How Much Alcohol Is Too Much?

We’ve long been told that a little bit of alcohol is beneficial, perhaps because of the antioxidants in red wine or the B vitamins in beer. Not surprisingly, about half of Americans got the memo, believing that a drink or two a day is good for our health, or at least not harmful, according to a nationally representative Consumer Reports survey of 2,062 adults conducted in August 2023 (PDF).

But alcohol researchers and public health experts say those perceptions should change, says Tim Naimi, MD, director of the University of Victoria’s Canadian Institute for Substance Use Research in British Columbia, and an author of the recent JAMA Open Network study.

The latest thinking, he says, is that when it comes to alcohol, "less is more."

That’s because Naimi and other researchers have pinpointed problems with the way much of the previous research was conducted.

Specifically, many of the studies that suggested a possible health benefit from alcohol compared moderate drinkers with people who abstained completely. But researchers now say those findings were biased because most—about 80 percent—of the studies looked at in the JAMA Open Network analysis didn’t consider why abstainers didn’t drink alcohol or when they stopped drinking.

In fact, many people gave up alcohol precisely because they developed health problems; researchers call them "sick quitters."

In the JAMA Open Network analysis, once the researchers compared only lifetime nondrinkers with the moderate drinkers, it became clear that there was no health benefit to consuming any amount of alcohol.

Actually, the risk of dying prematurely was 21 percent greater for women who had just under two drinks a day, and 15 percent greater for men who had around three drinks a day.

Tim Stockwell, PhD—a professor in the department of psychology at the University of Victoria who was also involved in the JAMA Open Network study—says other research now suggests that "the risk of mortality increases the moment you start drinking."

Or to look at it another way: On average, people who have one drink a day lose about 5 minutes a day—or a total of about three months over a lifetime, Stockwell says.

Other research shows that even in moderate amounts, alcohol increases the risk of several chronic diseases, including heart disease, some cancers, and possibly dementia. For example, a 2023 analysis of studies in the journal Hypertension linked drinking any amount of alcohol to rising blood pressure levels over a five-year period, even in people who had normal blood pressure.

That added weight to an earlier analysis in the Lancet, which looked at data from 83 studies and found that people who drank more than five to six glasses of wine or pints of beer per week had an increased risk of stroke, heart disease, heart failure, and other forms of cardiovascular disease.

The growing concerns prompted the World Heart Federation to issue a report that stated that "the belief that alcohol is good for cardiovascular health is no longer acceptable."

As for cancer, research shows that the body breaks down alcohol into a chemical called acetaldehyde, which damages DNA, says Marissa Esser, PhD, head of the Alcohol Program in the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. That chemical also "prevents your body from repairing the damage, and the cells then can begin growing out of control and creating a cancerous tumor," she says.

It might not take much alcohol to increase the odds of developing cancer. Low amounts of alcohol—as little as one drink a day—have been linked to oral, pharyngeal, esophageal, and female breast cancers.

For example, research suggests that light to moderate drinking raises breast cancer risk by 5 to 10 percent. And according to a report from the World Health Organization, about 6 percent of all of breast cancer cases diagnosed in the U.S. in 2020 were linked to alcohol.

The research on dementia and alcohol consumption is less clear-cut but still concerning. The connection is very obvious among heavy drinkers. A 2018 French study found more than a 300 percent increased risk of dementia among men and women with alcohol use disorders. Other research has detected changes in the structures of the brain that are associated with dementia in heavy consumers of alcohol.

While the research among moderate drinkers is more uncertain—with some evidence showing no or only small increased risks, and possibly even some benefits—Stockwell at the University of Victoria says caution is still warranted. "Ethanol in the bloodstream, and its metabolite acetaldehyde, damage human tissue," he says, "and the brain is not protected from those effects."

Alcohol, even in moderate amounts, increases the risk of several chronic diseases, including heart disease, some cancers, and possibly even dementia.

When it comes to activities that people enjoy, like drinking alcohol, "people are prepared to take more risks," Stockwell says. And the University of Victoria’s Naimi adds that he doesn’t "just say everyone should get down to two drinks a week, because we know that’s not practical or possible."

It’s pretty clear from the evidence that "if you think you’re drinking for your health, you’re probably misguided," Stockwell says. But if you’re not interested in becoming a teetotaler, here are a few things to consider when deciding how much alcohol is okay for you.

Your Age
Our body’s ability to tolerate alcohol decreases as we age. That is partly because lean body tissue (such as muscles and organs) absorbs alcohol and fat does not—and the amount of fat rises with age, while the amount of lean tissue decreases.

As a result, it takes less alcohol to affect our coordination, thinking, and behavior as we get older, making accidents more common. For example, alcohol can alter an older person’s sense of balance, leading to falls and fractures—or worse: Drinking is a factor in 65 percent of fatal falls.

Your Gender
Women may want to be more conservative drinkers than men because they are more prone to the immediate and long-term harmful effects of alcohol. (See "How Drinking Affects Women," below.)

Your Family History, Medical Conditions, and Prescription Drugs
If alcohol abuse, heart disease, or cancer runs in your family, you may want to be extra cautious with how much you drink.

And if you already have high blood pressure, diabetes, or another chronic illness, drinking could make it more difficult to manage your condition and may interact with over-the-counter drugs you take or medications you’ve been prescribed.

Taking aspirin and drinking, for example, can increase the risk of stomach or intestinal bleeding, and high doses of acetaminophen (Tylenol) with alcohol can cause liver damage. Combining alcohol with cold or allergy medications that contain antihistamines can make you very sleepy, and medicines that have a high alcohol content, such as some laxatives and cough syrups, can add to alcohol’s effects. And using alcohol while you’re on certain sleeping pills, pain pills, or medicines for anxiety or depression can be dangerous.

So check with your pharmacist or physician to see whether a particular condition or drug makes alcohol off-limits.

How You Drink
Lots of people—about a third, according to CR’s recent survey—think there is no difference, healthwise, between having three drinks in one day and having one drink on three different days. But the more alcohol the body has to process at one time, the greater the effect on the liver, heart, and other organs.

"For any amount of alcohol, it’s better to spread it out," Naimi says. So if Sunday through Thursday are dry days for you, it’s not okay to have four drinks on Friday and six on Saturday. In fact, that describes binge drinking, a type of excessive drinking that’s not just for college kids anymore: It’s on the rise among older adults and women, statistics show.

Why You Drink
If you tend to drink out of habit, because others around you do or because a party or dinner doesn’t seem special without alcohol, ask yourself why you feel that way. Becoming more aware of the role alcohol plays in your life can help you make a more conscious decision about when to drink. And that way, when you do, you might find that you consume less but enjoy it more.

Women, on average, still drink less than men (though they are catching up). But they are more sensitive to alcohol’s harmful effects, even if they weigh the same. For example, women become dependent on alcohol more quickly than men do, research shows, and develop other health-related problems sooner as well.

More of the alcohol women drink gets into their bloodstream and tissue. That happens in part because women have less of an enzyme called alcohol dehydrogenase, which breaks down alcohol in the stomach. And women tend to have less water overall in their bodies than men do—both in their blood and in their tissue—so the alcohol doesn’t get as diluted. As a result, more of the alcohol they drink ends up reaching—and potentially damaging—their organs.

Blood alcohol levels rise faster in women and stay elevated longer too. Because more of the alcohol women consume ends up in their blood, they can get intoxicated faster, and stay tipsy longer than men.

Estrogen has an effect. Alcohol raises estrogen levels in women, and high amounts of that hormone have been linked to breast cancer and certain other malignancies as well.