Is It Smart to Drink?

A surprising chart was posted by Razib Khan. In the General Social Survey, the higher Americans score on a vocabulary test, the more likely they are to drink alcohol:

Of course we know that correlation is not causality, so one should not immediately infer that reading drives one to drink, or that drinking improves memory (perhaps because, as the old joke argues, alcohol kills weaker brain cells, increasing the average quality of the brain).

It does, however, raise a serious question:  Is it smart to drink?

Epidemiology Recommends Moderate Drinking

Most people have read of the studies that show that moderate drinkers – who drink, say, a glass of wine or two with dinner – tend to have the best health, while teetotalers and alcoholics have the worst.

A recent prospective cohort study confirms this pattern and shows it to be surprisingly strong.

The study followed 1,824 adults, initially between ages 55 and 65, for 20 years.  Their conclusion: “even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers.” [1]

This is a pretty large effect. Without their adjustments, heavy drinkers had a 70% higher mortality rate, abstainers 23% higher. Still large, although not so bad for abstainers. If the choice is alcoholism or abstention, go with abstention.

What About the Biology?

Epidemiological studies often mislead due to confounding factors.  It would be nice to learn from biology that alcohol is safe.

A primary safety concern with alcohol is its effect on the liver. Alcohol consumption can produce fatty liver disease and, eventually, a scarred and damaged liver (cirrhosis).

Interestingly, in animal studies the harmful effects of alcohol on the liver occur only when it is combined with polyunsaturated fats:

  • Researchers induced liver disease by feeding mice a combination of alcohol and omega-3-rich fish oil.  They then stopped the alcohol and split the mice into two groups, one fed fish oil plus glucose, the other palm oil plus glucose. (Palm oil consists predominantly of saturated fat, and is less than 10% polyunsaturated.) Livers of the fish oil group failed to recover, but the palm oil group “showed near normalization.” The researchers hailed saturated fat as “a novel treatment for liver disease.” [2]
  • Mice fed 27.5% of calories as alcohol developed severe liver disease and metabolic syndrome when given a corn oil diet, but no disease at all when given a cocoa butter diet. (Corn oil is 55% polyunsaturated, cocoa butter is predominantly saturated fat and is less than 3% polyunsaturated.) The first line of this paper begins, “The protective effect of dietary saturated fatty acids against the development of alcoholic liver disease has long been known.” [3]
  • Scientists induced liver disease in mice by feeding alcohol plus corn oil.  They then substituted a saturated-fat rich mix based on beef tallow and coconut oil for 20%, 45%, and 67% of the corn oil. The more saturated fat, the healthier the liver. [4]

This makes biological sense. Alcohol is metabolized in the liver just like fructose, a toxic sugar. Polyunsaturated fats are chemically fragile and quick to react with sugars; saturated fat, which lacks fragile carbon double bonds, does not.

It seems that if you keep your liver clear of polyunsaturated fats, the alcohol will be disposed of safely.

What Does This Mean on the Perfect Health Diet?

Our diet is very low in polyunsaturated fats:  We eat as few omega-6 fats as possible, and purposely include only 1 lb of oily marine fish per week in order to get long omega-3 fats.

Thus, two dinners per week may have omega-3 fats, other meals will be largely polyunsaturated fat free.

Mice on a saturated fat (cocoa butter) diet can get 27.5% of calories as alcohol with no liver damage. In humans, that would correspond to a daily 350 ml (12 fluid ounce) bottle of 80-proof gin, rum, or vodka, or a liter (36 fluid ounces, 1.3 bottles) of red wine.

We don’t recommend such alcohol intakes! That said, it does seem to confirm that there is little risk in moderate alcohol consumption, if the rest of the diet is sound.

For Perfect Health Dieters, perhaps on salmon days alcohol should be limited to a single glass of wine. In general, however, moderate drinking should hold no concern.

Oh, and for you alcoholics, a little friendly advice: If you value your liver, remove polyunsaturated fats from your diet. The safest foods? Red meats and seafood; starches (rice, sweet potatoes, potatoes); vegetables; butter/cream and coconut oil.


[1] Holahan CJ et al. Late-Life Alcohol Consumption and 20-Year Mortality. Alcohol Clin Exp Res. 2010 Aug 24. [Epub ahead of print] Full text: (Hat tip:  Robin Hanson,

[2] Nanji AA et al. Dietary saturated fatty acids: a novel treatment for alcoholic liver disease. Gastroenterology. 1995 Aug;109(2):547-54.

[3] You M et al. Role of adiponectin in the protective action of dietary saturated fat against alcoholic fatty liver in mice. Hepatology. 2005 Sep;42(3):568-77.

[4] Ronis MJ et al. Dietary saturated fat reduces alcoholic hepatotoxicity in rats by altering fatty acid metabolism and membrane composition. J Nutr. 2004 Apr;134(4):904-12.

Leave a comment ?


  1. Reminds me of the old saw warning folks not to eat carrots because every single person who’s ever eaten one will die.

  2. Girl Gone Primal

    I’d suggest too that the therapeutic, stress reducing qualities of alcohol would play into all-cause mortality figures as well. My friends who drink with dinner effectively shut off their work brain and let go of the business of the day til the next morning. Others have no such cue, and some go back to working on or thinking about work stresses long into the night. Alcohol isn’t THAT relaxing, but the way some people sigh after their first sip tells me that they’re using it as a cue/excuse to forget their worries for a bit. I wonder if the ones who drink too much do so because they’re expecting the grog to do all the work for them..!

  3. Great point, GGP. I didn’t really address the benefits of alcohol, since those are hard to identify clearly, but stress reduction is probably the most important. If so the benefits are probably greatest at one or two glasses.

    I’m very much like your friends. When I have a glass of wine with dinner, it’s with a decision that I’m not going to do any more work that night, and will just relax. It does become a psychological cue as well as having physiological effects.

  4. It has to do with the lipid peroxidation that occurs with higher free radical damage. Lipid peroxidation is the largest cause of initial damage with atherosclerosis/cardiovascular disease (causes the damage, patched with a fatty streak, eventually develops into atherosclerotic plaque which can embolize or cause vessel restriction). Alcohol intake and sugar intake increase free radical exposure…PUFAs are much more sensitive to peroxidation. Plan on bingeing? It appears that it would pay to have steak over fish…

    doesn’t necessarily mean all pufas are automatically bad…context is important. The same can be said of saturated fats….saturated fats plus high glycemic load = lipid peroxidation as well….

    The key variable between everything? Vegetable intake. Provides antioxidants in the synergy and form needed to balance negative effects of these things so that the health benefits of saturated fat…alcohol intake etc can be realized.

  5. I know it’s best to avoid supplementing and just eat foods, but in this case, alcohol may not be an option!

    If you do supplement Resveratrol, I’d recommend checking Otherwise, just eat (or drink) Purple Corn!

    Also, is there anything wrong with fish oil supplementing?

  6. I just learned of your website through The Healthy Skeptic blog.

    For what it’s worth, I wrote a comment about alcohol addiction and nutrition for science writer David Bradley’s Sciencebase blog that got published on SciScoop. Here is the opening paragraph:

    I’ve studied alcohol issues to some extent as they relate to genetic predisposition and nutritional modulators. It appears that primates share configurations of genetically determined metabolism that affect drinking behavior. Check out this video. Note, it’s not meant to be funny.

    The remainder of my article is at:

    This appears to be an excellent website. I must explore it further.

  7. Hi,

    First time here, great site!

    My question is: since barley is on your toxic foods list, is wine healthier than beer? What about other liquors-tequila, rum, vodka etc.?

    My thought is that not all alcohols are the same. I am interested to hear your thoughts on that.


  8. Hi Donna,

    I do believe that wine is healthier than beer. The bacteria that ferment grains into beer do destroy some toxins, so beer is safer than wheat flour, but as wine starts from a healthy food to begin with it can’t possibly be more dangerous and is probably safer. Many people have “beer bellies” but few have “wine bellies”!

    Hi snoop,

    We recommend eating fish, not fish oil:

    We’ve done a post on the benefits of omega-3 ( but not on omega-3 toxicity. We’ll have to remedy that in the future.

    Hi David,

    I’ve just had time to skim your article. It’s thought-provoking. I don’t know much about addiction and will have to look into your ideas.

    Best, Paul

    • Dang!
      We have so many outstanding craft beers here on the West Coast. I’ve tried switching to wine before and it just doesn’t do it for me. This is going to be tough. Does anyone know of chemistry data that would help guide me as to whether toxic grain compounds remain in beer after brewing? Probably doesn’t exist though.

      • is gluten a toxin?…..anyway, i am presuming the fact that you can get gluten free beers, would mean that non-gluten free beers contain gluten?
        so gluten free beers may be your best choice.
        gluten free beers recently discussed here;

        • I guess whether gluten is a toxin depends on how you define one, but I think it is for purposes of what’s recommended to avoid in the PHD? But also, aren’t there many more compounds in grains, including barley and hops, that would also qualify as toxic for the PHD?
          I’m sad to say that, unless as I’m somewhat futilely hoping, fermentation takes all the potentially problematic stuff out, it looks like I’m SOL when it comes to my favorite beverage. Even if gluten free beer is safe, that still takes all the fun out of choosing from the zillion other great beers available here. If wine were problematic, wine drinkers wouldn’t be satisfied with just one generic version either.

          • Cronkster: two things that may (or may not) help you. One, I switched from beer, which I used to love, and got used to it after a while. Give it time. Two, even though snobs pretend there is a difference between cheap and expensive wine, it’s been clinically proven that even the most cultured wine snobs cannot tell the difference, and if cheap wine is labeled as expensive, they will go on about how it has subtle espresso, fig and centipede notes. So I say find a cheap brand you like and drink that.

  9. The major benefit to moderate wine consumption is that the alcohol lowers your blood sugar rise after a meal.

    My own experience is that my blood sugar level two hours after a meal is 20 points lower if I have wine with that meal.

    Knowledgeable diabetics will drink a glass a wine before bed to keep their blood sugar low throughout the night.

  10. Thanks, Jake. I didn’t know that.

  11. Thanks Paul. That’s good I prefer wine anyway.

    Good point, Jake.

  12. What about the link between alcohol and several types of cancer? Or the effects of alcohol on the brain?

    Does a diet low in polyunsaturated fats also protect against these effects?

  13. Hi Robert,

    Well, alcohol is clearly toxic in high doses. It will tend to hit the liver most because that is where toxins are metabolized, but at very high doses it can damage other organs.

    Cancer cells can metabolize alcohol so alcoholism should be similar to diabetes in its promotion of cancer progression.

    I don’t think a low PUFA diet protects against those effects. It may reduce the brain damage, but it probably won’t affect alcohol’s promotion of cancer. (Of course, omega-6 PUFA promote metastasis and cancer progression, so a low omega-6 diet will reduce cancer risk independently of alcohol.)

    But overall, moderate alcohol – say, one glass a day – seems to be neutral or maybe beneficial for health. Maybe cancer patients should avoid it.

  14. I’m a fit/trim 53yrld who consumes about 14-15oz (about 2000 calories)of 80 proof gin every night…going on 20 years now. And from my experience, this high consumption doesn’t seem to affect my waist line or my health markers taken during check ups. Definitely not proud of the excess, but it’s my normal routine at night about two hours before bed.

  15. Hi Neal – Stay away from vegetable oils, that’s all I have to say.

  16. Paul,

    Somehow I missed this post. I have always heard what could definitely be an old wives tale–that alcohol lowers metabolism by about 60%. Many personal trainers I have spoke with have said that when they are advising their clients to lose weight they encourage them to stay away from alcohol bc of this metabolic effect. Do you have any notion as to whether or not this is true? It seems to me that long term drinkers are generally heavier (not alcoholics who are generally thinner due I suspect to malnutrition). Because of this theory I have often given up drinking for a few weeks at a time to no real avail. Thoughts?


  17. Hi Lindsay,

    Alcohol above 1 glass per day is associated with obesity. This is likely because of liver toxicity, just like fructose alcohol reacts badly with polyunsaturated fats to poison the liver. Alcohol can cause metabolic syndrome by its interactions with PUFA. Possibly alcohol toxicity elsewhere in the body is also important.

    Contrary to that “old wive’s tale,” alcohol increases metabolic rate: However, transient food-induced changes in metabolic rate have little or no connection to obesity.

  18. Hi,

    Alcohol seems to blunt Leptin which could explain the association to obesity:

    PS: Having just read the PHD-book, I feel quite happy to say it is the most concise and insightful book on diet I have ever read. Coming from a Kwasniewski/OD background I feel it takes his concepts forward in very important ways (food toxins, O6 avoidance etc) while maintaining ODs fundament (like the starch-recommendation to just barely use the GNG mechanism). As a software-developer I appreciate that this leads to a diet that is fault-tolerant and have redundancy in achieving good nourishment.

  19. Perfect Health Diet » A Nice Comment to Wake Up To - pingback on January 20, 2011 at 8:38 am
  20. Patrick, interesting paper. This is the conclusion drawn from the authors: In summary, our results suggest that leptin could participate
    in appetite stimulation by alcohol consumption and the
    role of alcohol as an aperitif.

    The paper deals with acute ingestion of alcohol only (a single drink), so the conclusions are only valid there. And maybe only in Sprague-Dawley rats. Who knows?

  21. Hi Paul.

    I realise this is an old post, but I was wondering what you think of the argument this guy makes that n-acetyl-cysteine and vitamin c can protect against alcohol toxicity?

  22. Vitamin C anti-toxicity effect of alcohol is well known. I personally experienced it when my daughter was born – after drinking around 1L of rakija (40%-50% alcohol) I wasn’t able to move much and felt very sick, together (along with few of my friends). We were all using 5g/hour of ascorbate acid powder by waking up, drinking it, and returning to bed. After 4thd dose the experience was like we didn’t drink at all and it was rapid – first 3 doses attenuated nausea but not much more. 4th dose was where it really kicked in. I remember that my friend said that he had never had faster sobering.

    On biological level this is highly understandable – ascorbate is effective anti-oxidant in that it donates 2 electrons. Alcohol induces oxidative damage to the tissues of the brain and liver. This damage depend on level of alcohol dehydrogenase enzyme which levels are dependent on sex, food intake and previous drinking habits.

    NAC works by the similar mechanism, by boosting primary endogenous antioxidant – glutathion. NAC protected all rats exposed to near-lethal doses of alcohol. The old folk alcohol detox way is milk or whey drinking.

    From Effects of N-acetylcysteine on ethanol-induced hepatotoxicity in rats fed via total enteral nutrition:

    NAC treatment increased cytosolic antioxidant capacity, abolished ethanol-induced lipid peroxidation, and inhibited the formation of antibodies toward HNE and HER adducts without interfering with CYP2E1 induction. NAC also decreased ethanol-induced ALT release and inflammation and prevented significant loss of hepatic GSH content.
    The similar mechanism is probably achieved by Vitamin C which spares glutathion and vice-versa and hypothetically (Cathart – The Third Face of Vitamin C) produces anti-inflammatory effects in high doses. Vitamin C is known as strong detox vitamin (read this interesting 4 parts blog article or get the book “Curing the incurable” by T. Levy)

    Similar conclusions for NAC are displayed in “Effects of N-acetylcysteine on alcohol abstinence and alcohol-induced adverse effects in rats” research paper.

    Glutathion and C are so closely related, this is the reason for supplements like this one from LEF.
    I can only confirm it for Vitamin C and in my personal experience there is really nothing that can be it. Ill make sure to add NAC next time.

    As for concrete dose, I would listen Andrew Saul on it – take as much C as needed to get the results (don’t use preconceived doses, typical error)

  23. Thanks, majkinetor. You’ve contributed a lot of good stuff.

    Hi Eric, Sorry I missed your comment.

  24. Paul,

    I hope you read this. I love your site and the information so graciously provided to us all.

    I am 43 years old, eat “our” style, that is high in sat. fat, minimal grains, etc. I keep in great shape, rarely sick(even a cold), but I drink LOTS of beer; around 12 per day on average. My recent blood tests for liver enzymes were normal. I am just worried my beer drinking is going to catch up to me. thoughts?


  25. Hi Mark,

    That is a lot. Well, I can’t say it’s a good thing. Beer still has some grain toxins – thus wine is better – plus the alcohol is in the zone where health commonly starts to deteriorate (>5 drinks a day).

    That said, beer save for the alcohol is better than bread; the biggest problem with alcohol is when it meets polyunsaturated fats. If you’re going to stick with the beer, you have to try to minimize polyunsaturated fats – both omega-3 and omega-6. You might use flaxseed rather than salmon for omega-3, and rigorously limit omega-6 by eating red meats (beef, lamb) and low-omega-6 oils (butter, coconut oil) and lots of safe starches.

  26. Paul,

    Thanks for the reply. amazingly, I maintain a bf% of 8-10% yearround,sometimes lower. I hardly consume any omega3’s except for krill oil caps. I don’t digest STARCHES well at all. Major gas. I take a probiotic daily and eat lots of sauerkraut. Further, I take LiverCare by Himalaya for extra precaution.

    I love red wine too but here in Arizona, nothing taste better in 100 degrees than cold beer. :))

    Thanks again,


  27. Hi Paul,

    Would you be able to elaborate on why you suggested ‘flaxseed rather than salmon for omega-3’ to Mark.

    & also to clarify, were you suggesting the actual seed or flaxseed oil.

    thx, darrin

  28. Flaxseed oil is good. EPA and DHA are much more reactive than ALA, the omega-3 in flaxseed, so more likely to cause liver toxicity reacting with alcohol.

    ALA is not as good for improving tissue omega-3 levels, but with very high alcohol intake, better safe than sorry.

  29. Paul, what about flaxseed capsules that are kept refrigerated?

    • I don’t have any strong feelings about flaxseed in general. Might help, might not. I think if you eat salmon it’s not necessary. But it does go better with 12 beers a day than salmon.

      If you are going to eat flaxseed in any form, keeping it refrigerated is a good idea. I don’t know if there are any advantages to capsules relative to either the oil or the ground meal. Probably not.

  30. Paul, out of curiousity, do you know of a supplement or herb that curbs beer cravings?

    With that being said, I don’t know if its just a silly habit. Right now, I am unemployed so out of sheer boredom I start early and search for jobs. When I am working, I don’t drink nearly as much.


  31. Hi Paul,

    I was looking for something on mitochondria and came across this:
    I remembered this post of yours and this study seems to go counter to this.

    I’d appreciate your thoughts on this! Thanks 🙂

  32. Hi Evelyn,

    It’s an interesting paper. They are not precisely contrary because the papers I referred to dealt mainly with the 18-carbon PUFAs that are abundant in foods and are primarily oxidized for energy, this deals with long-chain HUFAs that are generally not oxidized in mitochondria and instead are modified and used as signaling molecules.

    I’m not sure whether I believe it, but if it’s true then it’s interesting info about mechanisms. It means the fatty liver disease is arising in mitochondria, not cytosolic/membrane peroxidation.

    By the way, do you prefer going by Evelyn now or CarbSane?

  33. Hi Paul, Thanks for the quick response and thoughts. Chuckle — I guess I won’t start that HALC (high alcohol low carb) diet after all 😉 I prefer Evelyn in conversation but have retained the CarbSane b/c that’s how most know me, for better or worse, so when you’re so kind as to link to my blog CS is probably best.

  34. Hi Paul,

    Since ethanol is often used as an antibacterial, I wonder if it would have any anti-bacterial effect in the body?

    Some of the older generation seem to use alcohol as medicine. My friend’s mother-in-law drinks milk and Guinness when sick. An older German woman once treated a big scrape on sister’s shoulder with schnapps.

    I ask because I found your description of your brain-hypoglycemia due to a bacterial infection and response to antibiotics interesting. I’ve been extremely lethargic and feeling mildly sick for a week or two and nevertheless had a couple of drinks last night and immediately felt better. It reminded me of how in the past I’ve found that I actually feel better when slightly hungover.

    Thus, this morning I looked up what you had to say about alcohol and found this article. The effects of alcohol are undoubtedly complex, and my feeling better could be due to social context, or sleep deprivation (which is therapeutic for depression), or any number of factors.

    Nevertheless, if alcohol has an antibiotic effect, since it can diffuse freely throughout the body, one can hypothesize that it might be helpful for infections such as brain infections. If so, that might help explain the inverse u-shape of the alcohol vs health relationship.


  35. Hi Gordon,

    Alcohol is a good antiseptic on the skin, where the dose can be large. But inside the body I wouldn’t expect it to be helpful.

    Bacteria can metabolize ethanol for energy (see And doses that are large enough to be deadly to bacteria inside the body would also be poisonous to human cells.

    Alcohol is definitely counter-indicated in fungal infections, since pathogenic fungi convert ethanol to dangerous toxins.

    So if alcohol makes you feel better, I would expect it’s by providing an energy substrate for the brain — thus relieving a brain hypoglycemia.

  36. Hey Paul, I’m using this article as a citation in my post about drinking, I hope that’s all right.

    I have a new hypothesis for why 1 drink per day might be beneficial. There are a few mechanisms, but I can’t see how those could lead to such a difference between no alcohol. I think that those who are able to limit themselves to one drink per day are those who have better self control already. Those who abstain completely might be recovering alcoholics, and excessive alcohol is harmful in itself, but also probably correlated with excessive junk food and the rest of what kills people.

  37. It’s possible Stabby. That would be disappointing, as I like 1 drink per day. I would prefer it to be doing me good.

  38. I think that is among the most important information for me. And i am happy reading your article. However should commentary on some general issues, The site taste is perfect, the articles is in reality excellent : D. Excellent task, cheers

  39. Great discussion about the effects of alcohol. Like non other that I’ve ever seen.

    My preference and habit is approx one beer daily. How does this calculate into the carbohydrate daily total (i.e. dense starches and fruit)? Should I then consume less dense starches & fruit or should I treat the alcohol separately like fibrous vegetables?

  40. If you have 1 pound of Salmon for lunch, will all the Omega-3 polyunsaturated fat clear your bloodstream and liver before the evening?

    How long should someone wait after eating a big piece of salmon before having a few alcoholic drinks?

  41. Paul,

    Have you read this study? Basically former drinkers are classified as abstainers, and they have stopped drinking for a number of health reasons:

    From the abstract:

    “Our meta-analytic results indicate that the few studies without this error (i.e., those that did not contaminate the abstainer category with occasional or former drinkers) show abstainers and “light” or “moderate” drinkers to be at equal risk for all-cause and CHD mortality.”

    How does this change your view of the health benefits of alcohol consumption?



  42. Hi Will,

    Thanks for that link.

    I am mainly concerned with whether moderate doses of alcohol may be harmful. Since it’s pleasurable, it would be nice to also know that it’s safe. I am not planning to recommend it as a health food.

  43. Dear Paul and Shou-Ching,

    I must congratulate you on such a great site and book. It is amongst many other things so well written and clear, logical, unlike the so-hard-to-follow research material. You are very talented.

    i have in the last 3 months moved to your diet and the only trouble I have is that i find i wake up so early. I understand this is a response to cortisol being released to elevate my blood sugar. I have tested my BG and it is around 4.0-5.0 during the day but in the morning it is 5.7 or so (European measures). I also have tested my ketones (Ketostix) and I do have a very mild ketosis during he day.

    Perhaps I should increase safe carbs a bit, I will test that out. i do a lot of exercise and currently eat about 100g a day of carbs.

    BTW I spent years eating a so called ‘health food’ diet: PUFA/soy/legumes (which we call pulses)/millet/brown rice etc…and it used to make me feel AWFUL, tired and ‘wrong’ inside – now i know why.

    and then i lived in France for 10 years in the Mediterranean region. Observationally the people there eat a lot of butter, fat and meat inc organ meats, only white bread and some but not many vegetables. They are eating traditional foods and there is little ‘industrialisation’ of foods. (in fact in French the word industrialisé as applied to food means manufactured food) The ‘Mediterranean diet’ of standard nutritional advice is a marketing creation.

    I ate like that too and my well being improved considerably

    I think that the French diet is fertile ground for study, even if anecdotal, as it has some similarities to the Perfect Health Diet although it goes much less far.

    David coles

    • Hi David,

      It does sound like you may need more carbs, perhaps a bit more protein too. But blood glucose drops as low as 4.0 during the day may be just as concerning as the rise on waking. Blood glucose should be more stable through the day, 5.0 – 5.3 is more or less optimal. It’s possible you have some adrenal fatigue; working on circadian rhythms might help, also make sure you don’t go too low carb or low protein, or train too intensely without rest.

      I agree with you about the French diet, in fact gourmet French cuisine would be almost perfect if they replaced wheat with rice. It doesn’t surprise me that they have long lifespans.

  44. Paul,
    Above in the comments, Dr. Rinehart makes the statement…

    “saturated fats plus high glycemic load = lipid peroxidation as well…”

    Is there any validity to that statement? I’m not looking for slam dunk evidence either way, I’m just interested in where this might have originated. Any thoughts?

    Thanks for your time,

    • Hi John,

      If you have an energy excess getting driven into mitochondria and the cell is already full of ATP, the voltage across the inner mitochondrial membrane becomes excessive and is dissipated either as heat or as ROS. Saturated fats generate more ROS than monounsaturated, monounsaturated more heat. If it’s ROS and there are PUFA in the membrane, they can be peroxidized. So it’s a rather indirect process.

      But eating the saturated fats reduces the PUFA content of mitochondria and also decreases appetite, so it makes the whole process less likely to develop. So short term potentially problematic, long term healthier to eat the saturated fats.

  45. I was listening to a Fat-Burning Man podcast where you advised not to drink wine with a fish dinner. The combo of alcohol and PUFA being bad for us makes so much sense.

    But…what *about* the Mediterranean combo of wonderful omega-3-rich fish, like sardines, and wine? (If the meal is eaten with olive oil [mainly monounsaturated] and cheese [saturated], are the bad effects of the fish oil in this case mitigated well enough?

    Did the marketers of the “Mediterranean Diet” notice m/any in the region with fatty liver?

  46. I also saw this 2008 WebMD article…how does that fit in? It would be great if red wine itself did protect against this problem.

  47. Hi Paul,

    Some of the conclusions in this article seem to be contradicted by the findings of this recent study:

    In the hope that you will address the issues raised,

    Keep up the good work!

  48. Dear Paul,

    Thanks for your prompt response, especially since I have just learnt you are holidaying in Korea at the moment. I am amazed at how you manage to keep up!
    Apart from improving my own health and quality of life, the main reason I am researching Paleo and other matters is to share my findings with friends and family here in Italy where it is difficult to come by reliable information on nutrition.
    I, therefore, need to understand the concepts thoroughly myself, before giving any advice to others, since I firmly believe that no advice at all is far more helpful than the half-baked variety.
    The reason I brought up the article in PLEFA ( is that for most Italians, it would be unthinkable to give up alcohol with a fish meal (sardines, anchovies, etc), just because of the high Omega 3 content. If such were the case, for populations living on Italy’s long coastline (not to mention the islands), drinking wine would become a rarity, rendering them practically teetotalers for most of the week. So while Italians can understand that saturated fats could help mitigate the ill-effects of excessive alcohol consumption, they find it difficult to countenance giving up all alcohol intake whenever they eat fish.
    The findings of the study reported in the PLEFA article seem to indicate that ethanol consumed TOGETHER with a DHA supplement appeared to be more protective against fatty liver disease when compared to ethanol administered alone, without the DHA.
    This seems to suggest that drinking alcohol with a fish meal high in Omega 3 fatty acids, would provide similar protection.
    You seem to suggest that consuming Omega-3 rich fish, let’s say at lunch, without alcohol, followed by a steak dinner that same evening with alcohol, would somehow be more protective of the liver on the overall, than consuming wine at both lunch and dinner (if I have understood correctly — PLEASE correct me if I’m mistaken!).
    So, basically, my question is, how do I explain this to people who have been consuming wine (and sometimes fructose-rich white wine!) with Omega-3 fish for decades, without seeming a complete “Johnny come lately” spewing some new-fangled heresy!
    Whilst I personally find abstaining from alcohol when consuming Omega-3 rich foods no particular problem, it is difficult to justify this practice when faced with highly sceptical family and friends, especially since I can find no direct evidence in the literature to contradict them.
    All clarifications regarding this would be very helpful, although, there is really no rush, and you should actually be focusing on having a great vacation, rather than having to bother yourself with queries like mine at this time!

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