What will revised U.S. dietary guidelines say about drinking?

The World Health Organization has said there’s no risk-free level of alcohol consumption. And studies increasingly debunk what have been called protective effects of moderate alcohol consumption, including findings of fewer all-cause deaths, strokes and heart attacks when compared to those outcomes in people who never drank.

But as the U.S. Dietary Guidelines get their mandated every-five-year revision in 2025, there’s speculation that Americans will be told a different story than is being shared in health warnings in other countries.

As a news analysis in The New York Times put it Wednesday, “Officials in other countries are warning about the health hazards of alcohol in any amount. Americans are still told that moderate drinking is safe. What gives?”

At issue is a report that was commissioned by the U.S. Department of Agriculture at the behest of Congress to do an “independent review of the evidence on the relationship between alcohol consumption and eight health outcomes,” including impact on weight, certain types of cancer, heart disease, brain health, all-cause mortality and — when consumed by women who are breastfeeding — the effect on postpartum weight loss, human milk and infant developmental milestones.

The “Review of Evidence on Alcohol and Health” by the National Academies of Sciences, Engineering and Medicine does report that “the harms of acute intoxication and habitual heavy drinking are well-known and, as with other drugs that are addictive, use at low levels carries a risk of increasing and excess use.” It also notes that “over 20% of those who consume alcohol will develop an alcohol use disorder sometime during their lifetime.” Alcohol use disorder is the most common substance use disorder in America, per the report, “although this progression is likely dependent on drinking patterns and individual characteristics including ancestry/genetics.”

In its summary, the report notes that the dietary guidelines “recommend that individuals should not start drinking for any reason” and that “drinking less is better for health than drinking more.”

But the report concludes “with moderate certainty” that compared with never consuming alcohol, moderate alcohol consumption is associated with lower all-cause mortality, as well as less risk of cardiovascular events. And it finds little or low-certainty evidence for many of the other harms different studies have concluded drinking creates, including several cancers that researchers have linked to even moderate alcohol use, including from The National Cancer Institute.

The report’s exception is small, but statistically significant increased risk of breast cancer related to moderate drinking.

Critics say the report is flawed. “This report is a thinly veiled effort to undo the growing evidence that alcohol causes cancer and is increasingly associated with serious health outcomes,” Diane Riibe, cofounder of the U.S. Alcohol Policy Alliance, told the Times. The alliance focuses on harms related to alcohol use.

Virtually everyone agrees that heavy use of alcohol is dangerous.

“Understanding the risks of alcohol is key — especially if you have a family history of alcoholism or struggle with mental health issues like anxiety or depression. What starts as a way to relax can quickly turn into something more harmful,” Randall Carlisle, spokesman for the substance use disorder treatment program Odyssey House of Utah, told the Deseret News.

“Recognizing when alcohol is becoming a problem, such as drinking to cope or feeling unable to cut back, is crucial. If you notice these signs, reducing your intake and seeking help can make a world of difference. Moderation, self-awareness and support are the best tools to stay in control and protect your well-being,” he said.

Guidelines for drinking

Another not-yet-published report is also expected to influence upcoming dietary recommendations regarding alcohol. It’s being prepared by a government committee, the Interagency Coordinating Committee on the Prevention of Underage Drinking, and is expected sometime this month. The Times said that “the process of commissioning two separate reports on moderate drinking is entirely new.” In years past, the U.S. Dietary Guidelines Advisory Committee looked at the scientific evidence about alcohol and other aspects of diet then made its recommendations.

The advisory committee report in 2020 called alcohol a carcinogen, which is in line with the World Health Organization’s description. “Alcohol is a substance that is intoxicating, potentially addictive and a leading preventable cause of death and other harms,” the committee wrote.

That report also noted that “more recent evidence justifies tightening guidelines for men in particular” in terms of what constitutes moderate alcohol consumption, which is considered to be two drinks or fewer a day for men and one or fewer for women. The difference in risk for men and women is too small at lower consumption levels to justify a difference in the recommendation based on gender, it said, recommending moderate consumption be limited to up to one drink a day for both men and women. “If you drink alcohol, at all levels of consumption, drinking less is generally better for health than drinking more.”

But while the committee report reached those conclusions, the final guidelines didn’t reflect them. The definition of moderate drinking stayed at no more than two daily for men and one for women — a level the guidelines deemed generally safe.

Does alcohol cause cancer?

Others have been more harsh in their assessment of alcohol’s health risks. The World Health Organization in June was blunt: “Alcohol is an established carcinogen and alcohol consumption increases the risk of several cancers, including breast, liver, head and neck, esophageal and colorectal cancers. In 2019, 4.4% of cancers diagnosed globally and 401 000 cancer deaths were attributed to alcohol consumption.”

The international health behemoth added, “There is no form of alcohol consumption that is risk-free. Even low levels of alcohol consumption carry some risks and can cause harm.”

In 2019, WHO reported, 2.6 million deaths were attributable to alcohol consumption, the vast majority among men. And those ages 20-39 were disproportionately at risk.

Canada is among governments becoming more critical of low-risk claims for moderate alcohol use.

“Canada’s Guidance on Alcohol and Health: Final Report,” released in early 2023, noted that “science is evolving and the recommendations about alcohol use need to change. Research shows that no amount or kind of alcohol is good for your health. It doesn’t matter what kind of alcohol it is — wine, beer, cider or spirits. Drinking alcohol, even a small amount, is damaging to everyone regardless of age, sex, gender, ethnicity, tolerance for alcohol or lifestyle. That’s why if you drink, it’s better to drink less.”

The document describes a continuum of risk associated with weekly consumption, calling risk low with two standard drinks a week or less, moderate for those who drink three to six standard drinks a week and increasingly high for those who drink more.

The UK’s National Health Service reports that “cutting back on booze can be a really effective way to improve your health, boost your energy, lose weight and save money.” And it touts the importance of “drink-free days” every week, including a downloadable app by that name.

The guideline there is no more than 14 units of alcohol a week, spread across at least three days — about six medium glasses of wine or six pints of beer. “There’s no completely safe level of drinking, but sticking within these guidelines lowers your risk of harming your health,” per the National Health Service website.

Health effects of drinking

Dr. Spencer Hansen, a board-certified addiction psychiatrist at LDS Hospital in Salt Lake City, told the Deseret News several months ago that beneficial effects of moderate drinking might be overestimated or even not related to alcohol consumption at all. He said that people who only drink moderate amounts “generally live a healthier lifestyle than individuals who cannot control their drinking, so they’re also able to control their diet or their various physical health lifestyle choices that contribute to overall health.”

He noted that medications can be very helpful to people who want to cut back their alcohol consumption or stop drinking entirely. But they are underutilized.

In women, studies most often link alcohol use to increased risk of breast cancer. But that’s not the only health risk. WHO said that more than 75,000 U.S. cancer cases and 20,000 cancer deaths are tied to alcohol consumption.

“A share of mouth and pharynx cancers in men and esophageal cancers in women are also associated with imbibing,” the Deseret News wrote of that report in August. “Alcohol use is associated with greater risk of heart disease, congestive heart failure, atrial fibrillation, hypertension and dementia. It increases risk of stomach and gastric disease, including reflux, ulcers and colon cancer. It aggravates mental and behavioral disorders. Drink and use tobacco, too, and the potential risks skyrocket. Alcohol use has been linked to obesity, liver damage, brain damage and dementia, among others.”

A review of studies that found health benefits to moderate consumption, published in the Journal of Studies on Alcohol and Drugs, noted “substantial scientific limitations.” Well-designed studies didn’t find those benefits, the article added.

Alcohol-related deaths

The Centers for Disease Control and Prevention said that alcohol use ticked up in the pandemic and the annual number of deaths in the U.S. from excessive alcohol use increased by more than 29%, to an average of 488 deaths each day in 2020-2021. That was after nearly two decades of increasing deaths from excessive alcohol use. A 2020 study in the journal Alcoholism: Clinical and Experimental Research found that from 1999 to 2017, alcohol consumption and related emergency room visits and hospitalizations increased.

In 1999, nearly 36,000 U.S. death certificates mentioned alcohol. That climbed to nearly 73,000 in 2017. “That compares to nearly 70,000 drug-related deaths, including opioids like heroin and fentanyl,” as the Deseret News reported.

The public health agency advocated increasing alcohol taxes and reducing the number and concentration of places that sell alcohol.

Among criticisms of studies that find health benefits is the degree to which the alcohol industry provided funding or involved researchers with direct ties to the alcohol industry.

On the blog Food Politics, Marion Nestle, author of “Unsavory Truth: How the Food Industry Skews the Science of What We Eat,” wrote about a study of other studies on the health effects of alcohol consumption that concluded “only a small proportion of observational studies in meta-analyses are funded by the alcohol industry. Based on this selection of observational studies the association between moderate alcohol consumption and different health outcomes does not seem to be related to funding source.”

Nestle points out that eight of the nine researchers conducting the study of the studies “were employed by the Dutch Beer Institute during the study and writing of the manuscript.” That’s the trade organization of the 14 biggest Dutch beer brewers. Just one author had no reported conflicts of interest.

Others, including Dr. Laura Catena, a former emergency room doctor who runs a family-owned winery in Argentina, worry that an anti-alcohol bias influences study findings regarding health harms.

While most of the negative health effects tied to alcohol in the past have hit men especially hard, research suggests that women are catching up. A study in Alcoholism: Clinical and Experimental Research found that from 1999 to 2017, deaths involving alcohol rose 85% for women and 35% for men.