Critique 158: Comments on Alcohol Recommendations included in the Scientific Report of the 2015 Dietary Guidelines Advisory Committee – 4 March 2015

The 2015 Dietary Guidelines Advisory Committee (Committee) submitted the Scientific Report of the 2015 Dietary Guidelines Advisory Committee (Advisory Report) to the Secretaries of the U.S. Department of Health and Human Services (HHS) and the U.S.  Department of Agriculture (USDA) in February 2015.  The purpose of the Advisory Report is to inform the Federal government of current scientific evidence on topics related to diet, nutrition, and health.  It provides the Federal government with a foundation for developing national nutrition policy.  However, the Advisory Report is not the Dietary Guidelines for Americans policy or a draft of the policy.  The Federal government will determine how it will use the information in the Advisory Report as the government develops the 2015 version of the Dietary Guidelines for Americans.  HHS and USDA will jointly release the Dietary Guidelines for Americans, 2015 later this year.

Public Comment Period

As announced in the Federal Register, the public is encouraged to view the Committee’s Advisory Report and provide written comments through midnight E.D.T. on April 8, 2015.  The public will have an opportunity to attend a public meeting to hear or provide oral comments on March 24, 2015. Registration is expected to open on or about March 9, 2015.

Copied below are selected sections from the Report related to alcohol consumption, with the line number from the full report.  The latter can be assessed at the following address:  http://www.health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf.  

130 Regarding alcohol, the Committee confirmed several conclusions of the 2010 DGAC, including

131 that moderate alcohol intake can be a component of a healthy dietary pattern, and that if alcohol

132 is consumed, it should be consumed in moderation and only by adults. However, it is not

133 recommended that anyone begin drinking or drink more frequently on the basis of potential

134 health benefits, because moderate alcohol intake also is associated with increased risk of

135 violence, drowning, and injuries from falls and motor vehicle crashes. Women should be aware

136 of a moderately increased risk of breast cancer even with moderate alcohol intake. In addition,

137 there are many circumstances in which people should not drink alcohol, including during

138 pregnancy. Because of the substantial evidence clearly demonstrating the health benefits of

139 breastfeeding, occasionally consuming an alcoholic drink does not warrant stopping

140 breastfeeding. However, women who are breastfeeding should be very cautious about drinking

141 alcohol, if they choose to drink at all.

249 Moderate alcohol consumption—Average daily consumption of up to one drink per day for

250 women and up to two drinks per day for men, with no more than three drinks in any single day

251 for women and no more than four drinks in any single day for men. One drink is defined as 12 fl.

252 oz. of regular beer, 5 fl. oz. of wine, or 1.5 fl. oz. of distilled spirits.

1571 considered evidence from several sources to

1572 inform recommendations. As noted above, moderate alcohol intake among adults was identified

1573 as a component of a healthy dietary pattern associated with some health outcomes, which

1574 reaffirms conclusions related to moderate alcohol consumption by the 2010 DGAC. The

1575 Committee also concurs with the conclusions reached by the 2010 DGAC on the relationship

between alcohol intake and unintentional injury and lactation.1

1576 However, as noted in Table D2.1,

1577 evidence also suggests that alcoholic drinks are associated with increased risk for certain cancers,

1578 including pre- and post-menopausal breast cancer. After consideration of this collective

1579 evidence, the Committee concurs with the 2010 DGAC that if alcohol is consumed, it should be

1580 consumed in moderation, and only by adults. However, it is not recommended that anyone begin

1581 drinking or drink more frequently on the basis of potential health benefits because moderate

1582 alcohol intake also is associated with increased risk of violence, drowning, and injuries from falls

1583 and motor vehicle crashes. Women should be aware of a moderately increased risk of breast

1584 cancer even with moderate alcohol intake. There are many circumstances in which people should

1585 not drink alcohol:

1586  Individuals who cannot restrict their drinking to moderate levels.

1587  Anyone younger than the legal drinking age.

1588  Women who are pregnant or who may be pregnant.

1589  Individuals taking prescription or over-the-counter medications that can interact with

1590 alcohol.

1591  Individuals with certain specific medical conditions (e.g., liver disease,

1592 hypertriglyceridemia, pancreatitis).

1593  Individuals who plan to drive, operate machinery, or take part in other activities that

1594 require attention, skill, or coordination or in situations where impaired judgment could

1595 cause injury or death (e.g., swimming).

1596 Finally, because of the substantial evidence clearly demonstrating the health benefits of

1597 breastfeeding, occasionally consuming an alcoholic drink does not warrant stopping

1598 breastfeeding. However, women who are breastfeeding should be very cautious about drinking

alcohol, if they choose to drink at all.§§

§§  If the infant’s breastfeeding behavior is well established, consistent, and predictable (no earlier than at 3 months of age), a mother may consume a single alcoholic drink if she then waits at least 4 hours before breastfeeding. Alternatively, she may express breast milk before consuming the drink and feed the expressed milk to her infant later.

1746 Energy drinks with high levels of caffeine and alcoholic beverages should not be consumed

1747 together, either mixed together or consumed at the same sitting.

Forum Comments

Members of the International Scientific Forum on Alcohol Research (the Forum) have reviewed the sections of the Advisory Committee’s report that relate to the consumption of alcohol.  They consider the report to be well written and a very clear statement on alcohol and health, one that generally reflects current scientific data.    

Some Forum members thought that for dietary guidelines, there should have been more emphasis on the inclusion of moderate alcohol consumption as part of a Mediterranean-type diet, which is described in the report as being associated with very favorable health outcomes.  The Forum found it interesting that the health problems associated with alcohol receive extensive detailed notice, but substantial favorable effects are barely mentioned.  For example, while the comments on the increase in the risk of breast cancer are warranted, there is no mention that moderate alcohol consumption provides substantial protection against ischemic cardiovascular events, despite consistent and extensive data showing that the latter issue has a major public health benefit.  Also, lacking any explanatory statements, the public and health professionals may be confused as to the basis for the recommendation that alcohol is “an important component of a healthy lifestyle.”  So we recommend that some explanations for the statement, based on the relevant scientific literature, should be included.  (Further, the report does not describe the favorable effects of moderate drinking on sociability, stress reduction, and relaxation, which are key reasons why most people consume alcohol in the first place.)

Despite our concerns, given that this is a statement that must get approval by a large number of governmental agencies and a variety of interested parties, it is consistent with current epidemiological data as well as mechanistic studies.  The Forum strongly agrees that current scientific evidence indicates that, for mature adults without contraindications to alcohol use, moderate alcohol consumption can be included as a component of a balanced and healthy lifestyle.   

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Comments on the Advisory Committee report were provided by the following members of the International Scientific Forum on Alcohol Research:

Yuqing Zhang, MD, DSc, Clinical Epidemiology, Boston University School of Medicine, Boston, MA, USA

Andrew L. Waterhouse, PhD, Department of Viticulture and Enology, University of California, Davis

David Van Velden, MD, Dept. of Pathology, Stellenbosch University, Stellenbosch, South Africa

Dag S. Thelle, MD, PhD, Senior Professor of Cardiovascular Epidemiology and Prevention, University of Gothenburg, Sweden; Senior Professor of Quantitative Medicine at the University of Oslo, Norway

Pierre-Louis Teissedre, PhD, Faculty of Oenology–ISVV, University Victor Segalen Bordeaux 2, Bordeaux, France

Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway

Creina Stockley, PhD, MSc Clinical Pharmacology, MBA; Health and Regulatory Information Manager, Australian Wine Research Institute, Glen Osmond, South Australia, Australia.

Erik Skovenborg, MD, specialized in family medicine, member of the Scandinavian Medical Alcohol Board, Aarhus, Denmark

Jean-Marc Orgogozo, MD, Professor of Neurology and Head of the Neurology Divisions, the University Hospital of Bordeaux, Pessac, France

Fulvio Mattivi, PhD, Head of the Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, in San Michele all’Adige, Italy

Ulrich Keil, MD, PhD, Professor Emeritus, Institute of Epidemiology & Social Medicine, University of Muenster, Germany

Giovanni de Gaetano, MD, PhD, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy

Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA

R. Curtis Ellison, MD.  Section of Preventive Medicine & Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA

Elizabeth Barrett-Connor, MD, Chief of the Division of Epidemiology, Distinguished Professor in the Departments of Family and Preventive Medicine & Medicine, University of California, San Diego, La Jolla, CA, USA