People have known for centuries that drinking too much alcohol is bad for you. The short-term physical effects on cognition and motor function speak for themselves. The longer-term physical consequences of abusing alcohol — liver damage, jaundice, and cancer — have long been impossible to ignore.
So why, in that case, has there been a widespread belief, even among many physicians, that moderate drinking might actually be good for you?
We can thank the so-called French paradox for this. In the early 1990s, French scientist Serge Renaud concluded that the French had low rates of cardiovascular disease despite their affinity for fatty foods like beef and cheese because they otherwise adhere to a healthy Mediterranean diet — and because they consumed “moderate” amounts of red wine. Scientists have theorized that the antioxidants in red wine could play a role in reducing cholesterol, for example.
Subsequent studies appeared to affirm the correlation, strengthening the belief among the general public about the benefits of red wine. But over the past decade, new studies and public health warnings have called that conventional wisdom into question, stating emphatically that no level of alcohol consumption could be considered safe — much less beneficial.
Alcohol after all, absolutely is a toxin, and has long been recognized by experts, if not the broader public, as a carcinogen, after all.
Since many people enjoy alcohol to some extent, says Timothy Naimi, director of the University of Victoria’s Canadian Institute for Substance Use Research, “there’s been a far more relaxed scientific standard.” “We all love studies that show, ‘oh, sex makes us live longer, or coffee is good for us, or chocolate is good for us.’ There is this irresistible idea.”
Science has clearly established that excessive drinking is bad for you. But what remains confusing, especially with the steady stream of new studies that sometimes seem to contradict each other, is how bad moderate drinking is — and what “moderate” even means. Here’s what we actually know.
“Moderate” drinking is elusive — and it’s very easy to drink too much
One of the most important things to understand about drinking and its health effects is what amount of alcohol is actually considered to be excessive. It is a common trope among doctors and alcohol researchers that people misunderstand what moderate drinking means.
“None of us like to think of ourselves as drinking to excess, right?” Naimi said. “Who among us wants to think of ourselves as immoderate? Of course, we’re all moderate drinkers.”
Even if we agree in colloquial terms that “one drink a night” is moderate, the details matter. Medical science has far more precise definitions for what constitutes a “drink” than the average person pouring themselves a glass of Chablis. One 12-ounce can of 5-percent alcohol beer, a 5-ounce glass of wine with 12-percent alcohol, or a 1.5-ounce glass of 80-proof liquor are all what constitutes a “standard drink.” So when we pour an extra-large glass of wine at night, we may consider it only one drink, but a doctor sees two or even three. The kind of beer or wine matters too: Your favorite 9 percent IPA is actually closer to two drinks than it is to one, according to medical definition.
People today are considered by the medical establishment to be heavy drinkers if, by these definitions, they consume more than 15 drinks in a week for men or more than eight drinks for women. (You are considered to have alcohol use disorder if you have tried to stop drinking in the past year but failed, have alcohol cravings, or believe drinking interferes with your life. It’s less about specific amounts.)
Below that threshold, based on these scientific standards, you might consider yourself to be a so-called moderate drinker.
This reflects a lot of progress in our understanding of problematic drinking. For centuries, people have known that excessive drinking could damage the liver, cause long-term health problems, and lead to alcohol dependence. The US temperance movement of the 1800s and early 1900s sought to eradicate those personal and social harms and briefly succeeded in outlawing alcohol during the Prohibition era.
But, as the failure of Prohibition attests, drinking is deeply embedded in our society. Some popular historians like to say that alcohol (along with caffeine) helped define human civilization. There may even be an evolutionary angle: Many animals consume alcohol (called ethanol when it is encountered naturally). Perhaps it’s because finding fruit with some fermented ethanol means you’re good at finding fruit, period — a natural advantage for survival. That is how deeply rooted our ancestral relationship to alcohol might be.
Even today, one of the biggest challenges in trying to convince people to drink less is the fact that so much of our collective social calendar is scheduled around drinking — let’s go to happy hour or grab some drinks for the big game, for example. Given the seemingly implacability of social drinking, the focus for a long time has been trying to reduce the kind of habitual, excessive drinking that we have historically called alcoholism.
And there was some progress made: Americans collectively report consuming less alcohol than they did in the 1970s and ’80s. Today, an estimated 10 percent of Americans 12 and older are classified as having alcohol use disorder, a number that has stayed fairly stable over the past decade. There is even evidence that younger people are drinking less than millennials or Gen X.
At the same time, however, alcohol-related deaths have been increasing, rising by 70 percent from 2012 to 2022, even with a definition of alcohol-related deaths that is limited to liver disease, poisoning and accidents. The actual count, when considering deaths to which alcohol was at least a contributor, such as cancer in heavy drinkers, is more difficult to quantify but likely much higher. A 2024 estimate by the Centers for Disease Control and Prevention put the number at 178,000 deaths attributable to alcohol overuse annually in the US.
These seemingly contradictory trends — stable rates of alcoholism, but increasing deaths — could be explained by a few things. For one, alcohol use disorder is likely underdiagnosed. Second, “heavy” drinkers may not be alcoholics, but they can still feel the negative health effects of their alcohol use.
And then there is an issue that has been worrying doctors for years: binge drinking, usually defined as consuming four (for women) or five (for men) drinks in two hours or less. You may not necessarily be considered an alcoholic if you binge-drink; you may not even be a heavy drinker much of the time. But even more limited episodes of such intense drinking can do serious damages; the immediate risk is death from an accident or alcohol poisoning, but repeated binge drinking raises the risk of longer-term consequences.
Put it all together and what’s become clear is that more people’s health is being put at risk by their alcohol use than was previously realized. And that means even people whose drinking is considered socially acceptable need to be aware of the threats it poses to their health.
Is any level of drinking safe or even beneficial?
Once you are having more than two drinks a day if you’re a man or one drink a day if you’re a woman, pretty much every researcher agrees that the health risks warrant trying to cut back. But the consensus fractures below that.
If we imagine the conversation about alcohol’s health effects as a football field, the consensus covers 95 yards of the 100-yard field — almost all the way to the goal of general unanimity. We all agree heavy drinking is bad, but the fight remains on the issue — the remaining five yards — of whether light drinking is truly bad and that is still being debated.
But a quarter century after that conventional wisdom about red wine benefitting the human heart really took hold, a growing number of public health organizations and researchers started to aggressively dispute the idea that moderate alcohol consumption could be “safe” or beneficial.
“All of the arguing in the past 20 years has been around the health effects of very, very small amounts of alcohol,” Naimi said. “But I don’t think that other than small amounts of alcohol, there’s any question that alcohol consumption is a leading and preventable cause of health and social problems in the US.”
One watershed moment was a 2017 publication from the American Society of Clinical Oncology that established that even modest drinking could increase a person’s risk of developing cancer.
The ASCO was alarmed by surveys that found only one in three Americans knew about the finding decades after medical literature had documented a link between, for example, alcohol use and breast cancer. And with its report, the group aimed to increase awareness among the public that alcohol is a carcinogen and advocate for specific policy strategies to try to reduce excessive alcohol use.
Another meta-analysis, also published in 2017, examined prior research alleging positive cardiovascular effects from moderate alcohol consumption. This analysis, which Naimi co-authored, found possible statistical errors and other countervailing factors in the earlier studies that appeared to support the French paradox’s framework. For example, moderate wine drinkers tend to be more moderate in general, more active, and in better overall health — all of which could help explain their better health outcomes, without alcohol factoring into it.
Additionally, some of the apparent abstainers studied in the various observational studies of alcohol use and health outcomes may be former drinkers who could still feel the health effects years later, which would explain the finding that some moderate drinkers live longer than both non-drinkers and heavy drinkers. More recent studies with more rigorous statistical randomization reported that “alcohol consumption of all amounts was associated with increased cardiovascular risk,” with the risk increasing with every drink.
In 2022, the World Health Organization took an even stronger position, stating that “no level of alcohol consumption is safe for our health” based on available evidence. As they put it, one’s risk appears to increase “from the first drop.” The board of scientists who advise the US government on diet guidelines, too, has advised that the guidance reduce the maximum recommended drinks for men from two to one daily, for example. Their input hasn’t yet been incorporated into the final federal dietary guidelines.
At the same time, you still have studies that came out in the past decade that acknowledged the cancer risks but continued to report cardiovascular benefits and a possible reduction in the risk of diabetes with modest drinking. Some research suggests that adhering to certain patterns — such as spacing your weekly allotment of drinks out over a few days and consuming them with a meal — may be beneficial. It’s understandable that people are confused.
Here’s what you should know: This is really hard to study. We are mostly relying on observational data, not randomized controlled experiments, which could be compromised by all kinds of confounding factors. In an ideal world, you could compare two groups of people who are alike, except one drinks and the other doesn’t, for life. But in practice, that’s very difficult to do.
Industry influence has shaped our ideas about alcohol consumption
Our ability to make sense of all of the confusing science around drinking is further complicated by the influence of the alcohol industry, which airs advertising campaigns with messages like “drink responsibly” that reinforce the idea that a certain level of drinking can be responsible.
The industry also lobbies lawmakers to stymie any attempt to place new restrictions, requirements or taxes on them. One attempt to stand up a randomized alcohol study, which was to be overseen by Kenneth Mukamal of Harvard, was shut down in 2018 because the alcohol industry had provided improper input on the study.
All of the researchers I spoke to acknowledged the challenge in substantiating alcohol’s effects, positive or negative, but again: Alcohol is a carcinogen; no one needs a randomized control trial to know that, it’s been the international consensus for decades.
There’s a reckoning with alcohol right now, which can leave people feeling unmoored. But all of this noise obscures the simple way to synthesize all of this: Less is better.
“I think for people that are light drinkers, they probably don’t need to put a ton of brain space here,” Noelle LoConte, who co-authored the ASCO’s 2017 statement on alcohol and cancer, told me.
If you want to drink less but not abstain completely, there are some obvious things you can do. Don’t pour too much wine in that glass. Maybe skip the 10 percent double IPA. In my own life, I have moderated my drinking by limiting myself to at most two nights per week and at most two drinks per night. I still get to enjoy my coveted Cabernet once in a while, but having some loose rules for myself has made it easier to reduce my intake.
“The people who have one drink with dinner or two drinks with dinner, I think it’s exactly the right way to do it; that’s the right way to calibrate it,” Kenneth Mukamal, a Harvard doctor who authored several of the studies finding some cardiovascular benefits to moderate alcohol consumption, said. “You should have it with food. You should have it with friends and have it in a way that you’re naturally limited in how much you’re going to drink.”
It is also getting easier — and less awkward — to not drink at all if that’s your preference or you simply want to make a change. The nonalcoholic drink market is flourishing, with better and better options coming to bars and restaurants. It should be more socially accepted not to drink, as fewer people do.
All things in moderation is classic health advice — and the same applies to alcohol: Don’t overthink (or over-drink).
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