The latest update to the US Dietary Guidelines has sparked discussion regarding its recommendations on alcohol consumption. While the guidelines advocate for reduced intake of ultra-processed foods, experts point out that the advice concerning alcohol is notably vague. During a recent episode of *Liver Lineup: Updates & Unfiltered Insights*, Dr. Kimberly Brown raised the question of whether there is a clear message regarding alcohol, to which Dr. Jessica Mellinger responded that the recommendation is simply to “drink less.”
Despite agreeing with this recommendation, Mellinger highlighted the need for more specific guidance, particularly for individuals with liver disease or conditions that heighten the risks associated with alcohol. The updated guidelines have shifted from defining “moderate” drinking through sex-based thresholds to omitting specific quantity recommendations entirely. This change aligns with emerging research indicating that even low levels of alcohol consumption can lead to negative health outcomes.
Dr. Mellinger pointed out that one of the most significant concerns in the literature is the association between alcohol and cancer risk. Alcohol is classified as a known carcinogen, and studies show measurable health risks even at minimal intake levels. Although the certainty regarding these risks decreases at lower consumption levels, the overarching trend suggests a public health push for reduced alcohol consumption across various demographics.
From a hepatology perspective, Mellinger noted that this shift in the guidelines reflects the realities faced by clinicians. In her alcohol-associated liver disease clinic, discussions with patients extend beyond mere quantity and frequency of alcohol intake. Instead, they delve into how alcohol consumption impacts health, personal relationships, and overall quality of life. Mellinger emphasizes that, based on current data, she cannot ethically endorse any level of alcohol consumption for patients already facing liver complications.
Rather than providing reassurance for those considering low-level use, she advocates for a more personalized approach. This involves understanding patients’ motivations, readiness to change, and feasible steps toward either reduction or complete abstinence from alcohol.
Dr. Nancy Reau added to the conversation by pointing out that important at-risk groups are not specifically addressed in the public-facing guidelines. In particular, individuals who have undergone gastric bypass surgery face unique risks associated with alcohol consumption that remain unmentioned. Beyond these considerations, the panel concluded that while the guideline’s message to “drink less” may serve as a general guideline for the public, it leaves significant gaps that require attention from healthcare providers.
The conversation reflects growing concerns about alcohol consumption’s health implications and the need for more tailored advice that considers individual circumstances. As the discourse around alcohol and health continues, the call for clarity and specificity in dietary guidelines remains critical.
Editors’ Note: Relevant disclosures for Dr. Reau include affiliations with AbbVie, Gilead, Salix, Arbutus, and VIR. Dr. Brown has disclosed relationships with Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal. Dr. Mellinger has disclosed affiliations with GlaxoSmithKline. Van Jacobs reports no relevant disclosures.
