Alcohol consumption 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]

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.

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.

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.[18][19] 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."[20]
• France: Total abstinence[14]
• Hong Kong: "Abstinence from alcohol during pregnancy is the safest choice."[21]
• Iceland: Advise that pregnant women abstain from alcohol during pregnancy because no safe consumption level exists.[14]
• Israel: Women should avoid consuming alcohol before and during pregnancy[14][22]
• The Netherlands: Abstinence[14]
• New Zealand: "Women who are pregnant or planning to become pregnant should avoid drinking alcohol."[23]
• Norway: Abstinence[14][24]
• Sweden: Abstinence.[25]
• UK: Abstinence during pregnancy[26]
• US: Total abstinence during pregnancy and while planning to become pregnant[27]

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

"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."[28] "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."[29] "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."[30]

• Australia: Total abstinence advised[6][7]
• Hong Kong: "Avoid alcohol and alcoholic drinks."[31]
• 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.[23]
• 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.[29]

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.[32][33][34]

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,[35] 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.[30][36][37]

Moreover, studies suggest even moderate alcohol consumption may significantly impair – neurobiologically beneficial and -demanding – exercise (possibly including the recovery and adaptation).[38][39][40][41]

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[42] 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.[43] However, few studies or guidelines distinguish between or compare "moderate consumption" patterns (i.e. frequency, timing and dosage/intensity[44] 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.[45]

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.[43] 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".[46]