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Alcohol presents a paradox. On one hand, it is linked to over three million deaths per year globally and fuels societal issues such as intimate-partner violence and traffic accidents. On the other hand, it’s not entirely a one-dimensional narrative of harm – potential benefits are intertwined with the undeniable perils. According to epidemiological studies, moderate daily consumption of alcohol – a common global practice – has been associated with a reduced risk of several serious diseases including type 2 diabetes, ischemic heart disease, coronary heart disease (CHD), and stroke, leading to decreased overall mortality rates. How do we resolve these findings with alcohol’s unambiguous toxicity? And how do we draw the line between healthy and unhealthy drinking patterns?
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A good summation of the complexities and confounding variables in the studies. However, perhaps I missed it but did not see anything here about ApoE4 heterozygotes or homozygotes. Neurologists increasingly seem to be saying to stay away from any alcohol consumption for those with one or two of these alleles. Are they erring on the side of “until we know more, don’t imbibe any amount”? Or is there good evidence for this view?
Very interesting and insightful article! The most rigorous recent observational epidemiology studies also now demonstrate that there is no safe amount of alcohol intake for all-cause and cause-specific mortality (https://pubmed.ncbi.nlm.nih.gov/30146330/). And using genetic evidence from Mendelian randomization studies in large biobanks in the UK (https://pubmed.ncbi.nlm.nih.gov/34379647/) and China (https://pubmed.ncbi.nlm.nih.gov/38000378/) further corroborates that there is no protective level of alcohol consumption for either all-cause and cause-specific mortality.
My partner and I have recently given up alcohol completely. This has lead to positive results for our pocketbooks, for our relationship, and for our stability of mood. As a lay person, I can’t say for certain what health improvements it has resulted in, except that it seems we have more energy and generally less sluggishness especially in the morning. We have been trying to become more educated on the topic and how exactly our bodies respond to alcohol for our own knowledge and for validation/support to continue with the “sober-curious” lifestyle that we have been experimenting with. So far so good. Thanks for the super insightful article.
This is helpful. I began to drink late in life, 15 years ago at 47, after reading a series of articles reporting on research supporting the supposed health benefits of moderate drinking, the conventional wisdom at the time. At <1 drink/day, mostly socially, I can't say that my somatic health has been affected in any noticeable way. What I can say with confidence is that my social life has improved. I've always hung out with drinkers, but there was something about sharing a drink with friends–none of whom are heavy drinkers–that increased intimacy and genuine engagement, and it has facilitated growing my friendship network. It would be interesting to see well conducted systematic studies of the relational implications of moderate drinking, controlling for cultural context and suchlike.
Excellent piece, thank you. I appreciate the thoughtful nature you and your staff continue to approach topics with inherent nuance. I’ve personally always been skeptical of alcohol research for a variety of reasons. Not the least of which is subject bias. My strong suspicion is that subjects who engage in moderate drinking also practice moderation in other aspects of their lives. In addition, moderate drinkers are likely receiving the social lubrication and human connection benefits of alcohol without approaching levels of alcohol toxicity. Thank you again for your much needed work! With respect, Ed
Thank you for this article. I have questioned how alcohol could be heart healthy. I consider two glasses of red wine daily for women hard on our organs. As more studies like this come out and podcasts such as The Drive make this information available and easier to understand, I have dramatically reduced my alcohol intake. I do enjoy a glass of red wine or a cocktail especially when cooking dinner but my focus on longevity overrides consumption. It’s dry January for me. I know I feel better and sleep better without alcohol. After January, I may return to an occasional glass of wine or cocktail. Most of my social outings involve coffee!
Dr. Attia has referenced back casting. Putting on my teaching hat, I’m using backward design and beginning with the end in mind for the next 30 years or more for my life. Wishing those well that have quit drinking and are sober curious. Cheers! Tina
Alcohol could be heart healthy because it is a fat solvent. I could certainly be persuaded that small amounts of alcohol could pull fat out of arterial walls (or keep fat dissolved in the bloodstream rather than depositing in the arterial wall). As a pathologist, it was common to note at autopsy that alcoholics (who would manifest lots of other problems) would tend to demonstrate much less arterial damage than the average person.
Brilliant read.
My takeaways:-
Glass of wine for dinner (earlier in the day) with friends or family..
Ethanol is a toxin.
Pick your poison if you think it has a prosocial effect..
But I can’t think of another poison I would select for its “positives”?
Thank you for looking at the question from so many angles with such rigor.
Very much appreciated
Appreciate this, and Dr. Attia’s other efforts to translate research pitfalls for non-academics.
I have been clean of alcohol and refined sugar for 38 years after two decades in alcohol, and four of sugar culture. Now, I much enjoy my 78 year self . Also appears to benefit family and associates by politely declining to endorse or participate in drug-centered socialization.
Eager to see a follow on article with recommendations for how moderate drinkers can minimize alc-related harm, both long term health issues as well as tactical tools (less hangovers etc). E.g., is “dry Jan” a good thing for moderate drinkers or would it only confuse the liver with such a start/stop pattern? What about drinking wine with a bowl of pasta vs a 12-oz ribeye? Does drinking alc and lots of water help or hurt? Would mixing different types of alc such as beer and tequila in one session result in a nastier hangover than consuming the same amount in just one form?
Great article. Im a Family Medicine MD, and I can add another point of view regarding alcohol and CV, it has come to my attention that heavy drinkers are prone to form bruises very easily, most likley affecting the liver and subsequently altering the coagulation cascade. But is this good or bad? We give antiplatelet/anticoagulants to non hemorragic strokes or in some cases to myocardial infarcts ( some patients may develop arrhythmia due to MI). So in Mexico some old folks take a shot of tequila after the last meal and most say it helps with digestion and dilutes (thins) out the blood. I can also add that I have been reading about the mass production of alcoholic beverages, for example some beer brands now use high fructose corn syrup to make their beers (bacteria need sugar to ferment to alcohol) so this is a cheap way to make it and the new flavored seltzers many use a moonshine type of alcohol. So I stay away from alcohol as much as I can and I change it up to a “salty dog” ( topo chico, salt and lime) when ever I do drink.
The long term cognitive effects of moderate alcohol consumption as published in the BMJ are important: Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study Topiwala Anya, Allan Charlotte L, Valkanova Vyara, Zsoldos Enikő, Filippini Nicola, Sexton Claire et al. Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study BMJ 2017; 357 :j2353
Wonderful discussion.I appreciate you presenting the science on both sides. My personal experience started several years ago when I went from what you categorize as moderate drinking to light drinking. Probably several months of light drinking I felt I was mor hypersensitive towards alcohol. Even one drink, early evening, Would cause a light “fog” the next morning. I truly believe that zero consumption will provide the best ,overall, health benefits. I try to get my Resveratrol from other sources.