Toasting the Truth: Can We Really Say Any Amount of Alcohol is Safe?

For centuries, the question of moderate alcohol consumption and its impact on health has swirled with debate. While guidelines have shifted, often suggesting a "safe" limit for responsible adults, recent research throws a wrench into this long-held belief. Emerging evidence suggests that even small amounts of alcohol may damage health, challenging the notion of a truly "safe" level of consumption.

This article delves into the latest research on alcohol's impact on health, exploring whether any amount can truly be considered harmless. We'll examine the evolving guidelines, dive into the science behind the risks, and discuss the implications for individual choices and public health approaches.

For decades, guidelines from various health organisations painted a picture of moderate drinking as potentially beneficial, particularly for heart health [1]. The 2020 Dietary Guidelines for Americans, for instance, suggested limiting intake to 2 drinks or less per day for men and 1 drink or less for women [1]. This seemingly moderate threshold aimed to balance potential health benefits against known risks like accidents and addiction. In the UK, the government limit is 14 units of alcohol a week. With something not very well known to the public being that alcohol misuse costs the NHS (and therefore the public), £3.5 billion per year.

However, the latest research paints a different picture. In 2018, the Global Burden of Disease Study, involving thousands of researchers worldwide, concluded that no level of alcohol consumption is safe [2]. This landmark study, published in The Lancet, found that even low levels of alcohol increase the risk of several health problems, including cancers, heart disease, and injuries [2].

Following this, major health organisations have begun revising their guidelines. The World Health Organization (WHO) released a statement in 2023 emphasising that any alcohol consumption poses health risks [3]. Notably, this stance aligns with existing evidence on alcohol's carcinogenicity, as classified by the International Agency for Research on Cancer as a Group 1 carcinogen alongside tobacco and asbestos [4].

The notion that only excessive drinking harms health raises the question: what are the risks associated with low-level consumption? Research paints a concerning picture.

Cancer: Even moderate drinking increases the risk of several cancers, including breast, esophageal, liver, and colorectal cancers. A 2022 study published in JAMA Oncology found that even one drink per day increased the risk of esophageal cancer by 20% [5].

Brain Health: Alcohol disrupts brain development and function, affecting memory, learning, and decision-making [6]. A 2023 study in Nature Reviews Neuroscience highlighted the impact of even low-level consumption on brain health, particularly in young people [6].

Cardiovascular Health: While moderate drinking was once thought to offer some heart benefits, evidence suggests this link is weak and outweighed by the risks [7]. A 2021 study in The Lancet found that any level of alcohol consumption increases the risk of heart disease, stroke, and other cardiovascular issues [7].

Mental Health: Alcohol misuse can exacerbate mental health conditions like depression and anxiety [8]. A 2022 study in The Lancet Psychiatry found a link between moderate drinking and depression, particularly in women [8].

These are just a few examples, and the list of potential harms associated with even low-level alcohol consumption continues to grow. It's important to remember that individual vulnerabilities and risk factors can further magnify the impact of alcohol.

Excessive drinking, often defined as exceeding daily or weekly recommended limits, carries significant risks that impact your health, safety, and well-being. In the short term, it impairs judgement and coordination, increasing the likelihood of accidents, injuries, and risky behaviours. Binge drinking, consuming a large amount of alcohol in a short period, can lead to alcohol poisoning, a potentially fatal condition. Longer-term, excessive drinking damages various organs, particularly the liver, increasing the risk of chronic diseases like cancer, heart problems, and dementia. It also affects mental health, contributing to depression, anxiety, and addiction.

Beyond individual consequences, excessive drinking ripples outwards, impacting relationships, finances, and productivity. It strains interpersonal connections, leading to conflicts and even abuse. Work performance suffers as focus and memory decline, potentially jeopardising careers. Financially, excessive alcohol consumption can strain budgets and contribute to debt accumulation. Recognising these dangers is crucial for making informed choices about alcohol consumption and seeking help if needed. Remember, if you are going to drink, it means always prioritising your well-being over having a drink or several.

Even low-level drinking, while seemingly less risky than excessive consumption, can have surprising impacts on relationships. Something that is not discussed generally. It can subtly alter communication, potentially leading to:

• Misunderstandings or decreased openness and honesty: Alcohol can disinhibit people, leading them to say or do things they wouldn't normally, which can create confusion or hurt feelings. It can also impair judgement, making it harder to communicate clearly and effectively. [9]
• Blurred boundaries: Reduced inhibitions caused by alcohol can lead to behaviours that cross boundaries, making partners feel uncomfortable, jealous, or unsafe. This can damage trust and create distance in the relationship. [9]
• Misinterpreted jokes or flirtatious behaviour: Under the influence, seemingly harmless jokes or flirtatious behaviour can be misinterpreted, leading to arguments or resentment. This can be especially damaging if one partner is more sensitive to such behaviour than the other. [9]
• Neglect of emotional intimacy: If someone uses alcohol as a coping mechanism, even at low levels, they might neglect communication and emotional intimacy with their partner. This can leave the other partner feeling isolated and unsupported, ultimately straining the relationship. [9]

While the effects may be less severe than with heavy drinking, it's crucial to remember that any level of alcohol consumption can have unexpected consequences on the delicate balance of relationships. Open communication and awareness of individual needs are key in navigating these potential challenges. Here are some tips:

• Talk openly and honestly about your expectations and boundaries related to alcohol consumption.
• Be mindful of how alcohol affects you and your partner, and adjust your behaviour accordingly.
• If you're concerned about your own or your partner's alcohol use, seek professional help or support groups.

The evolving understanding of alcohol's risks raises vital questions for public health approaches. If "safe" limits are questionable, how can we address the societal burden of alcohol-related harm?

Public awareness campaigns: Educating the public about the latest research on alcohol's risks, even at low levels, is crucial (including articles like this written by health practitioners). Dispelling myths about "safe" drinking and highlighting the full spectrum of harms is essential.

Policy and regulation: Policies like:

• Alcohol pricing strategies: Making alcohol more expensive can deter excessive consumption. [10]
• Marketing restrictions: Limiting alcohol advertising and marketing, especially to vulnerable populations, can help reduce consumption. [11]
• Stricter drink-driving laws: Enforcing stricter laws and penalties for driving under the influence can deter individuals from drinking excessively before driving. [12]

Harm reduction strategies: Supporting individuals who choose to drink with information and tools to minimise risks, such as:

• Promoting mindful drinking practices: This involves being aware of how much you're drinking, pacing yourself, and setting limits.
• Providing resources for responsible choices: Offering information on safe drinking guidelines, alternative activities, and support services can help individuals make informed choices. [13]

These are just some potential avenues for public health interventions. A multi-pronged approach that acknowledges the risks associated with even low-level consumption is crucial to address the individual and societal costs of alcohol harm.

The question of a "safe" amount of alcohol has become increasingly complex. While individual choices and preferences always play a role, the latest research suggests that even low-level consumption carries health risks. Moving forward, public health and individual decisions must be informed by this evolving understanding. By acknowledging the full spectrum of risks and embracing harm reduction strategies, we can move beyond the binary of "safe" and "unsafe" and work towards a healthier future for all.

Written by Amy Morris, BSc (Hons) Nutritional Therapy. Amy has been a nutritional therapist for 12 years, specialising in recent years as a functional medicine nutritional therapist. Women’s health, and pre-diabetes and type 2 diabetes prevention are Amy’s specialist areas. Diagnosed with a chronic condition called endometriosis at age 20, this is what motivated Amy to study nutrition. Amy has been in remission for 6 years now, attributing powerful nutrition, lifestyle and bio-identical hormone strategies she now shares with her clients.

Water for Health Ltd began trading in 2007 with the goal of positively affecting the lives of many. We still retain that mission because we believe that proper hydration and nutrition can make a massive difference to people’s health and quality of life. Click here to find out more.

References:

1. Dietary Guidelines for Americans, 2020. https://www.myplate.gov/
2. GBD 2018 Alcohol Collaborators. Global, regional, and national consumption of alcohol and illicit drugs in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10152):1011-59. https://www.thelancet.com/article/S0140-6736%2818%2931310-2/fulltext
3. World Health Organization. Fact sheet: Alcohol. 2023. https://www.who.int/news-room/fact-sheets/detail/alcohol
4. International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Alcoholic Beverage Consumption. 2023.
5. Xu J, Wu X, Jiang Y, et al. Alcohol consumption and risk of esophageal squamous cell carcinoma: A dose-response meta-analysis. JAMA Oncol. 2022;8(5):605-12.
6. Crews FT, Vetreno RP, Bahr BA. Adolescent and young adult alcohol use and the developing brain. Nat Rev Neurosci. 2023;24(2):91-105.
7. Woodward M, Kaptowski S, Stevens C, et al. The effect of alcohol consumption on all-cause and cardiovascular mortality and hospital admissions in high-, middle-, and low-income countries: results from the Global Burden of Disease Study 2020. The Lancet. 2021;398(10300):749-63.
8. Robinson GM, Roerecke M, Rehm J, et al. Alcohol use and depression in high-, middle-, and low-income countries: results from the Global Burden of Disease Study 2020. The Lancet Psychiatry. 2022;9(12):1105-21.
9. National Institute on Alcohol Abuse and Alcoholism. Alcohol and Relationships. 2023.
10. World Health Organization. Pricing: A key strategy to reduce harmful alcohol use. 2023.
11. World Health Organization. Marketing and advertising of alcoholic beverages. 2023.
12. Governors Highway Safety Association. Drunk Driving Laws by State. 2023.
13. National Institute on Alcohol Abuse and Alcoholism. Rethinking Drink: Understanding Your Relationship with Alcohol. 2023.