A glass of wine with dinner has always had a special treat. He enters the table with the air of civilized habit, of a small, almost domestic gesture. It stands next to the plate, to the conversation, to “it’s only one”. For years, then, a sort of health license was stuck on him, especially when it came to the heart. A little alcohol, it was repeated for a long time, could even be good for you. The new study on alcohol and health published in Journal of Studies on Alcohol and Drugs moves that phrase into much less comfortable territory: at low levels of consumption, researchers observed no net protective effect, and risks of mortality and disease increase even from amounts considered socially “moderate.”
The work was born within a very American and very political path. It was started to help update the Dietary Guidelines for Americans 2025-2030, the federal guidelines that guide public health messages, food programs and health advice in the United States. Then it was left out of the final document, published with a much more generic formula: consume less alcohol for better overall health. A correct phrase, of course, but poor in numbers. The new American guidelines also indicate some categories that should avoid alcohol altogether, including pregnant women, people recovering from alcohol use disorder, those taking medications or having medical conditions incompatible with consumption. On the daily quantity, however, the 2025-2030 version renounces the old explicit limits.
The “moderate” glass
The study hasn’t followed a new group of people for years. He put together already available data and read it with a model designed to estimate lifetime risk. The researchers combined US national data on consumption, information on mortality and disease, relative risk curves, and conditions with an already recognized causal link to alcohol. Inside there are tumors, cardiovascular disease, liver disease, infections and injuries. The comparison was constructed using long-term abstainers as a reference, to reduce the old problem of former drinkers included among the “non-drinkers” after having stopped perhaps for health reasons.
The result is rough, because it touches on the most reassuring image of drinking. Up to around seven drinks a week, the study estimates only slightly increased risks for many conditions, but already there there appears to be around one death attributable to alcohol per thousand people over the course of a lifetime. Above 8.5 drinks per week, the risk exceeds one death per hundred people. At fourteen drinks a week, the old upper limit for men in the United States, the estimated risk of death attributable to alcohol comes to about 1 in 25.
The recommendation that the authors derive from these numbers is more severe than in the American past: for adults who drink, a maximum of one drink a day. The threshold applies to men and women, without the old distinction that allowed men up to two drinks a day. And the central issue concerns the word “drink”, because in real life the glass rarely corresponds to the ideal measuring cup in the manuals. A strong craft beer, a large glass, a cocktail full of spirits can be worth more than a single unit. In Italy the standard alcoholic unit used by the PASSI surveillance system of the Istituto Superiore di Sanità corresponds to 12 grams of ethanol, i.e. more or less a 330 ml can of beer, a 125 ml glass of wine or a small glass of liqueur.
The way you drink also matters. Seven glasses distributed over a week have a different weight than seven glasses concentrated in one evening. The Ministry of Health recalls that the risks increase with the total quantity, with the quantity taken on a single occasion and with the methods of consumption. Drinking between meals, drinking a lot in a short time, drinking before driving or working are scenarios that immediately change the risk profile. Binge drinking remains one of the most dangerous forms, precisely because it combines acute intoxication, loss of clarity and greater exposure to accidents.
The myth of the protected heart
For years the narrative of the “good for the heart” glass has walked with a certain ease. The problem is that many observational studies in the past have compared moderate drinkers and non-drinkers without always being able to clear the data of income, education, access to treatment, eating habits, physical activity and previous conditions. Those who drink little, in some contexts, may belong to groups that are more socially favored and better followed from a health point of view. At that point the glass risks taking credit that belongs to everything else.
The new work goes in the opposite direction: no net benefit observed at low levels of consumption, risks that rise as weekly drinks increase, progressive increase for some outcomes related to cancer, cardiovascular disease and injury when exceeding one drink per occasion. The data must be read with the right measure: a single drink does not automatically become a health sentence. However, habitual consumption, even when it seems tidy and presentable, loses a lot of its old innocent aura.
The scientific picture, moreover, has been shifting for years. The World Health Organization has already clarified that, as far as health is concerned, it is not possible to indicate a risk-free level of consumption. Alcohol is a toxic, psychoactive substance, capable of creating addiction and is classified as a group 1 carcinogen by the International Agency for Research on Cancer, the same risk category that includes asbestos, radiation and tobacco. The ethanol contained in wine, beer and spirits is always the same molecule: the glass changes, the ritual changes, the price changes, the biological mechanism remains the same.
Even in Italy, health communication is moving towards a clearer formula. The Ministry of Health writes that it is not possible to identify levels of consumption without any risk and summarizes the indication with “less is better”. The Italian “low risk” thresholds remain 2 units of alcohol per day for men, 1 for women, 1 for over 65s and zero under 18 years of age. Low risk, however, means exactly this: lower risk, not absence of risk.
The political part of the glass
The American story also weighs on what it tells us about the relationship between science, industry and public decisions. According to available reconstructions, the study was one of the works commissioned to orient the guidelines. After a draft was released, alcohol industry groups and a Republican-dominated House committee strongly contested it, accusing it of being flawed. The Trump administration then released guidance without explicitly including those findings. The U.S. Department of Health has rejected the idea of the work being set aside, arguing that the report was evaluated alongside the body of available evidence and that the guidelines derive from the entire scientific record, not a single analysis.
To complicate the picture there is also a second relationship, that of National Academies of Sciences, Engineering, and Medicine. That paper concluded, with moderate certainty, that moderate drinking was associated with lower all-cause mortality than non-drinking, but also reported an increased risk of breast cancer in women and low or insufficient levels of certainty for several other outcomes. None of the report’s conclusions reached a high level of certainty, also due to the typical limitations of observational studies on alcohol and health.
The knot can be seen clearly here. Science on alcohol rarely offers comfortable slogans, because it has to work with real habits, often inaccurate self-certifications, different lifestyles, glasses filled by eye and years of consumption that are difficult to reconstruct. But the general direction has become clearer: using alcohol as a positive health argument is increasingly fragile. The old “a little is good” comes out badly when compared to tumors, liver, pressure, accidents, addiction and cumulative consumption.
In Europe the topic is even more sensitive, because wine and beer are material culture even before they are products. In Italy a glass can be inside a Sunday with the family, a dinner out, a festival, a work toast, a village celebration. Precisely for this reason we need a less ambiguous language. Nobody needs a lecture every time they raise a glass. You need to know that that gesture carries with it a risk, small or large depending on quantity, frequency, body, age, sex, health conditions and context.
The new study on alcohol and health does not end the discussion with a universal ban. However, it tightens the frame. One drink a day stops seeming like the free zone of absolute moderation and becomes a high limit to be looked at more carefully. Above that threshold, the numbers begin to lose the polite face of the toast. The glass remains on the table. Only now it weighs more.
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