Your Weekly Checkup: New Recommendations on Drinking Alcohol

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.  

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Two months ago, in my column about red wine, I noted that the American Heart Association endorsed a safe alcohol consumption of no more than one to two drinks per day for men and one drink per day for women, while the Canadian Center for Addiction and Mental Health considered low-risk alcohol consumption to be up to three drinks per day for men and two for women.

Because of these inconsistencies about the effects of alcohol, I recommended erring on the low side. A recent study supports that view and halves the suggested safe amounts to less than one drink a day for men and women. The investigators analyzed information from almost 600,000 participants and found that those who had one drink a day or less had the lowest risk of dying. Those who drank more one drink a day had reduced life expectancy with increased risk of stroke, coronary disease (excluding heart attacks), heart failure, and fatal hypertensive disease. Alcohol consumption was also associated with higher risks of cancers of the digestive tract and breast. The authors estimated that men who reduced long-term alcohol consumption from two drinks a day, recommended in US guidelines, to one drink a day or less enjoyed one to two years of longer life expectancy at age 40 years.

This study, though quite robust, shares the limitations of any observational study, including outside influences that change the effect and conclusions, unreliable reporting of actual alcohol consumption, reverse causality (for example, those at risk of dying maybe drank more alcohol) and other factors. I find it curious that alcohol consumption was associated with a lower risk of nonfatal heart attacks (perhaps by elevating the “good” cholesterol) but a higher risk of stroke, coronary disease and mortality, and that there was no difference between men and women.

The impact of alcohol on health can be quite variable from one individual to another because of many factors such as body weight and sex, medications, overall health, and rate and types of alcohol consumption. Finding a magic number applicable for everyone is impossible. I ended the previous column with the same advice I will repeat here: err on the low side, but, as Oscar Wilde said years ago, “Everything in moderation, including moderation.” Pundits often reflect that it’s not how long you live but how you live long that’s important.