How Much Alcohol Is Too Much?

Even when we have the best of intentions, we can tend to overindulge in … well, everything. Whether it’s a second helping of dinner, snacking on sweets or a venti-sized coffee, we often go a little too far. And that’s especially true — and risky — when it comes to alcohol.

Overdoing it with booze occasionally, like at a wedding or birthday party, might be fine (though your headache the next morning might make you think otherwise). But when does drinking frequently cross the line into being problematic? And what are the health risks of alcohol overconsumption? To gain some insight into these concerns, we spoke with hepatologist Jamile Wakim-Fleming, MD.

What are alcohol consumption guidelines?

It’s first best if we understand some of the dietary guidelines around alcohol. The U.S. Department of Agriculture and U.S. Department of Health and Human Services’ “Dietary Guidelines for Americans, 2020-2025” recommends adults of the legal drinking age should either not drink or limit their drinking to two drinks a day or fewer for men and one drink a day or fewer for women.

The guidelines say those who shouldn’t consume any alcohol under any circumstances include:

• Anyone under the legal drinking age.
• Anyone with liver disease.
• Anyone who’s pregnant or might be pregnant.
• Anyone with a medical condition or taking medication that has poor interactions with alcohol.
• Anyone recovering from “an alcohol use disorder” or has trouble controlling their alcohol consumption.

As for how much alcohol is considered standard, the guidelines define a standard drink as:

• 12 ounces of 5% alcohol by volume (ABV) like beer.
• 8 ounces of 7% ABV like malt liquor.
• 5 ounces of 12% ABV like wine.
• 1.5 ounces of 40% ABV (or 80 proof) distilled spirits like gin, rum and whiskey.

There are nuances to consider with these guidelines, though. While major American brands of beer have a 5% ABV measurement, many popular craft beers have higher alcohol content. That IPA you love might have an ABV of 7% or higher, so keep an eye on it when you’re knocking them back at your next summer barbecue.

But, as Dr. Wakim-Fleming explains, we also have to be cautious when applying these guidelines to our own habits for several reasons that go beyond the alcohol content of your beverage.

Factors in alcohol consumption

According to Dr. Wakim-Fleming, there are a few factors to consider when it comes to alcohol affecting you because each person is different. She outlines the following as the main ones when weighing alcohol consumption.

• Age. “A 50-year-old person will handle alcohol differently than someone who’s 70 years.”
• Gender. “Women don’t tolerate the same amount of alcohol as men because they have less of a certain enzyme — alcohol dehydrogenase — that metabolizes the alcohol before it’s absorbed into the blood.”
• Body size. If two people of different sizes intake the same amount of alcohol, the person with the smaller body carries less water and has a higher concentration of alcohol in their body, affecting the dilution.
• Family history. Those who are raised in a household with parents who drink are more likely to have an adverse relationship with alcohol.
• Comorbidities. Relatively healthy people will have an easier time processing alcohol than those with existing health issues.

Those factors are largely outside of our control. But other things we can control should also be considered, Dr. Wakim-Fleming advises. For instance, she says, “Drinking on an empty stomach is more toxic than if you’ve had something to eat. There’s no food to help absorb the alcohol so more goes into your blood system.”

And, again, there’s that percentage of alcohol to consider. “Remember that the percentages of alcohol vary among the types of alcohol,” she says. “Drinking 12 ounces of wine contains far more alcohol than 12 ounces of most common beers.”

How many drinks are too many?

Taking into account all of these factors, Dr. Wakim-Fleming says there are still ways to figure out where a person crosses the line into overindulging in alcohol, and separating what’s considered “binge” drinking, “heavy” drinking and “excessive” drinking.

What’s considered binge drinking?

Studies have shown that even if you only occasionally drink alcohol, drinking regularly over a long period can have negative outcomes on your health. “It’s a cumulating effect caused by drinking over time,” says Dr. Wakim-Fleming.

But a more present danger is binge drinking. According to the U.S. Centers for Disease and Prevention (CDC), binge drinking is classified for men as consuming five or more standard drinks within a few hours and four or more standard drinks within a few hours for women.

That kind of alcohol consumption can lead to severe reactions in your body, including:

• Dehydration and headaches (a hangover, in other words).
• Loss of motor skills that can lead to serious injuries.
• Alcohol poisoning.

The loss of judgment that comes from binge drinking can cause you to make poor choices, too, including driving under the influence, physical altercations and even further physical injury.

What’s considered excessive drinking?

Dr. Wakim-Fleming says excessive drinking is essentially the same as binge drinking. The CDC also includes underage drinking and drinking by women who are pregnant.

Most excessive drinking — more than 90%, according to the CDC — is binge drinking. Additional statistics on binge drinking from the CDC include:

• More than 38 million adults in the U.S. are binge drinkers.
• The average binge drinker does so around four times a month.
• The average binge drinker consumes eight drinks per binge.
• Most people who binge drink do not have an alcohol dependency.

Excessive drinking is something that’s thought of more in the short term, but can still be extremely damaging to your body, especially as it becomes a habit and potentially leads to more long-term, heavy drinking.

What’s considered heavy drinking?

While considered part of excessive drinking by the CDC, heavy drinking is applied to drinking over a longer period than binge drinking; while binge drinking is measured in an increment of two-to-three hours, heavy drinking is measured over a week.

“For women, heavy drinking is eight standard drinks a week or more,” says Dr. Wakim-Fleming, “While for men, it’s 15 drinks a week or more.” And, yes, multiple binges within a week do equal heavy drinking.

And no matter which category you fall into, there are consequences. “You subject your body to more health risks, to more toxicity and you begin a cycle of withdrawal problems,” she adds.

How does too much alcohol affect your body?

So, more about those consequences. “Alcohol affects the body in two ways,” says Dr. Wakim-Fleming. “The initial stage occurs right after drinking. Drinking causes inflammation of your swallowing tube [esophagus], stomach and gastrointestinal tract. Additionally, your liver is also inflamed which causes it to become enlarged and tender.”

If you stop drinking at this stage, she says, that inflammation is reversible. But if you continue to drink excessively over time or become a heavy drinker, that leads to serious complications.

Cancer

“If your drinking and inflammation continues daily, it leads to scarring and becomes irreversible, as in cirrhosis, which can lead to cancer,” notes Dr. Wakim-Fleming.

Both the American Cancer Society and the American Society of Clinical Oncology advise that alcohol directly raises the risk of cancer. The types of cancer of the gastrointestinal system that drinking alcohol can lead to include:

• Mouth.
• Tongue.
• Pharynx.
• Esophagus.
• Stomach.
• Liver.
• Pancreas.
• Colon and rectal.
• Breast.

“The important thing to remember is that these organizations consider alcohol a modifiable risk factor for cancer, which means you can do something about it,” adds Dr. Wakim-Fleming. “That means following their guidelines and avoiding drinking.”

How alcohol affects your brain

You may not realize it, but the most common consequence of overconsumption of alcohol — the hangover — is the alcohol directly affecting your brain. In the immediate aftermath, your hangover can include poor concentration, lagging reflexes, headache, nausea and vomiting.

Over time, though, excessive amounts of alcohol do far more damage to your brain, resulting in consequences beyond just an unpleasant morning after. “You can end up with alcohol dementia and a type of nerve damage we call neuropathy,” cautions Dr. Wakim-Fleming.

Some of the symptoms of neuropathy include:

• Tingling or numbness in hands and feet.
• Loss of motor control and coordination.
• Muscle weakness.
• Problems with bladder and digestion.
• Loss of muscle control.

Chronic alcoholism has also been linked to poor diets, which deprive your body of necessary vitamins and nutrients, which can compound issues with many parts of your body, including your brain and central nervous system.

How alcohol affects your heart

Alcohol can adversely affect muscles, and your heart is a muscle. Heavy drinking can lead to a poor diet, which means your muscles are using empty calories from alcohol rather than healthy foods.

The result can be a dilated heart muscle and, eventually, dilated cardiomyopathy. Your heart weakens and can’t pump blood as strongly, which can cause your kidneys to retain more fluid. That can lead to fluid build-up in your extremities and lungs, and even to congested heart failure.

How alcohol affects your liver

Excessive and heavy drinking can lead to cirrhosis and liver cancer. But, says Dr. Wakim-Fleming, the risks go beyond that.

Cirrhosis of the liver, which causes scar tissue that prevents your liver from functioning properly, is often caused by alcoholism. “Because that scarring affects the ability of the liver to function, it can lead to life-threatening conditions. And that’s why alcohol is one of the most common reasons for a liver transplant.”

Will one night of drinking impact your overall health?

Excessive drinking in one night can lead to acute damage and cause alcohol poisoning, which has severe consequences including, at its most extreme, death.

But if you drink only occasionally and in moderation — say, a glass of wine with dinner or a beer at a ballgame — it’s not going to create long-term damage. It’s all about moderation and avoiding chronic use, says Dr. Wakim-Fleming.

And while following recommended guidelines is important, it’s also about knowing yourself and your limits. “We don’t have personalized medicine when it comes to alcohol because everyone responds differently,” she says.

Even if you’re not overdoing it, consider taking a break or several breaks throughout the year. “Any break is good because your body needs time to reduce that inflammation. Taking a month or two off from consuming alcohol can help,” she suggests.

“Know your body, know your personal and family history and know your limits,” she continues. “Know what’s good for you because what works for others won’t necessarily work for you. Take charge of your health and if you need, seek help, whether from family, friends or other support groups and always discuss with your doctor.”