1. Brown, Judith E. PhD, RD, MPH

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Who knew that the dietary guideline for alcohol consumption would silently remain in Pandora's box for 28 years, only to be awakened in this issue of Nutrition Today? (See the article by Storey and Forshee, "The Alcohol Dietary Guideline: The Way Forward.") For likely the first time since the guidelines began, serious planning for action aimed at disseminating information about the alcohol guideline is underway. Storey and Forshee's article describes some of the issues faced and actions planned for implementing this guideline among the US public. The road to implementation will be bumpy because the issues surrounding alcohol intake are complicated and prickly. They are probably the reason the guideline has remained in a box for almost 3 decades.


The guidance "If you drink alcoholic beverages, do so in moderation" has been a stable dietary guideline since 1980. Unlike the guidelines on fat intake, weight management, food safety, and physical activity, educational campaigns aimed at disseminating information about the alcohol guidelines have been minimal. Many of us know that the "moderation" part of this guideline means no more than 1 drink a day for women and no more than 2 per day for men. How many of us know the following:


* A drink, as defined by the dietary guidelines, equals 12 oz of beer, 5 oz of wine, or 1.5 oz of distilled spirits.


* There are no nutrition labeling standards for alcohol-containing beverages. (These beverages qualify as food.)


* Most of the studies used to justify the recommendation of 1 or 2 servings of alcoholic beverage per day are based on self-reported alcohol intake.



Assessments of alcohol intake by self-reports are notorious for their underestimation of intake.1 Relatively few studies on alcohol and health use objective measures (such as biomarkers) of alcohol intake.


The alcohol guideline sits on a tightrope of mixed messages that both encourage and discourage the consumption of alcoholic beverages. Even for moderate intakes, the implementation of the guideline must give adults the option to drink or not, although the health benefits related to moderate alcohol intake are real. Advice on alcohol intake must exclude people who should not drink for reasons that range from genetic predisposition toward alcoholism to age, condition, and medication use. The positive message about moderate drinking and health may get lost amid a sea of negatives potentially related to alcohol intake. Implementation of the alcohol guideline should objectively address the continuum of risks and benefits of alcohol use to the health based primarily on alcohol dose.


Like the storied contents of Pandora's box, alcohol can inflict misery, disease, and a myriad of other pains on humankind. However, moderate and responsible drinking serves as a pleasurable daily dose for the prevention and mitigation of heart disease and perhaps type 2 diabetes. Moderate alcohol intake can enhance the quality of life. It serves as a social lubricant, facilitates relaxation, and increases the enjoyment of eating. Most people who drink practice moderate and responsible consumption of alcoholic beverages. Although abused by a minority of the population, it has proved to be beneficial to most.2


Scientists, clinicians, and others working on the implementation of the alcohol guideline may be tempted to collect the vapors, stick the alcohol guideline back in the box, and close the lid. You may be heartened to know that some mythographers believe that Pandora's box was also a vessel of hope.




1. Ekholm O. Influence of the recall period on self-reported alcohol intake. Eur J Clin Nutr. 2004:58:60-63. [Context Link]


2. Hanson DJ. History of alcohol and drinking around the world. In: Preventing Alcohol Abuse: Alcohol, Culture and Control. Westport, CT: Praeger; 1995. [Context Link]