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Changing Trends and Guidelines for Alcohol Consumption by Christina Badaracco, MPH, RDN, LDN

Americans' alcohol consumption has changed substantially in recent years, driven by factors such as new production technologies, a desire for improved health and environmental sustainability and, most recently, even the impacts of popular weight-loss medications on hunger and satiety. At the same time, new drinking options are becoming more widely available in stores and establishments. Amid these trends, research into alcohol's health effects continues and may drive potential changes in consumption guidelines. So, how can we follow healthy drinking behaviors that are sustainable for our lifestyles? 


How does drinking alcohol affect our health? 

Various alcoholic drinks contain different ingredients that have their own effects on flavor and our physiology, but they include one common psychoactive component called ethanol. This molecule affects the body in many ways — and our bodies' responses can vary based on our genes and other individual factors. Alcohol influences the functions of various organs, including the brain, gallbladder and liver. It affects various aspects of our metabolism, including reducing insulin secretion (which helps regulate our blood sugar) and increasing fat deposition in the liver. It can also affect mood, coordination, sleep quality, memory and other aspects of cognitive function. Alcohol is known to interact with many medications and even herbal supplements, so it is important to carefully read labels to avoid any potentially harmful effects before consuming it. Frequent overconsumption can also lead to addiction and behavioral problems that can negatively affect families and the broader society. 


While most people are aware of the adverse health effects of excessive alcohol consumption — and may have even experienced the negative mental and physical effects of alcoholism first- or second-hand — it's also been common belief (including among many health professionals) that moderate alcohol consumption can be beneficial for health for many people. Wine is a component of the often-touted Mediterranean diet, for example, and earlier studies — including meta-analyses — showed a lower risk of chronic conditions such as coronary heart disease among those who consume alcohol in moderation. (To read more about how alcohol affects the body and tips for healthy consumption, read this previous post.) However, more recent studies looking across the genomes of many thousands of adults have yielded new evidence about its potential harms, such as accelerating biological aging and posing as one of the top three modifiable risk factors for impaired cognitive health. This has led to conflicting recommendations about the safety or healthy frequency of alcohol consumption. Added to the existing evidence about alcohol's long-term health risks, such as dementia, various cancers and liver disease, experts have begun to question whether moderate consumption is indeed beneficial. 

How are Americans' drinking behaviors changing? 

Humans around the world have been drinking fermented beverages for thousands of years. In the US, drinking behaviors have changed substantially since our country's founding, with our overall per capita drinking volume declining precipitously for more than a century and then increasing gradually (particularly in the case of wine) since 1900. More recently, various publications showed that the stress and poor mental health caused by the recent pandemic led to a 3% increase in alcohol sales (which represented the most significant increase in more than 50 years), and roughly 25% of people drank more than usual. Liquor sales accounted for most of this increase.


Notably, these recent patterns have not changed uniformly across our country's population. A recent University of Michigan study showed that 2022 reportedly saw "the highest prevalence of binge drinking ever recorded" among adults aged 35–50. But a 2023 Gallup poll showed that younger adults are now less likely to drink (though more likely to use marijuana and vaping products), with the share of adults aged 18–34 who say they ever drink dropping by 10% since 2001. To replace alcoholic drinks, this age group is eagerly turning to alternative beverages when they socialize and dine out and to enjoy at home. 


How are guidelines around alcohol changing? 

Our Dietary Guidelines for Americans (DGAs) provide advice about what to eat and drink to meet nutrient needs and prevent disease. They are updated roughly every five years based on reviews of the latest science. The 2020–2025 DGAs (published in 2020) state that adults of legal drinking age should limit intake to two drinks per day for men and one drink per day for women. 


At the same time, international guidelines are changing. Canada changed its guidance in 2023 to limit to two alcoholic drinks per week (down from the previous 15 weekly drinks for men and 10 for women) to reduce health risks associated with drinking. And the World Health Organization released a statement in early 2023 that there is no "safe" level of alcohol consumption that does not affect health. 


The 2025–2030 DGAs are currently under development. A review of the current scientific evidence on the relationship between the consumption of alcohol and health outcomes presently being conducted by an expert committee convened by the National Academies' Food and Nutrition Board in early 2024 will help inform their conclusions. It remains to be seen how the expert committee will determine the alcohol guidelines should change (if at all). 

What alternatives to alcoholic drinks exist? 

In the past, non-alcoholic versions of beer, cocktails and other alcoholic drinks were much less common and often thought to be unappealing. However, companies have recently come out with many new options, and people can enjoy them in restaurants, bars and at home. Examples of new products include: 

  • Zero-proof liquors

  • Infused seltzers

  • Non-alcoholic wine

  • Sparkling hop water

  • Non-alcoholic canned cocktails


There are a few ways that non-alcoholic spirits can be made. Natural botanicals, flavorings and essences can be infused with water to replicate the flavor profiles of alcoholic spirits. Or, they can distill a full-proof spirit with all of the flavor of a traditional spirit, then distill it again to remove the alcohol. A less common method is to prevent alcohol from forming in the first place by stopping the fermentation process at an earlier stage and then diluting it with water. These products don't taste identical to the alcoholic versions, but many still find them appealing and a satisfying substitute for the alcoholic versions — especially when combined with bitters, mixers and other typical cocktail components. 


Cocktails can be made without non-alcoholic spirits, as well. Enjoying low- or no-alcohol drinks can be an opportunity to add beneficial ingredients to the diet. Mocktails can be made with herbs, flowers and fruits that provide polyphenols (plant compounds) that are beneficial to the diet. They can be very high in sugar; however, choosing or making drinks that derive most of their flavor and enjoyment from botanical ingredients or carbonation doesn't require large amounts of sugar. 


How can I modify my alcohol consumption and still enjoy being social? 

For most people, alcohol doesn't have to be entirely off limits, even if recommendations do continue to change. But, reducing your consumption and treating alcoholic beverages as occasional treats may prove to benefit your health (and can help reduce costs, too). Several ideas for moderating alcohol intake include: 

  • If you enjoy drinking when out, limit yourself to just one alcoholic drink at the restaurant or happy hour.

  • Consider trying one of the growing number of low-alcohol options that many restaurants have been adding to menus instead of your typical go-to mixed drink.

  • At home, save alcoholic drinks for occasional celebrations. For special occasions (such as a treat to celebrate the end of a busy workweek), try making a mocktail, like the recipe here, or one of these other ideas for fun drink recipes that are low in sugar and alcohol from FitOnNutrition Stripped and Everyday Health.

  • If buying pre-made mocktails, look for lower-sugar varieties that contain little or no sweetened soda, tonic water or syrups.

  • Remember that alcoholic drinks are made from grown and harvested ingredients, so consumers can choose varieties that are produced more sustainably. For example, wine grapes can be grown biodynamically, and spent grain can be diverted to compost or other edible products. Selecting forms of sustainably produced alcohol is also less detrimental to environmental health. 


Resources

A list of resources can be found here.


Christina Badaracco, MPH, RDN, LDN

Christina Badaracco, MPH, RDN, LDN, works as a healthcare consultant, educator and thought leader, focusing on evidence generation and advancing the role of nutrition in healthcare. She also regularly writes, teaches and develops curriculum about nutrition, culinary medicine and sustainable agriculture — including publishing The Farm Bill: A Citizen's Guide in 2019 and five cookbooks with the Transamerica Institute and co-developing a culinary medicine elective at the Georgetown University School of Medicine. Christina previously worked for the EPA, Teaching Kitchen Collaborative, Oakland Unified School District, NIH Clinical Center and more. She is the incoming president of the DC Metro Academy of Nutrition and Dietetics, is on the board for Slow Food DC, supports the Teaching Kitchen Collaborative's nutrition working group and contributes to various other organizations. She earned her Master of Public Health from the University of California, Berkeley and her bachelor's degree in Ecology and Evolutionary Biology, with a minor in Italian Language and Culture, from Princeton University. She completed her dietetic internship at Massachusetts General Hospital.


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