[100-Year Life Health] Is One Drink Beneficial for Health?

Many people believe that moderate drinking or wine consumption does not pose health problems. While there is no disagreement that excessive drinking is harmful to health, it is often said that one glass of wine a day is beneficial. For decades, conflicting and contradictory studies have caused confusion about the relationship between alcohol consumption and health. However, recent research continues to show that even small amounts of alcohol negatively affect health. If you are considering whether to reduce your drinking, it may be helpful to look at the latest findings on the impact of alcohol on health.

In the 1980s, there was a hypothesis that the reason French men had a low risk of cardiovascular disease despite their usual high-fat diet was due to wine. Subsequent studies also reported an association between moderate drinking and good health, but an association does not prove causation. Existing studies have limitations as observational research, and due to design and analysis constraints, the effects of alcohol may have been interpreted positively. Most studies show a 'J'-shaped relationship between alcohol consumption and mortality or cardiovascular disease. That is, non-drinkers have a higher risk, moderate drinkers have a lower risk, and risk increases again as alcohol consumption rises. However, there were some issues in interpreting these results due to the characteristics of abstainers. First, complete abstainers are a minority and may have stopped drinking due to illness. Those who enjoy moderate drinking may also have other favorable health-related factors. They are more likely to have better socioeconomic conditions, be more active, engage in regular exercise beneficial to health, maintain healthy eating habits, and have higher education levels. In other words, the beneficial effects on health are likely due to the characteristics of moderate drinkers rather than moderate alcohol consumption itself.

The standards for moderate drinking vary by country and institution. In the United States, the limit is set at 2 drinks per day for men and 1 drink per day for women, based on 14g of alcohol per drink. Recently, the World Health Organization announced that not even a single drink is safe. For reference, the Korean Academy of Family Medicine defines moderate drinking as up to 8 drinks per week for men, up to 4 drinks per week for women and men over 65, and up to 2 drinks per week for women over 65, based on 14g of alcohol per drink. These guidelines are currently reflected in the National Health Insurance Service’s health screening evaluation criteria. However, recent studies have reported that even one drink is harmful to health, and moderate drinking increases the risk of atrial fibrillation. A meta-analysis published in March 2023 in the Journal of the American Medical Association found no reduction in mortality risk with drinking up to 2 drinks per day, and reported increased mortality risk at drinking levels equivalent to 2 drinks per day for women and 3 drinks per day for men. A 2022 study in the same journal, which included medical, genetic, and lifestyle information in its analysis, reported increased cardiovascular disease risk at all levels of alcohol consumption, with a significant increase in risk for heavy drinking.

The best research would be randomized controlled trials where some participants abstain completely, others drink one glass per day, and others maintain 2 to 3 drinks per day, followed over time. However, such studies are very costly and difficult to conduct. In fact, an attempt was made in the United States in 2013, but it was halted in 2018 after concerns arose about compromised neutrality due to funding from a liquor company.

Even one drink increases the risk of cancer and liver disease. Decades ago, the International Agency for Research on Cancer classified alcohol as a Group 1 carcinogen. Alcohol is known to increase the risk of head and neck cancer, esophageal cancer, liver cancer, breast cancer, and colorectal cancer, and associations with pancreatic and prostate cancers have also been reported. It is commonly known that alcohol is harmful to the liver, generally progressing through stages of alcoholic fatty liver (fat accumulation), alcoholic hepatitis (inflammation), and alcoholic cirrhosis (fibrosis). The first two stages can recover with abstinence, but recovery is unlikely at the third stage.

However, it is difficult to say that everyone should absolutely avoid alcohol, as individual risk varies depending on underlying diseases, family history, or lifestyle. Of course, abstinence is best, but if you are drinking excessively beyond moderate levels, reducing alcohol intake will also benefit your health. Like a sweet dessert, it may be necessary to enjoy alcohol while recognizing that even small amounts carry potential risks. At the very least, alcohol should not be consumed for health benefits.

Jo In-Young, Professor, Department of Family Medicine, Samsung Medical Center