For some Americans, drinking may mean sharing a bottle—or two—of Sauvignon Blanc over dinner most nights. For others, it is a glass of wine in the late afternoon followed by a gin and tonic while preparing the evening meal.
It could also be several beers with friends during the week, followed by much heavier drinking while watching a weekend game. On vacation, meanwhile, keeping track may not seem important at all.
Many people who drink this way may privately recognize that their alcohol consumption has become excessive.
Yet plenty may still be unsure how their intake compares with official health advice—or where the line is between drinking moderately and drinking too much.
Until this year, the guidance was relatively simple: men who drank were advised to have no more than two alcoholic drinks per day, while women were advised to limit themselves to one.
Those limits referred to standard drinks, not necessarily the larger servings poured at home or in bars. A standard drink is 12 ounces of regular beer, five ounces of wine or 1.5 ounces of distilled liquor.
However, the federal government removed those specific daily limits in January.
The new Dietary Guidelines for Americans instead offer a broader message: “consume less alcohol for better overall health,” without stating a precise threshold for excessive drinking.
Previous US guidance advised men who drink to have no more than two alcoholic drinks a day and women no more than one
The change followed comments from Dr Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, who said there had “never really” been strong evidence supporting the former one-drink limit for women and two-drink limit for men.
That leaves millions of Americans wondering how to assess a regular glass of wine, a few beers or a nightly cocktail—and how concerned they should be if they drink more than the former recommended amounts.
Official health messaging has become increasingly direct about the possible consequences of alcohol consumption.
The Centers for Disease Control and Prevention says drinking less is better for health, adding that even moderate alcohol consumption may involve significant risks.
Put simply, the risks associated with alcohol do not switch on suddenly at one specific point.
Alcohol is linked to a higher risk of at least seven cancers, including breast, liver and colorectal cancer. Research has also increasingly questioned the once-popular belief that one or two glasses of wine each day could protect the heart.
Some experts maintain that the added risk associated with moderate drinking is relatively small and should be weighed against the many other risks people accept in daily life.
The CDC classifies heavy drinking as 15 or more drinks per week for men and eight or more drinks per week for women.
US guidance on how much alcohol people should drink has become less clearly defined
Even so, there is no sudden tipping point at which alcohol changes from harmless to dangerous.
Professor John Holmes, an alcohol policy expert at the University of Sheffield in England, says drinking guidelines should not be treated as a strict boundary separating safe consumption from dangerous drinking.
‘There is no magic number here where, if you drink below that level you’re safe to drink, and over that and you’re going to die,’ he says.
‘Broadly speaking, the risk increases with each additional drink you consume, and it increases particularly sharply for higher levels of consumption.’
Professor Sir David Spiegelhalter, a leading statistician at the University of Cambridge in England, has previously made the same point about Britain’s alcohol guidelines.
‘The UK recommended limits are described as “low-risk,” but this does not mean that anything above this is “high-risk,”‘ he said.
‘It would be wrong if people thought that drinking anything above the recommended limits is necessarily harming them – they could perhaps be considered as aspirational targets.’
Some of the statistics that have generated alarming headlines about alcohol can look rather different when the absolute risk is spelled out.
Prof Spiegelhalter has previously pointed to a major 2018 study involving nearly 600,000 drinkers which examined the relationship between alcohol consumption, cardiovascular disease and death.
Americans aged between 35 and 54 maintained a higher drinking rate, at 69 percent. Between 2001 and 2003, 67 percent of this age group said they were drinking
Compared with those drinking within the UK guidelines, Prof Spiegelhalter said, people drinking up to twice that amount had an average life expectancy around six months shorter.
In American terms, that’s roughly 16 standard drinks a week – a little over two drinks a day.
‘Of course, any effect of additional alcohol will vary hugely between people, but this gives an idea of the magnitude of the trade-off,’ he said.
Another huge international study, also published in 2018, generated headlines around the world after concluding that the safest level of alcohol consumption was none at all.
But Prof Spiegelhalter pointed out that the absolute increase in risk at low levels of drinking was tiny.
According to his analysis, if 100,000 people aged 15 to 95 drank no alcohol for a year, about 914 would develop one of the health problems examined by the researchers.
If all 100,000 instead had one alcoholic drink every day, that figure would rise to 918 – just four additional cases.
Put another way, for every 25,000 people drinking one alcoholic drink every day for a year, the study suggested there would be one additional alcohol-related health problem.
At two drinks a day, the difference became more substantial. The study suggested 977 out of every 100,000 people would develop one of the health problems examined – compared with 914 among non-drinkers.
That’s 63 additional cases for every 100,000 people.
None of this means drinking is harmless. But it illustrates an important distinction that can disappear in frightening headlines: an increased risk isn’t necessarily a large risk.
And the risks aren’t identical for everyone.
Women generally reach higher concentrations of alcohol in their blood than men after consuming the same amount, in part because they tend to have less body water in which to dilute it.
As a result, women can develop alcohol-related health problems at lower levels of consumption. These include liver disease and cardiovascular damage, while alcohol is also a well-established cause of breast cancer.
The risks of drinking aren’t identical for everyone
This graph shows the proportion of pregnant women in the US who admitted drinking between 2015 and 2017, and between 2018 and 2020
Each person’s individual risk will also vary depending on their genetics, age, health and drinking pattern.
And what about the increasingly popular idea of taking several alcohol-free days every week?
The evidence that simply squeezing the same amount of alcohol into fewer days makes it healthier is surprisingly limited.
‘There’s some evidence that, if you’re a heavy drinker, having a few days off can help the liver recover,’ explains Prof Holmes.
But he says recommendations to have alcohol-free days were also intended to prevent drinking from becoming an everyday habit that could gradually push consumption higher – rather than because there was compelling evidence that having a drink every day was inherently more damaging.
There is, however, less reassuring news for anyone who still regards their nightly glass of red wine as medicinal.
For years, studies appeared to suggest that moderate drinkers had healthier hearts – and sometimes lived longer – than people who never drank.
The resulting theory was enormously appealing: a little alcohol, particularly red wine, might actually be good for you.
But researchers increasingly believe at least some of that apparent benefit was caused by flaws in the studies.
One major problem was that groups described as ‘non-drinkers’ sometimes included former heavy drinkers who had quit because they were already ill.
And moderate drinkers may differ from abstainers in numerous other ways – including diet, income, exercise and general health – making it difficult to establish whether alcohol itself deserves the credit for their apparently better health.
‘We’re pretty confident now that we’ve been overestimating any benefits, and they may not exist at all,’ Prof Holmes says.
More recent research has continued to challenge the idea that drinking alcohol is good for your health.
Indeed, the new Dietary Guidelines for Americans, published earlier this year, make no claim that moderate drinking is beneficial. Instead, the message is blunt: ‘Consume less alcohol for better overall health.’
But none of this means the risks faced by every moderate drinker are enormous.
Professor Robert Dingwall, a sociologist at Nottingham Trent University in England, argues that public health messages can sometimes obscure the enormous difference between the risks faced by moderate drinkers and those consuming very large quantities.
‘The risks for most people are trivial,’ he says. ‘What you do have is a concentration of people for whom alcohol is a real problem and the public health challenge is how you get to that group, rather than change the advice for the population as a whole.’
Prof Holmes puts the decision more colorfully.
‘The way I often describe it is that most people have been given a pretty good hand, and there’s a good chance they’ll win the bet when it comes to their risk from alcohol.
‘But you’re betting against the house. It’s up to you whether you fancy your chances or not.’
