You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate medical and public health challenges. Click here to get the full newsletter in your inbox, including answers to reader questions and a summary of new scientific research.
Readers had strong reactions to my column this week about what we know and don’t know about alcohol’s health risks. I wanted to address those questions here and offer guidance for people who are considering cutting back.
“How could you be a doctor and say that the risks of alcohol are ‘acceptable’?” asked May from Virginia. “Alcohol is a poison, just like tobacco. Saying to people they can drink a glass or two is like saying they can smoke a pack or two.”
I understand May’s perspective. The evidence clearly shows that binge drinking and regular heavy drinking are associated with substantial harm to nearly every organ system. What is far less settled is whether drinking an occasional glass of wine is comparable to smoking an occasional cigarette. Light alcohol consumption does appear to slightly increase cancer risk. At the same time, some studies have found that people who drink small amounts have slightly lower rates of cardiovascular disease than people who abstain entirely.
People will interpret this evidence differently. Someone with a history of cancer in their family may reasonably decide to minimize risk and drink only on special occasions. Others might look at the same data, judge the absolute increase in risk to be small and decide to keep their daily glass of wine.
That said, even occasional drinking can be problematic for some people. John from Minnesota wrote that he comes from a family with a history of alcohol use disorder. “I tried alcohol twice in my life, and both times, I thought I liked it just a little too much,” he said. “So I stay away from the stuff.”
Meryl from Indiana expressed a similar view. She belongs to Alcoholics Anonymous, which helped her stop drinking 10 years ago. “There’s no such thing as drinking ‘in moderation’ for me,” she wrote.
Their experiences point to a key question that anyone who drinks should ask themselves: Who has control? When you have one drink, do you feel satisfied stopping there, or do you feel a pull to keep going? When you try to go days or weeks without alcohol, do you become anxious or uncomfortable? Being able to drink by choice is fundamentally different from feeling that alcohol exerts control over you.
Another red flag is using alcohol to cope with something else. Here, the question to ask is why you drink. Is it to manage feelings of depression or anxiety, or to help with sleep? Alcohol is not an effective or durable solution to these problems. While it may seem to relieve short-term symptoms, people often develop tolerance and need increasing amounts to achieve the same effect, with accumulating negative health consequences. In these situations, even individuals who are not drinking heavily might benefit from speaking with a clinician to address the underlying issue driving their alcohol use.
“I always enjoyed a glass of wine with dinner because I liked the taste, and I thought it was good for my heart,” wrote Michael from Pennsylvania. “Has that changed?”
It is true that red wine contains flavonoids and other antioxidant compounds that have been studied for potential cardiovascular benefits. However, these same compounds are readily available in a wide range of fruits and vegetables, such as grapes and blueberries. Earlier observational studies suggesting cardioprotective effects from wine have been tempered by more recent research showing far more modest benefits.
Alcohol should not be used as a strategy to improve cardiovascular health. People who want to protect their hearts are better served by following well-established recommendations, including eating a nutritious diet, staying physically active, and managing weight, blood pressure and diabetes.
“I don’t understand your hypocrisy,” wrote Jenny from Washington, D.C. “You’ve written so much about how cannabis is bad for health. I think you should be writing about how it’s so much better to use cannabis instead of alcohol.”
My concern about cannabis is the mistaken perception that because it is often described as having medical uses, it is therefore harmless. In reality, there are relatively few well-established medical indications, while the potential harms are increasingly well-documented. People who choose to use cannabis should do so with a clear understanding of those risks and an informed sense of trade-offs.
The same principle applies to alcohol. No one should be drinking because they believe it is good for their health. Instead, people should be aware of the risks, distinguish between the harms of heavy use and the risks associated with occasional light use and make choices that align with their own health priorities and individual circumstances.
That choice may well be to cut back. Dan from Maryland asked what I thought about Dry January. “I know we have less than half the month left,” he wrote, “but is this something worth trying?”
Yes. There are meaningful benefits to abstaining from alcohol for a defined period, whether it is a month or just a few days. One is that it can be informative. If stepping away from alcohol feels unusually difficult, that may signal an unhealthy reliance. Another benefit is that people may notice improvements in their mood, sleep and blood pressure control.
People who find that they cannot reduce their alcohol use and want additional support should speak with a clinician. Evidence-based treatments are available, including medications, psychotherapies and peer support groups. All of these can help people step back from alcohol and make clearer, more deliberate choices about its role in their lives.
The post What to ask yourself if you think you may be drinking too much appeared first on Washington Post.
