Alcohol and Longevity:
Why the 'Healthy Drink' Idea Doesn't Hold Up

For decades, many people believed that a drink a day, especially red wine, was good for the heart. Newer evidence has overturned that idea. A 2023 analysis of 107 studies with more than 4.8 million people found that low-volume drinkers didn't live longer than lifetime non-drinkers once the studies' biases were corrected; earlier studies often counted former heavy drinkers who had quit because of illness as "non-drinkers", making moderate drinking look protective. A 2018 Lancet analysis of nearly 600,000 drinkers found that death rates were lowest at about 100 grams of alcohol a week or less, and that drinking more than 350 grams a week at age 40 was linked to 4-5 fewer years of life. Alcohol is a Group 1 carcinogen that causes at least seven types of cancer, and the World Health Organization states that no level of drinking is safe for health. In Sri Lanka, about half of men drink, and 14% of male drinkers drink heavily. This article explains how alcohol affects long-term health and practical ways to cut down.

Key numbers

How alcohol affects the body

Alcohol (ethanol) is broken down mainly in the liver into acetaldehyde, a toxic compound that damages DNA. Alcohol affects almost every organ:

• Liver: fatty liver, hepatitis and cirrhosis (see Fatty Liver Disease (MASLD)).
• Heart and circulation: high blood pressure, atrial fibrillation, heart failure and stroke (see Atrial Fibrillation).
• Cancer: of the mouth, throat, oesophagus, liver, bowel and breast.
• Brain: memory problems, brain shrinkage and dementia with heavy use; disrupted sleep even at moderate levels.
• Metabolism: extra calories, weight gain and raised triglycerides.
• Mental health: depression, anxiety and dependence.

The problem with "moderate drinking is good for you"

Many older studies found a "J-shaped curve": moderate drinkers seemed to live longer than non-drinkers. But non-drinkers often included former drinkers who had stopped because they were already ill, and people who don't drink may differ in income, health and lifestyle. A 2023 meta-analysis in JAMA Network Open reanalysed 107 studies covering more than 4.8 million people, correcting for these biases. It found no reduced risk of death in occasional or low-volume drinkers compared with lifetime non-drinkers. Risk rose significantly from about 25 grams a day in women and 45 grams in men, with women at higher risk than men at the same intake.

What the research shows

Drinking and life expectancy. A 2018 Lancet study combined data on 599,912 current drinkers from 83 prospective studies. The risk of death from any cause was lowest at about 100 grams of alcohol a week or less, roughly 10 standard drinks of 10 grams. Higher drinking was linked to higher risks of stroke and heart failure. Compared with drinking less than 100 grams a week, a 40-year-old drinking:

• 100-200 grams a week could expect about 6 months shorter life expectancy.
• 200-350 grams a week, about 1-2 years shorter.
• More than 350 grams a week, about 4-5 years shorter.

Experts commenting on the study noted that any apparent heart attack benefit was outweighed by higher risks of other cardiovascular diseases and death.

Alcohol and cancer. The World Health Organization classifies alcohol as a Group 1 carcinogen, the same category as tobacco and asbestos. It causes at least seven types of cancer, including breast and bowel cancer. In a 2023 statement in The Lancet Public Health, WHO noted that about half of alcohol-attributable cancers in Europe occur in people who drink at light to moderate levels, and that no safe threshold has been identified. As a WHO Europe official put it, "the risk to the drinker's health starts from the first drop."

Drinking in Sri Lanka. The Sri Lanka Health and Ageing Study surveyed 6,473 adults in 2018-2019. About 26% of adults drank alcohol in the past year: 53.1% of men but only 2.0% of women. Among men who drank, 14.1% drank heavily, 21 or more units a week. Illicit and home-brewed alcohol, such as kasippu, adds further risks because its strength and purity vary.

When alcohol harms most

What you can actually change

1. Drink less, and less is better. There's no level of drinking that improves health. If you drink, keeping well below about 100 grams a week (roughly 10 standard drinks) limits risk, and drinking less lowers it further.

2. Don't start drinking for health. If you don't drink, there's no health reason to start.

3. Have alcohol-free days. Several alcohol-free days each week help reduce total intake and dependence.

4. Avoid binge drinking. Spread out any drinks, alternate with water, and eat when you drink.

5. Know your drink sizes. Spirits, beer and wine vary in strength. Arrack and other spirits are around 33-40% alcohol, so standard pours add up quickly.

6. Get help if cutting down is hard. If you drink to cope, need more to feel the effect, or find it hard to stop, talk to a doctor. Effective support and treatments are available.

Recommendations

• Treat alcohol as a risk, not a health food. The heart benefits once claimed don't hold up in better-designed analyses.
• Have your blood pressure, liver function and heart rhythm checked if you drink regularly.
• Avoid alcohol completely in pregnancy, with liver disease, with certain medicines, and before driving.
• Talk to your doctor if you're worried about your drinking.

Practical notes

The belief that moderate drinking is good for you came largely from flawed comparisons with non-drinkers. Better analyses show no survival benefit from light drinking, rising risks above about 100 grams a week and clear cancer risks at any level. For longevity, less alcohol is better, and none is best. Cutting down is one of the most effective changes you can make for your liver, heart, brain and cancer risk.