This past Tuesday the Centers for Disease Control (CDC) released new guidelines on the risks of consuming too much alcohol, and it appears that more of us might fall into the "excess drinking" category than we thought (Link). I think this article over at NPR sums up my initial reaction well in this statement : "But that doesn't seem to jibe with other studies that found that drinking alcohol makes for better heart health....." Fortunately, they also go on to say that the studies that indicated moderate consumption of alcohol is beneficial were based on population studies, not double blind studies, and they also reminded us that "correlation does not equal causation." In other words, people who drink moderately could also be engaging in other healthy behaviors and/or have a different set of genetics than people who are not drinking moderately. Which is also why the American Heart Association still does not recommend that people start drinking if they don't already do so.
So what kind of questions/considerations should a Skeptic ask/consider in light of the evidence that we do have as to whether or not to consume alcohol and how much? (Most of these questions are going to be based on individual health conditions; there are also plenty of social implications with excessive drinking that are also best discussed with your provider as well as your family, friends, or even a trained counselor).
1) Do you currently have any health conditions that would be made worse by consumption of alcohol? Some conditions, like liver disease, seem rather obvious. But some other conditions, like diabetic neuropathy, might be made worse by alcohol consumption as well. As with any type of health condition, you need to be in dialogue with your health care provider/specialist about the risks/benefits of consuming alcohol. You should take acute health conditions into consideration as well. For example, that hot toddy might help you feel better if you've got a head cold, but if you are recovering from an extended bout of the flu your body might not need one more thing to deal with.
2) Am I taking any medications that do not mix with alcohol? Some medications, when mixed with alcohol, could result in serious internal organ damage. Once again, you need to be upfront with your provider and/or your pharmacist about alcohol consumption so that you know if what you are taking is compatible with alcohol at all.
3) What is my daily caloric intake that I try to stay around to keep my weight under control? Alcohol has calories and needs to be applied toward your daily intake and quite often those calories can add up very quickly. There are plenty of resources on the Internet, and even on smart phones, that can help you get a good approximation for how many calories you are consuming per drink
4) For people with Type 2 diabetes/prediabetes and related conditions--How much carbohydrate is in what I am consuming? For people who are really working at controlling their blood glucose levels with diet and minimal medication/insulin, you may not have a lot of wiggle room in your meal time carbohydrate intake. Some of the beverages available might contain more carbohydrate than I would eat at one meal. As above, you can find resources online that can help you approximate how much carb you are taking in. For those with type 1 diabetes, always consume alcohol with food as you are more at risk for low blood glucose levels because alcohol inhibits gluconeogenesis in the liver.
5) How much is really in that glass that you are drinking? No seriously, how many ounces does your glass or bottle hold? That wine glass, etc might hold more than you think. So measure out your favorite wine, beer, etc at least one time so that you can get an idea of what your glassware holds. If at a restaurant or bar, ask how many ounces (they have to keep track of that for cost containment anyway) is in one of "their" glasses.
6) Does my alcohol consumption impact my appetite in some way? This can be either extreme, some people drink so much that they fail to take in enough nutrition, so you would definitely fall into the "excess consumption" category there. Some people find that that extra drink makes their appetite increase and they find it a lot harder to keep the calories under control.
7) Can I moderate my drinking? Some people find that in certain social situations that they find it very difficult to keep track of how much they are drinking. This could have some negative effects after that evening, but it could eventually thwart your other health goals as well. Put in place what you need to keep your social drinking under control.
Take home message--While we need more research on the long term effects of alcohol on cardiovascular health, etc, there are some known consequences for our weight control and everyday health that vary by individual.