The correct quote is by Sir Clement Raphael Freud who said “if you resolve to give up smoking, drinking and loving, you don’t actually live longer; it just seems longer.”
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I tell my 93 year old widowed, bladder cancer surviving father that he is free to drink as much as he wants, so long as he doesn’t fall. His primary care physician (gerontology practice at UCLA) doesn’t like it, but he accepts it. Fortunately, my dad has someone at his elbow to assist him. At his age, living better, however one defines it, is better than living longer, according to him. Who am I to disagree?
Tomorrow, we will eat fresh Dungeness crabs, washed down by a bottle of a BdB (his preferred style) Champagne. I cherish these evenings.
Edit: when I was a boy, he lost a a lot of weight following The Drinking Man’s Diet. What’s old is new, again.
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Right there with you. The Logic of Scientific Discovery and The Structure of Scientific Revolutions were the two most influential texts in shaping my own approach to a life of scientific inquiry. Honestly, I’m amazed at how many people come out of college with science degrees having never heard of either of these two men.
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Just to reiterate an important point being made here but possibly lost, a recent review of all literature on the subject of moderate drinking was done by the National Acadamies of Science, Engineering and Medicine.
Here is a link to the news report and at the bottom the review.
Thanks Anton for posting about this earlier.
The committee found no evidence of increased cancer risk with moderate drinking with the exception of a possible association with breast cancer in women.
From this report, a very important caveat to me included this paragraph. It keeps us from going too far out on a limb like the Surgeon General’s report.
Research Gaps
Throughout its review of current literature, the committee identified a consistent set of research gaps that, if addressed, could strengthen the existing evidence on moderate alcohol consumption and health outcomes. Overarching limitations in alcohol and health research include abstainer bias; a lack of standard definitions of alcohol consumption levels and a lack of standardized cutoffs for exposure categories; underreporting of alcohol consumption by participants; lack of data stratified by smoking status, age, sex, and genetic ancestry to evaluate possible interactions with alcohol consumption and health outcomes; and limitations of observational studies. The report urges that all studies addressing the impacts of alcohol on human health speak to these limitations and consider including menopausal status as well as postpartum women and their infants when possible.
The study — undertaken by the Committee on the Review of Evidence on Alcohol and Health — was sponsored by the U.S Department of Agriculture’s Food and Nutrition Service. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.
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Forgive me if this has already been posted but Joel Peterson shared this recently:
For years, public health messages have painted all alcoholic beverages with the same broad brush: alcohol is a carcinogen, no exceptions. Yet, a growing body of research suggests that this narrative oversimplifies a complex issue, particularly when it comes to wine. A landmark meta-analysis of over 4.3 million participants challenges the conventional wisdom, revealing that moderate wine consumption may not increase cancer risk—and might even lower it for certain types of cancer.
https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1197745/pdf
This nuanced evidence raises an uncomfortable question: Are we unfairly lumping wine into the same category as beer and spirits, overlooking its unique properties and potential health benefits? Here’s a closer look at the evidence, the controversies, and what it means for your next glass of red.
—The Landmark Study: Unpacking the Findings
The meta-analysis, published in Frontiers in Nutrition, is among the largest and most rigorous reviews to date. Analyzing data from 73 studies, it specifically examined the relationship between moderate wine consumption—defined as up to one drink per day for women and two for men—and cancer risk.
—The Results:
-
No Overall Increased Risk: Across all cancer types, moderate wine consumption showed no significant association with an increased risk:
• Relative Risk (RR): 1.00 (95% CI: 0.97–1.03). -
Protective Trends for Specific Cancers:
• Colorectal Cancer: 8% lower risk (RR = 0.92; p = 0.03).
• Pancreatic Cancer: 10% lower risk (RR = 0.90; p = 0.04).
• Lung Cancer: 15% lower risk (RR = 0.85; p = 0.02).
• Skin Cancer: 12% lower risk (RR = 0.88; p = 0.01). -
No Significant Risk for Breast or Ovarian Cancer:
• Breast Cancer: RR ≈ 1.00 (p = 0.45).
• Ovarian Cancer: RR ≈ 1.00 (p = 0.38).
—Why Wine Stands Apart
Unlike beer and spirits, wine contains a unique cocktail of bioactive compounds, particularly in red wine, that may offset the harmful effects of alcohol. These include:
• Resveratrol: Found in grape skins, resveratrol has been shown to inhibit tumor growth, reduce inflammation, and enhance DNA repair.
• Polyphenols and Flavonoids: These antioxidants suppress oxidative stress and tumor-promoting pathways, promoting cellular health.
• Anti-Inflammatory Effects: Wine’s compounds may counteract the inflammatory damage that contributes to cancer development.
These properties, largely absent in other alcoholic beverages, make wine a distinct case in the alcohol-cancer conversation.
—The Broader Context: Alcohol and Cancer
Public health agencies worldwide, including the WHO and the American Cancer Society, classify alcohol as a Group 1 carcinogen. The risks are clear for heavy drinkers: alcohol contributes to cancers of the mouth, throat, esophagus, liver, breast, and colon. The mechanisms are well understood:
• Acetaldehyde Production: Alcohol metabolizes into acetaldehyde, a carcinogen that damages DNA.
• Oxidative Stress: Alcohol increases free radicals, overwhelming the body’s ability to repair cellular damage.
• Hormonal Effects: Alcohol raises estrogen levels, a driver of breast cancer.
But here’s the rub: these conclusions often stem from studies that lump all forms of alcohol together, obscuring beverage-specific effects. The nuances of wine—its antioxidant properties, moderate alcohol content, and bioactive compounds—are lost in this aggregated data.
—The Controversy: Is Public Health Oversimplifying the Message?
Critics argue that public health messaging around alcohol has prioritized simplicity over nuance, resulting in blanket statements that may mislead the public. While the intent—reducing alcohol-related harm—is noble, it risks distorting the evidence.
—Points of Contention:
-
Aggregated Data Masks Differences:
• Most studies fail to differentiate between wine, beer, and spirits, treating a shot of whiskey the same as a glass of red wine. -
Lifestyle Confounders:
• Moderate wine drinkers often follow healthier diets, smoke less, and exercise more—all factors that independently reduce cancer risk. Critics argue that these confounders may exaggerate wine’s protective effects. -
Individual Variability:
• The effects of wine may vary based on genetics, pre-existing conditions, and lifestyle. A “one-size-fits-all” approach overlooks this complexity.
—What Does This Mean for Physicians?
For healthcare providers, the evidence invites a more nuanced approach to counseling patients about alcohol consumption:
-
Moderation is Key:
• The study reinforces the importance of moderation. Exceeding the recommended limits negates any potential benefits and significantly increases cancer risk. -
Wine as a Safer Choice:
• For patients who consume alcohol, wine may represent a safer option compared to beer or spirits, particularly when paired with a healthy lifestyle. -
Individualized Recommendations:
• Patients with a strong family history of cancer or genetic predispositions should be advised more cautiously, as even moderate alcohol intake may carry risks.
—Critiques of the Study
No study is without limitations, and this meta-analysis is no exception:
• Residual Confounding: While the study adjusted for smoking, diet, and physical activity, some unmeasured variables may have influenced the results.
• Observational Nature: Correlation does not equal causation. Without randomized controlled trials, causality cannot be definitively established.
Yet, the study’s size, scope, and rigorous methodology make it one of the strongest analyses to date. With over 4.3 million participants, the statistical power ensures that even modest trends are detectable.
—Red versus White Wine
The question of whether red wine offers unique benefits compared to white wine is an important one that the meta-analysis does not address. Red wine is rich in bioactive compounds, including resveratrol and polyphenols, which have demonstrated anti-inflammatory, antioxidant, and anti-carcinogenic properties in laboratory studies. These compounds, derived from prolonged contact with grape skins during fermentation, are far less concentrated in white wine. For cancers driven by inflammation and oxidative damage—such as colorectal and lung cancer—the protective trends observed in the meta-analysis may reflect red wine’s unique composition, but further research is needed to confirm these effects.
However, when it comes to breast cancer, the evidence suggests no difference between red and white wine. A 2009 study examining over 6,300 breast cancer cases found that neither red nor white wine increased or decreased breast cancer risk. https://aacrjournals.org/cebp/article/18/3/1007/164640/No-Difference-Between-Red-Wine-or-White-Wine
These findings align with the meta-analysis, which reported no significant association between wine consumption and breast cancer risk. This neutral effect highlights that the mechanisms driving breast cancer, such as hormone modulation, may not respond to wine’s bioactive compounds in the same way as cancers linked to inflammation or oxidative stress.
The distinction between red and white wine underscores the need for more targeted studies. While red wine may hold promise for reducing the risk of certain cancers, studies like the 2009 breast cancer analysis remind us that its benefits are not universal. Future research should investigate how the differences in polyphenol and antioxidant content between red and white wine influence outcomes for a broader range of cancer types. Additionally, long-term studies that separate the effects of red and white wine on cancer risk are critical for refining our understanding.
—My Takeaway
The evidence surrounding alcohol and cancer is complex, and wine occupies a unique position in this debate. While heavy alcohol consumption is undeniably harmful, the data suggest that moderate wine consumption may not only lack the same risks but could offer protective benefits against certain cancers.
For those who choose to drink, a glass of wine enjoyed as part of a balanced lifestyle—think Mediterranean diet—appears to be a reasonable and safe choice. However, public health officials and clinicians alike must walk a fine line, promoting moderation while acknowledging wine’s unique properties.
In a world hungry for simple answers, the story of wine reminds us that health is rarely black and white.
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It is what it is, I’ll continue to consume at what I feel are responsible levels along with consistent exercise and a good diet and let the chips fall where they may. I don’t have the energy to worry about everything that may cause cancer unless it is clear and very avoidable.
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That’s an interesting study, I’ll have to read it carefully.
Thank you for posting this and for pointing out the research gaps, which are, as you note, important caveats, and which include the limitations of observational studies.
The National Academies committee summarized their findings on alcohol and cancer as follows:
“Cancer — The report concluded with moderate certainty that consuming a moderate amount of alcohol is associated with a higher risk of female breast cancer compared to never consuming alcohol. It also concluded with low certainty that higher amounts of moderate alcohol consumption are associated with a higher risk of breast cancer compared to lower amounts of alcohol consumption. Among moderate alcohol consumers, the report concluded with low certainty that higher amounts of moderate consumption are associated with a higher risk of colorectal cancer compared with lower amounts of alcohol consumption. No conclusions could be drawn when comparing the risk of colorectal cancer for moderate alcohol consumers versus lifelong non-consumers, nor could an association be made between moderate alcohol consumption and oral cavity, pharyngeal, esophageal, or laryngeal cancers.”
How do you counsel your Barrett’s patients guys? You honestly tell them to drink to their heart’s content?
What about GERD +/- erosive esophagitis without Barrett’s changes?
I mean the 3-9 drinks/week moderates with the above scenarios.
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Can you ask Joel how moderate drinking was defined in this study? If it’s in there I missed it.
Of course there’s the old clinical adage of whatever the patient admits to you can safely double or triple that volume more often than not.
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This is really important, Glen, thanks for mentioning. Both for alcohol consumers themselves and for doctors. I had to be clear with myself when evaluating my personal risk, that by most public standards, I am a heavy drinker. It’s a different analysis and the tendency to understate, even to oneself, is real. I do actually tell my doc the truth, and he does me the courtesy of respecting my knowledge and understanding.
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That’s one of the problems with the research in this area; that it’s dependent on self-reported consumption. I think it’s likely that the research overstates the dose-response relationship and I think the concept of no safe level is likely not as compelling as the WHO is making it out to be. That all being said, the problem is that most regular drinkers really aren’t falling into the category of low/moderate alcohol consumption.
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I strive for truthfulness as well. Most weeks I exceed the moderate 3-9 drinks per 7 days.
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I learned that a glass of wine is not interesting or satisfying to me. I’d rather have none. My husband is the same. When we open a bottle, we finish a bottle, and sometimes open another. As I have gotten older, that behavior hasn’t changed, but drinking nights have gotten less frequent.
I also don’t ever want 3 potato chips, or one cookie. 
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I’ve spent a little time reading that study Brian posted, and I do think the conclusions are interesting but the biggest problem is that the vast majority of the studies they cited (all except 3) have relatively short follow up periods of less than 20 years. I’m not sure what to make of the relatively short term “protective” effect, but the problem with this type of research and cancer research in general is that it’s a chronic progress that takes many years to manifest. A short term case/control RCT even with a follow-up period of say 5 years (which is very long for a clinical trial) would have little or no real clinical significance, especially in younger people, because the pre-test probability of having cancer is so low in that population in such a short time period in the absence of genetic predisposition.
While the reservatol research and decreased oxidative stress research is very interesting (and a lot of it was done in my home town, by researchers my in-laws lived on the same street as) to date I haven’t seen real human data that is overly compelling. I do think that on balance, drinking wine, especially organically farmed wine, is likely potentially healthier than some alcohol drinks, but I do think more long term research is likely necessary to come to any specific conclusions.
I think the best way to approach the totality of the research is to assume there’s some potential likely modest negative long term effects, especially with moderate/high consumption, and likely no long term benefit. That doesn’t mean you shouldn’t drink. I think most research has shown that high consumption (which I think many people on this forum would actually be characterized as having, regardless what they think) isn’t particularly healthy, and moderating it some would likely be a good thing, which we’re seeing, with stuff like dry January.
Hard to say, everyone has a different idea of what a glass wine is.
Statistically it’s a 6oz pour. That’s almost 3 pours for me and these days I rarely finish a second and I’m down to maybe two nights a week. I call that moderate, to others that’s nothing.
A big challenge for clinical research there.
In medical queries a short pour is 4.5 oz, standard 5 oz. Moderate drinking I’m seeing defined now as 3-9 such drinks per seven days. 10+ makes one a heavy drinker clinically.
These definitions need address in papers like the one you linked from JP.
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I believe that the U.S. has a formal definition of an alcoholic drink. It is 0.6oz of pure alcohol.
One 12 ounce beer at 5%
One 5 ounce glass of wine at 12%
One 1 1/2 ounce shot of spirits at 40% (80 proof)
There is probably a need for adjustment as average alcohol per ounce of beverage is now probably higher than assumed in these guidelines… especially for wine.
It kind of doesn’t matter if there is a standard clinical definition, as most studies are self-reported, and people don’t measure their drinks most of the time. As many have said, it’s impossible to do RCTs of any significance on alcohol consumption, so dose can’t be controlled well.
My old girlfriend, who really doesn’t drink more than a sip or two just to taste, used to poke fun at me because of the way I measure my glass pours. Done by eye but I do watch the level in the glass. But I think you’re right and I know I am not the norm in this sense.
One of the things I don’t like about resto service is servers that top up a glass because it makes it tough to monitor consumption. I don’t like having more than even half a glass beyond two glasses.