Jessica Mellinger, MD, is a senior staff hepatologist at Henry Ford Health.

Jessica Mellinger, MD

Why Alcohol Recommendations in the New Dietary Guidelines Fall Short

In this segment from the latest episode of 

Liver Lineup: Updates & Unfiltered Insights

, the conversation around the newly updated US Dietary Guidelines turns to one of their most debated and most limited areas: alcohol.

While the guidelines emphasize reducing ultra-processed foods, Kimberly Brown, MD, presses the panel on whether there was a similarly clear message when it came to alcohol consumption. According to guest Jessica Mellinger, MD, the answer is yes, but only in the broadest sense.

“The message on alcohol was pretty limited,” Mellinger explains. “It was basically: drink less.”

While she says she does not disagree with that recommendation, she notes that the guidance lacks specificity and clinical nuance, particularly for patients with liver disease or conditions known to increase alcohol-related risk. Compared with prior guidelines, which defined “moderate” drinking using sex-based thresholds, the updated recommendations remove specific quantities altogether, reflecting a growing body of evidence suggesting that even low levels of alcohol consumption are associated with adverse health outcomes.

Mellinger highlights cancer risk as one of the most consistent findings in the literature, noting that alcohol is a known carcinogen with measurable associations even at low intake levels. Although certainty diminishes at lower levels of consumption, the overall trend has been toward recommending less alcohol across populations. From a hepatology standpoint, she emphasizes that this shift aligns with what clinicians increasingly see in practice.

However, Mellinger views the updated guidance less as a comprehensive directive and more as a starting point for individualized clinical conversations. In her alcohol-associated liver disease clinic, discussions often extend well beyond quantity and frequency, focusing instead on how alcohol affects a patient’s health, relationships, and quality of life.

From her perspective, there is no safe level of alcohol consumption she can ethically recommend to patients with liver disease based on the available data. Rather than offering reassurance around low-level use, she encourages clinicians to meet patients where they are, exploring motivation, readiness for change, and realistic next steps toward reduction or abstinence.

Nancy Reau, MD, adds that important at-risk populations remain absent from the public-facing guidance. Beyond pregnancy, she notes that patients who have undergone gastric bypass surgery represent another growing group for whom alcohol use carries significant risk, yet they are not explicitly addressed.

Ultimately, the panel agrees that while “drink less” may be an appropriate population-level message, it leaves critical gaps for clinicians to fill.

Editors’ Note: Relevant disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal. Relevant disclosures for Mellinger include GlaxoSmithKline. Van Jacobs reports no relevant disclosures.

Brooks A. New Dietary Guidelines Draw Criticism For High Fat Dairy, Protein Recommendations. HCPLive. January 8, 2026. Accessed February 9, 2026. 

https://www.hcplive.com/view/new-dietary-guidelines-draw-criticism-high-fat-dairy-protein-recommendations

AASLD. AASLD Raises Concern Over Removal of Evidence-Based Alcohol Guidance in 2025–2030 Dietary Guidelines for Americans. January 9, 2026. Accessed February 9, 2026. 

https://www.aasld.org/aasld-raises-concern-over-removal-evidence-based-alcohol-guidance-2025-2030-dietary-guidelines

Videos

In this segment of a Liver Lineup episode, experts discuss where the new US Dietary Guidelines miss the mark for alcohol recommendations.

Liver Lineup: Nutrition, Alcohol, and Liver Health in the New Dietary Guidelines

Liver Lineup: Updates and Unfiltered Insights

, hosts Nancy Reau, MD, and Kimberly Brown, MD, are joined by 2 experts from their respective institutions to unpack the implications of the newly released US Dietary Guidelines and what they mean for patients with liver disease. Amanda Van Jacobs, MS, RDN, a transplant dietitian at Rush University Medical Center, and Jessica Mellinger, MD, a transplant hepatologist at Henry Ford Health specializing in alcohol-associated liver disease, offer a nuanced, clinically grounded discussion that moves beyond headlines to practical patient care.

The conversation opens with a breakdown of what has changed in the most recent dietary guidelines, including the shift in visual messaging from the familiar “MyPlate” to a new inverted pyramid. Van Jacobs highlights one of the most consequential updates for hepatology: a substantial increase in recommended protein intake, a change with important implications for patients with cirrhosis, sarcopenia, and metabolic dysfunction-associated steatotic liver disease (MASLD).

At the same time, the panel grapples with internal inconsistencies in the guidelines, including the prominent placement of red meat, full-fat dairy, butter, and beef tallow alongside continued recommendations to limit saturated fat to < 10% of daily calories.

A major throughline of the discussion is the guidelines’ strongest and clearest message: reduce ultra-processed foods. Van Jacobs and Brown emphasize the need to educate patients on what “ultra-processed” actually means, distinguishing these foods from minimally processed options such as frozen vegetables or packaged nuts. The group underscores that without this context, visual guidelines risk being misinterpreted, leading patients to add recommended foods on top of an already calorie-dense, highly processed diet rather than replacing unhealthy staples.

Mellinger then turns the focus to alcohol guidance, which she describes as notably sparse. While the updated guidelines broadly recommend “drinking less,” they remove specific thresholds and fail to address liver disease directly.

Drawing on evidence from hepatology and oncology, Mellinger reinforces that there is no safe level of alcohol consumption she can recommend for patients with liver disease, and stresses the importance of individualized conversations that consider total health risk, not just cardiovascular outcomes.

Across nutrition and alcohol use, the panel converges on a shared conclusion: guidelines are a starting point, not a substitute for clinician-led education. Meaningful progress, they argue, will require clearer public messaging, earlier education, and systemic changes that address how food and alcohol are marketed, consumed, and understood.

Brooks A. New Dietary Guidelines Draw Criticism For High Fat Dairy, Protein Recommendations. HCPLive. January 8, 2026. Accessed February 4, 2026. 

AASLD. AASLD Raises Concern Over Removal of Evidence-Based Alcohol Guidance in 2025–2030 Dietary Guidelines for Americans. January 9, 2026. Accessed February 4, 2026. 

Podcasts

Reau and Brown are joined by Amanda Van Jacobs, MS, RDN, and Jessica Mellinger, MD, to discuss the new dietary guidelines through the lens of liver health.

Liver Lineup: Unmet Needs and Evolving Standards in Alcohol-Associated Liver Disease, With Jessica Mellinger, MD

, hosts Nancy Reau, MD, and Kimberly Brown, MD, are joined by guest Jessica Mellinger, MD, to discuss rising prevalence, new care models, and evolving concepts in alcohol-associated liver disease (ALD).

Mellinger begins by addressing the troubling rise in alcohol use and ALD. Despite widespread healthcare engagement, she says patients with ALD are often diagnosed late, underscoring the need for proactive screening approaches that combine assessments of both liver health and alcohol use. She also notes that defined screening models and pathways developed for MASLD could be adapted for ALD to improve early identification and intervention.

A key part of the discussion centers on Mellinger’s pioneering integrated clinic model, which brings hepatology and addiction psychiatry together in a single, co-located setting. She explains that addressing liver health and alcohol use disorder alongside underlying drivers such as anxiety, depression, insomnia, and chronic pain is critical—and that siloed systems of care have historically failed these patients.

The conversation also explores the emergence of MetALD and the overlap between metabolic and alcohol-associated liver disease. Mellinger notes that while definitions continue to evolve, understanding the interplay between metabolic dysfunction and alcohol use will be essential for tailoring therapies. GLP-1 receptor agonists, already transforming the metabolic liver disease landscape with the recent FDA approval of semaglutide for MASH, are showing early promise for ALD as well, with some patients reporting reduced alcohol cravings and improved liver parameters.

Turning to transplantation, Mellinger reflects on the progress since the Dallas Criteria were introduced, highlighting shifting attitudes toward early liver transplant in carefully selected patients. She stresses the importance of moving beyond rigid sobriety thresholds toward a more patient-centered approach focused on post-transplant support and relapse management.

The trio emphasizes that progress in alcohol-associated liver disease depends on bridging the long-standing divide between hepatology and addiction medicine. With integrated care models gaining traction, evolving definitions like MetALD reshaping clinical thinking, and novel therapeutics such as GLP-1 receptor agonists offering new hope, the field may be entering a pivotal era.

Editors’ Note: Editors’ note: Relevant disclosures for 

 include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for 

 include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal. Relevant disclosures for 

Brooks A. FDA Approves Semaglutide (Wegovy) Injection 2.4 mg for Noncirrhotic MASH. HCPLive. August 15, 2025. Accessed October 14, 2025. 

https://www.hcplive.com/view/fda-approves-semaglutide-wegovy-injection-2-4-mg-for-noncirrhotic-mash

Asrani SK, Trotter J, Lake J, et al. Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis. Liver Transpl. 2020;26(1):127-140. 

Mellinger joins Liver Lineup to discuss current shortcomings in ALD diagnosis and care, the importance of addressing underlying alcohol use disorder, and more.

Jessica Mellinger, MD

Articles