Moderate or "Safe" Alcohol Consumption: True or Oxymoron?

Is it unsafe to drink any alcohol? A new study indicates any drinking may cause dementia, which scares a lot of people. This study jars the belief that light to moderate drinking could provide cognitive benefits. While being debated, the Centers for Disease Control and Prevention (CDC) recommends moderate drinking, or no more than one drink per day for women and two per day for men. A new report from the World Health Organization (WHO) attributes 2.6 million deaths per year to alcohol consumption—4.7% of all deaths.

Projected estimates of dementia from the new study indicate worldwide the number of people living with dementia could nearly triple, from 57 million in 2019 to about 153 million by 2050. If true, this information points to an urgent need for effective prevention strategies.

For decades, we have been told moderate consumption of alcohol has protective effects, reducing heart disease and increasing life span. More recently, some researchers have questioned the health benefits of alcohol and linked any drinking with increased risks for premature death, heart disease, stroke, and cancer. So, who’s right? Read on.

Advanced Genetic Techniques

In the latest study on dementia, the one concluding any alcohol consumption is a risk, researchers examined data from nearly 314,000 white British adults from the U.K. Biobank database who currently drank alcohol. The researchers sought a relationship between light-to-moderate alcohol consumption and future dementia risk. Participants provided information about their drinking habits, with researchers tracking dementia cases through hospital and death records over 13.2 years. The average alcohol consumption recorded was 13.6 units per week, with nearly half the participants exceeding the UK’s recommended limit of 14 units per week.

Men reported more than double women's consumption, averaging 20.2 units weekly to women’s 9.5 units. The researchers found low levels of drinking (11.9 units per week) were linked with the lowest dementia risk. However, this risk increased at higher consumption levels, especially among men.

Even though the new study questions any long-term benefits of moderate drinking and focused on drinking causing dementia, it also reported light drinking was associated with a slightly longer life expectancy. This finding aligns with prior research showing modest benefits for cardiovascular health in light drinkers. However, the study emphasizes that these benefits could be due to confounding factors rather than alcohol itself. For example, light drinkers often have a higher socioeconomic status than others, as well as better diets, and engage in healthier behaviors overall, which could explain their longer life expectancy. However, when biases like socioeconomic status, lifestyle factors, and reverse causality (people stopping drinking due to declining health) were controlled, the protective effect of alcohol was reduced but not eliminated. The authors concluded the evidence for any meaningful health benefit from drinking alcohol was weak, and consequently, avoiding alcohol altogether may be the safest choice in the long term.

Alternative Opinions

According to Harvard’s Professor of Medicine Dr. Eric Rimm, ScD, studies purporting to prove any alcohol consumption increases risks for dementia and other diseases are problematic. Said Rimm, “For longevity and all-cause chronic disease, those who drink 1-2 drinks a day relatively frequently do the best. More is likely not beneficial nor is abstinence.” Rimm noted people’s drinking doesn’t depend on possible future effects, and they “don’t wake up in the morning and think, ‘hmmm, what disease should I prevent today with my drinking or not drinking.’” Instead, says Rimm, many other actions should be where most individuals create a healthy lifestyle—diet, physical activity, not smoking, and resolving obesity issues. “After that, if you enjoy a few drinks several times a week, it will probably do you benefit!” says Rimm.

John England, M.D., Richard M. Paddison Professor, Chair, President, Association University Professors of Neurology and Editor-in-Chief for Journal of the Neurological Sciences is also dubious any level of drinking could cause dementia, and says, “The relationship between dementia and alcohol use is complicated because dementia has many causes unrelated to alcohol and difficult to include in a statistical analysis.” He also noted the dementia paper relied on the self-assessment of individuals, which may be inaccurate. In addition, the paper did not account for different drinking patterns and says, “Low level drinking over several days/weeks is different than ‘binge’ drinking.’” In addition, the study relied on electronic health records, which may be inaccurate. Last, the analysis was based on current drinkers and ignored past drinking.

The Conundrum

Establishing whether moderate drinking is good or bad for health is nearly impossible due to confounding lifestyle and other factors. Confounding occurs when an observed association is influenced by a third variable, making it hard to determine if the relationship between alcohol and health outcomes is genuinely causal.

For example, as mentioned earlier, moderate drinkers often have many other lifestyle characteristics compared to non-drinkers or heavy drinkers. They may exercise, have preventative health care, be married, enjoy their jobs, be less bored or stressed, have a higher socioeconomic status, have better access to healthcare, have healthier diets, or have more robust social networks—factors independently associated with better health outcomes. In contrast, some non-drinkers may avoid alcohol because of family members who have or had AUD or alcohol problems, or they may belong to a religious group or have existing health issues, which can skew comparisons.

Ultimately, due to these confounding influences, proving a direct causal link between moderate drinking and health benefits/harms is not possible. Correlation is not causation.

Summary

The effects of alcohol vary based on individual factors like genetics, metabolism, gender, age, and pre-existing conditions, adding further complexity. Longitudinal studies have tried to adjust for these factors, but perfectly isolating the effects of moderate drinking remains difficult, if not impossible. This is why findings about moderate alcohol consumption are often contradictory, with some studies suggesting benefits (like reduced cardiovascular risk) and others showing risks (such as cancer or liver disease). Alcohol is one part of the ongoing debate surrounding the 2025 Dietary Guidelines for Americans. Other contentious issues center around recommendations for red meat, sugary beverages, and environmental sustainability. These issues will not be resolved quickly or easily. Pharmacological agents that do not eliminate drinking alcohol but reduce harm may emerge as harm-reduction options.

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In the meantime, it’s probably best to limit drinking. Less is better. Current CDC guidelines of no more than one drink per day for women and two drinks for men are likely to disappoint those who think any drinking is terrible and those who think moderate drinking improves longevity.