Alcohol consumption recommendations

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.

General recommendations

These guidelines apply to men, and women who are neither pregnant nor breastfeeding.

Alcohol-free recommendations

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"'.[1]

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."[2]

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.[3][4]

The Canadian Centre on Substance Use and Addiction states "Not drinking has benefits, such as better health, and better sleep."[5]

Alcohol intake recommendations by country

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.

Maximum recommended intake
Country
(or region)		MenWomenDetails
Australia40 g/day, 100 g/week (Both sexes)[6][7] (New guidelines were adopted in 2020.[8])
Austria24 g/day16 g/day
CanadaThe 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".[5]
Czech Republic24 g/day16 g/day
Denmark168 g/week84 g/weekFor low risk of disease
252 g/week168 g/weekFor high risk of disease.[9]
Finland165 g/week110 g/week.[10]
GermanyThe German Centre for Addiction Issues recommends everyone to reduce alcohol consumption, regardless of the amounts consumed. Alcoholic beverages pose health risks and ideally should be avoided completely.[11]
Hong Kong20 g/day10 g/day.[12]
Ireland170 g/week140 g/week.[13]
Italy24g/day
12g/day if over 65		12g/day[14]
Japan29 g/dayLess for women and the elderly[15]
NetherlandsThe Health Council of the Netherlands recommends an alcohol consumption level of zero or no more than 10 g per day.[15]
New Zealand30 g/day and 150 g/week20 g/day and 100 g/week (women)At least two alcohol-free days every week. To reduce long-term health risks[16]
50 g40 gOn any single occasion, to reduce risk of injury.[16]
Portugal37 g/day18.5 g/day[10]
Spain30 g/day20 g/dayAlso suggests a maximum of no more than twice this on any one occasion.[10]
SwedenThe National Board of Health and Welfare defines risky consumption as 120 g per week, and 48 g or more per occasion, once per month or more often.
Alcohol intervention is offered for people who exceed these recommendations.
108 g per week, and 36 g per occasion, is not considered risky according to the new guideline.[17]
Switzerland30g/day20–24g/day[15]
United Kingdom112 g/week112 g/week[15]
USAUp to 28 g/day
not to exceed 196 g/week		14 g/day
not to exceed 98 g/week		[18]

Overall, the daily limits range from 10–37 g per day for men and 10-16 g per day for women. Weekly limits range from 27–170 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 consistently lower than those for men.

Specific populations

Pregnant women

Excessive drinking in pregnancy is the cause of fetal alcohol syndrome (BE: foetal alcohol syndrome), especially in the first eight to twelve weeks of pregnancy. Therefore, pregnant women receive special advice. It is not known whether there is a safe minimum amount of alcohol consumption, although low levels of drinking are not known to be harmful.[19][20] As there may be some weeks between conception and confirmation of pregnancy, most countries recommend that women trying to become pregnant should follow the guidelines for pregnant women.

  • Australia: Total abstinence during pregnancy and if planning a pregnancy[6][7]
  • Canada: "Don't drink if you are pregnant or planning to become pregnant."[21]
  • France: Total abstinence[15]
  • Hong Kong: "Abstinence from alcohol during pregnancy is the safest choice."[22]
  • Iceland: Advise that pregnant women abstain from alcohol during pregnancy because no safe consumption level exists.[15]
  • Israel: Women should avoid consuming alcohol before and during pregnancy[15][23]
  • The Netherlands: Abstinence[15]
  • New Zealand: "Women who are pregnant or planning to become pregnant should avoid drinking alcohol."[24]
  • Norway: Abstinence[15][25]
  • Sweden: Abstinence.[26]
  • UK: Abstinence during pregnancy[27]
  • US: Total abstinence during pregnancy and while planning to become pregnant[28]

In short, all countries listed above now recommend that women abstain from alcohol consumption if they are pregnant or likely to become pregnant.

Breastfeeding women

"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."[29] "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."[30] "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."[31]

  • Australia: Total abstinence advised[6][7]
  • Hong Kong: "Avoid alcohol and alcoholic drinks."[32]
  • 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.[24]
  • 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.[30]

Minors

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.[33][34][35]

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,[36] 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.[31][37][38]

Moreover, studies suggest even moderate alcohol consumption may significantly impair – neurobiologically beneficial and -demanding – exercise (possibly including the recovery and adaptation).[39][40][41][42]

Daily consumption, habituation and addiction

As of 2022, moderate consumption levels of alcoholic beverages are typically defined in terms of average consumption per day. However, when drinking becomes a chronic daily activity the consumption puts individuals at an increased health risk[43] as it may lead to habituation, desensitization (consumption-induced tolerance), progressively increasing average dosages and addiction.

According to the CDC, it would be important to focus on the amount people drink on the days that they drink.[44] However, few studies or guidelines distinguish between or compare "moderate consumption" patterns (i.e. frequency, timing and dosage/intensity[45] per session) of occasional drinking and daily drinking. 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.[46]

Harmful physiological effects

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". Better health outcomes among moderate drinkers that some studies reported may be due to the moderate alcohol consumption itself but they may also instead be caused by "other differences in behaviors or genetics between people who drink moderately and people who don't". According to the CDC, recent studies indicate moderate consumption may not have the protective health benefits.[44] A 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".[47]

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.[15][48] 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.[49]

See also

References

Explanatory notes

    Citations

    1. ↑ "No level of alcohol consumption is safe for our health". www.who.int. Retrieved 25 September 2023.
    2. ↑ "Less meat, more plant-based: Here are the Nordic Nutrition Recommendations 2023". www.norden.org. Retrieved 25 September 2023.
    3. ↑ 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.
    4. ↑ Deedwania, Prakash (12 January 2015). "Alcohol and Heart Health". American Heart Association (AHA). Retrieved 4 August 2016.
    5. 1 2 "Canada's Guidance on Alcohol and Health". ccsa.ca. Retrieved 25 September 2023.
    6. 1 2 3 National Health and Medical Research Council 2020 Australian Guidelines to Reduce Health Risks from Drinking Alcohol
    7. 1 2 3 National Health and Medical Research Council 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol: Frequently Asked Questions
    8. ↑ "Australian guidelines to reduce health risks from drinking alcohol". Nhmrc.gov.au. 2020. Retrieved 10 June 2021.
    9. ↑ "Anbefalinger". www.sst.dk (in Danish). Retrieved 16 November 2018.
    10. 1 2 3 Drinking and You Drinking guidelines — units of alcohol Archived 8 February 2007 at the Wayback Machine
    11. ↑ "Empfehlungen zum Umgang mit Alkohol" (PDF). Deutsche Hauptstelle für Suchtfragen (in German). Retrieved 30 October 2023.
    12. ↑ Department of Health Action Plan to Reduce Alcohol-related Harm in Hong Kong September 2011
    13. ↑ "Health chiefs cut limits on safe drinking". Alcohol Action Ireland. 26 June 2012. Retrieved 1 March 2020.
    14. ↑ Alcol, zero o il meno possibile January 2022
    15. 1 2 3 4 5 6 7 8 9 10 "Drinking Guidelines: General Population". IARD.org. International Alliance for Responsible Drinking. Retrieved 23 June 2016.
    16. 1 2 Alcohol Advisory Council of New Zealand (ALAC) What's in a Standard Drink
    17. ↑ "Nya gränsvärden för riskbruk av alkohol till hälso- och sjukvården". www.socialstyrelsen.se (in Swedish). Retrieved 13 September 2023.
    18. ↑ "What's low-risk drinking? - Rethinking Drinking - NIAAA".
    19. ↑ NICE, Routine antenatal care for healthy pregnant women March 2007
    20. ↑ BBC 'No alcohol in pregnancy' advised 25 May 2007
    21. ↑ Canadian Center on Substance Abuse Canada's Low-Risk Alcohol Drinking Guidelines
    22. ↑ Department of Health
    23. ↑ "Proper Nutrition during Pregnancy". Ministry of Health. State of Israel. Retrieved 23 June 2016.
    24. 1 2 New Zealand Ministry of Health Manatū Hauora Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women
    25. ↑ "Alkovett for den lille" (PDF). avogtil.no/. AV OG TIL. Retrieved 23 June 2016.
    26. ↑ "Ej längre bruk av alkohol vid graviditet". roi.socialstyrelsen.se (in Swedish). Retrieved 24 September 2023.
    27. ↑ "New recommended drinking guidelines welcomed by NICE". www.nice.org.uk. 8 January 2016. Retrieved 17 September 2023.
    28. ↑ 'USDA, Dietary Guidelines for Americans 2005, Chapter 9: Alcoholic Beverages Archived 1 July 2007 at the Wayback Machine
    29. ↑ Alcohol and pregnancy
    30. 1 2 Alcohol and breastfeeding (2009) - Retrieved 23 May 2014
    31. 1 2 Australian Guidelines 2009
    32. ↑ Family Health Service, Department of Health
    33. ↑ "Consultation on children, young people and alcohol". Dcsf.gov.uk. Archived from the original on 14 June 2013. Retrieved 30 March 2014.
    34. ↑ Parents back alcohol free childhood 17 December 2009
    35. ↑ BBC 'No alcohol' urged for under-15s 29 January 2009
    36. ↑ Weathermon R, Crabb DW (1999). "Alcohol and medication interactions" (PDF). Alcohol Res Health. 23 (1): 40–54. PMC 6761694. PMID 10890797.
    37. ↑ Centre for Addiction and Mental Health / Centre de toxicomanie et de santé mentale Low-Risk Drinking Guidelines
    38. ↑ Alcohol Advisory Council of New Zealand (ALAC) Low Risk Drinking Archived 9 January 2008 at the Wayback Machine
    39. ↑ El-Sayed, Mahmoud S.; Ali, Nagia; Ali, Zeinab El-Sayed (1 March 2005). "Interaction Between Alcohol and Exercise". Sports Medicine. 35 (3): 257–269. doi:10.2165/00007256-200535030-00005. ISSN 1179-2035. PMID 15730339. S2CID 33487248.
    40. ↑ Barnes, Matthew. J.; Mündel, Toby; Stannard, Stephen. R. (1 January 2010). "Acute alcohol consumption aggravates the decline in muscle performance following strenuous eccentric exercise". Journal of Science and Medicine in Sport. 13 (1): 189–193. doi:10.1016/j.jsams.2008.12.627. ISSN 1440-2440. PMID 19230764.
    41. ↑ Lakićević, Nemanja (September 2019). "The Effects of Alcohol Consumption on Recovery Following Resistance Exercise: A Systematic Review". Journal of Functional Morphology and Kinesiology. 4 (3): 41. doi:10.3390/jfmk4030041. ISSN 2411-5142. PMC 7739274. PMID 33467356.
    42. ↑ Vella, Luke D.; Cameron-Smith, David (August 2010). "Alcohol, Athletic Performance and Recovery". Nutrients. 2 (8): 781–789. doi:10.3390/nu2080781. ISSN 2072-6643. PMC 3257708. PMID 22254055.
    43. ↑ "Mayo Clinic Q and A: Is daily drinking problem drinking?". Mayo Clinic News Network (in Spanish). 16 February 2018. Retrieved 24 April 2022.
    44. 1 2 "Facts about moderate drinking | CDC". CDC. 19 April 2022. Retrieved 24 April 2022.
    45. ↑ Heckley, Gawain; Jarl, Johan; Gerdtham, Ulf-G (2017). "Frequency and intensity of alcohol consumption: new evidence from Sweden". The European Journal of Health Economics. 18 (4): 495–517. doi:10.1007/s10198-016-0805-2. ISSN 1618-7598. PMC 5387029. PMID 27282872.
    46. ↑ Roerecke, Michael; Vafaei, Afshin; Hasan, Omer SM; Chrystoja, Bethany R; Cruz, Marcus; Lee, Roy; Neuman, Manuela G; Rehm, Jürgen (October 2019). "Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis". The American Journal of Gastroenterology. 114 (10): 1574–1586. doi:10.14309/ajg.0000000000000340. ISSN 0002-9270. PMC 6776700. PMID 31464740.
    47. ↑ 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.
    48. ↑ Kalinowski, Agnieszka; Humphreys, Keith (1 July 2016). "Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries". Addiction. 111 (7): 1293–1298. doi:10.1111/add.13341. ISSN 1360-0443. PMID 27073140.
    49. ↑ Mongan, Deirdre; Long, Jean (22 May 2015). "Standard drink measures throughout Europe; peoples' understanding of standard drinks and their use in drinking guidelines, alcohol surveys and labelling" (PDF). Reducing Alcohol Related Harm. p. 8. Retrieved 26 September 2017.
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