How Much Alcohol is Okay?

Conscious consumption starts with curiosity

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I didn’t think my relationship with alcohol was complicated until I spent the month of May without it. Suddenly, decompressing at the end of the day required effort. Social events seemed taxing. My inner monologue intensified. 

By most standards I don’t drink that much. But over the course of a month it became clear that alcohol was an uninvited houseguest in my subconscious. So, I began journaling again. I wrote down my worries instead of dulling them. I sat with discomfort instead of numbing it.

Listening to my noisy interiority was just what the doctor ordered. 

Photo by Kelly Visel on Unsplash

Which is why the doctorly question, “How much do you drink?” can’t possibly capture the way alcohol inserts itself into our lives without us even knowing it. It’s also why there’s no right answer to the question, “How much alcohol is okay?”

For alcohol enthusiasts who follow medical news headlines, the last few weeks have been dizzying. First came word of new research showing that any amount of alcohol could increase one’s risk of developing one or more of sixty different diseases, including stomach and lung cancer. That headline was quickly followed by a second study suggesting that small amounts of alcohol are in fact helpful, because they may turn down stress in the brain and thus benefit the heart.

So, what gives for the average reader? Should you worry that your nightly glass of wine is sure to cause cancer? Or that abstinence is actually bad for your health?

Let me help with both questions. 

First, new studies pop up every day of week. The validity and practical implications of new research varies widely. Sometimes a new study will cause a seismic shift in how physicians care for patients. Most of the time, however, a new study is simply food for thought. One of the best ways an individual study can grab a nice chunk of attention is by contradicting another recent study—and attaching a juicy headline.

So what about these two studies? The study about the dangers of alcohol came from a reputable source (Oxford University) and was large-scale (over 500,000 participants), both of which add validity. But all of the study participants lived in China, where more people smoke cigarettes, and are exposed to second-hand smoke and other environmental toxins compared to people in the U.S. These confounders make it difficult to consider alcohol as a proximate cause of cancers found by the researchers.

What about the “alcohol is good for you” study? As opposed to directly looking at the relationship between alcohol and the heart, the researchers in Boston studied the impact of alcohol on patients’ brains. Dr. Ahmed Tawakol, the senior author of the paper, noted that a little alcohol tended to make subjects feel relaxed, and concluded with his colleagues that alcohol likely had a de-stressing effect, particularly on patients who are prone to anxiety. He argues that this, in turn, was responsible for a reduction in cardiovascular events.

Sounds great, right? Well, here are some central problems with the premise and conclusions of this second study:

• Alcohol affects every organ in our body, not just the heart and brain. And every bit as importantly, it affects our behaviors, mental health, and relationships with other people.  

• For people with substance use disorders, depression, anxiety, or other emotional/mental health conditions, even one drink can be one too many.

• The long-term consequences of alcohol use may be greater than any short-term relaxation response.

• We know that alcohol use does increase the risk for other diseases, such as cancer. Myriad studies besides the one that establish this link.

• Even if light drinking is indeed associated with fewer cardiovascular events, we have no idea whether or not alcohol itself is the cause of such risk reduction.

So, when I talk to a patient about alcohol, I’m not going to embrace either study. I’m also not simply going to ask patients, “How much do you drink?” Instead, I will continue to ask them (and myself) about their relationship with alcohol—the when, how, and why.

The question is less about quantity than it is about the impact of alcohol on the whole health ecosystem. Specifically, how does alcohol affect:

• sleep, eating habits, and relationships? (behavioral health)

• mood, anxiety, self-esteem, sense of self-regulation? (emotional health)

• thoughts, judgment, impulsivity, memory? (cognitive health)

• headaches, blood pressure, pulse rate, heart rhythm, blood sugar, acid reflux, digestion, joint pains, neurological health, hot flashes, night sweats, sexual function? (physical health)

• risk for dementia, diabetes, atrial fibrillation, sleep apnea, breast cancer, colon cancer, depression, substance use disorder? (medical risk)

• body weight, BMI, hemoglobin, hormone levels, liver function, glucose, hemoglobin A1C? (medical metrics)

You’ve heard me talk about the Four “I”s—i.e., information, inputs, infrastructure and insight—and about redefining health as the intersection of these parts. While alcohol can be a wonderful thing, it can also gum-up the system.

The upshot? Everything we put in our body carries potential risk and benefit. Thus, there is no one-size-fits-all prescription (or one magical study) for alcohol use. Instead, deciding what, if any, role alcohol plays in our lives requires taking an honest look at our whole health—mental and physical—and a clear-eyed reckoning with the potential harms of a substance weighed against the benefits.

So, what should you do when you come across a new health study—whether on alcohol or anything else—that speaks to you? Use it as a starting point to contemplate your own habits, health status, and risk factors—what you want to keep, what you want to change, and where you want to be next month, or next year. I suggest you bring equal parts curiosity and self-compassion to the conversation with yourself—and ideally with your doctor, too.

Have I inserted more consciousness into my drinking habits since May? Absolutely. Am I delighted it’s June? Yes! It feels good to turn a reflex into a choice—at least for the time being. After all, health is a process, not an outcome. It’s about having awareness of our health ecosystem, acceptance of the things we cannot control, and agency over the areas we can change.

(For more on assessing the relationship with alcohol, my post about Dry January is here.)

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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

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