American Cancer Society Update: 'It Is Best Not to Drink Alcohol'

Roxanne Nelson, RN, BSN

June 09, 2020

In updated cancer prevention guidelines released today, the American Cancer Society (ACS) now recommends that "it is best not to drink alcohol."

Previously, ACS suggested that for those who consume alcoholic beverages, intake should be no more than 1 drink per day for women or 2 per day for men. That recommendation is still in place, but is now accompanied by this new, stronger directive.

The guidelines, revised for the first time since 2012, also place more emphasis on reducing the consumption of processed and red meat and highly processed foods, and on increasing physical activity.

Asked for independent comment, Steven K. Clinton, MD, PhD, associate director of the Center for Advanced Functional Foods Research and Entrepreneurship at the Ohio State University, Columbus, explained that he didn't view the change in alcohol as that much of an evolution. "It's been 8 years since they revised their overall guidelines and during that time frame, there has been an enormous growth in the evidence that has been used by many organizations," he said.

But importantly, there is also a call for action from public, private, and community organizations to work to together to increase access to affordable, nutritious foods and physical activity.

"Making healthy choices can be challenging for many, and there are strategies included in the guidelines that communities can undertake to help reduce barriers to eating well and physical activity," said Laura Makaroff, DO, American Cancer Society senior vice president.

The guidelines were published today in CA: A Cancer Journal for Clinicians.

The link between cancer and lifestyle factors has long been established, and for the past 4 decades both government and leading nonprofit health organizations, including the ACS and the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), have released cancer prevention guidelines and recommendations that focus on managing weight, diet, physical activity, and alcohol consumption.

In 2012 the ACS issued guidelines on diet and physical activity, and their current guideline is largely based on the WCRF/AICR systematic reviews and Continuous Update Project reports, which were last updated in 2018. The ACS guidelines also incorporated systematic reviews conducted by the International Agency on Cancer Research (IARC) and the US Departments of Agriculture and Health and Human Services (USDA/HHS), and other analyses that were published since the WCRF/AICR recommendations were released.

Emphasis on Three Areas

The differences between the old guidelines and the update do not differ dramatically, but Makaroff highlighted a few areas that have increased emphasis.

An area that Makaroff highlighted is alcohol, where the recommendation is to avoid or limit consumption. "The current update says not to drink alcohol, which is in line with the scientific evidence, but for those people who choose to drink alcohol, to limit it to one drink per day for women and two drinks per day for men."

Thus, the change here is that the previous guideline only recommended limiting alcohol consumption, whereas the update suggests that, optimally, it should be avoided completely.

Time spent being physically active is critical. The recommendation has changed to encourage adults to engage in 150 to 300 minutes (2.5 to 5 hours) of moderate-intensity physical activity, or 75 to 150 minutes (1.25 to 2.5 hours) of vigorous-intensity physical activity, or an equivalent combination, per week. Achieving or exceeding the upper limit of 300 minutes is optimal.

"That is more than what we have recommended in the past, along with the continued message that children and adolescents engage in at least 1 hour of moderate- or vigorous-intensity activity each day," she told Medscape Medical News.

The ACS has also increased emphasis on reducing the consumption of processed and red meat. "This is part of a healthy eating pattern and making sure that people are eating food that is high in nutrients that help achieve and maintain a healthy body weight," said Makaroff.

A healthy diet should include a variety of dark green, red, and orange vegetables; fiber-rich legumes; and fruits with a variety of colors and whole grains, according to the guidelines. Sugar-sweetened beverages, highly processed foods and refined grain products should be limited or avoided.

The revised dietary recommendations reflect a shift from a "reductionist or nutrient-centric" approach to one that is more "holistic" and that focuses on dietary patterns. In contrast to a focus on individual nutrients and bioactive compounds, the new approach is more consistent with what and how people actually eat, ACS points out.

The ACS has also called for community involvement to help implement these goals: "Public, private, and community organizations should work collaboratively at national, state, and local levels to develop, advocate for, and implement policy and environmental changes that increase access to affordable, nutritious foods; provide safe, enjoyable, and accessible opportunities for physical activity; and limit alcohol for all individuals."

No Smoking Guns

Clinton noted that the guidelines are consistent with the whole body of current scientific literature. "It's very easy to go to the document and look for the 'smoking gun' ­— but the smoking gun is really not one thing," he said. "It's a pattern, and what dieticians and nutritionists are telling people is that you need to orchestrate a healthy lifestyle and diet, with a diet that has a foundation of fruits, vegetables, whole grains and modest intake of refined grains and meat. You are orchestrating an entire pattern to get the maximum benefit."

Makaroff is an employee of the ACS. Clinton has disclosed no relevant financial relationships.

CA Cancer J Clin. Published online June 9, 2020. Full text

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