这个消息的呢？
And alcohol bumps our blood pressure up a bit as well, which would be expected to raise, not lower, our cardiac risk. So where do we get this idea that alcohol was good for us?
从著名的“J曲线”。让我们来一探究竟。
From the famous J curve. Check it out.
一般而言，如果你长时间观察大量人群就会发现他们饮酒越多，过早死亡的风险就会越高，然而风险最低，即寿命最长的人并不是那些滴酒不沾的戒酒者，而是那些一天一杯酒的适度饮酒之人。
If you follow large populations of people over time，in general，the more people drink, the higher their risk of dying prematurely, but the lowest risk, those who tend to live the longest, were not those who drank zero, the abstainers, but those who drank moderately, like one drink a day.
这就是为何你会听到一些人建议医生应该规劝终生戒酒者拾起饮酒习惯。
That's why you get some folks recommending that physicians should counsel lifelong nondrinkers to take up the habit.
当然，可以用他汀类药物，不过买酒精性饮料并不需要处方，价格更便宜，味道也更好。
Sure, there are statin drugs, but alcoholic beverages don't require a prescription, are far cheaper, and certainly more enjoyable.
适度饮酒真的具有保护作用吗？是什么让那些滴酒不沾的人处于有更高风险的类别里呢？
Is moderate drinking really protective, or is there just something about people who abstain completely from alcohol that puts them in a higher risk category?
我们心存怀疑的原因是那些戒酒者似乎处于患一大堆疾病的更高风险中，讽刺的是还包括肝硬化。
The reason we suspect something fishy is going on is that abstainers seem to be at higher risk of a whole swath of diseases including, ironically, liver cirrhosis.
相比起终生戒酒者，即那些根本不知酒滋味的人，喝少许酒的人们中肝硬化患者反而更少。
Compared to lifelong abstainers, those who've never touched the stuff, men and women drinking a little appear to have less liver cirrhosis.
等等，什么？
Wait---what?
喝一点酒怎么会和较低肝硬化患病率联系起来呢？
How could a little drinking be linked to lower rates of liver cirrhosis?
让我们来想一想。
Well, let's think about it.
更合理的说法是饮酒让肝硬化变少，还是肝硬化让人喝得更少？
What makes more sense, that drinking lead to less liver cirrhosis or liver cirrhosis lead to less drinking?
换言之，就是逆向因果，即所谓的因病弃之效应。
In other words, reverse causation, the so-called sick quitter effect.
如果关注吸烟者的研究，有时会看到相比起持续吸烟的人而言，戒烟者中反而有更高的死亡率。
If you look at studies of smokers, sometimes you see higher mortality rates among those who quit smoking compared to those that continue smoking.
为什么？原因是，他们戒烟正是因为他们生病了。
Why? Because the reason they quit smoking is because they got sick.
所以理所应当的，病较重的人死亡率比病较轻的人高。
So, of course, sick people die more often than less sick people.
这就是在研究中将某人划分为不吸烟者时必须确保其为终生不吸烟者而不只是从上周二才开始戒烟的人的原因。
That's why when you classify someone as a non-smoker in a study, you have to make sure they're a lifelong non-smoker and not just a non-smoker --- since last Tuesday.
然而难以相信的是，这竟不是大多酒精研究中的做法，反而是将之前喝过酒的人错误归类为终生戒酒者。
Yet, unbelievably, that's not what they do in most alcohol studies, where instead they misclassify former drinkers as if they were lifelong abstainers.
瞧，健康状况欠佳的人更可能减少饮酒量或完全戒酒，从而使当下的饮酒者相比起滴酒不沾者看起来更健康，原因就是一些戒酒者正是因为自己生病了才选择放弃饮酒的。
And, look, individuals with poorer health are more likely to cut down or stop drinking completely, thereby making current drinkers look good in comparison to those who drink zero, because some of the abstainers are just abstaining because they got sick and stopped.
好吧，那么如果你回到所有这些研究中纠正这些错误分类，并把有过饮酒经历的人从终生戒酒者中分离出来后会怎么样呢？
OK. So, what if you went back to all those studies and corrected the misclassifications, separate out the former drinkers from the lifelong abstainers?
直到现在，我们才真的有了答案。
We didn't know until now.
实际上，对饮酒者的错误归类实在是太常见了，且其对3/4的研究都有所影响，而当其被控制（纠正）时，J形曲线就消失了。
They, indeed, found drinker misclassification errors all too common, plaguing three quarters of the studies, and when they controlled for that, the J-shaped curve disappeared.
此时死亡与酒精摄入的关系就会变得更加一致它呈一条直线式的线性剂量反应，即酒精摄入越多死亡率越高：低水平的摄入并无任何保护作用。
The death versus alcohol relationship became more consistent with a straight line, linear dose response, meaning more alcohol, more death: no protection at low levels of consumption.
所以当你使用了更佳的对照组时会发现轻量适度饮酒是没有明显好处的。
So no apparent benefit of light to moderate drinking after all, when you use better comparison groups.
虽然这些结果不是大多数饮酒者所愿意相信的，但大众其实应该多去了解和阅读关于一直在更新的证据的更为完整且公正的细节，即，喝酒确实不太可能对健康有益。
Although these results are not what the majority of drinking adults may desire to believe, the public deserves to hear and to read in more complete and balanced detail the ever-growing evidence that drinking alcohol is very unlikely to improve their health.
后记：现在您知道结论了吗？不要被似是而非的各种假说所迷惑啊！
阅读往期相关文章：
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