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Which is worse for you? Doctors explain.

August 5, 2023 by Alix Martichoux

(NEXSTAR) – In nearly half of the United States, all three are legal for those over 21: alcohol, tobacco and marijuana. However, the three substances come with different rules, taxes and — of course — health effects.

We posed the question to three doctors around the country: How do alcohol, weed and cigarettes rank when it comes to your health?

All three doctors agreed on which is best.

First off, they had a few conditions. “It is difficult to conclusively rank them in the order of their risks, since there have been no major randomized controlled head-to-head trials among the substances,” said Dr. Michael L. Glickman, a Washington, D.C. family medicine doctor and weight loss expert. He added that the amount you consume of each substance also greatly impacts your risk of bad effects.

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Dr. Anand Akhil, a behavioral health doctor with Cleveland Clinic, also pointed out that each individual has their own risk factors based on family history, pre-existing conditions and more.

But when it comes to generalizing for the average person, Akhil said alcohol was the worst, followed by tobacco.

“Alcohol use is linked to over 200 health conditions and diseases, damaging every organ system in the body,” said Akhil. “Depression, anxiety, dementia, cancers, heart and liver disease, and bone disease can all result from alcohol consumption. Similarly, tobacco use is largely connected to serious cancers, chronic obstructive pulmonary disease, and cardiovascular diseases.”

Dr. Kevin Most, chief medical officer at Northwestern Central DuPage Hospital, agreed.

“I would certainly rank alcohol No. 1,” Most said in a recent interview with WGN Radio. “I’m going to say that alcohol in moderation is OK, but too much alcohol is going to have impact on many illnesses.”

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The harms of consuming tobacco, Most said, could be largely reversed when people stop smoking earlier in life. “If people understand the risk of lung cancer, based on how many years you’ve been smoking and how much you’ve been smoking, if you stop that smoking at an early age … your lungs can reinvigorate and get back almost to normal.”

But Glickman disagreed and ranked tobacco as worst due to the fact it has no proven health benefits.

“Tobacco I would argue is the worse substance of the three, given it has no conceivable benefit even in light amounts, and considerable risks. Tobacco has been linked to increases in heart disease, cancers, and premature mortality, among others,” Glickman expalined. “Alcohol on the other hand, could have benefits at light or moderate amounts, but then risks with large amounts.”

He said red wine in particular contains antioxidants, and pointed to studies showing up to one glass per day can reduce inflammation in blood vessels.

But all three doctors agreed on which ranked least harmful to the average person’s health.

“I would put marijuana third, mainly because we know that there’s a lot of medicinal uses for marijuana and used in the right format and in the controlled environment is fine,” Most said. He said chemotherapy patients often credit cannabis as the only thing keeping their appetite up, allowing them to get nutrition they need.

Glickman said evaluating cannabis’ healthfulness and harmfulness is more complicated than the other two.

“The available evidence suggests that cannabis could be of benefit when medically supervised as part of a treatment plan for certain conditions such as chronic pain, anxiety, trauma, insomnia, and muscular disorders, among others,” he said. But Glickman went on to say cannabis use could make certain mental health issues worse, as well as impair memory and concentration.

He said the data suggests there is an extra risk to young adults whose brains aren’t fully developed.

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Plus, Akhil noted, while the U.S. Department of Agriculture and Health and Human Services have guidelines on how much alcohol adults can consume in moderation (up to two drinks a day for men, one drink for women), there are no such guidelines for safe cannabis or tobacco use.

“I think negative health consequences could be possible for all of the three substances, even in moderate amounts, depending on the person and situation,” Glickman said. “There is no foolproof vice.”

All three experts emphasized each person is unique, and you should always talk to your doctor about your specific situation.

(NEXSTAR). In almost half of the United States alcohol, tobacco, and marijuana are all legal for anyone over 21. The three substances have different taxes, rules and, of course, health effects.

Three doctors from around the country were asked to rate the health effects of alcohol, marijuana and cigarettes.

The three doctors all agreed that the best treatment is a combination of both.

They had to meet a few requirements. It is hard to rank the risks of the different substances in order, as there has not been a major randomized controlled trial that compares them. This was said by Dr. Michael L. Glickman, Washington, D.C.’s family medicine physician and weight loss specialist. He also said that the amount of each substance you consume can have a significant impact on your risk of adverse effects.

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Dr. Anand Akhil is a behavioral doctor at Cleveland Clinic. He also noted that everyone has different risk factors, depending on their family history, existing conditions, and other factors.

Akhil says that when generalizing to the average person, alcohol and tobacco are the two worst.

Akhil said, “Alcohol consumption is associated with over 200 diseases and health conditions that affect every organ in the body.” Alcohol consumption can lead to depression, anxiety, dementia and cancers. It also causes heart disease and liver disease. Tobacco use is also strongly linked to cancer, chronic obstructive lung disease and cardiovascular diseases.

Dr. Kevin Most of Northwestern Central DuPage Hospital agreed.

Most said, “I’d definitely rank alcohol No. Most stated this in a interview conducted by WGN Radio. I’m going say that moderate alcohol consumption is fine, but excessive alcohol can cause many diseases.

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Most people said that the harms caused by tobacco consumption could be reversed if people quit smoking earlier in their lives. If people stop smoking early, they can re-energize their lungs and return to almost normal.

Glickman, however, disagreed. He ranked smoking as the worst because it is not proven to be good for your health.

“Tobacco is, I believe, the worst substance out of the three. It has no benefit, even at low doses, and it comes with considerable risks.” Glickman explained that tobacco has been associated with heart disease, cancer, and premature death, among other things. Alcohol, on the other side, can be beneficial in small amounts but dangerous when consumed in large quantities.

cited studies that showed up to one glass of red wine per day could reduce inflammation in the blood vessels.

All three doctors were in agreement on the least harmful foods for the average person.

Most stated, “I’d put marijuana third because we know there are many medicinal uses for it and that when used in the correct format and controlled environment, it is perfectly fine.” He said that chemotherapy patients often cite cannabis as being the only thing to keep their appetites up and allow them to get the nutrition they need.

Glickman says evaluating the healthfulness of cannabis and its harmfulness is more complex than the other two.

He said that “the available evidence suggests cannabis could be beneficial when medically supervised in a treatment plan to treat certain conditions, such as chronic pain and anxiety, trauma, insomnia and muscular disorders.” Glickman continued to state that cannabis could worsen certain mental issues, and also impair memory or concentration.

The data shows that young adults with brains not fully developed are at an increased risk.


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Akhil also noted that while the U.S. Department of Agriculture and Health and Human Services guidelines outline how much alcohol an adult can consume in moderation (2 drinks per day for men and 1 drink per day for women), no guidelines exist for cannabis or tobacco.

Glickman stated, “I believe negative health effects could be possible even for moderate amounts of all three substances depending on the individual and the situation.” There is no vice that’s foolproof.

Three experts said that each person is different and should speak to their doctor about any specific concerns.

Alix Martichoux
Author: Alix Martichoux

About Alix Martichoux

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