On the heels of the surgeon general's warning about the cancer risks of alcohol, there's a growing consensus that less is better.
But this doesn't mean that people who choose to drink should give it up entirely. Though there's no precise answer on how much alcohol can be consumed without increasing health risks, many experts say an acceptable amount ranges from about one drink per week to no more than seven drinks per week.
This is significantly less than what is currently recommended. A review underway may lead to changes to U.S. guidelines this year. And many experts agree the current advice, which is up to 14 drinks a week for men and seven for women, is out of date and may be too high.
"I do think a change is needed," says Dr. Aashish Didwania, a primary care physician and medical educator at Northwestern University.
A growing body of research points to a link between alcohol consumption and an increased risk of seven types of cancers, stroke and premature death. But what's still debatable is the exact threshold at which risks increase. This likely varies from person to person based on their genetic risks and other lifestyle habits.
"My guidelines would be that drinking fewer than seven drinks a week would be a healthier way to use alcohol," Didwania says, based on his interpretation of the evidence.
Didwania says that personally, he feels comfortable drinking alcohol, but limits his consumption. "I'll have one to two cocktails a couple days a week," he says.
Research suggests daily drinking is riskier. For instance, one study found people who consume alcohol three days a week have lower risks compared to those who drink every day.
When it comes to the harms of alcohol, the science is clear that there's a dose response. The more you drink, the higher the risk of bad outcomes.
But given all the lifestyle factors that contribute to disease, everything from diet and exercise to sleep and stress, it's complex to figure out an exact amount of alcohol that's OK, whether it's one, two or zero drinks a day.
"I don't know that we're ever going to be able to get to that level of precision," says Timothy Rebbeck, professor of cancer prevention at Dana-Farber Cancer Institute.
Epidemiological studies tend to capture the big picture, by asking participants how many drinks of alcohol they consume per week, then following their health over many years. But the data is far from perfect, given inconsistencies over time, or the fact that people often underestimate how much they actually consume.
"So there will always probably be some question about whether a certain number of alcoholic beverage drinks a day is going to be the right answer," Rebbeck says.
This helps explain why physicians land on different numbers. While Dr. Didwania is comfortable with fewer than seven drinks a week, Dr. Anna Lembke says anything more than two drinks per week increases health risks.
"If you really want to stay in the non-risky drinking zone, you would be drinking no more than one to two standard drinks per week," Lembke says. She's a professor of psychiatry and addiction medicine at Stanford University School of Medicine.
A standard drink is 12 ounces of regular beer (5% alcohol by volume), 5 ounces of wine (12% alcohol by volume), or 1.5 ounces of 80-proof liquor.
The evidence does not support the idea that we all need to be teetotalers. A recent study from the National Academies found that people who consumed moderate amounts had a lower risk of heart attacks and death from heart disease, compared to people who never drink alcohol.
One possible explanation for this is that people who consume light or moderate amounts of alcohol may have other habits that can explain their good health, such as a healthy diet and regular exercise.
Researchers at the National Institutes of Health say older studies may have overestimated the benefits of moderate drinking. And despite all the talk of red wine being good for our health, Lembke says science has evolved.
She also points to gender differences when it comes to alcohol. "Women are more susceptible to the harms of alcohol than men," Lembke says.
This could be due to hormones or differences in the way females metabolize alcohol. For instance, when a woman and a man of the same weight consume the same amount of alcohol, the woman's blood alcohol concentrations will tend to rise higher, according to the National Institute on Alcohol Abuse and Alcoholism.
When it comes to breast cancer, the surgeon general's report points to one analysis that found a 10% increase in breast cancer among women who consumed up to about one drink a day, compared to those who didn't drink.
When Canada updated its alcohol guidance in 2023, public health scientists there warned that all alcohol use comes with risk. Canadian researchers concluded that breast and colon cancer risks begin to increase with as few as three to six drinks per week. The country now recommends that people consume no more than two drinks per week, in order to avoid alcohol-related harms.
There are several mechanisms by which alcohol increases cancer risk that are clear. For example, when we drink alcohol, our bodies break it down into acetaldehyde, which is a carcinogen. "Acetaldehyde is a chemical that can lead to DNA damage. It can lead to other changes to cells that push them in the direction of a tumor," Rebbeck explains.
The advice to abstain during pregnancy is well established, and it's against the law to drive or operate heavy machinery if blood alcohol levels are elevated above a certain level. Doctors also warn cancer patients that alcohol can increase the risk of recurrence.
"I would encourage individuals to be aware of the amount of alcohol they are consuming," says Dr. Sarah Leitz, an addiction medicine physician at Kaiser Permanente in Portland, Ore.
She cautions there are many people who have trouble controlling their consumption. Alcohol Use Disorder, which falls along a spectrum and can be mild, moderate or severe, can be treated with medications and therapy. Leitz says many people who struggle with alcohol find abstaining is most effective.
For people who want to assess their own drinking habits, there's a simple tool that can help. It's a self-assessment quiz known as the CAGE questionnaire that asks four questions:
Have you ever felt you should cut down on alcohol? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to get rid of a hangover?
If you answer yes to any of these questions, it's a sign you may want to explore your relationship with alcohol further.
This story was edited by Jane Greenhalgh.
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