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Alcohol consumption recommendations

From Wikipedia, the free encyclopedia

Not to be confused with Alcohol law.

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]

General recommendations

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

Teetotalism advocacy by organization

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See also: Teetotalism and List of countries with alcohol prohibition
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.
  • The World Health Organization published a statement in The Lancet Public Health in April 2023 that "there is no safe amount that does not affect health"'.[2]
    • The World Heart Federation (recognized by the World Health Organization as its leading NGO partner) (2022) recommends against any alcohol intake for optimal heart health.[3][4]
  • The 2023 Nordic Nutrition Recommendations state "Since no safe limit for alcohol consumption can be provided, the recommendation in NNR2023 is that everyone should avoid drinking alcohol."[5]
  • The American Heart Association recommends that those who do not already consume alcoholic beverages should not start doing so because of the negative long-term effects of alcohol consumption.[6][7]
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For Standard drinks (stated in the references) to grams ethanol, see Standard drink § Definitions in various countries.
Alcohol consumption per person in 2016. Consumption of alcohol is measured in liters of pure alcohol per person aged 15 or older.[8]

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 recommended Low risk Medium to risky drinking Heavy drinking Details
Day Week Day Week Day Week Month
Men Women Men Women Men Women Men Women Men Women Men Women Men Women
Australia 40 g 100 g Reference.[9][10]
Austria 24 g 16 g
Canada "Not drinking has benefits, such as better health, and better sleep."[11] 27 g The 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]
Czech Republic 24 g 16 g
Denmark 48 g 120 g Reference.[12]
Finland 168 g 84 g Reference.[13]
Germany Alcoholic beverages pose health risks and ideally should be avoided completely.[14] The German Centre for Addiction Issues recommends everyone to reduce alcohol consumption, regardless of the amounts consumed.[14]
Hong Kong 20 g 10 g Reference.[15]
Iceland 32 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.[16]
Ireland 170 g 140 g Reference.[17]
Italy 24 g 12 g Reference.[18]
Japan 40 g 20 g Reference.[19]
Netherlands Recommends an alcohol consumption level of zero grams. 10 g The Health Council of the Netherlands recommends an alcohol consumption level of zero or no more than 10 g per day.[20]
New Zealand 30 g 20 g 150 g 100 g 50 g 40 g At least two alcohol-free days every week. 30 g for men, 20 g for women To reduce long-term health risks[21] 50 g for men, 40 g for women On any single occasion, to reduce risk of injury.[21]
Norway 20 g 10 g Reference.[22]
Portugal 37 g 18.5 g Reference.[23]
Spain 30 g 20 g Also suggests a maximum of no more than twice this on any one occasion.[23]
Sweden "Not possible to specify a limit for risk-free alcohol consumption."[24] 48 g 120 g The 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.[24]
Switzerland 30 g 20–24 g Reference.[20]
United Kingdom "There's no completely safe level of drinking."[25] 112 g a week, spread across 3 days or more. Reference.[25]
USA "People who do not drink should not start drinking for any reason."[26] 28 g 14 g 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 in the past year) (CDC) 56 grams (4 US standard drinks) or more in a single day in the past year) (CDC) 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.[27] NIAAA, SAMHSA.[28] 2020-2025 Dietary Guidelines for Americans[29]

By study

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Main article: Long-term effects of alcohol consumption

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,[30] 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".[31] 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.[32] 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".[33] 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.[34]

Specific populations

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Pregnant women

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Main article: Fetal alcohol spectrum disorder
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.[35][36] 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.

  • Australia: Total abstinence during pregnancy and if planning a pregnancy[37][38]
  • Canada: "Don't drink if you are pregnant or planning to become pregnant."[39]
  • France: Total abstinence[20]
  • Hong Kong: "Abstinence from alcohol during pregnancy is the safest choice."[40]
  • Iceland: Advise that pregnant women abstain from alcohol during pregnancy because no safe consumption level exists.[20]
  • Israel: Women should avoid consuming alcohol before and during pregnancy[20][41]
  • The Netherlands: Abstinence[20]
  • New Zealand: "Women who are pregnant or planning to become pregnant should avoid drinking alcohol."[42]
  • Norway: Abstinence[20][43]
  • Sweden: Abstinence.[44]
  • UK: Abstinence during pregnancy[45]
  • US: Total abstinence during pregnancy and while planning to become pregnant[46]

Breastfeeding women

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Not to be confused with Alcohol and breast cancer.

"Alcohol passes to the baby in small amounts in breast milk. The milk will smell different to the baby and may affect their feeding, sleeping or digestion. The best advice is to avoid drinking shortly before a baby's feed."[47] "Alcohol inhibits a mother's let-down (the release of milk to the nipple). Studies have shown that babies take around 20% less milk if there's alcohol present, so they'll need to feed more often – although infants have been known to go on 'nursing strike', probably because of the altered taste of the milk."[48] "There is little research evidence available about the effect that [alcohol in breast milk] has on the baby, although practitioners report that, even at relatively low levels of drinking, it may reduce the amount of milk available and cause irritability, poor feeding and sleep disturbance in the infant. Given these concerns, a prudent approach is advised."[49]

  • Australia: Total abstinence advised[37][38]
  • Hong Kong: "Avoid alcohol and alcoholic drinks."[50]
  • Iceland: Total abstinence advised because no safe consumption level exists.
  • New Zealand: Abstinence recommended, especially in the first month of breastfeeding so that sound breastfeeding patterns can be established.[42]
  • United Kingdom: Total abstinence advised by some, such as the Royal College of Midwives; others advise to limit alcohol to occasional use in small amounts not exceeding the recommended maximums for non-breastfeeding woman as this is known to cause harm, and that daily or binge drinking be avoided.[48]

Minors

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See also: Legal drinking age

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

  • United Kingdom: Children aged under 15 should never be given alcohol, even in small quantities. Children aged 15–17 should not be given alcohol on more than one day a week – and then only under supervision from carers or parents.[51][52][53]
  • Singapore: A recurring message of the Get Your Sexy Back campaign is that consuming 5 or more units of alcohol (70 g pure ethanol) at a single sitting constitutes binge drinking.[54]

Former alcoholics

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  • USA: According to the 2020-2025 Dietary Guidelines for Americans, alcohol consumption is not recommended for certain individuals. Specifically, those who are in recovery from Alcohol Use Disorder (AUD) or struggle to limit their alcohol intake should abstain from drinking entirely.[26]

Elderly

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  • Italy: 12 g/day for men over 65.[18]
  • Japan: Less than 29 g/day for the elderly (and women).[20]

Caveats

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See also: Alcohol and health

Risk factors

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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,[55] 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

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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.[49][56][57]

Moreover, studies suggest even moderate alcohol consumption may significantly impair – neurobiologically beneficial and -demanding – exercise (possibly including the recovery and adaptation).[58][59][60][61]

Drinking patterns

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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.[31] 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.[62] Studies analyzing binge drinking have consistently found negative effects. Although there are few studies or guidelines on moderate consumption patterns,[63] the general advice is that one should spread out consumption as evenly as possible, if one is consuming a fixed amount.[25]

However, it is also easy, when drinking daily, to become habituated to alcohol's effects (consumption-induced tolerance).[64] Most people cannot accurately judge how much alcohol they are consuming,[65] particularly relative to the amounts specified in guidelines. Alcohol-free days provide a baseline and help people cut down on problematic drinking.[25] 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.[66]

Alcohol promotion recommendations

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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.[67][68][69][70] The United Kingdom's National Health Service also recommends a Mediterranean diet to reduce cardiovascular disease risk.[71][72] 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.[73] A trial in Spain is expected to complete in 2028.[74]

Units and standard drinks

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Main article: Standard drink

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.[20][75] 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.[76]

See also

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References

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Explanatory notes

Citations

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  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.
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  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.
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