Think Twice Before You Drink

Medically Reviewed

When you drink to your health, how much is too much?

You’ve heard that moderate amounts of alcohol can improve your heart health. However, some researchers say that even moderate drinking can increase the risk for cardiovascular and other diseases, suggesting a fine line between healthy and hazardous drinking. What’s more, as you age, your tolerance for alcohol diminishes.

What is moderate drinking?

One standard drink is considered to be 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces (or a “shot”) of 80-proof liquor. The Dietary Guidelines for Americans defines moderate alcohol consumption as up to:

Two drinks a day for men

One drink a day for women (who generally weigh less than men and metabolize alcohol more slowly)

For men and women 65 or older, the National Institute on Alcohol Abuse and Alcoholism recommends no more than seven drinks in one week and no more than three drinks on any given day.

But even within those limits, alcohol can be risky, says Kent R. Olson, M.D., a clinical professor of medicine and pharmacy at the University of California, San Francisco, and the medical director of the San Francisco Division of the California Poison Control System. “Despite any benefits it confers, alcohol is still a drug. If you have a health condition, are taking medications, or are 65 or older, you are more susceptible to adverse effects.”

An alcoholic drink remains in your body for about two hours after its consumption. However, aging lowers your body’s tolerance: Metabolism slows and the body’s water content decreases. As a result, alcohol may remain in your body longer than two hours, so two glasses of wine that relaxed you when you were younger might now make you drunk.

Alcohol may also interfere with the metabolism of medications, potentially making them more toxic.

Toxin or tonic?

Before you raise your next glass, drink in these findings on how alcohol may affect your health:

• Heart. Many studies suggest that moderate drinking can lower the risk of heart disease, heart attack, and death from heart disease by reducing blood clotting, raising HDL (“good”) cholesterol, and providing an anti-inflammatory effect. But findings in the Journal of the American College of Cardiology in December 2016 suggest that habitual moderate drinking may slightly increase the risk of atrial fibrillation, an irregular heartbeat. Another study found an increased risk of cardiovascular-related death among women and men who drank more than two and three drinks a day, respectively. Heavy drinking can also worsen diabetes and, according to a January 2017 study in the Journal of the American College of Cardiology, increase the risk of a heart attack and heart failure.

• Blood pressure. Men and women who have more than two drinks a day are twice as likely to have high blood pressure compared with nondrinkers.

• Stroke. Heavy drinking is associated with an increased risk of stroke, but consuming one drink or less a day has been associated with preventing ischemic stroke (narrowed or blocked arteries to the brain).

• Brain. Several studies suggest that light to moderate drinking, when compared with abstention, may provide a protective effect against dementia or lower the risk of cognitive decline, but some findings are questionable. Conversely, one binge can disrupt the balance of neurotransmitters, increasing the risk of depression, memory loss, seizures, or mood changes. Chronic alcohol abuse can change brain structure and chemistry that can disrupt motor coordination, sleep, mood, and cognitive functions such as learning and memory.

• Cancer. Moderate alcohol use is linked to an increased risk for some cancers, including gastrointestinal, head and neck, esophageal, and liver cancer. Every 10 grams (slightly less than one drink) of alcohol that a woman drinks a day is associated with a small increase of breast cancer. Consuming three drinks a day is associated with a one-and-a-half-times increased breast cancer risk.

• Drug-alcohol interactions. Aspirin can cause stomach or intestinal bleeding when combined with alcohol. Chronic consumption of alcohol may increase the risk of liver injury from acetaminophen. Some medications contain alcohol; drinking will add to your alcohol load. Combining alcohol with antihistamines can cause excessive drowsiness. Alcohol can interfere with the therapeutic effects of certain drugs, such as warfarin. And be careful if you take prescription pain relievers, sleep medications, anti-anxiety drugs, or antidepressants, which can have additive effects on sleepiness.

More good news/bad news

Moderate drinking is associated with a reduced risk of gallstones, type 2 diabetes, and peripheral artery disease—while heavy drinking may do the opposite and actually intensify those risks. Excessive drinking can also increase your risk for certain medical problems, such as:

Liver disease

Pancreatitis (inflammation of the pancreas)

Osteoporosis (low bone density), which can lead to fractures

Weakened immune system

Accidents and injury from falls

Suicide

“If you enjoy an occasional cocktail or a glass of wine,” Olson says, “it could be beneficial if you are healthy and have no addiction history. But keep in mind, at the very least, alcoholic beverages cost money and add calories to the diet. More seriously, alcohol use can cause accidents, family conflicts, and medical problems.”

Learn more about alcohol addiction and how to cut back on alcohol.