Nutrition Diva

New research on risks and benefits of drinking alcohol

Episode Summary

Let's clear up some common misconceptions about alcoholic beverages and review some new research on the risks and benefits of regular consumption.

Episode Notes

Is there any amount of alcohol that can be considered safe? It’s not a one-size-fits-all answer.

Episode Transcription

Hello and welcome to the Nutrition Diva podcast. I’m your host, Monica Reinagel, and this week I got an email from Donald, who wrote:

“Alcohol appears to provide some health benefits if consumed in moderation, in particular, red wine or beer. What about nonalcoholic beer and wine? Can you gain the benefits of these beverages without the hazards? Are there other important considerations?”

Donald’s email made me realize that it’s time to revisit the subject of alcohol and your health—both to clear up some common misperceptions, as well as to update you on some new research.

First, some common misperceptions.

Despite its reputation, red wine is not really any healthier than other alcoholic beverages. Much has been made of the resveratrol in red wine—this is a polyphenolic antioxidant that’s been shown to have some health benefits. But red wine is not the only way to get resveratrol. Unfermented grapes and grape juice, blueberries, bilberries, pistachios, peanuts, and peanut butter are also good sources. But, more to the point, the amount of resveratrol that’s been shown in studies to produce health benefits is far beyond what you could get from your diet (much less from drinking red wine).

Beer also contains polyphenols, by the way, along with a variety of other nutrients. According to researcher and beer enthusiast Charles Bamforth, a half liter of beer can provide up to 25% of the daily requirement for niacin and vitamin C, up to 50% of your B6, and an entire day's worth of folate and B12, along with various other vitamins and minerals.

Margo Denke, another researcher, points out that the hops and barley used to make beer also contribute a significant amount of antioxidants. And studies have found that you absorb about the same amount of polyphenols from wine or beer. In answer to Donald’s question, the antioxidants and other nutrients typically found in beer and wine could also be gotten from nonalcoholic wine and beer. There is even some interesting research on the benefits of nonalcoholic beer as a recovery drink after exercise. (Take that, Gatorade!)

However, the health benefits that have been attributed to moderate alcohol consumption are not coming from the antioxidants or nutrients. They are primarily coming from the alcohol itself.

In small amounts, ethanol appears to have anti-inflammatory effects and reduce the tendency of blood to form clots. Moderate drinkers, therefore, are less likely to die of heart disease or coronary events than those who drink more heavily—or, for that matter, than those who drink nothing at all. In epidemiology, this is known as a J-shaped curve—and it’s not uncommon. Small amounts of a substance may reduce your risk but, at a certain point, the curve starts heading the other way, and greater consumption leads to increased risk.

Because heart disease is the leading cause of death in the United States, reducing deaths from heart disease is pretty impactful in terms of reducing all-cause mortality (which is your chance of dying from anything at all). And the reduction in deaths from heart disease is mostly what drives the reduction in all-cause mortality seen with moderate alcohol consumption.

On the other hand, when looking at the link between alcohol consumption and breast cancer, we do not see a J-shaped curve. Drinking alcohol in any amount appears to increase the risk of breast cancer. But, because far fewer people die from breast cancer than from heart disease, this does not have as big an impact on all-cause mortality statistics.

Clearly, all-cause mortality figures are of limited value in assessing any individual’s risk. As always, the devil is in the details. Someone with a family history of breast cancer, for example, may assess the risk/benefit ratio of consuming alcohol differently than someone with a family history of heart disease.

Up until recently, the generally accepted wisdom—reflected in our nation’s Dietary Guidelines and other public health advice—was that moderate consumption of alcohol by healthy, non-pregnant adults was essentially harmless. Moderate consumption was defined as no more than 2 drinks per day for men and 1 for women. Drinking more than that is clearly associated with increased health risks.

In 2018, however, a new meta-analysis, conducted as part of the Global Burden of Disease Study, caused a pretty big splash when they concluded that there was actually no amount of alcohol that could be considered safe, much less beneficial. In other words, no more J-shaped curve.

And then, in 2022, an even newer meta-analysis as part of the same Global Burden of Disease Study seemed to reverse course again, saying that for certain groups, moderate drinking was equivalent to not drinking at all in terms of the effects on all-cause mortality.

What changed between 2018 and 2022? They did add a few more years of data to the dataset, but the biggest difference was in the methodology that they used. There is a lot of variation in how alcohol consumption affects mortality in various parts of the world. Age also makes a huge difference. Therefore, running a risk assessment on the entire global population is likely to produce results that apply to almost no one.

In this latest analysis, they looked at alcohol consumption and all-cause mortality by global region, age, and sex, resulting in a much more nuanced picture. In the show notes, I’ve included a link to the chart if you want to see what level of consumption equals zero increased risk (or “non-drinker equivalence”) for you. Just a note of caution: in this analysis, they define a standard drink as containing 10 grams of ethanol; here in the U.S., we count 14 grams of ethanol as a standard drink. So when looking at the chart, remember to adjust accordingly. 1.4 standard drinks in the Global Burden of Disease chart = 1 standard US drink.

Here are some of the most notable findings to come out of this new analysis. The younger you are, the more risky drinking appears to be. A 49-year-old male living in North America who has one drink a day has the same risk as a 49-year-old male who doesn’t drink at all. But for a 25-year-old North American male, any alcohol at all increases his risk of death.

Now, again, we’re talking about all-cause mortality. A 49-year-old male is more likely to die of heart disease than a 25-year-old male. So the beneficial effects of alcohol on heart health are going to be more detectable in that age cohort. A 25-year-old male, on the other hand, is much more likely to die in an automobile accident, and the detrimental effects of alcohol on driving are going to be much more visible in that age cohort.

Even with this increased level of detail, these data don’t tell us everything we need to know about an individual’s risk from alcohol consumption. But the Global Burden of Disease studies inform a lot of public health guidelines and policy, and more nuance is likely to lead to more appropriate guidance than a one-size-fits-none approach.

I’m not here to make a case for or against the consumption of alcohol. There are plenty of others who are happy to do that. My goal is simply to give you better information with which to make an informed decision about alcohol consumption, especially if one of the things you’re basing that decision on is the impact of drinking on your health risks.

Another part of making informed decisions is being aware of how much alcohol you are actually taking in. You may have learned that a 12-ounce beer counts as a standard drink. However, that assumes that your beer is 5% alcohol by volume. Craft beers can easily be northward of 7% ABV, in which case a 12-ounce can or bottle might actually be 1.5 standard drinks, and a 16-ounce draft might be more than two standard drinks. The ABV of wines, spirits, and cocktails can also vary widely.

Members of the Distilled Spirits Council of the United States, a trade organization that represents most major liquor brands, have voted to voluntarily start including serving facts on liquor packages, including things like single-serve cocktails-in-a-can. The labels will include information on how much alcohol a serving contains, as well as things like calories and carbohydrates. You should be seeing those labels in stores by June 2024. In the meantime, if you want to calculate how much alcohol your favorite cocktail, craft beer, or wine contains, or how many standard drinks it counts as, I built a little calculator for you. (You know I love a spreadsheet!)

Thanks to Donald for that question. If you have a question you'd like me to answer, you can email me at nutrition@quickanddirtytips.com You can also leave me a message at 443-961-6206.

I’d also like to invite you to check out my other podcast. It’s called the Change Academy, where Brock Armstrong and I explore the art and science of behavior change. You can find it on all the major podcast platforms, so whatever app you’re using right now to listen to me, just head to the search bar and type in “Change Academy.”

Nutrition Diva is a Quick and Dirty Tips podcast. It's audio-engineered by Nathan Semmes with script editing by Adam Cecil. Thanks also to Morgan Christianson, Holly Hutchings, Davina Tomlin, and Kamryn Lacy.

That's all for this episode. Thanks for listening! I'll see you next week.