A glass of red wine a day keeps the doctor away, right? Not so fast. A large-scale European study recently published in the journal Lancet says the heart-healthy benefits from moderate drinking are slight, while the risk of stroke and other fatal heart conditions are significant. "These data support limits for alcohol consumption that are lower than those recommended in most current guidelines," the authors said.
Although drinking guidelines vary worldwide, the U.S. Dietary Guidelines - developed by the U.S. Department of Agriculture and the Health and Human Services Department - say that women should consume no more than one drink per day (about 100 grams per week) and men should consume no more than two (about 200 grams). The Lancet study, however, found that the threshold for health risks was 100 grams per week, regardless of gender.
The study calls into question two beliefs about alcohol widely shared among Americans: that drinking wine moderately might help keep their hearts healthy, and that, from a health standpoint, men can consume twice as much alcohol as women. So what should a moderate drinker make of it?
We consulted several experts in the field, who consider the study more as a good starting point for further discussion than the definitive word on how much alcohol people should consume.
William C. Kerr, a senior scientist at the Alcohol Research Group, a division of the Public Health Institute, said the study can prompt "a useful discussion" about individual behavior. But any discussion about how much a person drinks must consider a person's health and genetic makeup, he said.
"Guidelines are very difficult things," Kerr said. In addition to genetic variants among the population, there's the issue that some people might take them not as guidelines, but as permission or recommendations to drink a certain amount, even if they shouldn't drink at all. For those reasons, he says, "guidelines have to be conservative."
Steven Atlas, an associate professor of medicine at Harvard Medical School, agrees that studies such as this can help start general conversations about alcohol use, but aren't necessarily useful on an individual patient basis because of wide variations in family history, genetics and overall health. Instead, he tries to frame alcohol use in a broader sense, he said.
"I always ask, 'What are the most impactful changes you can make to improve your health?' " Atlas said. "And that's going to be very individual." For example, he said, because obesity is an even bigger killer than alcohol, overweight people may have an additional motivation to cut alcohol use (which can contribute to weight gain).
But, Atlas said, there are social aspects to drinking that are more difficult to evaluate and study. Although an estimated 15 million Americans have alcohol-use disorder, which the Diagnostic and Statistical Manual of Mental Disorders defines as alcohol abuse or dependence, "many people drink in a socially acceptable way and where a glass of wine is part of an enjoyable life," Atlas said.
Christopher Holstege, medical doctor and chief of the Division of Medical Toxicology at the University of Virginia, applauds the study in the Lancet for its broad scale, saying, "It gives us a lot to look at and discuss." Holstege said alcohol mortality is a complex topic, because it encompasses traumatic and chronic conditions, and involves lifestyle and genetic variations.
When deciding whether or how much to change your drinking habits in the wake of the Lancet study, it helps to be aware of statistics regarding deaths related to alcohol. You may be surprised, for example, to learn that alcohol deaths are still more common than deaths from opioid abuse, which seem to dominate news headlines over the past few years. About 88,000 Americans a year died from alcohol-related causes between 2006 and 2010, according to figures from the Centers for Disease Control and Prevention, while about 42,000 died from opioid overdoses in 2016. And alcohol-related deaths are increasing: From 1999 to 2015, mortality from alcohol-induced causes increased by 28 percent, according to the CDC.
Fatalities caused by alcohol-impaired drivers accounted for close to 10,000 deaths in 2014 (about 30 percent of all driving fatalities), according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol also plays a significant role in homicides and suicides. One NIAAA study found that four in 10 convicted killers said they were under the influence of alcohol when they committed homicide. And about 25 percent of suicides are alcohol-related, Kerr said.
When it comes to non-traumatic-alcohol-related deaths, liver disease is at the top. In 2015, of 78,529 liver deaths, almost 50 percent involved alcohol, according to NIAAA. "Cirrhosis peaked in the 1970s and then dropped in the 1990s. But it's picked back up again," Kerr said.
As for heart disease, the picture is a bit complicated, according to the Lancet study. The data show that moderate drinkers have a lower risk of nonfatal heart attacks, but are at a higher risk of death from other heart-related conditions such as heart failure, aortic aneurysm and stroke.
Alcohol is also a carcinogen and known to play a part in cancers of the liver, intestines, oral cavity and female breasts, Holstege said. (The carcinogenic agents in alcoholic drinks include ethanol and acetaldehyde, according to the International Agency for Research on Cancer.) The breast cancer link may come as a surprise to many women. But a meta-analysis of 53 studies, cited by the National Cancer Institute, showed that every 10 grams (slightly less than one drink) of alcohol consumed per day by a women increased her risk of breast cancer by 7 percent; a more recent study found a 12 percent increased risk.
So, overall, alcohol can be pretty bad for us. But what about wine, which many of us had the impression was good for us, in moderate amounts?
"There is some evidence that small to moderate amounts are beneficial for people with a family of heart disease," Atlas said. Some studies, which may have been overhyped in the media, have shown that a compound called resveratrol, found in red wine, helps prevent certain types of heart disease. (That said, those same benefits are seen in grape skin, peanuts and blueberries.)
Kerr thinks that if there is any room for interpretation, we selectively choose information that validates us. "I think people want to hear good news about the things they are already doing," he said.
But the bottom line, Holstege said, is that "no one should drink alcohol because of these perceived benefits."
In the end, Atlas said, we weigh risks against benefits all the time whether we're opting to ride a bike or live a sedentary life. Drinking is no different. There are risks and there are benefits, whether they are physical (which, according to the Lancet study, seem to weigh heavier on the risk side than previously thought), social or mental. So, he said, it's up to each of us to answer this question: How do you balance the risks?