The Nutrition Taskforce, which I chaired, agonised over recommendations for alcohol drinking.

After prolonged consideration, we agreed to the statement “If you drink alcohol, do so in moderation” with intake recommendation to limit alcohol intake to (or less than) 20 grams per day for women and 30 grams per day for men.1

The statement has remained the same in subsequent revisions, although there has been some variation in intake recommendations (up to 40 grams per day). The variation in the base statement that I would now wish is the addition of the words “preferably with food”.

In a recent paper published in your Journal,2 the authors calculate (from undeclared data, much reasoning, and the use of accepted analytical methodology) very precise conclusions purporting to accurately represent The burden of death, disease, and disability due to alcohol in New Zealand.

For many, but not all of the listed “alcohol related conditions included in the study”, there is a body of literature supporting benefits with moderate intakes. These benefits risk change to harm after an intake threshold is exceeded. Others conditions have no discernible alcohol benefit at moderate intakes and in others there are marginal, difficult to quantify adverse effect of low to moderate intakes. There are thus two populations which need separate analysis.

A provocative conclusion of this paper is “there are no health benefits before middle age”. In fact, it is likely that the demonstrated benefits may occur earlier in life. Most degenerative diseases such as coronary artery disease become manifest in middle or old age after a long incubation. The initiation of deterioration is due to multiple factors including adverse life styles. Surrogate markers may be present long before clinical disease is evident and provide an opportunity for an early insight into the evolution of risk factors and their relationship to alcohol intake.

There is a substantial literature directed to the effects of alcohol on disease risk markers. Most, but not all, suggest moderate alcohol intake is beneficial. I list a small sample3–6 A number of these studies include some younger adults but few focus specifically on moderate young adult drinkers.

Younger drinkers are usually the research target of studies of binge drinking and overall high alcohol intake.7 High alcohol intakes, especially if ingested rapidly (binging), is hazardous with risk of serious adverse social and long-term health consequences. The intake threshold for adverse events is generally considered to be about 60 grams of alcohol in 1 day, but for some people it may be lower. There are two results of inappropriate alcohol use; unsafe social behaviours (particularly in the young), and medical problems with loss of life at an older age. The benefits of moderate drink apply to all age groups.

I believe that the base alcohol guideline recommended by the Nutrition Taskforce is validated. The guideline would be strengthened by the addition of “preferably with food”, a concept supported by published evidence8,9 and offers a pleasurable approach to foster a culture of moderate drinking for those who choose to drink alcohol.