Can alcohol fit into a healthy lifestyle? Emerging evidence suggests that less alcohol is better. But there are a number of factors to consider when deciding whether alcohol should have a place in your lifestyle.

 

What are the recommendations for alcohol consumption?

The U.S Dietary Guidelines recommend that individuals who choose to drink limit their intake to no more than two “standard drinks” per day for men and one drink per day for women. The National Institute for Alcohol Abuse and Alcoholism recommends that individuals over 65 also limit alcohol to one standard drink per day [1]. And no, this does not mean you can save all your drinks for the weekend!

A standard drink contains 14 grams of pure ethanol [2]. This equates to:

• 5 ounces of wine (12% ABV)
• 12 ounces of beer (5% ABV)
• 1.5oz liquor (40% ABV)

Image from: https://alcohol.stanford.edu/faq/count-your-drinks

Here’s some food for thought when it comes to the portion size of drinks. Many beers have a much higher ABV than 5%, and if you get something on draft, it's usually served in a pint glass (16oz). So, for example, if you order an IPA at a bar, it’s likely much more than one standard drink, maybe even closer to two. Just like the diameter of our plates, the size of wine glasses has increased over time, which can lead to a distortion of how much we are drinking. Have you seen the glasses that fit whole bottles of wine?! And who measures out liquor in cocktails? The point is that it is easy to drink in excess of the guidelines outlined above.

 

Some research shows moderate alcohol consumption may be beneficial

It's well-documented and widely accepted that heavy and binge drinking isn't good for health. But what about “moderate” drinking? Actually, the data is not clear-cut. Like many topics in nutrition and health, it is challenging to study the relationship between alcohol and health. 

Some research suggests that moderate alcohol intake is beneficial for health. For example, this systematic review and dose-response meta-analysis, which pooled data from 26 studies, found that light to moderate intake of alcohol was associated with decreased risk of incident type 2 diabetes when compared with the “minimal” category of alcohol consumption: the lowest risk was observed at less than 20 grams of alcohol per day for women, and less than 40 grams for men. However, it is important to note that when the authors performed stratified analyses (e.g. looking at the risk of developing type 2 diabetes individuals with a family history versus no family history), many associations were no longer significant.

Another systematic review and meta-analysis of 84 studies looking at the relationship between alcohol consumption and cardiovascular health revealed that less than one drink of alcohol per day was associated with a 14–25% reduction in the risk of all outcomes assessed compared with abstaining from alcohol. Many of us have heard about the potential benefits of red wine, namely in the context of heart health. Red wine contains resveratrol and other antioxidants, which may improve various markers of cardiovascular health [3, 4]. 

 

But emerging evidence suggests alcohol may not be as healthy as we once thought

On the other hand, a growing body of evidence suggests a negative relationship between light to moderate alcohol consumption and health. For example, a recent study examined data from nearly 600,000 individuals from nineteen high-income countries and found that, among current drinkers, consuming more than five to six “standard” drinks per week was associated with an increased risk of mortality.

Furthermore, any amount of alcohol consumption increases the risk of certain types of cancer, such as esophageal cancer. Moderate alcohol intake has also been associated with an increased risk of breast cancer [5]. Based on the available evidence, The American Cancer Society and American Institute for Cancer Research recommend that it is “best” to avoid alcohol for cancer prevention [6, 7]. 

Even the Dietary Guidelines acknowledges that the tide is turning as far as the research on alcohol and health, stating: “Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease. Alcohol has been found to increase the risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day) [8].”

 

Why is alcohol intake hard to study?

Many studies are observational, meaning that individuals are followed over time. In this type of study design, a relationship between two variables may be found, but it can be difficult to know the cause and effect. For example, does moderate alcohol intake decrease the risk of chronic disease, or do people who have a lower risk of chronic disease tend to drink more moderately? In addition, other variables like demographics, genetics, and lifestyle factors may influence observed associations between alcohol intake and health. For example, do people who drink red wine eat differently than those who don’t, and to what extent does this explain the relationship between red wine intake and health? Overall, it is hard to draw firm conclusions from the existing data.

Of course, some individuals should avoid alcohol completely: e.g., those in recovery, managing certain medical conditions, taking specific medications, etc. Abstinence from alcohol during pregnancy and while trying to conceive is the safest and best advice.

 

So, is alcohol good for YOU?

First of all, always check with your healthcare provider about whether any level of alcohol consumption is appropriate for you.

We believe that alcohol can have a place in a “healthy” lifestyle, but it is important to consider many factors, such as:

• The pattern and frequency of drinking: i.e. are you saving all of your drinks for Saturday night?
• What do your portion sizes look like, and what is the alcohol content of your drinks; in other words, are you drinking in excess of the guidelines?
• How does alcohol make you feel physically and mentally when you drink it? The next day?
• WHY are you drinking, and how do you feel about your relationship with alcohol: e.g. are you drinking to cope with stress? Boredom? Loneliness?

Now more than ever, most of us can stand to be more mindful of our alcohol intake.

 

 

References

1. https://www.aagponline.org/index.php?src=gendocs&ref=substanceabuse&category=Foundation
2. https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink#:~:text=In%20the%20United%20States%2C%20one,which%20is%20about%2040%25%20alcohol
3. https://www.health.harvard.edu/blog/is-red-wine-good-actually-for-your-heart-2018021913285
4. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.117.030387
5. http://doi.org/10.1136/bmj.h4238  
6. https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/alcohol-use-and-cancer.html
7. https://www.aicr.org/news/alcohol-and-cancer-risk-the-latest-research/#:~:text=If%20you%20drink%20alcohol%2C%20keep,effect%20on%20coronary%20heart%20disease.
8. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf