A few days ago I was talking with Liz Earle about alcohol and ageing, and it struck me afterwards that this is one of those subjects most of us understand only partially.
People know alcohol can damage the liver. That much has got through. But alcohol’s effects are much broader than that. It affects the brain, the gut, the immune system, sleep, blood pressure, inflammation and cancer risk. In other words, it accelerates ageing in multiple systems at once. Some of that ageing you can see—in the skin, the face, the eyes, the quality of sleep. Some of it you can’t—in the blood vessels, the DNA, and the gradual wear and tear of inflammation.
This matters to me personally as well as professionally. I am now in my seventies, so longevity is no longer an abstract concept. It becomes rather more relevant when you realise you are living it. And one of the clearest conclusions from the science is this: by far the best thing a non-smoker can do to improve longevity is to reduce alcohol intake.
Alcohol is classified as a Group 1 carcinogen, meaning there is strong evidence linking it to cancers including breast, liver and colorectal cancer. These risks accumulate over decades, and some of the damage cannot be reversed, even if drinking stops later in life.
Many people still think of drinking as a fairly benign habit unless it becomes extreme, but even lower levels of drinking can impair sleep, raise blood pressure and increase inflammation.
Alcohol also becomes harder to tolerate as we age. The body’s ability to process it declines, metabolism slows, and the same amount produces a greater effect. This is why many people notice that hangovers worsen over time, even if their drinking habits have not changed.
Most of us drink for a purpose. Usually that purpose is to relax, feel less socially anxious, and become more connected to other people. The first drink does this largely through GABA, the brain’s main calming system. But after that, alcohol begins to interfere with other transmitters—dopamine, glutamate, endorphins—and that is when the immediate harms escalate. So the great paradox of drinking is that people often want the benefit of drink one, but end up paying the biological price of drinks three and four. This is why I increasingly think we should all become more reflective about drinking. Ask three simple questions: Why am I drinking? What effect do I want? Did I actually get that benefit? Too often, alcohol overshoots the target.
I am not prohibitionist. Humans are social animals, and social rituals matter. Pubs, bars, dinners and parties are not trivial parts of life. They are part of how we build trust, friendship and community. The challenge is not to abolish sociability, but to find healthier ways of supporting it.
That, I suspect, is where the future lies: not in abstinence for everyone, but in better options, better habits, and better questions about why we do the things we do.
— David Nutt
