For 25 years, the U.S. government’s recommended dietary guidelines for alcohol consumption have urged moderation, mentioning some possible health benefits but also recommending men limit themselves to no more than two drinks per day and women to one drink or less. Now a panel of health experts is saying that may be too much, recommending the guidelines be cut in half for men. The one drink recommendation for women will remain unchanged.
What’s more, the panel, part of the group in charge of revamping the U.S. Dietary Guidelines for Americans, used damning language to describe alcohol consumption as a major problem in America, pointing to rising evidence of binge drinking and to growing evidence of links between alcohol consumption and several forms of cancer. The Dietary Guidelines Advisory Committee Report, released July 15, was dismissive of numerous studies showing possible links between moderate wine consumption and lower rates of cardiovascular disease and did not mention studies linking moderate drinking to lower rates of type 2 diabetes, Alzheimer’s and dementia.
Members of the wine, beer and spirits industries were not happy with the report. The Wine Institute, which represents California wineries, issued a statement that “to change the long-established guidance on moderate consumption is not supported by science.”
The guidelines are published every five years by the U.S. Department of Agriculture (USDA) and Health and Human Services (HHS). They impact public health organizations and scientific research and also signal the United States’ ever-changing attitude toward alcohol. In 1990, the guidelines stated, “Alcohol has no net health benefit, is linked with many health problems, is the cause of many accidents and can lead to addiction. Its consumption is not recommended.”
But growing evidence of the French Paradox, including several studies showing that moderate drinkers also enjoyed lower rates of cardiovascular disease, convinced the government to change the guidelines in 1995 to read, “Current evidence suggests that moderate drinking … is associated with a lower risk for coronary heart disease in some individuals.”
The last round of guidelines, published in 2015, state, “If alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men.”
The scientific committee for the new guidelines, composed of 20 doctors from across the nation, begins the alcohol section by focusing intently not on moderation but on binge drinking. “Alcohol consumption in the United States has increased during the past 20 years,” state the authors. “Fifty-six percent of adults ages 21 years and older report past-month alcohol consumption. Binge drinking itself has increased, including among middle- and older-aged adults, as has mortality from fully alcohol-attributable causes of death, including alcoholic liver disease.”
The authors say that alcohol consumption accounts for about 100,000 deaths annually in America, and that about 88,000 of those can be blamed on excessive or binge drinking.
But it soon shifts its aim to what it calls “so-called moderate drinking,” pointing to increasing evidence that even small amounts of alcohol have been linked to seven types of cancer, including breast cancer.
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As for studies showing links between moderate drinking and lower rates of cardiovascular disease, it dismisses them, arguing that the studies could be explained by confounding factors, such as that moderate drinkers tend to be wealthier, eat better and exercise more. Based on that, the authors believe the guidelines should be more conservative. “The committee is not aware of studies demonstrating that drinking two drinks per drinking day is as safe or safer than drinking one drink per drinking day for men,” the authors state.
But scientists who argue that moderate alcohol consumption, particularly wine consumption, does have health benefits, say that these objections are not new. So why change the guidelines now?
Dr. Eric Rimm headed the panel that created the 2010 guideline recommendations and is now director of the Harvard School of Public Health’s Program in Cardiovascular Epidemiology. "The science has not changed in the last five years and all of the previous guidelines since 1990 have said up to one for women and two for men," he told Wine Spectator in an email. "Thus I think this committee got it wrong and was overly conservative about their advice for adults that drink moderately, can control their consumption and do not binge drink."
“A small group of advisors is proposing the government slash that definition in half for men, with a shocking lack of scientific support,” read a statement issued by the Distilled Spirits Council of the United States (DISCUS). “That would mean any adult man enjoying two drinks at dinner, during a football game, or at a distillery would suddenly be redefined as not drinking in moderation. The advisory group’s 835-page report admits that ‘only one study examined differences among men comparing one vs. two drinks’.“
Rimm questioned the data that was not used. "They ignored all research before 2010 and were very dismissive of observational studies of alcohol and chronic disease, even though this represents the only way to study alcohol and long term health," he said. "There are no long term clinical trials of alcohol."
A long term, clinical study of alcohol consumption would provide better data, but such studies are expensive, and alcohol is not a scientific priority. In 2014, the National Institutes of Health (NIH) launched an ambitious clinical trial designed to look at alcohol. It was cancelled in 2018 after reporters found that NIH officials had lobbied beer and liquor companies for funding.
The USDA and HHS are accepting public comments on the panel’s recommendations until Aug. 13, 2020. The new dietary guidelines will be released later this year.