How much alcohol is too much for men?

Federal dietary guidelines have long recommended alcohol consumption limits for Americans: one drink daily for women, two for men. But last spring, health officials began seriously considering a dramatic redefinition of moderate alcohol consumption for men, according to two people with knowledge of the process who spoke anonymously for fear of reprisal.

Officials suggested lowering the cap for men to one drink a day, the recommended limit for women. That proposal, contained in a draft document written in March and obtained by The New York Times, went nowhere.

When Robert F. Kennedy Jr., the secretary of health and human services, and other officials unveiled the new guidelines earlier this month, they included a vague instruction that only asked Americans to “limit” alcohol consumption. Even the tried-and-true hats for men and women were gone.

Details of the internal document, compiled by officials at the Department of Health and Human Services, were first reported by Reuters.

The proposal called for both men and women to “limit consumption to one standard drink or less per day.”

“Even moderate alcohol consumption can pose health risks,” the document states. “For example, the risk of certain types of cancer increases with less than one standard drink per day, regardless of the type of alcohol consumed.”

The advice never became a formal draft recommendation and the team that worked on the document was disbanded. Some were laid off last spring and others were reassigned.

Asked what happened to the individual limits for men and women, Andrew Nixon, a spokesman for the Department of Health, said the process was legal and transparent, adding: “The dietary guidelines were based on rigorous scientific review and independent oversight.”

In recent years there has been a heated scientific debate about the benefits and risks of moderate alcohol consumption. Two government-commissioned reports assessed research on health effects; One of the reports was withdrawn and never submitted to Congress.

The alcohol industry has steadfastly supported the long-standing caps for men and women and has opposed any changes to the formula. In fact, industry representatives often refer to the safe thresholds recommended in previous guidance.

“The spirits sector has long taken the position that the definition of moderate alcohol consumption is helpful to consumers and that the guidelines should not be changed unless there is a preponderance of scientific evidence to support it,” Amanda Berger, senior vice president of science and research at the Distilled Spirits Council, said in a recent statement.

She pointed to a congressionally mandated report on alcohol consumption from the National Academies of Science, Engineering and Medicine (NASEM), noting that it clearly defined “moderate alcohol consumption as one drink per day for women and two drinks per day for men.”

Last year, Congress determined that the NASEM report should be the only alcohol-related study used to inform dietary guidelines.

This report concluded that moderate alcohol consumption is associated with lower all-cause and cardiovascular mortality compared with abstinence from alcohol consumption. But drinking alcohol was also linked to a higher risk of breast cancer in women. The report based its conclusions on studies from around the world.

Dr. Ned Calonge, an epidemiologist at the University of Colorado Anschutz Medical Campus who led the NASEM panel on alcohol, said the new guidelines, which instruct men and women to simply drink less, are consistent with the report’s findings.

“There are many reasons why people drink alcohol,” said Dr. Calonge. “What we’re saying is that health shouldn’t be one of them. Doctors shouldn’t recommend people drink alcohol for any reason.”

But the other government report, the Alcohol Consumption and Health Report, concluded that the risk of death in the United States began to rise from just one drink a day, for both men and women.

This report was commissioned by HHS during the Biden administration but was met with sharp criticism in Congress and was ultimately withdrawn by the Trump administration.

Nevertheless, Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, noted a shift in scientific consensus at a news conference to introduce the new dietary guidelines this month.

There has been a “general move away from two glasses for men and one glass for women – there’s never really been any good data to support that alcohol consumption,” he said.

In the 1980s, dietary guidelines stated that all adults could consume one to two servings of alcohol per day, except during pregnancy. The separate recommendations for men and women introduced in 1990 were based on the fact that men and women are biologically different.

But the idea that men could drink more was never based on solid science, some experts say, and may have been partly influenced by paternalistic attitudes toward women.

The biological differences are real: Men are, on average, taller and heavier than women, and women metabolize alcohol differently because they have both higher levels of body fat (alcohol is water-soluble) and lower levels of a liver enzyme responsible for metabolizing alcohol.

But scientists say men are more likely to engage in risky behaviors when drinking and are more likely to engage in habits like smoking that increase the harmful effects of alcohol.

“Blood alcohol content depends on how tall someone is,” said Jürgen Rehm, senior scientist at the Center for Addiction and Mental Health in Toronto and author of the alcohol consumption study.

But that metric “mainly plays a role in acute events such as traffic accidents, and there are other processes and pathways for how alcohol affects mortality,” he said.

“Even with one drink a day the risk is small, but it increases,” he added.

Scientists have found that even with lower alcohol consumption, men are more likely to drive worse, commit violence, or drown and fall.

“Men drink more, get drunk more often and generally do stupider things when impaired,” said Tim Naimi, director of the Canadian Institute for Substance Use Research and another author of the alcohol report.

According to Dr. According to Naimi, men account for about three-quarters of alcohol-related deaths in the United States and Canada and are responsible for the majority of “second-hand harm.”

Men report nearly three times as many emergency room visits for alcohol-related diagnoses as women, according to national figures released Thursday. In 2021 and 2022 there will be an average of almost four million visits per year. For women there are 1.37 million visits to the emergency room.

For men, the risk of dying from something related to drinking begins to be more than 1 in 1,000 if they drink alcohol six and a half times a week, Drs. Rehm and his colleagues. For women, the threshold is roughly the same at more than seven drinks per week.

With eight and a half drinks per week, the risk is over 1 in 100 for both men and women.

“At low levels of consumption, men are at a similar risk of health effects from alcohol consumption as women at the same level of consumption,” the internal HHS document says.

The total number of deaths from alcohol far exceeds those from drug overdoses for both men and women. According to the Centers for Disease Control and Prevention, more than 178,000 deaths in the U.S. were related to alcohol in 2020-21.

The figure includes deaths directly related to alcohol consumption – including those caused by alcohol poisoning and car accidents – as well as those caused by cancer and suicides.

For example, alcohol causes 8 percent of deaths from breast cancer and almost half of deaths in men who develop a certain type of esophageal cancer.

If all American adults drank less than one drink per day, an estimated 17,000 alcohol-related cancer deaths could be prevented, the internal HHS document estimates.

In 2020, when the dietary guidelines were previously revised, scientific advisers also wanted to make a general recommendation of no more than one drink per day for all adults. Even then, the Council never reached the final dietary guidelines.

The guidelines released this month simply recommend that Americans drink less for health reasons. “It would have been helpful to be clear about what that meant,” said Marion Nestle, a nutritionist who studies food policy.

“If research shows that a reasonable limit is less than one drink a day, they should have said that – less than one a day, three to four drinks a week, and don’t worry about it. That’s very simple advice.”

The findings of the apparent cardiovascular benefits of moderate alcohol consumption have clouded the debate about what to say to men and women, Dr. Nestle.

At this point, however, “no one is suggesting drinking alcohol to reduce cardiovascular risk except the people in the alcohol industry,” she said.