Alcohol may have played a substantial role in humanity’s transition from hunting and gathering to farming, the strengthening social cohesion among our neolithic forebears, and the establishment of social hierarchies. The world’s most popular drug has lubricated conversations and coaxed countless reticent feet to dance floors since time immemorial.

But it still isn’t good for your health. And, sorry: That includes red wine.

There’s been no shortage of alcohol-related research over the years, and the science has evolved. UCHealth Today took a look at recent studies and data and also discussed alcohol research and health care with Elizabeth Kovacs, who has a doctorate in cell biology and leads the University of Colorado School of Medicine’s Alcohol Research Group, and Dr. Corey Lyon, a family physician at UCHealth A.F. Williams Family Medicine Clinic – Central Park. Here’s what we learned.

U.S. drinking deaths are on the rise

What the U.S. Centers for Disease Control and Prevention describes as “excessive alcohol use” was responsible for 178,000 U.S. deaths a year in 2020 and 2021. That represented a 29% increase over the same span four years earlier.

Two thirds of those deaths, or about 117,000 of them, emerged from chronic conditions that developed from long-term alcohol use. The other 61,000 happened mainly from motor-vehicle crashes and suicides.

Are people drinking more? If so, why?

Yes, and blame the pandemic. It led to a 3% jump in alcohol sales in its first year, and small studies found that 25% of people drank more than usual to cope with the stress and isolation of lockdowns. Whether that tapered back off with the end of the pandemic remains to be seen.

“What we’ve learned coming out of the pandemic is a greater appreciation of how alcohol is being used in unhealthy ways,” Lyon said. “There’s much more awareness of patients using alcohol as a coping mechanism to help sleep, as a distractor to other stressors or problems in their lives, and of unrecognized alcohol problems.”

At what point does drinking alcohol become riskier?

The National Institutes of Health considers a half-ounce of alcohol – 13.7 grams – to constitute one drink. That’s what’s in a 12- ounce can of beer (5% alcohol), a 5-ounce glass of wine (12% alcohol) or a 1.5-ounce shot of hard liquor (40% alcohol).

The NIH considers men who have more than 14 drinks a week or more than four drinks per occasion to be “at-risk” drinkers. The same definition applies to women and those over 65 who have more than seven drinks a week or more than three drinks per occasion. Steatosis (fatty liver disease) happens in 90% of those who have more than about four drinks a day over time, and cirrhosis occurs in about 30% of those who drink more than about three drinks a day long-term.

Wait: Older people have a lower alcohol threshold?

Natural increases in inflammation as we age (“inflammaging”) don’t play well with alcohol, Kovacs says, because you’re adding a system-wide inflammatory agent (alcohol and its metabolites) to a system with a high baseline of inflammation.

What health problems does alcohol cause?

The liver does the heavy lifting in metabolizing the ethyl alcohol that makes us tipsy, and it bears the brunt of alcohol-related disease. Of the more than 98,000 U.S. liver-disease deaths among those 12 and older in 2022, 46% involved alcohol. About half of cirrhosis deaths are alcohol related, and the percentages are much higher (75-80%) among those younger than age 45.

But the liver is only part of the story. The CDC’s Alcohol-Related Disease Impact data attributes a wide range of diseases to excessive alcohol consumption in particular. Those include alcohol polyneuropathy, alcoholic psychosis, alcohol myopathy, alcohol-induced acute pancreatitis, and others. Alcohol is also implicated in 5.6% of cancer cases and 4% of cancer deaths, including up to one-third of liver cancer deaths among men. In particular, heavy drinking boosts the risk of liver and colorectal cancers.

Alcohol’s damage extends to the cardiovascular system. In addition to obvious direct effects such as alcoholic cardiomyopathy, it boosts the risk of heart disease 1% to 2% and that of hypertension (high blood pressure) as 2% to 11% among males and 4% to 18% among females. A study of more than 370,000 people found that drinking increased the risk of both hypertension and coronary artery disease, with small increases with light alcohol intake and “exponentially greater risk increases at higher levels of consumption.”

Are other health problems linked to alcohol use?

Yes. Animal-model experiments and clinical observations have found wounds and broken bones to heal slower with alcohol use, Kovacs says. Her group’s studies along with other research shows that burn patients with alcohol use disorder fare worse. Alcohol also impacts the ability to recover from lung infections. Studies by Dr. Ellen Burnham and Dr. Marc Moss — pulmonologists and critical-care medicine specialists who care for patients at UCHealth University of Colorado Hospital on the Anschutz Medical Campus — have found that patients with alcohol use disorder have much higher acute respiratory distress syndrome (ARDS) mortality than typical patients – and that nearly half of ARDS patients have a history of alcohol abuse.

What might be causing these sorts of health problems?

The effect of heavy alcohol use on the liver is well understood. Enzymes in the liver convert alcohol into acetaldehyde. Downstream reactions lead to the buildup of triglycerides – fats – that accumulate in the liver (alcoholic fatty liver). Continued alcohol consumption leads the immune system to attack liver cells (alcoholic hepatitis), and, finally, scarring the liver (cirrhosis). Fatty liver disease is reversible; cirrhosis isn’t.

Transplant centers are seeing record numbers of liver transplant patients, and they’re arriving sicker than in the past. At UCHealth University of Colorado Hospital on the Anschutz Medical Campus, 80% to 90% of patients screened in 2023 needed transplants – roughly twice the prepandemic figure.

That’s the liver. How is alcohol causing these other health problems?

That’s still a subject of scientific research, but acetaldehyde damages DNA, and it’s irritates the epithelial cells that line blood vessels, the lungs, skin, gut, and vaginal tract, resulting in inflammation. Also, alcohol causes oxidative stress, which can stiffen arteries raising blood pressure and coronary artery disease.

“Alcohol has a huge effect on the immune system,” Kovacs said. “And that effect, depending on how much alcohol, is almost always bad.”

In addition to inflammatory effects, alcohol suppresses macrophage phagocytosis – white blood cells’ devouring of pathogens, and rogue and dead cells, she says.

What about the health effects of light-to-moderate drinking? I’ve heard it’s actually good for you. 

You’re not alone. Many people believe light to moderate drinking is “healthy.” That’s largely due to a 1997 study of 490,000 people whom researchers tracked for nine years. They found that men and women who had had at least a drink a day had 40% and 30% lower risk of cardiovascular disease than those who didn’t drink — and that overall death rates were lowest among men and women reporting about one drink daily. There’s also the “French paradox,” which also emerged in the 1990s. It partially attributed red wine consumption to lower rates of cardiovascular disease among the French despite eating more fatty foods.

So, was that research from the 1990s accurate? Is light-to-moderate drinking good for your health?

In a word, no. Later research cast doubt on what actually caused those improved health metrics. Light drinkers may have been better educated, wealthier, more physically active, better insured, and benefitting from better diets. The French also walked more and ate healthier. More recent research has adjusted for those sorts of factors and found no protective effect from alcohol consumption in terms of longevity and elevated risk of hypertension and coronary artery disease with each progressive drink.

“I’d say the medical community was always a little bit skeptical of the message that alcohol could be good for your health,” Lyon said.

Among other reasons, that’s because the studies showing positive health impacts were often “really low-level-of-evidence-type studies.”

And that’s also true for red wine? Is red wine unhealthy?

It is, alas. Red wine does contain resveratrol, a polyphenol with antioxidant and anti-inflammatory properties that indeed appears to be good for you (because it’s concentrated in the grape skins, there’s less of it in white wine, which has the skin removed before crushing). But it’s a matter of magnitude. Red wine contains 0.4 milligrams to 2 mg of resveratrol per liter. Resveratrol supplements come in pills ranging from 250 mg to 1,600 mg. You’d need to drink at least 833 glasses of wine — and up to 5,333 glasses — to get to the resveratrol dose of single supplement pill.

What are doctors telling their patients?

The focus is on drinking that exceeds risk thresholds, Lyon says.

“If they’re a social drinker having a couple of drinks with dinner, only a couple of nights a week, that’s probably not a barrier to them achieving their health,” he said. “If they’re a daily drinker getting up beyond two or three drinks per night, every night, then we start investigating the reasons why they’re drinking and what their overall health care goals are and how we achieve them.”

Sharing a few laughs with friends over a couple of drinks is probably a good thing. The social connectedness that have been associated with drinking for 10,000 or more years has very real positive health effects, too.

As with so much in life, the key is moderation, Lyon says.

“It’s the same conversation I have about diets with my patients who have diabetes,” he said.