Binge Drinking Is Bad. So Why Is the U.S. Government Targeting Moderate Wine Consumption?

Discouraging people from healthy drinking habits is not the solution for stopping alcohol abuse

Binge Drinking Is Bad. So Why Is the U.S. Government Targeting Moderate Wine Consumption?
America's relationship with alcohol ... It's complicated. (Ullstein bild via Getty Images)
Aug 19, 2020

It's easy to forget how big an impact the French Paradox had on wine's role in America—really on all alcohol in America. We had always had a tortured relationship with alcohol—any nation that outlaws all booze and then spends the next 13 years devoting a huge amount of energy toward circumventing that ban has some issues to work out.

But Morley Safer's 60 Minutes report on the French Paradox, the idea that moderate consumption of alcohol, preferably consumed with food, could actually improve health, opened a new chapter in our love-hate romance. A series of scientific studies over the next decade added credible backing to the idea that alcohol, possibly red wine in particular, could improve cardiovascular health.

The impact on the U.S. wine industry was dramatic. In 1970, America drank about 118 million cases of wine, according to Impact Databank, one of Wine Spectator’s sister publications. By 1985, it was 210 million cases. But there was a deeper change—a cultural one. Americans began to view alcohol less as a sin and more as a lifestyle choice. A glass of wine or two with dinner was acceptable, not a sign of dependency or European pretension.

But like a couple who hasn't worked on their relationship in too long, America and alcohol are starting to backslide into old habits. A vocal segment of public health experts, worried about the legitimate problem of binge drinking, is pushing back on the idea that moderate consumption can be healthy.

Every five years, the U.S. Department of Agriculture (USDA) and Health and Human Services (HHS) issue federal dietary guidelines. Before the final guidelines are set, a panel of respected health experts studies nutritional topics and writes an advisory report.

In 1995, the report broke new ground when it stated for the first time that there was significant evidence that moderate alcohol consumption had positive health benefits. "Current evidence suggests that moderate drinking … is associated with a lower risk for coronary heart disease in some individuals." Over the next 20 years, the guidelines changed around the edges, but continued to support the idea that a drink, in moderation, could have positive impacts. In 2015, they read, "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 consensus has not changed much in the five years since the 2015 guidelines came out. But when the scientific panel report for the 2020 guidelines arrived last month, it brought an unpleasant surprise. The guidelines were being changed—men should cut their consumption in half. If you drink, the panel recommended, don't consume more than one drink per day.

What's more, the tone of the report was dramatically different. Recent panels have balanced the idea that too much alcohol is a serious health problem but, at the same time, the evidence shows that those who drink in moderation have a lower all-cause mortality rate.

The first section of the 2010 report shows that balance: "Heavy drinking increases the risk of liver cirrhosis, hypertension, cancers of the upper gastrointestinal tract, injury and violence. A recent analysis of the preventable causes of mortality in the United States (U.S.) attributed 90,000 deaths a year to alcohol misuse." But, as it goes on to say in the same paragraph, "It is estimated that the benefits attributed to moderate alcohol consumption resulted in 26,000 fewer deaths from heart disease, stroke and diabetes."

The 2020 report? "Alcohol consumption accounts for approximately 100,000 deaths annually in the United States." That's it. There is no mention of moderate consumption offering any benefits.

Instead, the panel is dismissive of studies showing a link between moderate drinking and lower rates of cardiovascular disease. As for research showing a link between moderate consumption and lower rates of diabetes or dementia, the panel doesn't even mention them.

Dr. Timothy Naimi, a doctor and alcohol epidemiologist at Boston Medical Center and a professor with the Boston University Schools of Medicine and Public Health, was the leader of the panel. I asked him, Why the change?

"The evidence is pretty clear that, generally speaking, drinking less is better for health than drinking more," he told me. "And while many studies focus on two or less [drinks per day] for men, studies that look at smaller increments of consumption and meta-analyses and modeling studies based on cohort studies which can generate more detailed risk curves suggest consuming two drinks is associated with higher mortality than drinking one drink."

But the panel's primary focus is on binge drinking, a problem that has been growing in recent years. Naimi's career has focused on the impacts of binge drinking and substance abuse. "The main issue is getting people to reduce their drinking to more moderate levels—either based on current or the proposed revised recommendations," said Naimi. "We have a ways to go. So the data support the recommendation, but also with the alcohol-cancer concerns and other types of studies suggesting no benefit for alcohol on heart disease, folks are becoming more cautious about endorsing the consumption of other than relatively low amounts."

I suspect that like other health experts I have spoken to in recent years, the panel members believe that a green light for moderate consumption invariably leads to drinking too much.

The USDA and HHS will issue their final guidelines later this year. (The all-too-brief public comment period, which was less than a month, has already closed.) If they adopt the panel's recommendations, America will match the United Kingdom, where public health authorities slashed their guidelines for men from two drinks to one in 2016.

But will discouraging moderate drinking reduce binge drinking? I seriously doubt it. America's relationship with alcohol still needs a lot of work. Killing the idea that a glass or two of wine with dinner can offer health benefits will not combat alcohol abuse. In fact, it could hurt that fight by effectively saying that the only reason to drink is to get drunk.

Opinion Health United States

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