National Academies Science Engineering Medicine :: “Review of Evidence on Alcohol and Health”

National Academies Science Engineering Medicine

December 17, 2024

Dr. Catena’s Response:

I’m Dr. Laura Catena, a Harvard and Stanford-educated physician and fourth-generation vintner. A committee of the U.S. National Academies of Science, Engineering and Medicine, or NASEM, has issued a new report, “Review of Evidence on Alcohol and Health.” These are my immediate takeaways from a first review of the report:

• The NASEM report was written by 14 preeminent scholars in the field of alcohol and health, and it was reviewed by 10 more, including some individuals with whom I have disagreed. The NASEM report, which follows the scope of its Congressional mandate, is a well-researched perspective on the state of current science regarding the health effects of moderate alcohol consumption.
• The NASEM committee was asked to address eight specific questions, which are outlined in the report. This report should be helpful to those policymakers who draft the final Dietary Guidelines for Americans with respect to alcohol. 
• The NASEM report conclusion 3-1 is a powerful refutation to those who believe there is “no safe level” of alcohol. The conclusion states, with “moderate certainty”:
  • “Based on data from the eight eligible studies from 2019 to 2023, the committee concludes that compared with never consuming alcohol, moderate consumption is associated with lower all-cause mortality.” 
• The NASEM Committee also found “insufficient evidence to draw a conclusion regarding the association between weight-related outcomes and moderate alcohol consumption.”
• The NASEM Committee found an association with a small increased risk for cancer – specifically with respect to breast cancer (moderate certainty) and colorectal cancer (for higher consumption among moderate drinkers – low certainty). For other cancers no conclusion could be drawn.
• The report noted that consuming moderate amounts of alcohol was associated with lower risk of nonfatal myocardial infarction (low certainty), with lower risk of nonfatal stroke (low certainty), as well as with lower risk of cardiovascular death overall (the latter with moderate certainty). So there are protective cardiovascular effects from moderate alcohol consumption.
• With respect to dementia, Alzheimer’s disease and cognitive decline, there was insufficient evidence for any risk association.
• For breastfeeding mothers, no conclusion could be drawn between maternal alcohol consumption and milk composition/production or infant development.

The NASEM report experts were mindful to eliminate any “abstainer bias” from their report by requiring the “never drinkers” control group to not include any former drinkers who might have been less healthy due to prior alcohol use disorder. Their definition of moderate drinker included those drinking alcoholic beverages as defined by the Dietary Guidelines for Americans, up to two drinks or 28 grams of alcohol in a day for men and up to one drink or 14 grams of alcohol in a day for women. In addition to these findings, the NASEM report identified a number of research gaps. It noted that when those are addressed, the research could strengthen the evidence on moderate alcohol consumption and health outcomes.

The NASEM committee’s report affirms what I and many medical colleagues have been saying: Most studies are observational, and with observational data there can be many confounders (variables that provide alternate explanations for the results). The same applies to the headline-grabbing Mendelian Randomization studies. A large-scale randomized controlled trial—the gold standard of studies – would be optimal for determining health outcome causality, yet this has never been conducted for alcohol and health. 

It will be difficult for the upcoming ICCPUD report to contradict this NASEM report, as the NASEM process has been scientifically rigorous, based on the latest science, and the committee is composed of a diverse group of experts from leading U.S. institutions representing a broad and relevant range of expertise.

If you would like to understand more about my viewpoints on alcohol, please visit my website, http://www.indefenseofwine.com.

If you have a question or would like to contact me for an interview, please email both Erica Nonni at erica@nonnimarketing.com and Martina Debonis at mdebonis@catenazapata.com and cc me at licatena@gmail.com.