Can alcohol be part of a healthy lifestyle?

Alcohol has been around for more than 10 000 years, with the earliest evidence in China and later in the Middle East. It’s a fixture of social gatherings and celebrations. And more than half of adults in the U.S. and Europe consume alcohol. For years we’ve been told alcohol is good for us. In moderation, drinking alcohol was part of a heart healthy diet. But with new guidelines saying that no amount of alcohol is safe, is that about to change? Can alcohol still be part of a healthy lifestyle.

The most recent guidelines to question the benefits of alcohol come from Health Canada. Written by the Canadian Centre on Substance Use and Addiction, these state consuming no alcohol is the safest amount, with 1-2 per week as low risk, 3-6 as moderate and more than that, high risk. And as one country updates they’re guidelines, others soon follow.

Alcohol and Heart Health

Historically, dietary guidelines promoted the health benefits of drinking in moderation. The 2010 Dietary Guidelines in the U.S. recommended a limit of one drink per day for women and two drinks for men. A drink being defined as a bottle of beer (341 mL), a glass of wine (142 mL) or a shot of liquor (40 mL). (This excludes pregnant women, people recovering from substance abuse and taking certain medications.)

These recommendations were based on studies showing that when it comes to heart health, some alcohol was better than none. The pattern is a so-called ‘J-shaped’ curve. Those people who drank alcohol (one drink/day) had lower risk for heart disease than those who didn’t. For example, a 12-year study found a modest increase in alcohol was associated with lower chances for heart disease Even the heart-healthy Mediterranean Diet, which has been shown to reduce heart disease, includes consumption of alcohol. However, more isn’t necessarily better as higher amounts also increased the risk.

These observational studies are supported by beneficial effects of alcohol on various risk factors. In particular, consumption of alcohol increases HDL cholesterol, and higher HDL is associated with lower chances for heart disease. There is also evidence alcohol reduces inflammatory and hemostatic factors. Thereby making the blood thinner and less likely to clot in case plaques in the artery rupture. Wine, and particularly red wine, has been singled out as being protective due the presence of antioxidants. In addition, women who drink wine may have greater heart rate variability (fluctuation in beat to beat frequency). A possible indication of lower risk for heart disease.

But is alcohol really good for you?

But those previous studies focused only on heart disease. More recent ones have looked at other diseases and overall death. In one, with over half a million adults, having more than seven drinks per week was associated with early death, even though this amount was associated with fewer heart attacks. And any amount of alcohol increased chances for stroke and other heart diseases such as atrial fibrillation. The Global Burden of Disease Study estimated alcohol is the seventh leading risk factor for early death worldwide, and the number one for people aged 15 to 49 years. They concluded “…the safest level of drinking is none.”

While these conflicting findings may be enough to give you whiplash, even at the time when alcohol was promoted for heart health, there was underlying caution. Alcohol is considered an addictive substance and heavy drinking is associated with liver damage, depression and early death. There were even a few early studies indicating alcohol could increase your chances for cancer, and breast cancer in particular. And, from a dietary standpoint, alcohol provides calories without any nutritional benefit, providing a challenge for people wanting to lose weight.

In recent years, guidelines have shifted away from any mention of heart health benefits and highlight the potential health hazards. In addition, the recommendations of up to one drink per day for women and two for men are emphasized as upper limits and not targets. It’s also noted this is not a daily average and to avoid binge drinking (having six drinks on one day and none on the following days). At the same time, guidelines have specifically avoided recommending complete abstinence.

Limitations of Alcohol Guidelines

The Health Canada guidelines resulted in clickbait headlines across the news, which may not be justified by the science. While these guidelines reviewed 6000 papers, only 16 were selected upon which to base their recommendations. And while one drink per day was associated with a 20% increased chance for certain cancers, the absolute risk is quite small. Meaning a 20% increase of a small number is still a small number.

It’s also important to consider the above guidelines are based on observational studies, which have limits to them. These include self-report of alcohol intake and possible confounding. Confounding is when the thing of interest, in this case alcohol, is linked with something else. This is especially complicated when it comes to nutrition. Specifically, people don’t consume alcohol in isolation.

Alcohol is usually consumed alongside other behaviours and foods, whether healthy or not. For example, people who drink in modest amounts may be generally more health conscious. In addition, non-drinkers may abstain due to pre-existing medical conditions. Some people consume alcohol while smoking, eating fast food or other behaviours known to increase chances for disease. All of which add to the confusion interpreting observational studies. That being said, we’re unlikely to see a randomized trial to settle the argument due to ethical concerns.

And as written in The Conversation, our lives are faced with daily decisions of weighing risks and benefits of doing and not doing something. So while there’s consensus heavy drinking, and binge drinking, are associated with poor health outcomes, it’s still not quite as clear at much lower amounts. And for now, most guidelines consider the odd raising of the glass to be okay.

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This post was originally published on February 27, 2021 and updated on February 1, 2023.

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