Draft Federal Study Ties Even One Daily Drink to Cancer and Chronic Disease — But It Won’t Guide New U.S. Drinking Guidelines

A federal draft study that found links between even low levels of alcohol consumption and dozens of serious illnesses will not be used to update U.S. drinking guidelines, according to the study’s authors and reporting by news outlets.

The Alcohol Intake and Health Study, a large draft federal report published for public comment in January, concluded that drinking as little as one alcoholic beverage a day was associated with elevated risks for cancers, liver cirrhosis and other chronic conditions. Authors said they had been told the study would inform the government’s new drinking guidance, but the Department of Health and Human Services and Robert F. Kennedy Jr., who oversees an HHS initiative, chose not to publish the report and instead will rely on a competing review that aligns with the existing U.S. guideline of up to one drink per day for women and up to two for men.

Priscilla Martinez, deputy scientific director at the Alcohol Research Group and an author of the draft study, said the decision to exclude the report from the guideline process was disappointing. "This report and our findings were, as we were told, going to inform the new drinking guidelines," Martinez said. "I think you generally want to have any recommendations about diet or lifestyle behaviors [to be] informed by the most sound science. And so that’s what I think is unfortunate about the [Alcohol Intake and Health Study] not being included."

The draft study, available online for public comment, reported associations between alcohol use and more than 200 health conditions, ranging from mental health disorders to heart disease, digestive disease and multiple cancers. Researchers found that risks begin at low levels of consumption: one daily drink was linked with increased odds of developing certain cancers, including breast, liver, colorectal, pharyngeal, oral cavity, laryngeal and esophageal cancers, and an increased risk of liver cirrhosis.

The study also found some complex associations. People who consumed one drink a day had a lower risk of stroke, but that benefit disappeared if they occasionally drank more than one drink in a day, the authors reported. The study documented escalating harms with greater consumption: those drinking more than seven drinks per week had an estimated 1-in-1,000 risk of dying from an alcohol-related cause, while people consuming about nine drinks per week faced an estimated 1-in-100 risk, according to the draft.

"There’s almost a 40-fold increase in risk of a man dying from an alcohol-related disease when he goes from one drink to two drinks a day," Martinez said. The draft also noted that women face higher alcohol-related cancer risks than men in many cases because of the strong link between alcohol and breast cancer.

Public health experts and clinicians stressed that alcohol’s impacts include both immediate harms — intoxication, injuries and impaired driving — and long-term chronic disease. Martinez described the distinction as "right-now effects" and "long-term effects," with the latter including the cancers and organ damage detailed in the draft. Brooke Scheller, a clinical nutritionist who is not affiliated with the study, said the draft underscores how alcohol affects mood, cognition, digestion and energy in addition to cancer risk.

The decision to sideline the draft has drawn criticism from study authors and public-health advocates, some of whom said withholding the findings is a disservice to the public. Scheller called the move "enraging" and said it raises questions about industry influence on guidance. Reporting by The New York Times said some members of the panel whose review will inform the guidelines have financial ties to the alcohol industry. HHS did not respond to a request for comment on the draft study or the process for selecting evidence to inform the guidance.

The World Health Organization classified alcoholic beverages as carcinogenic in 1988, and several countries have revised their drinking guidance in recent years. In 2022, Canada’s updated guidance lowered weekly limits, recommending that one to two drinks per week carry low risk, three to six per week moderate risk, and seven or more per week high risk — a substantial reduction from the previous guideline that mirrored current U.S. limits.

Authors of the draft study and outside experts said more transparent, rigorous use of the evidence is needed so individuals can make informed choices. "People should have access to the most rigorous information available when it comes to alcohol use and their health so they can make decisions about drinking," Martinez said.

Clinicians and advocacy groups emphasize practical steps for people seeking to reduce alcohol intake: track the number of drinks and the alcohol-by-volume (ABV) of beverages, choose lower-ABV options, set alcohol-free days during the week, and consider nonalcoholic beers, wines and mocktails. Martinez noted that many craft beers exceed the alcohol content of a standard drink; a 12-ounce beer at 5% ABV is the usual benchmark for one standard drink, so a higher-ABV beer can be the equivalent of one and a half standard drinks.

Health professionals also urged people who suspect they have alcohol use disorder to seek medical and mental-health care. In the United States, the Substance Abuse and Mental Health Services Administration operates a national helpline at 1-800-662-HELP (4357).

The unpublished draft and the competing review that will inform the U.S. guideline update reflect ongoing debates about how to weigh evidence and manage potential conflicts of interest in setting public-health recommendations. Authors of the federal draft said their findings point to risk at consumption levels lower than many Americans assume, and they urged that guidance reflect the full scope of evidence so the public can make informed decisions about alcohol and health.