January 28, 20257 min readModerate Drinking CarriesHealthRisksHere's How to Imbibe More SafelyConsuming alcohol, even in moderate amounts, is associated with health harms, but participating in Dry January and using other strategies can help limit themBy Simar Bajaj edited by Tanya Lewis Malte Mueller/Getty ImagesEarlier this month the U.S. Surgeon General released an advisory that stated that moderate alcohol consumption was associated with seven different types of cancer and called for new warning labels on alcohol products. But recently a review from the National Academies of Sciences, Engineering, and Medicine found that moderate drinking was associated with a lower risk of heart disease and death, while a competing federal report essentially found the opposite.This dizzying flurry of research comes at a time when many Americans are reevaluating their relationship with alcohol. In the name of Dry January, about a third of drinkers had said they would cut back or abstain from alcohol this month, according to a consumer trends report from the New Consumer and venture capital firm Coefficient Capital. The growing popularity of alcohol-free drinks similarly reflects how some people are forgoing alcohol year-round: global sales of nonalcoholic beverages rose from about $10 billion to $20 billion between 2019 and 2023.Scientific American spoke with experts about what the research on alcohols health effects saysand how people can limit their risk while still enjoying the occasional vice.On supporting science journalismIf you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.How Alcohol Impacts the BodyAlcohol is a leading cause of preventable death. It is associated with more than 200 health conditions across every organ system and about 100,000 deaths in the U.S. each year. Most of these harms are linked to heavy consumptionwhich national guidelines define as four or more drinks daily (or eight weekly) for women and five or more daily (or 15 weekly) for menaccording to Eric Rimm, an epidemiologist at the Harvard T. H. Chan School of Public Health.For example, people who have at least six drinks a day account for about half of alcohol-related cancer cases globally despite representing a small fraction of the overall population1 to 2 percent of women and 10 to 20 percent of men in the U.S., for example. For this group, drinking less or quitting is essential for survival.On the other hand, drinking in moderation (about one drink per day for women and two for men, respectively) poses a small risk for the average person, Rimm says. One study in the Lancet looked at 23 different alcohol-related health problems globally and found that, compared with people who didnt drink, men and women who had one drink per day had a 0.5 percent higher risk of developing a health problem over the next yearand a 7 percent higher risk if they consumed two drinks per day. To put this in terms of absolute risk, in a group of 100,000 people, 914 individuals who didnt drink were expected to develop one of these health problems compared with 918 who had one drink per day and 977 who had two drinks.For breast cancer specifically, the Surgeon Generals advisory cited a study that found that, for women, having a drink a day was associated with a 13 percent lifetime risk of developing this cancer compared with an 11 percent risk among those who had less than one drink per week. Rimm says the association is at least 20 times weaker than the one between smoking and lung cancer. Similarly, eating 50 grams of baconor about four slicesper day is associated with a similar risk of colorectal cancer as having two to three drinks per day.But the key difference between drinking alcohol and eating processed meat or smoking is awareness; less than half of Americans recognize alcohols connection with cancer, according to Jiyoung Ahn, a cancer molecular epidemiologist at NYU Langone Health. She says that alcohol itself is not terribly toxic, but the liver breaks it down into acetaldehyde, which damages DNA and plays a key role in cancer development.Another way alcohol may contribute to cancer is by magnifying the effect of other risk factors, such as smoking (by potentially speeding up the conversion of tobacco tar into carcinogens) and by increasing estrogen levels, which fuels the growth of hormone-sensitive cancers such as breast cancer, Ahn says.All these pathways in the body are linked to inflammation and oxidative stress, says Pranoti Mandrekar, a liver biologist at University of Massachusetts Chan Medical School. The metabolism of alcohol generates free radicalsessentially, unstable oxygen moleculesthat damage proteins and DNA. Mandrekars research explores how these free radicals alter certain chaperone proteins and push the gas pedal on tumor growth.As long as youre aware of these risks and the guidelines that suggest limiting your intake to just one or two drinks per day, its probably okay to have that beer at the ballpark or a glass of wine with dinner, according to Ashish Jha, dean of the Brown University School of Public Health.What people shouldnt be doing is justifying their drinking because its supposed to be healthy, says Luis Seija, an internist and pediatrician at the University of Pennsylvania. That misconception is rooted in a 1992 paper that found that moderate wine consumption protected French people against heart diseaseeven though their diet included plenty of meat, oil and butter. This conclusion was corroborated by more than 100 observational studies and even biological evidence, given that alcohol consumed in moderation increased the level of good cholesterol, thinned the blood and improved insulin sensitivity, Rimm says.But newer research has questioned some of the heart benefits of moderate drinking and has noted key limitations in many analyses. For example, nondrinkers may have had greater mortality simply because they were more likely to be poor or to have recently quit drinking for health reasons. Moderate drinkers, on the other hand, tend to exercise regularly, sleep more and have healthier habits in general, which could help explain their lower death rate.Rimm thinks the biological evidence still shows that moderate alcohol consumption offers a small benefit for heart disease and other conditions such as type 2 diabetes. But these benefits are probably averaged outor maybe even outweighedby traffic injuries, breast cancer and other risks of moderate drinking.People shouldnt wake up in the morning and say, Lets see, what disease am I trying to prevent today? Should I drink or not? Rimm says.Safer Ways to DrinkThere are various reasons to drink, from enhancing a meal to celebrating special occasions. Many people find it easier to interact and have fun and maybe feel a little less reserved while drinking, says Raymond Anton, an addiction psychiatrist at the Medical University of South Carolina.Here are a few key strategies for how to limit the risk while enjoying the occasional vice. First, people should be mindful of healthier drinking patterns, such as consuming alcohol with food and avoiding binge drinking. Food reduces the release of alcohol into the intestine and liver, so its metabolized slower, and you dont get as high an alcohol concentration, Anton says. Similarly, having four or five drinks at a Friday night party or Saturday brunch is significantly more dangerous than spreading them outand is associated with an increased risk of heart disease, breast cancer and overall mortalityeven among people who report binge drinking only once in a while.Second, people should recognize their personal risk. While it is technically true that no level of alcohol is risk-free, neither are many daily activities, from driving to eating bacon. Still, there are some groups for whom going sober might be the best policy, such as those with a family history of addiction, liver disease or cancer, Anton says. Abstinence is also important for people who are pregnant, take medications that interact with alcohol or have certain genetic conditions.Lifestyle factors are also key to the risk-benefit calculus: alcohol has a smaller impact on people who have a good diet, exercise regularly and dont smoke, according to the federal alcohol report from the Substance Abuse and Mental Health Services Administration. In fact, one study has found that although alcohol intake is directly linked to cancer risk in low-level exercisers, the risk essentially goes away among those who drink moderately but engage in at least 7.5 hours of activity per week.Anton emphasizes that exercise doesnt necessarily have a direct effect on how alcohol is metabolized, so it shouldnt be an excuse to start drinking. When people are thinking about drinking, and if they choose to do so, it should be part of a healthy lifestyle, Rimm says.Third, people can try out Dry Januarywhether that involves cutting back or quitting entirely. The all-or-nothing approach is never a good idea, Seija says, because while some people can go cold turkey, its unrealistic to demand that everyone who drinks should quit forever. Thats where this idea of sober-ish comes to play. This can involve having alcohol-free days, ordering fewer drinks or turning to nonalcoholic beverages as a way to preserve the social benefits of drinking.Preliminary research supports Dry Januarys benefits, from helping reduce peoples blood pressure, weight and insulin resistance to prompting them to reconsider their long-term relationship with alcohol. One study found that, six months after participating in Dry January, 40 percent of participants reported drinking less often and having fewer drinks, whereas 10 percent reported the opposite. The key, according to Seija, is not to do Dry January just to go binge drinking on February 1 but to perhaps find a new drinking pattern that feels comfortable and sustainable.The key takeaway: enjoy alcohol responsibly by recognizing its risks while finding a balance that fits into a healthy lifestyle. Im not trying to take away your autonomy; Im trying to at least give you the agency to make those informed decisions for yourself, Seija says.