Misguided USDA Guidelines Regarding Alcohol Need to be Fixed

décembre 10, 2025 | Articles, Featured Articles

By Michael Apstein

Editor’s Note: For this scientifically oriented article, I should note up-front the credentials of WRO’s Senior Columnist Michael Apstein, MD, FACG. Dr. Apstein is a gastroenterologist at the Beth Israel Deaconess Medical Center in Boston, a Fellow of the American College of Gastroenterology, and an Assistant Professor of Medicine at the Harvard Medical School. ~MF

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Focusing on what’s in the glass instead of what’s in the blood explains why the current U.S. Department of Agriculture guidelines regarding alcohol consumption – two drinks per day for men and one drink per day for women is considered safe – get it wrong. Since the federal government is currently updating its dietary guidelines, now is a good opportunity to get it right.

Blood alcohol is the elephant in the room.

Blood alcohol determines the harm or putative benefit of alcohol. Whether you drink wine or whiskey – and whether you drink that wine or whiskey during a leisurely dinner or rapidly at a party – determines your blood alcohol level. Current USDA guidelines treat all alcohol the same. And chemically it is, whether it comes from wine or whiskey. But the setting determines what winds up in your bloodstream and that’s where the money is.

Blood alcohol, that is the level of alcohol in the blood – and/or maybe in the intestine as well—determines the harm or putative benefit of alcohol. The level of alcohol in the blood over time eventually determines whether people develop liver disease, breast cancer, or other illnesses, or whether they might be protected from heart or other diseases. Nowhere do government or public health guidelines account for the importance of blood alcohol, except, of course, in relation to driving a vehicle. That’s understandable because measuring blood alcohol levels regularly, especially in a group of people, is impractical. That said, overlooking the fundamental importance of blood alcohol is why current guidelines make no sense.

Blood alcohol levels differ vastly depending on whether you drink wine or spirits. That’s why conflating wine with other alcoholic beverages is fundamentally mistaken. Most importantly, lumping wine and spirits together distorts public health policy and undermines the advice public health organizations provide regarding alcohol consumption. Equally important, this simplistic advice fails to educate people about the importance of moderate and thoughtful consumption.

The numbers expose the foolishness of the U.S. guidelines. What happens to those 14 grams of pure ethanol, the amount of alcohol contained in what the government calls “one standard drink,” when they are consumed quickly as one 1.5-ounce shot of 80 proof Tequila or Bourbon, or as one five-ounce glass of a 12 percent Pinot Noir sipped over 15 minutes? The hypothetical 155-pound male winds up with about a 40 percent higher blood alcohol level after drinking the Tequila compared to drinking Pinot Noir. The difference shows the enormous effect between differing beverages you may consume will have on your blood alcohol level.

Even seemingly small changes in the alcohol content of wine influences blood alcohol level more than you might think. For example, shifting from drinking a racy, dry Saumur Blanc containing 12 percent alcohol to a Napa Cab containing 15 percent alcohol – a 25 percent increase in alcohol concentration – increases blood alcohol concentration not by 25 percent…but by 35 percent.

It’s easy to explain why that shot of 80-proof Tequila or Bourbon increases blood alcohol levels more than wine.

The higher concentration of alcohol in a spirit like Tequila outstrips the liver’s ability to metabolize it, so more winds up in the blood. So, is a glass of wine equivalent to a shot of Tequila? The total content of alcohol is the same – each has 14 grams of alcohol – but their effects on your brain, liver, risk of cancer, and their putative benefit to your cardiovascular system is clearly not equivalent, simply because the blood alcohol level differs enormously due to differing patterns of consumption in differing settings.

Regarding “differing settings,” let’s add food consumption to the comparison. After consuming two shots of Tequila before dinner on an empty stomach, the same hypothetical 155-pound male will have a blood alcohol level about two and half times higher than that of someone who drank two 5-ounce glasses of 12 percent Pinot Noir over two hours with dinner. That’s because alcohol is absorbed into the blood more slowly when food is present in the stomach. And our hypothetical drinker is consuming wine, with its lower concentration of alcohol, over a longer period, which also slows alcohol’s absorption. How can the “two drink” rule possibly make sense when the setting variable almost invariably results in vastly different blood alcohol levels? The U.S. guidelines state that two drinks per day for a man is safe. But that only prompts the question – two drinks under what circumstances or in what setting?

Let’s look at data when investigators quantify what and how people drank. Most of the studies compare the effects of consuming wine versus spirits. There could be similar differences comparing consumption of beer or other alcoholic beverages with spirits, but the scientific studies are more limited.

Thirty years ago, investigators from Denmark showed that wine drinkers had a lower risk of death and severe cardiovascular disease compared to those who drank spirits. (Grønbaek et al., British Medical Journal, 1995). The authors confirmed and extended their findings in a subsequent article (Grønbaek et al., Annals of Internal Medicine; 2000).

More recently, a study from the U.K. showed that individuals drinking wine regularly with food (especially red wine) had a lower risk compared to those who drank spirits of either stroke or heart attack as well as death after seven years. (Dinesh et al.; BMC Medicine, 2021).

Drinking wine or drinking wine with meals, compared to other types of alcohol intake, was associated with lower overall death rates and with lower death rates specifically from cancer and cardiovascular disease, according to a recently published study by investigators from Spain and the Harvard T.H. Chan School of Public Health. (Ortolá et al.; JAMA Network Open, 2024).

At a molecular level, investigators showed that red wine, but not vodka, stimulated production of an enzyme in humans that protects against oxidative stress in cells. (Di Renzo et al., Oxidative Medicine and Cellular Longevity, 2018).

Investigators from Spain (Dominguez-Lopez et al.; European Heart Journal, 2025) used a unique and objective measure of wine consumption, namely, urinary tartaric acid concentration, as opposed to asking people how much wine they drank. The research results showed convincingly that light to moderate – but not heavy – wine consumption was associated with a reduction in cardiovascular disease in a Mediterranean population at high risk of heart disease.

The studies cited above are but a few of many in the scientific literature that distinguish between the effects of wine and spirits on health.

It is important to point out that these studies only report associations. They do not establish cause and effect.

You cannot conclude from these studies that moderate consumption of wine with meals will reduce heart attacks, stroke and death from all causes. Whether the reduction in death and cardiovascular disease is due to wine per se or the type of person who drinks wine moderately with meals—a person who is typically more affluent and may have better overall health habits in general—is still unknown. However, these studies do point out that the consumption of wine and spirits have different effects on health and disease.

These studies do indeed suggest strongly that consumption of wine and spirits have significantly different effects on health and disease.

Distilling down a complex issue to a simplistic “one-drink, two-drink” guideline is bad public health advice. Updated guidelines need to correct it, and could start here:

• If you drink, chose beverages like wine that have a lower concentration of alcohol.

• Drink moderately, slowly, and with food. Avoid becoming intoxicated.

• Never binge drink. Binge drinking is always harmful and dangerous.

• Check your blood alcohol level before you drive, and don’t drive if your level is above the legal limit even if you “feel fine.” Remember, services like Uber, Lyft and local taxis are readily available in most locations.

• If you do not drink now, do not start with the intention of improving your health.

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Nothing in this article should be construed as medical advice. The opinions in this article are mine and mine alone, and do not represent the opinions or advice of the Beth Israel Deaconess Medical Center, the American College of Gastroenterology, or the Harvard Medical School.

décembre 10, 2025