Recommended maximum intake of alcoholic beverages

This article summarizes the recommended maximum intake (or 'safe limits') of alcohol as recommended by the health agencies of various governments. These recommendations are varied, reflecting scientific uncertainty. The recommendations are distinct from legal restrictions that may apply in those countries.

Guidelines are general in nature

The guidelines are general guidelines applying to a 'typical' person. Those who are larger than average might be able to consume more. However, there are some people who should not consume alcohol, or limit their use to less than guideline amounts. These are:
* "People with chronic hepatitis C (or other forms of chronic hepatitis infection) who drink heavily [and exceed maximum recommended consumption levels] have poorer health outcomes than those who drink less." That is, they have poorer health outcomes than do those who drink within the guidelines. [http://www.nhmrc.gov.au/publications/synopses/_files/ds9.pdf "Australian Alcohol Guidelines: Health Risks and Benefits"] ] Centre for Addiction and Mental Health / Centre de toxicomanie et de santé mentale [http://www.camh.net/About_Addiction_Mental_Health/Drug_and_Addiction_Information/low_risk_drinking_guidelines.html Low-Risk Drinking Guidelines] ]
* Thin people - those below average body weight (60kg for men, 50kg for women)Alcohol Advisory Council of New Zealand (ALAC) [http://www.alac.org.nz/LowRiskDrinking.aspx Low Risk Drinking] ]
* People with a relative who has, or has had, a problem with alcohol. First-degree relatives are parents and siblings; second-degree relatives are grandparents, uncles, aunts, and cousins. (, p10) These individuals "are urged to be careful about how much they drink."
* People with a mental health problem (including anxiety or depression) and/or sleep disturbance (, p11) Individuals with a mental health problem "should take particular care to stay within the levels set in Guideline 1" [i.e., for men an average of no more than 4 standard drinks a day. For women, an average of no more than 2 standard drinks a day.]
* People taking medications or other drugs, if contraindicated , p12) "Numerous classes of prescription medications can interact with alcohol, including antibiotics, antidepressants, antihistamines, barbiturates, benzodiazepines, histamine H2 receptor antagonists, muscle relaxants, nonnarcotic pain medications and anti-inflammatory agents, opioids, and warfarin. In addition, many over-the-counter and herbal medications can cause negative effects when taken with alcohol." [Ron Weathermon, Pharm.D., and David W. Crabb, M.D. [http://pubs.niaaa.nih.gov/publications/arh23-1/40-54.pdf Alcohol and Medication Interactions] "Alcohol Research & Health" Vol. 23, No. 1, 1999 pp40–54] Others include analgesics, aspirin, insulin, and oral contraceptives. "The list of medications that may interact with alcohol is so long that you should always consult a pharmacist or physician before drinking while using any medicine." [Prevention Source BC [http://www.preventionsource.org/pdf/alcohol_drug.pdf Alcohol and Drug Interactions] Winter 2000]
* Older people because their bodies may be less able to handle the effects of alcohol(, p13) Older people are urged "to consider drinking less than the levels set in Guideline 1" [i.e., for men an average of no more than 4 standard drinks a day. For women, an average of no more than 2 standard drinks a day]
* Young adults (aged about 18–25 years) (, p6 & p14)are "urged not to drink beyond the levels set in Guideline 1" [i.e., for men an average of no more than 4 standard drinks a day. For women, an average of no more than 2 standard drinks a day] .
* Young people (up to about 18 years) (, p15))"should not drink to become intoxicated."
* People who are or have been dependent on other drugs
* People who have a poor diet, or are under-nourished However, alcohol may be useful to stimulate their appetite.
* People who have a family history of cancer or other risk factors for cancer (see Alcohol and cancer for details of how alcohol affects the risk of various cancers)
* People who are told not to drink for legal, medical or other reasons
* "People who choose not to drink alcohol should not be urged to drink to gain any potential health benefit, and should be supported in their decision not to drink. … Non-drinkers can use other strategies, such as regular exercise, giving up smoking, and a healthy diet, to gain protection against heart disease."(, p17)

The standard guidelines may be too high when:
* undertaking activities that involve risk or a degree of skill such as flying, scuba diving, water sports, ski-ing, using complex or heavy machinery or farm machinery, and driving(, p7)
* suffering an acute or chronic physical disease such as heart and lung disease, influenza, diabetes, epilepsy or acute infections
* recovering from an accident, injury or operation
* drinking regularly to relieve stress or get to sleep
* responsible for the safety of others at work or at home

A physician can provide additional information.

Units and standard drinks

Countries express alcohol intake in 'units' or 'standard drinks' when recommending alcohol intake. In ascending order of unit size:
*United Kingdom: A 'unit' is 8g or 10 millilitres of alcohol. A unit is roughly equivalent to half a pint of ordinary strength beer, lager, or cider (3–4% alcohol by volume), or a small pub measure (25 ml) of spirits (40% alcohol by volume), or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). [PRODIGY Knowledge (Department of Health) [http://www.prodigy.nhs.uk/patient_information/pils/alcohol_and_sensible_drinking.pdf Alcohol and Sensible Drinking] ] [http://www.icap.org/PolicyIssues/DrinkingGuidelines/StandardDrinks/KeyFactsandIssues/tabid/209/Default.aspx Key Facts and Issues] International Center for Alcohol Policies (ICAP)]

*Iceland: 9.5g [http://www.drinkingandyou.com/site/uk/biggy.htm Worldwide Recommendations on Alcohol Consumption] ]
*Netherlands: A standard drink is 9.9g.
*Australia, Austria, Ireland, Italy, New Zealand, Poland, Spain [Department of Health and Ageing [http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/standard The Australian Standard Drink] ] Alcohol Advisory Council of New Zealand (ALAC) [http://www.alac.org.nz/WhatsInAStandardDrink.aspx What's in a Standard Drink] ] ,: A standard drink is 10g / 12.7 millilitres of alcohol. So in these countries, a standard drink is 30ml of straight spirits, a 330ml can of beer, or a 100ml glass of table wine. To calculate standard drinks, use the following formula: Volume of container (litres) x % alcohol by volume (mL/100mL) x 0.789 = The number of standard drinks [New Zealand Food Safety Authority (NZFSA) / Te Pou Oranga Kai O Aotearoa [http://www.nzfsa.govt.nz/consumers/food-safety-topics/food-processing-labelling/food-labelling/fact-sheets/fs-2003-04-alcohol-labelling.htm What's on a Food Label? Alcoholic Beverages and Foods] ]

*Finland: A standard drink is 11g.Drinking and You [http://www.drinkingandyou.com/site/uk/what.htm Drinking guidelines - units of alcohol] ]
*Switzerland: A standard drink is 10–12g.
*Denmark, France, South Africa: A standard drink is 12g.
*Canada: A standard drink is 13.6g alcohol. Examples of standard drinks are: 5 oz/142 mL of wine (12% alcohol), 1.5 oz/43 mL of spirits (40% alcohol), 12 oz/341 mL of regular strength beer (5% alcohol).
*Portugal, United States: A standard drink is 14g / 18 millilitres / 0.5 ounces of alcohol.
*Hungary: 17g
*Japan: A standard drink is 19.75g / 25 millilitres of alcohol.
*Hong Kong: 1 unit is a glass of wine or a pint of beer

Men

The standard drink size is given in brackets.

Daily maximum drinks (no weekly limits recommended)

*Austria: 24g
*Czech Republic 24g
*Italy: 40g (30g for the elderly)
*Japan 1–2 (@19.75g = 19.75–39.5g)
*Netherlands: 3 (@9.9g = 29.7g)
*Portugal 37g
*Spain: 3 (@10g = 30g) Also suggests a maximum of no more than twice this on any one occasion.
*Sweden: 20g
*Switzerland: 2 (@10–12g = 20–24g)ICAP [http://www.icap.org/PolicyIssues/DrinkingGuidelines/GuidelinesTable/tabid/204/Default.aspx International Drinking Guidelines] ]

Therefore, these countries recommend limits for men in the range 20–40g 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.
*Australia: 6/day; 28/week (@10g = 60g/day, 280g/week) Recommends one or two alcohol-free days per week.Department of Health and Ageing [http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/summary Australian Alcohol Guidelines in Summary] ] The Australian guidelines will be reduced in 2008 to two drinks a day for an adult. [http://www.nhmrc.gov.au/consult/archive/draft_australian_alcohol_guidelines.htm Public consultation on the draft revised Australian alcohol guidelines for low-risk drinking] ] [http://www.nhmrc.gov.au/news/media/rel08/080122.htm Alcohol Guidelines based on strong evidence] ] [http://www.smh.com.au/news/national/two-a-day-safe-limit-on-drinks/2007/10/12/1191696173751.html Two a day safe limit on drinks] ]
*Canada: 2/day; 14/week (@13.6g = 27.2g/day, 190g/week) [http://www.lrdg.net/ Low-Risk Drinking Guidelines (LRDG)] (goes live September 2006)]
*Hong Kong: 3–4/day; 21/week (glass of wine or a pint of beer)
*New Zealand: 3/day; 21/week (@10g = 30g/day, 210g/week)
*UK: 3–4/day; 21/week (@8g = 24–32g day, 168g/week)
*USA: 4/day; 14/week (@14g = 56g/day, 196g/week)

Therefore, these countries recommend limits for men in the range 24–60g per day and 168–280g per week.

Weekly maximum drinks

*Denmark: 252g
*Finland: 15 units (@11g = 165g/week)
*Ireland: 21 units (@10g = 210g/week)

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)

*Austria: 16g
*Czech Republic 16g
*Italy: 30g (25g for elderly women)
*Netherlands: 2 (@9.9g = 19.8g)
*Portugal 18.5g
*Spain: 2 (@10g = 20g) Also suggests a maximum of no more than twice this on any one occasion.
*Sweden: 20g
*Switzerland: 2 (@10–12g = 20–24g)
*India : ?Therefore, these countries recommend limits for women in the range 12–30g 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.
*Australia: 4/day; 14/week (@10g = 40g/day, 140g/week). Recommends one or two alcohol-free days per week. The Australian guidelines will be reduced in 2008 to two drinks a day for an adult.
*Canada: 2/day; 9/week (@13.6g = 27.2g/day, 122.4g/week)
*Hong Kong: 2–3/day; 14/week (glass of wine or a pint of beer)
*New Zealand: 2/day; 14/week (@10g = 20g/day, 140g/week)
*UK: 2–3/day; 14/week (@8g = 16–24g/day, 112g/week)
*USA: 3/day; 7/week (@14g = 42g/day, 98g/week)

Therefore, these countries recommend limits for women in the range 16–42g per day and 98–140g per week.

Weekly maximum drinks

*Denmark 168g
*Finland: 10 units (@11g = 110g/week)
*Ireland: 14 units (@10g = 140g/week)

Pregnant women

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, advice for pregnant women is different from that for those who are not. 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: Consider abstinence but if choosing to drink, then limit intake to less than 7 standard drinks, and, on any one day, no more than 2 standard drinks (spread over at least two hours).(, p16) (Australian standard drink = 10 grams or 13 millilitres of alcohol.) The Australian guidelines will be reduced in 2008 to total abstinence for a pregnant woman.
* Canada: "Don't drink if you are pregnant or planning to become pregnant."
* France: Total abstinence
* Iceland: Advise that pregnant women abstain from alcohol during pregnancy because no safe consumption level exists.
* Israel: Total abstinence
* The Netherlands: Abstinence
* Norway: Abstinence
* New Zealand: "There is no known safe level of alcohol consumption at any stage during pregnancy. Therefore, the Ministry recommends that, to be on the safe side, it is best that women avoid drinking alcohol at all during pregnancy."New Zealand Ministry of Health Manatū Hauora [http://www.moh.govt.nz/moh.nsf/0/CF41544E550A61ADCC2571620081488D Ministry releases revised food and nutrition guidelines for pregnancy and breastfeeding] ]
* UK: Until 25 May 2007, the advice was to avoid more than 1–2 units once or twice a week (unit = 8 grams or 10 millilitres of alcohol). The advice was changed to total abstinence. [Department of Health [http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=287152&NewsAreaID=2&NavigatedFromDepartment=False Updated alcohol advice for pregnant women] ] [BBC [http://news.bbc.co.uk/1/hi/health/6687761.stm 'No alcohol in pregnancy' advised] 25 May 2007] [ Rosemary Bennett [http://www.timesonline.co.uk/tol/life_and_style/health/article1837653.ece Zero – the new alcohol limit in pregnancy] "The Times" 25 May 2007] NICE guidelines issued in March 2007 state,"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." [NICE [http://www.nice.org.uk/nicemedia/pdf/CG062PublicInfo.pdf Routine antenatal care for healthy pregnant women] ]
* US: Total abstinence during pregnancy and while planning 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." [http://www.direct.gov.uk/Parents/HavingABaby/HealthInPregnancy/PregnancyArticles/fs/en?CONTENT_ID=4002864&chk=wx/7LB Alcohol and pregnancy] ] "Alcohol clears from a mother's milk at the rate of around one unit [8g] every two hours. So try to avoid alcohol before breastfeeding, or plan ahead and express milk if you know you'll be drinking." [http://www.drinkaware.co.uk/aware_life4.php Is it advisable to drink while you're pregnant?] ] "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."
*Australia: "Women who are breastfeeding are advised not to exceed the levels of drinking recommended during pregnancy, and may consider not drinking at all."
*Iceland: Advise that women abstain from alcohol during breast feeding because no safe consumption level exists.
*New Zealand: "The guidelines recommend women do not drink alcohol, smoke, or use non-prescription drugs unless prescribed during pregnancy and breastfeeding, as these can all affect the growth and development of the baby."
*United Kingdom: "The occasional drink - one to two units [8–16g] no more than once or twice a week - probably won't do any harm. Any more than this isn't good, as it can make the baby so sleepy that it won't take enough milk."

References

ee also

*Standard drink
*Unit of alcohol

External links

*The Cancer Council New South Wales page, [http://www.cancercouncil.com.au/editorial.asp?pageid=1777 Alcohol recommendations / guidelines by other organisations] , summarizes some recommendations by country.

Brilliant Breastfeeding Alcohol page [http://www.brilliantbreastfeeding.com/alcohol.html] /describes pros and cons of drinking alcohol while breastfeeding