Why You Might Be Drinking Too Much Without Knowing It
Social conventions on what represents ‘a drink’ have evolved, and that is driving up our alcohol consumption and health risks
October 23, 2023
A number of readers were surprised by my recent column that mentioned “regular drinkers” might have a lifespan as much as seven years shorter than nondrinkers. Haven’t many studies over the years suggested some benefit from an occasional drink, especially against cardiovascular diseases?
There are a number of reasons why drinking shortens lifespans, and one is that we have lost track of what a “drink” actually is.
Longstanding U.S. alcohol guidelines assume that a standard drink consists of just 0.6 ounce of alcohol. That is a 12-ounce beer with 5% alcohol, or a 5-ounce glass of wine with 12% alcohol. But over time, Americans are drinking larger and boozier beers and stronger wines, and getting heavy pours at bars, all of which deliver more alcohol than the standard drink.
This has troubling implications for health: We are drinking more alcohol, just as many epidemiologists are lowering what they think the safe level of alcohol is.
“One of the big challenges of alcohol research is how do we define the basic metric of ‘a drink,’” said Priscilla Martinez, deputy scientific director of the Alcohol Research Group, part of the nonprofit Public Health Institute. “How do we help people understand what that metric really means?”
Boozier and bigger
A number of trends have contributed to the growing alcohol content of a drink.
“You get a couple 20-ounce craft beer cans and think, ‘I had two drinks,’” said Martinez. “In reality, in that setting, you might be closer to four” standard drinks, she added. Martinez has found that between 2003 and 2016 the average alcohol percentage of beer, wine and spirits all rose.
The climate might be partially to blame. The online wine database Liv-ex has found warmer growing seasons are producing grapes with more sugar and, thus, wines with more alcohol. The alcohol in the average Bordeaux red wine rose from 12.8% in the 1990s to 13.8% in the 2010s, with California reds increasing from 13.7% to 14.6% and reds from Tuscany up from 13.7% to 14.2%.
Blame generous bartenders, too. In one amusing study, researchers were dispatched across California bars to order beer, wine, shots, margaritas and mixed drinks such as rum and Coke. Each drink’s alcohol content was then “discreetly measured using graduated cylinders and beakers at a relatively private table or in the bathroom.”
Nearly every drink contained more alcohol than a “standard” drink, some nearly twice as much.
But this isn’t the only reason drinkers die sooner than nondrinkers.
The widespread notion that modest drinkers live longer than nondrinkers and heavy drinkers is what researchers call the “J-shaped” relationship between alcohol and health, which dates back to Johns Hopkins University research during Prohibition. The idea is that drinking a little bit might protect your health relative to not drinking at all, but as consumption goes toward excess, health outcomes get bad and then very bad.
In 2017 a team of researchers in the Journal of the American College of Cardiology found mortality risks are somewhat lower at as many as roughly six drinks a week, then get worse. By 13 drinks a week—about two drinks a day—risks are rising quickly.
The J-shaped curve remains controversial. People who abstain from alcohol entirely might be different than the general population: They might have illnesses or be on medications where they’re advised not to drink, for example. It might not be modest drinking that makes people healthier. Rather, people might drink modestly when they’re already healthy.
A study in JAMA Network Open, an American Medical Association journal, analyzed 107 studies of different cohorts of drinkers and concluded that, properly measured, there are no significant benefits from modest drinking. The entire notion that there’s a healthy level of modest drinking could be flawed, said Tim Stockwell, one of the co-authors and a scientist at the Canadian Institute for Substance Use Research at the University of Victoria in British Columbia.
“There’s not two camps,” said Stockwell. “It’s a continuum that’s distributed according to how much we drink.”
A number of health experts similarly reject the J-shaped relationship and contend that less alcohol is always better. Earlier this year, the World Health Organization declared: “When it comes to alcohol consumption, there is no safe amount that does not affect health.” The latest U.S. dietary guidelines, released in 2020, advise that “drinking less is better for health than drinking more,” and urge men stick to two drinks or fewer a day, and recommend only one drink for women. New guidelines are under consideration for 2025.
You probably drink more than you think
Regardless of whether there’s a safe level of alcohol consumption, another problem is that many people underestimate how much they consume. Responding to surveys, people claim to drink only about half as much alcohol as they purchase based on sales data. Some glasses of wine don’t get finished, or an extra bottle lingers in the fridge, but researchers agree there’s no way that people are buying twice as much alcohol as they actually drink.
And it’s the self-identified modest drinkers who tend to underestimate how much they drink.
“People are often drinking more than they realize,” said Stockwell. “When you look at it in the cold light of day, it stacks up.”
The disagreement over whether the J shape exists is only about the very start of the curve. Everyone agrees that risks start to rise quite quickly as drinking increases beyond modest amounts.
Life is about more than absolutely minimizing mortality risk, of course. You would be safer if you never got in a car too, yet sometimes it’s worth leaving the house. Sometimes, for many people, it’s worth celebrating with a drink.
Still, even while celebrating, mind your drink sizes, or you’ll find yourself dangerously far along the curve.