Earlier research linked moderate drinking to a lower risk of heart disease. But many health experts now say some of those studies are flawed.
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Men should consume no more than one alcoholic drink a day, according to a federal committee’s recommendations for new U.S. dietary guidelines.
That’s a reduction from the current recommended limit of two drinks a day, and matches the guidance for women. The shift reflects scientists’ evolving thinking on moderate drinking, and comes as a 20-year rise in Americans’ drinking is accelerating during the pandemic.
Earlier research linked moderate drinking to a lower risk of heart disease. But many health experts now say some of those studies are flawed, and that there’s more and better evidence showing wider health risks of alcohol.
“We looked at deaths from cancer, cardiovascular disease, and more than 60 alcohol-related conditions,” says Timothy Naimi, a physician and alcohol researcher at Boston University who served on the federal committee. “Whatever kind of study you look at, two drinks a day is associated with a higher risk of death than drinking one drink a day. In the context of a health document, why would you endorse people drinking up to a level in which mortality increases?”
The recommendation is part of a wider effort to revise the U.S. government’s Dietary Guidelines for Americans, which is updated every five years. The guidelines are intended to influence what Americans eat and drink, and they shape everything from school lunch programs to food manufacturers’ plans.
Intense lobbying takes place: The alcohol industry voiced objections at a public hearing last week, and some scientists have suggested a greater focus on binge, rather than moderate, drinking.
The alcohol advisory committee issued its recommendations in July. The U.S. Department of Agriculture and Department of Health and Human Services are set to review the recommendations and issue the final guidelines by the year’s end.
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Doctors and scientists on the committee say they examined alcohol’s role in all causes of death. Even if there is a modest benefit for heart health, committee members say, a wider assessment of mortality indicates that less alcohol is better.
Studies show that mortality risks for both men and women start to increase after half-a-drink, says Dr. Naimi. Alcohol consumption in the U.S. has increased about 8% over the last 20 years, according to data from the National Institute on Alcohol Abuse and Alcoholism, part of the federal National Institutes of Health. And alcohol sales have surged 23.6% since March when the Covid-19 pandemic hit, through Aug. 1, compared with the same period in 2019, according to research firm Nielsen.
The 1990 guidelines were the first to specifically recommend no more than two drinks per day for men and one for women. Studies have found that about 90% of Americans say their drinking falls within those guidelines, on average, says George Koob, director of NIAAA.
Elizabeth Mayer-Davis, chair of the nutrition department at the University of North Carolina at Chapel Hill, chaired the subcommittee that reviewed beverage recommendations. She says the new recommendation comes in light of rising alcohol consumption and increasing evidence showing alcohol contributes to a number of diseases, most notably cancer.
“From a cancer point of view, the risks have become much more clear as more research has accumulated,” says Nigel Brockton, vice president of research at the American Institute for Cancer Research, which praised the proposal. “This can make a substantial contribution to increasing people’s health and lowering their cancer risk.”
Dr. Brockton says there’s strong evidence that drinking alcohol increases the risk of six types of cancer. Four such cancers—esophageal, stomach, liver, and head and neck—are more common in men than women, he says. For breast and esophageal cancer, any amount of alcohol increases risk, he says.
Earlier findings suggesting alcohol confers certain health benefits have been called into question by more recent studies, says Dr. Koob. For instance, research that associates moderate drinking with less cardiovascular disease often includes people who eat a Mediterranean diet, he says, so the health effects may come from the foods eaten, not alcohol. “While there may be some benefit in the cardiovascular domain, there are so many other issues when considering how alcohol impacts health,” says Dr. Koob.
Alcohol-related studies are often based on self-reports, which can be biased, says Dr. Mayer-Davis. People don’t always remember how much they drink or may underreport their intake. People who don’t drink alcohol may abstain due to specific health conditions.
Some scientists say the guidelines should focus more on binge-drinking. Eric Rimm, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, chaired the subcommittee that reviewed alcohol for the 2010 dietary guidelines advisory committee. He says the aim should be reducing binge drinking, not lowering the limit for moderate drinking.
“Some of the ill effects of alcohol are from people who look like they consume moderately who are big weekend drinkers,” says Dr. Rimm, who says he doesn’t receive funding from the alcohol industry.
He disagrees with the idea that the recommended limit for alcoholic drinks should be the same for men and women. The biological effect on women’s bodies is stronger, he says. Women lack an enzyme in their stomach, so alcohol isn’t metabolized there before getting into the bloodstream, he says. Men also have more body water, so alcohol is diluted more in their body fluids, he says.
The alcohol industry has voiced objections, too. Tiffany Sizemore-Ruiz, medical adviser for the Distilled Spirits Council of the United States, an industry group, is among those who spoke on behalf of the alcohol industry at a public hearing last week. She said the lowered limit for men isn’t based on sound science, and that the committee didn’t look at enough research that specifically studied the difference between one and two daily drinks. The Beer Institute president and CEO Jim McGreevy said the committee “cherry picked studies” to make their point.
Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston, wasn’t on the dietary guidelines committee and isn’t involved in the process. He says the lower limit is a sensible recommendation backed by research.
“They conclude appropriately that two drinks is worse than one for men, and we now have enough data to say that because of the harms of alcohol on cancers, liver diseases, accidents and other things,” says Dr. Mozaffarian.
Write to Sumathi Reddy at sumathi.reddy@wsj.com
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