Current guidelines say that women should drink no more than seven drinks a week, and men should drink no more than 14 drinks a week.
But these limits could be lowered as part of the review of the Dietary Guidelines for Americans (DGA).
A new report from a US government agency – published on Tuesday – has propelled the issue into the headlines.
It reviews a number of studies on alcohol risk, and says the risk of dying from alcohol use begins at low levels of average use (the report, however, does not set out recommended new limits for the revised DGA).
But industry associations say they’re concerned the report is flawed: citing a potential conflict of interest of the authors: “heightening our concerns that the Dietary Guidelines for Americans’ recommendations with respect to alcohol will not be based on a preponderance of sound scientific evidence.”
Alcohol: and the risk of death or a shortened life
This week’s report was compiled by the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) - a U.S. Department of Health and Human Services (HHS) committee.
The report has been tasked with assessing the relationship between alcohol and health with the goal to inform the the upcoming Dietary Guidelines for Americans, 2025-2030.
Dietary Guidelines for Americans
Guidance on the consumption of alcoholic beverages has been included in the Dietary Guidelines since the first edition in 1980.
The ICCPUD report finds that drinking more than six to nine drinks per week — which is within the range of the current Dietary Guidelines for Americans — begins to significantly raise the risk of alcohol-related death and cancer for both men and women.
Even small amounts of alcohol increase cancer risk, with women facing a higher risk than men for the same level of drinking.
According to the 2023 National Survey on Drug Use and Health (NSDUH), 47.5% of Americans aged 12 or older (134.7 million people) drunk alcohol in the past month.
And 8.6% of individuals aged 12 to 20 (3.3 million people) reported binge drinking on five or more days in the past month compared to 23.7% of those aged 21 and older (58.1 million).
And while some surveys report a reduction in alcohol consumption in the US, that’s not what the ICCPUD review found.
“The prevalence of alcohol consumption in adults has remained relatively stable over recent years, with slight fluctuations,” notes the report.
“It is also noteworthy that between 1999 and 2021 alcohol beverage sales data suggest that per capita consumption rose by 13%. Notably, while the data suggest beer sales declined by 38%, they also suggest spirits sales rose by more than 50% and wine by more than 40%.”
At the population level, an average of 178,000 individuals (of all ages) in the US die a year from excessive alcohol use, making it a leading preventable cause of death.
Alcohol risk
The report set out to assess relationships between alcohol use and health in the US, with a particular focus on morbidity and mortality (death and reduced life expectancy).
Most of the evidence comes from systematic reviews and meta-analyses of observational cohort studies.
The study maintains that higher levels of alcohol consumption are linked with progressively higher mortality risk.
However, it also highlights that the risk of dying from alcohol use begins at low levels of average use.
This is in line with the WHO, which declared war on alcohol in 2022 with a report that ‘no level of alcohol consumption is safe’.
In the United States, males and females have a 1 in 1000 risk of dying from alcohol use if they consume more than 7 drinks per week. This risk increases to 1 in 100 if they consume more than 9 drinks per week.
Alcohol use is associated with increased mortality for seven types of cancer (colorectal, female breast, liver, oral cavity, pharynx, larynx, esophagus [squamous cell type])
Women experience a much greater risk of an alcohol-attributable cancer per drink consumed.
US Surgeon General calls for revamped drinking guidelines
The US Surgeon General suggests revising guidance on alcohol consumption limits , as well as suggesting cancer risk warning labels.
In a report published at the beginning of this month, US Surgeon General Dr Vivek Murthy, highlights that many Americans remain unaware of the cancer risk of alcohol.
Estimating risk
The report is based on an assessment of 56 reviews of alcohol use and the risk of alcohol-related conditions.
It acknowledges that the data is based on the general population and that an individual’s risk will depend on numerous factors, such as smoking, diet, physical activity, obesity, hepatitis infection and genetics (alcohol will have a greater impact on the health of people with these risk factors).
But the review has come under fire from a number of organizations: primarily citing a conflict of interest of the authors.
A coalition of the agriculture, beverage and hospitality industries has come together to criticize the report: with signatories including the Brewers Association, Distilled Spirits Council of the US, American Cider Association, Beer Institute, Hop Growers of America, Wine America, Wine Institute and Wine & Spirits Wholesalers of America.
“This report is the product of a flawed, opaque and unprecedented process, rife with bias and conflicts of interest,” says a statement from the organizations.
“Several members of the six-member ICCPUD panel have affiliations with international anti-alcohol advocacy groups, and the panel has worked closely with others connected with these advocates. Congress never authorized or appropriated money for the panel or its work, and numerous letters from Congress and industry have voiced serious concerns over the process.”
The organizations raise concern that a report on adult alcohol consumption was assigned to a committee created to address underage drinking; and cites ‘clear evidence of bias and conflicts of interest in those tasked with conducting the research, including ties to international temperance organizations and anti-alcohol advocacy efforts’.
In addition, the organizations say there’s been a lack of transparency and limited opportunities for stakeholder input.
“This report heightens our concerns that the Dietary Guidelines for Americans’ recommendations with respect to alcohol will not be based on a preponderance of sound scientific evidence,” continues their statement.
“We urge the Secretaries of Agriculture and Health & Human Services to uphold the integrity of the DGAs to promote informed and responsible decision-making around alcohol. The agencies should disregard the ICCPUD report in their final assessments for the 2025-2030 Dietary Guidelines.”
Concerns raised about the ICCPUD review panel include:
- Lack of transparency and limited opportunities for stakeholder input;
- Issues with statutory authority, especially assigning research on adult alcohol consumption to a committee created solely to address underage drinking;
- Clear evidence of bias and conflicts of interest in those tasked with conducting the research, including ties to international temperance organizations and anti-alcohol advocacy efforts;
- An unprecedented process that allows for original research based on cherry-picked data and flawed methodologies.
But the US Alcohol Policy Alliance – a non-profit, non-partisan organization – is calling for reducing the recommended alcohol consumption amounts in the 2025 dietary guidelines.
“In Washington, the $2.5 billion alcohol industry spends more than $45 million on lobbying and has over 300 lobbyists working tirelessly to make sure the DGAs go unchanged and their profits don’t fall,” it says.
“The ICCPUD report highlights the critical need to reduce alcohol harms by properly informing the public of the health risks of consuming alcohol. Combined with the Surgeon General’s recent advisory on alcohol and cancer risk, the evidence is clear and indisputable. The fact that any amount of alcohol is harmful to your health can no longer be ignored.”