Sake and Health: A Scientific Look at Effects and Cautions

There is an old Japanese saying: “Sake is the best of all medicines.”

Yet there is a considerable gap between the era in which that phrase was coined and our present scientific understanding. It is worth setting out clearly what can and cannot be said about the relationship between sake and health as things stand today.

Note: This article is intended as general information only and is not medical advice. If you have any health condition or are taking medication, be sure to consult your doctor.

2024: Japan’s First Drinking Guidelines

On February 19, 2024, Japan’s Ministry of Health, Labour and Welfare published the Guidelines on Drinking with Consideration for Health. This was the first time the national government had compiled a set of guidelines on alcohol consumption.

What makes these guidelines significant is that they take pure alcohol content, rather than the type of drink, as their yardstick. Whether it is beer, sake, or wine, the reasoning goes, if the amount of alcohol entering the body is the same, so is the effect.

Calculating Pure Alcohol Content

Pure alcohol content is found using the following formula.

Volume consumed (ml) × alcohol strength (ABV ÷ 100) × 0.8

The 0.8 at the end is the specific gravity of alcohol.

Consider drinking one go (180ml) of sake at 15% alcohol.

180 × 0.15 × 0.8 = 21.6g

In other words, one go of sake amounts to roughly 20g of pure alcohol. The guidelines themselves cite 500ml of beer or one go of sake as examples of the 20g benchmark.

Amounts at Which Risk Increases

The guidelines give the following figures as the levels of drinking that raise the risk of developing lifestyle-related diseases.

	Pure alcohol per day	Converted into sake
Men	40g or more	Roughly 2 go or more
Women	20g or more	Roughly 1 go or more

Note that the figure for men is double that for women. Women are said to have less water in the body than men and are therefore more susceptible to the effects of alcohol.

These numbers are not a guarantee that anything below them is safe; they mark the line beyond which risk increases. That distinction is not a small one.

The Idea That “Moderate Drinking Is Good for You” Is Now in Question

The once widely repeated claim that moderate drinking leaves you healthier than not drinking at all — the so-called J-curve — has had its evidence base called into question in recent years.

It has been pointed out that in earlier studies, the group of non-drinkers included people who had stopped drinking because their health had deteriorated, which may have made non-drinkers appear to be in worse health than they were. Studies that correct for this have reported that even small amounts of alcohol raise the risk of certain diseases.

The Ministry’s guidelines, too, are not framed as a claim about health benefits. Their purpose is to help people understand the risks correctly and to reduce inappropriate drinking.

The reasonable understanding at present, therefore, is this.

Sake is something to be enjoyed for its own sake, not something to drink for your health.

Flavor, the way it pairs with food, cultural enjoyment — those are reason enough to drink, and that is what drinking sake was always about.

On the Components Found in Sake

Sake contains certain components that are distinctive compared with other alcoholic drinks. How they are discussed, however, calls for care.

Amino acids — Sake contains more than 20 kinds of amino acids, and its content is said to be high compared with other alcoholic beverages. Junmai-shu (sake brewed from rice, water, and koji alone, with no added distilled alcohol) and sake made by the kimoto method (a traditional, labor-intensive starter process) are especially rich in them. These amino acids are the source of umami and give sake’s flavor its depth.

Organic acids — Lactic acid, succinic acid, malic acid and others are present, lending dimension to the taste.

Peptides — Formed when proteins break down. There are research reports investigating the physiological activity of some of them.

The important point here is that the presence of these components is a separate matter from whether they are good for you. The quantities involved are minute, and if you were to drink alcohol in order to obtain them, the risks of the alcohol itself would very likely outweigh any benefit.

Talking about these components is meaningful for understanding how sake tastes. As grounds for a health claim, they should be handled cautiously.

What Happens When You Drink Too Much

Strain on the liver — Alcohol is broken down chiefly in the liver. When excessive drinking continues, risk rises through the stages of fatty liver, alcoholic hepatitis, and cirrhosis.

Dependency — Alcohol is addictive. Changes such as feeling unsettled without a drink, drinking more than you used to, or finding yourself impatient for drinking time to arrive are signs to consult a specialist early.

Lifestyle-related diseases — The risk of high blood pressure, diabetes, dyslipidemia and similar conditions goes up. The figures in the guidelines above are based on precisely this point.

Sleep quality — A nightcap may help you fall asleep sooner, but it also makes you more likely to wake during the second half of the night and interferes with deep sleep. Drinking in order to sleep tends to be counterproductive as far as sleep quality is concerned.

Calories — One go of sake is said to be somewhere around 190–200 kcal. Repeated daily, that alone affects weight management. It is worth remembering that the calories in the snacks alongside it add up too.

Living With It in Practice

If, with the risks in mind, you decide to drink, there are several ways to lighten the load.

Don’t drink on an empty stomach. With nothing in the stomach, alcohol is absorbed more quickly. Eating while you drink makes the rise in blood alcohol concentration more gradual.

Drink yawaragi-mizu. This is the practice of drinking water alongside your sake — the equivalent of a chaser with Western spirits. Your pace naturally slows, and dehydration is easier to avoid.

Drink slowly. If you take the time to taste what you are drinking, a smaller amount can be satisfying. The same single go puts a completely different burden on the body depending on whether you finish it in ten minutes or over an hour.

Set aside days without alcohol. Keeping a few days a week free of drinking is an effective way to manage quantity. When daily drinking becomes habitual, it is hard to notice that the amount has been creeping up.

Know your own numbers. The formula for pure alcohol content is worth committing to memory. Simply being conscious of how many grams you have had today allows more accurate management than relying on how you feel.

When You Should Not Drink

Drinking should be avoided if any of the following apply.

• Those who are pregnant or breastfeeding
• Those under the age of 20 (in Japan, drinking under the age of 20 is prohibited by law)
• Those who plan to drive a car, motorcycle, or bicycle
• Those instructed by a doctor to abstain
• Those in recovery from alcohol dependency

In addition, if any of the following apply, consulting a doctor beforehand is advisable.

• Those with conditions of the liver, pancreas, or digestive system
• Those undergoing treatment for diabetes, high blood pressure, and the like
• Those taking medication (there can be interactions between drugs and alcohol)
• Those who constitutionally react to alcohol with facial flushing, palpitations, or similar symptoms

Flushing in the face indicates difficulty processing acetaldehyde, the toxic compound produced as alcohol is broken down in the body. Forcing yourself to keep drinking raises the risk to your health. Being unable to drink is a matter of constitution, not something that changes with training.

A Caution About “Good for Your Health” Marketing

You will sometimes come across the claim that “such-and-such a component in sake is good for you.”

When you meet information of this kind, consider whether you actually need to consume alcohol in order to obtain that component. If there is a food that supplies the same component more safely, choosing that is the more sensible course.

The language used to sell sake and information intended to inform your health are best kept apart.

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How to live with sake is, in the end, fairly simple.

Know in numbers how much you are drinking, drink slowly alongside a meal, and set aside days without alcohol. Depending on your condition and circumstances, choose not to drink at all.

The saying “sake is the best of all medicines” has also, in part, been used not to justify drinking but to counsel not going too far. The conditions for enjoying it over a long life have not changed much between then and now.

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For its effects on beauty, please see Sake and Beauty.

Tips for avoiding hangovers are covered in detail in How to Drink Without Getting a Hangover.

References: Japan’s Ministry of Health, Labour and Welfare, “Guidelines on Drinking with Consideration for Health” (published February 19, 2024), and “Health Japan 21.”