How Much Alcohol Is Too Much?

We’ve been told a lot in recent years about the protective effect of moderate alcohol use. It’s a message that people are eager to hear. But how much alcohol is too much?

When drunk to excess and over a long period of time, alcohol can damage the liver, as well as increase cancer risk.

I’ve argued that much or most of the association between moderate drinking and better health is not causal, but related to the fact that the higher your intelligence, the more likely you are to drink, and higher IQ is associated with longer lifespan and better health.

If the effect of drinking on health were controlled for IQ, the answer might become more definitive.

Whether alcohol causes better health or whether it merely associates with it, we do know that heavy drinking causes disease. What constitutes heavy drinking?

Alcohol and cirrhosis

Perhaps the most serious disease associated with alcohol is cirrhosis of the liver, in which the liver becomes scarred and fibrotic and loses function.

One consequence of cirrhosis is bleeding, since the liver makes blood clotting factors.

Long ago, when I worked in blood banking, I was fascinated (morbidly?) by the fact of hard-core alcoholics needing transfusions. It’s a relatively frequent occurrence. I asked a doctor friend who sometimes treated these people how much drinking was necessary to cause the need for a transfusion.

His reply: a bottle of liquor a day for ten years.

Damn, that’s a lot of booze. I did a little research recently and it turns out that his estimate is indeed in the ballpark.

A paper called “Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse” details the investigations of a doctor who looked at hundreds of alcoholics at a clinic in Germany.1

Several factors must be taken into account for the study of alcohol and its relation to health and disease. Among these are

  • amount
  • lifetime duration
  • intensity

Getting a handle on these is difficult due to high variation among drinkers, recalling amounts and times, differences in the type of alcohol, male vs female, etc.

The doctor found the results shown in the following graph, which charts the incidence of cirrhosis versus lifetime alcohol intake in grams per kilogram of body weight per day, multiplied by the number of years of drinking. This is helpfully translated into lifetime equivalent intake of liters of 100 proof whiskey.

cirrhosis

At a total lifetime intake of 7,100 liters of 100 proof whiskey, you’re guaranteed to get cirrhosis. However, 50% of the alcoholics had cirrhosis at an intake of about 2,000 liters.

That’s a lot of drinking.

Nevertheless, it’s estimated that only between 8 and 30% of alcoholics show signs of liver damage. You can also see in the above chart that some drinkers got liver damage at much lower levels of drinking. What accounts for this?

Diet and alcohol

One variant between people who experience liver damage and those who don’t may be diet.

Dietary saturated fat protects rats from alcohol-induced liver disease. In fact, saturated fats not only protect, but reverse it.2

Rats that were fed both ethanol continuously plus palm oil showed a reversal in liver damage due to down-regulation of COX-2 and TNF alpha.

Rats that were fed ethanol plus fish oil showed the worst liver damage.

In another experiment by the same group, beef tallow wholly prevented alcoholic liver disease in rats, whereas those fed corn oil got a severe case of it.3

So, it could be that among humans, those who get cirrhosis eat a high amount of polyunsaturated fats. Those who don’t may eat lots of meat and butter.

Normal drinking and liver damage

We now have a ballpark figure of how much alcohol causes liver damage. Generally, it’s a lot.

What about “normal” drinking, say, a couple glasses of wine or a couple cocktails in the evening — does that have a potential to cause damage?

A “standard drink” in the U.S. is deemed to be one that contains 14 grams of pure ethanol. Translated into everyday terms, a standard drink is

  • one 12-ounce beer, if that beer is 5% alcohol
  • one glass (5 ounces) of wine, at 12% alcohol
  • 1.5 ounces of spirits, at 40% alcohol

In “A meta-analysis of alcohol consumption and the risk of 15 diseases”4, the authors found

Strong trends in risk were observed for cancers of the oral cavity, esophagus and larynx, hypertension, liver cirrhosis, chronic pancreatitis, and injuries and violence. Less strong direct relations were observed for cancers of the colon, rectum, liver, and breast. For all these conditions, significant increased risks were also found for ethanol intake of 25 g per day.

Conclusions. This meta-analysis shows no evidence of a threshold effect for both neoplasms and several non-neoplastic diseases. J-shaped relations were observed only for coronary heart disease.

The effect of alcohol in causing disease showed no threshold effect — that is, any amount led to increased incidence of a number of cancers as well as liver and pancreatic damage, as well as the more obvious injuries and violence.

Significantly increased risks were found at consumption of more than 25 grams of ethanol daily, that is, the amount in about 2 drinks.

They found a protective effect of alcohol only for coronary heart disease, with a minimum risk at up to 20 grams of ethanol daily, or less than 2 drinks — although up to 72 grams a day, or about 5 drinks, still showed protection.

While heart disease is the leading killer of Americans, cancer isn’t far behind.

If you’re in shape, eat right, exercise regularly, do the important things for your health, you’re likely at low risk for heart disease already.

Drinking alcohol won’t offer you additional protection from heart disease. It will, however, increase your risk of cancer and a number of other conditions that you don’t want.

Alcohol and blood pressure

Regular drinking has a significant effect in raising blood pressure.5

However, blood pressure drops rapidly upon cessation of or even cutting back on drinking, within a few days.6 Alcohol consumption increased blood pressure only if that consumption was in the 3 days prior to blood pressure testing. If the consumption was prior to 3 days before examination, no effect was seen.

If you’ve been told you have high blood pressure, and you drink alcohol, abstaining from drinking for a few days and retesting may be wise. It could save you from being medicated for it with drugs that have a high incidence of adverse side effects, like fatigue.

Conclusion: Moderate drinking

Heavy drinking has well-defined adverse effects, but we’re told that moderate drinking of a couple drinks daily may be protective when it comes to heart disease.

Moderate drinking may be protective, or there may just be an association among intelligence, health, and drinking. And the protective effect of alcohol with regard to heart disease is typically seen in older populations and/or those who have a high background risk of heart disease.

If you’re in-shape and/or less than old, alcohol probably won’t decrease your risk of heart disease.

However, moderate drinking can cause other illnesses, including cancer.

I’m forced to conclude that the benefits of alcohol have been overblown. However, in moderate drinking, the risks may be small — nonetheless, they are there.

Don’t fool yourself that your moderate drinking is good for you. It facilitates social interaction, makes you temporarily less anxious — but good for your health? Seems doubtful.

I don’t intend this article to be an exercise in puritanism. I like a drink myself, and perhaps for that reason wanted to get to the bottom line on alcohol and health.

PS: Whether you drink or not, staying in good shape is your best bet for health; find out how in my book Muscle Up.

PPS: Check out my Supplements Buying Guide for Men.

 

  1.  Lelbach, Werner K. “Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse.” Annals of the New York Academy of Sciences 252.1 (1975): 85-105.
  2.  Nanji, Amin A., et al. “Dietary saturated fatty acids down‐regulate cyclooxygenase‐2 and tumor necrosis factor alfa and reverse fibrosis in alcohol‐induced liver disease in the rat.” Hepatology 26.6 (1997): 1538-1545.
  3.  Nanji, Amin A., Charles L. Mendenhall, and Samuel W. French. “Beef fat prevents alcoholic liver disease in the rat.” Alcoholism: Clinical and Experimental Research 13.1 (1989): 15-19.
  4.  Corrao, Giovanni, et al. “A meta-analysis of alcohol consumption and the risk of 15 diseases.” Preventive medicine 38.5 (2004): 613-619.
  5.  Puddey, Ian B., and Lawrence J. Beilin. “Alcohol is bad for blood pressure.”Clinical and Experimental Pharmacology and Physiology 33.9 (2006): 847-852.
  6. Maheswaran, Ravi, et al. “High blood pressure due to alcohol. A rapidly reversible effect.” Hypertension 17.6 Pt 1 (1991): 787-792.
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Leave a Comment:

50 comments
Ross says August 28, 2016

Down regulating COX-2, eh? My friend “vitamin I” (ibuprofen) does that, too.

Thanks good article. Wished you’d found an exclusion for type of alcohol…:-)

A meta-analysis regarding congeners, perhaps?

Reply
    P. D. Mangan says August 28, 2016

    Hi Ross, the research I read found no difference in type of alcohol with regard to health effects, although beer has more of an association with being overweight.

    Reply
How Much Alcohol Is Too Much? – Technology and Longevity Feed says August 28, 2016

[…] Original Article: How Much Alcohol Is Too Much? […]

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TAL Feed says August 28, 2016

Another excellent article!

I’ve been contemplating removing Alcohol altogether after hearing about the increased cancer risk. Not sure if I can do it though. I like some red wine or a beer.

I make sure to have 2 days off completely without any, and drink plenty of green and white tea, which hopefully offsets it somewhat.

There is a very interesting part in the book; The Island where they refuse to die (can’t remember the full title off the top of my head) where it said that their wine is extremely strong compared to others.

If you haven’t read that book, it’s the one based on a Greek island where the people live very long lives, and it’s full of recipes and looks at their diet. It’s a good read for sure.

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    P. D. Mangan says August 28, 2016

    Thanks! I would have trouble removing it from my routine too. It just seems the perfect thing for about 5 PM.

    Reply
    Kathy Guerra says September 4, 2016

    The Blue Zones, the Greek island of Ikaria I believe. Good read!

    Reply
Herman Rutner says August 28, 2016

I dined with a friend in ME who drank only 1 glass of wine since he feared that 2 glasses may raise his blood alcohol to over the state limit if tested shortly after drinking. It apparently takes anout 1 hr to metabolize the alcohol in 1 glass of wine depending on the type of fat in the food. Sugar may also slow down alcohol metabolism. Food for thought to the wise!

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    P. D. Mangan says August 28, 2016

    One of the variables I came across but didn’t manage to include in the article was the intensity of drinking, which is what you’re referring to. If you had an IV drip of alcohol, you could ingest a couple dozen drinks a day without feeling a thing. Obviously no one drinks like that. Real damage comes from getting drunk, in which the blood alcohol level goes high and becomes toxic. Hence binge drinking is the most damaging.

    Reply
David Nystrom says August 28, 2016

I believe there are three real effects of alcohol consumption that are health protective:

1. The CHD effect appears to be real. In addition to down regulating COX-2, alcohol is a blood thinner. It should therefore have similar effect to aspirin.

2. Stress and anxiety relief. We’re always told that alcohol is an unhealthy way to regulate stress, but compared to the alternatives most people employ it might not be so bad. Particularly in moderation.

3. Combating loneliness. Unless you’re part of a religious group that practices prohibition, most socialization involves alcohol. How many friends do non-drinkers have?

Is it worth the costs? Maybe not. Speaking from my n=1 personal experiments, alcohol even in fairly moderate quantities causes me sleep disruption (note: can be avoided with specifically disciplined drinking wherein I consume no more than three drinks and end at least four hours prior to bedtime, not realistically sustainable), more frequent and less healthy stools, and most notably of all skin inflammation.

Ethnic factors need also to be considered. We all know Indians (feather) can’t handle fire water and that Asians get loaded fast, but there are distinctions beyond this. Northern Europeans have a tendency to binge drink that Southern Europeans simply don’t have. For many of us abstaining in general is a preferable strategy.

If you’re not a Mediterranean, alcohol is at best a double-edged sword, and this is even before considering the social costs.

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ziel says August 28, 2016

Thanks – excellent summary of a topic near and dear to (some) of our hearts! I don’t have a great family history when it comes to alcohol, so while I drink too much probably less than I might considering:)

One thing I’ve observed (I might be all wet here) is that the businessman-alcoholic syndrome seems to be a thing of the past. It seems 30 to 40 years the heavy-hitter successful businessman who was a severe alcoholic was a somewhat common phenomenon, and I’ve known a few who’ve gone AA or died premature deaths (often of cirrhosis). But I don’t see that really anymore. There seems to have been a strong cultural shift away from alcohol consumption. I assume it’s due to the more stringent DUI laws – have you observed such a shift over the last few decades?

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    P. D. Mangan says August 28, 2016

    Yes, I concur. My late Dad told me that he used to go out for lunch and drink several martinis, then go back and work in the afternoon. I think that was relatively commonplace, and it’s all but unheard of now. If you worked for someone else, you’d get fired for drinking on your lunch hour. Basically, getting drunk was considered cool a few decades ago, now, not so much.

    Reply
G Vinyard says August 28, 2016

Old UK study = Omega 3 vanquishes hangovers. Big dose required, before or after drinking. Seemed to work for me. Maybe it was placebo effect. Can you confirm?

Reply
    P. D. Mangan says August 28, 2016

    Afraid I don’t know that one. However, n-acetylcysteine may work. Alcohol depletes glutathione levels, NAC replenishes. Magnesium could help too.

    Reply
G Vinyard says August 28, 2016

I often consult the large number of Durk Pearson articles as he tackles so many interesting questions. Here is his answer tho I believe this goes back to the 80’s: http://www.life-enhancement.com/magazine/article/1141-going-to-a-party-be-prepared

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Jer says September 1, 2016

How disappointing! However, it won’t stop me drinking. Based on a line you included in one of your articles (possibly as a joke in retrospect) which said that French/Mediterranean people don’t limit themselves to a glass a day…more like a bottle….and that that might account for their health, I took the advice on the benefits of booze as as an order! While it may not be causative of good health, at least it’s associated therewith, and so for the purpose of status signalling to annoying people claiming to know the difference between claret and beaujolais and for persuading medically aware people that I am of above average intelligence, i will continue to imbibe with a heavy heart…

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    P. D. Mangan says September 2, 2016

    Hey Jer, sorry to disappoint! I do think that wine as an iron chelator could have something to do with the Med diet, also wine polyphenols likely have other effects. So it’s not all about high IQ people drinking so far as we know. I like wine and stronger alcohol myself, have no intention of quitting. However, I do have the intention of lowering my usage of it.

    Reply
jer says September 3, 2016

Wait…what? (it’s funny how that has become an idiom). You only drink 2 glasses of red a day you’ve said previously. Going down to 1 a day is spartan!! Almost better to eliminate completely to avoid the temptation.

Reply
    P. D. Mangan says September 3, 2016

    Yeah, I think just having a dry day is better than limiting it to one drink.

    Reply
Weekend Link Love – Edition 416 | Mark's Daily Apple says September 4, 2016

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Weekend Link Love – Edition 416 - Health Services Online says September 4, 2016

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joe says September 4, 2016

There is ten times or more clinical evidence refuting all of your outlandish claims.

It’s all documented in The Good News About Booze by Tony Edwards:

http://www.dailymail.co.uk/health/article-2512175/Alcohol-good-health-Leading-science-writer-claims-tipple-prevent-cancer-help-improve-sex-life.html

You sound like a crypto temperance league agent trying to scare a gullible public since prohibition didn’t work.

Reply
    P. D. Mangan says September 4, 2016

    Show me where I made outlandish claims. Everything in that Daily Mail article is an association, and teetotalers and drinkers, or light drinkers and heavy drinkers, are different kinds of people. There are no randomized controlled trials in which a group of people were instructed to drink, and another to abstain, and followed for a period of years.

    Reply
David Mitchell says September 4, 2016

Chris Masterjohn has an interesting article on the lack of choline in the diet (think liver and egg yolks) could be a major cause of fatty liver–alcohol induced or the non-alcoholic kind produced by too much fructose in the diet. It seems choline is necessary to de-fat the liver.

http://chrismasterjohnphd.com/2010/11/23/sweet-truth-about-liver-and-egg-yolks/

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    P. D. Mangan says September 4, 2016

    Thanks, David. Good thing I eat lots of eggs.

    Reply
      peter connor says September 4, 2016

      I notice that egg yolks also block uptake of iron, a big plus for me….

      Reply
Steve says September 4, 2016

I really liked this honest and well written post. So how much do you drink?

Reply
    P. D. Mangan says September 4, 2016

    Thanks, Steve. usually a couple of glasses of wine, occasional scotch, most days of the week.

    Reply
      Steve says September 4, 2016

      It’s beer and Irish whiskey for me, most days. I am trying to switch to weekends only. Maybe we could get a mutual support group or a challenge growing here.

      Reply
        Nick says September 4, 2016

        I’m a beer drinker, haven’t had a day without at least one beer in literally a couple of decades. Colds, flu…whatever. The past several years have seen me oriented towards lower-alcohol beer, like what is common in British and Czech pubs: 4% ABV or less. And I consume on the order of 3 – 4 x 60 cl glasses (bit more than 3 – 4 UK pints) a day.

        Which is too much, of course, being I’m of average size. Looking at yesterday’s 180 cl of 3.7% beer + small glass of wine, I got 50 of my daily total of 130 g of carbohydrate through drink. Plus the 60 g of alcohol, another “nutrient” macro or whatever. If it weren’t for my beer intake, I’d be on a low-carb feeding scheme. And I’d be obscenely ripped, I think.

        But now that I’m 51 and am re-orienting how I feed and exert myself with the goal of looking like this website’s author, I’m keeping better track of it. Specifically, trying to keep it at 3 big low-alc beers a day. I just have to re-orient towards a lime-n-soda in the evenings instead of that extra beer or ale. When I’m at home, at least.

        Reply
          Steve says September 5, 2016

          Sounds quite familiar. I’m the same age as you (exactly). Craft beer is more my thing… IPA, etc. VERY high in carbs. My only body fat is in the gut and intermittent fasting every day keeps it in check but without the beer I’m be ripped. I really have to take the week days off. If I crack one I can’t really keep it to one or two (or three or four).

          Reply
          Nick says September 6, 2016

          I lived in Oregon from 93 – 04, during the explosion of microbreweries & brewpubs. (Guess the explosion hasn’t stopped.) And so like you, that stronger sort of beer was what I drank back then. It’s only been the last decade, living in Germany, when we started visiting England & Wales that we got onto lower-abv beer, which is what you traditionally find in pubs there. But it’s still flavo(u)rful like “craft” beer is, just generally not as strong. You can drink it down without getting so sloshed.

          I wonder though, is your IPA really that more carb-loaded than my 3.8% session beer? It depends on the residual sugars after fermentation. IPA is generally dry and pale, meaning there should be minimal sugar left over, on the order of the same or less than the weight of alcohol present. It’s really strong, sweeter beers that have more residual sugars. The yeast just poops out and doesn’t ferment really strong beers as completely. Also darker beers will have malts in them that are not as fermentable as pale malts, resulting in more residual sugars.

          My very simpleton investigation led me to figure that 5% abv pale beer will contain 4% alcohol by weight and 3.6% carb/sugar by weight. So 12 oz. / 355 ml will contain 14 g alcohol and 13 g sugar. Alcohol delivers 7 cal/g and sugar 4, so that beer will deliver about 150 calories.

          Convert % ABV to % ABW by multiplying by 0.8 , then multiply this times milliliters (grams) of beer to get grams of alcohol. Multiply that by 0.9 to get grams of carbs. Should be linear for beer strength, more or less.

          Either way, beer is sadly UNhelpful in the pursuit of fitness.

          Had two of my 60 cl 3.7% beers yesterday, plus some red wine with supper. I can live with that. But when I’m out on a piss-up crawl through English pubs, it can be a 10-pint day. Day after day.

          I’ve no idea how to figure how much residual sugar various wines contain, but I generally only drink wine with certain meals.

          Reply
          Steve says September 6, 2016

          You’re obviously an enlightened individual! I never do the math because I don’t want to know the answer, but I can easily put away 10 pints. Most nights it’s five or six. I had just assumed IPAs had more calories because of the strong flavo(u)r. I’m no fan of sweeter beers and beers that have been defiled by fruit, so those don’t enter into the equation. Most days per week I ride my bike to and from work (over an hour each way), do daily calisthenics, and never take in calories before about 2:00 PM. Those three things have allowed me to be fairly open-ended about my beer habit without too much negative consequence. But you are right, beer is no friend to the trim waistline, especially in the middle aged male. If I could just follow the 80/20 rule on this, I think I could have my cake and eat it too. If…..

          Reply
          Nick says September 18, 2016

          Enlightened? Nah, I’ve just had beer as a serious hobby for a long time, including homebrewing. So I’ve learnt a few of the technical specifics along the way.

          One thing I’ve read is that beer does not seem to trigger a large insulin reaction, although it contains some sugar. In a small study, 5 fasted men drank TWO LITRES IN AN HOUR. Perhaps unsurprisingly, “a substantial rise in the blood alcohol concentration occurred”. But insulin had only a “short-lived” increase.
          http://www.ncbi.nlm.nih.gov/pubmed/7046102

          Reply
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Thomas Weaver says September 5, 2016

I appreciate this article. Well written, to the point. I had not thought about the other risks as well. For the healthy, and those on basically a paleo diet with saturated fats, basically not at risk for heart issues, but still at risk for potential cancer. Food for thought.

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Shaq says September 12, 2016

Drink up! Looks like exercise is the cure….

http://edition.cnn.com/2016/09/07/health/exercise-alcohol-and-death-risk/index.html

Reply
Matt.E says September 16, 2016

I’ve always found intoxication to be idiotic, and I don’t care if that makes me sound “puritan”.

I’m glad there are others who agree with me, because in my younger years I was a gaslighted pariah for just saying these things.

I’ve noticed that heavy drinkers often look prematurely aged. I rarely drank and people think I’m in my early 20s, but I’m early 30s.

I think all the hate I got on this matter was pure jealously, and I spit that spite right back at them from deep within my heart when I behold these washed up degenerates today.

This article is comforting because I validates my choices even though everyone around me at the time was giving me nothing but hate for not being a drunk bum.

Reply
    Nick says September 18, 2016

    I went through a long period of my youth totally teetotal. I don’t regret it, and my social circle in those years was mostly of a similar mindset. So, we went out and had all kinds of fun without drinking at all. I can’t imagine having gotten through college if I hadn’t been booze-free then.

    OTOH, now that I’ve been a daily drinker for about 2-1/2 decades, people still think I look ten years younger than I am, especially now that I’ve started working on proper fitness and feeding myself properly.

    Reply
Joshua says September 29, 2016

One thing I wonder about is the influence of confounding variables upon cancer risk in moderate drinkers. It seems pretty clear that alcohol is protective against CHD risk. It also seems clear that it’s not protective against the various cancers mentioned in the study (esophagal, colon, etc.). However, I think we must consider the possibility of an “unhealthy user bias”. Perhaps alcohol is never helpful nor harmful for these cancers, but people who drink moderately are more likely than abstainers to be sedentary and eat poor diets.

Or at least, this is what I’ll tell myself later as I pour that 2nd glass or red wine. 🙂

Reply
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Joshua says October 10, 2016

One the other hand, I found this study which suggests that drinking up to 5 glasses a day (!!) of wine actually REDUCED all-cause mortality. Sounds crazy, but here you go:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2549555/

Wine drinkers, bottoms up?

Reply
    P. D. Mangan says October 10, 2016

    Very interesting, Joshua, thanks for bringing it to my attention. Assuming that the results are valid, the effect of wine seems due not to alcohol but maybe to polyphenols or some other constituent, since beer and spirits didn’t have the same effect. Nevertheless, can’t argue with results.

    Reply
Joshua says October 12, 2016

Agreed, wine seems to be the drink of choice for health. Long story short, I think I’ll stick with my 1-2 glasses of red wine / day habit….and if occasionally I have a bit more, I won’t worry about it. (Worrying about it would probably be worse than the actual drinks anyways!)

Reply
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