Ever since the federal government began issuing the Dietary Guidelines in 1980, it has told Americans to limit themselves to one or two standard alcoholic drinks a day. Over time, the official advice morphed to no more than two drinks a day for men, and no more than one for women.
No longer. The updated guidelines issued on Wednesday say instead that people should consume less alcohol “for better overall health” and “limit alcohol beverages,” but they do not recommend clear limits.
The guidelines also no longer warn that alcohol may heighten the risk of breast cancer and other malignancies.
It is the first time in decades that the government has omitted the daily caps on drinking that define moderate consumption — standards that are used as benchmarks in clinical studies, to steer medical advice, and to distinguish moderate from heavy drinking, which is unquestionably harmful.
The new guidance advises Americans who are pregnant, struggle with alcohol use disorder or take medications that interact with alcohol to avoid drinking altogether. The guidelines also warn people with alcoholism in the family to “be mindful of alcohol consumption and associated addictive behaviors.”
They do not, however, distinguish between men and women, who metabolize alcohol differently, nor do they caution against underage drinking.
The guidelines also 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.
“Alcohol is a social lubricant that brings people together,” Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, said at a news briefing on Wednesday.
”In the best-case scenario, I don’t think you should drink alcohol,” he said, though he added that alcohol provides “an excuse to bond and socialize, and there’s probably nothing healthier than having a good time with friends in a safe way.”
He said that people should drink “judiciously” in small amounts, and that, in healthy populations, it was often consumed in a celebratory context. But he said that “there was never really good data to support” the guidance of no more than one drink a day for women and two for men.
That definition, however, has been the standard that has informed hundreds of scientific studies comparing the health impacts of different levels of alcohol consumption, which have almost universally concluded that heavier levels of drinking are damaging to health.
Though there is robust debate within the medical community as to the relationship between moderate drinking and various forms of cardiovascular disease, there is more scientific certainty about the link between alcohol and at least seven types of cancer.
Warnings about alcohol increasing the risk of breast cancer were included in the dietary guidelines 25 years ago. Former Surgeon General Dr. Vivek Murthy last year called for putting cancer warning labels on alcoholic beverages, similar to those for cigarettes.
The new recommendations come at a pivotal time for the alcohol industry, which is experiencing a slump in sales.
The percentage of U.S. adults who say they consume alcohol has fallen to 54 percent, down from 62 percent in 2023, according to a recent Gallup poll, and 53 percent believe that even a drink or two a day is bad for health, more than double the percentage who thought so in 2011.
Several experts said they were puzzled by the guidelines’ omission of clear-cut definitions of moderate drinking.
“The word ‘limit’ isn’t satisfactory,” said Marion Nestle, a nutritionist who has written extensively about food policy. “Limit to what? That is exactly the question. You really need to know what it means.”
“The alcohol industry is going to love this,” she added.
Katherine Keyes, a professor of epidemiology at Columbia University who was one of the authors of a government interagency report that was withdrawn by the Trump administration, said she was concerned that people under 21 were not mentioned among those who should avoid alcohol altogether.
The lack of clear daily recommended limits on drinking will cause confusion, she said.
“I don’t think there’s any magical cutoff,” she said, though she added that the guidelines are “a benchmark for people” and “should always be updated with the most recent scientific evidence.”
“If you talk to serious researchers who study alcohol and health, you’ll find a consensus that the relationship between alcohol and health risks is a dose-response relationship, and health risks start even at low levels,” she said.
A dose-response relationship generally means that, as the level of exposure to a given substance increases, the effects increase in turn.
While the putative benefits of moderate drinking with regard to cardiovascular disease have been a subject of heated controversy, there is no debate about either the health risks or social risks of heavy drinking, which has been linked to liver disease, alcohol use disorder, violent behavior and accidents.
Until now, heavy drinking has been defined as consuming eight or more drinks a week for women, and 15 or more drinks a week for men.
But some experts have endorsed the idea that there is no safe level of drinking, and that risks begin with the first sip. The World Health Organization, along with health authorities in many parts of the world, including Canada and the United Kingdom, have been encouraging people to drink less, quit drinking altogether or aim for two to three alcohol-free days each week.
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
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