SOUTH AFRICAN LIFESTYLE MEDICINE ASSOCIATION

Alcohol and Health: Understanding the Risks and Benefits

By Dr Megan Michaux

Perhaps the black sheep of the lifestyle medicine family, the harmful substances and behaviours pillar, often gets pushed aside during discussions and consultations. Why? Maybe because it is one of the most challenging areas to change, or because practitioners lack the knowledge, skills, and confidence to bring up these topics for fear of making our clients feel uncomfortable or defensive.

However, if we are going to truly provide lifestyle medicine that is patient-centred and focused on the whole person in front of us, going face-to-face with these tough topics is necessary. To meet our goals to educate people, to highlight healthy behaviours, and to guide people towards those behaviours, we need to understand the past and present of the evidence surrounding alcohol use and misuse, and how to talk to our patients about it.

Where does the idea that alcohol is healthy originate?

Many of us will remember hearing that a glass of red wine every day is a heart-healthy habit. Words like resveratrol, antioxidants, and polyphenols were scattered amongst discussions of the benefits of a little bit of alcohol. The definition of “a little bit” was always somewhat elusive, as was the specific mechanism through which alcohol – a known toxin – suddenly landed on the list of healthy diet habits. Of course, one of the hallmarks of being evidence-based is a willingness to change our opinions when the evidence changes. Unfortunately, changing the message is not as easy as getting the original, incorrect message out there (ever hear of Brandolini’s law?), and so even today this misconception is widespread amongst the general public and healthcare professionals alike.

What is the French Paradox?

The French Paradox was first mentioned in research during the 1980s1, although the concept was probably developed much earlier in the 1800s. Early researchers noted that French people had lower mortality rates from heart disease than other Western countries, despite having a significant number of risk factors (e.g., high cholesterol, diets rich in saturated fats, and hypertension). In trying to isolate the reason for this, they came up with the idea that French people drank more alcohol than other nations, particularly red wine. This association gained traction, and people began talking about it as though it were causation.

An article from 1992 by Serge Renaud gave the idea more traction and even suggested platelet reactivity as a mechanism for the protective effect, although this was largely based on data from pilot studies.2

Later researchers suggested that those polyphenols (like quercetin and resveratrol) were protecting the heart through antioxidant and anti-inflammatory actions. However, these claims also do not hold up to closer scrutiny.3 4

So, if it wasn’t the alcohol, what was it?

While the initial data favoured the alcohol in moderation concept, it was flawed data.

Research has come a long way since the 1980s, of course. In the original study, confounding variables were unaccounted for, and important factors like overall diet, physical activity, and social connection (ah, lifestyle medicine has joined the chat!) were certainly contributing to the health of the French people. It was also noted that French people at the time had lower stress levels than other nations. Taking a closer look at the data showed that lifestyle was a major contributor to the reduced cardiovascular risk, and not more alcohol! 4 5

 What about those antioxidants?

Okay, so some types of alcohol, red wine in particular, contain compounds that are beneficial to our health. Keeping in mind that alcohol itself is a toxin, using it as a source of those healthy compounds creates a risk-benefit imbalance.

For example, red wine has about 10 mg of quercetin in a glass. Human trials use quercetin at a dose of 500 mg – 1000 mg per day. So that is a mere 50 glasses of red wine to reach your daily dose. I hope you see a problem with that math!6 7 8 9 This is just one example. Other compounds like resveratrol10 or catechins11 lead to similar sums, making wine an implausible source of polyphenols. If you are trying to increase your antioxidant and polyphenol intake, a whole food, plant-based diet is probably the way to go. Some more sensible options you could recommend to your patients include eating grapes, adding some blueberries to your breakfast, or sipping on green tea.

What does modern evidence have to say?

Major organisations would agree that alcohol is not health-promoting at any dose. The WHO (2023) agrees with researchers and has noted that there is no safe level of alcohol intake, a clear shift from the previous guidance.12 13

The World Heart Federation notes an increased risk of stroke, heart failure, and atrial fibrillation in people who use alcohol regularly.14 In South Africa, the Heart and Stroke Foundation and the South African Cardiology Society agree that there is no evidence to recommend alcohol intake to protect the heart.15

So everyone needs to go alcohol-free?

As a lifestyle medicine practitioner, always make it clear that the minimal potential benefits of alcohol are outweighed by many serious risks, and avoidance is the healthiest option. However, since alcohol is legal and accessible, and often a part of social norms in South Africa (and all over the world), not everyone will be on board with that idea. So, the next best thing is minimising alcohol intake. Moderate intake looks like 1 or 2 drinks per day (for women and men, respectively). Binge drinking (6 or more drinks in one sitting) is just as bad as overdoing it every day and should also be discouraged. However, autonomy and person-centred care mean that you, as a practitioner, offer support, not judgement, should someone not be ready to change. It is important to emphasise that moderate intake is now referred to as “lower-risk drinking”, because it is not without risk.

Clinical Practice: What do I ask about?

People who need help with alcohol misuse are often afraid to ask about it or ashamed of their behaviour. As lifestyle medicine practitioners, we can offer an empathetic and supportive space to encourage patients to share their struggles. Including screening tools (for example, the Alcohol Use Disorders Identification Test or AUDIT-C) in your intake forms can help you identify people who need help. Also, remember that not everyone who needs help with this is going to be diagnosed with alcohol use disorder; some people may want to cut back or try out things like “dry January” to improve their overall health.

Brief advice (e.g., cutting back on alcohol could improve your sleep), educational resources that explain low-risk drinking and what a unit of alcohol looks like, and motivational interviewing techniques like supporting self-efficacy, might be enough to inspire a safer lifestyle in some people. Be ready to refer to a specialised treatment centre for those who need it!

Take-home points for lifestyle medicine practitioners

There is no safe level of drinking, only lower-risk drinking. Don’t be afraid to bring up alcohol use in your consultations, because some of your clients might still believe that moderate drinking is healthy, and others may be too nervous to raise their concerns with you.

Bring your motivational interviewing techniques out – be empathetic and supportive, take note of resistance, but don’t become argumentative. Education, offering brief advice, and even offering to have another consult when the client feels ready to discuss alcohol, can be helpful.

Also, keep in mind that the other lifestyle medicine pillars (like exercise, nutrition, and sleep) could be worsening alcohol use, or vice versa. For example, exercise programs might be a helpful tool for reducing anxiety and depression symptoms in people with alcohol use disorder.16 Someone who is not ready to tackle alcohol use, but who is willing to look at the other pillars, can benefit from your insights, and may find themselves ready for bigger changes in the future.

Conclusion

Alcohol misuse is a gargantuan challenge we face in society – alcohol is legal, available, and often used from a young age. This problem is only compounded by misinformation like the idea that moderate alcohol use is good for your heart. As lifestyle medicine becomes more commonplace in GP and specialist consults, we have the opportunity to educate people about the risks of alcohol, to offer support to people who wish to reduce or stop using alcohol, and to provide a whole-person service where minimising the use of toxic substances like alcohol can result in healthier populations that not only live longer, but also enjoy that extra time.  By addressing alcohol use with empathy, evidence, and curiosity, we honour the core principles of lifestyle medicine and care for the whole person, not just their diagnosis.

 

 

References

  1. Richard JL, Cambien F, Ducimetière P. Particularités épidémiologiques de la maladie coronarienne en France [Epidemiologic characteristics of coronary disease in France]. Nouv Presse Med. 1981;10(14):1111-1114.
  2. Renaud S, de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet. 1992;339(8808):1523-1526. doi:10.1016/0140-6736(92)91277-f
  3. Covas MI, Gambert P, Fitó M, de la Torre R. Wine and oxidative stress: up-to-date evidence of the effects of moderate wine consumption on oxidative damage in humans. Atherosclerosis. 2010;208(2):297-304. doi:10.1016/j.atherosclerosis.2009.06.031
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  5. Mezzano D, Leighton F, Strobel P, et al. Mediterranean diet, but not red wine, is associated with beneficial changes in primary haemostasis. Eur J Clin Nutr. 2003;57(3):439-446. doi:10.1038/sj.ejcn.1601558
  6. Zahedi M, Ghiasvand R, Feizi A, Asgari G, Darvish L. Does Quercetin Improve Cardiovascular Risk factors and Inflammatory Biomarkers in Women with Type 2 Diabetes: A Double-blind Randomized Controlled Clinical Trial. Int J Prev Med. 2013;4(7):777-785.
  7. Dehghani F, Sezavar Seyedi Jandaghi SH, Janani L, Sarebanhassanabadi M, Emamat H, Vafa M. Effects of quercetin supplementation on inflammatory factors and quality of life in post-myocardial infarction patients: A double blind, placebo-controlled, randomized clinical trial. Phytother Res. 2021;35(4):2085-2098. doi:10.1002/ptr.6955
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  9. Tzanova M, Atanassova S, Atanasov V, Grozeva N. Content of Polyphenolic Compounds and Antioxidant Potential of Some Bulgarian Red Grape Varieties and Red Wines, Determined by HPLC, UV, and NIR Spectroscopy. Agriculture. 2020; 10(6):193. https://doi.org/10.3390/agriculture10060193
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  12. World Health Organisation. No level of alcohol consumption is safe for our health. Jan 2023. Accessed on 10 Dec 2025. Available from: https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
  13. Burton R, Sheron N. No level of alcohol consumption improves health. Lancet. 2018;392(10152):987-988. doi:10.1016/S0140-6736(18)31571-X
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