For decades, Americans have been told moderate alcohol consumption may offer protection against the number one killer, cardiovascular disease, and possibly contribute to longevity. As that assertion was promulgated by countless health advisories, a body of scientific evidence challenging this belief has accumulated making it difficult to continue to rationalize alcohol consumption for health reasons. Because Americans—especially women—are drinking more alcohol than ever before we should look more closely at what’s at stake.

In 2019, the first of a handful of studies were published questioning whether alcohol consumption truly offers any health advantage. The ten-year long study of 500,000 subjects would turn the decades-old thinking on its head. As little as one drink a day, the study found, increases blood pressure, which may raise the risk for stroke by 10 to 15 percent. Further, the authors emphasized they found alcohol offered no protection of any kind to drinkers. By 2023, a team at the Canadian Institute for Substance Use Research, performed a meta-analysis of 107 previous studies involving 4.8 million participants – nearly four decades of research on the subject. The authors concluded that the studies used to assert a protective effect from drinking were flawed, and moderate drinking offers no protection against cardiovascular or any other disease.

For decades we’ve known of numerous adverse health consequences of drinking, including a greater risk of mouth, throat, esophageal, breast and bowel cancers and damage to the pancreas, bone, liver and heart. What we’ve heard relatively little about is the association between drinking and the risk of dementia.

Alcohol works on several fronts to compromise brain function and elevate the risk of cognitive decline and dementia. It impairs the synthesis and release of neurotransmitters, chemical messengers that enable brain cells to communicate with other cells. Alcohol promotes unstable molecules called free radicals that can damage brain cells, and it hampers the brain’s ability to clear itself of beta amyloid, the protein that forms the hallmark brain plaques seen in Alzheimer’s disease. Alcohol also disrupts nerve cell communication in the hippocampus, the region of the brain critical to forming new memories.

In her research in the VA Boston Healthcare System and as assistant professor at Harvard Medical School, neuropsychologist Catherine Brawn Fortier has studied the adverse effects of alcohol on the brain. Using MRI scans, she found the more people drink, the more damage they do to their frontal cortex, the region of the brain that involves planning, complex cognitive behavior, personality expression, decision making, and moderation of social behavior.

Compared to non-drinkers, even moderate and light drinkers experience brain shrinkage at an accelerated rate. While we all lose a degree of brain volume as we age, accelerated brain loss is a hallmark of dementia. Researchers at the Geisinger Medical Center in Danville, Pennsylvania performed MRI brain scans on 1,839 subjects aged 34 to 88. They classified them as nondrinkers, former drinkers, low drinkers, moderate drinkers, and high drinkers. Then they re-scanned their brains over the next several years. They found the more alcohol subjects consumed, the more brain matter they lost.

In a separate study, the difference between drinking half a beer or half a glass of wine a day and a full pint of beer and full glass of wine resulted in brain atrophy equivalent to two additional years of aging. Drinkers aged 50 and older who consumed one and a half beers or glasses of wine daily aged their brains an additional 3.5 years. Compared to abstainers, having four drinks per day aged the brain an additional 10 years.

With levels of consumption seen in alcohol use disorders things get substantially worse. In 2018, the largest study ever conducted on alcohol use and brain health examined medical records from one million hospital cases in France that involved dementia. Ultimately, the study reported that alcohol use disorders were associated with triple the risk of all types of dementia.

For those seeking to maximize cognitive health and minimize the risk of future dementia, as well as other serious problems associated with alcohol consumption, traditional liquor, wine, and beer producers are responding to an expanding market of sober drinkers. An increasing variety of spirits made from botanicals, alcohol-free wines, and beers are now available, as well as sober bars serving extensive menus of mocktails.