We are writing in reference to our editorial,1 in which we mention that the most effective measures shown to extend life expectancy include moderate alcohol intake (5-14.9g of ethanol/d). A healthy lifestyle, including moderate intake of alcoholic beverages, led to a reduction of 74% in all-cause death, 65% in cancer mortality, and 82% in cardiovascular mortality.2

Numerous studies have found that moderate alcohol intake has a protective effect on the cardiovascular system. Meta-analysis results3 indicate that a moderate intake of alcoholic beverages—mainly wine—lowers the risk of breast cancer, provided that it is part of a healthy dietary pattern. These studies take into consideration the presence of confounding factors, such as the lack of “patients” in the control arm (abstainers), avoid inaccurate records on the use of alcoholic beverages, specify the alcohol intake pattern (differentiating between daily alcohol intake and cumulative weekend or binge drinking), and look at the effect of healthy dietary patterns, such as the Mediterranean diet. Additionally, in vitro studies have identified various possible mechanisms for the protective effects of moderate alcohol intake, supporting the plausibility of epidemiologic results.

In conclusion, as clinicians we have sufficient evidence to counsel patients according to alcohol consumption: a) patients who drink in excess should be urged to reduce intake to less than 20g of alcohol a day for men and less than 10g for women; b) patients with moderate alcohol intake should be reminded to avoid any increase in intake, and c) patients who abstain should never be advised to drink alcohol. All of these patients should be encouraged to eat a healthy diet, namely the Mediterranean diet, and those who drink alcohol should be directed to preferably drink wine or beer, always with meals.