Dietary guidelines become mired in war over alcohol safety

Lawmakers and industry players are asking the Department of Health and Human Services to put a stop to a controversial study on alcohol and health that could inform the next round of U.S. nutrition recommendations.

Specifically, they’re taking issue with a committee housed within HHS’ Substance Abuse and Mental Health Services Administration focused on underage drinking.

The committee has plans to draft a report compiling research on alcohol intake and health, which HHS plans to use to inform the Dietary Guidelines for Americans, the comprehensive document updated every five years with recommendations on how Americans should eat and drink for a healthy lifestyle. HHS and the U.S. Department of Agriculture are currently drafting new guidelines for 2025 to 2030 and plan to publish them by the end of 2025.

The guidelines have long recommended that Americans limit alcohol intake to two drinks per day for men and one drink per day for women. But it’s unclear whether officials will recommend an even lower amount of alcohol in this round of updates in light of research suggesting that no amount of drinking is safe.

“Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease,” the current guidelines state.

Controversy over process

Earlier this year, the Interagency Coordinating Committee on the Prevention of Underage Drinking began a study on the relationship between alcohol intake and health that’s intended to inform the updated dietary guidelines.

The announcement sparked fury among some lawmakers, who argue such a study is inappropriate.

In a letter sent to USDA and HHS on Oct. 7, a bipartisan group of 100 lawmakers led by Reps. Mike Thompson, D-Calif., and Dan Newhouse, R-Wash., who serve as co-chairs of the Congressional Wine Caucus, called on the underage drinking committee to suspend the study.

“The secretive process at ICCPUD and the concept of original research on adult alcohol consumption by a committee tasked with preventing underage drinking, jeopardizes the credibility of ICCPUD and its ability to continue its primary role of helping the nation prevent underage drinking,” the lawmakers wrote.

The lawmakers and industry also argue that HHS’ study interferes with the Agriculture Department’s work in the area. Under the fiscal 2023 spending law, Congress allocated $1.3 million to USDA and directed the National Academies of Sciences, Engineering and Medicine to create a report on alcohol and human health that would inform the recommendations for the updated dietary guidelines.

In their letter, the lawmakers asked the committee to halt the study until the national academies completes its report.

“We question why ICCPUD would choose to redirect limited resources away from its core responsibilities that are meant to fund a national media campaign as well as offer federal grants to community coalitions and the medical community,” the lawmakers wrote.

The letter came after Rep. James R. Comer, R-Ky., who chairs the House Committee on Oversight and Accountability, late last month subpoenaed HHS and USDA for documents involved in the process to evaluate alcohol’s impact on health, citing concerns that HHS is overstepping its authority.

In a statement to CQ Roll Call on Friday, a SAMHSA spokesperson said ICCPUD approached SAMHSA about conducting a study on alcohol and health in early 2022, before the 2023 spending bill was passed that directed the national academies to work on its own report.

SAMHSA said the associate administrator for alcohol prevention and treatment policy selected a list of initial nominated members for the scientific review panel based on “scientific expertise, publications, and a review of conflicts of interest,” which was then narrowed down.

The panel also plans to consult with experts in cancer, cardiovascular disease, digestive conditions, neurological disorders, infectious diseases and injuries. The selection of additional experts will be based on the quantity of research they’ve spearheaded in their respective areas.

The spokesperson underscored that the ICCPUD study is meant to be complementary to the national academies study and that neither study will constitute the final recommendation.

“Given this work aligns with the development of the Dietary Guidelines, findings from the study will be shared with HHS and USDA for the Departments to consider as they develop the next iteration of the Dietary Guidelines,” the spokesperson said in an email.

The spokesperson said HHS has received Thompson and Newhouse’s letter and will respond directly to the lawmakers.

A USDA spokesperson deferred comment to HHS.

Jessica Brown, a partner at Holland &Knight who represents clients in the alcohol industry, said in an interview with CQ Roll Call that it’s premature to tell how the industry will respond in the event that the Dietary Guidelines for Americans are updated. But she said the industry is concerned about a lack of transparency from ICCPUD.

“The alcohol beverage industry is one of the most highly regulated and compliant, focused-on-compliance industries out there,” she said. “So I think, regardless of the outcome, the industry will respond in the best interest of the public.”

Evolving research

Since the dietary guidelines were last updated in 2020, more research has emerged suggesting that even drinking moderately could be associated with health issues. The World Health Organization in 2023 updated its stance to recommend that no amount of alcohol is safe to drink.

An investigation published in the Journal of the American Medical Association in March 2023 concluded that drinking moderately does not protect against heart disease or contribute to a longer life. Further, it found that drinking low levels of alcohol, less than 1 ounce per day for women and 1.5 ounces a day for men, was associated with increased risk of death.

But there’s no consensus on how much weight the findings will have with those drafting the new guidelines.

Marion Nestle, a former nutrition policy adviser to HHS who worked on the alcohol recommendations when the guidelines were updated in 1995, said the alcohol industry is “frantic” about how the dietary guidelines could be updated. She underscored that alcohol intake is associated with issues like domestic violence, gun violence and car crashes and evaluating them from a public health standpoint is key.

“The higher the level of alcohol consumed in the population, the more problems there are,” she said.

Laura Catena, a former emergency room physician and a consultant for a family winery in Argentina, said she’s concerned about the potential for bias against the alcohol industry by the ICCPUD. She said while there’s clear evidence that drinking in excess is harmful, there’s less convincing evidence that drinking within the recommended limits poses direct health risks.

Catena pointed to a randomized controlled study underway in Spain that will evaluate people who choose to abstain from drinking for five years. The study could yield clearer information on the effects of moderate drinking on health.

“It’s observational studies there,” she said. “There is potentially a small increased risk of cancers for moderate drinking. But again, there’s not even a standard finding in all the studies.”