How Much Alcohol Is Too Much? (excerpt)
Where you need to draw the line

HealthEssentials
April 20, 2022

Even when we have the best of intentions, we can tend to overindulge in … well, everything. Whether it’s a second helping of dinner, snacking on sweets or a venti-sized coffee, we often go a little too far. And that’s especially true — and risky — when it comes to alcohol.

Overdoing it with booze occasionally, like at a wedding or birthday party, might be fine (though your headache the next morning might make you think otherwise). But when does drinking frequently cross the line into being problematic? And what are the health risks of alcohol overconsumption? To gain some insight into these concerns, we spoke with hepatologist Jamile Wakim-Fleming, MD.

What are alcohol consumption guidelines?

It’s first best if we understand some of the dietary guidelines around alcohol. The U.S. Department of Agriculture and U.S. Department of Health and Human Services’ “Dietary Guidelines for Americans, 2020-2025” recommends adults of the legal drinking age should either not drink or limit their drinking to two drinks a day or fewer for men and one drink a day or fewer for women.

The guidelines say those who shouldn’t consume any alcohol under any circumstances include:

• Anyone under the legal drinking age.
• Anyone with liver disease.
• Anyone who’s pregnant or might be pregnant.
• Anyone with a medical condition or taking medication that has poor interactions with alcohol.
• Anyone recovering from “an alcohol use disorder” or has trouble controlling their alcohol consumption.

As for how much alcohol is considered standard, the guidelines define a standard drink as:

• 12 ounces of 5% alcohol by volume (ABV) like beer.
• 8 ounces of 7% ABV like malt liquor.
• 5 ounces of 12% ABV like wine.
• 5 ounces of 40% ABV (or 80 proof) distilled spirits like gin, rum and whiskey.

There are nuances to consider with these guidelines, though. While major American brands of beer have a 5% ABV measurement, many popular craft beers have higher alcohol content. That IPA you love might have an ABV of 7% or higher, so keep an eye on it when you’re knocking them back at your next summer barbecue.

But, as Dr. Wakim-Fleming explains, we also have to be cautious when applying these guidelines to our own habits for several reasons that go beyond the alcohol content of your beverage.

Factors in alcohol consumption

According to Dr. Wakim-Flemings, there are a few factors to consider when it comes to alcohol affecting you because each person is different. She outlines the following as the main ones when weighing alcohol consumption.

• Age. “A 50-year-old person will handle alcohol differently than someone who’s 70 years.”
• Gender. “Women don’t tolerate the same amount of alcohol as men because they have less of a certain enzyme — alcohol dehydrogenase — that metabolizes the alcohol before it’s absorbed into the blood.”
• Body size. If two people of different sizes intake the same amount of alcohol, the person with the smaller body carries less water and has a higher concentration of alcohol in their body, affecting the dilution.
• Family history. Those who are raised in a household with parents who drink are more likely to have an adverse relationship with alcohol.
• Comorbidities. Relatively healthy people will have an easier time processing alcohol than those with existing health issues.

Those factors are largely outside of our control. But other things we can control should also be considered, Dr. Wakim-Fleming advises. For instance, she says, “Drinking on an empty stomach is more toxic than if you’ve had something to eat. There’s no food to help absorb the alcohol so more goes into your blood system.”

And, again, there’s that percentage of alcohol to consider. “Remember that the percentages of alcohol vary among the types of alcohol,” she says. “Drinking 12 ounces of wine contains far more alcohol than 12 ounces of most common beers.”

How many drinks are too many?

Taking into account all of these factors, Dr. Wakim-Fleming says there are still ways to figure out where a person crosses the line into overindulging in alcohol, and separating what’s considered “binge” drinking, “heavy” drinking and “excessive” drinking.

Binge drinking

Studies have shown that even if you only occasionally drink alcohol, drinking regularly over a long period can have negative outcomes on your health. “It’s a cumulating effect caused by drinking over time,” says Dr. Wakim-Fleming.

But a more present danger is binge drinking. According to the U.S. Centers for Disease and Prevention (CDC), binge drinking is classified for men as consuming five or more standard drinks within a few hours and four or more standard drinks within a few hours for women.

That kind of alcohol consumption can lead to severe reactions in your body, including:

• Dehydration and headaches (a hangover, in other words).
• Loss of motor skills that can lead to serious injuries.
• Alcohol poisoning.

The loss of judgment that comes from binge drinking can cause you to make poor choices, too, including driving under the influence, physical altercations and even further physical injury.