For decades, the idea of “moderate drinking,” such as a glass of wine with dinner or weekend cocktails, has been framed as part of a healthy lifestyle—a ritual that might even protect the heart. However, as research is showing, there’s genuinely no “safe” level of alcohol consumption.
“Despite our wish that would be the case, no study has ever demonstrated a protective or beneficial effect of alcohol,” says Patricia Molina, a physiology researcher at Louisiana State University, Health Sciences Center, whose research focuses on the impact that alcohol has on the body.
That doesn’t mean every sip carries equal risk—but it does raise a new question: What does “moderate drinking” actually mean, and how much is too much? While no amount of alcohol is entirely risk-free, there are levels of drinking that cause less harm—and cutting back, even slightly, can make a measurable difference.
“If you are looking to make any change to your behavior that are helpful to reducing your risk for various chronic health conditions, reducing your alcohol use can be a really easy, modifiable way to do that,” says Andrea Weber, a psychiatrist and addiction specialist at the University of Iowa. “Even going to a lower level than what you are consuming can have an overall positive benefit.”
What does alcohol do to the body?
The moment alcohol enters the bloodstream, the liver begins to break it down. In doing so, it produces acetaldehyde, a highly reactive compound and known carcinogen responsible for much of alcohol’s harm. “When we drink alcohol, every single cell in our body, every single organ in our body, is exposed to alcohol,” Molina says. “That explains why so many organs that normally we don’t even think of as being affected by alcohol, suffer consequences.”
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Alcohol consumption is linked to more than 200 health conditions, including heart disease, dementia, muscle loss, osteoporosis, and several cancers, including breast cancer. In addition to contributing to various health problems, “it can actually accelerate the aging process,” Molina says. “It’s almost like an added burden to our body, which makes many of our organ systems start showing an elderly phenotype at an earlier age.”
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For some people who have a mutation in a gene that processes acetaldehyde, their risk for developing alcohol-related health conditions is even higher, because their body takes a longer time to process the acetaldehyde. “If you have these genetic variants, when you drink alcohol, you get this flushing response to alcohol,” says Iona Millwood, an epidemiologist at the University of Oxford. “It’s really unpleasant. You go bright red. Your heart starts beating faster. You don’t feel well because you’re not metabolizing the alcohol properly, and this toxic metabolite of alcohol persists in your circulation.”
This mutation is most prevalent among people of East Asian descent and puts them at a much higher risk for developing alcohol-related health conditions, such as cancer, if they do choose to drink. “The threshold for cancer risk is much lower,” says Che-Hong Chen, a researcher at Stanford University Medical School, whose research focuses on studying these genetic variants.
What are the risks of moderate drinking?
Historically, most studies that look at the health effects of alcohol have done so by asking people about their drinking habits, and then following them over a period of years to decades, to see what kind of health outcomes they experience.
In these studies, researchers have observed what is called a J-curve. People who drank moderately appeared to live longer than both heavy drinkers and those who abstained entirely. It seemed to suggest that a small amount of alcohol might be good for you.
However, “it’s not necessarily a causal relationship, because alcohol is often correlated with many other health-related factors,” such as smoking, pre-existing health conditions, socioeconomic status, or dietary patterns, Millwood says.
These confounding factors can make alcohol look healthier than it is. For example, people with health problems will often quit drinking due to their health conditions, which can create what is known as a reverse causation effect, where the health problem is what led to cutting out alcohol, rather than the lack of alcohol causing the health problems.
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Moderate alcohol drinking, which used to be considered a healthy level of drinking, is often associated with other factors that contribute to a healthy lifestyle, such as a higher income, a more nutritious diet, and increased access to healthcare, which can help mask the damage that alcohol does to the body.
Moderate drinking can also be hard to research, as a person’s drinking patterns can change from day to day or year to year. “The moderate group is probably the most heterogeneous group across drinking groups, because they might be heavy drinkers the next year, or light drinkers the other years,” says Carolin Kilian, an epidemiologist at the University of Southern Denmark.
Once researchers have been able to account for these confounding factors, they’ve found a clear pattern of health risks associated with alcohol, with the likelihood of developing chronic health issues increasing as alcohol consumption increases.
Even light drinking can sharply raise your risk
When it comes to alcohol, the danger doesn’t rise gradually—it accelerates. Research shows that as drinking increases, so does the likelihood of developing health problems, from cancer to heart and liver disease.
And the turning point happens sooner than most people think. As two major government reports have shown, for all-cause mortality, which is death from any alcohol-related cause, this increase in risk happens at right around the one-drink-per-day mark, with the risk of dying from an alcohol-related cause going from 1 in 1,000 to 1 in 100.
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Canada’s Guidance on Alcohol and Health Report, which was issued in 2023, estimates this increase in risk to happen when going from two drinks a week to 3 to 6 drinks per week. The Alcohol Intake and Health Study, which was conducted by the U.S. Department of Health and Human Services using a similar methodology, estimates this increase in risk to happen when going from seven drinks a week to nine drinks a week.
“The risk increases very rapidly,” says David Streem, a psychiatrist who serves as the medical director of the Alcohol and Drug Recovery Center at the Cleveland Clinic.
Health benefits of reducing your alcohol intake
Because alcohol’s effects rise with every sip, even small reductions in how much you drink can have measurable benefits. Cutting back doesn’t just lower your risk for disease—it can help the body begin to repair itself.
To help with understanding how your alcohol consumption contributes to your overall health, Canada‘s Guidance on Alcohol and Health developed a tool that estimates your lifetime risk of dying from an alcohol-related cause and estimates the impact of each drink on your overall life expectancy.
“The average person drinking one drink per day, over the course of their life, each of those drinks is expected to shave about five minutes off their life expectancy,” says Tim Stockwell, a researcher and the director of the Canadian Institute for Substance Use Research at the University of Victoria.
This risk decreases if a person cuts back on drinking, with the Canadian guidelines estimating that two drinks per week will have almost negligible impact on a person’s overall health and life expectancy.
In terms of developing cancer, the risk accelerates with higher alcohol intake. However, this risk can be moderated. “A lot of alcohol related disease or cancer risk is reversible,” says Chen, noting that some studies are showing that once you stop drinking, your liver and brain can recover, while your cancer risk goes down.
For other chronic health conditions, such as heart disease, liver disease, or diabetes, cutting back can have a beneficial impact, especially if it is done earlier. “Cutting back before you develop the disease, that is what is really key,” says Mike Ren, a family physician at Baylor College of Medicine.
For people who have health conditions that are associated with alcohol consumption, such as heart disease or diabetes, reducing their alcohol intake can make managing their condition easier. “When you add alcohol on top of the existing conditions, you are making the situation worse,” Molina says.
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