Decades of conflicting reports seem to have finally settled into a clear, noise-killing picture, as yet another study confirms it: No amount of alcohol consumption will protect against disease or extend your life, according to in-depth review published at the end of March.
The meta-analysis, published in Journal of the American Medical Associationis based on more than a hundred studies involving nearly 5 million people.
The researchers found that just 25 grams a day for women and 45 for men — roughly two and three drinks, respectively — carried a significant health risk.
Tim Stockwell, lead author and professor of psychology at the University of Victoria, admits this is not welcome news for many casual drinkers.
“It’s our favorite recreational drug,” he says, adding some sobering advice. “Don’t be fooled into thinking it will improve your health. The evidence for this is increasingly shaky as research accumulates.”
Read more: How much alcohol is too much?
The French paradox
The belief that alcohol in moderation is good for you originated in the 1980s with the so-called French paradox — despite an apparently high-fat diet, men in France were unexpectedly free of cardiovascular disease.
Early research attributed the phenomenon to their fondness for wine, and although further investigation disproved it, the idea persists.
Many subsequent studies have shown a link between moderate alcohol consumption and general well-being, but as they say, correlation does not imply causation.
Stockwell and his colleagues concluded that most previous assessments were riddled with biases, skewing the results to give alcohol more credit than it deserved.
A new interpretation of the health effects of alcohol
In these studies, the relationship between alcohol and all-cause mortality—death from everything from disease to injury—typically appears as a J-shaped distribution curve.
The tail represents abstainers at relatively high risk; immersion represents moderate drinkers, with the lowest risk; and from there the slope rises steadily as the risk increases with each cup. But that version of the story is misleading, says Stockwell.
First, the comparison to abstainers is unfair.
This category often includes former drinkers who gave it up due to illness. Others who give up alcohol may not be able to afford it, and lower socioeconomic status comes with a host of health challenges.
On the other hand, anyone who limits themselves to one or two drinks on a regular basis probably has a long list of benefits. They are likely to be wealthier, better educated and more physically active, for example.
In other words, “it’s not the moderate drinking that’s healthy, it’s the moderate drinker,” says Aaron White, senior science advisor to the director of the National Institute on Alcohol Abuse and Alcoholism, who was not involved in the study.
Correction of deficiencies
When the authors of the new analysis adjusted for these factors, removing the bias as best they could, the decline in J (that is, the risk of death for moderate drinkers) appeared much closer to the height of the tail.
The protective effect of alcohol has almost disappeared.
However, they were not able to fully correct the shortcomings of previous studies, so even the updated results should be taken with a grain of salt.
“My feeling,” says Stockwell, “is that when we do better research, we’ll find that we’ve underestimated the risk of alcohol at every level.”
Read more: A major study links excessive alcohol consumption to aging
Effects of alcohol on the body
The moment you ingest any amount of ethanol, he believes, you increase your chances of cancer, liver disease and a myriad of other health problems.
This is not to say that occasional drinking is a death sentence – small portions, small danger may be a good rule of thumb.
According to White, this simply means that you should view alcohol as cake or something else that is enjoyable but has potentially harmful side effects.
“If you like it and are willing to take the risk,” he says, there’s no need to fully commit.
Read more: Here’s how alcohol affects the brain
More conclusive research
The JAMA study is not the first to question the role of alcohol in health.
Last year, a team of researchers from MIT and Harvard analyzed genetic and medical data on nearly 400,000 people and found that even small amounts of alcohol are associated with heart disease, although the risk increases exponentially at higher levels.
One problem with most previous research, in addition to methodological biases, is that they are based on observational studies that cannot prove cause and effect.
Genetic evidence adds much-needed diversity to the literature in the field, Stockwell says.
Designing the perfect experience
The gold standard will be a randomized controlled trial in which participants voluntarily maintain consistent drinking habits – some will abstain, some will have one drink a day, others two or three.
By following them throughout their lives, researchers would gather much more accurate information. Such a project would be almost prohibitively expensive.
The National Institutes of Health began a similar effort in 2013, then shut it down in 2018 amid concerns that NIH officials had compromised their impartiality while seeking $100 million in funding from the world’s largest brewer Anheuser-Busch InBev and Heineken .
Historically, many studies have been conducted proving the health benefits of moderate drinking funded by the alcohol industryleading some experts to question their results based not only on the methodology but also on a conflict of interest.
A sobering consensus
Despite the difficulties in conducting ideal research at the right scale, the scientific consensus appears to have firmly established itself.
Even red wine, which contains the antioxidant resveratrol and was long thought to prevent coronary artery disease, has lost advocates.
in short policy published last year, the World Heart Federation stated unequivocally that “contrary to popular belief, alcohol is not good for the heart.”
Dietary authorities have also become more cautious in their messaging over the past decade.
The latest US guidelines recommends no more than two drinks a day for men and one for women, adding that “even drinking within the recommended limits can increase the overall risk of death.”
It should be noted, however, that the guidelines do not advocate sobriety per se. They state that no one should drink specifically to improve their health.
The reaction of the alcohol industry
Even industry figures who have historically presented moderate drinking as part of a well-balanced life are now echoing that point.
Amanda Berger, vice president of science and health at the Distilled Spirits Council, criticized some aspects of the new research, but acknowledged that “no one needs to drink alcohol to get potential health benefits,” according to New York Times.
There’s still something to be said for alcohol, according to White, when you consider the pleasure it brings some people.
But when it comes to its direct effect on our health, “the conversation is really changing,” he says. “Alcohol is not good medicine, and I think that’s ultimately what we’re seeing here.”
Read more: What’s worse: binge drinking or drinking a little every day?