What are the health benefits and risks of consuming one glass of wine per day for a generally healthy adult?

Health Benefits and Risks of One Glass of Wine Daily

The American Heart Association explicitly states that the risks of moderate wine consumption outweigh any potential cardiac benefits, and there is insufficient evidence to recommend alcohol or wine as a cardioprotective strategy. 1

Cardiovascular Considerations

While observational data suggests potential benefits, the evidence is not definitive enough to recommend starting wine consumption:

Potential Benefits (Observational Evidence Only)

• More than 60 prospective studies suggest an inverse relationship between moderate alcohol consumption (1-2 drinks daily) and coronary heart disease, though higher intakes increase total mortality 2
• Light-to-moderate alcohol intake (5-15 g/day) in adults with diabetes was associated with decreased coronary heart disease risk, presumably through increased HDL cholesterol 2
• Alcohol reduces platelet aggregation through an antithrombotic mechanism similar to aspirin 2
• However, no clinical trials verify that alcohol can be used to increase HDL cholesterol levels, unlike statins and fibrates which have demonstrated benefits 3

Critical Limitations

• Most cohort studies do not support wine being superior to beer or spirits for heart disease prevention 2
• Wine drinkers tend to exercise more, eat less fat, and have healthier lifestyles overall—confounding factors that statistical modeling cannot fully eliminate 2
• If wine has benefits beyond alcohol content, many could be achieved with grape juice instead 3

Cardiovascular Risks That Outweigh Benefits

Hypertension Risk

• Consuming more than 20 g of alcohol daily (approximately 1.5 drinks) causes a linear increase in blood pressure, particularly in women 2, 1
• Drinking 6-8 drinks daily raises systolic blood pressure by 9.1 mm Hg and diastolic by 5.6 mm Hg compared to non-drinkers 2, 1
• Hypertensive patients should avoid alcoholic beverages entirely 2, 1

Stroke Risk

• Heavy alcohol consumption (>60 g/day) increases risk for all stroke subtypes, especially intracerebral and subarachnoid hemorrhage 2, 3
• Effects of moderate consumption on ischemic stroke remain unclear with conflicting reports 2, 3

Other Cardiovascular Harms

• Chronic consumption of more than 3 drinks daily is associated with cardiomyopathy, cardiac arrhythmias, and sudden death 2, 3

Cancer Risks

Alcohol is an established cause of cancers of the mouth, pharynx, larynx, esophagus, liver, and breast 2, 1:

• Each alcoholic drink per day increases breast cancer risk by 10-12% 1
• Alcohol intake above 50 g/day may increase breast cancer risk 2, 1
• Risk increases substantially with more than two drinks daily for all alcohol-related cancers 2
• Women at high risk for breast cancer should reasonably consider abstaining from alcohol 2

Specific Recommendations by Sex

For Women

Limit to no more than 1 drink per day (5 oz wine = 15 g alcohol) 2, 3, 1:

• Lower limit reflects smaller body size and slower alcohol metabolism 2
• Particular concern exists about breast cancer risk even at moderate levels 2

For Men

Limit to no more than 2 drinks per day 2, 3, 1

Absolute Contraindications—Never Consume Alcohol

• Pregnant women (risk of fetal alcohol syndrome) 2, 1
• Hypertensive patients 2, 1
• Teenagers and young adults (automobile accidents, trauma, and suicide are leading causes of mortality in this age group) 2, 3, 1
• Individuals with history of alcohol addiction 1
• Children and adolescents 2, 1
• People with pancreatitis, advanced neuropathy, or severe hypertriglyceridemia 2

Clinical Bottom Line

There is no compelling reason for adults who currently do not consume alcohol to start drinking wine to reduce cardiovascular risk. 2 Cardiovascular risk reduction is better achieved through proven interventions: not smoking, consuming a low-saturated-fat diet, avoiding obesity, staying physically active regularly, and controlling blood pressure 2, 1.

The American Heart Association maintains that alcohol use should be an item of discussion between physician and patient, not a recommendation for cardioprotection. 1 For those who already drink, strict adherence to sex-specific limits is essential, with awareness that even these "moderate" amounts carry cancer and hypertension risks that may outweigh any potential cardiovascular benefits.