Conflicting research over the years on alcohol and its supposed benefits – and non-benefits – has resulted in fluctuating messages to millions of drinkers worldwide, but the inescapable conclusions are that yes, it’s bad for you.
For many years, people felt it was okay to have a glass of wine or a beer with dinner. In the early 1990s, some researchers promoted the idea that moderate drinking – for women, a drink a night; for men, two – was linked to greater longevity.
The cause of that association was not clear, but red wine, researchers theorised, might have anti-inflammatory properties that extended life and protected cardiovascular health.
The New York Times reports that major health organisations and some doctors always warned that alcohol consumption was linked to higher cancer risk, but the dominant message moderate drinkers heard was one of not just reassurance but encouragement.
More recently, though, research has debunked the idea that moderate drinking is good for you. Last year, a major meta-analysis that re-examined 107 studies over 40 years concluded that no amount of alcohol improves health; and in 2022, another study found that even a small amount posed some heart health risk.
That same year, Nature published research stating that just one or two drinks a day (even less for women) was associated with shrinkage in the brain – normally associated with ageing.
Drinking increased during the pandemic, which may be why news of any kind about alcohol seems to have found a receptive audience in recent years.
Some governments are responding to the new research by overhauling their messaging. Last year, Ireland became the first country to pass legislation requiring a cancer warning on all alcohol products sold there, similar to those found on cigarettes.
And in Canada, a government-funded organisation recently proposed revised alcohol guidelines, announcing: “We now know that even a small amount of alcohol can be damaging to health.”
The proposed guidelines characterise one to two drinks a week as carrying “low risk” and three to six drinks as “moderate risk.” (Current guidelines suggest women have no more than two standard drinks most days, and that men place that limit at three.)
No amount of alcohol is good for you, that much is clear. But just how bad is it? The information we receive on health risks often glides over the specifics of how much actual risk a person faces, as if those were not details worth knowing.
Over the years, we’ve been told so many things are either very good or very bad for us: drinking coffee, running barefoot, restricting calories, eating all protein, eating all carbs.
Should we worry? Clearly, to some degree, yes. But how much, exactly?
Defining ‘low risk’
Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research, is one of the people most responsible for our cultural course correction on alcohol, a credit that’s all the more notable since he used to be convinced of its health benefits.
He believed so strongly in the soundness of moderate drinking that he wrote in 2000 that sceptics on that subject might reasonably be lumped into the same category as “doubters of manned lunar missions and members of the Flat Earth Society”.
Shortly afterwards, he received a call from Kaye Middleton Fillmore, a sociologist at the University of California-San Francisco, who said she had her doubts about the research that Stockwell considered so sound.
Fillmore was concerned about possible misleading variables in the studies: they included ex-drinkers in the category of “abstainers”, which meant they were failing to account for the possibility that some people had stopped drinking specifically because of illness.
The moderate drinkers looked healthy by comparison, creating the illusion that a moderate amount of alcohol was beneficial.
Fillmore was looking for funding to prove her point, and Stockwell was intrigued enough that he not only found her a source of funding but joined ranks with her.
The results of this collaboration, published in 2006, confirmed Fillmore’s suspicions. Stockwell, increasingly convinced that an entire field of research suffered from the same fundamental error, continued with the line of research, work that led to the 2023 meta-analysis, which triggered many of the headlines and reappraisals we’re seeing now.
Stockwell and his colleagues detected a statistically significant increase in risk for all-cause mortality – the risk of dying from any cause, be it medical or accidental – for women who drank just under two drinks a day and for men who consumed more than three a day.
Based on the research that formed the basis of Canada’s new guidelines, which he helped write, Stockwell cited this example. If a 53-year-old woman had around six drinks a week, the lifetime risk of dying from an alcohol-related cause was increased by a factor of 10, compared with those who drank about only one or two drinks a week.
Or in context, if she consumed six drinks a week, the risk of dying of some alcohol-related cause was still, by any measure, small on average – only about 1%. And the risk of all-cause mortality was pretty low – Stockwell said that at 53, it was – then any incremental added risk was also going to be very low.
Stockwell suggested another way of thinking about it: how much time does a certain amount of drinking shave off your life?
For those who have two drinks a week, that choice amounts to less than one week of lost life on average, he said. Seven drinks a week, however, boosts it to about two and a half months.
Those who push five drinks daily or more face the risk of losing, on average, upward of two years.
Stockwell said all of those numbers were averages, that it was impossible to predict the level of impact on an individual person.
It can be hard to address the assumptions of the past without over-correcting. For example, a recent article warned: “More than one alcoholic drink a day raises heart disease risk for women”.
The cardiologist behind the study, Jamal Rana, from the Permanente Medical Group, said that even young and middle-aged women who drank eight or more drinks a week and who binge drink “are at risk for coronary heart disease”.
This was based on his research, but his phrasing lacked context; it seems loaded with the intent of shaping behaviour rather than fully informing people about how to understand that risk.
Rana acknowledged that the increased risk is, in fact, “small and incremental” – emphasising that he considered his work important in that it further contradicted the notion that drinking was good for the heart.
Individual risks vs collective harms
The cultural grip of alcohol is powerful, its symbolism as a source of pleasure deeply entrenched.
Its outsize role in our culture is only one reason it is challenging to fit drinking into the usual kinds of risk-benefit analyses that apply to so many routine choices. Most of those choices, like driving, or taking certain medications, have some practical offset that make the downsides justifiable; few of them are addictive.
Alcohol is somewhat unusual in that its upside, most broadly conceived, is pleasure.
Its risk profile also has an added layer: the direct risk posed to others. A woman who has two strong cocktails with friends or a man who has three beers on a night out may be more likely than someone sober to do harm to those around them – more likely to make an ill-advised left turn as another car is speeding their way; or to fail to notice, once home, that the baby has something in her mouth; or to have unsafe sex.
That’s why thinking about alcohol in terms of your own individual risk is a limited exercise, says Jim McCambridge, chair in addictive behaviours and public health at the University of York in England.
He encourages people to think instead about the number of lives lost globally to alcohol, which research puts at about 3m a year (about four times more than the number of women who die of breast cancer annually).
Individual risk associated with moderate consumption may be small, but the damage of alcohol is vast because the number of people who consume it is so high. Even as drinking has declined among young people in the US and Britain, among those middle-aged and older, and among women, consumption is up.
One function that drinking plays in so many people’s lives is that it’s a way to turn off the part of our brains that unhappily obsesses over rational calculations, allowing us to feel we’re living in the moment, even as we’re blaming ourselves for not finding another, healthier way to do so.
Nature article – Associations between alcohol consumption and gray and white matter volumes in the UK Biobank (Open access)
PubMed article – Moderate alcohol use and reduced mortality risk: systematic error in prospective studies and new hypotheses (Open access)
See more from MedicalBrief archives:
Mixed reaction to Canada’s new two drinks a week only guideline
Moderate alcohol use can be good for the heart if rich, fatal if poor
No amount of alcohol is good for the heart – World Heart Federation
Moderate alcohol use associated with lower CVD risk and all-cause mortality – ASPREE
No alcohol is good for your health – Canadian analysis