Revised U.S. Alcohol Guidelines: How Much Is Too Much?

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Whether uncorking a bottle of wine, shaking (not stirring) vodka martinis, or popping the cap off a frosty beer, men and women should limit themselves to one drink a day. This is the conclusion of a draft report from the Dietary Advisory Committee, a panel of experts that meets every five years to examine the latest science and recommend updates to the Dietary Guidelines for Americans.

The committee’s drink-a-day directive is an unexpected departure from the federal government’s long-held position on alcohol consumption. For several decades, the guidelines have defined moderate drinking as two drinks a day for men and one for women. The dietary information has also warned pregnant women and people with certain medical conditions to completely avoid alcohol.

A standard drink, according to the National Institute of Alcohol Abuse and Alcoholism, is 12 ounces of regular beer (5% alcohol), eight to nine ounces of malt liquor (7% alcohol), five ounces of table wine (12% alcohol), and 1.5 ounces (40% alcohol), or one shot, of distilled spirits, such as rum, tequila, vodka, whiskey, or gin.

In recent years, the guidelines have noted that moderate drinking, especially red wine, could prove beneficial to heart health, cognitive function, and may contribute to a longer life. But health advocates have argued that those studies were questionable and, even if accurate, the risks may still outweigh the benefits of alcohol. On its website, the National Cancer Institute notes that “clear patterns have emerged between alcohol consumption” and head and neck, breast, esophageal, liver, and colorectal cancers. “In fact, a recent study that included data from more than 1000 alcohol studies and data sources, as well as death and disability records from 195 countries and territories from 1990 to 2016, concluded that the optimal number of drinks to consume per day to minimize the overall risk to health is zero,” according to the NCI website.

But does downing a drink a day significantly raise the risk ante for alcohol-related health issues compared to a teetotaler?

Aaron Carroll, M.D., a pediatrician and professor of pediatrics at Indiana University School of Medicine and author of several books including “The Bad Food Bible,” wrote that there is no question heavy drinking is bad and can have serious health repercussions. In a 2018 opinion piece for the New York Times, Dr. Carroll interpreted the results of a meta-analysis of the dangers and benefits of alcohol consumption published in the British medical magazine, The Lancet.

“There is no debate, and this study confirms once again, that heavy drinking is really bad for you,” wrote Carroll, vice chair for Health Policy and Outcomes Research, director of the Center for Health Policy and Professionalism Research. While he agreed that the risks of drinking alcohol are real, they may be smaller than studies and headlines indicate. Using statics from The Lancet study, Carroll found that, for every set of 100,000 people having one drink a day per year, 918 can expect to experience one of the 23 alcohol-related problems in any year. “Of those drinking nothing, 914 can expect to experience a problem,” Carroll said. “That means that 99,082 are unaffected, and 914 will have an issue no matter what.”

The committee’s final report, expected later this month, will go to the Departments of Agriculture and Health and Human Services. The updated Dietary Guidelines are expected later this year.

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