New U.S. Guidelines on Alcohol Consumption

Victory for Public Health: New U.S. Guidelines on Alcohol Consumption Drop Positive Spin on Drinking

On May 27, the U.S. Department of Agriculture and the U.S. Department of Health and Human Services released the updated Dietary Guidelines for Americans. We applaud the revisions in the U.S. Dietary Guidelines on alcohol consumption. The new edition provides a far more objective, comprehensive, and specific summary of the relative risks and benefits of consuming alcoholic beverages than the previous (1995) version.

Without encouraging drinking, the Guidelines acknowledge that small amounts of alcohol -- up to one per day for women and two per day for men -- consumed by most consumers who choose to drink may not be harmful. The Guidelines catalogue the many and varied risks of drinking above the more restrictively defined "moderate" standard and identify those classes of consumers who should not drink at all. In citing a potential benefit of modest alcohol consumption on coronary heart disease (CHD) risk, the Guidelines -- quite in contrast to the 1995 edition -- specify that the benefit is essentially limited to older men and women, those at highest risk for the disease. The Guidelines wisely acknowledge that younger people, who have a low risk of CHD, have little if anything to gain -- and perhaps much to lose -- by drinking.

For the first time, and in keeping with recent epidemiologic evidence, The Guidelines include a specific mention that alcohol consumption increases the risk of breast cancer, a matter of considerable concern to women. The Ninth Report to Congress of the National Toxicology Program, which was released earlier this month, listed alcoholic beverages as a "known human carcinogen," and specifically identified alcohol as a likely cause of breast cancer, as well as many other cancers.

Significantly, the new Guidelines advise "women who may become pregnant" to avoid alcohol to reduce the risk of birth defects; this language is an expansion of an earlier warning to "women who are trying to conceive," and reflects the reality that many women do not always plan pregnancies.

Lastly, the current text omits previous gratuitous language about the use of alcohol to enhance the enjoyment of meals. The same statement could have been included in reference to salt, sugar, and fat, and the Advisory Committee opted to eliminate an obvious inconsistency with other text in the Guidelines.

The new Guidelines provide balanced, objective summary information on alcohol consumption. Fortunately, they clearly discourage drinking above moderate levels (one drink per day for women, two for men) and can no longer be interpreted as official encouragement of drinking for health reasons.

1995 Language		2000 Language
•Alcoholic beverages supply calories but few or no nutrients (language removed). •Alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history (language removed).		•Alcoholic beverages are harmful when consumed in excess (language changed). •Excess alcohol alters judgement and can lead to dependency and a great many other serious health problems (language changed).
•Higher levels of alcohol intake raise the risk for high blood pressure, stroke, heart disease, certain cancers, accidents, violence, suicides, birth defects, and overall mortality (language changed).		•Taking more than one drink per day for women and two drinks per day for men can raise the risk for auto accidents, other accidents, high blood pressure, stroke, violence, suicide, birth defects, and certain cancers (language enhanced). •Even one drink per day can slightly raise the risk of breast cancer (new language).
•If adults choose to drink alcoholic beverages, they should consume them only in moderation (language changed).		•If adults choose to drink alcoholic beverages, they should consume them only in moderation and with meals to slow alcohol absorption (language enhanced).
•Current evidence suggests that moderate drinking is associated with a lower risk for coronary heart disease in some individuals (language changed).		•Drinking in moderation may lower risk of coronary heart disease, mainly among men over age 45 and women over age 55 (new language). •Moderate consumption provides little, if any, health benefit for younger people (new language). •Risk of alcohol abuse increases when drinking starts at an early age (new language).
•Moderation is defined as no more than one drink per day for women and no more than two drinks per day for men (language changed).		•Moderation is defined as no more than one drink per day for women and no more than two drinks per day for men. This limit is based on differences between the sexes in both weight and metabolism (language enhanced).
•Who should not drink? Women who are trying to conceive or who are pregnant . . . While there is no conclusive evidence that an occasional drink is harmful to the fetus or the pregnant women, a safe level of alcohol intake during pregnancy has not been established (language changed).		•Who should not drink? Women who may become pregnant or who are pregnant. A safe level of alcohol intake has not been established for women at any time during pregnancy, including the first few weeks (language enhanced).
•If you drink alcoholic beverages, do so in moderation, with meals, and when consumption does not put you or others at risk (language changed).		•If you choose to drink alcoholic beverages, do so sensibly. Limit intake to one drink per day for women or two drink per day for men, and take with meals to slow alcohol absorption. Avoid drinking before or when driving, or whenever it puts you or others at risk (language enhanced).