Alcohol is poised to take center stage in debates over public health this year as advocates on both sides of the issue vie for influence over crucial dietary recommendations that will set the course of federal nutrition standards for the rest of the decade.
A complex nutrition policy document, the Dietary Guidelines for Americans, could quickly become a point of contention for the incoming Trump administration, as Republicans in Congress representing booze-making districts grapple with the confirmation process for Robert F. Kennedy Jr., the longtime Democrat-turned-Republican health spokesman who has sworn off drugs and alcohol for 42 years.
The battle over the amount of alcohol that is considered medically safe has been intensifying slowly for the past several years, but the matter came to the fore earlier this month when Surgeon General Vivek Murthy issued a report calling for mandatory warning labels on alcohol noting its association with certain types of cancer.
Murthy’s call fell upon deaf ears in Congress, receiving sharp pushback from Rep. James Comer (R-KY), a strong advocate of his state’s bourbon distilleries.
But cancer warning labels on alcohol are not the only threat to business the industry faces this year.
The Dietary Guidelines for Americans 2025-2030, or DGA, a comprehensive nutrition policy document produced every five years by the Department of Agriculture and the Department of Health and Human Services, could lower the recommended daily alcohol consumption levels based upon increasing evidence of alcohol’s carcinogenic properties.
President-elect Donald Trump’s nominees to lead the USDA and HHS will have a strong hand in the development of this year’s DGA, so alcohol consumption recommendations could be a sticking point during their confirmations.
Moderate drinking is defined by the current DGA as two alcoholic drinks per day for men and one drink per day for women. Reducing those recommended levels of drinking, or recommending abstinence, could prove to be the biggest and most consequential upset in federal nutrition policy of the century so far.
Importance of the DGA
All federal food programs, including the National School Lunch Program and the Supplemental Nutrition Assistance Program, or SNAP, must adhere to the guidelines set by the DGA.
This year marks the 10th iteration of the DGA. HHS is taking the administrative lead on the massive undertaking, but both HHS and USDA secretaries are responsible for finalizing the weighty document.
Although the document itself is written for professional nutritionists and policy wonks, the DGA has broad-reaching social effects, influencing what doctors recommend to their patients and general public awareness of dietary health.
The fatally flawed food pyramid, for example, now highly criticized as both inaccurate and outdated, was created in 1992 by the USDA to translate the principles of the DGA for a general audience.
Although the food pyramid was replaced by Michelle Obama’s MyPlate graphic and nutrition initiative in 2011, the triangular image is still widely recognizable, highlighting the lasting resonance of DGA recommendations and their branding.
The alcohol industry itself highlights the importance of the DGA.
In a statement provided to the Washington Examiner by the Wine Institute, a spokesperson for the wine lobbying firm said that it “always refers consumers to the most current DGAs and recommends that any person who has concerns about consuming alcohol [to] consult with their healthcare provider.”
Amanda Berger, senior vice president of science and research for the Distilled Spirits Council, told the Washington Examiner that her organization also refers consumers to the current DGA recommendations.
“Many lifestyle choices carry potential risks and potential benefits, and the consumption of alcohol is no exception,” said Berger.
Controversy and corruption in alcohol studies
Studying the health effects of alcohol has been mired in controversy for decades, with much of the research producing conflicting findings or results with low statistical confidence.
This is in large part due to study design, using observational techniques to sample from the general public, as opposed to more tightly controlled clinical trials, the gold standard for medical testing.
Observational studies that do not have a patient’s full medical history cannot account for underlying health reasons for why he or she would choose not to drink, including cardiovascular disease.
In 2013, the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, attempted to overcome these challenges by establishing a first-of-its-kind large clinical trial to test the effects of alcohol on cardiovascular disease. Researchers hypothesized that the clinical trial would conclusively show moderate alcohol consumption to have positive heart effects.
But in March 2018, a New York Times exposé revealed that key officials at NIAAA had lobbied alcohol industry leaders, including Anheuser-Busch, to sponsor the $100 million undertaking, compromising the scientific objectivity of the clinical trial.
Then-NIH Director Francis Collins and then-principle deputy director Lawrence Tabak started an investigation into the alleged impropriety within one week of the exposé being published. They pulled the plug on the trial by June.
How the 2020-2025 DGA created a fight in Congress
The NIAAA clinical trial controversy, with ripple effects through the public health community, coincided chronologically with the development of the 2020-2025 DGA, as the committee that evaluates the research that informs the guidelines begins the process several years in advance of final publication.
In preparation for the 2020 guidelines, the DGA Committee recommended that the limit for men be lowered to one drink daily, but the final guidelines did not reflect this change, citing lack of evidence. The 2020-2025 DGA also only referenced data on all-cause mortality, or death from any cause, related to alcohol, as opposed to linking alcohol consumption to cardiovascular effects, cancer risk, or other diseases.
More importantly, when the current DGA Committee submitted its research questions for the guidelines to the Federal Register in 2022, there were no stated plans to study the specific health outcomes of alcohol consumption.
As a remedy, Congress in 2023 appropriated $1.3 million to the National Academies of Sciences, Engineering, and Medicine, or NASEM, to conduct a comprehensive review of disease risk for alcohol consumption explicitly to inform the 2025 guidelines.
But when it became clear that the Biden administration HHS was conducting its own parallel investigation to inform this year’s DGA alcohol recommendations, Comer as chairman of the House Oversight Committee in April 2024 launched an investigation into the two competing studies.
“The Biden Administration appears to be driving towards approving Dietary Guidelines that by default recommend Americans consume no alcohol whatsoever, despite a continually evolving scientific debate about the risks and benefits of moderate alcohol consumption,” Comer wrote to HHS Secretary Xavier Becerra and USDA Secretary Thomas Vilsack when inquiring about the parallel study.
HHS and USDA, which at the time were also stalling the Oversight Committee’s investigations into the origins of COVID-19, did not substantively respond to Comer’s inquiry until he subpoenaed documents in September. And even then, the departments only provided 18 pages worth of material in total, most of which Comer said is irrelevant to the inquiry.
Comer declined a request for an interview about Murthy’s recent cancer warning report in connection to this year’s DGA, but he previously told the Washington Examiner that Murthy’s report was “yet another example of the Biden administration operating behind closed doors.”
Rep. Mike Thompson (R-CA), co-chairman of the Congressional Wine Caucus and representative for Napa Valley, California, told the Washington Examiner in a statement that alcohol consumption “should always be done in moderation” but that the medical evidence about its effects should be clear and unbiased.
“Dietary recommendations for the consumption of alcohol should be rooted in transparent and sound scientific evidence,” said Thompson. “That’s why Congress funded the National Academies of Sciences’s recent study on alcohol consumption to inform future dietary guidelines for Americans.”
Conflicting reports on alcohol’s consequences
The NASEM study, the HHS study, and the surgeon general’s report, all published within the past month, each recognized with moderate scientific confidence that one alcoholic drink a day for women does increase the risk of breast cancer. This may be due to the fact that women metabolize alcohol differently than men.
But the NASEM report concludes with low certainty that consuming moderate amounts of alcohol is associated with a lower risk of heart attacks and nonfatal strokes and with moderate certainty lowers the risk of cardiovascular death for both women and men.
NASEM scientists were unable to draw any conclusions as to whether alcohol consumption had any effect on weight-related outcomes, neurocognitive disorders such as Alzheimer’s disease, or other cancers.
Both the surgeon general’s report and the HHS independent review found that alcohol use is associated with increased mortality for six different types of cancers other than breast cancer for women. This includes colorectal, liver, oral cavity, pharynx, larynx, and esophageal cancers.
The World Health Organization in 2022 classified alcohol as a Group 1 carcinogen, the same category as asbestos and formaldehyde, saying that cancer risks “start from the first drop.”
Dr. Michael Siegel, professor of public health at Tufts Medical School, told the Washington Examiner that it would be “unethical in medicine and in public health” to recommend a carcinogen even if it does have positive cardiovascular effects.
Siegel, a sharp critic of the alcohol industry’s influence over public health recommendations, said the evidence of alcohol as a carcinogen is “very convincing.”
“If you’re going to have dietary guidelines, and if alcohol increases risk of breast cancer, it’s simply not tenable under those circumstances to make a recommendation,” said Siegel.
Berger told the Washington Examiner that the Distilled Spirits Council does “not recommend that anyone drink to achieve health benefits and [urges] all adults who choose to consume alcohol to consult with their health provider.”
A teetotaler walks into a bar fight
Into this long-term controversy walked Trump and Kennedy, his nominee for HHS secretary, both of whom have promised to “Make America Healthy Again” and also have strong personal convictions against alcohol.
Trump has been candid about how he advises his children to stay away from drinking and his own abstinence. Kennedy has also been very public about his sobriety after struggling with alcohol and hard drugs for 14 years after the assassination of his father in 1968.
Both men also lost brothers to addiction. Trump’s older brother, Fred, died as a result of alcoholism at the age of 42 in 1981, and Kennedy’s younger brother David died of a drug overdose at the age of 28 in 1984.
Kennedy built his career in environmental law on exposing the toxicity of common business practices and products. Kennedy was one of the chief lawyers involved in the case against Monsanto, the maker of Roundup, because of the carcinogenic properties of its ubiquitous weed killer’s main ingredient, glyphosate.
As an HHS secretary who has promised to root out industry-bureaucrat conflicts of interest across the board within the public health sector, Kennedy could invest more resources into studying the health benefits and detriments of alcohol, perhaps even funding a clinical trial like the NIAAA promised more than a decade ago.
Nutrition policy experts have already noted that Kennedy will likely target the DGA as a primary vehicle to reduce the influence of ultraprocessed foods. This would be the main way Kennedy could influence the federal school lunch program, which is informed by the DGA but administered by the USDA.
The MAHA architect will also likely take aim at the DGA program as a whole, as experts have noted that the diet quality of the U.S. population has not noticeably improved since the DGA was first introduced in 1980.
On alcohol, Kennedy could use the guidelines as an opportunity to emphasize that no alcohol is safe for human health, a principle that he has put into practice during his own journey with sobriety.
Dr. Jeff Singer, a practicing surgeon and a health policy contributor with the libertarian Cato Institute, told the Washington Examiner that he is “very concerned” that Kennedy’s policy approach to alcohol and drugs will be molded by his personal experience, which is the exception, not the rule.
“Evidence is that it usually doesn’t work for most people because, when people have a problem, in many cases their self-esteem is already at the bottom. And if they end up transgressing, they tend to look at it as ‘I failed. I can’t do this,’” said Singer. “As a clinician, I don’t think it’s helpful to insist on abstinence.”
Trump’s nominee for USDA, Brooke Rollins, would have as great of a role in developing the DGA as Kennedy. Little is publicly known about her views on alcohol but she has been described as a “Bush conservative.”
The Trump transition team did not respond to the Washington Examiner’s request for comment.
Most of Congress’s power to shape the development of the 2025-2030 DGA has already been exercised through the appropriations process, but the Senate confirmation process for both Rollins and Kennedy could prove to be an opportunity for alcohol advocates to shape the trajectory of how the departments draft the guidelines.
Younger people are drinking less
Regardless of what the federal government does, younger people are already starting to drink less alcohol.
Individuals in Generation Z, born between 1997 and 2012, are not only consuming fewer alcoholic drinks per day but are also drinking overall less frequently than generations past.
A 2023 Gallup study found that only 62% of people between the ages of 18 and 34 reported any drinking behavior, compared to 72% of the same age bracket in 2003.
This partly could be attributed to the COVID-19 pandemic shutting down bars and restaurants in 2020, which hit Gen Z at a pivotal moment in their young adult social development.
A study from Carnegie Mellon University in 2024 examined the pre- and post-pandemic alcohol habits of more than 200 heavy drinkers, defined as five or more drinks per occasion for men and four or more drinks per occasion for women. Study participants drank on average nearly 13 drinks less per month than before the pandemic, mainly due to decreased alcohol consumption on the weekends.
The trend has been dubbed “sober curiosity,” which involves questioning your drinking habits for health-focused reasons without necessarily giving up alcohol entirely. The sober curious movement has even started to change the landscape of nightlife across the U.S., with nonalcoholic bars becoming increasingly popular.
The market for nonalcoholic and low-alcohol beverages had an estimated global market value of over $13 billion last year and is one of the fastest-growing segments within the broader beverage sector, with an expected growth rate of about 7% between 2023 and 2027.
This is slower than the expected growth rate of the global alcohol industry at about 2.4% between 2024 and 2032, but the sober curious industry pales in comparison to the $1.6 trillion value of the world alcohol market in 2021.
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Even if the DGA does change alcohol recommendations, Singer said he doesn’t expect alcohol, a feature of human culture for all of recorded history, to go anywhere any time soon.
“Any informed person knows that too much alcohol, just like too much of anything, can have harmful effects,” said Singer. “So I don’t know how seriously people are going to take this report.”