1 glass, not 2 or 3: Study says Canada’s drinking guidelines are too high

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You’re still at risk of developing severe alcohol-related health problems, even if you drink within Canada’s low-risk drinking guidelines, according to a new study.

The Canadian guidelines specify 15 drinks per week for men, with no more than three drinks a day most days. For women, it’s 10 drinks per week, with no more than two per day most days.

But these limits are too high, said Adam Sherk, a post-doctoral fellow at the Canadian Institute for Substance Use Research at the University of Victoria, and lead author of the study, which was recently published in the Journal of Alcohol and Drugs.

“(The guidelines) haven’t been updated in about 10 years, and the information in our field is evolving pretty quickly, particularly regarding the strong link between alcohol and cancer,” he said.

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“Given that the shelf life of national guidelines like that is about 10 years anyway, it’s probably about time that we revised them lower.”

Data from the Canadian Institute for Health Information (CIHI) show 10 Canadians die in hospital every day from harm caused by substance use, and 75 per cent of those deaths are related to alcohol.

CIHI data also show that in 2017-2018, there were 249 alcohol-related hospitalizations in Canada every day per 100,000 people.

This new study examined the rates of illness and injury that can be directly attributed to alcohol, among groups who reported different amounts of drinking. It looked at data on hospitalizations and deaths in B.C. in 2014.

More than half of alcohol-attributable cancer deaths were among people who drank within the weekly low-risk drinking guidelines, the researchers found.

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People drinking within the guidelines also accounted for 18 per cent of digestive conditions like liver cirrhosis and 40 per cent of injuries, including motor vehicle collisions. A large proportion of hospitalizations due to alcohol were also among this group.

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“We found that those drinking within moderate guidelines, even though they are following the low risk drinking guidelines still in one year, experienced about 140 more deaths and nearly 4000 hospital stays, than they would have if they had instead abstained,” Sherk said.

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Canada’s guidelines, which were put out in late 2010, actually allow more drinking than similar guidelines from other countries.

Canada’s 15 drinks per week for men works out to 201.75 grams of ethanol. Germany’s guidelines suggest a maximum of 168 grams per week. American guidelines for men suggest up to 196 grams per week. France’s suggest just 100 grams per week.

A more appropriate guideline might be just one drink per day, Sherk said.

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When health experts originally put the guidelines together a decade ago, they examined studies which suggested benefits to alcohol consumption and put them up against those which suggested harms, compared them to not drinking at all, and tried to strike a balance, according to one of the guidelines’ authors, Catherine Paradis, who is now a senior research and policy analyst at the Canadian Centre on Substance Use and Addiction.

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“In other words, we established a balance where the risk of dying of certain diseases would not be higher than it was for someone who was not consuming alcohol,” she said.

But the research has progressed since then, she said. She’s concerned about this study’s findings.

“That even people drinking within the low risk drinking guidelines, a great proportion of them would be suffering from cancer, that is certainly cause for concern, especially given that many Canadians are unaware of the causality between alcohol use and cancer,” she said.

“Many people may be drinking and drinking too much without really knowing that they might be harming themselves.”

Guidelines provide a useful reference point for health care workers discussing alcohol use with their patients, Sherk said. “It’s part of a larger goal of us slowly over time, changing people’s attitudes towards alcohol.”

While she wouldn’t say whether the current guidelines are too high, saying the research needs to be done to determine that, Paradis does believe they merit another look after all this time.

“It’s an open secret among those involved in the process, that there’s definitely been discussions in the last months and even couple of years, saying, ‘Is it time? Perhaps now we’re ready, perhaps it’s time.’”

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For now, Sherk said, it would be wise for Canadians to limit their drinking due to the harms it might cause.

“On any given day, if you’ve had zero drinks, consider not having your first. But even if you’ve already had four drinks, consider not having your fifth.”

— With files from the Canadian Press

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