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Is There a Safe Amount of Alcohol?

Confused by the mixed messages on drinking? Get the facts on recommended alcohol intake and see how much is too much.

Medically reviewed in November 2020

Updated on September 1, 2021

If you relax or unwind with an occasional beer or glass of wine, you may be wondering if this habit is good for you, bad for you—or maybe somewhere in between. Given the many competing (and sometimes misleading) news reports on the subject, you’re likely not alone.

By now, the serious health risks of heavy drinking are widely known. But for years, public health officials have asserted that light or moderate drinking (defined as up to two drinks per day for men, or up to one for women) is probably safe. Some studies have even suggested that this level might offer health benefits for some people, particularly a lower risk for heart attacks and stroke.

Then, in August 2018, a comprehensive review of research published in The Lancet challenged conventional wisdom about recommended alcohol intake. Scientists concluded that even one alcoholic drink per day could increase the risk for injuries and certain diseases, including several forms of cancer. Moreover, as alcohol consumption increases, so does one’s odds of developing a range of other health issues, from high blood pressure to lung or liver disease. One of the study’s most quoted takeaways: “The safest level of drinking is none.”

The review made for some splashy headlines, but were the researchers’ conclusions true? Is even one daily drink a health risk?

The short answer: It depends.

A closer look at the research
The dangers associated with drinking really depend on you—your age, sex, DNA, lifestyle and other individual risk factors for cancer and chronic diseases, explains Keith Roach, MD, associate professor in clinical medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital.

“If you take a really careful look at that meta-analysis, you find that what we've been saying for the last 40 years is still true. People who drink moderately within recommended limits—one drink per day for women, two per day for most men—have a lower incidence of coronary artery disease than people who drink nothing,” says Dr. Roach. He notes, however, that the risks for other diseases are higher.

For the Lancet study, a team of scientists analyzed levels of alcohol use around the world and its effects on global health from 1990 to 2016. The researchers reviewed more than 1,000 studies to estimate the effects of alcohol on the risk for 23 health issues, including cancer, high blood pressure and stroke, as well as car accidents and injuries. Using mathematical models, the team predicted the overall harm associated with drinking.

The review found that alcohol was tied to 2.8 million deaths in 2016 and was the leading risk factor for disease worldwide among people between 15 and 49 years old. The researchers calculated that the health risks associated with alcohol were lowest at zero drinks per day and increased along with consumption. Essentially, the more people drink, the higher their risk for a wide range of health issues. The scientists concluded that the health risks associated with any amount of drinking outweigh any possible benefits.

Is one drink really too many?
Given these findings, is it time to cancel your wine of the month club subscription?

Not necessarily. Here’s why.

The results of this global study shouldn’t be interpreted on a personal level. In other words, your individual risk for the 23 health issues included in the review may be different than that of someone else with a different age and genetic makeup who’s living in another part of the world.

For example, tuberculosis was among the three leading causes of death linked to alcohol. This highly contagious bacterial infection is one of the top 10 causes of death worldwide. In 2017, 10 million people developed the infection, according to the World Health Organization. But only 9,105 cases were reported in the United States that year, the Centers for Disease Control and Prevention reports. Of these people, only about 9 percent were heavy drinkers.

While tuberculosis is a serious global health concern, it’s not as relevant for most Americans who may be more concerned about diabetes or heart disease.

It’s also important to understand that this review included observational studies, which tracked people over time, considered their alcohol intake and examined rates of disease to find associations. It’s nearly impossible for these studies to control for all possible variables and to tease out with certainty which specific foods, drinks or nutrients are causing a particular outcome, Roach explains.

Large, long-term, randomized trials are needed to determine true cause-and-effect relationships. These are studies in which scientists identify the effects of a particular variable by comparing groups of people randomly assigned to be exposed to it with groups of similar people who are not. But it’s impractical and even impossible to investigate the effects of alcohol consumption with this type of study.

Drinking still isn’t healthy
It’s important to understand the limitations of the 2018 study, but that doesn’t mean that you should drink with abandon—or at all, for that matter.

The study adds to a huge pile of evidence and reaffirms what we already know: Heavy drinking is dangerous. The more people drink, the greater their risk for a number of serious health issues, including cancer, liver disease, atrial fibrillation and stroke.

You also shouldn’t drink with the idea that your alcoholic beverage will offer certain health benefits, Roach advises. The scientific evidence suggesting that people who drink any kind of alcohol in moderation have a lower risk of death or lower rates of heart problems than people who abstain is murky at best.

It’s unclear if the protective effects linked to drinking are actually tied to the alcohol or if they are associated with other traits that are common among moderate drinkers, Roach points out. “There's good evidence to suggest that the second possibility is at least partially true,” he says. “People who drink moderately tend not to smoke, tend to see their doctors, tend to have good blood pressure control, tend to exercise regularly, tend to eat well. All of those things tend to reduce the risk of death.”

People who drink alcohol in the hopes of deriving a health benefit may also be tempted to overdo it, Roach adds. “I've seen so many people say, ‘My doctor said one must be good, so 10 must be better.’"

How much is one drink?
Keep in mind, even people who classify themselves as light or moderate drinkers may be consuming more alcohol than they realize.

“The dose of alcohol is defined really precisely,” Roach says.

For example, in the U.S., a single drink contains 0.6 fluid ounces or 14 grams of pure alcohol, which is the equivalent of 5 ounces of wine, 12 ounces of beer or 1.5 ounces (a shot) of liquor, such as gin, vodka, tequila or whiskey.

Many people exceed these portions, but still think they’ve had one drink. Complicating matters, different types of beer, wine and liquor also contain different amounts of alcohol.

Regular beer is about 5 percent alcohol, but some kinds are 9 percent. That means a 12-ounce glass of a beer that’s 9 percent alcohol is the equivalent of nearly two drinks. Most wines are about 12 percent alcohol, but some varietals are 17 percent or more, so a 5-ounce glass of wine that’s 17 percent alcohol is really about 1.5 drinks.

Most liquors, meanwhile, are about 40 percent alcohol, but some have more than others. For example, fruit liquors may be only 28 percent alcohol. Clear distilled spirits, like gin and vodka, on the other hand, can range from about 35 to 46 percent. Darker liquors, such as rum and whiskey, range from about 40 to 46 percent. Some whiskeys are as high as 60 percent alcohol.

“There is a big difference in the dose of alcohol depending on what you're drinking,” Roach cautions.

What’s the bottom line?
No level of drinking is completely risk-free, and the more you drink, the greater the potential harms. If you don’t drink, it’s probably best not to start. If you do choose to drink, don’t exceed current alcohol consumption recommendations for light or moderate drinking. If you’re a man, that means you shouldn’t have more than two drinks daily. If you’re a woman, limit yourself to no more than one drink per day.

Keep in mind that these guidelines are daily limits, not averages across several days. In other words, having four drinks in one night doesn’t qualify as moderate drinking even if you abstain for the rest of the week.

One way to make sure you're following recommended guidelines is by tracking your alcohol intake with the Sharecare app (available for iOS and Android).

It’s also wise to consider your individual risk factors, which could make drinking potentially more harmful for you than for someone else. These include your medical history, whether or not you smoke, your weight and other lifestyle factors. Talk to your doctor about what’s best for your situation.

Some people should not consume any alcohol, including pregnant women, those with a personal or family history of alcoholism or those with a history of alcohol-related liver or pancreatic disease.

Drinking for health benefits is also misguided, Roach cautions. The possible health benefits of alcohol are slight and unproven while the very clear risks associated with drinking escalate with every sip you take.

It’s tough to make the case for even moderate drinking, given the significant number of health risks involved. That said, some people will enjoy life a bit more if they have their daily glass of wine, Roach concedes.

“If that's the case for you, and it's worth it to you to take a small risk of developing health problems later on, then, by all means. You make choices in life,” he says. “It's not unreasonable to say, ‘Yeah, I'm going to have a glass of wine a couple of times a week.’ The potential harm from that is small. But, don't fool yourself into thinking it's a benefit.”

Sources:

van Tol A, Hendriks HF. "Moderate alcohol consumption: effects on lipids and cardiovascular disease risk." Curr Opin Lipidol. 2001;12(1):19-23.
GBD 2016 Alcohol Collaborators. "Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016." Lancet. 2018;392(10152):1015-1035. Chiva-Blanch G, Badimon L. "Benefits and risks of moderate alcohol consumption on cardiovascular disease: current findings and controversies." Nutrients. 2019;12(1).
Centers for Disease Control and Prevention (CDC). "Dietary Guidelines for Alcohol." Published December 30, 2019.
Trevor AJ. "The Alcohols." In: Katzung BG, ed. Basic & Clinical Pharmacology, 14e. McGraw Hill; 2017.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). "What Is A Standard Drink?" Published October 9, 2019.

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