The effect of alcohol consumption on medical strokes

The effect of wine on our medical condition is not all bad, in spite of what you may hear these days. Consider this recent publication in the medical literature about its effect on the incidence of strokes, what is technically called Ischemic Stroke, which happens when a blood clot blocks a blood vessel in your brain (a medical emergency that can be fatal):

Alcohol use and types and ischemic stroke: a systematic review and meta-analysis
by Ahmad A Toubasi and Thuraya N Al-Sayegh
European Neurology 2025 88: 140-150

Here are the technical details, for those of you who are interested:
Introduction: This systematic review and meta-analysis was conducted to investigate the association between alcohol use pattern and ischemic stroke risk.
Methods: We searched PubMed, Scopus, Web of Sciences, Embase, and CENTRAL till the 1st of June, 2024. Studies were included if they were articles that assessed the impact of alcohol drinking pattern on the risk of ischemic stroke. The random-effect model was utilized to combine the results. Data analysis was performed using Meta XL, version 5.3.
Results: The total number of included participants was 21,293,471 from 125 studies. The model that investigated the association between light alcohol use and ischemic stroke risk showed no association (relative risk [RR] = 0.97, 95% confidence interval [CI]: 0.89-1.05). Moderate alcohol use was associated with significant decrease in ischemic stroke risk (RR = 0.87; 95% CI: 0.83-0.92), while heavy alcohol use was associated with significant increase in ischemic stroke risk (RR = 1.31; 95% CI: 1.19-1.44). Subgroup analysis among males showed results similar to the primary analysis, while among females only moderate alcohol drinking was significantly associated with ischemic stroke (RR = 0.50; 95% CI: 0.33-0.75). Moderate and heavy wine use was associated with significant reduction in ischemic stroke risk (RR = 0.61; 95% CI: 0.45-0.84; RR = 0.77; 95% CI: 0.63-0.93).
Conclusions: Our analysis provided a strong and robust evidence that there was a significant association between moderate and heavy alcohol use with ischemic stroke risk. However, this association varied by several variables including type of alcohol with the effect being more protective among people who use wine.

In this graph you can see see a summary of the outcome, in which people with light and moderate alcohol use (lines one and two) had far fewer strokes (ES) than those people with heavy alcohol use (line three). However, note that this was overall alcohol, while both moderate and heavy wine use was associated with a significant reduction in stroke.

Now, this is all very well, and as a wine drinker I like it. However, as a scientist I know that it is not actually a scientific experiment. A well-done alcohol study is a dietary intervention study, in which, for example, one group of participants abstains from alcohol completely, for the length of the experiment, while the other group will consume some specified amount of wine. This would produce much more convincing results. An introduction to this type of work is provided by Lewis Perdue at the Stealth Syndromes Human Study website (Consumer introduction to assessing scientific studies). Lewis also has other interesting relevant pages on this website (eg. A strength of evidence report card for human studies).

There are other pieces of work indicating that moderate wine consumption may benefit your cardiac health, such as: Is it true that … a glass of wine a day is good for your heart? Indeed, there is now an entire book about wine and health: Tony Edwards (2023) The Very Good News About Wine: Authoritative Health Evidence the Health Authorities Don’t Tell You, which covers topics like cancer, heart disease, diabetes, and dementia. This book was reviewed by Neal Hulkower (Uncorking the truth).

Nevertheless, perhaps I would not like to participate in an experiment in which I might increase my chances of getting a blood clot in my brain!

A recent survey of consumer support for changes to alcohol policies in the USA

There is much talk these days about alcohol consumption and the extent to which it should be subject to government regulation. There is much pressure, especially in the USA, to more severely restrict it (eg. The backlash to the alcohol recommendations of the U.S. Dietary Guidelines is coming). Tom Wark notes: “I believe that the single most important thing the industry can do to give wine a real lift is to repeal the most regressive wine regulations” (What does the wine industry actually need right now? 9 experts weigh in).

So, it is timely to find out what the opinions might be from the populace as a whole. One recent attempt (October 3, 2025) to do this is:

Support for alcohol control policies among US alcohol consumers
JAMA Network Open 8(10): e2535337

The authors summarize their work this way:
Key Points

Question: To what extent do US adults who consume alcohol support alcohol control policies?

Findings: In this survey study of 1036 US adults who consume alcohol, approximately one-half supported — and few opposed — policies to restrict alcohol advertising to children and to require calorie content information, drinks per container information, and cancer warnings on alcohol containers. Fewer adults supported policies to lower the blood alcohol content limit for driving, increase alcohol taxes, or limit the times or places alcohol can be sold.
Meaning: These findings suggest that among alcohol control policies, public support is highest for advertising restrictions and information provision policies.

Crucially, the authors make a big deal of having “a nationally representative sample of US adults who consume alcohol”, and they describe this sample in great detail. So, we can reasonably rely on their work.

Their detailed results were:

“Approximately one-half supported policies requiring alcohol containers to display cancer warnings (49%), drinks per container information (51%), and calorie content information (56%). Likewise, 52% supported prohibiting alcohol advertisements on television when children are likely to be watching. By contrast, fewer participants supported than opposed policies to lower the blood alcohol content limit for driving, prohibit alcohol sales late at night, and increase taxes on alcohol (range supporting: 16% to 25%); support was lowest for policies to reduce the number of outlets licensed to sell alcohol (10%).”

The main limitation of the work appears to be their requirement that the surveyed people “reported drinking at least 1 alcoholic beverage per week during the past 4 weeks”. The authors note that also “assessing support also among non-consumers is important given that alcohol control policies could prevent consumption among non-consumers”.

Thanks to Lewis Perdue for drawing this work to my attention.

Wine and health experiments

It should be obvious to most adults that binge drinking is detrimental to health. However, humans have consumed alcohol for several millennia now, so it should be equally clear that smaller amounts may well be okay. I am a scientist, and my approach is that we need experimental evidence about how much is “too much”.

Indeed, in a couple of months the 2026 Unified Wine & Grape Symposium (January 27-29) will tackle this topic again in one of its sessions:

This straight-talk session cuts through the noise that’s leaving wine professionals scrambling for answers. With U.S. Dietary Guidelines under scrutiny and consumer perception shifting, Felicity Carter will moderate a dialogue with Dr. Laura Catena to address what the science actually reveals and how the industry can communicate responsibly.

Myself, I have written about this topic quite a few times before (look under “Wine health” in the menu to the lower right). I also continue to do my reading in the scientific literature about health; and I have recently come across a review / summary article that is worth highlighting here. It is of most relevance because it is about the quality of the scientific experiments conducted about alcohol intake.

How much is too much? A methodological investigation of the literature on alcohol consumption and health. Journal of Wine Economics (2025):

Until a few years ago, moderate alcohol consumption was thought to have (mild) beneficial effects on health. However, some recent studies have suggested that “there is no safe level” of alcohol intake. Consequently, public health institutions have responded by advising against any level of alcohol use and suggesting governments a number of policies to reduce overall alcohol consumption. Nonetheless, medical studies suffer from a variety of intrinsic limitations that could undermine the reliability of their findings, especially when focusing on low-intake levels. On the one hand, we show that the literature on alcohol consumption may suffer from publication bias; such a problem is known to be present in the scientific literature in general. On the other hand, we discuss other potential sources of bias, which are inevitable due to the infeasibility of randomized controlled trials. We assess a sample of articles for the presence of omitted variable bias, miscalculation of alcohol intake, use of linear in place of non-linear models, lack of validation of Mendelian randomization assumptions, and other possible weaknesses. We conclude that the claim that “there is no safe level” of alcohol intake is not sufficiently supported based on our current scientific knowledge.

So, this gives you a clear idea about what is required for high-quality results, and that plenty of experiments meet these requirements.

WHO has an unattainable requirement for health and wine

In my professional life I have been a biologist in Australia. I studied at the University of Sydney (B.Sc., and Ph.D.), and I was an academic at the University of Technology, Sydney (UTS). For example, I studied the biology of native Australian plants in response to fire; and I also studied the evolutionary biology of particular Australian plants. (And yes, I have described a few new plant species; eg. see Lechenaultia, and the picture below.)

I taught about biomedical science, as well as plant and animal biology. So, the effect of wine on human bodies has been of both professional and personal interest to me. It has consequently made its appearance many times in this blog. More importantly, I don't just accept what official bodies tell me about how good or bad wine is for me, but I can make my own professional judgement based on the scientific evidence available.

Recently, for example, there have been these Wine Gourd blog posts:

• Contrary to WHO, recent medical research shows that wine is safe for cancer
• Medical research concerning heart disease indicates that wines are safe to drink 
• More medical results suggesting that wines are usually safe to drink
• Another official study indicating that alcohol is not necessarily a risk for cancer

What I would like to do in this current post is point out another recent commentary article, by Dr Erik Skovenborg, that seems to me to make a set of very important points regarding the current negative attitude of the World Health Organization (WHO) towards alcohol:

An unattainable WHO condition for the enjoyment of wine
August 26, 2025
Dr Erik Skovenborg

The essential point of the article is this: Science can’t prove a negative. So, as Skovenborg quotes the UK Health Security Agency:

“As the nation’s top public health advisory body, it’s a pretty regular occurrence for Public Health England to release health advice on a range of topics. Often enough, the bottom line for one of these pieces of advice is that the issue at hand ‘poses a low risk to health.’ Sometimes it’s even a ‘very low risk.’ What we never say, however, is that it poses no risk.”

That is, science can never prove that alcohol poses no risk to health, only that it is or is not a low risk. However, the WHO does require precisely that:

“To identify a ‘safe’ level of alcohol consumption, valid scientific evidence would need to demonstrate that at and below a certain level, there is no risk of illness or injury associated with alcohol consumption.”

So, as Skovenborg notes, “there can be no scientific demonstration of a 100% safe level of alcohol consumption ... Nevertheless, the WHO recommends an unattainable condition for the enjoyment of wine: the scientific demonstration of a 100% safe level of alcohol consumption.”

What we can all do, however, in light of the fact that virtually everything in life is risky, is decide whether any given circumstance poses an acceptable risk to us personally.

Dr Skovenborg provides an excellent discussion of evaluating the magnitude of the health risk of light to moderate wine enjoyment. This risk cannot be zero, as required by WHO, but there is little evidence that the risk to health is high. I recommend that you read his article, and take his discussion quite seriously.

PS. The latest news is: Moderate drinking linked with lower mortality in Parkinson’s patients.

Another official study indicating that alcohol is not necessarily a risk for cancer

I have written quite a few blog posts about the possible relationships between alcohol and particular health issues, particularly cancer, because this has become a big issue for a number of health organizations (see: Has WHO got it wrong with its new zero-alcohol policy?). My own reading of the primary literature is that wine is one of the least problematic causes of cancer, unless consumed in excess of the recommended doses. I have listed some of my relevant posts at the bottom of this page.

In this new post, I will point out another recent official publication from the USA that indicates there is a lack of evidence regarding a link between alcohol and cancer, in particular:

Review of Evidence on Alcohol and Health (2025).

Here is the Introduction from the review:

The Dietary Guidelines for Americans (DGA), which serves as the primary source of dietary guidance from the federal government, provides recommendations for dietary intake and healthful dietary patterns — including alcohol intake. DGA recommendations are informed by systematic reviews. The last review on alcohol and health conducted for the DGA focused on all-cause mortality in 2020; however, questions related to weight changes, cancer, cardiovascular disease, neurocognitive health, and lactation have not been examined since 2010.

Hence this new Review was produced. It is broken into a number of sections, each of which concludes with a set of Findings, and a set of Conclusions. Here I will list here a few of the relevant conclusions.

For the section on All-Cause Mortality, they have:

• Conclusion 3-1: Based on data from the eight eligible studies from 2019 to 2023, the committee concludes that compared with never consuming alcohol, moderate alcohol consumption is associated with lower all-cause mortality (moderate certainty).

This sounds very good to me — a small amount of alcohol intake lowers mortality.

For the section specifically about Cancer, they have several conclusions:

• Conclusion 5-1: The committee concludes that compared with never consuming alcohol, consuming a moderate amount of alcohol was associated with a higher risk of breast cancer (moderate certainty).
• Conclusion 5-2: The committee concluded that, among moderate alcohol consumers, higher versus lower amounts of moderate alcohol consumption were associated with a higher risk of breast cancer (low certainty).
• Conclusion 5-3: The committee determined that no conclusion could be drawn regarding the association between moderate alcohol consumption compared with lifetime nonconsumers and risk of colorectal cancer.
• Conclusion 5-4: The committee concluded that among moderate alcohol consumers higher versus lower amounts of moderate alcohol consumption were associated with a higher risk of colorectal cancer (low certainty).
• Conclusion 5-5: The committee determined that no conclusion could be drawn regarding an association between moderate alcohol consumption and oral cavity, pharyngeal, esophageal, or laryngeal cancers.

Once again, this all seems pretty reasonable to me — a lot of the relevant commentary is about lack of evidence for any relationships, which situation the Review takes very seriously.

In support of this, the table above is from The IARC perspective on alcohol reduction or cessation and cancer risk (IARC = International Agency for Research on Cancer). It lists the biggest issues about the same cancer studies discussed by the Review, indicating that there is insufficient formal evidence regarding a link of alcohol to cancer, for several parts of our bodies. If there is insufficient evidence, then how are any of us arriving at any conclusions that problems exist?

Here are some of my previous posts from this year about this topic (in publication order):

1. Current medical evidence says that wine is not harmful in small doses
2. Recent study shows that alcohol does have an important benefit in older age 
3. Recent science reports suggesting that wine alcohol is usually safe to drink
4. Contrary to WHO, recent medical research shows that wine is safe for cancer
5. Medical research concerning heart disease indicates that wines are safe to drink
6. More medical results suggesting that wines are usually safe to drink

Useful official advice on alcohol and your health (EU brochure)

I have recently produced a series of posts about wine availability and consumption in the Nordic countries, pointing out that it is not actually restricted, as is sometimes claimed. However, various parts of the government in, for example, Sweden do take alcohol consumption really quite seriously, healthwise. The World Health Organization (WHO) would be impressed.

As one example, my local municipal council (region Uppsala) has a web page about health, for locals. As part of this information they produce a brochure on alcohol use, which I think is very informative for everyone. Here, I have provided a translation from the original Swedish text. The original PDF file is available at: Alkohol och din hälsa.

The document is claimed to have been “compiled by specialists in the field of alcohol and health in the Uppsala Region and Uppsala Municipality”. It was last revised in January 2019, although it is still very current. You would be well advised to look through it, for your own edification.

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Region Uppsala

Alcohol and your health
How do you drink?

Alcohol affects health

Alcohol affects us in different ways. New studies show that no level of alcohol intake is completely risk-free. The risk of health problems increases the more you drink. How the body is affected by alcohol can vary. Even small amounts of alcohol can cause harm to children, adolescents, the elderly, and those with illness or medication. Alcohol should also be avoided during pregnancy, when caring for others, and before surgery.

Drinking alcohol often increases the risk of becoming addicted. Alcohol impairs judgment, thinking ability, and reaction ability. It can increase the risk of harming yourself or others in accidents. Being drunk always involves a risk.

Some examples where alcohol may be important:

• Sleep problems and headaches
• Depression and anxiety
• Reduced fertility
• Lowered immune system
• Poor wound healing
• Cardiovascular diseases
• Diabetes
• Psoriasis and skin problems
• Diseases and problems in the stomach, intestines and liver
• Cancer in the mouth and throat, gastrointestinal tract, breast and liver
• Dementia
• Brittle bones and gout
• In the event of accidents and relationship problems

Benefits of drinking less

You can have better general health and sleep. Your memory and ability to concentrate can improve and you can handle stress more easily. You also reduce your risk of developing various diseases.

Consider your own habits

• When do you drink beer, cider, wine or spirits?
• How often do you drink?
• How much do you drink at one time?
• How are you and others affected when you drink?
• What could you do if you wanted to drink less alcohol?

Risky alcohol use

Risky alcohol use involves drinking alcohol in a way that greatly increases the risk of physical, mental and social problems.

In Sweden, the term “standard glass” is commonly used to calculate how much you drink. A standard glass is the amount of drink that contains 12 grams of pure alcohol:

50 cl beer or cider (2.8–3.5%)
33 cl strong beer, strong cider or alcoholic soft drink (5%)
1 small glass (12 cl) wine (12.5%)
8 cl fortified wine (15–22%)
4 cl spirits, e.g. whiskey

A bottle of wine (75 cl) contains about 6 standard glasses.

Limits for hazardous alcohol consumption

Female: 4 standard drinks or more on the same occasion (for example, during an evening). 10 standard glasses per week (equivalent to just under 2 bottles of wine).

Male: 4 standard glasses or more on the same occasion (for example, during an evening). 10 standard glasses per week (equivalent to just under 2 bottles of wine).

Pregnant: For pregnant women, as well as children and young people, all use of alcohol is considered risky use.

Tips for those who want to drink less

• Write down how much alcohol you drink for a few weeks.
• Think about situations in which you can change your habits.
• Allow at least two days each week to be completely alcohol-free.
• Replace every other glass of alcoholic drink with water and thus halve the amount of alcohol you drink.
• Choose drinks without alcohol or with a lower alcohol content.

Did you know that …

• Alcohol contains a lot of calories, the higher the alcohol content, the more calories in the drink.
• One can of folk beer per day for a year is equivalent to approximately 19 full bottles of hard liquor.

How much do you drink?

Fill in how many standard glasses you drink per day during a week.

To compare different types of alcoholic beverages, use the standard glass measurement. For example, a standard glass is equivalent to:

Support for those who want to change their drinking habits

You can always turn to health care professionals for advice and support. There are prescription drugs that can reduce alcohol cravings. All health care clinics are confidential.

At the Alcohol Line there are counsellors who can provide information and support. Tel. 020-84 44 48 or info@alkohollinjen.se.

 

At alkoholhjalpen.se there are facts, tips and discussion forums. The services are free of charge and you can remain anonymous.

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Brochures like this are part of the increasing pressure on alcohol consumption, in the modern world (after all: Mid-strength wines may win where no-alcohol failed). Indeed, there is explicit pressure for wine labels to have health warnings, similar to those for tobacco packages. Indeed, recently: Alaska introduces cancer warnings to bars and liquor stores. Even the USA officially links alcohol and tobacco, as the United States Department of the Treasury has the Alcohol and Tobacco Tax and Trade Bureau, and the United States Department of Justice has the Bureau of Alcohol, Tobacco, Firearms and Explosives. Sweden has not yet gone that far!

How long does alcohol stay in your system?

 I noted in my previous post (More medical results suggesting that wines are usually safe to drink) that it is often difficult for drinkers to estimate their own intake. This is because even Small changes in wine alcohols can make a big difference. I presented a table showing the blood alcohol concentration for an average 130-pound woman who consumes two 5-ounce glasses of wine over 1.5 hours. It looked like this:

Alcohol     Blood alcohol
content     concentration
  12%          0.065%
  13%          0.073%
  14%          0.081%
  15%          0.088%

So, let’s look at how it gets like this. Alcohol enters your stomach as its first stop. Here, if you produce enzymes known as alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) then these break down some of the alcohol, thus preventing it from entering your bloodstream. Sadly, studies have shown that women tend to have lower levels of ADH than men; and people who drink regularly have lower ADH levels than people who rarely or never drink (Cleveland Clinic).

From the stomach the alcohol goes into the small intestine, where it is transferred to your bloodstream. This is when you notice it. The liver then picks up the alcohol from the blood, and starts to convert it to acetaldehhyde and then acetate, using ADH, ALDH, cytochrome P450 (CYP2E1) and catalase (Overview: how is alcohol metabolized by the body?) — see the diagram if you want the details. About 90% is processed by the liver, with the rest coming out via your kidneys (to your urine), lungs (to the air) and skin.

Alcohol typically stays in your system for about 1 hour per standard drink consumed. One standard drink is about 14 grams of ethanol (ie. alcohol), the amount found in (Cleveland Clinic):

• 12 ounces of regular beer with 5% ethanol (about one can of beer)
• 5 ounces of wine with 12% ethanol (about one glass of wine)
• 1.5 ounces of distilled spirits (80 proof) with 40% ethanol (about one shot).

Alcohol takes around 60—90 minutes to reach peak levels in your blood, before the body begins breaking it down. The half-life of alcohol (how long it takes for your body to get rid of half of it) is 4—5 hours. However, you need about 5 half-lives to get rid of alcohol completely — so, it takes about 25 hours for your body to get clear all of the alcohol.

Furthermore, alcohol can be detected:

• in blood for 6 to 12 hours,
• in breath and saliva for 12 to 24 hours,
• in urine for 12 to 24 hours (ethanol test), but up to 80 (EtG test) to 130 hours (5.5 days), and
• in hair for up to 90 days.

There is even a biomarker called Phosphatidylethanol (PEth) that reflects alcohol intake, and can be detected in urine up to 14 days.

The exact duration of alcohol detection varies based on characteristics of your body like:

• body weight — the less you weigh then the less water you have in your body; and since alcohol goes into the water in your blood, if you have less water then your blood alcohol concentration (BAC) will be higher,
• metabolism — some health conditions can make it harder for your body to process alcohol,
• medications — prescription medicines and over-the-counter medications can have interactions with alcohol,
• age — the speed of alcohol processing slows down as we get older,
• gender — women take longer to process alcohol than men (see above),
• your ancestry — we all have different genes, which may have an effect on alcohol processing, and
• the amount of alcohol consumed.

It is usually better to consume alcohol with food. However, food changes how your body processes alcohol but not how fast it can do it (Cleveland Clinic). Food makes the alcohol hang on in the stomach for a while, and your stomach then gets time to break down some of the alcohol before it moves into the small intestine, and thus into the bloodstream.

Caffeine is sometimes recommended, as it is a stimulant, which can perk you up and make you feel less intoxicated (Cleveland Clinic). However, you can then lose track of how much you’ve had to drink; and the caffeine won’t clear the alcohol from your system any faster.

It is also important to consider the effect on your brain of drinking too much. Moderate drinkers have been seen as those who have seven or fewer drinks per week, while heavy drinkers have had eight or more drinks per week. The latter can have problems (Eight or more drinks per week linked to signs of injury in the brain).

As a final aside, there is also a thing known as “auto brewery syndrome” (Man with rare condition that turns carbs into alcohol in his stomach). Here, your body turns sugary and starchy foods (ie. carbohydrates) into alcohol in your stomach, via endogenous ethanol fermentation (a.k.a. gut fermentation syndrome). So, people with this condition can get drunk simply by eating a slice of cake. This syndrome has appeared in TV episodes of both Chicago Med and Doc Martin.

More medical results suggesting that wines are usually safe to drink

People seem to be becoming more mindful of their alcohol intake for health reasons. However, I have recently noted medical evidence that wine is usually safe to drink with regard to both cancer and heart disease, which are currently the two major causes of death in the Western world.

There are, however, many other health issues that we may encounter, and it is interesting to check out whether wine is troublesome there, as well. Indeed, commentators other than WHO (who have focused on cancer) have emphasized some of these alternative medical issues. Here, I will look at these other issues, noting that they are not necessarily a big deal, either.

At first, however, I will note that Risky drinkers underestimate their own alcohol consumption. Indeed, it is often difficult even for non-risky drinkers to estimate their own intake. This is because even Small changes in wine alcohols can make a big difference. The table below shows the blood alcohol concentration for an average 130-pound woman who consumes two 5-ounce glasses of wine over 1.5 hours. When I was a teenager in Australia, the slogan was “under .05 or under arrest”, as far as driving a car was concerned.

Alcohol     Blood alcohol
content     concentration
  12%          0.065%
  13%          0.073%
  14%          0.081%
  15%          0.088%

So, now being mindful of the volume of alcohol intake, we might start by looking at what is called All-Cause Mortality. In this regard, we can consider Is drinking wine in moderation good for health or not? We can quote from this science report:

Drinking alcoholic beverages is associated with various health effects in the population ... All these effects seem primarily to be associated with the amount of alcohol consumed; the role of the different alcoholic beverages, and of their minor components, in this regard is in fact not clearly defined ... the association with all-cause mortality is complex, and J-shaped, with a consumption window theoretically associated with a reduction in all-cause mortality, up to 25 g alcohol per day. However, this issue is the subject of intense scientific debate.

So, that does not really help us in much of a practical way. So, let's move on, in particular, to red wine itself. Here, we get information directly from medical experiments: Health effects of red wine consumption: a narrative review of an issue that still deserves debate. To quote from this comprehensive review of the recent medical literature (in 2023):

This review evaluated randomised controlled trials (RCTs), examining the recent literature on the correlations between acute and chronic RW [red wine] consumption and health. All RCTs published in English on PubMed from 1 January 2000 to 28 February 2023 were evaluated. Ninety-one RCTs were included in this review, seven of which had a duration of more than six months. We assessed the effect of RW on: (1) antioxidant status, (2) cardiovascular function, (3) coagulation pathway and platelet function, (4) endothelial function and arterial stiffness, (5) hypertension, (6) immune function and inflammation status, (7) lipid profile and homocysteine levels, (8) body composition, type 2 diabetes and glucose metabolism, and (9) gut microbiota and the gastrointestinal tract. RW consumption mostly results in improvements in antioxidant status, thrombosis and inflammation markers, lipid profile, and gut microbiota, with conflicting results on hypertension and cardiac function. Notably, beneficial effects were observed on oxidative stress, inflammation, and nephropathy markers, with a modest decrease in CVD [cardio-vascular disease] risk in five out of seven studies that evaluated the effect of RW consumption.

So, that sounds very promising. Diet is also of importance (Research shows wine enhances the impact of the Mediterranean diet):

This year [2024], for the seventh year running, the Mediterranean diet was ranked the healthiest in the world by US News & World Report ... Professor Ramon Estruch: “but if you put moderate drinking, especially wine, under the umbrella of the Mediterranean diet, the health effect is much higher. And if you practise exercise and so on, the effect is much better. But I think that the highest power of these is diet.” Indeed, the importance of diet has been emphasized elsewhere. For example, when studying Alcohol consumption patterns and mortality among older adults with health-related or socioeconomic risk factors, it was noted that: “Wine preference and drinking only with meals were associated with attenuating the excess mortality associated with alcohol consumption.”

Furthermore, red wine with the food can lower blood sugar faster, especially in combination with Mediterranean food (Vin, snus och ingen frukost? Här är professorns råd som vänder upp och ner på hälsomyterna [in Swedish]).

Regarding diet and sugar, diabetes itself is often of concern. However, it has been noted in a recent experiment (Alcohol intake, drinking pattern, and risk of Type 2 Diabetes in three prospective cohorts of U.S. women and men) that: “Light to moderate alcohol consumption, especially regular light drinking, was associated with a lower risk of Type 2 Diabetes in both men and women.” A much earlier (2009) summary of this pattern is illustrated in the graph above, with females at the top and males below (Alcohol as a risk factor for Type 2 Diabetes).

If you want to read another summary of potential issues then The Drinks Business (The scientific studies showing the health benefits of wine) has this overview:

Here, we look back through the years at the drinks business, and provide a comprehensive overview of the health benefits associated with wine from scientific studies that we have covered in the past several decades.

As I have noted before: There are NO scientific experiments saying: don’t drink alcohol. Much of the current “scientific” anti-alcohol noise comes from Tim Stockwell, as I explicitly discussed in that post, and his associated new-Prohibitionist organization Movendi International (aka the International Organisation of Good Templars). Felicity Carter provides an alternative perspective on this issue (The rise of anti-alcohol messaging and ‘neo-prohibitionism’). In the meantime, stick to wine (as opposed to other alcohols) and science says that you will be quite well off.

Medical research concerning heart disease indicates that wines are safe to drink

The main point that I made in the previous blog post (Contrary to WHO, recent medical research shows that wine is safe for cancer) was that the WHO's recent attack on drinking alcohol has focused on cancer as a cause of health problems, and that this has been shown by medical evidence not to be true for wine.

I also pointed out that cancer is only the No.2 cause of deaths, whereas No. 1 is heart disease, as shown in the first figure below (from Leading causes of death in the US, 2019—2023). Indeed, the WHO Cardiovascular diseases 2023 reports an estimated 17.9 million deaths each year, making up 32% of total global fatalities.

So, the thing we should be most interested in is what is known technically as Cardiovascular Disease, the No. 1 cause of deaths in the USA for many years. That is what I will do in this post, noting that it also is fairly safe as far as wine is concerned.

I will proceed in the same manner as last time. As before, it is important to first note that wine is not the same as other forms of alcohol intake, especially in terms of the medical effects. Then we can proceed to look at a recent research publication (17 June 2023) that compiled the results from 25 medical research studies concerning the effects of wine on people in relation to heart disease (Association between wine consumption with cardiovascular disease and cardiovascular mortality: a systematic review and meta-analysis). This has made it clear that heart disease is not often associated with wine intake, as opposed to other forms of alcohol or other health issues.

So, this publication (Nutrients 2023, 15:2785) was based on a search of the medical literature, in which 7 suitable studies were found from the 1980s/90s and 18 from the 2000s. The studies were from nine countries, including Australia, Czech Republic, Denmark, France, Greece, Italy, Norway, Spain, Sweden, and the United Kingdom. The study looked separately at cardiovascular mortality, cardiovascular disease (CVD), and coronary heart disease (CHD).

The detailed summary of the publication is this:

Background: The objective of this systematic review and meta-analysis was: (i) to examine the association between wine consumption and cardiovascular mortality, cardiovascular disease (CVD), and coronary heart disease (CHD), and (ii) to analyse whether this association could be influenced by personal and study factors, including the participants’ mean age, the percentage of female subjects, follow-up time and percentage of current smokers.

Methods: In order to conduct this systematic review and meta-analysis, we searched several databases for longitudinal studies from their inception to March 2023. This study was previously registered with PROSPERO (CRD42021293568).

Results: This systematic review included 25 studies, of which the meta-analysis included 22 studies. The pooled RR [Relative Risk] for the association of wine consumption and the risk of CHD using the DerSimonian and Laird approach was 0.76 (95% CIs: 0.69, 0.84), for the risk of CVD was 0.83 (95% CIs: 0.70, 0.98), and for the risk of cardiovascular mortality was 0.73 (95% CIs: 0.59, 0.90).

Conclusions: This research revealed that wine consumption has an inverse relationship to cardiovascular mortality, CVD, and CHD. Age, the proportion of women in the samples, and follow-up time did not influence this association. Interpreting these findings with prudence was necessary because increasing wine intake might be harmful to individuals who are vulnerable to alcohol because of age, medication, or their pathologies.

The situation is now quite clear. Wine is no more dangerous for increasing the risk of heart disease than it is for increasing the risk of cancer. It is worth also noting that a more recent, much smaller, set of medical data (Urinary tartaric acid as a biomarker of wine consumption and cardiovascular risk: the PREDIMED trial) suggests that “∼3–12 and 12–35 glasses/month of wine, were associated with lower CVD risk [HR 0.62 (95% CI 0.38; 1.00), P=.050 and HR 0.50 (95% CI 0.27; 0.95), P=.035, respectively].” This reduction in risk has previously been reported in the generalist literature (New evidence on the relationship between moderate wine consumption and cardiovascular health).

The WHO stated attitude in their 2023 publication in The Lancet that: “no safe amount of alcohol consumption for cancers and health can be established” (Health and cancer risks associated with low levels of alcohol consumption) is therefore even more mysterious than I noted last week, flying as it does in the face of two sets of comprehensive medical evidence.

Mitch Frank, editor of Wine Spectator, thinks that this “is part of a movement trying to paint all alcohol as dangerous by making broad, oversimplified claims”(Cherry-picked science? the confusing narrative around wine and health). In that same article, wine writer Dave McIntyre says that the current anti-alcohol movement, which in his recent coverage he dubs The New Prohibition, is trying to shift consumer messaging away from drinking responsibly to not drinking at all. Frank also calls attention to a major new scientific report from the National Academies of Sciences, Engineering, and Medicine (NASEM) (National Academies publishes findings on alcohol and health) which found that moderate drinking is linked to lower death rates compared to not drinking at all. This finding is expected to help shape U.S. dietary guidelines for 2025–2030.

Contrary to WHO, recent medical research shows that wine is safe for cancer

One of the main points that I made in my previous blog post (Recent science reports suggesting that wine alcohol is usually safe to drink) was that the World Health Organization's recent attack on drinking alcohol has focused mainly on cancer as a cause of health problems. Other commentators, however, have emphasized alternative medical issues, which may be less troublesome.

You should read that previous post to set the scene. This obviously has a big effect on the wine industry, affecting wine sales especially among the young people.

In this new post, I will take a more recent look specifically at cancer in relationship to wine consumption. I will look at the range of the other health issues next week, noting that they are also not necessarily as big a deal as has been made out. So, we can all continue to safely drink wine (in moderation).

First, however, it is worth mentioning that there actually is a good reason for the WHO’s focus on cancer. If we take the USA as but one example, we can see that Cancer has been recorded as the No. 2 cause of death, behind Heart disease, as shown in the first figure (from Leading causes of death in the US, 2019—2023). So, anything that potentially increases cancer risk is worth looking at, as far as health is concerned.

However, it is also important to note that wine is not the same as other forms of alcohol intake, especially in terms of the medical effects. Indeed, a very recent research publication (31 January 2025) compiled the results from 42 medical research studies concerning the effects of wine on people in relation to cancer (Consumption of red versus white wine and cancer risk: a meta-analysis of observational studies). This has made it clear that cancer is not associated with wine intake, as opposed to other forms of alcohol or other health issues.

So, this publication (Nutrients 2025, 17:534) was based on a search of the medical literature, in which 8 studies were found from the 1990s and 34 from the 2000s. There were 24 studies found from the US / Canada and 18 in Other regions, which are quite respectable sample numbers. The organs studied for cancer included: skin, lung, kidney / urinary tract, colon / rectum, prostate, ovary, and female breast.

The detailed summary of the publication is this:

 

Objectives: While alcoholic beverage consumption increases cancer risk, red wine has been touted as a healthier option. To address this unexplored question, we conducted a meta-analysis to summarize evidence from observational studies.

 

Methods: A literature search of PubMed and EMBASE through December 2023 identified studies examining wine and cancer risk. A random-effects meta-analysis was performed to estimate relative risks (RRs) and 95% confidence intervals (CIs) for an association between wine intake and overall cancer risk.

Results: A total of 20 cohort and 22 case–control studies were included. Wine intake was not associated with overall cancer risk (n = 95,923) when comparing the highest vs. lowest levels of consumption, with no differences observed by wine type (red: summary RR = 0.98 [95% CI = 0.87, 1.10], white: 1.00 [0.91, 1.10]; Pdifference = 0.74). However, white wine intake was significantly associated with an increased risk of cancer among women (white: 1.26 [1.05, 1.52], red: 0.91 [95% CI: 0.72, 1.16], Pdifference = 0.03) and in analyses restricted to cohort studies (white: 1.12 [1.03, 1.22], red: 1.02 [95% CI: 0.96, 1.09], Pdifference = 0.02). For individual cancer sites, there was a significant difference in associations between red and white wine intake only in skin cancer risk [6 studies, white: 1.22 (1.14, 1.30), red: 1.02 (0.95, 1.09); Pdifference = 0.0003].

Conclusions: We found no differences in the association between red or white wine consumption and overall cancer risk, challenging the common belief that red wine is healthier than white wine. Our significant results related to white wine intake in subgroup analyses warrant further investigation.

The situation is now quite clear. The WHO's 2023 publication in The Lancet that: “no safe amount of alcohol consumption for cancers and health can be established” (Health and cancer risks associated with low levels of alcohol consumption) has two limitations. First, it pools all alcohol types together, rather than looking at wine separately — and wine is very different in terms of its health effect. Second, it does not take into account the 2025 publication concerning the effect of wine on cancer — this points out that the medical studies do not find any important effects of wine consumption on human cancer.

As a final point, it is also worth noting the comments about WHO made by Ramon Estruch:

When it comes to the WHO declaration, Prof. Estruch has some scepticism about the methods used. 

 

First, the declaration was based on the Global Burden of Disease work, and he says the results were confounded because the general consumption of alcohol across the world was dropped into the mix, and the specific way that alcohol is consumed is extremely important.

“Context is very important in the effects of alcoholic beverages,” he says. “Drinking gin outside of meals is not the same as drinking wine with meals. The frequency of consumption is also important.”

He says another problem was that some studies considered weekly consumption of alcohol, rather than daily consumption. “It’s not the same. If you have one drink, seven days a week, it’s not the same as seven drinks in one day. That’s binge drinking.”

Recent science reports suggesting that wine alcohol is usually safe to drink

We are all well aware that back in 2023 the World Health Organization (WHO) published in The Lancet a statement that “no safe amount of alcohol consumption for cancers and health can be established” (Health and cancer risks associated with low levels of alcohol consumption). No evidence was explicitly provided in this publication, but half a dozen references are cited in support of the claims that: “The overall risks and harms resulting from alcohol consumption have been systematically assessed and are well documented.”

I thought that it might be interesting to gather together references to publications that refute these claims, or at least suggest that they are exaggerated; and that is what I have done here and in the next post.

At first, I will start by pointing out that a reply to the above publication was published in The Lancet a couple of months later (Alcohol and health: all, none, or somewhere in-between?):

The risks and harms associated with alcohol are well documented, and the substantial harms of heavy or binge drinking are not debated. But health benefits of lower levels of alcohol intake have been widely reported. Many studies have shown that low or moderate amounts of alcohol (particularly red wine) can reduce risk for cardiovascular disease, diabetes, and even death — possibly due in part to a tendency to reduce systemic inflammatory mediators. These benefits might be limited to adults older than 40 years ... Potential benefits of light to moderate alcohol consumption have also been reported among patients with rheumatoid arthritis.

Dire warnings like these seem to have become commonplace (a similar statement about alcohol and cancer was issued by the American Society of Clinical Oncology in 2017) and have the potential to be ignored by many people as undesirable and unattainable. WHO correctly argues that no studies have addressed whether the potential benefits of alcohol on cardiovascular disease and diabetes outweigh the risks with regard to cancer, and that the harms of alcohol fall disproportionately on disadvantaged and vulnerable populations. In view of these truths, a why-risk-it approach might seem sensible. But interpretation of the seemingly conflicting reports requires consideration of many factors, including the varying levels of alcohol intake considered light to moderate, competing risk factors for disease, choice of comparator groups, and the known pitfalls of self-reported alcohol consumption. It is also important to put the results of these studies in the context of absolute levels of risk (versus relative risk) associated with alcohol intake, which are generally quite small.

So, even at the time, the WHO’s pronouncement was questioned, because it focused on cancer rather than any other health characteristics (of which there are many!). And, of course, alcoholism itself is not good for you, by definition.

However, organizations that advocate for more stringent policies around the sale and marketing of alcohol are gaining momentum (What do neo-prohibitionists really want?). In fact, it has been suggested that the influence is entering US politics (Source says Feds will declare “no amount of alcohol” is healthy). So, we need to take this seriously.

Now we might look at some other publications, that review the topic. These also refer to things other than cancer, and in particular they focus on wine as opposed to other forms of alcohol. I will look at an overview paper here, and then continue next week with some more details.

We should start with defining low (1–7 drinks/week) and moderate (8–21 drinks/week) wine drinkers, as designated in the best of the recent review articles (Moderate wine consumption and health: A narrative review). These researchers note:

Although it is clearly established that the abuse of alcohol is seriously harmful to health, much epidemiological and clinical evidence seem to underline the protective role of moderate quantities of alcohol and in particular of wine on health. This narrative review aims to re-evaluate the relationship between the type and dose of alcoholic drink and reduced or increased risk of various diseases, in the light of the most current scientific evidence. In particular, in vitro studies on the modulation of biochemical pathways and gene expression of wine bioactive components were evaluated. Twenty-four studies were selected after PubMed, Scopus and Google Scholar searches for the evaluation of moderate alcohol/wine consumption and health effects: eight studies concerned cardiovascular diseases, three concerned type 2 diabetes, four concerned neurodegenerative diseases, five concerned cancer and four were related to longevity. A brief discussion on viticultural and enological practices potentially affecting the content of bioactive components in wine is included. The analysis clearly indicates that wine differs from other alcoholic beverages and its moderate consumption not only does not increase the risk of chronic degenerative diseases but is also associated with health benefits particularly when included in a Mediterranean diet model. Obviously, every effort must be made to promote behavioral education to prevent abuse, especially among young people.

So, wine is not the same as other forms of alcohol. If you want to get technical: “the beneficial effects of wine are mostly derived from its polyphenolic content, and this represents the crucial difference between wine and other alcoholic beverages.”

We also need to get clear what we mean by “a drink”. We might try this definition (Why do medical experts define moderate drinking as one to two glasses of wine per day?):

In the United States, the Departments of Agriculture (USDA) and Health and Human Services (HHS) recommend that men consume no more than two alcoholic beverages per day, and that women consume no more than one. Those U.S. Dietary Guidelines issued by the federal government also serve as guidelines for medical professionals when they define moderate drinking.

However, exactly how much alcohol constitutes one “drink” varies from country to country, as do dietary guidelines. In the U.S., one “drink” is defined as containing 14 grams (0.6 fluid ounces) of pure alcohol, which equates to 12 ounces of beer (5 percent alcohol by volume), 5 ounces of wine (12 percent ABV) or 1.5 ounces of 80-proof distilled spirits (40 percent).

In Europe, a standard glass is often taken to contain 12 grams of alcohol, instead. This is: 50 cl standard beer, 33 cl strong beer, 12 cl wine, 4 cl of liquor (Dags för “alkoholfri operation“ [in Swedish]). By risky use of alcohol these scientists then mean: >14 standard glasses / week for men and ≥5 standard glasses at one time for men, and >9 standard glasses / week for women and ≥4 standard glasses at one time for women. This Swedish paper then discusses how much you should reduce these before hospital operations.

That might be enough science for one week. Next week I will look some more at where those glasses can safely go, according to research.

Recent study shows that alcohol does have an important benefit in older age

This post is about alcohol, dementia and old age. There is a new research report that concludes that the occurrence of dementia is the lowest among people with moderate alcohol consumption, and the risk is higher among those who never drink or who drink excessively.

But, to set the scene, my wife spent a Monday recently in a hospital, being examined some of the time, but mostly just sitting there waiting (I kept her company). I then did exactly the same thing myself on the Tuesday (and she accompanied me). In my wife’s case they said: “It will be okay”, and so far they have been right. However, in my case they gave me some pills to take 3 times per day, every day for the rest of my life. These are the outcomes of getting older — back in the old days we didn’t make it, to get any older, but these days we slowly undergo physical and mental degeneration for quite a long while.

In this regard, old age is acknowledged to be the most important predictor of the syndrome known as dementia (a general decline in cognitive abilities affecting one's ability to perform everyday activities). Therefore the number of people living with this condition is expected to grow, along with the number of old adults. It should be obvious, then, that detecting this as far ahead as possible will help us (family, friends, colleagues, community, society) cope with the situation as best we can.

To this end, a recent report appeared:

Identifying early predictors of cognitive impairment and dementia in a large

nationally representative U.S. sample. Rand Research Report 2024 RR-A3207-1

It’s relevance to us in this blog should be obvious: alcohol is often implicated in cases of dementia. Well, this report makes it clear that alcohol does indeed play a potential role, but not in the way you may have suspected — there is good news aplenty.

Let’s start with what this study is, since we know that it is not a scientific experiment. It is simply a survey in which people answer questions and are measured in various ways. So, it is the quality of the surveying that matters, in terms of its size and how well it represents the intended population. According to the authors:

The data for this study come from the Health and Retirement Study (HRS), a United States nationally representative, biennial longitudinal survey of adults over age 50. The first wave was conducted in 1992 with a target population of the cohorts born in 1931 through 1941. Older cohorts and a younger cohort (born in 1942 through 1947) were added in 1998 [cohort = wave], so that the 1998 study represented the population born in 1947 or earlier. Since 1998, refresher cohorts of 51- to 56-year-olds have been added to the HRS every six years to maintain a population representation of adults ages 51 and older. The sample includes about 20,000 individuals per wave; more than 45,000 individuals have participated in the HRS since its inception.

This sounds pretty darned good to me — better than most such surveys. Their objective is clear:

In this report, we aim to identify predictors of dementia and cognitive impairment for individuals in the United States up to 20 years in advance using the cognition and dementia measures from the Health and Retirement Study (HRS).

So, the HRS already has within it “a validated probabilistic measure of dementia and cognitive impairment that was developed in prior research”, so that each person has been evaluated for cognitive ability. The HRS then:

allows us to evaluate the predictive power of many potential dementia risk factors, such as demographics, socioeconomic status (SES), labor-market measures, lifestyle and health behaviors (such as exercising and smoking), subjectively reported and objectively measured health, genes, parental health, cognitive abilities, and psychosocial factors (such as personality traits, social activities, and loneliness). We estimate how these factors predict cognitive impairment and dementia of individuals two, four, and twenty years after age 60.

So, that idea should be clear, from this here figure. The authors used their fancy univariate and multivariate analyses to try to work out how each of 181 potential risk factors, measured now, relates to developing dementia at a later age: “dementia prevalence among persons approximately age 80 according to their observed characteristics when they were about age 60”.

The report itself is quite readable, and you should consult it if you are interested in learning about all of the relevant factors they detected. For example:

In terms of explained variation, an individual’s baseline cognitive abilities, health, and functional limitations were the strongest predictors of dementia, whereas parental health, family size, marital history, and demographics were the weakest ones.

However, here we are interested in alcohol, which does make a suitable appearance:

Alcohol consumption is also predictive of dementia incidence; the incidence and prevalence of dementia are the lowest among those with moderate alcohol consumption, and the risk is elevated among those who never drink or who drink excessively. We found the same patterns in both sex groups and in all three dementia models that we considered.

This remarkable observation is shown in the next graph. This graph shows the males in the left pair of graphs and the females in the right pair. The top pair shows the effect of moderate exercise, for comparison, and the bottom pair shows the effect of alcohol intake. Each individual graph shows five possible situations (horizontally), and the rate of dementia associated with it (vertically).

So, to take exercise for men, as an example you should be familiar with: as the incidence of exercise decreases from left to right, the incidence of dementia increases. Or put around the other way, as exercise increases dementia decreases. You do not have all be told that exercise is good for you, but here it is one clear example.

Now look at alcohol. For both men and women, the highest incidence of dementia is among people who do not drink alcohol at all. For both men and women, the lowest incidence of dementia is among people who do have only one drink (or a couple of drinks) at a time. However, further increasing alcohol intake beyond this does increase the incidence of dementia — remember, five drinks at one time is a whole bottle of wine!

So, what people have been saying for years, that a little bit of alcohol is good for you, actually turns out to be true in this study.

The authors are moderate but clear:

Alcohol consumption is predictive of dementia incidence; the incidence and prevalence of dementia are the lowest among those with moderate alcohol consumption, and the risk is elevated among those who never drink or who drink excessively. We found the same patterns in both sex groups and in all three dementia models that we considered ... The lifestyle and health behavior predictors are noteworthy because they are modifiable risk factors and can be controlled by the individual.

Based on their whole analysis, they note:

We found strong associations between the outcomes and several modifiable risk factors. Therefore, our results suggest that there might be scope for slowing cognitive decline and dementia among at-risk people through behavioral changes and interventions. Such lifestyle modifications could be achieved by individuals taking the initiative to make such necessary changes, and public policy could also play an important role.

Our results suggest that it might be beneficial for maintaining cognitive health to exercise at least sometimes, even if it is only light physical activity, such as walking. Consuming alcohol in moderation, working longer, and engaging in hobbies and novel information activities after retirement are also associated with a lower risk of developing dementia. Similarly, maintaining good physical health is associated with reduced dementia incidence, which suggests that adopting a healthy lifestyle might be beneficial not only for general health but also for brain health ...

All these findings point toward the importance for policymakers and other stakeholders to promote healthy behaviors in the population and to strengthen individuals’ access to quality health care.

To this latter end, getting the bureaucrats’ alcohol-consumption ideas right is important. It seems that the World Health Organisation, and a number of other national and international bodies, have not yet got it right, as they have recently come out strongly against alcohol. The basic issue is that we cannot do proper scientific experiments (where we manipulate people’s behavior) to study the relevant social situations critically. All we can do is look at large databases, of which the one discussed here seems to be an important one.

The WHO is making a mistake about state-owned alcohol retailers

Last week, the World Health Organization (WHO) released a new report:

Nordic alcohol monopolies protect public health

This continues the current WHO anti-alcohol campaign, apparently heading back towards the days of Prohibition, or something like it. Their online announcement will give you an idea of their tone:

• WHO highlights Nordic alcohol monopolies as a comprehensive model for reducing alcohol consumption and harm

WHO has released a new report highlighting the Nordic alcohol monopolies as an effective model for reducing alcohol consumption and harm. Unlike commercial alcohol sales systems, these state-owned monopolies operate with a public health mandate, restricting availability and limiting the influence of private profit interests. Countries like Finland, Iceland, Norway, Sweden, and the Faroe Islands have maintained relatively low alcohol consumption levels, despite being part of a region historically known for heavy drinking and related harms.

So, their basic point is that retail alcohol monopolies can be an effective way to reduce alcohol consumption and harm. By removing the private profit motive of sales, monopolies often have:

• fewer outlets
• shorter hours of sale
• no advertising and promotion.

I should comment on this because I seem to be the only person regularly blogging about the wine industry, and who actually has personal experience of a state-owned Nordic / Scandinavian alcohol retailer. Also, I should compare this with the situation in the USA and Canada.

The WHO claim is that they have compiled some data that support their current agenda against alcohol. One example is shown in the graph below, looking at alcohol per capita consumption (APC) in the various countries. The Nordic countries have smaller APC than most of the other European countries.

However, the WHO have not looked at how the “government monopolies” actually behave, in practice. They may once have behaved the way WHO imagines, but that was decades ago. My own experience is of Systembolaget in Sweden, for the past quarter of a century (I also have experience of Australia), where the Swedes are dedicated to providing excellent customer service.

My own personal experience of Systembolaget includes:

• it is not closely supervised by the government, but acts as an independent retailer that just happens to be owned by the government (eg. it has recently expanded its opening hours)
• if you can import it then they will sell it, although you may have to order it (and wait a few days for delivery) rather than them always stocking it on their shop shelves
• if you can pay for it then they will sell it to you, unless you are clearly intoxicated at the time or are under-age
• they have plenty of easily accessible shops
• only when the importer runs out does supply of a product end.

Systembolaget currently lists as being available nationally: 15,251 wines, 4,067 beers, 5,272 spirits, 419 cider etc, and 170 alcohol-free drinks. This is hardly a limit on supply, for a country of 10.5 million people.

I have written quite a few blog posts on this situation, including the following:

An explanation of the situation:

Why are there wine monopolies in Scandinavia?

Product availability:

Wine monopolies, and the availability of wine
The availability of wines in government-owned retail monopolies
The availability of older wine vintages in Sweden?

The prices of alcohol:

Why is wine often cheaper in Sweden than elsewhere?
Is Scandinavia currently the most attractive wine export market?

Availability of alcohol from elsewhere within the European Union (EU):

Sweden is not actually restricted to a government alcohol retail monopoly

Similarity to alcohol availability elsewhere in the world:

Why does the world have Three-Tier systems for alcohol supply?

Not everything is necessarily perfect, of course:

My annoyances with my alcohol monopoly

While on the point of alcohol sales in the rest of the EU, looking at the above graph, I would ask the obvious question: what about Croatia, Malta, Cyprus, and especially Italy and Greece? It is not like these countries don’t produce lots of alcohol, including wine, beer and spirits, and sell them both nationally and internationally. The locals apparently consume less alcohol per person than the Nordic countries, according to the graph, without government ownership of retail. Also, Denmark should be noted in this list as a Scandinavian country, but their government does not own the alcohol retail.

More to the point, there was a research report published last year (Classifying national drinking patterns in Europe between 2000 and 2019), which looked at drinking patterns within the different countries of Europe four times this century, and the changes in drinking behavior during that time make a mockery of the one-time-only analysis of the WHO.

Finally, this whole issue undervalues the fact that, as alternative examples, both the USA and Canada also have states and provinces with partial or complete government ownership of alcohol retail. This is mentioned in the report as an alternative to Prohibition but not elaborated upon; and it hardly differs from the Nordic countries.

For Canada you can read: Alcoholic drinks in Canada. For the USA, you can read Alcoholic beverage control state, which lists the relevant states:

Alcoholic beverage control states, generally called control states, less often ABC states, are 17 states in the United States that have state monopolies over the wholesaling or retailing of some or all categories of alcoholic beverages, such as beer, wine, and distilled spirits.

Mind you, the United States continues to be the top global market for wine consumption, and for the USA there is pressure on the current retail situation:

Retailer DtC wine shipping: the time has come
Poll: NYers want wine in grocery stores

So, WHO’s anti-alcohol campaign seems to have led to some mis-understanding about the real situation among the countries of both Europe and North America. Unfortunately, they may not need to continue their campaign for long, because APC has been decreasing in many markets worldwide, no matter what the retail structure (What’s driving wine’s structural decline?). Nevertheless, Current medical evidence says that wine is not harmful in small doses.