Hawaii Health Alert: Is There a Safe Amount of Alcohol?

Confused by all the mixed messages on drinking? Get some answers and find out if one drink a day is really too much.

If you relax or unwind with an occasional beer or Mai Tai, you may be wondering if this habit is good for you, bad for you—or maybe somewhere in between. Given the myriad competing (and sometimes misleading) news reports on the subject, you’re likely not alone.

By now, the serious health risks of heavy drinking are widely known. But for years, public health officials have asserted that although people shouldn’t start drinking if they don’t already, it’s probably safe for men to have up to two alcoholic drinks per day while women can safely have one. Some studies have even suggested that for some people, light or moderate drinking might offer health benefits, particularly a lower risk for cardiovascular problems, such as heart attacks and stroke.

Then, in August 2018, a comprehensive review of existing research published in The Lancet challenged conventional wisdom, concluding that even one alcoholic drink per day could increase the risk for injuries and certain diseases, including several forms of cancer. Moreover, as people’s alcohol consumption increases so do their odds of developing a range of other health issues, from high blood pressure to lung or liver disease. One of the study’s most quoted takeaways: “the safest level of drinking is none.”

The review made for some splashy headlines, but were the researchers’ conclusions true? Is even one daily drink a health risk?

The short answer: it depends.

A closer look at the research

More specifically, the dangers associated with drinking really depend on you—your age, sex, DNA, lifestyle and other individual risk factors for cancer and chronic diseases, explains Keith Roach, MD, Sharecare’s Chief Medical Officer and Associate Professor in Clinical Medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital.

“If you take a really careful look at that meta-analysis, you find that what we've been saying for the last 40 years is still true. People who drink moderately within recommended limits—one drink per day for women, two per day for most men—have a lower incidence of coronary artery disease than people who drink nothing,” says Dr. Roach. He notes, however, that the risks for other diseases are higher.

For the Lancet study, a team of scientists analyzed levels of alcohol use around the world and its effects on global health from 1990 to 2016. The researchers reviewed more than 1,000 existing studies to estimate the effects of alcohol on the risk for 23 different related health issues, including cancer, high blood pressure and stroke as well as car accidents and injuries. Using mathematical models, the team predicted the overall harm associated with drinking.

The review found that alcohol was tied to 2.8 million deaths in 2016 and was the leading risk factor for disease worldwide among people between 15 and 49-years old. The researchers calculated that the health risks associated with alcohol were lowest at zero drinks per day and increased along with consumption. Essentially, the more people drink, the higher their risk for a wide range of health issues.

The scientists concluded that the health risks associated with any amount of drinking outweigh any possible benefits.

This is especially relevant in Hawaii, where 21.1 percent of adults report excessive drinking, compared to 19 percent nationally. In addition to the health risks posed by excessive drinking, Hawaii also has a problem with drunk driving, with 35 percent of traffic fatalities linked to alcohol-impaired driving while the national average is 29.3 percent.

Is one drink really too many?

Given these worrisome findings, is it time to stop your pau hana tradition with friends?

Not necessarily. Here’s why.

The results of this global study shouldn’t be interpreted on a personal level. In other words, your individual risk for the 23 health issues included in the review may be different than that of someone else with a different age and genetic makeup who’s living in another part of the world.

For example, tuberculosis was among the three leading causes of death linked to alcohol. This highly contagious bacterial infection is one of the top 10 causes of death worldwide. In 2017, 10 million people developed the infection, according to the World Health Organization. But only 9,105 cases were reported in the United States that year with 116 cases in Hawaii, the Centers for Disease Control and Prevention and the Hawaii Department of Health reports. Of the 9,105 cases nationally, only about 9 percent of patients were heavy drinkers.

While tuberculosis is a serious global health concern, it’s not as relevant for most Americans who may be more concerned about diabetes or heart disease.

It’s also important to understand that this review included observational studies, which tracked people over time, considered their alcohol intake and examined rates of disease to find associations. It’s nearly impossible for these studies to control for all possible variables and tease out with certainty which specific foods, drinks or nutrients are causing a particular outcome, Roach explains.

Large, long-term, randomized trials—studies in which scientists identify the effects of a particular variable by comparing groups of people randomly assigned to be exposed to it with groups of similar people who are not—are needed to determine true cause and effect relationships. But it’s impractical and even impossible to investigate the effects of alcohol consumption with this type of study.

Drinking still isn’t healthy

It’s important to understand the limitations of the 2018 study, but that doesn’t mean that you should drink with abandon—or at all, for that matter.

The study adds to a huge pile of evidence and reaffirms what we already know: heavy drinking is dangerous. The more people drink, the greater their risk for a number of serious health issues, including cancer, liver disease, atrial fibrillation and stroke.

You also shouldn’t drink with the idea that your alcoholic beverage will offer certain health benefits, Roach advises. The scientific evidence suggesting that people who drink any kind of alcohol in moderation have a lower risk of death or lower rates of heart problems than people who abstain are murky at best.

It’s unclear if the protective effects linked to drinking are actually tied to the alcohol or if they are associated with other traits that are common among moderate drinkers, Roach points out. “There's good evidence to suggest that the second possibility is at least partially true,” he says. “People who drink moderately tend not to smoke, tend to see their doctors, tend to have good blood pressure control, tend to exercise regularly, tend to eat well. All of those things tend to reduce the risk of death.”

People who drink alcohol in the hopes of deriving a health benefit may also be tempted to overdo it, Roach adds. “I've seen so many people say, ‘My doctor said one must be good, so 10 must be better.’"

Keep in mind, even people who classify themselves as light or moderate drinkers may be consuming more alcohol than they realize.

“The dose of alcohol is defined really precisely,” Roach says.

For example, in the United States, a single drink contains 0.6 fl ounces or 14 grams of pure alcohol, which is the equivalent of 5 ounces of wine, 12 ounces of beer or 1.5 ounces (a shot) of liquor, such as rum, vodka, tequila or whiskey.

Many people exceed these portions, but still think they’ve had one drink. Complicating matters, different types of beer, wine and liquor also contain different amounts of alcohol.

Regular beer is about 5 percent alcohol, but some are 9 percent. So, a 12-ounce glass of a beer that’s 9 percent alcohol is the equivalent of nearly two drinks—not one. Most wines are about 12 percent alcohol, but some varietals are 17 percent or more. That means a 5-ounce glass of a wine that’s 17 percent alcohol is really about 1.5 drinks.

Meanwhile, most liquors are about 40 percent alcohol, but some have more than others. For example, fruit liquors may be only 28 percent alcohol. Clear distilled spirits, like gin and vodka, on the other hand, can range from about 35 to 46 percent while darker liquors, such as rum and whiskey, range from about 40 to 46 percent. Certain whiskeys are actually as much as 60 percent alcohol.

“There is a big difference in the dose of alcohol depending on exactly what you're drinking,” Roach cautions.

What’s the bottom line?

No level of drinking is completely risk-free, and the more you drink, the greater the potential harms. So, if you don’t drink, it’s probably best not to start. But if you do choose to drink, don’t exceed current guidelines for light or moderate drinking. If you’re a man, that means you shouldn’t have more than two drinks daily. If you’re a woman, limit yourself to no more than one drink per day.

Keep in mind that these guidelines are daily limits—not averages across several days. In other words, having four drinks in one night doesn’t qualify as moderate drinking even if you abstain for the rest of the week.

You can track your alcohol intake with the Sharecare app (available for iOS and Android).

It’s also wise to consider your individual risk factors, which could make drinking potentially more harmful for you than someone else, including your medical history, whether or not you smoke, your weight and other lifestyle factors.

Talk to your doctor about what’s best for your situation. Keep in mind, however, some people should not consume any alcohol, including pregnant women, those with a personal or family history of alcoholism or those with a history of alcohol-related liver or pancreatic disease.

Drinking for health benefits is also misguided, Roach cautions. The possible health benefits of alcohol are slight and unproven while the very clear risks associated with drinking escalate with every sip you take.

It’s tough to make the case for even moderate drinking, given the significant number of health risks involved, but some people will enjoy life a bit more if they have their daily beer, Roach admits.

“If that's the case for you, and it's worth it to you to take a small risk of developing health problems later on, then, by all means. You make choices in life,” he says. “It's not unreasonable to say, ‘Yeah, I'm going to have a glass of wine a couple of times a week.’ The potential harm from that is small. But, don't fool yourself into thinking it's a benefit.”

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