Canada’s new alcohol guidelines advise fewer drinks

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Canada’s new guidelines on alcohol and health have arrived, with the following advice: Any reduction in drinking helps. The more you drink, the higher the risks are. And preferably, consume no more than two drinks on a given day.

The guidelines, released Tuesday by the Canadian Centre on Substance Use and Addiction, or CCSA, present a continuum of health risks associated with different amounts of alcohol, including the risks of several types of cancer, such as breast and colon cancer, heart disease and stroke.

One to two standard drinks a week, each the equivalent of a 12-ounce serving of 5-per-cent-alcohol beer or a five-ounce glass of 12-per-cent-alcohol wine, is considered low-risk, and that risk increases with greater amounts of consumption, according to the CCSA document, titled Canada’s Guidance on Alcohol and Health: Final Report.

Even though about 80 per cent of Canadians 15 and older drink, people often think only of alcohol-use disorder when it comes to alcohol-related harms, said Catherine Paradis, interim associate director of research for the CCSA, a non-governmental organization that reports to Parliament.

“Very few people know that alcohol causes a lot of disease, including cancer,” she said.

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The guidelines, funded by Health Canada, replace Canada’s Low-Risk Drinking Guidelines, which the CCSA released in 2011, and advise drinking substantially lower amounts. The previous guidelines recommended no more than 10 drinks a week for women and 15 drinks a week for men. Under the new guidelines, updated by a scientific expert panel to reflect the latest research, three to six drinks a week is considered moderate risk for both men and women, and seven or more drinks a week is deemed high risk. They recommend not exceeding two drinks on any given day.

Only when people have zero drinks a week are there no health risks, and not drinking has benefits, such as better health and better sleep, the report said.

The report also said there is no safe amount of alcohol use when pregnant or trying to get pregnant. And while not drinking is safest when breastfeeding, a standard drink occasionally can be okay, as long as it is planned, it said, noting it takes about two hours for the amount of alcohol in one standard drink to leave breast milk.

Zero is the limit in certain circumstances, such as when driving, using machinery or taking drugs that interact with alcohol, it added.

The report also recommends introducing mandatory labelling for all alcoholic beverages with health warnings and information about the guidelines.

Currently, anyone who wants to know how much alcohol they’re drinking must rely on their own calculations, using the percentage of alcohol that appears on a bottle, Dr. Paradis said. And most people don’t know how much to pour for a standard drink, which is 17.05 millilitres or 13.45 grams of pure alcohol, she said.

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“People need to have that information the same way that they have information for the food that they eat,” she said, adding that alcohol is the only legal psychoactive substance available in Canada that does not require health warnings. “People have the right to know that alcohol causes cancer. Just say it, and then people can make up their mind.”

Dr. Paradis said the purpose of the report is not to dictate how much people should drink – ”We’re not the red wine squad,” she said – but to present the evidence they found, so people can make informed choices.

Elizabeth Holmes, senior manager of health policy at the Canadian Cancer Society, said she was pleased to see the emphasis on cancer risks in the new guidelines.

More than 40 per cent of Canadians are not aware alcohol increases the risk of cancer, she said, noting the new guidelines complement her own organization’s advice to limit drinking.

“The less alcohol you drink, the lower your cancer risk,” she said.

According to the Canadian Cancer Society, consuming about 3½ drinks a day doubles or triples one’s risk of developing cancer of the mouth, pharynx, larynx and esophagus, and increases one’s risk of colorectal cancer and breast cancer by 1½ times.

Ashley Wettlaufer, a research methods specialist at Toronto’s Centre for Addiction and Mental Health who works with the Canadian Alcohol Policy Evaluation research project, said alcohol labelling is important for increasing the public’s awareness and understanding of these health risks.

However, she said she anticipates resistance from the alcohol industry, which led to the interruption of an alcohol labelling study, led by the University of Victoria’s Canadian Institute for Substance Use Research and Public Health Ontario, in the Yukon in 2017.

Industry pressure “has a lot to do with why we don’t have warning labels on alcohol containers right now,” she said.

To get people to actually follow the new guidelines, the information needs not only to be put on bottles, but also promoted in a sweeping campaign across the country, and endorsed by the provincial, territorial and federal governments, she said.

Dr. Paradis said the next step is to increase awareness of guidelines, and to work with public-health organizations and clinicians to use them in discussions with patients.

She emphasized people who are unable or unwilling to cut their drinking to low-risk or moderate-risk levels can still benefit from reducing drinking by even small amounts. She said those who consume very high amounts have more to gain by reducing their drinking by as much as they’re able.

“They should not be judged in any way,” she said. “In fact, the final report emphasizes that every drink counts and that any reduction in alcohol consumption is beneficial.”

While Health Canada mandated and funded the project, Dr. Paradis said she has no information yet as to how the results will be used in policies and government programs.

In an e-mailed statement on Monday, Health Canada said alcohol use “presents a serious and complex public-health and safety issue,” and that it looks forward to reviewing the recommendations to the updated guidelines.