Are two drinks a day too much? Inside the debate on what to tell America about alcohol.
A spirited debate is playing out in Washington, D.C., over what the government should tell Americans about spirits.
Federal dietary guidelines are getting an update this year, including guidance on how much alcohol Americans can safely drink. The current guidelines suggest a daily limit of two drinks for men, one for women.
The alcohol industry wants that language preserved. But alcohol safety groups, joined by many researchers, say the guidance is bad advice. Both sides are attacking the science behind a pair of reports prepared to help federal regulators craft new guidelines. February 14 is the last day for public comment.
'I personally subscribe to the view that the guidelines are outdated and too high, and the evidence doesn't support them,' said Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research.
Stockwell points to Canada's new alcohol guidelines, which suggest a healthy limit of two drinks a week. Other voices suggest a more moderate fix: Change America's guidelines to recommend no more than one drink a day for anyone, regardless of gender.
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Alcohol industry leaders would rather let the old guidance stand.
'I don't think the science is there for changing the number from two to one,' said Laura Catena, a winemaker, physician and author. Catena says the current guidelines, read as a whole, are 'fantastic.'
Are 'two drinks a day' too many?
The full Dietary Guidelines for Americans on alcohol, which few Americans read, offer abundant cautions. Drinking more alcohol raises your risk of dying from drink, the guidelines say. Even if you follow the one drink/two drinks limit, they state, you face a potentially higher risk of cancer and other diseases.
'The government's not recommending that you drink two drinks a day,' said Michael Kaiser, executive vice president of WineAmerica, an industry trade group. 'If you look at the guidelines themselves, they also say, if you don't drink, don't start.'
Americans are getting mixed signals on the dangers of drinking. Not long ago, scientists widely believed moderate drinking conferred health benefits. That view has soured in recent years, and many researchers have drifted toward the view that no amount of alcohol is safe.
'We're all relearning what we know about alcohol,' said Mike Marshall, CEO of the U.S. Alcohol Policy Alliance, an alcohol safety group.
Marshall cites a statistic from one of two reports prepared to shape the federal guidelines, written by the Interagency Coordinating Committee on the Prevention of Underage Drinking.
According to that report, if you down two drinks a day, following the current guidelines for men, there's a 1 in 25 lifetime chance you will die an alcohol-related death.
'That's crazy, right?' Marshall said. 'I think that really brings home why we have to change the guidelines.'
Health risks rise from one to two drinks a day
The study, published last month, assesses the risk of dying from alcohol at one and two drinks a day. At one drink a day, the risk is infinitesimal: A roughly one in 1,000 chance of alcohol-related death.
At two drinks a day, the lifetime risk rises to about one in 25. The largest single peril is not disease, the study says, but 'unintentional injuries,' such as falling down stairs while intoxicated. There's a smaller risk of alcohol-related cancer and cirrhosis – and a small benefit, in reduced risk of cardiovascular disease. The heart benefit diminishes, and other disease risks rise, with heavier drinking.
'Below a drink a day, the risks seem to be small, if any,' said William Kerr, senior scientist at the nonprofit Alcohol Research Group. 'Above that, things start to go up steeply.'
Kerr favors changing the federal guidelines to advise no more than one drink a day for anyone.
The second report, released in December by the National Academies of Sciences, Engineering and Medicine, caused a stir in the research and temperance communities. The report emphasized the benefits of moderate drinking, while seeming to downplay the risks. Among its conclusions: 'compared with never consuming alcohol, moderate alcohol consumption is associated with lower all-cause mortality.'
Both reports will influence the dietary guidance on alcohol. Advocates of temperance have attacked the more positive report, while the alcohol industry assailed the more critical one.
Biden, Trump may have different alcohol messages
Complicating matters, in January, the Biden Administration weighed in with a surgeon general's advisory that tagged alcohol as 'a leading preventable cause of cancer,' contributing to roughly 20,000 deaths a year.
(Smoking, by comparison, was once estimated to cause more than 160,000 cancer deaths a year.)
But a lot has changed in the month since that surgeon general's report. The nation has (or will soon have) a new president, health secretary and surgeon general. And what advice they might offer the public on the hazards of drinking is anyone's guess.
Donald Trump reportedly does not drink. Neither does Robert F. Kennedy Jr., the new secretary of health and human services.
Kennedy 'does not drink alcohol because of the huge consequences it's had for him and his family, so he's conscious of this,' said Marshall of the Alcohol Policy Alliance. 'He works for a president who doesn't drink, either, and who has often said that alcohol is not good for you.' Those facts would suggest 'that the climate is somewhat favorable to government doing the right thing,' he said.
On the other hand, the Trump administration seems intent on less government regulation, rather than more. Following that impulse, the administration might elect to remove alcohol from the dietary guidelines altogether, said Catena, the winemaker.
'It remains to be seen what the new administration does with any of this stuff,' said Kaiser, of WineAmerica.
The new guidelines are scheduled for release by the end of 2025, said Andrew G. Nixon, spokesman for the Department of Health and Human Services.
Only then will we know if the alcohol industry, the research community or alcohol safety groups will have anything to toast.
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