Hello everyone,

We know that alcohol negatively impacts our health, yet many people enjoy a few drinks with their friends or family to unwind and socialise. In many parts of the world alcohol consumption is both culturally and economically important – this year revenue in the alcoholic drinks market was around 1,400 billion US dollars.

At a population level, how can a society allow drinking whilst also protect the health of its citizens? One approach is to spread information about how high alcohol consumption can be detrimental. Most commonly this is done through alcohol guidelines. Ideally, if you stick to the alcohol limits in these guidelines, you should significantly lower your risk of harming your health. There is one complication: alcohol does not affect everyone’s health to the same extent. Our genetics, environment and sex are all factors to be taken into consideration. We asked two experts in alcohol use and clinical research, ‘Should alcohol limits for men and women be the same?’, this is what they said…

EXPERT CONSENSUS

Should alcohol limits for men and women be the same?

2 out of 2 experts say ‘uncertain’

What are the current alcohol limits?

Dr Rachel Visontay, an expert in alcohol use and mental health from Sydney University in Australia, says “countries differ in what they think is appropriate. For example, the US currently gives sex-specific recommendations, advising no more than 1 drink per day for women, and no more than 2 for men. On the other hand, Australia’s recently-updated guidelines are uniform for men and women, advising no more than 10 drinks per week (note that this is actually the equivalent of 7 US standard drinks).”

Dr Bob Patton, an expert in psychology and clinical research from Surrey University in the UK, says “The UK’s alcohol guidelines advise that men and women shouldn’t drink more than 14 units of alcohol a week. Previous advice for the British drinker presented a higher threshold for men, so this represents a considerable change.” A unit of alcohol in the UK equates to 10ml of pure alcohol. For reference, a small glass of wine in the UK would constitutes 1.5 units, whilst a pint of beer is between 2 and 3 units.

Dr Patton says that “Most countries that provide guidelines on alcohol consumption suggest higher threshold levels for men than women.”

Does the same quantity of alcohol have different effects for men and women?

Dr Visontay says “The answer here is a near certain yes. In the short-term, women reach higher peak blood alcohol content and display more impairment than men after the same number of drinks. There are a range of biological factors responsible, including the fact that women are on average smaller, have less body water per kilo (meaning less dispersal of alcohol), and metabolise alcohol differently (with men having a better ability to break down alcohol when it first reaches the stomach).”

Dr Patton agrees, saying “It is well known that, physiologically, women are more vulnerable to the toxic effects of alcohol than men. Pint for pint, women have a greater risk of alcohol related problems such as dependency, certain cancers (liver, mouth and stomach) and other physical and psychological health issues.”

The differences between men and women increases the more you drink. Dr Patton says “The different risk factors faced by men and women are particularly apparent at higher levels of consumption – what we now call ‘drinking with increasing risk’. That is, men who regularly drink more than three or four units a day and women who regularly drink more than two or three units a day. But at levels of consumption lower than this, these differences are not as clear cut”

What is the safe amount to drink for men and women?

Identifying a safe alcohol limit is challenging due to the number of factors at play.

Dr Patton says “The [2016 UK] guidelines are based on data provided by the University of Sheffield. It shows that anyone who drinks every day and who consumes no more than 14 units of alcohol a week has a less than one percent chance of dying from an alcohol-related health condition at any time”

One issue with this is that most people don’t drink alcohol every day. Dr Patton says “it’s not just how much, but also how often, we drink that counts, with decreasing frequency associated with increased risk. [Data from the University of Sheffield] shows that men drinking 14 units a week on a single occasion have a 4.5% lifetime risk of dying from an alcohol-related health condition. For women drinking at the same level on a single occasion each week, the risk is 2%”

Another issue is the threshold which we consider ‘safe’. The 1% chance of death is a fairly arbitrary cut-off. Dr Patton says “One percent was adopted by the guidelines committee as the maximum level of risk that would be acceptable to the public. This has been presented as a similar level of risk to the chance of dying in a car accident. (In fact, the chances of dying in a road accident are even smaller – at less than 0.5% over a lifetime.)” He goes on to highlight that there is a range within that 1% threshold, saying “Interestingly, at [the 2016 UK] guideline threshold, men have an almost five times (0.99%) greater risk of death than women (0.18%), but still less than 1% overall”.

Should men and women have different safe drinking guidelines?

Dr Patton says “Given that there are well established and significant differences between male and female responses to alcohol across a range of quantities and frequencies of consumption, it is difficult if not impossible to encompass this diversity into a single recommendation of what represents the optimal limits of consumption with regard to the likelihood of dying from an alcohol related condition.” He goes on to say that “It might be better to present information on the relative risks associated with increasing use. This allows a comparison with non-drinkers, for example: ‘Men who regularly drink five units a day have a threefold increased risk of death from cirrhosis of the liver compared with non-drinkers.’” This could provide a better alternative to the 1% risk of death currently used in the UK.

Dr Patton concludes that “ignoring the differences between male and female responses to alcohol is a risky strategy. If the guidelines don’t resonate with those of us who choose to drink, they will simply be ignored, and that won’t do anyone any good at all.” However, Dr Visontay disagrees, saying “Modelling indicates that had separate guidelines been issued, the male limit would have only been slightly higher – 12 drinks per week. Simplifying guidelines may also be advantageous when it comes to effective public health messaging.”

The takeaway:

Whilst sex (and many other factors) influence how alcohol impacts your body, drinking guidelines are sometimes unisex to make them easier to remember and stick to.

May the facts be with you!

Eva

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Should alcohol limits for men and women be…