New dietary guidelines omit alcohol limits

The Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) released the updated Dietary Guidelines for Americans, federal nutrition guidelines that are updated every five years.

The main point: The new guidance aligns with earlier versions in suggesting limited alcohol consumption, but it does not offer specific recommendations on what that means and omits warnings on the health risks of alcohol.

Reminder:

• Previous versions of the guidelines have for decades recommended no more than 1-2 alcoholic drinks per day, most recently recommending no more than 1 for women and no more than 2 for men.
• Federal officials had requested studies on alcohol and health from the Interagency Coordinating Committee on Prevention of Underage Drinking (ICCPUD) and the National Academies of Science, Engineering, and Medicine (NASEM) to inform the new guidelines. But there were tensions between industry, federal officials, and public health advocates about the how the studies were conducted and their findings, which in some cases conflicted.

The details: The new guidelines include only two bullet points on alcohol.

• The first recommends consuming “less alcohol for better overall health.”
• The second lists groups that should abstain from drinking, including pregnant women, people in recovery from alcohol use disorder (AUD) or who are “unable to control” their drinking, and people taking medications that may have hazardous interactions with alcohol. It says that people with a family history of AUD should “be mindful of alcohol consumption and associated addictive behaviors.”

What’s missing:

• The updated guidelines say that people should consume “less alcohol” and “limit alcohol beverages,” but no longer recommend clear limits on number of drinks.
• The new guidance does not distinguish between men and women, who metabolize alcohol differently.
• It does not caution against underage drinking, failing to include people under 21 in the list of populations that should abstain from alcohol use.
• The guidelines also no longer warn that alcohol may heighten the risk of breast cancer and other malignancies. They no longer include a warning that was in the last set issued in 2020, that even moderate drinking may increase the risk of cancer and some forms of cardiovascular disease, as well as the overall risk of dying.
• It is unclear whether the ICCPUD and NASEM studies were used to inform the recommendations, given the brevity of the guidance and lack of footnotes.

Why it’s important:

• The standards of 1-2 drinks as “moderate drinking” are used as benchmarks in clinical studies, to steer medical advice, and to distinguish from heavy drinking, which is unquestionably harmful.
• Though there is debate as to the relationship between moderate drinking and cardiovascular disease, there is more scientific certainty about the link between alcohol and several types of cancer.
• The new guidelines fail to provide clear recommendations to Americans and to explain the risks associated with alcohol use.

Read more: RFK Jr. says to eat more protein, less sugar in new dietary guidelines; Dietary guidelines declare war on processed foods and sugar, encourage more protein and dairy; New Dietary Guidelines Abandon Longstanding Advice on Alcohol