
We spoke to two researchers who disagree about the answer to this question.
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Bird Pinkerton
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Dylan Scott
Dylan Scott, senior correspondent and senior good pal of mine, Bird Pinkerton.
Bird Pinkerton
Pal of mine and co host of Unexplainable.
Dylan Scott
You have a. You have a mystery for me, I believe about alcohol.
Bird Pinkerton
I do. So if you're anything like me, you know, I think we both grew up in the 90s. You have heard some very mixed messages about what drinking moderate amounts of alcohol can do for your health. Just in time for the weekend, a new warning about the dangers of alcohol and cancer. It feels like every week you read the news and there's a new study about alcohol and it's saying the exact opposite of the study you were reading about last week. Several studies have shown moderate drinking may.
Dylan Scott
Be good for your overall health, but.
Ken Mukamal
No amount of alcohol is good for your health. Less drinking means less risk.
Bird Pinkerton
So I decided, like, I want to get to the bottom of this for myself and for our audience. Like, I want to actually understand what to think about the health effects of drinking moderate amounts of alcohol.
Dylan Scott
Okay, and so what, what did you find? Like, what are the health effects of drinking moderate amounts of alcohol?
Bird Pinkerton
Well, this is unexplainable. So I found it was unexplainable, but in a way that I think is really interesting and revealing because this story of alcohol's health effects and our imperfect attempts to measure it is, I think, the story of, of how it's really, really Hard to isolate and pin down the health effects of all kinds of things that we really would want answers about these things that we interact with and consume all of the time.
Dylan Scott
Okay, let's. Let's go.
Bird Pinkerton
You know, I think to start, we should establish that the science is pretty settled when it comes to heavy drinking. Alcohol is bad for you. It has neurological effects. It causes liver disease, and we've known that for hundreds and hundreds of years.
Dylan Scott
How much is too much, though, I guess, or, like, what is a lot of alcohol?
Bird Pinkerton
This was one of the things that surprised me when I looked into this, and I think it would surprise a lot of people, which is that what normal people think is a lot of drinking and what scientists and doctors think is a lot of drinking, there's a pretty big gap there. But looking at the scientific definition, for some people, the limit is two drinks per day. Anything above that is heavy drinking. And for other people, it can be just one drink per day, and anything above that is heavy drinking. And like, you know, a drink can be a pretty small amount. Even one can of beer, if it has really high alcohol content, can be more than one drink. And so if you're drinking more than that limit each day, the researchers that I talked to were in agreement that that's going to be a problem. There are heart risks, There are cancer risks. It's damaging your liver, and you would do better to drink less.
Dylan Scott
But what if you are drinking, like, just a glass of wine every two days or whatever?
Bird Pinkerton
I mean, this is where things get contentious. This is where all of the argument is. So let's start with sort of the pro alcohol side, and we can start with a researcher who has made the case that maybe some small amount of alcohol might actually be good ish for you.
Ken Mukamal
My name is Ken Mukamal. I'm a primary care physician at Beth Israel Deaconess Medical Center.
Bird Pinkerton
I do think it's worth pointing out that Ken has been in the news in the past, and he has faced some criticism from his peers about his research allegedly being influenced by the alcohol industry. Like, back in 2018, he was leading a study on alcohol's health effects for the nih, and that study got shut down because the NIH found some suggestion that there was bias in the study's design. But, you know, even with that history, I thought it was really helpful to talk to Ken and to get his perspective on the research. And I also thought it was interesting, like, he's staked out this position, but he doesn't really seem to have a personal investment in Drinking alcohol.
Ken Mukamal
Although a sizable part of my research career has been related to alcohol, we hardly drank at all in my house. My dad was a chemical engineer, and if he happened to open a beer, it was like, you know, a major event in the house. And in fact, I continued hardly to drink at all.
Bird Pinkerton
But even so, part of the reason he wanted to study alcohol is that, as he said, he's actually a primary care doctor. So he's not like just a cardiologist by training who's only worried about your heart. He's not only a liver doctor or a kidney doctor. He's worried about the whole person. And for him, alcohol was a really good fit because alcohol touches on so many aspects of people's lives. You know, decades ago, as he was starting to think about this, he developed this question about whether some amount of alcohol might be helpful.
Ken Mukamal
This was right around the time that in kind of clinical medicine more generally, when I was going through training at that time, we were moving into the idea that when people had heart attacks, that one of the ways that we could either treat them or prevent them was to do things like giving people baby aspirin. Right? And that eventually turned into, like, you know, lore all over the world.
Bird Pinkerton
Aspirin is a blood thinner, and heart attacks happen basically because the flow of blood to the heart is blocked in some way, and so thinning out the blood might help.
Ken Mukamal
And indeed, the New England Journal had published a sort of small paper, like in the early 1980s, showing that aspirin prolongs how long it takes somebody to clot their blood. And if you give them aspirin plus alcohol, it was markedly longer than even just with aspirin alone. So I'll be honest, I'm thinking to myself, well, if that's true, and we're spending all this time, you know, trying to give people aspirin and stuff, like, why aren't we washing down that aspirin with a little bit of alcohol? If that data from the early 1980s was right? And we're seeing that alcohol has a little bit of blood thinning effect, and we're looking for additional blood thinners like, this seems like the natural next thing to do.
Bird Pinkerton
And his boss actually didn't totally shoot this idea down. And, you know, Ken told me, like, there are better blood thinning options than alcohol. So the idea wasn't like, let's, you know, give everybody who's having a heart attack a shot of whiskey. But, you know, he was still interested, like, could naturally thinning your blood this way, you know, prevent Heart attacks just over the long term and could there be other positive impacts that alcohol might have on your health somehow?
Dylan Scott
So if you're like having a glass a day, is your blood just like a little bit thinner and maybe that prevents heart attacks?
Bird Pinkerton
This more like kind of long term, small dose exposure, prophylactic approach. Yes, that's what he was curious about. And he, you know, went down this long rabbit hole for many years after that looking for some answers. He was mostly looking at, you know, these big data sets, these things that are called cohort studies or large population based studies, more or less.
Ken Mukamal
The idea is quite simple, right? We're going to take lots of people, we're going to ask them some universal standard questions, including things like how often do you drink alcohol? When you drink, how much do you have, what's the most that you have? And then using that information, we're going to then sort people into bins and then wait and see what happens. Now these are not experiments. I want to emphasize that because that's going to then come back to haunt us a little bit. These are not situations where I ask you to drink a certain amount or ask you not to drink a certain amount and manipulate it the way that say I would do with mice in a laboratory. These are just you chose to drink or you didn't chose to drink. And I'm going to follow along and see what happens. And in our case, they involved anywhere from, you know, a few thousand to tens of thousands of people followed for anywhere from three or five years to 25 years.
Bird Pinkerton
And so, you know, Ken's looking at these studies where people have reported their alcohol consumption and then he's looking at data that shows their health outcomes and he's going through the numbers and he found a slight link in small doses to some potential health benefits from drinking alcohol.
Ken Mukamal
To the extent that there's sort of a simple message that, that I could offer, it's that where we see, well, I'll call quote, benefits of alcohol. These are not proven is definitely causal. But to the extent that we see any, it's predominantly for things like diabetes and heart disease.
Bird Pinkerton
So he's saying that there may be a slight benefit, a slight positive health effect for your from low level drinking.
Ken Mukamal
If there's any benefit, there's benefits from drinking small amounts frequently. And in fact, binge drinking for the most part obliterates any of the benefits that you see from frequent drinking.
Dylan Scott
He doesn't sound super sure about this though, or like confident. Like when he says if there's any benefit he's not making like a, a particularly definitive statement.
Bird Pinkerton
No, he's not. And I mean, this is what I found the most interesting. After digging into this, Ken actually spent a lot of our time in our conversation talking less about, like, the specific data he found and what it showed and more about, like, the problems with the data itself.
Ken Mukamal
This is not high quality evidence in the same way that you would want, say, to have a new drug approved. It's just not.
Dylan Scott
What's wrong with the evidence, that is. After the break.
Bird Pinkerton
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Dylan Scott
Alcohol withdrawals.
Bird Pinkerton
That's great.
Dylan Scott
So, Dylan Scott, before the break, you basically told me that our data on alcohol is bad. Why is that?
Bird Pinkerton
Well, it might be most helpful to start with, like, what would high quality data even look like? And in an ideal world, what you would do is set up a randomized control trial. Like, you have two groups of people and one group would drink and the other group wouldn't drink. And you would follow them both over time and you'd track what happened with their health. And at the end of this trial, you would be able to measure what the health effects of alcohol actually were. And that is the gold standard that we use for approving pharmaceutical drugs, for example.
Dylan Scott
I can see why it would be pretty impossible to get like a thousand people or whatever into a randomized control trial and basically be like, you have to drink two bottles of IPA every day for the rest of time. And you know, you can't drink any alcohol, but you have to drink two bottles of orange juice or something. Like, that's not, that's not realistic in the world we live in.
Bird Pinkerton
No, no, exactly. So instead we have the setup we were describing before the break. We have these observational studies that just ask people about their real lives, you know, how much alcohol they drink. And, you know, we try to follow them over the course of their lives just as they unfold naturally, try to deduce some health effects from that observational data. But that kind of study, it has some pretty big problems.
Tim Namie
And I'll just try to do a thumbnail sketch about what most of the evidence is about and what its problems are. And you can like edit it out of your thing if you want to.
Bird Pinkerton
This is Tim Namie. He is the director of the University of Victoria's Canadian Institute for Substance Use Research. He has been doing research since the 1990s, and at first glance, it would seem that he fundamentally disagrees with our first researcher, Ken. Like, Ken is out here saying there's a possibility that a small amount of alcohol might be good for your health. And Tim thinks the opposite.
Tim Namie
The science is very consistent for 40 years that, like, when it comes to alcohol, that less is better.
Bird Pinkerton
He is basically saying there is no amount of alcohol that is good for you.
Tim Namie
It's not that people shouldn't enjoy alcohol or shouldn't drink alcohol. It's just that there are many things in life that we do that come with some risks and it's okay, right? But it's just like, I guess as a scientist and a public health person, I like to call BS when I think there's been a bit of BS. And I think we've seen over the past 20 years that that kind of health halo around particularly wine and particularly so called moderate drinking has kind of fallen away. At no level of consumption was there a significant protective effect.
Bird Pinkerton
But when we talked to Tim and he was explaining to me why he doesn't think that glass of red wine has any kind of health halo, I realized that he was actually saying a lot of the same things that I was hearing from Ken because, you know, as it turns out, they're both looking at the same kind kind of data and they both agree on this key.
Tim Namie
Central Point, I think the evidence base is pretty crappy.
Bird Pinkerton
In fact, you know, a lot of Tim's argument for why he's calling BS on the idea that a small amount of alcohol could have some health benefits is because of his frustration with the data sets that we're drawing on. Like, he says that for one thing, a lot of studies out there aren't asking questions that are specific enough.
Tim Namie
Most of what informs our information about the relationship between alcohol and say, heart disease is based on what we call big cohort studies. These are studies that are designed to ultimately study like heart disease, cancer, but they weren't really designed with alcohol in mind. Why is that important? It's important because typically they're only asking people at one point, like at the beginning of the study, for example, like, okay, how many days a week do you drink and how much do you drink on the days you drink? And then from that they calculate an average consumption.
Bird Pinkerton
We know there's a big health difference between one drink every night versus having seven drinks in a week, and they were all consumed within two hours on Saturday night. But, you know, depending on the way the researchers phrase their questions or just the information they choose to collect, in theory, both of those could be recorded as I had seven drinks this week. And that imprecision makes it hard in general to interpret some of the data we have on alcohol and its health effects.
Dylan Scott
That does seem like fixable though, right? In the design of either future studies or current studies.
Bird Pinkerton
I mean, sure, you know, we could, we could design a perfect survey question to ask about people's alcohol use, but even if we did, there are other things that are not so easily fixed, like the lack of randomness in studies like this, because, you know, you're not, when you're not randomizing things truly, like when you're just having people report how much they're drinking and then letting them go about their lives. There are a lot of ways that the, the cultural context in which they live could affect the data that you're getting. You know, we could go back, I think, to like the idea that moderate drinkers are seeing some positive health effects to their drinking. As Tim pointed out, you know, moderate drinkers actually tend to fit a certain profile and they share other things in common.
Tim Namie
The problem is the so called moderate drinkers, especially in developed countries, tend to be very socially advantaged. These people also have higher education, they have higher incomes, their children smile at them, they go to the gym, they drive BMWs. I mean, this is, this is a big problem, right?
Bird Pinkerton
So basically, Tim's argument here is that maybe it's not that little bit of alcohol consumption that's good for you. It's that the people who tend to have lots of other healthy things going for them in their lives tend to be the ones who are drinking only a little bit. And that might kind of bump up the numbers, you know, showing positive health effects from their drinking.
Tim Namie
So it makes it appear like, oh, moderate drinking, you know, gives you straight teeth and it gives you a good job and it gives you a BMW, but in fact, it's the BMW and the nice job that lets you buy a nice bottle of wine.
Bird Pinkerton
And on the flip side, you know, he said, we also need to be really careful about how we think about and study non drinkers.
Tim Namie
Those people are actually in many cases not never drinkers, but are in fact former drinkers. Former drinkers we know are very unhealthy. They tend to be unhealthy, and it may be because they drank a lot or had bad effects of alcohol and they stopped drinking. But what we know about former drinkers is for a variety of reasons, they tend to not do well.
Bird Pinkerton
Some folks might not be drinkers at the time of the study, but they might have been heavy drinkers before the study even started. But at the time of the study, when the researchers are collecting all this data, they would report that they actually don't drink. So this could really, this could really influence the results that this study ultimately reports. And I've seen, you know, other studies have pointed out that, like some of the people who are really, really heavy drinkers, they die at such a young age that they don't end up getting included in these studies. And so, you know, all of these things are the problems with observational studies and relying on observational data to draw firm conclusions about the health effects of different things. Unless you're controlling for all of this stuff, it becomes really hard to isolate for the specific health effects of alcohol.
Dylan Scott
But like, my understanding is that you can find ways to correct data for stuff like this, right? Like if, if you ask people who join your study, did you or have you had a problem with alcohol, can't you kind of control for all those factors, I guess, or like weight the study accordingly?
Bird Pinkerton
I mean, you can certainly try. And you know, Tim Nami is a co author on a recent really big meta analysis of all the prior research of cardiovascular effects from alcohol use. And that's exactly what they were trying to do. You know, they were trying to slice and dice this data to account for all kinds of different Things, you know, gender and age and race and even this abstainer bias that they were cognizant of. But, you know, there's, there's an art to doing that kind of work. You know, different people could choose to weigh different variables to different degrees, and that's what leads to some of these differences of opinion that we've seen between different scientists.
Dylan Scott
Is there any hope of getting better data? Like, I don't know. I, I personally would like to have better data on this thing that's, that's pretty ubiquitous in modern society.
Bird Pinkerton
Yes, I agree. And there are researchers who are trying to use things like genetics to improve the data we have. You know, they're studying people who have a genetic tendency to drink or not to drink and looking at their health outcomes. And then we've got other researchers who are trying to set up studies to measure the specific biological mechanisms that might explain some of the benefits or, you know, negative consequences that we're seeing. And so, you know, I think that would make people feel more confident at least that, like, okay, it's actually the alcohol that's doing something here. And it's not just that, you know, these people have to happen to have certain drinking patterns or their health outcomes are actually being determined by, you know, having a BMW or their kid is smiling at them, whatever it may be. But, you know, overall, I mean, I thought, Look, I thought Ken made a compelling point that even though this is hard, even though the answers may not be perfect, we could and should try to do better.
Ken Mukamal
At least for me, the fact that something is hard is not a reason not to do it. Especially when something as important as this. Right? A lot of people drink alcohol. Over half Americans are drinking alcohol. How is it that we don't know exactly what the hell this stuff does if half of Americans are doing it? And the fact that it's hard is a cop out answer, I think, for not having good information.
Dylan Scott
Were you surprised by this at the end that we, that we don't have better answers?
Bird Pinkerton
You know, it. Honestly, it simultaneously did and did not surprise me. You know, I've reported on health for a long time, reported a lot on how people's behavior affects their health. And this is a recurring theme that, you know, understanding how people's behavior affects their well being is really difficult. With caffeine or chocolate or sugar, you know, these substances that we're consuming all the time, and we want to understand what they're doing to our bodies. We've run into this problem again and again where it's really hard to set up a proper randomized trial that would really give us the answers that we want. And so instead, we're left with this imperfect observational data that leaves us a little bit uncertain about exactly what conclusions we should be drawing with it.
Dylan Scott
What should people do in the face of this imperfect data? Should they start drinking? Should they stop drinking entirely?
Bird Pinkerton
I think the most important thing is that people just be aware of the facts that we've been covering on this episode. Because as we've said, you know, the researchers who we talked to were all in agreement that once you're drinking heavily according to the scientific definition, you're inviting some pretty serious health risks. And I don't think anybody would say, you know, you should start drinking because it's going to be good for your health. But I don't think anybody we talk to would say, like, absolutely everyone, you know, we need to go back to prohibition. Everybody should stop drinking. Like, I, I myself enjoy drinking, but I am approaching 40 now. I write about healthcare. I've been following this research and I've, you know, I do try to moderate my drinking even more these days because I am aware of all this stuff, but I still get to enjoy that glass of wine with dinner or have a beer when we're grilling out on the back patio. I don't, I try to worry about it too much. It's really, I think, about just informed consumption. People should be informed. They should know what they're getting into. And beyond that, we each got to make our own choices.
Dylan Scott
Dylan has a lot more reporting on alcohol and health. He has especially been digging into the influence that industry has on what we think about moderate drinking and its health effects. So we will link to his recent piece on that in the transcript and you can hear him on Today Explained tomorrow talking about the alcohol research that RFK Jr. S health department has buried in the meantime. This episode was produced by me, Bird Pinkerton. It was edited by Julia Longoria. Meredith Hodnot runs our show. Noam Hassenfeld makes our music. Christian Ayala did the mixing and the sound design for this episode. Melissa Hirsch checked the facts. Jorge just is a wonderful fact and I am always, always grateful to Brian Resnik for co creating the show. If you have thoughts about this episode, we are@ unexplainableox.com and I love hearing from you all. If you want to support the show perhaps and help us keep making it, please join our membership program. It is@vox.com members and you will get ad free podcasts. You'll get unlimited access to Vox Journalism and you'll be supporting this show. In fact, if you sign up because you love Unexplainable, please tell our bosses that it would make a very big difference. You can also support us by leaving a nice rating or a review or just by telling people in your life to listen to the show. Unexplainable is part of the Vox Media Podcast network, and we will be back on Wednesday.
Date: September 8, 2025
Host: Bird Pinkerton & Dylan Scott
Guests: Dr. Ken Mukamal, Dr. Tim Naimi
This episode takes on the pervasive question: “Is moderate alcohol consumption actually good (or bad) for your health?” Host Bird Pinkerton and co-host Dylan Scott investigate the conflicting evidence, interviewing scientists on both sides of the debate, and exploring why it’s so hard to get a definitive answer. The episode ultimately demonstrates how tricky it is to study the health effects of common lifestyle choices.
Background:
Rationale for Interest:
Research Methodology:
Findings & Caveats:
On frustration with imperfect evidence:
On illusion of moderate drinking benefits:
Overarching theme:
| Timestamp | Segment Description | |-----------|--------------------| | [01:26] | Setting up the conflicting headlines around alcohol’s health effects | | [03:25] | Clarifying the strong harms of heavy drinking, confusion around definitions | | [05:13] | Dr. Ken Mukamal introduces the potential for small benefits & his reasoning | | [09:08] | Cohort study methodology and limits; the challenge of drawing causality | | [10:26] | Mukamal summarizes where slight benefits appear (heart, diabetes) and major caveats | | [13:41] | Dr. Tim Naimi counters: less alcohol is always healthier, “health halo” is overblown | | [17:47] | Weaknesses of observational data, moderate drinker bias explained | | [20:54] | Problems with using ‘former drinkers’ as the comparison group | | [23:27] | New research approaches: genetics, mechanistic studies | | [25:57] | Final takeaways for individuals: “informed consumption” |
Throughout, the hosts use a light, conversational, and self-aware tone—acknowledging both the frustration and the humor in chasing something “unexplainable.” Both guest experts present their positions clearly, with humility about the limits of available data rather than dogmatic certainty. The takeaway is both sobering and realistic: definitive answers are elusive, but moderation and informed choices remain wise.
This episode walks you through the main scientific debate about moderate alcohol consumption and health. It reveals why the evidence is so inconclusive and why confident claims in headlines are often unwarranted. If you want to be a savvy consumer of alcohol (and health news about it!), knowing the limits of current research is its own kind of wisdom—until, perhaps, truly definitive studies emerge.