How true is the claim that alcohol in moderation is good for the heart?

Causing heart attacks & strokes is one of the most common ways in which alcohol kills people; and yet the belief which gives reassurance to many alcohol drinkers is that ‘alcohol in moderation is good for the heart’. This shows how successful the alcohol industry has been in shaping public opinion. 

Faulty methodology of studies which make this claim:

If one wants to study the impact of light alcohol consumption, one must compare those who drink in small quantity with those who have never taken alcohol (abstainers). However, in most studies which claim beneficial effect of light alcohol use, past alcohol users (who would have usually quit alcohol because of it having royally screwed up their health) were included in control group rather than taking only life-time abstainers. Many systemic reviews have shown that when you remove such bad quality studies and analyse only the good quality studies, this claim doesn’t hold true. Eg. In a recent meta-analysis of 87 previous studies on this issue, which analysed the data of  39,98,626 people, after controlling for various quality-related study characteristics -  no significant reduction in mortality risk was observed for low-volume drinkers (RR = 0.97, 95% CI [0.88, 1.07]).¹

Any guesses - how come so many studies chose a faulty methodology? How come none of the investigators realised that people with bodies severely damaged due to alcohol were on the control side? Either they had low IQ or they had decided before the study what conclusion they wanted to reach. I leave the judgement to you.

Influence of alcohol Industry in shaping public opinion:

It might interest you to know that ‘International Centre on Alcohol Policy’ is funded by the major alcohol producers of the world. A lot of ‘gyan’ on alcohol which you or your doctor get to read could have been funded by them. Two major ideas ICAP tries to propagate are:

a) Drinking alcohol is not problematic, only certain drinking patterns are problematic

b) Alcohol industry (which pursues aggressive marketing to get youngsters hooked on to it) is not at fault, but the people who drink irresponsibly are at fault.²

Even if we assume the claim of benefit to heart to be true, its important to keep following things in mind:

What is exactly meant by moderate consumption:

The industry uses word moderation as its very vague and most users assume that what they drink falls within moderate range. So its good to know that what is being referred to as moderate consumption is upto two drinks (2 small pegs) a day for men and upto one drink a day for women.

The claim is not applicable to atleast Indians:

In a multi-centric Indian study having a large sample size (11898 men), it was seen that the risk for Coronary Heart Disease (CHD) increased with even occasional alcohol intake, in Indian population atleast.³

People don’t get addicted by choice

Continuing to drink in control is not entirely a matter of choice: A significant proportion of drinkers end up drinking excessively, though they intended to drink in control. This brings in a lot of negative consequences for the person and his family. Hence, American Heart Association writes on its website, ““Drinking more alcohol increases such dangers as alcoholism, high blood pressure, obesity, stroke, breast cancer, suicide and accidents. Also, it's not possible to predict in which people alcoholism will become a problem. Given these and other risks, the American Heart Association cautions people NOT to start drinking ... if they do not already drink alcohol”⁴

Many who start with wish to drink in moderation end up becoming addicts:

3 of my patients of alcohol addiction had not taken their 1^st drink because some friend had forced them, but because some great doctor had advised them to start drinking alcohol in control to improve their health.

 

There are many better ways to improve your health than to drink an addictive poison:

If you really are bothered about your health - regular exercise, healthy diet, etc. is the way ahead. 

Even light alcohol consumption leads to many cancers:

There is now evidence that certain cancers are caused by even light alcohol consumption:   In a meta-analysis of 222 studies it was estimated that in 2004 worldwide, 34,000 cancer deaths were attributable to light drinking.⁵

So next time when your friend reassures you that its safe to drink in moderation, or when you are thinking of teaching your teenager son ‘responsible drinking’, or when you are thinking of giving your dear ones a treat of an alcohol party – do keep in mind this evidence and the fact that this beloved party drink kills around 30 lakh people every year, 1 person every 10 seconds.  

Dr. Dharav Shah

(Consultant Psychiatrist, Mumbai. dharavshah@gmail.com)

I have given more than 400 awareness talk on this issue. 

Our presentation can be seen on YouTube – Poisons We Love. Also do check out our facebook page www.fb.com/truthofalcoholandtobacco for cool posters which you can share with your dear ones on whatsapp & facebook.

References:

1.      Tim Stockwell, Jinhui Zhao, Sapna Panwar, Audra Roemer, Timothy Naimi and Tanya Chikritzhs. Do “Moderate” Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality.  J Stud Alcohol Drugs. 2016; Mar; 77(2): 185–198. doi:  10.15288/jsad.2016.77.185

2.      David H. Jernigan. Global Alcohol Producers, Science, and Policy: The Case of the International Center for Alcohol Policies. Am J Public Health. 2012 January; 102(1): 80–89. doi:  10.2105/AJPH.2011.300269

3.      Roy A, Prabhakaran D, Jeemon P, Thankappan KR, Mohan V, Ramakrishnan L, et al. Impact of alcohol on coronary heart disease in Indian men. Atherosclerosis 2010; 210:531-5.

4.      Alcohol & Heart Health. American Heart Association [Website on internet], Dallas. [cited on 2016 December] Available from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Alcohol-and-Heart-Health_UCM_305173_Article.jsp#  

5.      Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, et al. Light alcohol drinking and cancer: a meta-analysis. Ann Oncol. 2013; 24:301-308.

Power of an honest self-reflection

Angels can fly…

Because they choose to travel light

-          Unknown

Many times in couple therapy, the partners are unable to reach a common hypothesis of what went wrong, even after long deliberations. Around a year ago, a couple I was seeing dropped out of therapy, after a similar dead-lock.

They had been quarreling since 3 years now and things had gone from bad to worse. Everything appeared gloomy and hopeless. 3 weeks back, the sister of the guy was able to convince him to start therapy again. They seemed to agree that healing the marriage ought to be the highest priority at this point in time.

He chose to come alone and work on his own-self first. We had 2 long sessions in a single day, totaling around 4 and half hours of therapy. Later we came to know, his wife was ringing him repeatedly during therapy to ask for my contact number. She believed she had had enough and wanted to confirm with someone whether it was a right decision for her to take divorce or not?

One week later when we all met, she asked me, “Is he following any strategy?” In that 1 week, the kind of behaviour her husband was demonstrating, she had never experienced in the past 3 years. She was finding it too good to be true. I couldn’t believe what I was hearing either. Because in the session, he had only partially agreed to the misinterpretations I had pointed out. And then we had some discussion on was there any unintentional mistake from his side as well and is it possible that her complains were also valid to some extent? That was it. 

In this session, there was lot of crying over hurts of the past 3 years. But I was euphoric J We did a lot of clarifying and all; but bottom-line is that it has been 3 weeks now and the atmosphere in their home is still jovial... They have been able to see the fallacies in some of the past grudges they had nurtured. They have been planning vacations…finally they did have an argument yesterday – but managed to end it fast and to remind themselves that things said in anger ought to be ignored.

I am no longer naive enough to get complacent with initial breakthroughs. However I am sure, they have successfully navigated the most difficult turns. The psychiatrist in me is happy – quality of life for this 1 couple is going to be different J

So what are the important lessons I learnt?

1    

      1)  Most of the couples I have worked with, don’t show such dramatic response. So I cant claim it was majorly because of my efficiency. Usually both partners believe that its essentially their partner who has a problem and they cant tolerate him/her any longer. They don’t take suggestions about where they themselves need to change very kindly. Here also there was a lot of negativity on both sides. But here, 1 partner showed the courage to acknowledge his unintentional mistake without expecting any counter apologies from the other side. He also made an effort to understand the reasons which were leading to his partner’s abusive behaviour and large heartedly chose to forgive that. Because of the clear apology, it was easy for the partner also to forgive graciously and inturn see her part of the misinterpretations.

Usually either because of a tendency to feel guilty or because of an assumed fear that partner will keep accusing them, people hesitate to fully acknowledge their mistake. This precludes the necessary corrective action and problems fester. I guess this openness to suggestions about ‘where I myself need to change my perspective’ made all the difference. The more we cultivate this quality in ourselves, more would be the growth and joy in our life.

  

      2)      Though typically we do couple therapy together, few individual sessions with each partner separately, may help a lot in certain cases.

      3)      When valid needs are not expressed or responded to for a long time, violent expressions and blaming over silly things invariably starts. So we must voice our hurts & expectations in a respectful way in time; even if it feels very awkward. Not discussing them openly creates negative prejudices in our own mind and that hurts the relationship much more than expressing our feelings. (And ofcourse, we must thank our partner for expressing; rather than take an offense) 

      4)      If rather than trying to find ‘who went wrong’, if we try to find ‘what went wrong’ – accurate diagnosis is much faster. And with the right diagnosis, a complex mess of emotions can also melt away completely.

      5)      Yes, therapy is expensive. But it would still amount to less than 5% of marriage cost in most cases. So if discussing amongst self, with friends and with relatives doesn’t seem to be helping, one must consider going for therapy before the hearts are permanently scarred.  

I pray to God to give all of us the ego strength to focus on our own mistakes J

Thanks for reading!

When vaginal contractions suffocate the marriage

As a psychiatrist I have seen many sad consequences of the negative attitude our society harbours towards sexuality. One such consequence is a disorder which many women & couples suffer helplessly for many years; called Vaginismus.

A woman with this disorder gets intense pain every time she attempts intercourse. Initially both the partners feel that they don’t know the right way to do it and are hopeful that soon they will figure it out. But after few days or weeks of marriage it sinks in that something is majorly wrong.

Ofcourse, with the kind of sexual ignorance prevalent in our society, the couple has no clue of what is the cause of the pain and what is the solution. People they ask for help are equally ignorant. Some of my patients of Vaginismus have been doctors and yet the same story... One of them got advice from her medico friends, “It happens to everyone. It will go away with time. Keep trying.” A senior gynecologist advised another, “Come on. Nothing is wrong with your vagina. You are a doctor yourself. Why are you keeping such an attitude. Just do it!”   

The pain is actually because the vaginal muscles involuntarily go in spasm (severe contraction), every time a woman with this problem attempts penetration. Subconsciously, her mind wants to avoid the act. This results in spasm which prevents any penetration. Usually this is seen in women who are from orthodox backgrounds. Consciously, most of them are as excited about sex as other women, at the time of marriage. But the number of negative messages about sex & masturbation they receive during adolescence is so high, that their subconscious gets strongly programmed to regard the act as undesirable; and hence something to be avoided. For some women, stories of how painful sex is or how painful a vaginal examination is leads to the negative conditioning. However, this conditioning is subconscious. Most of them are looking forward to intimate moments with their husband.

This subconscious conditioning can be easily reversed by appropriate counseling and gradual dilatation (by using fingers or vaginal dilators designed for this purpose). However, as most women or people they ask help from are not aware about it, they sincerely continue with the only solution they know – of just doing it. The severe pain which accompanies these sincere attempts further aggravates the negative conditioning. Worse than the physical pain, is the emotional pain of feeling inadequate and insecure. Also there is guilt of not being able to perform their sexual role in marriage. And since the attitudes in our society make them feel uncomfortable in discussing about all this to anyone, their anxiety and stress get bottled up; coming out in all unhealthy ways – blaming others (especially the husband) for various things, irritability over everyone, etc. 

With each unsuccessful attempt this stress keeps building up and a belief sets in that this is not solvable. So to avoid any further pain of failure, they start avoiding penetration or attempts to work on this issue. Some tell their husbands, “Accept me as I am unconditionally; otherwise anyways the marriage is not worth it”. Some start treatment but leave it half way, as they find it stressful to think about all this. Some decide to stop treatment as soon as some penetration occurs. By this time, their goal is not sexual enjoyment but just to solve this ‘big problem’. They are eager to get over with it and are happy to take some penetration as a sign of ‘All is well now. No more need to bother about this.’ However, as the conditioning is not reversed adequately pain keeps occurring intermittently and normal sexual intimacy is not established.

Another factor which facilitates avoidance is the cultural belief that sexuality is a ‘cheap’ aspect to our existence (गंदी बात). It is one of the 6 bad qualities of mind which we must strive to overcome. Hence, both the partners often decide to not give Vaginismus too much importance and carry on life as usual. However, frustration soon builds up and unconsciously husband also starts feeling irritated about various aspects of her personality. A volley of accusations and counter-accusations starts: ‘you are not giving enough time’, ‘you are self-centered’, ‘he/ she is very immature’, ‘he/she has no genuine love for me’, etc. In many cases, the couple isn’t even aware that concern about sexual life is the actual reason underlying their frequent fights over trivial issues.   

At times husband decides to not bother her as she gets pain and avoids physical intimacy. She feels offended that because there is no sex he doesn’t even want to hug her or kiss her. To express her affection and to feel assured about their bond, she cuddles and kisses. He gets irritated that when they are not going to have sex, why un-necessarily arouse him… Efforts to ignore the issue really don’t help and situation keeps getting complicated.

I also grew up with quite a negative attitude towards sexuality. However, now I have a drastically different view – I regard it to be a gift of God to mankind and all animal species J Certain observations have made me start believing that just as desire to get food or water are biological drives; sexual urge is also a biological drive which is difficult to control beyond a point. A person not getting food doesn’t die. But just as a hungry person may go to any extent to satisfy his desire, a sexually starved person also becomes quite distracted and crazy. When a person with conversion disorder (hysteria) comes to us, the 1^st thing we explore for is sexual history… as sexual frustration is one of the most common stressors causing it.

Its interesting to note that many patients of conversion disorder aren’t even aware that they are feeling the sexual frustration. The culturally conditioned mind doesn’t want it; but something within them keeps craving for it badly. For example, there was a saint of a particular religious group who was married; but they were supposed to not get physically intimate as per the rules prescribed for the position he was at in the institution. He used to get severe pain for which he had become dependent on some pain killers. He ofcourse believed that his unexplained pain had nothing to do with his decision of abstinence. Most doctors thought otherwise.

We keep hearing of so many sex scandals involving religious leaders of various religions. How come people who had decided to dedicate their life to society, end up in that situation? In my opinion, that is because most religious traditions have failed to take a balanced attitude to this biological urge. They judged it to be a sin and prescribed rules to suppress it so much that it actually started leading to sins.

Point I wish to make is that you cant expect a person to be at peace if his need for sex is not met. As one of my spiritual gurus said – Sexuality is one of the less important aspects of life but its presence is essential for a happy life; just like many other basic needs eg. food, clothing, shelter, etc. Its said that sexual life has around 20% importance in marriage. But if there is a problem with it, then its influence on marriage become 80%. If a couple tries to ignore the problem in their sexual life, regarding it to be a minor issue, their marriage is bound to fail sooner or later.

In many cases, husband keeps trying to gently encourage her to work on the issue. And she keeps finding reasons why she has no time for it. Avoidance is because of the reasons mentioned above. As extra-marital intimacy is not allowed in our society, he is unable to find any solution to his frustration. His heart yearns to get out of the marriage but can’t as he also understands her struggles and is aware of all her goodness. After few years when the husband can no longer take the avoidance of the issue and talks of separation, she finds it unacceptable that how can he talk of separation over such a trivial thing? She develops a belief that he is just obsessed with sex and doesn’t value all that she has done for him in all these years. This judgement in turn makes the husband develop a belief that she has no value for all the understanding he has shown and for all that he has done for her. Both feel un-understood, rejected and deeply hurt.

Now with a prejudiced mind all the negatives of the other person become intolerable and mind fails to register any positives. Trust leaves the relationship. Over the years their heart is wounded so often that they hesitate to respond to even the friendly initiatives made by the other person. They start fearing other person’s reactions and genuine sharing stops. Being in such an emotionally distanced relationship is at times more painful than separation… and all the blame for this pain is on the partner.

Both develop a view that even if vaginismus gets solved, its not worth living with the other person as the basic personality of the partner itself is not good or that the other person doesn’t love genuinely and can’t be trusted. Usually it requires quite a few therapy sessions to undo the psychological mess which gets created over the years. However, partly because of stigma and partly because therapy is perceived as expensive, most people don’t complete adequate follow up. So in many cases, even after vaginismus is solved the negative beliefs about the other person continue and that prevents harmony & joy from returning back into the relationship.

Thus not addressing vaginismus in time can scar your mind and happiness for a long time. Luckily all studies on this topic have shown that more than 95% of those who complete the full treatment programme, are able to enjoy pain free intercourse. Vaginismus and most other sexual disorders are treatable. Please take professional help in time, before negative prejudices set it.Don’t waste your energy in passing negative judgements on your partner. That will only increase your misery. You getting a disorder is not your fault; but working on it and resolving it is definitely your responsibility. If you don’t like the therapist or if things are not working, change the therapist. But please don’t go in avoidance mode. As we all know ‘a stitch in time saves nine’.

Thanks for reading and wishing you a very satisfying sexual life J

Dr. Dharav Shah

dharavshah@gmail.com

(I shall be very thankful if you share your positive and negative experiences of sexuality with me. Your learnings will help me in guiding young couples struggling with it. I promise to maintain complete confidentiality.) 

PS: There is an enlightening ted talk ‘Reclaiming Female Sexual Desire’, on the related topic of lack of sexual desire, by a woman who was herself suffering from that problem, Pam Costa

Testimonials

For maintaining confidentiality, most of the testimonials are anonymous. I understand that without name, one may find it difficult to trust. But for those who dont mind the anonymity...here are some testimonials of people I have worked with.

1)  I am grateful to get professional help from Dr. Dharav shah, to heal personal problems. His unique style of therapy helped me to deal with my divorce and heal trauma and be a better human being in the process. I feel its good to take professional help to understand and sort out our mental health issues, instead of living in denial and suffering.

                           - Dr Ayshwarya Revadkar,

                             Gynecologist, writer and social activist.

                             Blogs at www.matichimulagi.blogspot.com

2) I had a normal emotional life and did engineering from a prestigious college. But then I had an episode wherein I had lost control of my behaviour and did some odd things. I was admitted and became much better with treatment. But some amount of sadness and anxiety lingered on for many months ... when I took second opinion from Dr. Dharav Shah, the component of  Bipolarity was identified. One of the tablets was changed and I returned to my emotional state previous to the episode... It brought me so much relief.

                              

                             - A young engineer.

3) I am a physician myself and I have been taking therapy from Dr. Dharav Shah. It has tremendously changed the way I have been handling relationships and I am today deeply healed because of the time and efforts he invested in me especially in times when I had given up the hope and will to continue the therapy.

 It required a lot of hard work including being absolutely honest about yourself, being open to seeing and believing in the therapist and his suggestions especially when you have been holding an exactly opposite view of the issues for several years,  internalising and practically applying all that you have internalised in your actions, through therapy. 

And all this is only possible if you have a therapist who is committed and sincerely strives to communicate, empathise, comfort and gently but firmly  helps you work on yourself and that's what Dr Dharav does, a rare quality that unfortunately most of the psychiatrists today lack, especially of investing more in patient counselling rather than disposing off the patient with some medicine  prescription.

All it takes to heal yourself through his consultations is honesty, willingness to see, understand and improve and the  patience to give it the time it takes. Undoubtedly he is the finest psychiatrist I have known. 

                             - Dr Jyoti Puthron (DNB Internal Medicine)

4) I am 33 year old female gynaecologist from Pune. I am in therapy with Dr Dharav Shah since 3 years for depression. 

     We, I and my family, consider this is the most transformative period of life.During therapy I have undergone a metamorphosis.For this remarkable turnaround I credit the skill and expertise of Dr.Dharav Shah. Taking therapy is emotionally very challenging.Whole journey is daunting .But worth it. Dr.Dharav Shah's empathetic, non judgemental, patient and compassionate approach gave us strength to take therapy.

      He has gone beyond what a typical psychiatrist is expected to do and he sees each patient as a unique individual with unique needs. Psychiatry treatment is not mere taking medicines but it's more of working on thought process. Dr.Dharav Shah is very rare combination of the best counselling and medicines. It doesn't come without  years of blood,sweat and tears. He has a degree from the best college of India NIMHANS and has a lot of experience in social work.

    He helped us going to the root of the problem. Superficially treating symptoms doesn't help for long term. My problem started at the age of 5 years. I suffered for more than 25 years in variable amount .Even my family and friends also suffered because of me. But after therapy everything resolved in a dramatic way.

         My brother was stuck up in an unhappy marriage to the extent of considering divorce.We all had lost hope but miraculously couple came out of it ,living very happily and enjoying everlasting togetherness now. It's all because of Dr.Dharav Shah's perfect diagnosis of the problem & exceptional communication skills.

     Me and my husband always cherish remembering his words, my journey during therapy. We can speak for an hours how my life did an amazing 180 degree turn  because of Dr. Dharav shah. He has become a central theme of our many discussions.

          Taking psychiatry treatment for emotional pain is extremely important and we have one of the best psychiatrists around.l highly recommend Dr. Dharav Shah for every kind of psychiatry problem.

          Million thanks Sir for everything you have done for us..

                          - A young gynaecologist

5) It is with great pleasure that I write this testimonial for Dharav.

If it wasn't for him I don't know what would I have done!

I seeked his help when I realized I was in a very unhappy marriage. 

I was so stressed due to my personal problems that my emotions had clouded my rational thinking. 

Dharav helped me to think again and use my rational centre. After his sessions I would go back with a more positive attitude and would feel more braver to face the situations. 

He pointed out my strengths and weakness and told me how I should work on it. 

Its been almost 3 years now and am very happy with the way things have turned out in my life. 

If it wasn't for him I would have been one of those countless, unknown victims of emotional abuse. 

Talking to him was like finding an oasis in the middle of the dessert.   

He is very thorough in his work and helps you genuinely as he believes in giving back to the society and more importantly in the power of helping people. 

I wish him all the best for his future. 

                           - a young lady