ROW OVER NEW US DIETARY ON ALCOHOL

The latest version of the highly influential Dietary Guidelines for Americans, issued by the Federal Government of the US, have been condemned by some alcohol control advocates as a threat to public health and safety.

Revised every five years, the guidelines include both nutrition advice and recommendations regarding alcohol consumption. But the draft guidelines issued for consultation have been attacked by the Marin Institute as too alcohol-friendly and as scientifically dubious and likely to be exploited by the alcohol industry.

The Guidelines

The new advice on alcohol was drawn up by a panel of expert scientists who reviewed the available scientific literature, particularly in regard to the health impact of ‘moderate’ alcohol consumption.

They concluded that an average daily intake of one to two alcoholic beverages was associated with the lowest allcause mortality and a low risk of diabetes and CHD among middle-aged and older adults. However, the panel continued:

“Despite this overall benefit of moderate alcohol consumption, the evidence for a positive association between alcohol consumption and risk of unintentional injuries and breast and colon cancer should be taken into consideration.

The Dietary Guidelines Alcohol Committee recommends that if alcohol is consumed, it should be consumed in moderation, and only by adults. Moderate alcohol consumption is defined as average daily consumption of up to one drink per day for women and up to two drinks per day for men and no more than three drinks in any single day for women and no more than four drinks in any single day for men. One drink is defined as 12 fl. oz. of regular beer, 5 fl. oz. of wine, or 1.5 fl. oz. of distilled spirits.

The substantial epidemiological literature is based on studies where individuals report their “average” intake as drinks per day, month or year. Because most US citizens do not drink every day, the DGAC also recommends that the definition for moderation be based on this general “average” metric over the course of a week or month instead of an exact threshold of “one drink per day for women or two drinks per day for men” each day. The Committee further explored whether there was compelling evidence to expand the definition of moderation to include a specific healthy pattern of consumption, but could not find one particular pattern of consumption that had a strong evidence base and could provide more clarity than the recommendation above. The DGAC did find strong evidence that heavy consumption of four or more drinks a day for women and five or more drinks a day for men had harmful health effects. A number of situations and conditions call for the complete avoidance of alcoholic beverages.”

MARIN ATTACKS THE GUIDELINES

Marin Institute, based in California, USA, promptly attacked the new Guidance, as too pro-alcohol, and in particular for softening or abandoning the old advice that the maximum recommended consumption was two drinks on any day for a man, and one drink for a woman. In a statement, the Marin invited supporters and other alcohol control advocates to submit comments to the Dietary Guidelines Alcohol Committee objecting to the Committee’s suggestion “that increased daily consumption is safe”, and to tell the Committee “they are making unscientific and potentially dangerous recommendations that the alcohol industry will surely use to its advantage.”

Marin identified three particular failings of the new Guidance:

A Dangerous Shift from Daily to Average Consumption Guidelines
The Report suggests that alcohol consumption guidelines be based on average consumption, rather than per-day consumption (as the current Guidelines recommend). The Report also states that drinking up to 4 drinks per day, three times a week for men and 3 drinks per day, twice a week for women would constitute “moderate” drinking, as long as the average limits over one week are not exceeded. This type of drinking behavior poses serious risks to the general public, and should not be recommended by any agency concerned about public health.

Studies of “Moderate” Drinking are Seriously Flawed
Moderate drinking is associated with myriad health risks, including numerous cancers (e.g. breast and oesophageal) and chronic illnesses such as pancreatitis. In addition, the evidence regarding health benefits from drinking alcohol is questionable at best. There have been zero randomized controlled trials—the gold standard for scientific evidence— for low alcohol consumption levels and mortality outcomes to date. Without such evidence, we should remain as conservative as possible when drawing scientific conclusions regarding any alleged health benefits of moderate alcohol consumption.

Alcohol Industry Misuse of Public Health Recommendations
The substantial shift to recommending higher peroccasion and per-day alcohol consumption, plus suggestions that the questionable benefits from drinking outweigh the known risks, are gifts to the alcohol industry. The Committee must be aware that the Report’s messages about alcohol consumption will be misinterpreted by the powerful corporations and trade organizations that sell and promote alcoholic beverages. The alcohol industry has a long history of exploiting the Dietary Guidelines for their benefit, and the suggestions contained in the Report lend themselves to further misuse.

Marin concluded:

“We are especially concerned that, despite the Report’s caveats, the industry will use the new recommendations to promote alcohol consumption and increased consumption.

We ask that the Committee revise the Report and subsequent Guidelines to send a much more cautionary, evidencebased message regarding alcohol consumption to the public.

We specifically ask that the new Guidelines maintain the formulation of 2/1 drinks per-day consumption of alcohol for men and women, respectively.”