Alcohol and Health Risks
Is there a safe level?
One of the toughest conversations I have as a physician is discussing the relationship between alcohol consumption and health. People often ask, "Is there a safe amount of alcohol?" or "What does the research really show?" Let's unpack the current scientific consensus clearly and honestly.
Alcohol and Cancer Risk: The Evidence
Alcohol has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), meaning it is known to cause cancer in humans. Alcohol consumption is associated with an increased risk of several cancers, including:
Breast cancer
Colorectal cancer
Esophageal cancer
Liver cancer
Oral and throat cancers
Limitations in Alcohol Research
While the evidence is strong, it isn't perfect. A widely-cited study in the Surgeon General’s advisory analyzed over 485,000 cancer cases from more than 500 studies. However, some of this data was collected retrospectively, as opposed to an ongoing prospective study.
When discussing alcohol intake with patients, the rule is most people will under report their drinking. Unless they do not consume alcohol. Meaning, if you don’t drink alcohol, it is easy to recall.
In the Mediterranean Diet, allowable alcohol is about 14 grams per day for a woman and 28 grams per day for a man. That is about a five ounce pour of wine - 12% alcohol per volume. It is rare for someone to have only a five ounce pour - try and measure your wineglass.
The context also matters. Clearly drinking alcohol while smoking increases all cancer risks above smoking alone. But how well is a person eating? Are they eating a standard American diet, rich in saturated fat and sugar, or are they eating a Mediterranean style diet?
But even if you ate perfectly, there does not appear to be a zero risk or a level that is immune from increasing risk of cancer.
What Level of Alcohol Has Been Studied?
Researchers have examined alcohol consumption at varying levels—from as low as one drink per day to several drinks daily. Here's what we know:
Even moderate drinking (approximately one drink per day) is linked with increased cancer risk, particularly breast cancer. For women, the risk increases notably even at this seemingly low level of consumption.
Higher consumption (two to three or more drinks per day) significantly elevates cancer risks, particularly for colorectal, liver, esophageal, and oral cancers. Notably, some cancers, such as colorectal cancer, showed increased risks primarily at moderate to heavy drinking levels.
Alcohol and Cognitive Decline
Beyond cancer, alcohol intake has been associated with other serious health risks, notably dementia and cognitive decline. Chronic heavy drinking is a well-established risk factor for alcohol-related dementia and long-term cognitive impairment. Even moderate consumption has been linked in some studies to subtle cognitive declines, particularly affecting memory, executive functioning, and processing speed. Reducing alcohol intake can significantly lower these risks, preserving cognitive health and brain function over time.
Is There a "Safe" Level?
No study has conclusively demonstrated a "safe" level of alcohol consumption when it comes to cancer risk. Some organizations, such as the American Cancer Society, recommend minimizing alcohol consumption or abstaining entirely to reduce cancer risk.
Balancing Risk and Life Choices
While the evidence linking alcohol to cancer and cognitive decline is clear, I understand that decisions about alcohol consumption are personal. If you choose to drink, the key is moderation—ideally fewer than seven drinks per week for women and fewer than fourteen for men, according to current guidelines.
Most importantly, awareness matters. Understanding the risks can help you make informed choices about your health.
Alcohol and Heart Disease
We once believed moderate wine consumption could benefit heart health. However, recent research reveals that evidence supporting these claims is weak and inconsistent. In fact, alcohol consumption increases the risk of atrial fibrillation, a common heart rhythm disorder, and can be directly toxic to heart muscle cells (cardiotoxic). Rather than offering protection, alcohol may contribute to cardiovascular problems, particularly at higher consumption levels.
Final Thoughts
Science continues to show that alcohol consumption—even at moderate levels—increases cancer risk, risk of heart disease and may negatively impact cognitive health. The best health advice, supported by current evidence, is to minimize or avoid alcohol to lower your overall cancer and dementia risk. Your body, brain, and long-term health will thank you.