Is alcohol allowed on the Mediterranean diet?

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The Mediterranean diet does not explicitly recommend alcohol. However, moderate alcohol intake — in particular, red wine consumed with meals — is a recognized part of the dietary pattern.[1] Moderate intake is defined as up to 2 drinks per day for men and 1 drink per day for women, and is included as a component in most Mediterranean-diet-scoring indexes.

One study found that people who followed a “moderate Mediterranean drinking plan” including the consumption of red wine with meals had a lower mortality risk compared to people who abstained from alcohol and had low adherence to the Mediterranean diet.[2] Excluding moderate alcohol intake as a component of the Mediterranean diet reduces the overall association of the diet with mortality risk, with alcohol’s contribution being greater than a low red meat consumption or a high vegetable intake.[3]

These “health-protective” effects of alcohol (red wine) have been attributed to its polyphenol content (e.g., resveratrol), but this is mostly mechanistic speculation; most people don’t accept that alcohol exerts a health benefit per se. Alcohol — especially in large quantities — is toxic to the brain and can increase the risk of accidental deaths and certain types of cancer;[4] it’s one of the main risk factors for the global burden of disease.[5] Thus, while a few glasses of red wine can complement the healthy foods that comprise the Mediterranean diet, an individual’s risk factors, tolerance to alcohol, and personal/religious beliefs should all be taken into consideration. The Mediterranean diet can be incredibly health-promoting in the absence of alcohol.

References
1.^Giacosa A, Barale R, Bavaresco L, Faliva MA, Gerbi V, La Vecchia C, Negri E, Opizzi A, Perna S, Pezzotti M, Rondanelli MMediterranean Way of Drinking and Longevity.Crit Rev Food Sci Nutr.(2016)
2.^Morales G, Martínez-González MA, Barbería-Latasa M, Bes-Rastrollo M, Gea AMediterranean diet, alcohol-drinking pattern and their combined effect on all-cause mortality: the Seguimiento Universidad de Navarra (SUN) cohort.Eur J Nutr.(2021-Apr)
3.^Trichopoulou A, Bamia C, Trichopoulos DAnatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study.BMJ.(2009-Jun-23)
4.^IARC Working Group on the Evaluation of Carcinogenic Risks to HumansPersonal habits and indoor combustionsIARC Monogr Eval Carcinog Risks Hum.(2012)