Alright, let me just say right out the gate that this article is probably going to be a bit of a downer. I don’t mean to rain on anyone’s parade, but I made this blog mainly to discuss research topics in nutrition/health that people may be interested in, and that’s what I’m going to do today. Additionally, this article is not about the morality of drinking. Its purpose is to shed light on the real-life consequences of trivializing alcohol consumption, nothing more, nothing less. The video version of this article can be found here.
Okay, enough preamble – let’s talk about alcohol.
It is common knowledge that drinking excessive amounts of alcohol is bad for your liver. Nevertheless, alcohol is generally considered to be safe in “lesser” doses. Drinking at parties, having some wine after a long day of work, or doing shots on your birthday are all common, some would say normal, adult activities.
Wine after a stressful day at work is just self-care for us millennials, right?
Alcohol advertisers, who are projected to spend 7.7 billion dollars next year on alcohol advertisements, do a phenomenal job of normalizing alcohol consumption. Their alluring ads sell us a lifestyle that is fun and cool but, is the wool being pulled over our eyes?
When did we come up with this idea of a "safe dose," anyway?
Is alcohol really "safe" at “low” doses?
Only alcoholics who drink 6 beers every night are at risk for developing health issues related to their alcohol intake, right?
Keep reading to learn more about the messages being put out by the media about alcohol that are actually quite nefarious, what the data say about light to moderate drinking, and what you may want to change about your own drinking habits moving forward.
Here are the topics that I will be covering, feel free to skip ahead:
The normalization of alcohol consumption
Statistics on alcohol use
Unpopular opinions from Reddit
Wine mom culture
Scientific research on light/moderate drinking and cancer
Scientific research on the effects of alcohol in East Asian and Eastern European populations
Consequences of heavy drinking
The normalization of alcohol consumption
Alcohol gets a lot of promotion as a cool beverage. Music videos for many pop songs take place in a club, coming of age movies often show young people chugging alcohol, and it’s not hard to find movies aimed at young people where the main characters are only able to confess their love for one another after a few drinks.
Liquid courage, anyone?
According to Dr. James Sargent, a professor at Dartmouth school of medicine who has been studying alcohol use in films for over two decades, over 80% of motion pictures contain depictions of alcohol use. Dr. Sargent and his team published research showing that alcohol brand placements in movies have almost doubled over the past couple of decades, especially in movies rated for children.
On social media it’s not hard to find posts of people drinking until they are barely able to stand, or in the most extreme cases, need to be carried home after a night of drinking. Videos like these get tons of likes and laughs, but have you ever asked yourself why? To be so drunk that you don’t know where you are or cannot even remember all of the fun that you had with your friends seems far from desirable, yet it is propped up as a symbol of youthful exuberance.
Who decided that the best nights of our lives are the ones that we can barely remember?
Movies, commercials, and social media all tell us that drinking is normal. But how common is drinking in the US, really? According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA):
About 86% of adults in this country have consumed alcohol at some point in their lives,
One quarter of adults report binge drinking, which is defined as 4 or more drinks for women and 5 or more drinks for men in the span of 2 hours,
And 14.5 million people ages 12 years and above have experienced Alcohol Use Disorder (AUD).
Many adults who have problems with alcohol are also parents. An estimated 10.5% of children live with a parent who has AUD.
Now, let’s be honest about what alcohol is – alcohol is a toxin, hence the use of the term “intoxicated” when talking about imbibing. At some point you may have wondered – why is this toxin given a pass, while the use of other toxins like cigarettes or cocaine is generally frowned upon?
Cigarettes were branded as cancer sticks, but alcohol has managed to avoid the same disdain, despite it being well-earned.
While I recognize that this is not a representative sample, I like to look on Reddit to get a sense of how other people feel about the topics that I discuss. I found lots of posts criticizing the normalization of alcohol in modern society and have included a few of them below. Warning - some of these comments may not be what you would consider to be polite, but they are all worth reading.
This user called alcohol “one of the most toxic normalized practices in modern life”:
This other user lamented how common it is that drinking is basically a given for most social occasions:
There was no shortage of posts (like this one, this one, and this one) from people questioning the normalization of ingesting what is a essentially a poisonous liquid as a way to be social, seem manly (mostly in the case of beer), de-stress, or any other excuse that you can come up with.
The New York Times has covered this topic too, reporting that rates of alcohol abuse and alcohol-related deaths are on the rise, especially among women. To quote Dr. Yusuf Ransome, Associate Professor of Public Health at Yale:
“Alcohol kills many more people than many may realize. It is a major contributor to deaths linked to physical injuries, interpersonal violence, motor vehicle crashes, self-harm and other harmful outcomes.”
The Washington Post sent out a similar smoke signal several years before. Women in this country have been filling up their glasses with more and more alcohol in recent decades, and this has led to an increase in alcohol-related deaths among females. During the pandemic, national sales of alcohol increased 54% for the week ending March 21, 2020, and online sales were 262% higher than the year before. While the rise in the prevalence of alcohol use is a complex, multifactorial issue, some suspect that the wine mom culture may have something to do with the trivialization and consequent popularization of drinking among women.
Wine mom culture
If you are not familiar, this definition from urban dictionary will bring you right up to speed.
The “wine mom” trend has grown in popularity, as evidenced by the amount of merch out there sporting this seemingly innocuous phrase, with lines like:
"I’ve waited 9 months for this"
"Mama needs some wine," and,
"Oh look, it’s wine oh clock"
Tiktok is full of examples of this too, just search by the hashtag #winemom to see for yourself. The subtext propping up many of these clips is that it is normal for women to get black out drunk if no one is around to stop them, and when chores and kids stress you out, alcohol is the answer.
Day drinking is not the key to good parenting, don't let the wine moms lure you in.
The popularization of wine mom culture is an example of how marketing can push people to identify with a particular product that they otherwise would distance themselves from. Beer is seen as a masculine drink, and wine is seen as a feminine drink, yet wine has way more alcohol than beer does. A 12 fl oz can of beer is normally around 5% alcohol, while a 5 fl oz glass of wine has 12% alcohol. Wine is a more potent alcoholic beverage, but perhaps because it comes in a curvy glass that is normally associated with fine dining and elegance, we forget that.
Why we should be wary of the normalization of drinking
Despite how innocuous casual alcohol drinking may seem, research evidence shows that even light drinking can be harmful for your health. Let’s start by looking at the data for head and neck cancers.
Head and neck cancers
There are multiple publications that I pulled from for this video, and they will be included in the reference section below as usual, but I will use this paper as an example.
The following quote is taken from the abstract:
“The evidence suggests that at low doses of alcohol consumption (i.e., ≤1 drink/day) the risk is also increased by about 20% for oral and pharyngeal cancer and 30% for esophageal squamous cell carcinoma. Thus, for these sites there is little evidence of a threshold effect.”
Even a drink or less a day significantly increases the risk of mouth and throat cancers. In other words, it doesn’t take 10 shots to cause damage – just one will do.
But, what about wine?
So and so's grandmother drank wine every day and lived until 100, so the fountain of youth must be a never-ending cascade of wine, right?
You may be asking yourself, isn’t wine good for you, or at least better then beer and liquor, since it has antioxidants? Given how much publicity the Mediterranean diet gets, it makes sense that you would ask yourself that question. To put it simply, wine does have antioxidants, but those antioxidants are not magical.
In this paper, the authors state that:
"phytochemicals [antioxidants] seem not to affect oral cancer risk, being probably present below the effective dosages and/or due to their low bioavailability.”
Bioavailability is an estimate of how well a substance gets absorbed. Wine contains antioxidants like resveratrol which have anticancer and anti-inflammatory properties, but you would need to drink 100 glasses of wine a day to reach the effective dose of resveratrol – of course, I do not recommend this.
It is true that some studies on the Mediterranean diet, which may include wine, show a reduced risk for oropharyngeal cancers, but we have to be careful about making recommendations for the global population based on this alone. Alcohol, or to be more specific to the type of alcohol that humans consume, ethanol, is known to cause cancer in humans and to increase cancer risk particularly in places where there is direct contact, hence the high risk of mouth and throat cancers. This is because it causes damage to the DNA of the cells there and produces reactive oxygen species (ROS), substances that deplete antioxidants and damage DNA and proteins. Furthermore, ethanol can also activate other cancer-causing chemicals, including the ones found in cigarettes and environmental pollutants.
Going back for a moment to my point about being cautious about making general recommendations based on studies done mainly in one region of the world, some people are more susceptible to the effects of alcohol at low doses because of their genes. East Asians typically have a genetic variation which makes it harder for them to break down alcohol, making it potentially more toxic for them.
How our bodies respond to alcohol is a reflection of the enzymes that we have to break them down, and some of us have more of those enzymes than others.
Also, despite the fact that people often joke about Eastern Europeans being able to tolerate alcohol better than people of other ethnicities, that isn’t really true. Their higher intake of spirits is linked to higher rates and a greater number of deaths for oral cancer.
All in all, light drinking in this systematic review was found to be associated with a higher risk of oral, oro-pharyngeal, or upper aero-digestive tract cancers when compared to abstention from alcohol.
Now, let’s talk about Breast Cancer.
Breast Cancer
Alcohol is associated with an increased risk of breast cancer. This review of the evidence indicates that:
“intake, even intake of less than 10-15 grams per day, is associated with increased risk of this disease.”
For reference, one drink has about 14 grams of alcohol.
As was the case with head and neck cancers, the research does not show that there is any “safe” dose of alcohol when it comes to reducing the risk of breast cancer. For every 10 grams of alcohol consumed, there is an estimated 4-9% increase in breast cancer risk. This is true for all types of alcoholic drinks, including wine, and binge drinking may be especially harmful.
Now go forth and ruin your next social gathering with these stats.
Some research shows that the risk per drink may be slightly higher for younger women – in this paper, it was reported that for women who have never been pregnant, every drink increases risk of breast cancer by 11%. Possible explanations for these undesirable findings include increased breast density with greater alcohol intake, altered estrogen metabolism, and the carcinogenicity of the alcohol itself.
This meta-analysis supports the findings of the previous studies. As does this report. This report by the World Cancer Research Fund from 2018 supports these conclusions too, and has more data if you’re interested in reading more on this topic. The overarching conclusions from this publication are that there is strong evidence that alcohol consumption increases cancer at several sites, including the mouth, the liver, the colon, and the stomach. A peculiar finding here is that 2 drinks a day may protect against kidney cancer. Still, it isn’t worth it to protect your kidneys and destroy all of your other organs in the process.
Heavy drinking
I wrote this article to highlight the harms of light to moderate drinking, but I also want to take this opportunity to highlight the fact that alcohol abuse – heavy drinking – is a major cause of disease and death worldwide.
Alcohol abuse is associated with:
increased risk of drowning, injuries from violence, falls, and motor vehicle crashes,
increased risk of female breast cancer, oropharyngeal cancer, esophageal cancer (especially in individuals who inherit a deficiency in an enzyme involved in alcohol metabolism), and harmful medication interactions,
and risk for Fetal Alcohol Spectrum Disorders (FASD) in the children of women who consume alcohol during pregnancy
As if that wasn't enough, one in three liver transplants in the US are done to save people from alcohol-related liver disease, and 50% of people who die from cirrhosis abused alcohol.
Conclusion
To summarize, there really is no “safe” dose of alcohol – alcohol causes harm to the body well below the amounts that most of us would consider to belong to the realm of alcoholism. Every time we drink, we cause some damage to our bodies and increase our cancer risk. Also keep in mind that what you see on TV or social media is just a slice of real life. Alcohol ads tend to show people who are young and carefree drinking away, but what they don’t show are the cancer patients, drunk driving victims, and people waiting in line for a liver transplant. At the end of the day, there are many things in this life, including your profession, your hobbies, where you live, etc., that can increase your risk of dying from cancer or just dying in general. How you weigh those risks is entirely your decision.
Lastly, if you are struggling with alcohol addiction, or someone you care about is struggling with this, please check out the links below for some resources that may help.
Take care.
Resources for help with alcohol abuse
References:
The popularization of alcohol in film:
Black, L. (2017, May 4). Alcohol marketing in popular movies doubles in past 2 decades. EurekAlert! https://www.eurekalert.org/news-releases/911945
Panko, B. (2017, May 9). From Budweiser to Heineken, Alcohol Brands Are Rampant in Hollywood Films. Smithsonian Magazine. https://www.smithsonianmag.com/science-nature/budweiser-heineken-alcohol-brands-are-now-rampant-hollywood-films-180963207/
The prevalence of alcohol consumption and consequences:
Shmerling, R. H. (2018, August 8). Sorting out the health effects of alcohol - Harvard Health Blog. Harvard Health Blog. https://www.health.harvard.edu/blog/sorting-out-the-health-effects-of-alcohol-2018080614427
Chikritzhs T, Livingston M. Alcohol and the Risk of Injury. Nutrients. 2021; 13(8):2777. https://doi.org/10.3390/nu13082777
Taylor B, Irving HM, Kanteres F, et al. The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend. 2010;110(1-2):108-116. doi:10.1016/j.drugalcdep.2010.02.011
Zenith The ROI Agency. (2021). Business Intelligence – Alcohol: Beer + Spirits. https://movendi.ngo/wp-content/uploads/2021/05/Business-Intelligence-Alcohol-Beer-and-Spirits.pdf
National Institute on Alcohol Abuse and Alcoholism. (2022, March). Alcohol Facts and Statistics. National Institute of Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
Ndugga, N., & Frakt, A. (2021, April 19). What’s Behind the Growth in Alcohol Consumption? The New York Times. https://www.nytimes.com/2021/04/19/upshot/alcohol-deaths-pandemic.html
Kindy, K., & Keating, D. (2016, December 23). For women, heavy drinking has been normalized. That’s dangerous. The Washington Post. https://www.washingtonpost.com/national/for-women-heavy-drinking-has-been-normalized-thats-dangerous/2016/12/23/0e701120-c381-11e6-9578-0054287507db_story.html
Pollard MS, Tucker JS, Green HD. Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US. JAMA Netw Open. 2020;3(9):e2022942. doi:10.1001/jamanetworkopen.2020.22942
Wine mom definition:
Urban Dictionary. (2018). Urban Dictionary: Wine Mom. Urban Dictionary. https://www.urbandictionary.com/define.php?term=Wine%20Mom
Measuring alcohol portions:
NIAAA. (n.d.). What Is A Standard Drink? | National Institute on Alcohol Abuse and Alcoholism (NIAAA). Www.niaaa.nih.gov. https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink
Cancer research data:
Pelucchi C, Tramacere I, Boffetta P, Negri E, La Vecchia C. Alcohol consumption and cancer risk. Nutr Cancer. 2011;63(7):983-90. doi: 10.1080/01635581.2011.596642. Epub 2011 Aug 24. PMID: 21864055.
Varoni, Elena M., Giovanni Lodi, and Marcello Iriti. 2015. "Ethanol versus Phytochemicals in Wine: Oral Cancer Risk in a Light Drinking Perspective" International Journal of Molecular Sciences 16, no. 8: 17029-17047. https://doi.org/10.3390/ijms160817029
Freudenheim JL. Alcohol's Effects on Breast Cancer in Women. Alcohol Res. 2020 Jun 18;40(2):11. doi: 10.35946/arcr.v40.2.11. PMID: 32582503; PMCID: PMC7295577.
Liu Y, Nguyen N, Colditz GA. Links between alcohol consumption and breast cancer: a look at the evidence. Womens Health (Lond). 2015 Jan;11(1):65-77. doi: 10.2217/whe.14.62. PMID: 25581056; PMCID: PMC4299758.
Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, Pelucchi C, Bellocco R, Negri E, Corrao G, Rehm J, Boffetta P, La Vecchia C. Light alcohol drinking and cancer: a meta-analysis. Ann Oncol. 2013 Feb;24(2):301-308. doi: 10.1093/annonc/mds337. Epub 2012 Aug 21. PMID: 22910838.
Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ. 2015 Aug 18;351:h4238. doi: 10.1136/bmj.h4238. PMID: 26286216; PMCID: PMC4540790.
World Cancer Research Fund International. (2018). Alcoholic drinks and cancer risk. WCRF International. https://www.wcrf.org/diet-activity-and-cancer/risk-factors/alcoholic-drinks-and-cancer-risk/
Rumgay H, Murphy N, Ferrari P, Soerjomataram I. Alcohol and Cancer: Epidemiology and Biological Mechanisms. Nutrients. 2021 Sep 11;13(9):3173. doi: 10.3390/nu13093173. PMID: 34579050; PMCID: PMC8470184.
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