What Are the Health Effects of Moderate Alcohol Consumption?
Few pleasures rival the sharing of good food and drink with dear friends. From raising a toast at the outset of a meal to lingering over dessert with a digestif, alcohol can add fun, pleasure, and ceremony to social gatherings.
“Animals feed, but humans tend to eat and build a culture around it,” says nutrition-psychology educator Marc David, MA. “Lingering and socializing over a meal gives us a chance to celebrate food and drink, a chance to get to be human.”
Still, the health effects of drinking alcohol are hotly debated, with advocates and abstainers who are equally passionate. While most of us know that drinking to excess isn’t in anyone’s best interest, and addiction issues are a separate category, we might still be wondering what’s up with moderate social imbibing: What is moderation? How does it affect health? Are certain drinks more beneficial (or risky) than others? What factors contribute to a higher or lower alcohol tolerance — and how does it change over time? We decided to dig into these questions.
What Are the Benefits of Drinking?
Many cultural traditions feature moderate drinking as part of a healthy life. Four of the five Blue Zones — cultures around the world with the longest-lived populations — include modest social drinking as part of their routines. (The exception is -Seventh-day Adventists, who refrain.)
The jury is still out on precisely how or whether alcohol actually contributes to longevity, but many experts believe modest drinking can help facilitate stronger social networks, and those do sustain us.
“Research shows that people who drink socially . . . tend to have more friends and so more emotional support, a key source of mental health,” writes neuropsychopharmacologist David Nutt, DM, in Drink? The New Science of Alcohol and Your Health. “They also feel more contented and more involved in their local community.”
In a 2012 study, psychologists filmed groups of three people getting to know each other: Some groups drank alcohol, some a placebo, and some a control beverage. Unsurprisingly, the members of the mildly intoxicated group reported more feelings of closeness in their interactions and displayed more genuine smiles than those in the other two groups.
Beer and wine may also offer some modest health benefits. Red wine contains resveratrol, a polyphenol in red grapes that’s beneficial for heart wellness. Functional nutritionist Jesse Haas, CNS, LN, notes that the silicon and hops present in beer may protect brain cells and slow neurological disorders, such as Alzheimer’s.
“Beer can be a source of magnesium, calcium, and phytoestrogens that are beneficial for hormonal balance,” adds Haas.
David notes that alcohol’s relaxing effects are also supportive. “Give me a stressed-out human, and after a drink or two they’re going to relax,” he says. “Alcohol stimulates the mental and emotional but also the physiologic relaxation response. That’s where we’re designed to do our most optimal digestion, assimilation, and natural appetite regulation.”
How Does the Body Process Alcohol?
Here’s what happens under the hood after that cold beer or celebratory margarita. First, the alcohol is absorbed through the walls of the stomach and small intestine. The bloodstream carries it to the liver, where an enzyme called alcohol dehydrogenase starts to break it down, producing a byproduct called acetaldehyde. (An excess of this chemical compound is the culprit behind hangovers.)
The alcohol and acetaldehyde mixture travels from the liver to the heart and crosses the blood–brain barrier to enter the brain. This gives you a buzz, usually within 10 or 15 minutes of your first sip. Your blood vessels start to expand, possibly making you feel warmer and a little flushed.
Alcohol then activates the calming GABA (gamma aminobutyric acid) system in the brain, which relaxes you and lowers your inhibitions; it also stimulates the release of the feel-good neurotransmitters serotonin and dopamine as well as endorphins, your body’s natural opioids. These chemical rewards all contribute to alcohol’s de-stressing effects — as well as its addictive allure.
Why Do We Each Handle Alcohol Differently?
Have you ever wondered why you seem to tolerate alcohol so differently than your Uncle Bill, who spills all his secrets after two sips of beer? Or your Aunt Bethune, who can drink the entire family under the table? Several factors influence how we process alcohol, including age, sex, genetics, body composition, and hormonal fluctuations.
“How we detoxify is different from person to person,” notes functional-medicine practitioner Marcelle Pick, OB/GYN, NP.
In general, male bodies tend to tolerate alcohol better than female ones, due in part to larger size, but also because of differences in body composition, including water (which dilutes alcohol) and fat. “People with ovaries have higher body fat than people with testes. Alcohol doesn’t absorb into fat, so it ends up being in the blood longer and at higher concentrations,” explains Haas.
Women also have lower levels of alcohol dehydrogenase, the enzyme that breaks down alcohol in the liver. And roughly a third to half of people of Asian descent possess a genetic variant that lowers levels of this enzyme, which means they don’t break down alcohol as easily and may get flushed and nauseated from drinking.
How Does Tolerance Change as We Age?
When we’re in our 20s, enthusiastic social drinking might fit seamlessly alongside fitness routines, jobs, and other obligations. A couple of decades hence, the same approach to alcohol might tank our functioning.
That’s because as we age, we process alcohol less efficiently. “Some are surprised by it and find they feel intoxicated by the same amount of alcohol they used to drink [without a problem],” says Pick. But as we get older, we have less muscle mass and body water, she explains, which affects alcohol processing.
The liver’s capacity to break down alcohol also decreases with time. Think of a bathtub: When the drain is open, the tub empties easily. As we move on in years, the liver’s drain tends to slow down. “One hypothesis is there’s less blood flow to the liver as we age,” says Haas. “If blood is flowing to the liver at a lower rate, then that drain is also slower.”
There’s also the simple fact that the longer we live, the greater our exposure to various toxins — and the greater their cumulative burden on the liver.
“The more you’re hanging on to those toxins, the more the drain is clogged and metabolism is slowed down,” cautions Haas. “It’s important for everyone to cultivate a detox-supportive diet and lifestyle, and keeping alcohol consumption moderate is important for that. The less effectively those detox pathways function, the more likely we are to experience disease as we age.”
How Do Hormones Influence Tolerance?
Like age, hormones can also affect how we process alcohol. Higher estrogen levels, for example, slow alcohol metabolism. For women, that means tolerance is generally highest around menstruation, when estrogen levels drop, and lowest around ovulation, when estrogen is high. (Other factors can affect this equation: Overall hydration, for instance, can dip during menstruation, decreasing tolerance.)
In general, excess alcohol consumption increases production of estrogen and decreases the ways it’s metabolized, says Pick. “There are different pathways where estrogen is metabolized, and some pathways increase the risk of breast cancer. That may be one reason there’s an association between regular alcohol consumption and breast cancer.”
People with uterine fibroids, endometriosis, or PMS symptoms may want to be especially careful to moderate their consumption, says Haas. “PMS symptoms like breast tenderness or night sweats are indicative of an estrogen imbalance.”
Alcohol may exacerbate perimenopause symptoms, too, in part because it increases noradrenaline, which contributes to hot flashes. It can also lower testosterone by increasing levels of the enzyme that breaks it down.
What Is Moderation?
Everyone’s tolerance is different, so the question of moderation can be tricky.
The Centers for Disease Control and Prevention (CDC) defines it as no more than two drinks a day for men and one per day for women. Functional-medicine physician Elizabeth Boham, MD, MS, RD, encourages men to aim for 10 or fewer drinks per week; women for five or fewer. “It’s healthier not to concentrate those drinks into one or two days, but to spread them out.”
If you’re regularly drinking more than this, she suggests looking for the underlying reason. Is it to relax? To socialize? Or has drinking simply become a habit?
“Once you figure out what’s driving it, you can find other ways to meet those needs,” she says. Going for a walk or hitting a yoga class can be a great way to relax and transition after work. If it’s the ritual you miss, try swapping in sparkling water or a mocktail.
Finally, if you pay closer attention to how drinking makes you feel, it may become easier to notice — and switch to water — when you’re overdoing it.
“Alcohol, like caffeine and sugar, is a powerful substance,” says David. “With any powerful substance, it’s always about the dose. You want to come to that substance with a healthy respect and understand I can get a great benefit from this if I can hit the sweet spot, where I get what I’m looking for without stepping over the line.”
Can Drinking Aid Digestion?
It certainly can. Digestifs such as aquavit, amaro, and brandy are made with herbs and spices containing potent digestive benefits. “These can be quite intense in their taste and herbal profile,” says David. They help stimulate digestive enzymes after a big meal, ushering the contents of the stomach along the GI tract.
Historically, alcohol was sometimes used to protect the gut against parasites; fermenting grains was a way to create drinkable beverages in the absence of clean water. And Haas notes that vermouth is made with wormwood, which is antiparasitic.
Still, alcohol’s most important contribution to digestion is stimulating the relaxation response, critical for our ability to digest and assimilate nutrients from food. “Anything that helps us move out of the stress response makes us more open to pleasure,” says David, noting that the stress hormone cortisol naturally blunts our pleasure receptors. “If you eat a dessert when you’re stressed, you’ll have to eat more cake or ice cream to get the same amount of pleasure.”
In short, by catalyzing the relaxation response, enjoying a drink at the beginning of a meal can help attune us to the pleasure of eating, which helps enhance our digestion.
How Do Different Alcohols Affect Us?
Though many of us feel that certain alcohols affect us differently (red wine disturbs our sleep, or tequila makes us euphoric), there’s little science to explain why this is so. “From a chemical standpoint, there’s no difference from one alcohol to another — though there may be a difference in other compounds in the beverage,” says Haas.
Brown liquors, such as brandy and bourbon, as well as darker beer and red wine, tend to have more congeners — complex alcohols formed in the aging process that are associated with worse hangovers and possibly greater intoxication.
And if gluten gives you trouble, so will gluten-containing beverages, such as beer or rye whiskey. As for tequila’s reputation as a “clean” spirit, it is grain-free and made from agave, and it doesn’t spike blood sugar as much as other liquors. This may account for why some people feel less of an impact after drinking it.
The way alcohols are processed also has an effect. “There are toxins and pesticides in alcohol that can impact how much stress it puts on the body’s detox system,” notes Boham. Opting for organic or biodynamic wines can minimize the toxic load.
As with most things, you’ll have to experiment to find which alcoholic beverages, if any, feel right for you. “If you want to occasionally have a drink, experiment to see what’s less problematic for you,” advises Pick.
And then savor it — ideally in wonderful company.
The Problem of Excess
If you’re not prone to alcohol addiction and are able to drink socially, keeping consumption occasional and modest does have real benefits — including avoiding the pitfalls of excess.
According to the CDC, excessive alcohol use can put you at risk for high blood pressure, heart disease, digestive problems, cancer, weakening of the immune system, dementia, depression, and alcohol dependence. And risks from drinking alcohol are not linear but exponential, meaning they don’t just increase with more drinking — they worsen.
There is a small silver lining here: “If you drink a lot, cutting down will reduce your risk of harm much more than if you are reducing from a low level,” explains David Nutt, DM, author of Drink? The New Science of Alcohol and Your Health.
Cutting down on frequency and taking occasional breaks can also be helpful. Elizabeth Boham, MD, MS, RD, notes that 90 percent of people who have two or more drinks a day are at risk for fatty liver, where sugars from alcohol are stored in the liver as fat. (Fatty liver has also been linked with insulin resistance and type 2 diabetes.)
But stopping alcohol consumption even just for a couple of weeks can start to reverse the condition. (For more on fatty liver, see “The Hidden Liver Crisis“.)
This article originally appeared as “A Toast to Moderation” written by Mo Perry in the December 2021 issue of Experience Life.
