How Much Alcohol is Healthy?

The short answer for how much alcohol is healthy is: not much. 1-2 doses per day for men, 1 for women. “Bingeing,” weekends-only, for example, is much more harmful than moderate regular use.

Many studies suggest that up to 4 drinks per day for men, and up to 2 for women, provide an overall health benefit. Augusto Di Castelnuovo, ScD; Simona Costanzo, ScD; Vincenzo Bagnardi, ScD; Maria Benedetta Donati, MD, PhD; Licia Iacoviello, MD, PhD; Giovanni de Gaetano, MD, PhD, “Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies,” JAMA Internal Medicine (Dec 2006), available here. However, the CDC reports lower numbers — up to 2 drinks for men and 1 for women. Why?

The CDC considers a man to have transitioned from moderate to excessive drinking when he consumes more than 4 drinks in a day or 14 drinks in a week (3 and 7 for women). That’s the same daily drinking conclusions from the collection of studies above. The difference is the weekly drinking standards.

In a Study published in Alcohol, Japan’s Hyogo College of Medicine researchers found that cholesterol, triglyceride and overall blood-borne fats tend to build up in heavy drinkers and — especially — occasional heavy drinkers. In other words, occasionally heavy drinkers have more blood-borne fat than regular heavy drinkers.

Triglyceride and cholesterol levels are regular parts of medical checkups as we age. Pay attention to those levels. If you see elevated levels, consider either changing your drinking habits or ceasing drinking. At some point, we have to weigh the (substantial, non-trivial) benefits of regular moderate alcohol use — longer life, less risk of heart disease, less chance of ischemic stroke and diabetes — against our actual blood test results. Objective, individual evidence wins against trends in health among large populations.

Incidentally, I should point out that road deaths significantly decline when a state adopts legal marijuana access (an average of 15% reduction in traffic fatalities). If alcohol might be a problem in your life, consider a switch to cannabis as your go-to stress relief. It comes with far less side-effects, including hangover, is a natural powerful anti-inflammatory, and offers a growing list of health benefits. When I see clients make the switch to cannabis from alcohol (or opiates), it has always inured to a net public good. Better for them, better for those around them, all-around better.

Is there another reason CDC might suggest the lower levels of alcohol use? It could be because the CDC is worried about people developing alcohol use disorder, which the CDC describes as, “a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work.” In plain English: if your drinking is causing problems.

The CDC might also understate healthy alcohol use out of our country’s particular strain of Puritanism. The same energy that fueled the Puritans fueled Prohibition and resulted in the passage of the 18th Amendment banning alcohol. That same energy fuels the Drug War, the War on Women. And it all comes back to: piety. Wanting to tell other adults what they can and cannot do with their own body. Denying people agency. Control. Or, as one colleague termed it, “Everybody on probation / Everybody in treatment” thinking. (Don’t get me started on kids — the CDC says that “binge drinking” is any underage drinking. So if your kid takes Communion, or has wine at Passover: binge drinking, according to the CDC.)

Finally, what is a dose? 12 oz. of 5% ABV beer. 5% ABV beer is: Deschutes Brewery Twilight Summer Ale, Rainier, etc. Lighter beers. If you order a pint — 16 oz. — of Ninkasi IPA, consider that about 2 doses. A dose is also 5 oz. of wine — i.e., not a restaurant pour. Or 1.5 oz. of distilled spirits. You cannot “bank” your doses — in other words, having 14 doses on the weekend, but abstaining during the week, isn’t healthy. In conclusion, be careful out there, be thoughtful and honest about alcohol use, but don’t think abstinence is the healthiest thing for everyone.