It’s a big year for booze, both for the people who drink it and the companies that make it: U.S. officials are set to sift through competing science on drinking to decide how much is too much.
Any change in the Dietary Guidelines for Americans later this year—currently up to two drinks a day for men and one drink a day for women—could upend people’s perception of their nightly tipple with far-reaching consequences for the alcohol industry and the public.
The verdict on heavier drinking has been clear for years: It raises the risk for many conditions including heart and liver disease and over half a dozen types of cancer, resulting in some 178,000 deaths in the U.S. each year. The more a person drinks, the greater the risk.
The problem? The scientists don’t agree on moderate drinking. Conventional wisdom used to say that a little bit of alcohol had some health benefits. Now, more researchers and governments are saying that less alcohol is best for your health.
One committee of scientists this past week said one drink a day for both men and women raises the risk of death from several alcohol-related illnesses or injuries. The other group last month said moderate drinking was linked to a lower risk of dying overall compared with not drinking at all.
The Health and Human Services and Agriculture departments will consider both committees’ reports, as well as federal input and public comment for the new dietary guidelines.
One group of scientists said one drink a day for both men and women raises the risk of death from several alcohol-related illnesses or injuries.
The agencies in 2022 tasked a group within HHS, the Interagency Coordinating Committee on the Prevention of Underage Drinking, with a review on alcohol and health. Months later, Congress provided funding for the National Academies of Sciences, Engineering and Medicine to conduct its own report.
The ICCPUD-led committee set out to estimate the risk of dying from health conditions that are caused by alcohol consumption, eliminating causes of death that might not be alcohol-related. The estimates were based on 56 published scientific reviews on the risk of alcohol use and different health conditions.
The scientists’ findings released in January were stark: Men and women in the U.S. have a 1 in 1,000 risk of dying from alcohol use if they consume more than seven drinks a week. This risk increases to 1 in 100 if they consume more than nine drinks a week.
Having one drink a day was linked with an increased risk of liver cirrhosis, esophageal cancer and oral cancer. It also was linked to a lower risk of strokes due to blood clots; but that benefit could vanish if people drink a lot in one sitting, even on rare occasions, the report said.
“This study highlights the nuanced relationship between alcohol intake and health,” said Dr. Annie DePasquale, a family medicine physician and founder of physician matching service Collaborating Docs, who wasn’t involved with the study. “While moderate consumption has often been framed as safe, the evidence increasingly shows that even low levels of alcohol can contribute to serious conditions.”
Even casual drinkers could still see adverse effects: The risk of developing several types of cancer—including colorectal, breast and esophagus—begins with any alcohol use. Cancer risk was particularly acute for women, the group said.
“People shouldn’t be drinking for health reasons. There’s no evidence of it,” said Kevin Shield, one of the study’s authors and senior scientist at the Institute for Mental Health Policy Research.
Yet the National Academies’ review, published in December, concluded that adults who drank moderately—up to two drinks a day for men and one drink for women—had a 16% lower risk of dying from any cause compared with never-drinkers, and a lower risk of cardiovascular death. It also found that moderate drinkers had a 10% higher risk of breast cancer.
All of the links were relatively small, said Dr. Ned Calogne, chair of the NASEM’s committee and an associate dean at the Colorado School of Public Health.
“I think we can say it’s a complex relationship,” he said.
The National Academies’ review used different methods than the ICCPUD report. It looked at studies that have come out since 2010 for conditions including cancer and studies from 2019 onward for overall mortality. The reviewers removed studies that included people who had quit drinking to account for bias, Calogne said, as well as smaller studies or modeling studies.
The alcohol industry has thrown its public support behind the review by the National Academies. Science Over Bias, a coalition of more than two dozen industry trade associations, recently called the ICCPUD report flawed and biased in a statement. Science Over Bias didn’t respond to requests for comment.
The two competing reports are set to influence the updated U.S. dietary guidelines set for later this year.
The National Academies group drew scrutiny before the review even began; two researchers were removed from the committee before the group was finalized, following concerns about prior research funding from the alcohol industry. Calonge, who was added to the committee when the others were removed, said that he stands by the integrity and rigor of the report.
Some other scientists took issue with the report itself, including the connection between moderate drinking and lower mortality. People who don’t drink sometimes have health problems that preclude them from it, researchers said. Moderate drinkers also might be moderate in other activities including diet, and some studies show that they have higher incomes.
That can make moderate drinking look good, even when the health halo isn’t from the alcohol.
“I don’t believe the association is a real one,” said Dr. Michael Siegel, an alcohol and tobacco researcher at Tufts University School of Medicine, who wasn’t involved in either report. “It’s such a normal part of our culture that people who don’t drink, there’s something unique about them.”
Alcohol research often relies on asking people about their drinking habits and recording their health outcomes, making direct causes sometimes difficult to tease out, researchers say. People also underestimate how much they drink.
Some newer research that uses other methods hasn’t found a beneficial link for longevity or heart health. That, along with the evidence of cancer risk, has led many doctors and researchers to turn away from the notion that a bit of alcohol is healthy.
Genetics, smoking history and behaviors including exercise add or detract from personal risk, researchers said. Binge-drinking is worse than spreading it out.
“Everyone will have to start thinking about their own level of risk that they’re willing to accept,” said Timothy Rebbeck, a cancer prevention researcher at the Dana-Farber Cancer Institute in Boston, who wasn’t involved with either review. “And some people are going to ignore it altogether.”
Write to Brianna Abbott at [email protected] and Julie Wernau at [email protected]
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