You may have read that drinking alcohol reduces inflammation. On the other hand, you may have read that it makes inflammation worse. So which is it? Is alcohol your friend in the fight against chronic inflammation, or is it your foe?

Although considerable research has been done on the role of alcohol in inflammation, some of it has been contradictory, and there’s a lot we still need to learn. However, the bulk of the latest research supports the idea that alcohol causes or exacerbates chronic inflammation. It can now safely be said that the more you drink, the more likely you are to experience inflammation, and that severely restricting or completely cutting out alcohol consumption is a wise choice for your health.

What is Inflammation?

Colloquially, we often conflate inflammation with swelling, using the two terms interchangeably. But they’re not quite the same thing. Swelling—visible puffiness—may sometimes be caused by inflammation, but it can also be an effect of water retention and dehydration (The puffy facial features of a person after a night of drinking, caused by dehydration, explain why alcohol and swelling are linked in many people’s minds). Inflammation, specifically, is the protective action of your immune system in response to a damaging substance such as a virus, bacteria, or environmental toxin. Unfortunately, rather like innocent bystanders at a drive-by shooting, harmless tissues and cells sometimes are “in the line of fire” when the immune system undertakes its inflammatory processes. That kind of repeated damage is why chronic inflammation—the kind that is long-lasting—is associated with so many disease states, including dementia, cancers, liver disease, arthritis, and more.

Alcohol, inflammation, and the gut

Have you ever wondered what happens inside your gut when you drink alcohol? Research over the past couple of decades has yielded an increasingly clear picture of the processes that play out when you swallow a glass of beer, wine, or liquor.

No matter what form of alcohol you consume, once it reaches your gut, a few things happen. First, the alcohol suppresses the action of a type of gut cells called Paneth cells, which are a key defense against bacteria. Normally, Paneth cells release antibacterial compounds, but the presence of alcohol in the gut hampers their work. In the absence of those antibacterial compounds, bad bacteria are allowed to flourish, releasing toxic byproducts, especially an endotoxin type called lipopolysaccharides (LPSs). The immune system then springs into action, releasing inflammatory cytokines to do battle with those toxins. That inflammatory action inside the gut has been linked to gastrointestinal diseases, but like many an armed conflict, this one is not long contained to its place of origin. Some of those toxins and inflammatory cytokines leave the gut and enter the bloodstream and the liver, causing whole new immune battles at each new site, complete with the release of additional inflammatory substances. The result can be fibrosis of the liver as well as damage to the circulatory system and, as we shall see, to the brain.

But that flourishing of harmful bacteria thanks to the suppression of Paneth cells (a state doctors refer to as dysbiosis) is just part of the story. At the same time the dysbiosis story is playing out, alcohol produces another effect in the gut…it makes the intestinal wall more permeable. This allows LPSs and those inflammatory compounds more easily to exit the gut and travel throughout the body, wreaking havoc as they go.

And alcohol has yet a third effect on the gut. To understand it, bear in mind that your body is in a constant, behind-the-scenes struggle to limit the amount of “free radicals” within your cells. Free radicals are unstable byproducts of metabolism that can damage the DNA or RNA of cells, and even cause cell death. Our normal defense against them are antioxidants, which we can get through the foods we eat. A healthy person has enough antioxidants in their system to limit the damage caused by free radicals. But when the body metabolizes that red wine or craft beer you had with dinner, it generates an abundance of a type of free radical called reactive oxygen species (ROS). The resulting imbalance between antioxidants and free radicals is a condition known as oxidative stress, which is closely related to inflammation and which is implicated in several diseases and with premature aging.

Alcohol, inflammation, and the brain

Inflammation brought about by alcohol also reaches the brain, where it has been linked to several neurological diseases including dementia. But in 2023, scientists at Scripps Research found that, in mice, alcohol consumption caused the release in the brain of a pro-inflammatory immune molecule called interleukin 1β, or I-1β. Compared to mice that were not dependent on alcohol or who consumed no alcohol at all, the mice who were dependent on alcohol had twice the levels of I-1β in an area of the brain called the medial prefrontal cortex, which helps manage impulsive behavior. If the finding applies to people and not just mice, that could mean that brain inflammation inhibits the ability of heavy drinkers to refrain from drinking…a nasty and potentially fatal feedback loop.

All things considered

But what about the evidence that alcohol may actually be anti-inflammatory? That thinking is based on decades of research that associates moderate consumption of red wine (one drink per day for women, two for men) to improved blood vessel health, blood pressure control, and cognition. Since red wine contains anti-inflammatory phytochemicals, the thinking goes, then drinking red wine in moderation makes sense.

And other research] has shown decreased levels of biomarkers for inflammation associated with moderate consumption of other forms of alcohol.

Yet plenty of research points the other way. Despite the earlier studies showing cardiovascular benefit, a 2022 Harvard-led study found that drinking any amount of alcohol boosted cardiovascular risk, and suggested that the positive effects historically associated with moderate alcohol consumption could most likely be explained away through other lifestyle factors.

Unfortunately, even when modest improvements in outcomes have been linked to alcohol, they hinge on keeping consumption “moderate.” In fact, in some studies showing lower levels of biomarkers for inflammation, the ideal amount of alcohol was less than one glass of wine or beer per day, and the other positive health outcomes from drinking red wine disappear quickly as levels of consumption go beyond moderate.

Once drinking surpasses the minimal threshold of a drink per day for women and two for men, evidence for negative health effects begins to pile up in the research. Not just liver disease, but cardiovascular issues, gastrointestinal problems, neurological disorders, and several types of cancer are linked to alcohol consumption. And keep in mind that we’re not necessarily talking about particularly heavy drinking. For example, a South Korean study of 4 million adults, published in the Journal of the American Medical Association in 2023 found that two drinks per day was associated with reduced risk of dementia, but just adding another drink per day caused a 17% increase in dementia risk compared to non-drinkers. Plus, that study must be viewed in light of other research that has found that brain volume decreases with alcohol consumption, and that going from half a beer or glass of wine per day to a full drink brought about brain changes equivalent to two years of aging in 50-year-olds.

Leaving aside the question of inflammation, the American Cancer Society now lists alcohol as a known human carcinogen, thanks to abundant research linking alcohol to increased risk of several cancers, including those of the breast, colon, esophagus, liver, head, and neck.

On balance, there is little evidence to support the idea of consuming alcohol in pursuit of an anti-inflammatory benefit, and plenty of evidence to support the idea of severely limiting alcohol intake if not avoiding it altogether (It’s especially important for older adults to limit alcohol consumption to one drink per day and never to exceed two drinks). In fact, a landmark paper published in Lancet in 2018 concludes that you give yourself the best chances of overall health by not drinking alcohol at all. If you’re stuck on the idea of drinking wine to get at its beneficial phytochemicals, bear in mind that you can also get them from berries, nuts, the cocoa in dark chocolate, and nearly 70 other foods.

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