Your Brain and Alcohol

You know you shouldn’t drink too much alcohol, but you’ve probably heard that one or two drinks a day (especially wine) is no big deal and could even have health benefits. Right? Well, it may not be that simple.

“There’s always been a story that moderate drinking, particularly red wine, might be good for you. But that’s become quite controversial, and many people dispute it now,” says Anya Topiwala, a senior clinical researcher in the department of psychiatry at the University of Oxford in England.

More recent evidence, including research Topiwala herself has conducted, suggests not only that moderate drinking may not be beneficial but that it could also, in fact, do harm — and that no amount of alcohol is good for your brain. 

“I want people to know that it’s a myth that drinking is good for brain health,” Topiwala says.

The Global Council on Brain Health (GCBH), an independent collaborative of scientists, health professionals, scholars and policy experts convened by the AARP, reviewed the existing research and concluded that even small amounts of alcohol may hurt the brain. While the GCBH doesn’t make a specific recommendation about drinking, it does advise that no one should start drinking if they don’t already.

Could even a little alcohol do harm?

Some research suggests that moderate drinking — about one to two drinks a day — can help lower your risk of death from heart disease and possibly reduce your risk of diabetes and some types of stroke.

Some experts have deduced that these cardiovascular benefits must translate into brain benefits, too, because of the increased blood flow to the brain and established evidence that what’s good for the heart is good for the brain.

In theory, says neurologist Brad Klein, this makes sense. “You can imagine that if you’ve got better blood flow to the brain, then you’re going to get some brain health benefits out of that, too,” adds Klein, who works in private practice at Abington Neurological Associates in Abington, Pennsylvania, where he sees patients with stroke, dementia and memory disorders.

Though your brain is a relatively small part of your body — it only accounts for about 2 percent of your body weight — it requires 15 to 20 percent of your blood supply. That’s how oxygen gets to the brain, and without enough oxygen, brain cells die.

So, yes, proper blood flow keeps brain cells alive.

In fact, a June 2020 study in the Journal of the American Medical Association showed that older women who have about a drink a day and men who have two drinks do reap some brain benefits. Compared with those who don’t drink at all, the imbibers performed better on routine tests of their thinking skills over the 10 years that researchers tracked them. Even when researchers made allowances for factors known to impact brain health — such as smoking, education and age — the differences in test scores still stood.      

Of course, healthy eating patterns that promote brain health, such as the Mediterranean diet and the MIND diet, also allow for a glass of wine a day, adding possible evidence to the case for moderate drinking.

But some research suggests that regardless of these benefits, even a little imbibing every week, over time, can take a toll on the brain in other ways.

Topiwala studied 550 middle-aged adults who didn’t have alcohol addiction. They reported how much they drank on a regular basis over the course of 30 years, and they took routine memory tests and brain scans. What the research found was that the more people drank over a 30-year period, the more brain mass they lost. Specifically, the MRI scans showed loss of brain tissue in the hippocampus, which plays a major role in learning and memory.

Sure, those who drank the most had the highest odds of brain atrophy. But even the ones who drank as little as 35 ounces a week (about 1.5 bottles of wine) showed loss of brain mass on routine brain scans. It took even less alcohol — about 17.5 ounces — to correlate with a dip in brain performance on memory and thinking tests even if brain changes didn’t show up on scans.

Topiwala believes past research that shows health benefits of moderate drinking may need a second look.

“One theory that I have, and others as well, is that if you look at the kind of people who drink only moderately, especially red wine, they tend to be better educated, high-income individuals that do better on memory tests to start with. So it’s harder to pick up a decline in their thinking skills,” she says. “They may also be doing all sorts of other healthy things, like watching their diet, exercising and looking after their medical health in general.”

Topiwala may be onto something. A September 2009 study in the American Journal of Health Promotion showed that people who drink do indeed exercise more than teetotalers. This and other healthy behaviors that, as Topiwala suggests, may be a common part of moderate drinkers’ lives could explain the purported health benefits of liquor.

Similarly, the Mediterranean and MIND diets are about a whole lot more than wine. Both eating plans emphasize nutrients that have proven positive effects on brain health. Arguably, practitioners of these diets would get brain benefits with or without the wine.

Regardless of what alcohol does for blood flow, Klein says, “The improved blood flow to the brain could make a positive impact on long-term health, but the impact of alcohol on brain cells is not great. It’s not a positive impact on the brain.”

Other studies also bolster the case against alcohol. Published in August 2018, one study of the health effects of drinking in subjects across 195 countries around the globe concluded that the only way to minimize the health consequences of drinking was not simply to drink in moderation, but rather to forgo alcohol altogether.

In recent years, the Centers for Disease Control and Prevention has also called the possible health benefits of alcohol into question. The agency acknowledges that while past research may have suggested health benefits, newer evidence contradicts it. They note that it’s impossible through the available evidence to know whether positive health effects seen in research came directly from drinking or from other factors, such as genetics and lifestyle.

So, is it safe to drink at all?

Until more research is available on the effects of even smaller amounts of booze, your own health care providers may continue to recite the old adage “All things in moderation.”

“If I were advising my own parents,” Klein says, “I’d recommend just one or two drinks at most in a night, but preferably only on the weekends. And I’d expect that to be one to two glasses of wine — not three shots of whiskey.” Just 1.5 ounces of whiskey and other spirits — a “standard” drink — is 40 percent alcohol. Compare that with a standard 5-ounce glass of wine with 12 percent alcohol.

Topiwala’s studies have shown that if you do drink a full 35 ounces of alcohol a week (again, about 1.5 bottles of wine), it’s best to spread them out across the week and not drink them all at once.

Her current research suggests that even smaller amounts of alcohol than the 17.5 to 35 ounces reported in her previous studies could lead to brain shrinkage. But, she stresses, her research is still in the works and has not yet been reviewed by a panel of experts — the requirement before scientific findings are published and incorporated into doctors’ recommendations.

In the meantime, she says, while it’s certainly possible that no level of alcohol consumption is safe, everyone must decide for himself or herself whether to drink — and how much. Your doctor can help you weigh your personal risk.

“Everyone accepts a different level of risk. It’s a very personal decision,” Topiwala says. “But I want people to know that it’s a myth that drinking is good for brain health. People should be knowledgeable about that if they choose to drink.”