Experts warn new U.S. dietary guidelines downplay alcohol risks

BALTIMORE — Public health experts at Johns Hopkins Bloomberg School of Public Health are raising alarm over newly released U.S. dietary guidelines that omit long-standing limits on alcohol consumption, warning that the changes could hinder public understanding of the health risks associated with drinking—even at low levels.

“Removing specific alcohol limits doesn’t reflect new scientific uncertainty; it reflects a communication choice,” said Dr. Johannes Thrul, associate professor in the Department of Mental Health at Johns Hopkins.

“The evidence that alcohol harms health at increasing doses hasn’t disappeared.”

The revised guidelines, released by the U.S. Department of Health and Human Services (HHS), no longer include precise caps on alcohol intake and soften prior messaging linking alcohol consumption to cancer risk.

According to Thrul, the absence of explicit language could make it easier for the public to ignore well-documented harms.

“Alcohol is a known carcinogen,” he said.

“Downplaying that link doesn’t make it less true, but I worry that it will make it easier to ignore.”

Thrul emphasized that alcohol risk is “dose responsive”—meaning that harm increases progressively with the amount consumed, without a clear threshold where alcohol suddenly becomes unsafe.

“Guidelines should help people understand that gradient, not obscure it,” he said.

Dr. Patti Truant Anderson, assistant practice professor in Environmental Health and Engineering at Johns Hopkins and policy director at the Center for a Livable Future, noted that the final dietary guidelines also appear to sideline evidence-based recommendations on protein sources.

“By choosing to emphasize animal proteins over vegetable proteins, the final guidelines ignored some important advice from the Dietary Guidelines Advisory Committee that was well grounded in evidence,” Anderson said.

“Plant-based proteins like beans, peas, and lentils have fiber, which we know is associated with satiety and health benefits. A plant-forward diet is better for both health and the environment, and it’s a shame they chose to de-emphasize that.”

Decline in drinking trends, but health risks persist

Alcohol use in the United States has declined in recent years, particularly among young adults.

According to Gallup and the Monitoring the Future survey, drinking rates among those aged 18 to 34 have dropped from nearly 60 percent to 50 percent since 2023.

Just 54 percent of U.S. adults now say they drink alcohol—the lowest figure in nearly 90 years and a 13 percent drop since 2022.

“We’re seeing a major cultural shift in the U.S.,” Thrul said.

“Young people are drinking much less, and less frequently, than previous generations, and social pressures to drink are weakening.”

Despite this trend, public awareness about alcohol’s health effects lags behind the science.

“Moderate drinking is still widely interpreted as low risk,” Thrul added.

“We should be honest that alcohol is a carcinogen, but we can also emphasize the immediate, tangible benefits of cutting back that matter to people’s everyday lives.”

Even small amounts of alcohol increase health risks

Recent research challenges earlier studies that suggested health benefits from moderate alcohol intake.

Experts say earlier findings were often flawed due to methodological errors, such as failing to control for confounding factors or comparing drinkers with former drinkers who quit for health reasons.

Today, large-scale studies affirm that alcohol increases the risk of numerous conditions, even at low levels.

According to Dr. Elizabeth Platz, professor of epidemiology at Johns Hopkins, “The safest amount of alcohol is none.”

Alcohol consumption has been linked to self-harm, addiction, high blood pressure, heart disease, liver damage, stroke, and at least seven types of cancer.

It is the third-leading preventable cause of cancer in the U.S., causing approximately 100,000 cancer cases and 20,000 cancer deaths annually, according to a 2025 advisory by the U.S. Surgeon General.

“For some cancers, like breast cancer, the risk is increased at even one drink per day,” Platz said.

Population-specific risks and health equity

Certain populations face a higher risk from alcohol consumption.

Individuals of East Asian descent, for example, are more likely to carry a genetic variant that slows the metabolism of acetaldehyde, a mutagenic byproduct of alcohol, resulting in elevated cancer risk.

Women are also at increased risk, particularly for breast cancer.

Of the 100,000 alcohol-related cancer cases in the U.S. each year, more than 44,000 are breast cancer cases.

Thrul emphasized that alcohol affects all users biologically, but individuals with a family history of alcohol use disorder may be more prone to develop problematic drinking patterns.

Short-term benefits of reducing alcohol intake

Reducing alcohol use can produce measurable improvements in physical and mental health in just weeks.

Studies of “Dry January” participants have shown reductions in blood pressure, anxiety, and fatigue, as well as improved sleep and concentration.

“Abstinence or reduced drinking not only prevents future disease but also improves how you feel tomorrow morning and next month,” said Thrul.

He added that strategies such as counting drinks, alternating with water, and designating alcohol-free days are proven to help.

The growing popularity of non-alcoholic beer, wine, and spirits reflects a shift in consumer demand.

“More people want the social experience without the physiological downsides of alcohol,” he said.

Policy and communication strategies to reduce harm

Experts at Johns Hopkins argue that clearer labeling and stronger public health communication are key to reducing alcohol-related harm.

A 2024 survey found that just 37 percent of U.S. adults were aware that alcohol increases cancer risk, while 53 percent said they did not know.

“Labeling could be a start,” Thrul said, citing a Canadian pilot program where warning labels reduced alcohol sales.

He added that education in primary care settings and through medical training would also help normalize conversations about alcohol’s risks.

Public health policies, such as raising taxes, limiting sales hours, and restricting advertising, have proven effective in reducing alcohol consumption, much like earlier tobacco control efforts.

Yet alcohol marketing remains widespread, often endorsed by celebrities.

“We have been treating the alcohol industry differently from the tobacco industry,” Thrul said.

“We should double down on those evidence-based alcohol policy strategies, and that includes limiting and restricting alcohol advertisements.”

Platz echoed the call for stronger messaging: “Alcohol drinking is a preventable cause of cancer and cancer death.”

While the new dietary guidelines fall short of setting limits on alcohol intake, experts say shifting norms and greater public awareness could still lead to healthier behaviors.

If the U.S. were to adopt stricter standards, such as Canada’s recommendation of no more than two drinks per week, the public health impact could be substantial.

“The bottom line is, if the guidance shifts downward, the burden isn’t just on individuals to drink less,” Thrul said.

“It’s on the entire system, including public health, medicine, and the alcohol industry, to support that change.”