For decades, observational studies have reported associations between low to moderate alcohol intake and reduced cardiovascular risk, often described as a “J-curve.” The American Heart Association (June 2025) acknowledges such associations at low amounts but stresses substantial bias in observational data and explicitly advises against drinking for health reasons. (AHA Journals)
By contrast, the World Health Organization (WHO) and IARC reiterate there is no safe level of alcohol consumption, with IARC estimating about 740,000 alcohol-attributable new cancer cases worldwide in 2020—roughly 4% of all new cancers (inside.beer, 14.10.2025). Importantly, heavy and risky drinking accounted for the vast majority (≈86%) of these cases, while light-to-moderate intake contributed about one in seven (≈100,000) cases. (iarc.who.int)
A key pillar for recent guidance is the 2023 modeling from the Canadian Centre on Substance Use and Addiction (CCSA). Its risk estimates are built primarily on ethanol amount, not beverage type (an exception being acute poisoning risks with spirits). This approach—used in combination with national and WHO datasets—underpins the message that any increase in alcohol raises health risk. (UK Biobank)
Critics, including Prof. Dr. Nicolai Worm, argue that national bodies such as the Deutsche Gesellschaft für Ernährung leaned too heavily on the Canadian model while overlooking studies that report lower mortality among moderate drinkers—especially in older cohorts and when drinking occurs with meals as part of a healthy lifestyle. (Robert Koch-Institut)
Age and dose shape the risk profile. While earlier Global Burden of Disease work emphasized that the safest level is zero, the 2022 update nuanced this, indicating very low daily amounts among adults over 40 can minimize risk, whereas risk rises as intake increases. These estimates describe minimal-risk levels (not recommendations) and vary by sex, region, and baseline disease risk. (The Lancet)
Patterns matter. Prospective analyses from the UK Biobank link spreading intake over three to four days per week, consuming alcohol with food, and preferring wine to lower risks of vascular events and all-cause mortality among regular drinkers, after adjusting for total volume. A Mayo Clinic Proceedings analysis similarly highlights the potential importance of “with-meals” patterns in cohorts where overall intake remains modest. (UK Biobank)
Lifestyle confounders are pivotal in cancer risk. A pooled analysis in the British Journal of Sports Medicine suggests that meeting physical-activity recommendations can attenuate alcohol-related mortality risks, including cancer mortality. Likewise, a British Journal of Nutrition study finds that higher adiposity drives much of the elevated risk for obesity-related cancers across drinking categories. (PubMed)
Beverage-specific evidence remains mixed, but a 2023 review reported no overall association between moderate wine consumption and total cancer risk, while noting dose-dependent increases for certain cancers at higher intakes. Such findings underscore the need to distinguish between low, moderate, and heavy use when communicating population risks. (Frontiers)
Questions about independence persist. Since 2018, Movendi International—an NGO with temperance roots in the International Organisation of Good Templars—has held official relations status with WHO (a formal engagement category for non-state actors, not funding of WHO). Several Canadian guidance authors (including Tim Stockwell, Tim Naimi, and Adam Sherk) have documented collaborations or affiliations with Movendi; critics say these ties warrant careful scrutiny in evidence reviews, even as direct funding of their research by Movendi is not established in primary disclosures. (WHO)
In light of competing datasets and modeling choices, experts call for an independent, multidisciplinary re-appraisal of the evidence base—one that weighs age, pattern, lifestyle, and dose more transparently—so future guidance reflects both cancer prevention imperatives and the heterogeneity observed in cardiovascular outcomes. (AHA Journals)
