Drinking alcohol has long been a contentious topic, but in recent years, health experts seem to be increasingly criticizing it more harshly.
Indeed, alcohol use is associated with numerous diseases and negative consequences. So, why has alcohol remained so pervasive throughout history and across cultures, embraced for thousands of years despite its risks? Could there be more to its story than just its harmful effects? Or should we all really be sticking to sobriety?
In Part 1 of this review, we examine the scientific evidence, evaluating studies that suggest alcohol's effects can range from very harmful to neutral, and even potentially beneficial in certain aspects. In Part 2, we focus on the cultural and traditional uses of alcohol throughout time and cultures, exploring why symposiums used to be so lively and why some religions encourage drinking.
The punchline? Alcohol might offer a benefit or two that go beyond what science can easily measure, but play a significant role in why people drink.
Many thanks to Shahid for supporting this research, and stay tuned for our upcoming real-world experiment on this!
Alcohol is carcinogen and significantly increases the risk of developing many kinds of cancer (1, 2), especially breast cancer in women (3). It leads to increased risk of cardiovascular disease (4), nutritional deficiency (5), liver disease (6), and premature aging (7). It is also associated with behavioral dangers, such as traffic fatalities (8), homicides (9), fatal falls, intimate partner violence, and suicide risk (10).
At high levels of consumption, the risks are severe. Alcoholism is extremely destructive, both for addicted individuals and those surrounding them. The stories on this Reddit thread, for example, vividly illustrate this.
At this level or even less, drinking causes extreme health issues, debilitating social consequences, and death. Excessive alcohol use is undoubtedly associated with numerous negative health outcomes, particularly when multiple drinks are consumed daily.
But you already knew that.
Several epidemiological studies find that there is a “j-curve” of alcohol consumption and cardiovascular mortality risk, with moderate drinkers enjoying a significantly decreased risk compared to abstainers or heavy drinkers (eg 11, 12). However, this effect is highly debated, since these are observational studies where it is difficult to account for confounders (13). Other studies that account for confounders more rigorously find no benefit from moderate drinking (14).
Similarly, alcohol is associated with reduced risk of dementia in low doses and an increased risk in high doses (15). This is according to a meta-review of 28 other multi-study reviews, the majority of which supported this association. However, many of the underlying studies had methodological issues which make it unclear to say whether alcohol has a causal effect on dementia risk or if there is some other explanation.
One commonly referenced study about alcohol and brain health analyzed the brain scans and drinking habits of over 36,000 people (16). This study is discussed extensively in Huberman Lab's episode on alcohol, and it is also mentioned by other health influencers such as Rhonda Patrick. The study found that even 1-2 drinks per day is associated with lower gray matter and white matter volume in the brain, which indicates reduced cognitive abilities.
However, what Huberman and other media coverage does not mention is that the effect sizes are difficult to interpret. For example, the estimated reduction in gray matter volume from having one drink daily instead of zero is just 0.03 standard deviations, which seems relatively small considering that this corresponds to a loss of 1.65 cubic cm (assuming a standard deviation of 55, as reported in the study). It is typical for people to lose ~2 cubic cm per year from normal aging (17).
How would this difference in brain volume actually affect cognitive function? We reached out to the authors for comment, and they advised caution in drawing over-simplified conclusions, emphasizing that different areas of the brain are affected by drinking in various ways, and that cognitive functions extend beyond what can be easily measured with standard tests. We also posted about the topic on Research Hub, where it received some insightful commentary from the scientific community.
Basically, this currently popular claim about how any amount of drinking is dangerously damaging to brain health is actually not so clear cut.
Another study that doesn't necessarily demonize alcohol is the Beer-HIIT study, a randomized controlled trial of 73 adults who did a 10 week training program and either drank moderately (1 drink daily for women, 2 for men) or abstained (18). All of the groups increased their VO2 max from the training program, and the moderate alcohol intake did not affect their progress.
People in “blue zones,” places where many live to be 100 years old, tend to report drinking in moderation (e.g. less than 1-2 drinks daily) (19, 20). Some studies refute the association between moderate alcohol consumption and longevity (21), but most do not find a negative impact, suggesting that the effect of moderate drinking on longevity is likely either small or nonexistent.
You may have heard of the concept of Dunbar’s number, which suggests that humans have the cognitive capacity to maintain stable social relationships with about 150 people. The anthropologist who coined this term in the 90s, Robin Dunbar, published a paper in 2017 suggesting that alcohol consumption remains pervasive across human cultures because it is key to facilitating large-scale social bonding (22). At an evolutionary level, this benefits our fitness, as it has been widely demonstrated that having strong social relationships greatly increases survival (e.g. 23).
Another intriguing finding concerns alcohol and erectile dysfunction. The pooled results of 46 studies (n > 200k in total) found that moderate alcohol consumption significantly reduced ED (24, also supported by 25 and 26).
It’s another one of these j-curve associations where too much drinking is bad but moderate drinking is helpful. Why might drinking help with ED? It's possibly due to the reduced anxiety and sexual inhibition caused by a small dose of alcohol.
This brings us to an important and potentially misunderstood effect of alcohol – disinhibition.
Inhibition is the psychological mechanism that restrains thoughts and behaviors. It serves as a regulatory function to control impulses, ensuring that behavior conforms to social norms, personal goals, and ethical standards.
Alcohol reduces inhibition. This fact is both scientifically demonstrated (27, 28, 29) and obvious to anyone who has drunk alcohol before.
Disinhibition can be a bad thing, for instance, when you have the impulse to seek more alcohol to an excessive degree (30), engage in risky sexual behavior (31), or become aggressive towards others (32). But when is disinhibition a good thing?
Disinhibition helps by breaking down mental barriers, encouraging experimentation, and enabling open and honest expression. Broadly, it can be useful in situations involving creativity (innovation, art, programming, entrepreneurship) or connection (social bonding, team collaboration, personal relationships, therapeutic settings, sexual intimacy).
Disinhibition in any of these areas can be harmful in excess. But the less-discussed fact is that excessive inhibition can also be harmful, and there are certain situations in which people would benefit from greater disinhibition.
The feeling of a small dose of alcohol is not unlike the feeling of drinking Felix Felicis, the luck potion from Harry Potter’s world.
“What does it feel like?” whispered Hermione.
Harry did not answer for a moment. Then, slowly but surely, an exhilarating sense of infinite opportunity stole through him; he felt as though he could have done anything, anything at all… and getting the memory from Slughorn seemed suddenly not only possible, but positively easy…
He got to his feet, smiling, brimming with confidence.
The potion enables Harry to creatively overcome a challenge by following his impulses and ignoring social pressures. Similarly, alcohol can lower inhibitions and enhance spontaneity, allowing you to think more freely about something that you may have been stuck on.
Maybe you are now in agreement that disinhibition has its place. But can it be achieved through healthier methods, such as meditation and mindfulness techniques, confidence-building hobbies (e.g. dance classes), or other drugs (e.g. Viagra for ED)?
Mindfulness has more commonly been used for enhancing inhibition rather than decreasing it; for instance, it helped young criminal offenders improve their inhibitory control (33). But it’s plausible that the anxiety reduction of meditation and mindfulness could also help with positive disinhibition. Dance has physiological and psychological benefits (34), but effects on disinhibition in particular have not been studied. Viagra helps with ED specifically but not general disinhibition.
These methods may not offer the same immediate ease that moderate alcohol consumption can provide. Alcohol used responsibly can lower inhibitions quickly and effectively, creating a relaxation that is often difficult to achieve through other means.
In ancient times, and possibly up until the mid 19th century, water-borne diseases like typhoid were the most common way to die (35). One way to avoid drinking dirty water was to drink alcohol instead.
In unearthing Tutankhamen’s tomb, they discovered a text called The Book of the Heavenly Cow. It begins with a story called The Destruction of Mankind which illustrates the transformational power of alcohol. You can actually read the original text here, hieroglyphs and all.
Ra, the sun god and the father of all creation, finds out that humans have a plot to overthrow him. Enraged, he decides to kill them all, sending the goddess Hathor to each village to murder the inhabitants and drink their blood. She starts going crazy with bloodlust and transforms into the savage deity Sekhmet.
Ra realizes that this is going too far, but now Sekhmet cannot be stopped. He adds a red dye to 7000 jars of blood and delivers it to her. Thinking it is more blood, she drinks it all: “Then she drank and it pleased her heart.” She gets drunk and passes out. She wakes up again as the peaceful, beautiful Hathor, and she has stopped killing all the people.
This story is hard to interpret because of the giant chasm of time between the Amarna Period of Ancient Egypt (around 1353 BC) and today, attempting to decipher an online copy of a translation made by a British Egyptologist in 1905. However, it seems that drinking alcohol had a positive effect on the goddess, transforming her tense wrath into relaxation and friendliness towards humanity.
The ancient Egyptians would celebrate humanity’s salvation by beer in a festival of drunkenness called the Tekh Festival. Beer was seen as a symbol of life and transformation.
The ancient Egyptians were also big on drinking beer in their daily life. The way they brewed it, it was likely a thick consistency like oatmeal rather than smooth liquid. It was used as a source of food – the laborers who built the pyramids of Giza were rationed 10 pints of this beer daily (British Museum).
In ancient Greece, wine was the drink of choice. They even had a whole god about wine -- the famous Dionysus. He was sometimes called Dionysus Eleutherius (the “liberator”) because his drinking and dancing traditions freed people from self-consciousness.
Today, a symposium brings to mind a scholarly lecture hall with people formally presenting research. But back in the day, a symposium was a social gathering for drinking, conversation, and entertainment – it literally means “drinking together.” The male elite would gather, recline on couches, sip wine, and talk philosophy and politics.
One of Plato’s most well-known works is The Symposium, a socratic dialogue exploring the nature of love. The men at the event, including Socrates, explored their ideas through speeches, using wine as a way to open up and speak freely. It is noted that “no man has ever yet seen Socrates drunk” – some people interpret this as a testament to Socrates’ wisdom and restraint, while others suggest that he was so used to drinking that it did not affect him.
Another philosopher named Xenofon also wrote a similar book called Symposium, and in his he quotes Socrates speaking on drinking:
“... so far as drinking is concerned, you have my hearty approval; for wine does of a truth ‘moisten the soul’ …
When God gives the plants water in floods to drink, they cannot stand up straight or let the breezes blow through them; but when they drink only as much as they enjoy, they grow up very straight and tall and come to full and abundant fruitage. So it is with us. If we pour ourselves immense draughts, it will be no long time before both our bodies and our minds reel, and we shall not be able even to draw breath, much less to speak sensibly; but if the servants frequently ‘besprinkle’ us—if I too may use a Gorgian expression—with small cups, we shall thus not be driven on by the wine to a state of intoxication, but instead shall be brought by its gentle persuasion to a more sportive mood.”
To keep stating the obvious, moderation is key, and they knew this then as well as now. But what has been partially forgotten is the acknowledgement of what benefits drinking brings, that it “moistens the soul,” that it brings us “to a more sportive mood” where we can speak and think openly. Wine was key to the philosophical insights produced in ancient Greece.
Alcohol is frequently incorporated into Jewish festivals and ceremonies as a way of enhancing happiness and celebration.
Purim, a holiday where people dress up in costumes and celebrate the salvation of the Jews from the evil Haman, involves copious drinking. In the Talmud, an essential Jewish rabbinical text, Rabbi Rava says:
“It is one’s duty (levasumai) to make oneself fragrant [with wine] on Purim until one cannot tell the difference between arur Haman (cursed be Haman) and barukh Mordekhai (blessed be Mordecai).”
Jews also drink wine in other ceremonies – reciting blessings at the marriage ceremony, at circumcision, and every Friday evening to usher in the Shabbat. At Passover, one of the most important Jewish holidays, it is required to drink 4 cups of wine during the several-hour course of the Seder dinner.
Another religion that seems to meaningfully incorporate drinking is Shinto, Japan’s native religion. Sake is their drink of choice, said to bring people closer to kami (the gods). People drink Omiki (a sake offering) as a way to communicate with the gods.
Most English-language sources about Shinto religion are secondary, so it is hard to tell how accurately they represent the traditions. However, one anthropologist from the University of Iowa explains that although “Japanese society is characterized by an emphasis on harmony and self-restraint… alcohol is often considered a necessary catalyst for promoting the open expression of alternative viewpoints, though only in certain culturally prescribed contexts.” He describes the Shinto shrine festival during which shrine bearers “purify” themselves by drinking a lot of sake and then carrying a heavy shrine whose wobbly movements are thought to be controlled by the will of the deity (36).
The examples mentioned here are only a few of the cultural and traditional uses of alcohol. Most cultures are cautious of excessive drinking, and some completely frown upon it. In Islam and Baha’i faith it is entirely prohibited. In India, there has traditionally been strong criticism of drunkenness (37), as reflected in the words of the famous Tamil poet Thiruvalluvar, who wrote: “To pay and drink and lose the sense is nothing but rank ignorance.”
Even in the cultures mentioned above, there is a strong emphasis on moderation and responsible consumption. Beer saved humanity from Sekhmet, but she was brought down by her own intoxication. The Greeks traditionally mixed one part wine with three parts water in order to lower their consumption. In Jewish and Shinto traditions, wine and sake are integral to rituals but consumed with respect and moderation.
Alcohol has been used across various cultures and religions as a means of celebration and ritual, open philosophical discourse, connection with the spiritual realm, transformation, and sustenance. Most cultures recognize alcohol's power to both enhance and disrupt social and spiritual harmony.
Despite its well-known dangers, its biggest underrated benefit relates to its ability to enhance light-hearted openness and create a shift in perspective.
Stay tuned for our upcoming study: Alcohol-Induced Peak Performance.
