Alcohol in Moderation: What the Current Guidelines and Research Actually Say
Alcohol in Moderation: What the Current Guidelines and Research Actually Say
Alcohol in moderation has long been one of the few areas in nutrition that has been clearly defined. Yet even with specific numbers, the conversation around alcohol has never been simple.
Previous Dietary Guidelines stated that adults of legal drinking age could choose not to drink, or drink in moderation by limiting intake to one drink per day for women and two drinks per day for men, on days when alcohol was consumed. The updated Guidelines have shifted that language. They now state, “Consume less alcohol for better overall health.”
That is a meaningful change and is partially addressed in a couple of my prior blogs.
Read More: Where the 2025–2030 Dietary Guidelines Fall Short
Read More: When Science Meets Politics: What Happened to the Advisory Committee’s Recommendations
Instead of defining a specific daily limit, the emphasis is now on reducing intake overall. The Guidelines also clearly state that some people should completely avoid alcohol, including pregnant women, individuals recovering from alcohol use disorder, or who cannot control the amount they drink, and those taking medications or living with medical conditions that can interact with alcohol. Individuals with a family history of alcoholism are encouraged to be mindful of their intake and patterns of use.
This reflects what the research has increasingly shown over the past several years.
What the Current Research Shows
Alcohol is classified as a Group 1 carcinogen, meaning it is a known human carcinogen in the same group as tobacco use and asbestos. Even at low levels of intake, alcohol increases the risk of certain cancers, including breast, colorectal, liver, esophageal, and head and neck cancers. The risk is dose-dependent, meaning the more alcohol consumed over time, the greater the risk. However, research now supports that risk begins at low levels, not only at heavy use.
Earlier observational studies suggested moderate alcohol intake, particularly wine, might offer cardiovascular benefits. More recent analyses have questioned that conclusion. Some of the observed benefits appear to have been influenced by differences in lifestyle, income, healthcare access, and baseline health between moderate drinkers and non-drinkers. When those factors are more carefully accounted for, the protective effect becomes much less clear. Yes, we must consider multiple factors, not just one.
For heart health, the current understanding is that any potential benefit is small and does not outweigh cancer risk for many individuals.
The American Heart Association does not recommend that anyone start drinking alcohol for heart health.
The American Cancer Society states that it is best not to drink alcohol. For those who do choose to drink, limiting intake is advised because even small amounts increase cancer risk.
TheAmerican Diabetes Association acknowledges that alcohol can affect blood glucose levels and may increase risk for hypoglycemia, especially in individuals using insulin or certain diabetes medications. Moderation and careful monitoring are emphasized.
Who Should Not Drink
Certain populations should completely avoid alcohol:
Pregnant persons or those trying to become pregnant, due to the risk of fetal alcohol spectrum disorders, no amount of alcohol is considered safe
Individuals recovering from alcohol use disorder or who struggle to control their intake
People taking medications that interact with alcohol, which is a lot of them
Individuals with liver disease, pancreatitis, certain heart conditions, or other medical conditions affected by alcohol
Anyone under the legal drinking age
For individuals with a family history of alcohol use disorder, awareness matters. Genetic susceptibility, environmental exposure, and behavioral patterns all influence risk.
If You Choose to Drink
If you do not drink alcohol, there is no health reason to begin.
If you choose to drink occasionally, there is no reason to increase intake.
While the newest Guidelines no longer list specific daily limits, the prior definition of moderation remains a useful reference point for understanding portion size. Historically, one drink was defined as containing 0.6 fluid ounces of pure alcohol. That equates to approximately:
12 ounces of beer at 5% alcohol by volume (ABV)
5 ounces of wine at 12% alcohol by volume (ABV)
1.5 ounces of distilled spirits at 40% alcohol by volume (ABV)
Many pours exceed these amounts, especially in restaurants and social settings. Cocktails often contain more than one standard drink. The type of alcohol does not change the health impact. Ethanol is ethanol.
The concept of “per day” also matters. Drinking several days’ worth of alcohol in one evening is not equivalent to spreading it out. Binge drinking carries a higher risk for injury, cardiovascular events, and long-term health consequences. This is a case of use it (or drink it) or lose it. No saving for the weekend.
Calories and Metabolism
Alcohol provides seven calories per gram. That is more than carbohydrate or protein (with four calories per gram each) and nearly as much as fat (with nine calories per gram). These calories provide energy but no essential nutrients.
Alcohol is metabolized primarily in the liver. When alcohol is present, the liver prioritizes breaking it down. With this, I tend to say, think of it as the “Kanye” of substances…it pushes everything else aside to get metabolized first. This can interfere with the metabolism of medications and other metabolic processes. It can also contribute to fatty liver changes over time. This is why it is important to consider how alcohol interacts with medications. If the medication is not metabolized properly, it may not work adequately.
Alcohol can impair sleep quality, even when it seems to help with falling asleep. It affects brain function quickly, influencing judgment and decision-making even at low intake levels. Hence the reason people should not operate heavy machinery, including vehicles, when consuming alcohol.
The Bottom Line
The shift from defined limits to “consume less” reflects a growing recognition that alcohol carries risk at any level. It does not mean every individual must abstain. It does mean that the concept of a clearly safe threshold is less certain than previously believed.
Alcohol is legal. Many adults choose to include it socially or culturally. But it is not required for health, and it does carry measurable risk.
If you choose to drink, understand what a standard drink is, pay attention to portion sizes, avoid “saving” drinks for a single occasion, and be aware of how alcohol interacts with your personal health history, medications, and family risk.
And if you choose not to drink, you are not missing out on any health benefits.
That is what the evidence currently supports.
Real World Nutrition Refreshed: I am revitalizing and updating my blog archive and re-publishing it. Stay tuned as I review, update, refresh, and re-share these posts to provide you with even more valuable information on nutrition, health, and overall wellness—and keep things timely. A portion of this blog was initially posted on December 2, 2021, and has been updated here.
