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.

Check out the full episode here.

“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.

References

1. 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

2. 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