While this article was more about sake in its Japanese meaning of “alcohol” (酒) rather than what is referred to English as “sake” (which is nihonshu, 日本酒, in Japanese) it was interesting to see how the discussion revolved around sake and the the old gō (合) measurement (equivalent to 180 ml), implying that the average Japanese reader knows how much alcohol that contains.
There are two contrasting ways to look at alcohol: a modern view that sees it as a poison associated with elevated risk of cancer, lifestyle-related disease, and depression; and an older one that sees it as “the best of all medicines”. Which is it, and is there a way to drink and stay in good health? This question is explored in “The Best Way to Drink, from a doctor who likes his alcohol” by “sake journalist” Kaori Haishi. She caught up with Doctor Shin’ichi Asabe of the Saitama Medical Centre of Jishi Medical University (who supervised the aforementioned publication) and reported their conversation in Nikkei Style.
Dr Asabe starts off by saying that as a doctor he has to say that alcohol is fundamentally a poison. A multipurpose cohort study run in 12 sites nationwide and involving 140,000 people showed that those who reported drinking the equivalent of 2 gō (1 gō is 180 ml, so 360 ml) or 3 gō (540 ml) or more of sake once a day were 1.4 and 1.6 times more likely to develop cancer compared to those who drank once a week or less frequently. He also notes that a study of this size gives good evidence for the observation.
Haishi counters this by mentioning the “J-curve” seen with moderate drinking – those who drink a small amount seem to live longer than those who do not drink at all. Dr Asabe concedes that moderate drinking is associated with decreased rate of death, but argues that some studies were either done in the lab on cells or in small numbers of people (which increases the risk that the small group has some other factor in common that explains the effects). He also emphasises that the studies only suggest alcohol may be good for health, or that there is an argument to believe it may be, and that they are much less robust than the large studies showing its risks.
With an exclamation of mock shock, Haishi remarks that 1 gō of sake or one medium-sized bottle of beer doesn’t feel like enough, and Dr Asabe agrees from his other perspective as someone who enjoys a drink. Haishi presses him on these two conflicting attitudes: as a doctor, is he satisfied with “moderate” drinking? The answer, delivered with a laugh, is that it doesn’t always end up that way.
They then move to talking about non-drinking days, to rest the liver, and how this fits in with drinking a satisfying amount in the course of a week rather than a day. Haishi mentions that this is the focus of the book they worked on together, where research with specialists suggested that the total amount drunk over the course of a week is more important than the amount consumed daily. 1 gō of sake contains about 20 g of pure alcohol, which if drunk daily comes to about 150 g of pure alcohol a week. So, setting non-drinking days would allow consumption of more alcohol on drinking days while still staying in good health. Dr Asabe agrees that this form of weekly management is essential, but extreme forms such as drinking 150 g of pure alcohol on one day and abstaining for the rest of the week will not work.
- Original article (Japanese, Nikkei Style, 13 December 2017)
The debate about any benefits from moderate drinking continues. The J-curve has been around for a while, was briefly “debunked” as former drinkers with compromised health were included in the non-drinker group, then returned after former drinkers were removed from the statistics, showing a flatter but still significant curve. There are also a number of factors that compromise the groupings (asking people to estimate and report how much they drink is notoriously unreliable) and other possible causes (moderate drinkers are more likely to be socioeconomically advantaged and have better health care so would live longer anyway).
- That Cabernet Might Not Be Good For Your Health After All (English, NPR, 22 March 2016)
- Better research flattens the J shaped curve (English, The British Medical Journal, 8 June 2017)