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{{Use dmy dates|date=March 2020}}
{{Use dmy dates|date=March 2020}}
There is no global consensus on recommended maximum intake (or {{em|safe limits}}) of the drug [[alcohol (drug)|alcohol]] (also known formally as ethanol).<ref>{{cite web|url=http://www.theargus.co.uk/news/10188546.Sussex_uni_finds__no_consensus__on_safe_drink_limits/ |title=Sussex uni finds "no consensus" on safe drink limits |publisher=Theargus.co.uk |date=2013-01-27 |access-date=2014-03-30}}</ref> The guidelines provided by health agencies of governments are varied and are shown below. These recommendations concerning maximum intake are distinct from any legal restrictions (e.g. driving after consuming alcohol) that may apply in those countries. 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]].<ref name="MechanickKushner2016">{{cite book|last1=Mechanick|first1=Jeffrey I.|last2=Kushner|first2=Robert F.|title=Lifestyle Medicine: A Manual for Clinical Practice|date=21 April 2016|publisher=[[Springer Science]]|language=en |isbn=978-3-319-24687-1|page=153|quote=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.}}</ref><ref>{{cite web|url=http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Alcohol-and-Heart-Health_UCM_305173_Article.jsp|title=Alcohol and Heart Health|last=Deedwania|first=Prakash|date=12 January 2015|publisher=American Heart Association (AHA)|language=en|access-date=4 August 2016}}</ref>
There is no global consensus on recommended maximum intake (or {{em|safe limits}}) of the drug [[alcohol (drug)|alcohol]] (also known formally as ethanol).<ref>{{cite web|url=http://www.theargus.co.uk/news/10188546.Sussex_uni_finds__no_consensus__on_safe_drink_limits/ |title=Sussex uni finds "no consensus" on safe drink limits |publisher=Theargus.co.uk |date=2013-01-27 |access-date=2014-03-30}}</ref> The guidelines provided by health agencies of governments are varied and are shown below. These recommendations concerning maximum intake are distinct from any legal restrictions (e.g. driving after consuming alcohol) that may apply in those countries. 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]].<ref name="MechanickKushner2016">{{cite book|last1=Mechanick|first1=Jeffrey I.|last2=Kushner|first2=Robert F.|title=Lifestyle Medicine: A Manual for Clinical Practice|date=21 April 2016|publisher=[[Springer Science]]|language=en |isbn=978-3-319-24687-1|page=153|quote=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.}}</ref><ref>{{cite web|url=http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Alcohol-and-Heart-Health_UCM_305173_Article.jsp|title=Alcohol and Heart Health|last=Deedwania|first=Prakash|date=12 January 2015|publisher=American Heart Association (AHA)|language=en|access-date=4 August 2016}}</ref>

==International response==
The [[World Health Organization]] published a statement in ''[[The Lancet]] Public Health'' on April 2023 that ''"there is no safe amount that does not affect health"'.<ref>{{cite web |url=https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health}}</ref>


==Caveats==
==Caveats==

Revision as of 06:59, 13 September 2023

There is no global consensus on recommended maximum intake (or safe limits) of the drug alcohol (also known formally as ethanol).[1] The guidelines provided by health agencies of governments are varied and are shown below. These recommendations concerning maximum intake are distinct from any legal restrictions (e.g. driving after consuming alcohol) that may apply in those countries. 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.[2][3]

International response

The World Health Organization published a statement in The Lancet Public Health on April 2023 that "there is no safe amount that does not affect health"'.[4]

Caveats

See also: Alcohol and health

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,[5] 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.[6][7][8]

Moreover, studies suggest even moderate alcohol consumption may significantly impair – neurobiologically beneficial and -demanding – exercise (possibly including the recovery and adaptation).[9][10][11][12]

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[13][medical citation needed][additional citation(s) needed] as it may lead to habituation, desensitization (consumption-induced tolerance), progressively increasing average dosages and addiction.[citation needed]

According to the CDC, it would be important to focus on the amount people drink on the days that they drink.[14] However, few studies or guidelines distinguish between or compare "moderate consumption" patterns (i.e. frequency, timing and dosage/intensity[15] per session) of occasional drinking and daily drinking.[citation needed] 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.[16]

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.[14] 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".[17]

Units and standard drinks

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.[18][19] 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.[20]

Men

The standard drink size is given in brackets.

Daily maximum drinks (no weekly limits recommended)

  • Australia: 4/day; 10/week (@10 g = 40 g/day, 100 g/week)[21][22] (New guidelines were adopted in 2020.[23])
  • Austria: 24 g
  • Canada: 3 standard drinks per day.[24]
  • Czech Republic: 24 g
  • Germany: 24 g/day
  • Hong Kong: 2/day (20 g)[25]
  • Italy: 24g (12g for those over 65)[26]
  • Japan: 1–2 (@19.75 g = 19.75–39.5 g)
  • Netherlands: 10g (0g recommended)[18]
  • Portugal: 37 g[27]
  • Spain: 3 (@10 g = 30 g) Also suggests a maximum of no more than twice this on any one occasion.[27]
  • Sweden: 20 g[28]
  • Switzerland: 3 (@10g =30g) for men and 2 (@10g =20g) for women[18]

Therefore, these countries recommend limits for men in the range 20–40 g per day.

Daily/weekly maximum drinks

These countries recommend a weekly limit, but intake on a particular day may be higher than one-seventh of the weekly amount.

  • Canada: Based on a standard drink of 13.6g, no more than: 3 (40.8 g)/day most days, 15 (204 g)/week, or 4 (54.4 g) on any single occasion.[7]
  • New Zealand: Based on a standard drink of 10g, to reduce long-term health risks, no more than: 3 (30 g)/day; 15 (150 g)/week. At least two alcohol-free days every week[29] To reduce risk of injury per occasion: no more than 5 standard drinks (50 g) on any single occasion.[29]
  • USA: Up to 4 units/day (56 g/day)(2.4 fl. oz./day), not to exceed 14 units/week (196 g/week)(8.4 fl. oz./wk)[30]

Therefore, these countries recommend limits for men in the range 27.2–32 g of ethanol per day and 168–210 g of ethanol per week.

Weekly maximum drinks

  • Denmark: Low risk of disease: less than 168 g; High risk of disease: more than 252 g.[31]
  • Finland: 15 units (@11 g = 165 g/week)[27]
  • Ireland: 17 units (@10 g = 170 g/week)[32]
  • United Kingdom: 14 units (@8 g = 112 g/week)[18]

Women who are neither pregnant nor breastfeeding

Women trying to become pregnant should look at the guidelines for pregnant women given in the next section.

Daily maximum drinks (no weekly limits recommended)

  • Australia: 4/day; 10/week (@10 g = 40 g/day, 100 g/week)[21][22]
  • Austria: 16 g
  • Czech Republic: 16 g
  • Germany: 12 g/day
  • Hong Kong: 1/day (10 g)[25]
  • Italy: 12 g [26]
  • Netherlands:10g (0g recommended)
  • Portugal: 18.5 g[27]
  • Spain: 2 (@10 g = 20 g) Also suggests a maximum of no more than twice this on any one occasion.[27]
  • Sweden: 10 g
  • Switzerland: 2 (@10–12 g = 20–24 g)[18]

Therefore, these countries recommend limits for women in the range 10–30 g per day.

Daily/weekly maximum drinks

These countries recommend a weekly limit, but your intake on a particular day may be higher than one-seventh of the weekly amount.

  • Canada:Based on a standard drink of 13.6g, no more than: 2 (27.2 g)/day most days, 10 (136 g)/week, or 3 (40.8 g) on any single occasion.[7][33]
  • New Zealand:Based on a standard drink of 10g, to reduce long-term health risks, no more than: 2 (20 g)/day; 10 (100 g)/week. At least two alcohol-free days per week[29] To reduce risk of injury per occasion: no more than 4 standard drinks (40 g) on any single occasion[29]
  • USA: 1/day; 7/week (@14g = 14 g/day, 98 g/week)

Therefore, these countries recommend limits for women in the range 14–27.2 g per day and 98–140 g per week.

Weekly maximum drinks

  • Denmark: Low risk of disease: less than 84 g; High risk of disease: more than 168 g.[31]
  • Finland: 10 units (@11 g = 110 g/week)[27]
  • Ireland: 14 units (@10 g = 140 g/week)
  • United Kingdom: 14 units (@8 g = 112 g/week)[18]

Pregnant women

Main articles: Fetal alcohol syndrome and Fetal Alcohol Spectrum Disorder

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.[34][35] 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[21][22]
  • Canada: "Don't drink if you are pregnant or planning to become pregnant."[7]
  • France: Total abstinence[18]
  • Hong Kong: "Abstinence from alcohol during pregnancy is the safest choice."[36]
  • Iceland: Advise that pregnant women abstain from alcohol during pregnancy because no safe consumption level exists.[18]
  • Israel: Women should avoid consuming alcohol before and during pregnancy[18][37]
  • The Netherlands: Abstinence[18]
  • New Zealand: "Women who are pregnant or planning to become pregnant should avoid drinking alcohol."[38]
  • Norway: Abstinence[18][39]
  • UK: Previously, UK government advice was to avoid alcohol for first 3 months of pregnancy.[35][40][41][42] NICE guidelines (2007) stated, "If you are pregnant or planning to become pregnant, you should try to avoid alcohol completely in the first 3 months of pregnancy because there may be an increased risk of miscarriage. If you choose to drink while you are pregnant, you should drink no more than 1 or 2 UK units of alcohol once or twice a week. There is uncertainty about how much alcohol is safe to drink in pregnancy, but at this low level there is no evidence of any harm to the unborn baby. You should not get drunk or binge drink (drinking more than 7.5 UK units of alcohol on a single occasion) while you are pregnant because this can harm your unborn baby."[34] However the draft UK Health Department guidelines, released in January 2016 now advise to avoid alcohol altogether if pregnant or planning a pregnancy.
  • US: Total abstinence during pregnancy and while planning to become pregnant[43]

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."[44] "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."[45] "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."[6]

  • Australia: Total abstinence advised[21][22]
  • Hong Kong: "Avoid alcohol and alcoholic drinks."[46]
  • 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.[38]
  • 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.[45]

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.[47][48][49]

See also

References

Explanatory notes

Citations

  1. ^ "Sussex uni finds "no consensus" on safe drink limits". Theargus.co.uk. 27 January 2013. Retrieved 30 March 2014.
  2. ^ 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.
  3. ^ Deedwania, Prakash (12 January 2015). "Alcohol and Heart Health". American Heart Association (AHA). Retrieved 4 August 2016.
  4. ^ https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health. {{cite web}}: Missing or empty |title= (help)
  5. ^ Weathermon R, Crabb DW (1999). "Alcohol and medication interactions" (PDF). Alcohol Res Health. 23 (1): 40–54. PMC 6761694. PMID 10890797.
  6. ^ a b Australian Guidelines 2009
  7. ^ a b c d Centre for Addiction and Mental Health / Centre de toxicomanie et de santé mentale Low-Risk Drinking Guidelines
  8. ^ Alcohol Advisory Council of New Zealand (ALAC) Low Risk Drinking Archived 9 January 2008 at the Wayback Machine
  9. ^ 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.
  10. ^ 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.
  11. ^ 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.
  12. ^ 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.
  13. ^ "Mayo Clinic Q and A: Is daily drinking problem drinking?". Mayo Clinic News Network (in Spanish). 16 February 2018. Retrieved 24 April 2022.
  14. ^ a b "Facts about moderate drinking | CDC". CDC. 19 April 2022. Retrieved 24 April 2022.
  15. ^ 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.
  16. ^ 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.
  17. ^ 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.
  18. ^ a b c d e f g h i j k "Drinking Guidelines: General Population". IARD.org. International Alliance for Responsible Drinking. Retrieved 23 June 2016.
  19. ^ 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.
  20. ^ 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.
  21. ^ a b c d National Health and Medical Research Council 2020 Australian Guidelines to Reduce Health Risks from Drinking Alcohol
  22. ^ a b c d National Health and Medical Research Council 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol: Frequently Asked Questions
  23. ^ "Australian guidelines to reduce health risks from drinking alcohol". Nhmrc.gov.au. 2020. Retrieved 10 June 2021.
  24. ^ Canadian Center on Substance Abuse Canada's Low-Risk Alcohol Drinking Guidelines
  25. ^ a b Department of Health Action Plan to Reduce Alcohol-related Harm in Hong Kong September 2011
  26. ^ a b Alcol, zero o il meno possibile January 2022
  27. ^ a b c d e f Drinking and You Drinking guidelines — units of alcohol Archived 8 February 2007 at the Wayback Machine
  28. ^ "Rekommendationer om alkohol - Livsmedelsverket". www.slv.se. Archived from the original on 2 August 2009. Retrieved 17 January 2022.
  29. ^ a b c d Alcohol Advisory Council of New Zealand (ALAC) What's in a Standard Drink
  30. ^ "What's low-risk drinking? - Rethinking Drinking - NIAAA".
  31. ^ a b "Anbefalinger". www.sst.dk (in Danish). Retrieved 16 November 2018.[permanent dead link]
  32. ^ "Health chiefs cut limits on safe drinking". Alcohol Action Ireland. 26 June 2012. Retrieved 1 March 2020.
  33. ^ Low-Risk Drinking Guidelines (LRDG)
  34. ^ a b NICE, Routine antenatal care for healthy pregnant women March 2007
  35. ^ a b BBC 'No alcohol in pregnancy' advised 25 May 2007
  36. ^ Department of Health
  37. ^ "Proper Nutrition during Pregnancy". Ministry of Health. State of Israel. Retrieved 23 June 2016.
  38. ^ a b New Zealand Ministry of Health Manatū Hauora Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women
  39. ^ "Alkovett for den lille" (PDF). avogtil.no/. AV OG TIL. Retrieved 23 June 2016.
  40. ^ Department of Health Alcohol Advice
  41. ^ NHS Alcohol and pregnancy
  42. ^ Rosemary Bennett Zero – the new alcohol limit in pregnancy The Times 25 May 2007
  43. ^ 'USDA, Dietary Guidelines for Americans 2005, Chapter 9: Alcoholic Beverages Archived 1 July 2007 at the Wayback Machine
  44. ^ Alcohol and pregnancy
  45. ^ a b Alcohol and breastfeeding (2009) - Retrieved 23 May 2014
  46. ^ Family Health Service, Department of Health
  47. ^ "Consultation on children, young people and alcohol". Dcsf.gov.uk. Archived from the original on 14 June 2013. Retrieved 30 March 2014.
  48. ^ Parents back alcohol free childhood 17 December 2009
  49. ^ BBC 'No alcohol' urged for under-15s 29 January 2009
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