New research shows that no level of alcohol consumption is risk-free, with mortality risks jumping sharply after just seven drinks per week. Professor Christopher Kahler breaks down the health hazards of moderate drinking and shares realistic strategies for reducing risk.

No substance has quite the impact on American life that alcohol does. It's there when we celebrate a big achievement with a bottle of champagne. It's there when you spend an evening with friends over a glass of wine. It's at sports events and backyard parties.

A lot of people know there are health risks related to alcohol. But those risks have gotten a lot clearer lately. A major new study, published earlier this summer, revealed some pretty alarming health risks tied to drinking alcohol.

[00:01:04] Megan Hall: That’s Chris Kahler, a professor at Brown's School of Public Health, and the director of Brown's  Center for Alcohol and Addiction Studies. Chris is a co-author on this new study.

[00:01:22] Megan Hall: Got it. Okay. So after seven drinks, what happens?

[00:01:34] Megan Hall: So if you double your drinking, it drastically increases your chance of death related to alcohol.

[00:01:42] Megan Hall: This research Chris co-authored, isn't your run of the mill academic study. It was huge, with 25 coauthors. And it was a government commissioned study, intended to inform the latest round of Dietary Guidelines for Americans.

Chris and I sat down for an interview, where he explained what the study found, and near the end of our conversation, he gave some practical advice. You’ll probably find it helpful no matter your relationship to alcohol. But first, I asked Chris how this study came about

[00:02:26] Megan Hall: That means they looked at all sorts of potential causes of death related to alcohol. Everything from heart disease to cancer—even physical injuries.

So when drinking is, say, four or five drinks in a given day, we know the risk of suicide, the risk of interpersonal violence, the risk of car accidents are greatly increased.

[00:03:12] Megan Hall: So it's sort of like you said, okay, in the overall population, this is the risk of getting, at least for women, breast cancer. And now let's look at people who drink this amount. What's their risk? What about people who drink a little more? What's their risk? Is that kind of what you did?

[00:03:52] Megan Hall: What they found was that the risk of death associated with alcohol increases dramatically as drinks rise, especially once you get past 7 drinks a week. At just 9 drinks, 1 in 100 deaths are due to alcohol. And by 14 drinks a week, it's 1 in 25.

So the risks of certain things are quite low at four, five, six drinks a week. By 14 drinks a week, that's now become a real risk, so that's now being added onto the increased risk of cancer, the increased risk of liver disease, the increased risk of injury. All of those things are, are beginning to add up.

[00:04:47] Chris Kahler: It's clear we don't have an absolute level where we can say there's no risk. That's been established for a while. The question is, what's the kind of risk that people are willing to tolerate?

[00:05:07] Megan Hall: Maybe a glass of wine a day is good for you. Maybe you should drink a little bit. Is there any evidence to support that?

[00:05:44] Megan Hall: Cardioprotective just means - something that's healthy for your heart.

But Chris says that there are new techniques, which allow researchers to factor in people's genetic predisposition to drink. These new studies are contradicting those old results.

[00:06:05] Megan Hall: So basically drinking is not good for you?

You know, let's go back about 20 years ago. The dietary guidelines were suggesting that not only is moderate drinking unlikely to be associated with any harms, there also may be some health benefits of moderate drinking, and that actually showed up in the dietary guidelines for a little while, both overall health benefits and, cardioprotective, benefits.

And those already had been removed, and now it's clear that when you think about the risk associated with cancer at pretty low levels of drinking, any benefit that may or may not be there for the heart is completely canceled out by risks associated with cancer and liver disease.

[00:07:15] Chris Kahler: And they used a different set of evidence and came to the conclusion that the guidelines are solid as they are, that certainly anything above those one a day for women, two a day for men, is associated with increased risk, and did not find evidence that lowering those thresholds was necessary.

[00:07:43] Chris Kahler: The dietary guidelines were supposed to comment on both of those sets of evidence and provide specific guidelines for drinking based on the results there.

In fact, the guidelines didn't rely on either, and went with a very, very simple message that ‘drinking less is better for health.’ And I think that message is true. But it also means for people who are a little more quantitatively minded, who really wanna know, well, less than what? We don't have any guidance in that official federal guidance there.

[00:08:22] Chris Kahler: There is certainly some frustration. I would like the dietary guidelines to both have clear and simple communication, but also show the work behind that communication. It is something that, our group at the Research Society on Alcohol, where I'm the current president, we're putting together a working group on guidelines so that there can be some official statement from a research organization of, "Here's what the evidence is. Here's what we recommend and why," referring out to the best evidence that's out there.

[00:09:18 Chris Kahler: Therefore, I would recommend that people take days off, stay below seven drinks a week and on occasions where they go above one drink, that trying to limit that to two or three drinks, is helpful.

[00:09:44] Chris Kahler: Yeah. I would say, first of all, is the glass of wine you're having actually an official standard drink? So that would be five ounces. And you can kind of tell based on how fast the bottle goes. A bottle is five standard drinks, so if you're going through more than a bottle a week, you're having more than five standard drinks a week.

If you're gonna be going out and having two drinks, then maybe there's two or three days during the week where you don't drink at all, and that would help you get that drinking below seven drinks a week.

If you're concerned about breast cancer risk, I would suggest only drinking two or three times a week and limiting that to one and no more than two drinks.

[00:10:41] Chris Kahler: Yes, absolutely. And I think for some people, first when they hear the cutoff of seven drinks a week, they think that's not just reasonable for them at all. You know, they might be drinking 14 drinks a week or 20 drinks a week.

First, knowing that reducing from wherever you are is important. So if someone's drinking 20 drinks a week and gets down to 10 drinks a week, that's a very, very meaningful reduction in health risk, but also you might feel better.

You can do things like, first of all, counting your drinks, making sure you're being very aware, but alternating drinks is a very, very simple way. So you've had one beer, maybe the next beer is a non-alcoholic beer.

If your rise in your blood alcohol level is slower, it tends to reduce the craving for that next drink. You might experience some of those sedative effects, and that starts to reduce the rate at which you're drinking.

[00:11:42] Chris Kahler: Yeah, absolutely. Now, not everyone finds that works, and if you're someone who finds that doesn't work, there's a few things. First is taking a real break from drinking.

[00:12:13] Chris Kahler: And there's other alternatives, things like moderation management, other online groups like The Phoenix for, kind of finding sober events. And then of course your primary care providers. There's medications that are effective for changing alcohol use, like naltrexone. And I think some of those things that we hope will be coming online soon, like the GLP-1 agonist that we've heard so much about, recently for dieting, seem to also have an effect on alcohol use.

[00:12:53] Chris Kahler: I think we're having a national conversation about alcohol, and I think the more that that continues, the better.

Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded at the Upward and Onward studio at CIC Providence.

I'm Megan Hall. Talk to you next month!