As it pertains to the safety and health effects of alcohol, the pendulum has swung back and forth over the years, with prior observational studies potentially even suggesting a benefit to low-level consumption of red wine.
Is There a Safe Drinking Limit?
Unfortunately for those who do drink alcohol regularly, newer studies using more advanced statistical methods such as Mendelian randomization repeatedly suggest that there is unlikely to be any significant benefit from regular alcohol consumption, and any potential benefit would be strongly outweighed by the multiple, well-established, negative health effects. The current recommendation from the World Health Organization is that there is no safe level of alcohol consumption.1
What are the Health Effects of Drinking Alcohol?
Many of you will be well aware that alcohol is a major cause of liver disease and liver failure, but beyond that there are a whole host of additional health concerns. Alcohol is a recognized carcinogen, with strong links to cancers involving the liver, breast, and essentially the full extent of the digestive tract. Regular alcohol use is associated with cardiovascular disease and is a leading cause of pancreatic inflammation.2,3
Regular consumption also has strong links with earlier-onset cognitive impairment and dementia, has adverse implications from a mental health perspective, increases the likelihood of physical injury, and is a well-established cause of fetal developmental issues when consumed during pregnancy.2,4-5
From a metabolic perspective, alcohol is relatively calorically dense at 7 calories per gram, and its disinhibitory effects and effect on acutely lowering blood sugar can often trigger increased hunger and poorer dietary choices.6
Lastly, sleep is notably impacted by alcohol consumption: through its sedative effect, it may be easier to fall asleep, but sleep architecture is affected, with reduced rapid eye movement (REM) sleep and more awakening especially in the 2nd half of the night.7
My Recommendation
When I’m speaking with patients of mine regarding their alcohol use, I advise a harm reduction approach, whereby whenever possible alcohol consumption is limited to special social occasions, ideally not more than once per week, and no more than 1 or 2 drinks per sitting. At these levels, risk of harm is relatively low.
References
1. Anderson BO, Berdzuli N, Ilbawi A, Kestel D, Kluge HP, Krech R, Mikkelsen B, Neufeld M, Poznyak V, Rekve D, Slama S. Health and cancer risks associated with low levels of alcohol consumption. The Lancet Public Health. 2023 Jan 1;8(1):e6-7.
2. Gapstur SM, Bouvard V, Nethan ST, Freudenheim JL, Abnet CC, English DR, Rehm J, Balbo S, Buykx P, Crabb D, Conway DI. The IARC perspective on alcohol reduction or cessation and cancer risk. New England Journal of Medicine. 2023 Dec 28;389(26):2486-94.
3. Levesque C, Sanger N, Edalati H, Sohi I, Shield KD, Sherk A, Stockwell T, Butt PR, Paradis C. A systematic review of relative risks for the relationship between chronic alcohol use and the occurrence of disease. Alcohol: Clinical and Experimental Research. 2023 Jul;47(7):1238-55.
4. Prince M, Albanese E, Guerchet M, Prina M. World Alzheimer Report 2014. Dementia and Risk Reduction: An analysis of protective and modifiable risk factors(Doctoral dissertation, Alzheimer's Disease International).
5. Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, Ames D, Banerjee S, Burns A, Brayne C, Fox NC. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024 Aug 10;404(10452):572-628.
6. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Alcohol consumption and ethyl carbamate.
7. McCullar KS, Barker DH, McGeary JE, Saletin JM, Gredvig-Ardito C, Swift RM, Carskadon MA. Altered sleep architecture following consecutive nights of presleep alcohol. Sleep. 2024 Apr 1;47(4):zsae003.