Is moderate drinking good or bad?
What amount of alcohol can I safely drink?
We might have quite different, discordant feelings about moderate drinking today. On the one hand, we associate having a drink or a glass of wine with good times—sharing a meal with family members or friends we love, laughter, fun, quiet conversations. On the other hand, we hear warnings from health authorities about the damage alcohol can do to our bodies, such as the Surgeon General’s warning in January.
Is there a balance between the two? Is any amount of alcohol safe for you to consume? How do you judge what is right for you? I will try to help you answer these questions in this article. The evidence available for finding the answers has significantly improved and expanded in recent years.
How large is one drink?
So that we start from the same place, look again at the picture above. How much wine is in each glass? Is the glass half full or a “full glass of wine?” I am quite sure that each glass has about five ounces of wine, and this is the universal standard definition of “one glass of wine.” If you want to manage your drinking, this knowledge is key. Measure out five ounces into the glass you usually use so you will know when you have reached a full glass.
For other types of alcohol, a standard glass of beer is twelve ounces, and one drink of distilled spirits or liqueur is one and a half ounces. We will use these definitions throughout our discussion.
The history of moderate drinking
We may have imbibed alcoholic drinks for an exceptionally long time. Some consumption of alcohol may go back to pre-human days about ten million years ago when our ancestors developed a gene mutation that increased the ability of our bodies to metabolize alcohol. One professor of biology, Robert Dudley at the University of California, Berkeley, has observed inebriated baboons and chimps who consumed fermented fruit. The alcoholic content of overripe fruit in the wild tested as high as eight percent, about the same as some beer and wine.
Based on this history, some would claim that consumption of alcohol is programmed into our physiology (we will look at what happens in your body later}. And indeed, with some exceptions, alcohol consumption is found in almost all cultures. However, the amount, types, and characteristics of alcohol available today have expanded well beyond the beer and wine drunk a thousand years ago. Like many other products consumed in our culture today, we have used modern refinement and manufacturing methods to make many of the products more appealing but also much more dangerous. They are also more available and easier to obtain.
But sticking to the basics, are there any benefits to consuming alcoholic drinks?
Possible positive outcomes
In the best of circumstances, wine or a cocktail can be social lubricant that facilitates friendship and intimacy with those you are close to. These relationships not only add depth and joy to your life, but they also impact your health. Good social connections can add 3.5 years to your life, and adults with a good relationship with a spouse or partner live longer and experience less disease. (Beer has some other problems we will discuss below.)
Wine or other alcoholic beverages may facilitate positive social and partner interactions, but are they necessary? When at social events, a friend of mine often holds a glass of wine or a non-alcoholic drink that looks like a cocktail in his hand but drinks little or none of it. Works for him.
More than other types of alcohol, wine does contain tiny amounts of beneficial plant polyphenols like quercetin and resveratrol, but many other foods far outdistance the amounts you will get from five ounces of red wine. Organic or wild blueberries or raspberries, green tea, and onions contain significant amounts of these healing polyphenols, and more, but without the risk of alcohol.
Other claimed health benefits by some sources, especially for wine, have been based on studies with methodological flaws or were influenced by the alcoholic beverage industry. In fact, in 2018 the National Institute on Alcohol Abuse and Alcoholism had to shut down a $100 million study on moderate drinking and heart disease when it discovered that large alcohol companies like Anheuser-Busch and Diageo had directly influenced the design.
More recent independent research has contradicted any modest health claims, such as improving cardiovascular health or lowering the risk of colorectal cancer. If any of these benefits are real, they disappear above an extremely low level of consumption, about a half glass (2.5 ounces) of wine a day.
What happens when you drink alcohol
The biological process and short-term impact on your body helps us understand why we continue to drink these questionable beverages:
Absorption When you drink alcohol, about a fifth is absorbed directly from the stomach, with the majority absorbed from the small intestine. This is much quicker than most foods, and because alcohol is water soluble, it spreads rapidly through the whole body.
Circulation Alcohol rapidly reaches blood vessels, water-containing tissue, and organs in all parts of the body, including the brain.
Brain Effects Unlike most substances, alcohol crosses the blood-brain barrier to affect neurotransmitter activity: (1) boosting chemicals that lead to relaxation and even drowsiness, (2) suppressing glutamate, which impairs thinking and coordination, (3) stimulating dopamine, leading to feelings of pleasure and reward. These effects keep us drinking.
Detoxification The largest solid organ in your body, the liver, controls most attempts to eliminate or neutralize toxins. When the liver detects alcohol in your blood, other critical work stops, such as supporting energy creation, to deal with the three-alarm fire of eliminating this top priority poison. However, this detox process itself creates a cancer-promoting compound, adds fat to the liver, and damages the mitochondria energy factories in the liver and brain.
Elimination After detoxification, alcohol has been converted into carbon dioxide and water and leaves the body in urine or through breathing.
How does “moderate drinking” affect your body?
The CDC defines moderate drinking as no more than one drink (5 oz of wine, 12 oz of beer, or 1.5 ounces of spirits) per day for women and no more than two drinks per day for men. However, even this level can create significant problems for most of us:
Creates poor coordination that can lead to injuries from falls
Produces foggy, slow thinking that leads to automobile accidents and deaths
Disrupts serotonin and releases adrenaline, damaging the quality and length of sleep, which is critical for your health
Causes inflammation and oxidative stress in the brain, leading to brain shrinkage, poorer memory function, and mild cognitive impairment
Increases insulin resistance, leading to diabetes, Alzheimer’s, heart disease and a host of other chronic conditions
Increases blood pressure and often, leads to fatty liver disease, especially when combined with the fructose part of refined sugar that most people consume
Depletes stores of antioxidants in your cells and generates damaging free radicals
Increases the likelihood of seven types of cancer, especially for women (See the U.S. Surgeon General’s report published in January 2025 on Alcohol and Cancer Risk)
Damages your microbiome, leading to leaky gut or gut dysbiosis (a chronic condition of pain, diarrhea, bloating, discomfort, weakness, etc.)
Damages your mitochondria energy factories, which can lead to fatigue in the short term and chronic disease in the long term
We all know that excessive drinking, defined as more than one (women) or two (men) drinks per day can lead to addiction, a multiplication of these effects, and fatty liver disease. But the lengthy list of short- and long-term problems from moderate drinking should give us pause.
The decreasing tolerance problem
Like me, you might have noticed that you cannot handle the same amount of alcohol you did when younger. This shared experience is not your imagination! One drink at age 65 might affect you the same as two or three drinks did in your twenties or thirties. As you age, your body’s ability to handle alcohol decreases, and the sensitivity to it increases. Some of the reasons include:
You lose body water as you age, with less ability to absorb the alcohol
The enzymes that process alcohol diminish with age
The brain becomes more sensitive to alcohol with age, impacting judgement, reaction time, and driving ability
You are more likely to be using pharmaceutical drugs or over-the-counter products like pain relievers or sleep aids that interact with alcohol
Because women have less body water and fewer stomach enzymes than men, these changes affect women even more. Some experts feel the changes that occur by age 60 or 65 should trigger a reduction in the level that the CDC considers safe.
Is any level of consumption safe?
The latest research is constantly revising our understanding of what is safe. In 2023, the WHO (World Health Organization) declared that no level of alcohol is safe to consume. It leads to over a hundred chronic conditions and is responsible for causing over three million deaths worldwide every year. We can no longer consider moderate drinking safe!
Eliminating alcohol from our diets may be the best course, but we should at least consider consumption well below the “moderate” level. Just one drink a day increases your risk of high blood pressure and a stroke. Even drinking an average of one half a glass of wine a day increases the risk of cancer. However, few research studies find a significant problem below this small amount, suggesting that occasional use may not be hazardous. Some experts suggest:
Consider eliminating alcoholic beverages from your diet, with only limited exceptions, if any, for special occasions (limited to one drink or less)
Limit any ongoing consumption to less than three drinks a week. For instance, limit drinks to a few per month or one glass per weekend. My personal decision has been to no longer have a small glass of wine with dinner but have one-half a glass at weekend dinners only.
If you have a chronic disease or a condition that will lead to one, be more restrictive in limiting consumption. This includes an elevated level of inflammation or a HOMA-IR score over 1.8, indicating significant insulin resistance (see my post on “The Train Wreck - Insulin Resistance”), or being significantly overweight or obese.
Be selective about the beverages you consume:
Avoid beer, which is the most hazardous to your health. In addition to the effect of alcohol, the gluten and significant level of carbs beer contains will add weight gain and may cause leaky gut that can lead to autoimmune diseases.
Avoid any alcohol made from grains, including beer, whiskey, bourbon, and some liqueurs. In addition to gluten, the grains contain substances that trigger poor nutrient absorption, chronic inflammation, and digestive problems. Gin, rum, brandy, cognacs, and most vodka are not made from grains and are better choices.
Severely limit or avoid sweet alcoholic drinks, such as sweet liqueurs or drinks including any syrup, sugar, or flavoring or those mixed with soft drinks or other sweetened beverages. These will spike blood sugar and create insulin resistance, leading to a variety of chronic diseases.
Choose dry wines, such as red wines like pinot noir, malbec, merlot, and cabernet sauvignon or white wines like pinot gris, chardonnay, or sauvignon blanc. Avoid or severely limit sweet wines such as sauternes, ice wine, dessert wines, or sweet ports.
Never consume alcohol on an empty stomach to avoid magnifying the impact on your body and overwhelming your liver’s ability to metabolize it.
Measure your consumption to better manage what you consume. Keeping a written record of what you drink and how it affected you will also help.
These steps become more important, even critical, as you age. If you are trying to prevent chronic disease, or deal with the disease you have now, these steps become essential. Get healthy first before drinking that next glass of wine or shot of spirits!
Note: Based on the writings of many functional medicine doctors, including Drs. Will Bulsiewicz (Fiber Fueled), Robert Lufkin (Lies I Taught in Medical School), William Davis (Undoctored), Michael T. Chang (Mitochondrial Dysfunction), Casey Means (Good Energy), and Georgia Ede (Change Your Diet, Change Your Mind).