No Healthy Dose of Alcohol, But Is There a Safe One? With Cliff Harvey

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Episode Summary

Cliff Harvey PhD is back on the podcast, and this one ranges widely before settling on its main subject. Cliff is a registered clinical nutritionist, qualified naturopath and strength and nutrition coach who has been in clinical practice since the late 1990s, and he founded the Holistic Performance Institute. He and Mikki open with wearables — Cliff has swapped an ageing Oura ring for an under-mattress Withings sleep analyser — before getting into whether an already-active person really needs dedicated cardio, and why Mikki has deliberately upped her carbohydrate intake for running after years of being firmly in the low-carb camp.

The second half is a careful working-through of the alcohol evidence. Cliff's central point is a distinction that often gets lost: the research supports the claim that there is no healthy dose of alcohol, but that is not the same as showing there is no safe dose. He walks through why all-cause mortality is the endpoint to start from, where the cancer data genuinely does look different, and why effect sizes at low intakes are small enough to be hard to interpret. Both are clear that alcohol is a toxin and neither is advocating that anyone start drinking. What they are arguing is that absolutist public health messaging that outruns the data erodes trust, and that time spent getting people active would do more good than telling them to drink nothing at all.

Key Topics

• Cliff's move from an ageing Oura ring to a Withings under-mattress sleep analyser, what resting heart rate and HRV are and aren't useful for, and Mikki's 59-day Garmin step streak and how it ended
• The one thing they openly disagree on: Cliff argues accumulated movement at varying intensities can make structured zone two largely redundant for an already-active person, while Mikki champions aerobic work in its own right and pushes back on messaging that walking plus lifting is all anyone needs
• Why Mikki has substantially increased her carbohydrate intake around running after years of being low carb, and the difference she reports in running, recovery and appetite
• Cliff on the research he co-authored — habitually low-carb athletes benefit from carbohydrate during exercise to essentially the same extent as high-carb athletes — and early-2000s field research at a 24-hour mountain bike event where athletes needed far more per hour than the then-accepted 60 g glucose and 90 g glucose-fructose ceilings
• The distinction the episode turns on: no healthy dose of alcohol is not the same claim as no safe dose, and why the Zhao 2023 meta-analysis is often read as saying the second
• Where the cancer data does look different, how relative risk and absolute risk come apart, and why a 5% relative increase can mean very little in absolute terms
• Confounding, residual confounding and abstainer bias — why abstainers can look worse in the data until you account for who stops drinking and why
• Guardrails rather than prohibition: Cliff's dozen beers a month, what he used to tell clients, and why zero-tolerance messaging that diverges from the data erodes trust and tends to fail in clinical practice
• Congeners, drink type and individual response, including why some people react differently to whiskey than to vodka — and why no spirit gets you out of a hangover at dose
• Linchpin behaviours: why both land on physical activity as the thing most worth people's limited attention, and Cliff's case for mindfulness as an effective non-diet intervention

Chapters

00:00 Introduction
03:07 Wearables, sleep tracking and step streaks
10:38 Does everyone need dedicated cardio
15:40 Running, mobility and upping carbohydrate
18:31 Carbohydrate during exercise and low-carb dogma
28:45 Alcohol guardrails and personal limits
33:10 Mortality versus single disease endpoints
38:51 Cancer risk, relative and absolute
47:29 Confounding, abstainer bias and patterns
58:46 Drinking culture and absolutist advice
1:07:43 Drink type, congeners and sleep
1:13:35 Linchpin behaviours and what matters most
1:18:19 Take-homes, recommendations and outro

Guest / Resources

Cliff Harvey PhD

• Website: cliffharvey.com
• Holistic Performance Institute: holisticperformance.institute
• Instagram: @cliffdoggydog

Cliff is a registered clinical nutritionist, a qualified naturopath, and holds a diploma in fitness training and health coaching in patient care. He has over 20 years' experience as a strength and nutrition coach and has been in clinical practice since the late 1990s. His PhD research was in ketosis and ketogenesis, and Mikki helped supervise part of that pathway. In the episode he mentions that a full review on alcohol and mortality was due to go up in the Holistic Performance Institute's database of living review articles.

Studies and research discussed

• Zhao et al. (2023), Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: