How Alcohol Affects Your Health

In the U.S., national guidelines currently recommend no more than two drinks per day for men and one drink per day for women. Those Dietary Guidelines for Americans are up for renewal this year, and after two large studies offered two very different visions for federal regulators to consider, recent reporting indicates the government is considering eliminating recommended limits altogether.

Before we get into what the science says, it’s worth noting that advocates on all sides have questioned the scientific basis for these guidelines, with some experts arguing they reflect political compromises more than current research. Some researchers say the guidelines should be more strict, pointing out that one-size-fits-all recommendations fail to account for individual differences in genetic risk, metabolism, body composition, and health status. They also often rely on outdated gender binaries rather than personalized health factors. Others, including alcohol industry advocates, have argued against tightening the guidelines at all.

With so much information swirling, it can be tough to make sense of what it means for you. Here’s how to think about alcohol and your health.

The state of the science

The World Health Organization has said in recent years that there is no completely safe level of alcohol, and several countries, including Canada, the United Kingdom, and the Netherlands, have adopted similar messages, putting out guidelines that tighten the recommended limit of drinks. Next year, Ireland will become the first country in the world to introduce elaborate health warning labels on all alcohol products. Other recent research has found that alcohol is one of the key modifiable risk factors for dementia.

The dangers of heavy drinking are not new, but more recent research has linked even moderate drinking to negative health consequences throughout the body. These are some of the areas that alcohol can impact:

Liver

The liver breaks down (metabolizes) and eliminates alcohol from the body. Each person has different alcohol metabolism, which is affected by genetic factors, how much you drink, and your overall diet. If you consume too much alcohol for your liver to process, that can make it harder for the liver to oxidize fat and lead to steatotic liver disease (formerly known as fatty liver disease). While steatotic liver disease is reversible, heavy drinking can eventually lead to worse problems and irreversible scarring in your liver known as cirrhosis.

Metabolism

Metabolic health is another area where even moderate drinking can have an impact. Drinking alcohol can lead to weight gain because the calories you’re consuming in a drink have very few nutrients but your body prioritizes metabolizing alcohol over everything else. So while your body focuses on processing the alcohol, any protein, carbohydrates, and fats you’ve eaten sit around and can become body fat.

Alcohol can also throw off digestive function, inhibit nutrient absorption, and disrupt sleep, all of which affect your metabolic health.

Immune system

Alcohol can weaken your immune system, making you more susceptible to infections, such as colds, flu, and other illnesses.

Pancreas

Drinking alcohol can lead to pancreatitis, or inflammation of the pancreas. Heavy drinking can lead to acute pancreatitis, and over time, this can develop into chronic pancreatitis.

Brain

Alcohol is what doctors call a neurotoxin. So while most people likely know about alcohol’s short-term effects such as slurred speech, blurred vision, lack of inhibition, and decreased coordination, alcohol can also have dangerous long-term effects on the brain. Excessive drinking can lead to brain damage, and research has shown that alcohol is one of the key modifiable risk factors for dementia.

Heart

Heavy drinking, and even infrequently high levels of drinking, increases the risk for a range of cardiovascular problems, including heart disease, heart attack, and stroke. There have been mixed results about the effects of alcohol on the heart, but recent analyses have found no protection at low levels of consumption, and in the past few years, the World Heart Federation has put out a policy brief explaining the dangers of alcohol for the heart.

Cancer risk

While the link between alcohol and cancer has been well established, this is an area the public is still learning about. Consuming alcohol increases the risk of developing at least seven types of cancer, including oral, esophageal, throat, larynx, breast, liver, and colorectal.

There are a few ways alcohol increases the risk of cancer. First, alcohol breaks down into a chemical called acetaldehyde, which damages your DNA. Alcohol also induces oxidative stress, damaging DNA, proteins, and cells, and increasing inflammation. Alcohol also changes the levels of hormones such as estrogen, increasing the risk of breast cancer, and leads to greater absorption of other carcinogens like tobacco.

The World Health Organization’s International Agency for Research on Cancer classified alcohol as a “Group 1 carcinogen,” which means there is sufficient evidence that it causes cancer in humans. That category also includes tobacco, asbestos, and radiation. Men and women are both at risk, but research has shown that women are more likely to develop cancer from drinking.

How the guidance has changed

This is all a notable shift from previous health guidance suggesting that drinking in moderation could be beneficial. While the idea that a glass of wine with dinner was good for cardiovascular health (known as the “French paradox”) was popular for decades, it has been largely debunked in recent years.

Understanding your personal risk

While it makes sense for governments to release population-level health guidelines, Dr. David Dodick, a leading preventive neurologist and Chief Science and Medical Officer at the Atria Health and Research Institute, says your individual risk varies depending on many factors, including age, sex, and preexisting conditions, such as heart disease, neurological issues, liver disease, diabetes, and mental health issues. Your genetics also play a role: genes can influence how you metabolize alcohol as well as your risk of cancer, dementia, and other diseases. Even moderate alcohol consumption in people with certain genetic variants is associated with a significantly elevated risk of gastrointestinal tract cancers, brain atrophy (shrinkage), and cognitive decline.

This is the kind of information that genomic sequencing can provide insight into. For those of us who have not done genetic testing, Dr. Dodick recommends considering a few factors: personal history of cancer; family history of cancer, neurodegenerative and dementia disorders like Alzheimer’s Disease; diet, sleep and exercise status; and any current conditions such as obesity, diabetes, hypertension, and heart disease.

“In individuals with underlying health conditions or at significant risk for future conditions, alcohol may act as a biological amplifier, accelerating disease progression, intensifying symptoms, and undermining treatment. In other words, alcohol doesn't just add to the problem, it turns up the volume on whatever health issue you already have or are at risk for,” Dr. Dodick says. By contrast, for adults in good health who eat and sleep well and stay active, and who don't have significant genetic risk or conditions that increase alcohol-related risk, having a drink now and then is considered low risk based on the latest research.

Finding a balance

We know many of our individual behaviors, from sitting at work all day to eating cheeseburgers, may not be optimal for our health, and gleaning knowledge about why that’s the case can motivate us to make different choices.

“As a physician, I can sit here and say you should never smoke—but it took us over a century for medical consensus and public awareness to solidify into the never-smoke message,” Dr. Dodick says. “The key is helping people understand their individual risks.”

There’s evidence education works. A new survey released April 1 by the Annenberg Center for Public Policy at the University of Pennsylvania found that public awareness of the link between alcohol and elevated cancer risk increased from 40% to 56% after the Surgeon General’s warning in January. Nearly 1 in 3 respondents said this information would make them less likely to accept a drink in a social situation.

It’s clear things are changing.

If you’re looking to slow down on drinking in the meantime, there are plenty of steps you can incorporate into your current social life. Here are a few examples from our colleagues:

• Try a mocktail, a non-alcoholic beer, or mix non-alcoholic herbal bitters into sparkling water—all tasty alternatives to alcohol and a nice ritual for some.
• Create alcohol-free rituals with enjoyable alternatives such as fancy tea, adaptogenic elixirs, or creative hobbies. These can disrupt the reward loop from alcohol and find other ways to get pleasure.
• Track your drinking. Use an app such as DrinkControl, Reframe, or TryDry, or use a journal to monitor when, where, why, and how much you drink. This can help increase awareness and accountability.
• Set specific, achievable goals such as no alcohol on weekdays, no more than two drinks per week, or one drink at social events only. Gradual reduction is often more sustainable than abrupt abstinence.
• If you prefer a more subtle tactic at social events, a glass of seltzer with lime removes the alcohol—and the questions.

Ultimately, the decision to drink or not remains personal—and, as Dr. Dodick says, should be personalized.