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The last few years have brought a lot of discussion about the links between alcohol and health. A decades-old view that alcohol might be good for the heart has been challenged. In January of 2025, the U.S. Surgeon General recommended that all alcohol come with a warning label about the risks of cancer. Canada announced new guidelines that suggest the only truly safe approach is no alcohol consumption at all.
And yet, some medical bodies still argue that light drinking might have some benefits. The conflicting viewpoints can be confusing. The reason for this confusion is that the data is very poor. So here, what does the data really say, why is it hard to interpret, and what would I really take away from it?
What we know about alcohol and health
One thing we do know is that alcohol is a significant contributor to death. In an article from JAMA Network Open, researchers argued that one in eight deaths among people in the U.S. ages 20 to 64 could be attributed to excess alcohol use. These are largely some combination of liver disease, alcohol poisoning, and drunk-driving-related deaths.
It is evident, even beyond this paper, that heavy alcohol consumption is associated with negative health consequences that are clearly causally associated with alcohol. The most obvious link is with liver disease. The liver processes alcohol, and excessive alcohol consumption overloads it, leading to cirrhosis, fatty liver disease, and other complications.
(This discussion focuses on the physical consequences of heavy alcohol consumption; we also know that alcoholism causes emotional distress and is linked with a large number of other social problems.)
What we do not know about alcohol and health
Most other things. In particular, we do not (in my view) have good data on the relationship between alcohol and health at lower levels of drinking.
The reason for this gap is that alcohol consumption is associated with many other features of people, and nearly all of our analysis of the relationship between alcohol consumption and health is based on observational data. The people who drink alcohol are different from those who do not, and sussing out causality from that kind of data is just, simply hard. And I will note: in this case, it’s not even obvious what the direction of the bias is. Light drinking tends to be associated with some positive health behaviors and some negative ones.
There is an enormous amount of scholarship about this link, using data of this type. The most comprehensive study of it was published in The Lancet in 2018. This is a truly extraordinary work of scholarship, as the authors combine virtually every study of the link between alcohol and long-term health and try to draw conclusions. They make some really fantastic graphs; I’ve included two simplified versions below, one on alcohol and colon/rectal cancer and one on the relationship between alcohol and ischemic heart disease in women.
What you see in these graphs is that, for colon and rectal cancer, there is an upward-trending relationship at all levels of drinking, but it becomes much more significant above about four drinks per day. In the case of heart disease, you see the familiar (to people who study this) dip initially, where light drinking seems to promote heart health but heavier drinking makes it worse.
There is so much data in these graphs. But the thing is that it’s all from studies that individually have problems. One sometimes gets the sense that if you combine many studies, that somehow fixes these issues, but it doesn’t. Adding more studies increases the statistical precision of your estimates; it doesn’t fix the bias. If all the individual studies are biased, their average will be biased too. This point cannot be overstated.
If we take these graphs at face value (which I would not), then it appears that for most outcomes other than heart disease, the health risks generally trend up. But clearly, three drinks a day have far worse health consequences than one. This makes it hard to think about drawing a line anywhere in particular. “Less is better” is what comes out. But again, there are biases.
A related issue is that once we have a meta-analysis like this, it gets repackaged in the media in ways that make it difficult to understand how skeptical we should be about the conclusions. For example, in an NYT article from 2023, we have this quote: “The risk of developing alcoholic liver disease is greatest in heavy drinkers, but one report stated that five years of drinking just two alcoholic beverages a day can damage the liver.”
Reading that, it seems like the link would be directly to data, which ideally one could then evaluate. If you click through to the report, though, you don’t find one with data analysis but rather a continuing-education piece on the diagnosis and treatment of alcoholic liver disease. Midway through the report, the authors say that “daily consumption of 30 to 50 grams of alcohol over five years can cause alcoholic liver disease.” This has no citation, but I suspect it is drawing on the Lancet study or similar. This amount of drinking is about 2.5 to 4 drinks per day, so it is actually a bit higher than is stated in the article. But more importantly, without knowing where this conclusion came from, it’s really hard to know if it is reliable.
In all of this, there is a lot of “it could be” or “it might be.” But there is not much “it is.”
And this lack of clarity leads to disagreement, even among official bodies. The American Association for Cancer Research, for example, discusses alcohol as a contributor to rising rates of cancer in young people. But the American Heart Association has continued to suggest that alcohol consumption might lower the risk of heart disease. Which is it? Is it both? Neither?
The main problem here is that all of these studies are based on non-randomized data. If we really want good, causal answers, we need a randomized trial. A single well-designed, randomized trial of light drinking would be head and shoulders above the evidence we have. And not too long ago, someone designed one and started it! You can see information on The Moderate Alcohol and Cardiovascular Health Trial here.
The design of this trial seemed reasonable, but the funding was from alcohol manufacturers. This appeared problematic for a number of reasons, and the trial was shut down shortly after it started. I am skeptical about getting better data, as much as I think we should have it.
So, where does this leave us?
Despite the discussion of the heart-healthy value of red wine, my read of the evidence is that alcohol isn’t especially good for your health. However, I do not think this means that we shouldn’t drink! Cookies are also not necessary. Doritos aren’t needed for survival. There are people who say that the key to a long life is extreme calorie restriction. That might be true, but most of us wouldn’t choose it because, honestly, what would be the point?
As a society, in the U.S. in particular, we imbue alcohol with a sense of shame that is (often) different from the way we think about cookies or Doritos. My sense is that this is part of why people like the idea that red wine might help your heart — there is something that can feel a little off about saying, “I like to have a nightly glass of wine because it’s fun and it helps me relax.” People would rather say, “It’s for my heart.”
However, the statement “I enjoy this” can very much be enough to overcome the possible small negative health consequences, just like with cookies.
A difference, obviously, is that alcohol is addictive in a slightly different way from cookies. Many people struggle with drinking. Among the best pieces I’ve read on this is by Lucy McBride, who has a great Substack and wrote this piece about how she talks to patients about alcohol. She writes about asking two questions of yourself. One is how much you are drinking. But the second is, what is your relationship with drinking? The second recognizes that you could feel like your alcohol consumption is too much, even if it is not too much by some arbitrary CDC guideline (or you could feel fine even if it is slightly above).
The bottom line
- Most of our evidence on the health impacts of light drinking is very poor and difficult to learn from.
- Alcohol isn’t a health food, but neither are many other things, and enjoyment is a perfectly valid reason to drink some. But if you feel like it’s too much, then that’s a time to re-evaluate.
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Great article.
I imagine that a controlled trial for light drinking (say 1 glass per day of wine) would be subject to an important bias arising from the pool of participants willing to be randomized into one group or the other regardless of their present or past drinking habits. Such participants, in my mind, would not be very representative of the general population. Controlled trials are not the end-all.
I appreciate the perspective of being able to just say we enjoy it and that is reason enough. I do have one thought though, humans and our primate ancestors have been consuming alcohol for millennia and I get that it could be linked to some cancers but how can it be responsible for a rising cancer rates among young people? Whatever diseases it is linked to are already baseline. It is not as if alcohol or its consumption is new, so it can be linked to disease but those diseases would not increase, it would just be part of the cause for an already stable baseline of those diseases rising and falling with consumption level in a population. Also, how can rates be rising when the level of drinking is generally going down? Just thoughts I’ve had on the topic that no one seems to consider.
Your points and questions are being considered. Obesity and overweight in young adults has more than doubled (over 200% increase). In the last few decades. Obesity and overweight; there is high confidence these increase cancer risk. For 13 cancers, and being a risk factor in about 40% of all human cancers. Check the above out, online. Certain carcinogens can be synergistic, that is more than additive. Such as smoking and asbestos for lung cancer, if I remember right. So it’s possible that (excessive) alcohol and overweight/obesity may be combining to increase risks of certain cancers.
Alcoholic drinks, for some folks, are a major source of calories.
In the classes I teach, as students learn about risks of alcohol consumption, and excess calories. This arms them with info. Granting, in their words, more easily saying no (or fewer) drinks after work, with friends, family events, etc. Where their is pressure to drink more than they’re comfortable with.
Cancer risk from alcohol, however slight, is an external reason for people to say no. Similar to pregnancy. And in so doing, granting others an opportunity to drink less as well.