Alcohol consumption recommendations

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Cancers-associated-with-drinking-alcohol-infographic.jpg

Recommendations for consumption of the drug alcohol (also known formally as ethanol) vary from recommendations to be alcohol-free to daily or weekly drinking "safe limits" or maximum intakes. Many governmental agencies and organizations have issued guidelines. These recommendations concerning maximum intake are distinct from any legal restrictions, for example countries with drunk driving laws or countries that have prohibited alcohol. To varying degrees, these recommendations are also distinct from the scientific evidence, such as the short-term and long-term effects of alcohol consumption. [1] From a scientific and medical standpoint, the World Health Organization recommendation is teetotalism, with this being published in The Lancet in April 2023: "there is no safe amount [of alcohol] that does not affect health". [2]

Contents

General recommendations

These guidelines apply to men and women who don't belong to populations with more specific advice.

Teetotalism advocacy by organization

Share of over-fifteen-year-old population who haven't drunk alcohol in the past year (interactive version); in most countries, it exceeds a third. Share of adults who have not drank alcohol in last year, OWID.svg
Share of over-fifteen-year-old population who haven't drunk alcohol in the past year (interactive version); in most countries, it exceeds a third.
Alcohol consumption per person in 2016. Consumption of alcohol is measured in liters of pure alcohol per person aged 15 or older. AlcoholPerCapita.jpg
Alcohol consumption per person in 2016. Consumption of alcohol is measured in liters of pure alcohol per person aged 15 or older.

Some governments set the same recommendation for both sexes, while others give separate limits. The guidelines give drink amounts in a variety of formats, such as standard drinks, fluid ounces, or milliliters, but have been converted to grams of ethanol for ease of comparison.

Approximately one-third of all countries advocate for complete alcohol abstinence, while all nations impose upper limits on alcohol consumption. Their daily limits range from 10-48 g per day for both men women, and weekly limits range from 27-196 g/week for men and 27-140 g/week for women. The weekly limits are lower than the daily limits, meaning intake on a particular day may be higher than one-seventh of the weekly amount, but consumption on other days of the week should be lower. The limits for women are often but not always lower than those for men.

Country (or region)Teetotalism recommendedLow riskMedium to risky drinkingHeavy drinkingDetails
DayWeekDayWeekDayWeekMonth
MenWomenMenWomenMenWomenMenWomenMenWomenMenWomenMenWomen
Australia40 g100 gReference. [9] [10]
Austria24 g16 g
Canada"Not drinking has benefits, such as better health, and better sleep." [11] 40.35 g with no more than 5 drinking days per week per the federal government26.9 g with no more than 5 drinking days per week per the federal government27 g, CCSUA; 201.75g, federal government27 g, CCSUA; 134.5g, federal government53.8 g on special occasions per the federal government40.35 g on special occasions per the federal governmentThe Canadian Centre on Substance Use and Addiction has a sliding scale of intakes.
The scale states that at 27 g or less per week, "you are likely to avoid alcohol-related consequences for yourself or others". [11] However, the Canadian Government has not officially adopted the Centre's recommendations and the 2011 guidelines remain federal policy. [12] [13]
Czech Republic24 g16 g
Denmark48 g120 gReference. [14]
Finland168 g84 gReference. [15]
GermanyAlcoholic beverages pose health risks and ideally should be avoided completely. [16] The German Centre for Addiction Issues recommends everyone to reduce alcohol consumption, regardless of the amounts consumed. [16]
Hong Kong20 g10 gReference. [17]
Iceland32 g"Stop drinking before reaching five drinks on the same occasion". 1 standard drink in Iceland = 8 g ethanol. 8 g x 4 drinks = 32 g. [18]
Ireland170 g140 gReference. [19]
Italy24 g12 gReference. [20]
Japan40 g20 gReference. [21]
NetherlandsRecommends an alcohol consumption level of zero grams.10 g"The Health Council of the Netherlands included a guideline for alcohol consumption in the Dutch dietary guidelines 2015 (DDG-2015), which is as follows: ‘Don’t drink alcohol or no more than one glass daily’." "In the Netherlands, one regular glass of an alcoholic beverage contains approximately 10 grammes (12 millilitre) alcohol." [22]
New Zealand30 g20 g150 g100 g50 g40 gAt least two alcohol-free days every week. 30 g for men, 20 g for women To reduce long-term health risks [23] 50 g for men, 40 g for women On any single occasion, to reduce risk of injury. [23]
Norway20 g10 gReference. [24]
Poland40 g20 gMaximum 5 drinking days per week. Reference. [25]
Portugal37 g18.5 gReference. [26]
Spain30 g20 gAlso suggests a maximum of no more than twice this on any one occasion. [26]
Sweden"Not possible to specify a limit for risk-free alcohol consumption." [27] 48 g120 gThe National Board of Health and Welfare defines risky consumption as 10 (Swedish) standard drinks per week (120 g), and 4 standard drinks (48 g) or more per occasion, once per month or more often.
Alcohol intervention is offered for people who exceed these recommendations. [27]
Switzerland30 g20–24 gReference. [28]
United Kingdom"There's no completely safe level of drinking." [29] 112 g a week, spread across 3 days or more.Reference. [29]
USA"People who do not drink should not start drinking for any reason." (DGA) [30] "Adults of legal drinking age can choose not to drink." (DGA) [31] 14-28 g (1-2 US standard drinks) (DGA) [a] 14 g (1 US standard drink) (DGA) [a] 0.08% BAC (NIAAA), or 70 g (SAMHSA)0.08% BAC (NIAAA), or 56 g (SAMHSA)70 grams (5 US standard drinks) or more in a single day) (NIAAA)56 grams (4 US standard drinks) or more in a single day) (NIAAA)210 g (15 US standard drinks) (NIAAA)112 g (8 US standard drinks) (NIAAA)Five binge drinking sessions, each involving 70 grams (5 US standard drinks) of alcohol (SAMHSA).Five binge drinking sessions, each involving 56 grams (4 US standard drinks) of alcohol (SAMHSA)References: CDC. [32] NIAAA, SAMHSA. [33] 2020-2025 Dietary Guidelines for Americans [a]
Notes
  1. 1 2 3 "The Committee recommended that adults limit alcohol intake to no more than 1 drink per day for both women and men for better health)" [34] "For those who choose to drink, intakes should be limited to 1 drink or less in a day for women and 2 drinks or less in a day for men, on days when alcohol is consumed." [31] "Alcohol has been found to increase risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day). Caution, therefore, is recommended." [31] "Drinking less is better for health than drinking more." [31]

By study

Emerging evidence suggests that "even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer". It is not clear that alcohol has any beneficial effects, [35] as the better health outcomes that some studies reported may be due not to alcohol consumption itself but instead be caused by "other differences in behaviors or genetics between people who drink moderately and people who don't". [36] At 20 g/day (1 large beer), the risk of developing an alcohol use disorder (AUD) is nearly 3 times higher than non-drinkers, and the risk of dying from an AUD is about 2 times higher than non-drinkers. [37] One systematic analysis found that "The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week". [38] Supposing the apparent beneficial effects found in observational studies are genuine, these effects are maximized at relatively low levels of consumption, ranging from 1-18 g/day depending on age, location, and gender. [39]

Specific populations

Pregnant women

A label on alcoholic drinks promoting zero alcohol during pregnancy Zero alcool pendant la grossesse.svg
A label on alcoholic drinks promoting zero alcohol during pregnancy

Excessive drinking during pregnancy, especially in the first eight to twelve weeks, is associated with fetal alcohol spectrum disorders such as abnormal appearance and behavioral problems. Most guidelines state that no safe amount of alcohol consumption has been established and recommend that pregnant women abstain entirely from alcohol. [40] [41] As there may be some weeks between conception and confirmation of pregnancy, most guidelines also recommend that women trying or likely to become pregnant should avoid alcohol as well.

Breastfeeding women

Moderate alcohol consumption by breastfeeding mothers can significantly affect infants. Even one or two drinks, including beer, may reduce milk intake by 20 to 23%, leading to increased agitation and poor sleep patterns. Regular heavy drinking (more than two drinks daily) can shorten breastfeeding duration and cause issues in infants, such as excessive sedation, fluid retention, and hormonal imbalances. Additionally, higher alcohol consumption may negatively impact children's academic achievement. [52]

Minors

Countries have different recommendations concerning the administration of alcohol to minors by adults.

Former alcoholics

Elderly

Caveats

Risk factors

The recommended limits for daily or weekly consumption provided in the various countries' guidelines generally apply to the average healthy adult. However, many guidelines also set out numerous conditions under which alcohol intake should be further restricted or eliminated. They may stipulate that, among other things, people with liver, kidney, or other chronic disease, cancer risk factors, smaller body size, young or advanced age, those who have experienced issues with mental health, sleep disturbances, alcohol or drug dependency or who have a close family member who has, or who are taking medication that may interact with alcohol, [60] or suffering or recovering from an illness or accident, are urged to consider, in consultation with their health professionals, a different level of alcohol use, including reduction or abstention.

Activities

Furthermore, the maximum amounts allowed do not apply to those involved with activities such as operating vehicles or machinery, risky sports or other activities, or those responsible for the safety of others. [61] [62] [63]

Moreover, studies suggest even moderate alcohol consumption may significantly impair – neurobiologically beneficial and -demanding – exercise (possibly including the recovery and adaptation). [64] [65] [66] [67]

Drinking patterns

As of 2022, moderate consumption levels of alcoholic beverages are typically defined in terms of average consumption per day or week. However, drinking pattern (i.e. frequency, timing and dosage/intensity) is also significant. [36] Although countries define binge drinking in different ways, the consensus recommendation is to avoid any form of binge drinking pattern, in addition to not exceeding the daily or weekly limit. [68] Studies analyzing binge drinking have consistently found negative effects. Although there are few studies or guidelines on moderate consumption patterns, [69] the general advice is that one should spread out consumption as evenly as possible, if one is consuming a fixed amount. [29]

However, it is also easy, when drinking daily, to become habituated to alcohol's effects (consumption-induced tolerance). [70] Most people cannot accurately judge how much alcohol they are consuming, [71] particularly relative to the amounts specified in guidelines. Alcohol-free days provide a baseline and help people cut down on problematic drinking. [29] One review showed that among drinkers (not limited to moderate consumption levels), daily drinking in comparison to non-daily drinking was associated with incidence of liver cirrhosis. [72]

Alcohol promotion recommendations

Polymeal and most versions of the Mediterranean diet recommend a moderate amount of red wine, such as 150 mL (about one glass) every day, in combination with other several food items. Since about 2016, the American Heart Association and American Diabetes Association have recommended the Mediterranean diet as a healthy dietary pattern that may reduce the risk of cardiovascular diseases and type 2 diabetes, respectively. [73] [74] [75] [76] The United Kingdom's National Health Service also recommends a Mediterranean diet to reduce cardiovascular disease risk. [77] [78] The WHO has stated that there is currently no conclusive evidence that the potential benefits of moderate alcohol consumption for cardiovascular disease and type 2 diabetes outweigh the increased cancer risk associated with these drinking levels for individual consumers. [79] A trial in Spain is expected to complete in 2028. [80]

Units and standard drinks

Guidelines generally give recommended amounts measured in grams (g) of pure alcohol per day or week. Some guidelines also express alcohol intake in standard drinks or units of alcohol. The size of a standard drink varies widely among the various guidelines, from 8g to 20g, as does the recommended number of standard drinks per day or week. [28] [81] The standard drink size is not meant as recommendations for how much alcohol a drink should contain, but rather to give a common reference that people can use for measuring their intake, though they may or may not correspond to a typical serving size in their country. [82]

See also

References

Explanatory notes

    Citations

    1. ↑ Armstrong, Elizabeth Mitchell (2017). "Making Sense of Advice About Drinking During Pregnancy: Does Evidence Even Matter?". The Journal of Perinatal Education. 26 (2): 65–69. doi:10.1891/1058-1243.26.2.65. PMC   6353268 . PMID   30723369.
    2. 1 2 "No level of alcohol consumption is safe for our health". www.who.int. Archived from the original on 12 January 2023. Retrieved 25 September 2023.
    3. ↑ Arora, Monika; ElSayed, Ahmed; Beger, Birgit; Naidoo, Pamela; Shilton, Trevor; Jain, Neha; Armstrong-Walenczak, Kelcey; Mwangi, Jeremiah; Wang, Yunshu; Eiselé, Jean-Luc; Pinto, Fausto J.; Champagne, Beatriz M. (22 July 2022). "The Impact of Alcohol Consumption on Cardiovascular Health: Myths and Measures". Global Heart. 17 (1): 45. doi: 10.5334/gh.1132 . ISSN   2211-8179. PMC   9306675 . PMID   36051324.
    4. ↑ Salamon, Maureen (1 May 2022). "Want a healthier heart? Seriously consider skipping the drinks". Harvard Health. Archived from the original on 31 May 2024. Retrieved 31 May 2024.
    5. ↑ "Less meat, more plant-based: Here are the Nordic Nutrition Recommendations 2023". www.norden.org. Archived from the original on 22 September 2023. Retrieved 25 September 2023.
    6. ↑ Mechanick, Jeffrey I.; Kushner, Robert F. (21 April 2016). Lifestyle Medicine: A Manual for Clinical Practice. Springer Science. p. 153. ISBN   978-3-319-24687-1. However, even light alcohol use (≤1 drink daily) increases the risk of developing cancer, and heavier use (≥2-4 drinks daily) significantly increases morbidity and mortality. Given these and other risks, the American Heart Association cautions that, if they do not already drink alcohol, people should not start drinking for the purported cardiovascular benefits of alcohol.
    7. ↑ Deedwania, Prakash (12 January 2015). "Alcohol and Heart Health". American Heart Association (AHA). Archived from the original on 21 January 2016. Retrieved 4 August 2016.
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    10. ↑ "Australian guidelines to reduce health risks from drinking alcohol". Nhmrc.gov.au. 2020. Archived from the original on 16 June 2021. Retrieved 10 June 2021.
    11. 1 2 3 "Canada's Guidance on Alcohol and Health". ccsa.ca. Archived from the original on 11 September 2023. Retrieved 25 September 2023.
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    20. 1 2 Alcol, zero o il meno possibile Archived 16 January 2022 at the Wayback Machine January 2022
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    23. 1 2 Alcohol Advisory Council of New Zealand (ALAC) What's in a Standard Drink Archived 23 April 2011 at the Wayback Machine
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    26. 1 2 Drinking and You Drinking guidelines — units of alcohol Archived 8 February 2007 at the Wayback Machine
    27. 1 2 "Till hälso- och sjukvården: Nya gränser för riskbruk av alkohol". Socialstyrelsen (in Swedish). 15 December 2023.
    28. 1 2 3 4 5 6 7 8 "Drinking Guidelines: General Population". IARD.org. International Alliance for Responsible Drinking. Archived from the original on 23 April 2018. Retrieved 23 June 2016.
    29. 1 2 3 4 "Drink less - Better Health". nhs.uk. 6 July 2021. Archived from the original on 14 March 2024. Retrieved 14 March 2024.
    30. 1 2 "What Are the U.S. Guidelines for Drinking? - Rethinking Drinking | NIAAA". rethinkingdrinking.niaaa.nih.gov.
    31. 1 2 3 4 https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf.{{cite web}}: Missing or empty |title= (help)
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    36. 1 2 "Facts about moderate drinking | CDC". CDC. 19 April 2022. Archived from the original on 26 January 2021. Retrieved 24 April 2022.
    37. ↑ Carr, Tessa; Kilian, Carolin; Llamosas-Falcón, Laura; Zhu, Yachen; Lasserre, Aurélie M.; Puka, Klajdi; Probst, Charlotte (2024). "The risk relationships between alcohol consumption, alcohol use disorder and alcohol use disorder mortality: A systematic review and meta-analysis". Addiction. 119 (7): 1174–1187. doi:10.1111/add.16456. ISSN   0965-2140. PMC   11156554 . PMID   38450868.
    38. ↑ Griswold, Max G.; Fullman, Nancy; Hawley, Caitlin; et al. (22 September 2018). "Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016". The Lancet. 392 (10152): 1015–1035. doi:10.1016/S0140-6736(18)31310-2. ISSN   0140-6736. PMC   6148333 . PMID   30146330.
    39. ↑ GBD 2020 Alcohol Collaboration (July 2022). "Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020". The Lancet. 400 (10347): 185–235. doi:10.1016/S0140-6736(22)00847-9. PMC   9289789 . PMID   35843246.{{cite journal}}: CS1 maint: numeric names: authors list (link)
    40. ↑ NICE, Routine antenatal care for healthy pregnant women Archived 11 July 2009 at the Wayback Machine March 2007
    41. ↑ BBC 'No alcohol in pregnancy' advised Archived 30 May 2007 at the Wayback Machine 25 May 2007
    42. 1 2 National Health and Medical Research Council 2020 Australian Guidelines to Reduce Health Risks from Drinking Alcohol Archived 13 June 2021 at the Wayback Machine
    43. 1 2 National Health and Medical Research Council 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol: Frequently Asked Questions Archived 13 June 2021 at the Wayback Machine
    44. ↑ Canadian Center on Substance Abuse Canada's Low-Risk Alcohol Drinking Guidelines Archived 20 July 2020 at the Wayback Machine
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    47. 1 2 New Zealand Ministry of Health Manatū Hauora Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women Archived 26 December 2010 at the Wayback Machine
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    50. ↑ "New recommended drinking guidelines welcomed by NICE". www.nice.org.uk. 8 January 2016. Archived from the original on 17 January 2024. Retrieved 17 September 2023.
    51. ↑ 'USDA, Dietary Guidelines for Americans 2005, Chapter 9: Alcoholic Beverages Archived 1 July 2007 at the Wayback Machine
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    55. ↑ "Chapter 12: Alcohol".
    56. ↑ "Consultation on children, young people and alcohol". Dcsf.gov.uk. Archived from the original on 14 June 2013. Retrieved 30 March 2014.
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