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Alcohol consumption recommendations

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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]

Caveats

See also: Alcohol and health

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,[4] 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. 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.[5][6][7]

Units and standard drinks

See also: Standard drink

Guidelines generally give recommended amounts measured in grams (g) of pure alcohol. Some guidelines also express alcohol intake in units or standard drinks when recommending maximum alcohol intake. The size of a standard drink varies widely, as does the recommended maximum number of drinks per day or week, among the various guidelines.[8][9] The amounts listed are 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.[10]

In North America, one standard drink corresponds to a typical 12 fl. oz. bottle of 5% Alcohol by Volume (ABV) beer, 5 fl. oz. of 12% ABV wine, or a 1.5 fl. oz. shot of 40% ABV liquor.[8] Due to the different size of the US and Canadian ounce however, the actual amount of alcohol is slightly different. In Europe the most common standard drink size is 10g of pure alcohol, making a typical 330ml bottle of 4.8% ABV beer correspond to 1.2 drinks or a 500ml bottle 1.9 drinks; 100ml of 11% wine is 0.9 drinks, and a 40ml shot of 33% spirits equal 1.0 drink, while in countries that use 12g, those same servings are 1.0, 1.6, 0.7, and 0.9 drinks respectively. Studies have shown that most people find it difficult to understand and define exactly what a standard drink is, and consistently underestimate how much they drink.[10]

The amount of pure alcohol is stated in the table in both grams and millilitres. The number of standard drinks contained in 500ml of beer of 5% ABV (a typical large drink of beer, similar to a US pint of 473ml) is stated for comparison.[11]

Country/region Mass (g) Volume (mL) 500 mL[n 1] of 5% ABV beer is
Australia[12] 10 12.7 2.0 standard drinks
Austria[8] 20 25.3 1.0 standard drinks
Canada[13][6] 13.6 17.2 1.4 standard drinks
Denmark[8] 12 15.2 1.6 standard drinks
Finland[14][15] 12 15.2 1.6 standard drinks
France 10 12.7 2.0 standard drinks
Germany[16] 10 12.7 2.0 standard drinks
Hong Kong[17] 10 12.7 2.0 standard drinks
Hungary 17 21.5 1.2 standard drinks
Iceland[18] 8 10 2.5 standard drinks
Ireland[19] 10 12.7 2.0 standard drinks
Italy 10 12.7 2.0 standard drinks
Japan 19.75 25 1.0 standard drinks
Netherlands[8] 10 12.7 2.0 standard drinks
New Zealand[20][21] 10 12.7 2.0 standard drinks
Poland 10 12.7 2.0 standard drinks
Portugal[15] 14 17.7 1.4 standard drinks
Spain 10 12.7 2.0 standard drinks
Switzerland 12 15.2 1.6 standard drinks
United Kingdom[22] 8 10 2.5 units of alcohol
United States[23][15] 14 17.7[n 2] 1.4 standard drinks

The amount of alcohol in any drink is calculated by the formula:

For example, 0.35-litre glass of beer with ABV of 5.5% has 15.2 grams of pure alcohol. Pure alcohol has density of 789.24 g/l (at 20 °C).

Men

The standard drink size is given in brackets.

Daily maximum drinks (no weekly limits recommended)

  • Australia: 2/day; 14/week (@10 g = 20 g/day, 140 g/week)[24][25] (New guidelines were adopted on 6 March 2009.[26])
  • Austria: 24 g
  • Canada: 3 standard drinks per day.[27]
  • Czech Republic: 24 g
  • Germany: 24 g/day
  • Hong Kong: 2/day (20 g)[28]
  • Italy: 40 g (30 g for the elderly)[29]
  • Japan: 1–2 (@19.75 g = 19.75–39.5 g)
  • Netherlands: 10g (0g recommended)[8]
  • Portugal: 37 g[15]
  • Spain: 3 (@10 g = 30 g) Also suggests a maximum of no more than twice this on any one occasion.[15]
  • Sweden: 20 g[30]
  • Switzerland: 3 (@10g =30g) for men and 2 (@10g =20g) for women[8]

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.[6]
  • 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[21] To reduce risk of injury per occasion: no more than 5 standard drinks (50 g) on any single occasion.[21]
  • 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)[31]

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.[32]
  • Finland: 15 units (@11 g = 165 g/week)[15]
  • Ireland: 17 units (@10 g = 170 g/week)[33]
  • United Kingdom: 14 units (@8 g = 112 g/week)[8]

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: 2/day; 14/week (@10 g = 20 g/day, 140 g/week)[24][25]
  • Austria: 16 g
  • Czech Republic: 16 g
  • Germany: 12 g/day
  • Hong Kong: 1/day (10 g)[28]
  • Italy: 30 g (25 g for elderly women)[29]
  • Netherlands: 2 (@9.9 g = 19.8 g)
  • Portugal: 18.5 g[15]
  • Spain: 2 (@10 g = 20 g) Also suggests a maximum of no more than twice this on any one occasion.[15]
  • Sweden: 10 g
  • Switzerland: 2 (@10–12 g = 20–24 g)[8]

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.[6][34]
  • 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[21] To reduce risk of injury per occasion: no more than 4 standard drinks (40 g) on any single occasion[21]
  • 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.[32]
  • Finland: 10 units (@11 g = 110 g/week)[15]
  • Ireland: 14 units (@10 g = 140 g/week)
  • United Kingdom: 14 units (@8 g = 112 g/week)[8]

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.[35][36] 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[24][25]
  • Canada: "Don't drink if you are pregnant or planning to become pregnant."[6]
  • France: Total abstinence[8]
  • Iceland: Advise that pregnant women abstain from alcohol during pregnancy because no safe consumption level exists.[8]
  • Israel: Women should avoid consuming alcohol before and during pregnancy[8][37]
  • The Netherlands: Abstinence[8]
  • New Zealand: "Women who are pregnant or planning to become pregnant should avoid drinking alcohol."[38]
  • Norway: Abstinence[8][39]
  • UK: Previously, UK government advice was to avoid alcohol for first 3 months of pregnancy.[36][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."[35] 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."[5]

  • Australia: Total abstinence advised[24][25]
  • 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.[46][47][48]

See also

References

Explanatory notes

  1. ^ 16.9 fl oz; just over 1 US pint
  2. ^ defined as 0.6 fl oz

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 9783319246871. 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. ^ Weathermon R, Crabb DW (1999). "Alcohol and medication interactions" (PDF). Alcohol Res Health. 23 (1): 40–54. PMID 10890797.
  5. ^ a b Australian Guidelines 2009
  6. ^ a b c d e Centre for Addiction and Mental Health / Centre de toxicomanie et de santé mentale Low-Risk Drinking Guidelines
  7. ^ Alcohol Advisory Council of New Zealand (ALAC) Low Risk Drinking Archived 9 January 2008 at the Wayback Machine
  8. ^ a b c d e f g h i j k l m n o "Drinking Guidelines: General Population". IARD.org. International Alliance for Responsible Drinking. Retrieved 23 June 2016.
  9. ^ 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.
  10. ^ a b 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.
  11. ^ ICAP Report 5 - "What is a 'standard drink'". URL:[1]. Accessed on 19 June 2008.
  12. ^ Population Health Division, Australian Government Department of Health and Ageing The Australian Standard Drink
  13. ^ Canadian Public Health Association. URL: [2]. 2006.
  14. ^ paihdelinkki.fi, How to use alcohol wisely
  15. ^ a b c d e f g h i Drinking and You Drinking guidelines — units of alcohol Archived 8 February 2007 at the Wayback Machine
  16. ^ "Was ist ein Standardglas?" [What is a standard drink?]. Alkohol? Kenn dein Limit. (in German). Bundeszentrale für gesundheitliche Aufklärung. Retrieved 26 September 2017.
  17. ^ Department of Health Alcohol and Health: Hong Kong Situation
  18. ^ Landlæknisembættið, Icelandic Directorate of Health
  19. ^ Hope, A. (2009). A Standard Drink in Ireland: What strength? (PDF). Health Service Executive. Retrieved 2 February 2015.
  20. ^ New Zealand Food Safety Authority
  21. ^ a b c d e Alcohol Advisory Council of New Zealand (ALAC) What's in a Standard Drink
  22. ^ PRODIGY Knowledge (Department of Health) Alcohol and Sensible Drinking Archived 25 September 2006 at the Wayback Machine
  23. ^ "Alcohol and Public Health: Frequently Asked Questions". CDC. Retrieved 17 October 2011.
  24. ^ a b c d National Health and Medical Research Council 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol
  25. ^ a b c d National Health and Medical Research Council 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol: Frequently Asked Questions
  26. ^ "New alcohol guidelines say reduce drinking to reduce risk". Nhmrc.gov.au. 6 March 2009. Retrieved 30 March 2014.
  27. ^ Canadian Center on Substance Abuse Canada's Low-Risk Alcohol Drinking Guidelines
  28. ^ a b Department of Health Action Plan to Reduce Alcohol-related Harm in Hong Kong September 2011
  29. ^ a b Worldwide Recommendations on Alcohol Consumption Archived 26 May 2006 at the Wayback Machine
  30. ^ [3]
  31. ^ "What's low-risk drinking? - Rethinking Drinking - NIAAA".
  32. ^ a b "Anbefalinger". www.sst.dk (in Danish). Retrieved 16 November 2018.
  33. ^ "Health chiefs cut limits on safe drinking". Alcohol Action Ireland. 26 June 2012. Retrieved 1 March 2020.
  34. ^ Low-Risk Drinking Guidelines (LRDG)
  35. ^ a b NICE, Routine antenatal care for healthy pregnant women March 2007
  36. ^ a b BBC 'No alcohol in pregnancy' advised 25 May 2007
  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). http://avogtil.no/. AV OG TIL. Retrieved 23 June 2016. {{cite web}}: External link in |website= (help)
  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
  44. ^ Alcohol and pregnancy
  45. ^ a b Alcohol and breastfeeding (2009) - Retrieved 23 May 2014
  46. ^ "Consultation on children, young people and alcohol". Dcsf.gov.uk. Archived from the original on 14 June 2013. Retrieved 30 March 2014.
  47. ^ Parents back alcohol free childhood 17 December 2009
  48. ^ BBC 'No alcohol' urged for under-15s 29 January 2009
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