Health Professionals
Adults/Consumers
Standard Drinks Model
 

IV. Moderate Beverage Alcohol Consumption in the Adult Diet

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A. Dietary Guidelines for Americans 2010 – Alcohol Guideline

The Dietary Guidelines for Americans, published every five years by the U.S. Departments of Health and Human Services and Agriculture, provides science-based advice to promote health and to reduce risk for major chronic diseases through diet and physical activity. It is useful in developing educational materials, serves as the basis for U.S. nutrition policy, and designing and implementing nutrition-related programs, including federal food, nutrition education, and information programs and helps policymakers, educators, clinicians, and others to speak with one voice on nutrition and health. It includes guidelines on all aspects of diet, nutrition and health, food groups such as grains, fruits and vegetables, fats, sugars as well as fitness and food safety (1). (A copy of the Dietary Guidelines (2010) is included in the folder at the end of this section and can be used for both educational purposes and as a handout. An online version of the is available at http://www.health.gov/dietaryguidelines)

The Dietary Guidelines for Americans has always included a guideline on beverage alcohol consumption. (The alcohol guideline is reproduced as a one page handout in Section II – The Essentials: Tools and Handouts for Patient Education.) The beverage alcohol guideline that has appeared in the Dietary Guidelines for Americans since the first edition was published in 1980 is as follows:

If you choose to drink alcohol, do so in moderation
According to the Dietary Guidelines for Americans (2010 (1)):
“Moderation is defined as the consumption of up to one drink per day for women and up to two drinks per day for men…. This definition of moderation is not intended as an average over several days but rather as the amount consumed on any single day.”

What counts as one drink?

  • 12 fluid ounces of regular beer (144 calories)
  • 5 fluid ounces of white/red wine (100/105 calories)
  • 1.5 fluid ounces of 80-proof distilled spirits (96 calories)

Why Are There Different Limits for Men and Women?

According to the National Institute on Alcohol Abuse and Alcoholism and the Dietary Guidelines for Americans (2010), the different guidelines for alcohol for men and women are based on several things (2, 3, 4):

  1. The proportion of body water to body mass is less in women than in men; because alcohol is more soluble in water than in fat, alcohol becomes more highly concentrated in women than in men.
  2. Weight and metabolism.
  3. The enzyme alcohol dehydrogenase, which breaks down the alcohol in the stomach before it reaches the bloodstream, is four times more active in males than in females.

 

B. What is a standard drink?

Alcohol Content

A standard drink of regular beer, distilled spirits and wine each contains the same amount of alcohol, approximately 0.6 fluid ounces or 14 grams (5). Standard servings for beverage alcohol are:

Standard Drink

Knowing the amount of alcohol in a standard drink is a critical aspect of responsible drinking.

According to a 2004 survey of health professionals, 95 percent of the professionals surveyed reported that it is important for people to understand the standard drink definition taught by the federal and state governments to guide responsible decisions about drinking. They also believe that their patients do not know:

  • What is a standard drink
  • A standard drink of spirits, wine and beer each contains the same amount of alcohol
  • The ethanol in all types of beverage alcohol has the same physiological effect on the body (6).

Most adults do not understand the facts of beverage alcohol equivalency. Fewer than half of all adults (41%) know that a standard drink of distilled spirits, wine and beer each contain the same amount of alcohol, according to a 2001 Gallup Poll (7). This lack of understanding may foster the misperception that different types of beverage alcohol products may have different physiological effects. The physiological effects associated with the consumption of beverage alcohol products result from the effects of ethanol on the body. The chemical composition of ethanol is exactly the same for distilled spirits, wine and beer.

Tools for Patient Education

There are several tools in Section II of the Tool Kit to assist in teaching patients about standard drinks, alcohol content, calories, and the physiological effects of beverage alcohol consumption. These include:

  • Standard Drinks: A Teaching Tool
    American Academy of Nurse Practitioners, American Academy of Physician Assistants, American Medical Women’s Association, Distilled Spirits Council of the United States, National Medical Association, Nutrition Educators of Health Professionals a Dietetic Practice Group of the American Dietetic Association, Society of Teachers of Family Medicine, United States Department of Agriculture Center for Nutrition Policy and Promotion: MyPyramid Corporate Challenge Partnership. 2008. Standard Drinks: A Teaching Tool.
  • Alcoholic Beverages – Dietary Guidelines for Americans, 2010
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2010). Alcoholic beverages. Dietary Guidelines for Americans, 2010. 7th Edition. Washington, DC: U.S. Government Printing Office.
  • Adult Beverage Consumption: Making Responsible Drinking Choices
    The American Dietetic Association. (2008). Nutrition fact sheet: Adult beverage consumption: making responsible drinking choices. Journal of the American Dietetic Association, 108(9).
  • Benefits and Dangers of Alcohol
    Hwang, M. Y., Glass, R. M., Molter, J. (1999). Benefits and dangers of alcohol. Journal of the American Medical Association, 281(1), 104.
  • Alcohol: How it All Adds Up
    National Consumers League. (2009). Alcohol: How it all adds up [Fact sheet].
  • Drinking and your pregnancy
    National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health and National Organization on Fetal Alcohol Syndrome. (1996, Revised October 2001, Updated September 2004). Drinking and your pregnancy (NIH Publication No. 96-4101) [Brochure].
  • As you Age…A guide to Aging, Medicines, and Alcohol
    U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration and Food and Drug Administration. (Reprinted 2005). As you age… A guide to aging, medicines, and alcohol (SMA# 05-3995, NCADI# PHD 1082) [Brochure].
  • Harmful interactions: Mixing alcohol with medicines
    U.S. Department of Health and Human Services, National Institutes of Health and National Institute on Alcohol Abuse and Alcoholism. (Reprinted August 2005). Harmful interactions: Mixing alcohol with medicines (NIH Publication No. 03-5329) [Brochure].

 

C. Reported health effects

Please refer to the Dietary Guidelines for Americans (2010) and other materials in the Tools for professional education provided in the folders at the end of this section for a more complete discussion of the reported health effects of beverage alcohol consumption. The summary below is taken primarily from the American Dietetic Association’s Nutrition Fact Sheet: Adult beverage consumption: Making responsible drinking choices. This fact sheet in its entirety is included in the folder at the end of this section.

Moderate Drinking and Health

Consumption of beverage alcohol can have beneficial or harmful effects depending on individual factors such as the amount consumed, age and health status, as well as the conditions under which the alcohol is consumed. According to the Dietary Guidelines (2010 (1)), “The lowest all-cause mortality occurs at an intake of one to two drinks per day. The lowest coronary heart disease mortality also occurs at an intake of one to two drinks per day. Morbidity and mortality are highest among those drinking large amounts of alcohol.”

Current research shows:

  • Light to moderate beverage alcohol consumption for some age groups may reduce the risk of heart disease, the leading cause of death in the United States (8, 9, 10, 11).
  • The reported potential benefits are associated with the ethanol (alcohol) found in all beverage alcohol products—distilled spirits, beer or wine (8, 9, 10, 11). There are also a number of other dietary and lifestyle factors associated with reducing disease (8, 9).
  • Even one drink per day can slightly increase the risk of breast cancer, according to a report from the National Institute on Alcohol Abuse and Alcoholism (NIAAA (8, 9)).
  • According to the Dietary Guidelines, moderate drinking does not affect overall diet quality and is not associated with obesity (1). Some research suggests that alcohol energy may be used differently than energy from other calories consumed. However, all alcohol drinks contain calories and heavy drinking contributes to weight gain (8, 9).
  • According to NIAAA’s The Physicians’ Guide to Helping Patients With Alcohol Problems (2000 Edition), “Most adults who drink alcohol drink in moderation and are at low risk for developing problems related to their drinking. However, all drinkers, including low-risk drinkers, should be aware of the health risks associated with alcohol consumption. Provide your patients with information and advice about the risks of drinking (12).”

Mechanism of Action for Potential Cardiovascular Benefits Associated with Moderate Beverage Alcohol Consumption

In studies by Rimm and colleagues (10, 13), the putative biological mechanisms underlying the potential cardioprotective action of alcohol are suggested to be:

  • Increase in blood High Density Lipoprotein (HDL) levels
  • Increase in apolipoprotein AI
  • Decrease in fibrinogen concentration
  • Increase in tissue type plasminogen activator antigen concentration and plasminogen concentration
  • Decrease in platelet aggregation
  • Improved insulin sensitivity

The increase in HDL, or “good cholesterol” likely accounts for most of the potential benefits to cardiovascular disease associated with moderate beverage alcohol consumption. In the case of HDL-C, the benefit is likely to be greatest for those with lower HDL-C levels. Increased HDL and other potential beneficial mechanisms listed have been shown to be associated with the ethanol in all types of beverage alcohol.

 

D. Tools for Professional Education

 

E. References

For copies of these references, please contact [email protected].

  1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2010). Dietary Guidelines for Americans, 2010. 7th Edition. Washington, DC: U.S. Government Printing Office. http://www.drinkinmoderation.org/wp-content/uploads/2012/10/2010-alcohol-DG-tear-pad-Sep-24-2012.pdf.
  2. U.S. Department of Health and Human Services, Public Health Services, National Institutes of Health and National Institute on Alcohol Abuse and Alcoholism. (1992, April). Alcohol Alert – Moderate drinking (NIAAA Publication No. 16, PH 315).
  3. U.S. Department of Health and Human Services, Public Health Services, National Institutes of Health and National Institute on Alcohol Abuse and Alcoholism. (1997, January). Alcohol Alert – Alcohol metabolism (NIAAA Publication No. 35, PH 371).
  4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2000). Nutrition and Your Health: Dietary Guidelines for Americans, 5th Edition. Washington, DC: U.S. Government Printing Office.
  5. U.S. Department of Health and Human Services, National Institutes of Health and National Institute on Alcohol Abuse and Alcoholism. (Reprinted May 2007, Updated 2005 Edition). Helping patients who drink too much: A clinician’s guide (NIH Publication No. 07-3769).
  6. American Medical Women’s Association. (2005). Press release: New survey shows that majority of doctors talk to their patients about alcohol. Alexandria, VA: American Medical Women’s Association; January 11, 2005.
  7. Multi-sponsor Surveys, Inc. The Gallup Organizations (2001). New Gallup Survey on Alcohol Equivalence.
  8. Gunzerath, L., Faden, V., Zakhari, S., Warren, K. (2004). National Institute on Alcohol Abuse and Alcoholism report on moderate drinking. Alcohol Clinical and Experimental Research, 28(6), 829-847.
  9. U.S. Department of Health and Human Services, National Institutes of Health, and National Institute on Alcohol Abuse and Alcoholism. (2003). State of the science report on the effects of moderate drinking.
  10. O’Keefe, J. H., Bybee, K. A., Lavie, C. J. (2007). Alcohol and cardiovascular health: The razor-sharp double-edged sword. J Am Coll Cardiol, 50(11), 1009-1014.
  11. Mukamal, K. J., Chung, H., Jenny, N. S., Kuller, L. H., Longstreth, W. T., Mittleman, M. A., Burke, G. L., Cushman, M., Psaty, B. M., Siscovick, D. S. (2006). Alcohol consumption and risk of coronary heart disease in older adults: The cardiovascular health study. J Am Geriatr Soc, 54, 30-37.
  12. U.S. Department of Health and Human Services, National Institutes of Health, and National Institute on Alcohol Abuse and Alcoholism. (Updated March 2000, Printed 1995). The physician’s guide to helping patients with alcohol problems (NIH Publication No 95-3769).
  13. Rimm, E. B., Williams, P., Fosher, K., Criqui, M., Stampfer, M. J. (1999). Moderate alcohol intake and lower risk of coronary heart disease: Meta-analysis of effects on lipids and haemostatic factors. British Medical Journal, 319, 1523-1528.