Alcohol consumption clearly reduces risk of cardiovascular disease (CVD) in populations throughout the world and may contribute to lower rates of CVD among residents of Mediterranean countries. In addition, overall mortality rates are generally slightly lower among moderate drinkers than among abstainers. However, several studies have linked alcohol consumption (even amounts equivalent to two drinks daily) to increased rates for certain cancers, especially breast cancer in women. A Mediterranean diet, which is high in fruit, vegetables, and grains, also typically includes one to two drinks per day. Whether one to two drinks adversely affect cancer incidence in the presence of a Mediterranean diet has not been fully explored. With the evidence currently available, we conclude that alcohol, when consumed responsibly in most populations, is an important component of the Mediterranean diet and a component of a healthy lifestyle.