Is There Really No Safe Amount of Drinking?

The safest amount of alcohol to drink is none, according to 2023 guidance from the Canadian Centre on Substance Use and Addiction.

That’s a marked change from Canada’s previous national guidance on alcohol consumption, which advised women to have no more than 10 drinks per week and men no more than 15. By contrast, the report says those who drink only one or two boozy beverages per week “will likely avoid” alcohol-related health consequences including chronic diseases, liver injury, and accidents—but the safest choice, it says, is not to drink at all.

To researchers who study alcohol, that recommendation isn’t surprising. The report reflects a long-brewing shift in the way scientists and health-care providers think about the risks and benefits of alcohol, and follows a similar statement from the World Health Organization (WHO) released Jan. 4.

For “the past 20-plus years the evidence has been building and building that alcohol is not good for your health,” says John Callaci, a researcher with Loyola University Chicago’s Alcohol Research Program.

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If you grew up believing that a glass of red wine per night is good for your heart, you’re not alone. Decades ago, lots of studies suggested that light to moderate drinking—often defined as no more than a drink per day for women or two drinks per day for men—is beneficial for cardiovascular health. That finding stuck, both among the public and policymakers.

But Callaci says more recent research has called those older studies’ findings into question. Some researchers didn’t adequately account for underlying differences between non-drinkers (some of whom abstain because they have health problems) and light drinkers (who might have healthier lifestyles overall). So while it looked like light drinkers were healthier than non-drinkers, the booze may not have been the reason.

While some modern studies have found benefits associated with small amounts of alcohol, there’s been a shift in scientific consensus over the past couple decades. Researchers reexamined some previously published data on alcohol use, this time accounting for the “abstainer bias”—the idea that some people don’t drink because they have health or prior substance-abuse issues—and found little to no benefit associated with light drinking.

In 2022, the World Heart Federation released a policy brief debunking the notion that alcohol is heart-healthy. “Contrary to popular opinion, alcohol is not good for the heart,” the report says, noting that some studies that show cardiovascular benefits from drinking are flawed and more recent research points to a host of chronic conditions linked to alcohol. In the past year alone, studies have found that alcohol consumption may accelerate genetic aging, shrink the brain, and increase the risk of cardiovascular disease.

Alcohol is also considered a known human carcinogen and has been linked to a variety of cancers, including those of the breast, liver, colon, throat, mouth, and esophagus.

Cancer was a focus of the WHO’s recent statement on alcohol. The agency noted that half of all alcohol-related cancers diagnosed in Europe are caused by light or moderate drinking, a consumption pattern that is common across the region. (About 8% of European Union adults drink daily and about 29% drink weekly, data show.) There is no proven threshold at which booze is risk-free, according to the WHO. “We cannot talk about a so-called safe level of alcohol use. It doesn’t matter how much you drink—the risk to the drinker’s health starts from the first drop of any alcoholic beverage,” Dr. Carina Ferreira-Borges, regional advisor for alcohol and illicit drugs in the WHO’s European office, said in the statement.

Canada’s recent report made a similar point, arguing that, “Drinking alcohol, even a small amount, is damaging to everyone, regardless of age, sex, gender, ethnicity, tolerance for alcohol or lifestyle.”

Other countries haven’t come out as strongly against alcohol. U.S. federal nutrition guidelines recommend that men have no more than two drinks per day and women no more than one. They do say that “drinking less is better for health than drinking more,” but stop short of recommending abstinence.

Australia, meanwhile, recommends no more than 10 drinks per week, and no more than four in a single day. New Zealand says women may have up to 10 per week and men up to 15, but suggests taking at least two alcohol-free days per week. The U.K. recommends drinking no more than six glasses of wine or beer per week. “There’s no completely safe level of drinking,” its guidance says, “but sticking within these guidelines lowers your risk of harming your health.”

Dr. Denise Hien, director of the Rutgers Center of Alcohol and Substance Use Studies, says it’s difficult to issue blanket recommendations around drinking because risks vary from person to person depending on their demographics, overall health, lifestyle choices, and genetic predisposition to certain conditions. “That one glass of wine for me may not be the same as for someone else,” she says.

Still, while it’s difficult to make specific recommendations about how much an entire population should—or should not—be drinking, Hien says no one should pour themselves a glass of wine for wellness purposes. Having a cocktail now and then might not harm health, she says, but that’s not the same as helping it.

Callaci, for his part, thinks there’s enough evidence to suggest that zero drinking is the safest choice—but he doubts the U.S. would issue such a recommendation any time soon. The U.S. isn’t as proactive as many other countries on public-health issues, and the alcohol industry has a huge amount of money and political power, he says. Plus, drinking is deeply embedded in U.S. culture and that’s unlikely to change overnight.

It took decades for smoking rates to fall to their current historically low levels, even after U.S. public-health authorities began sounding the alarm about associated health risks. Cultural perceptions of alcohol may evolve in a similar way, Callaci says, but only if public-health officials are willing to send strong signals, like putting more extensive warning labels on alcohol packaging or releasing policy statements like those seen elsewhere.

The U.S. isn’t there yet, “but at least we can start telling people to cut back on their alcohol consumption,” Callaci says. “Maybe that’s the first step.”