Many of us enjoy a glass of wine in the evening. Or a cold beer on a hot summer day. Or a fancy cocktail on girls’ (or guys’) night out. We are all wondering, is a drink ok?

We know heavy drinking is unhealthy and unsafe. But the questions remain: does light to moderate alcohol consumption impact overall health? And is it safe? It has been said that 1-2 drinks per day could be beneficial, particularly to cardiovascular health. Others say it is a toxin and to avoid at all costs. I will discuss recent literature, present the possible risks and benefits, and decide where the consensus falls as of today.

Recent Literature:

In March 2023 JAMA published an article identifying an association between daily alcohol use and all-cause mortality. This systematic review and meta-analysis included more than 4.8 million participants. The conclusions were: 1) light drinking (<25 g of ethanol daily) did not decrease overall mortality 2) there was a non-statistically significant increase in mortality in those that had light to moderate alcohol consumption (25-44 g daily) 3) there was a statistically significant increase in mortality with heavy alcohol consumption (>/=45 g/day) 4) There was a statistically significant increase in mortality in female drinkers. Limitations include: likely inaccurate and underreported drink volumes and confounding factors not accounted for (certain past medical, family, and social histories).⁵

In April 2023 the Lancet Rheumatology published an article discussing potential benefits and risks of alcohol consumption. The article outlines the documented cardiovascular benefits, reduced diabetes risk, and overall mortality. However, it is important to note these benefits are only noticed in those >40 years of age based on a 2022 global disease burden analysis. There may also be benefit in rheumatic disease including: lower risk of developing rheumatoid arthritis, increased quality of life and lower disease scores. However, some medications for autoimmune disease should not be combined with alcohol.³

In June 2023 a press release discussed a new study out of Mass General Hospital which looked at: “Why Light to Moderate Drinking is Tied to Better Heart Health”. The first part of the study included >50,000 individuals within the Mass General biobank system and concluded that light/moderate alcohol consumption resulted in a “substantial” decrease in cardiovascular events. Part 2 of the study included 754 individuals who had previously undergone PET/CT imaging of the brain in effort to evaluate alcohol’s effect on stress-related neural activity. They concluded that there was reduced stress signaling in the amygdala in those who consumed light-moderate amounts of alcohol compared to those who abstained. Finally, this study concluded that the cardiovascular benefits of light to moderate alcohol consumption may be in part due to the reduced stress signaling in the nervous system. Again, this study also found that any amount of alcohol consumption increased the risk of cancer.²

Possible Risks vs Benefits of Light/Moderate Alcohol Consumption:

The Centers for Disease Control and Prevention (CDC) has taken the stance, for those who choose to drink you may limit the risk of harm by consuming no more than 1 drink per day (women) or 2 drinks per day (men). They go on to recommend if you do not drink, do not start and the less you drink the better for your overall health. They continue on to cite that the risk of cancer increases with very low alcohol consumption (<1 drink/day).¹

Conclusions

Back to our question, is a drink ok? There are serious risks associated with light alcohol consumption. As mentioned it is a class 1 carcinogen. Other class 1 carcinogens include: asbestos, tobacco, processed meats, UV radiation (from sunlight), many medications (including hormones), some viruses, and more. (see full list here https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/known-and-probable-human-carcinogens.html) It is important to note that just because a substance is identified as a carcinogen does not mean it always causes cancer and should be entirely avoided.

There are many probable and possible carcinogens in our day to day life we don’t think about. Or maybe we don’t know the risks yet. It is not possible to accurately quantify the risk of cancer with each drink. The number one cause of death world wide is heart disease and number two is cancer. Could the cardioprotective benefit outweigh the cancer risk? Or is this proof there is minimal cardiovascular benefit? A few benefits of light alcohol consumption are evident. But is there something else that has similar rewarding effects without the risks? Perhaps morning exercise or evening yoga.

I have presented recent literature, risks and benefits, and organizational consensus. Now, the decision is yours. In my opinion, there is not currently overwhelming evidence in either direction. If a drink is supplemental to your lifestyle and the benefits outweigh the risks for YOU, then go for it. But like much in life, moderation is key.

This is a hot topic. Studies and literature are going to continue to emerge. Thoughts, opinions, and even facts may change or develop.

Please reach out with comments, questions, and discussion points!

Lindsey, PharmD, BCPS

References

¹Centers for Disease Control and Prevention. (2022, April 19). Facts about moderate drinking. Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm

²Mass General Hospital Researchers Uncover Why Light-to-Moderate Drinking Is Tied to Better Heart Health. (2023, June 12). Massachusetts General Hospital. Retrieved May 2, 2024, from https://www.massgeneral.org/news/press-release/mass-general-hospital-researchers-uncover-why-light-to-moderate-drinking-is-tied-to-better-heart-health.

³The Lancet Rheumatology. (2023). Alcohol and health: All, none, or somewhere in-between? The Lancet Rheumatology, 5(4). https://doi.org/10.1016/s2665-9913(23)00073-5

⁴World Health Organization. (2023). No level of alcohol consumption is safe for our health. World Health Organization. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health

⁵Zhao, J., Stockwell, T., Naimi, T., Churchill, S., Clay, J., & Sherk, A. (2023). Association between daily alcohol intake and risk of all-cause mortality. JAMA Network Open, 6(3). https://doi.org/10.1001/jamanetworkopen.2023.6185