The Moderate Drinking Debate: Weighing the Risks and Benefits

Defining Moderate Drinking: Standards and Guidelines

Many people drink alcoholic beverages, but are the guidelines clear on what is an appropriate amount or moderate consumption of alcohol? Various health agencies worldwide have defined moderate drinking, but the definitions and limits differ, leaving conflicting information for people to digest.

The Dietary Guidelines For Americans 2020-2025 defines drink equivalents as such: 

• One alcoholic beverage = 14 grams of pure alcohol or 12 fl. oz beer (5% alcohol), 5 fl. oz wine (12% alcohol) or 1.5 fl. oz distilled spirits (40% alcohol). 
• They recommend that men limit their intake to 2 alcoholic beverages daily while women limit to 1 drink a day or less. 

Do keep in mind that most alcoholic beverages are not the exact percentage of alcohol listed (5% alcohol by volume beer compared to 8.5%). Therefore, one may overdo the recommended “moderate” consumption intake limit. Other organizations, such as the CDC, Mayo Clinic, and The National Institute on Alcohol Abuse and Alcoholism (NIAAA), all outline the same recommendations. Organizations outside of the U.S. have different definitions of what moderate alcohol consumption looks like, and they also have looser restrictions on the legal drinking age.

The Historical Perspective: The Evolution of Alcohol Consumption Advice

Alcohol has been a part of America’s history since the beginning. Settlers brought alcohol with them from Europe, which was their main beverage source due to poor water sanitation. Most people drank some form of alcohol all day long for hydration, and alcohol was also the center of events/celebrations/meetings, etc, during this time period. However, after the American Revolution, the influence of alcohol began to shift, and health advocates/religious leaders began to see its detrimental effects, which eventually led to the prohibition movement in the 1920s. During this time, there was a lot of turmoil surrounding alcohol intake, manufacturing, and distribution. 

However, even after prohibition ended, health advocates began to encourage moderation of alcohol consumption, and people became more aware of alcoholism and ways to combat and manage this disease. Outside of alcoholism/health reasons, many different organizations and institutions recommend limiting alcohol intake due to its detrimental effects of drunk driving, domestic violence, abuse, etc, as research has shown the correlations between alcohol and these incidents.

Potential Health Benefits of Moderate Drinking: Fact or Myth?

Heart Health and Alcohol: A Complex Relationship

I’m sure you’ve heard that a glass of red wine is heart-healthy. This isn’t entirely true. While grapes contain phytonutrients like polyphenols and antioxidants that benefit heart health, fermenting them into an alcoholic beverage may counteract some small benefits. Alcohol is oxidative and, therefore, can lead to the destruction of cells within the body and affect heart health in a negative sense. 

Current research has identified that even moderate alcohol consumption (as outlined by current American guidelines) can significantly increase one's risk for cardiovascular diseases like hypertension and coronary artery disease. The bottom line is that if you want heart-healthy nutrients like polyphenols, stick to a diet rich in fruits and vegetables.

Other Claimed Benefits: Social Connection and Stress Reduction

As previously mentioned, alcohol has been a part of America’s history since its founding. It is often the center of celebrations, holidays, and evenings out. Still furthermore, some people rely on alcohol for stress management, which can teeter on the line of addiction and alcoholism. Current research has identified that individuals who have anxiety and depression are more likely to rely on alcohol as a means of stress reduction, making them more susceptible to addiction/alcoholism; there is also evidence to suggest that there is an increase in anxiety/depression secondary to alcohol intake making this a vicious cycle.

It is important to find healthful ways to moderate stress and anxiety. Below are some great ideas to try! Furthermore, if you want to decrease your alcohol intake, take some simple steps to be more mindful. Opt for a mocktail when out with friends or co-workers, stick to drinking non-alcoholic beverages with meals, and encourage social connection in settings where alcohol is not offered (e.g., meet up with a friend to go on a walk, go shopping, etc.).

Options for stress management:

• Walking, exercising
• Grounding, prayer, and meditation
• Talking with a trusted friend, family member, pastor, or therapist
• Getting involved with a church/support group
• Participate in fun hobbies!

The Risks of Alcohol Consumption: Even in Moderation

Increased Cancer Risk: The Link Between Alcohol and Cancer

Alcohol is classified as a group 1 carcinogen or known carcinogen per the IARC. It is linked to increased incidence of the following types of cancer: head and neck cancers, esophageal cancer, stomach cancer, liver cancer, colorectal cancer, and breast cancer. Even in moderation, the increase of risk is highly significant with the development of cancer; therefore, abstaining from alcohol is a critical way to reduce your cancer risk.

Alcohol acts as a carcinogen through several mechanisms. First, ethanol, which is found in alcoholic beverages, is metabolized to form acetaldehyde, which is also a carcinogen. Ethanol is a solvent that can allow for easier absorption of other dietary carcinogens into cells (nitrates/nitrites). Alcohol metabolism is oxidative, leading to cell damage, and can increase circulating levels of estrogen.

As someone who works in oncology, I highly recommend avoiding alcohol, as it is a known carcinogen. Opt for antioxidant-rich beverages like 100% fruit juices, teas rich in phytochemicals, and water to hydrate!

Liver Damage and Other Health Risks: The Cumulative Effects of Alcohol

Besides cancer, intake of moderate alcohol can lead to other health issues such as chronic GERD, GI ulcers, liver cirrhosis, depression, anxiety, and other psychological disorders. It also contributes to excessive calorie intake, leading to obesity and type 2 diabetes.

Navigating Personal Decisions: Factors to Consider

Individual Health and Genetics: Personal Risk Factors

In addition to all the information provided above, it is also crucial to determine if alcohol is appropriate for you based on other factors like genetic predisposition to cancer development and predisposition to alcoholism. If you have anyone in your family diagnosed with cancer or known to struggle with alcoholism, it might be best for you to abstain from alcohol intake as well. Talk with a doctor to learn more about your risk for disease development and alcohol intake.

Pregnancy and Alcohol: A Clear Warning

If you’re pregnant or trying to conceive, avoiding alcohol is highly encouraged. Not only does alcohol harm you, but it can also harm a growing baby when development is occurring at a rapid pace. Alcohol crosses the blood-brain barrier and can negatively impact your baby, leading to cognitive and physical deficits.

The Bottom Line: Informed Choices and Responsible Consumption

Seeking Professional Advice: Consulting a Healthcare Provider and striking a healthy balance.

Make sure to have an honest conversation with your doctor about your health and alcohol consumption. Information is the critical component in making informed health decisions for yourself. Ask questions, seek help, and strive for a balance that meets your lifestyle and goals. If you do choose to consume alcohol, be responsible. If you find that you struggle with managing alcohol consumption, ask for help.

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