Consuming more than one drink a day results in a steep increase of the risk of premature death, a new federal review has concluded. The draft report was published Tuesday ahead of a major update to influential federal guidelines on how much alcohol Americans should drink.
“In the United States, males and females have a 1 in 1000 risk of dying from alcohol use if they consume more than 7 drinks per week. This risk increases to 1 in 100 if they consume more than 9 drinks per week,” the report’s authors concluded, in a final draft published by the Department of Health and Human Services.
The review is one of two written by committees of outside experts to inform this year’s update to the Dietary Guidelines for Americans. The other was published last month by the National Academies of Sciences, Engineering and Medicine.
The upcoming guidelines are important because the Food and Drug Administration and other agencies often rely on the recommendations to justify new rules, like on how to label food and drinks. Men are currently recommended to limit intake to no more than two drinks per day and women are recommended to limit to one drink per day.
“Once you’re over a drink a day, your risk of dying from alcohol is already above one percent. Some people may think that doesn’t sound like a lot, but in terms of a public health guideline, that would be really, really high,” said Dr. Timothy Naimi, director of the Canadian Institute for Substance Use Research and one of the authors of the report.
Naimi was careful to say that the report was “not endorsing any level of risk” caused by drinking, but pointed to other countries and health regulations that have used 1 in 100 and 1 in 1,000 death risks as thresholds to set rules.
It is unclear whether the incoming Trump administration will incorporate the findings of the latest report into any updated guidelines. In 2020, the Trump administration rejected a call by its outside expert panel to recommend limiting drinking for all Americans to no more than once per day, saying the “emerging evidence” did not support the move.
Alcohol linked to deaths from cancer, injuries, other causes
The report was designed to weigh all of the data on a range of diseases and injuries, and boiled down a complex web of studies that have looked at alcohol’s health risks and benefits into “alcohol-attributable death” estimates.
This modeling is likely underestimating the true health risks of alcohol, Naimi said, given limits in how researchers can study its health impacts.
Risks can also vary widely from person to person, the report cautions, meaning some harms can be very small for some even if they add up to substantial risks at the public health level.
“The overall effect of alcohol consumption on all-cause mortality is dependent upon the risk of diseases and injuries that are causally related to alcohol. These risks are affected by numerous factors, including smoking, diet, physical activity, obesity, hepatitis infection, and genetics,” the report states.
At one drink a day, the report estimated that injuries and cancer added up to the biggest contributors of the risk for a premature death.
For men, injuries made up a substantial portion of the risk of dying. This includes a variety of accidents, road injuries and intentional harm, like suicide and violence linked to drinking.
Cancer, which was next largest factor, made up a third of the additional risk of death for men.
For women consuming one drink a day, the risk of death from cancer was statistically similar or larger compared to the increased risk of fatal injuries.
Increased risk of a number of cancers — colorectal, female breast cancer, and cancers of the liver, mouth, throat and esophagus — “begins with any alcohol use and increases with higher levels of use,” the report states.
U.S. Surgeon General Dr. Vivek Murthy issued an advisory earlier this month calling for a warning about the risk of cancer to be included on alcoholic beverages.
Liver disease poses the next highest risk, and can be especially risky for people with other underlying conditions like hepatitis C that make people vulnerable.
One risk that was lower in people drinking once per day, compared with never drinking, was for ischemic stroke. But that apparent benefit virtually disappears at two drinks per day.
“Drinking at levels that many people have considered to be, quote, moderate, may in fact be moderately risky or may not be moderate in terms of the health risk,” said Naimi.
