In January 2016, the UK announced the revised guidelines for low-risk drinking of 14 units (112 g) per week for men and women. Anstie’s limit from 1864 of 42.5 g of alcohol as the maximum daily consumption was now reduced to 16 g, and the proposed weekly limits were reduced from 56 drinks per week (1979) to 14 units per week. One unit was defined as 8 g of pure alcohol. The guidelines shifted from daily limits to the weekly cap of 14 units, but it was stated that “it is best to spread the units evenly over three days or more. Heavy drinking sessions increase the risks of death from long-term illnesses and from accidents and injuries. The risks of single drinking sessions can be reduced by limiting the amount of alcohol, drinking more slowly, drinking with food, and alternating alcoholic drinks with water.”
Critique of specific statements
• No safe alcohol limit: Dame Sally Davies and fellow UK chief medical officers clearly expressed their view that there is no “safe” alcohol limit and drinking any level of alcohol raises the risk of a range of cancers. Most human activities, however, are associated with some risk, and it is scaremongering to say that there is no safe amount when a small amount increases risk only marginally. In 2023, 28% of the global breast-cancer burden was linked to six potentially modifiable risk factors. High red-meat consumption had the biggest impact (linked to nearly 11% of all healthy life lost), followed by tobacco use including secondhand smoke (8%), high blood sugar (6%), high body mass index (4%), high alcohol use, and low physical activity (both 2%).1 In a UK Biobank Study, moderate alcohol intake (50–200 g/week = 6–25 units/week) was not associated with cancer mortality in participants with a regular alcohol consumption with meals.2 The Sister Study of women with a sister with breast cancer (which doubles the risk of developing breast cancer) did not find an increase in risk for moderate drinking without bingeing.3 Failing to emphasize the importance of drinking patterns risks unnecessarily stigmatizing the enjoyment of responsible drinking with a healthy meal.
• Drink-free days: Dame Sally Davies urged the public to take two—possibly even three—alcohol-free days each week to give their livers a rest. But there is not sufficient empirical evidence to recommend weekly drink-free days for people with a light to moderate consumption—neither with the argument that your liver needs drink-free days’ rest, nor to support a statement that the same quantity consumed daily would bear a higher risk of alcohol dependence than the same quantity consumed on six days a week. The evidence shows that male and female daily drinkers who consume alcohol during family meals tend to have few alcohol-related problems.4
Royal Statistical Society critique
In its response to the Department of Health’s consultation on new alcohol guidelines, submitted March 2016, the Royal Statistical Society (RSS), represented by president Peter Diggle and president-elect Sir David Spiegelhalter, argued that the guidelines should be less prescriptive, focus on informed choice rather than strict rules, and better reflect the available statistical evidence.
Related
• Minimal risk: The guidelines failed to reflect properly the minimal risks associated with low-level, moderate consumption, particularly among older drinkers. The RSS suggested the guidelines should mention the potential benefits (like cardiovascular) of low-level drinking rather than focusing solely on cancer risks.
• Uniform limits: The newly proposed 14-unit weekly limit for both men and women was considered misleading, because it was ignoring established biological differences in alcohol metabolism.
• Higher-risk focus: Instead of a single low threshold, the RSS recommended focusing on higher-risk levels—suggesting 35 units for women and 50 for men—and presenting the 14-unit limit as an “aspirational” target rather than a strict limit.
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Here is an RSS-cited example of flawed data used by the health evidence expert group: “The net benefits from small amounts of alcohol are only significant for women over the age of 55, for whom the maximum benefit is gained when drinking around 5 units a week with some beneficial effect up to around 14 units a week.” The conclusions from the study quoted as evidence, however (CS Knott et al, “All-Cause Mortality and the Case for Age-Specific Alcohol Consumption Guidelines: Pooled analyses of up to 10 population-based cohorts,” British Medical Journal 350, 2015, h384), was misleading due to the poor use of statistics. To quote Professor Spiegelhalter: “Essentially, the study is grossly underpowered to convincingly detect a plausible protection, and the authors have committed the cardinal sin of saying that non-significance is the same as ‘no effect’ in a study lacking sufficient events—in this case, deaths in non-drinkers.”
Alcohol guidelines debate
Critical comments were made at a debate about the new guidelines in the House of Commons on June 30, 2016.
• Byron Davies: “I declare an interest as a member of the all-party beer group. I am concerned that the process by which the chief medical officer reaches their conclusion is flawed and has, in some ways, been hijacked by a group of campaigners with a clear anti-alcohol, total-abstinence agenda. I take issue with organizations such as the Institute of Alcohol Studies, which is funded directly by the temperance movement. The proposed new guidelines do not reflect the full international evidence base on alcohol and health, and actively downplay decades of epidemiological evidence that shows the protective effects of low to moderate drinking against cardiovascular disease, stroke, type 2 diabetes, and cognitive impairment.”
• Dr James Davies: “As a GP, I can confirm the current lack of faith in the validity of the guidelines. Many feel, for instance, that the social benefits of moderate alcohol intake have not been given sufficient weight.”
• Byron Davies: “Having raised my concerns with the process adopted in undertaking the review, which I believe have prejudiced the outcome, I turn to the presentation of the review’s findings and, in particular, to the assertion that there is no safe level of alcohol consumption, the lowering of the recommended weekly levels for men in line with those for women, and the communication of risk. I believe that that assertion is at the heart of the flawed nature of the proposed guidelines, and it is, in some respects, clearly deliberate on the part of campaigners. If the government accepts that there is no safe level of consumption, it becomes much easier to argue for more restrictions on alcohol availability.”
Lack of international agreement
British research on government advice in 57 countries found “a remarkable lack of agreement about what constitutes harmful or excessive alcohol consumption” and also “no consensus about the ratios of consumption guidelines for men and women.”5 According to a 2016 study, men from the UK now had one of the world’s lowest levels for low-risk drinking: “low-risk drinking ranging from 10–42 g per day for women and 10–56 g per day for men, to 98–140 g per week for women and 150–280 g per week for men.”6
The most recent overview from 2020 found important differences in low-risk drinking guidelines from 58 countries, ranging from 15 to 170 g per week for women and 15 to 294 g per week for men. “Many guidelines do not seem to consider biological and social aspects or scientific evidence.”7
A scientific committee report exemplifies a review of the scientific evidence to produce standard low-risk guidelines for Ontario. A standard drink (SD) is defined as 14 g of alcohol.
• “Regarding overall mortality, men averaging less than 210 g (up to 14 SD) a week are at lower risk of early death than men who abstain, while larger amounts are associated with increased risk. Women who drink 9 SD or less per week are at lower risk of early death than abstainers; risk begins to increase at an average intake of 140 g (10 SD) a week. Therefore, weekly upper limits of 14 SD per week for men, and 9 for women were adopted.
• Women typically reach higher BAC levels than men drinking the same amount. For most acute problems, however, men are at much greater risk. Therefore, daily limits were not made sex-specific. A daily limit of no more than two SD was chosen because this should not result in a significant risk of problems for most people.
• One analysis showed that when intake is limited to 7 to 14 drinks a week, spreading it over seven days instead of six reduces the risk of some problems. Therefore, a statement about abstinent days was not included.”8
NOTES
1. “GBD 2023 Breast Cancer Collaborators. Global, Regional, and National Burden of Breast Cancer among Females, 1990–2023, with Forecasts to 2050: A systematic analysis for the Global Burden of Disease Study 2023,” Lancet Oncology 27:3 (2026), pp.302–26.
2. H Ma, X Li, T Zhou, D Sun, et al, “Alcohol Consumption Levels as Compared with Drinking Habits in Predicting All-Cause Mortality and Cause-Specific Mortality in Current Drinkers,” Mayo Clinic Proceedings 96:7 (2021), pp.1758–69.
3. AJ White, LA DeRoo, CR Weinberg, DP Sandler, “Lifetime Alcohol Intake, Binge Drinking Behaviors and Breast Cancer Risk,” American Journal of Epidemiology 186 (2017), pp.541–49.
4. C Martic, A Wyllie, S Casswell, “Types of New Zealand Drinkers and Their Associated Alcohol-Related Problems,” Journal of Drug Issues 22 (1992), pp.773–96.
5. NAFF Furtwængler, RO De Visser, “Lack of International Consensus in Low-Risk Drinking Guidelines,” Drug and Alcohol Review 32 (2013), pp.11–18.
6. A Kalinowski, K Humphreys, “Governmental Standard Drink Definitions and Low-Risk Alcohol Consumption Guidelines in 37 Countries,” Addiction 111 (2016), pp.1293–98.
7. TCS Paula, C Chagas, LB Martins, CP Ferri, “Low-risk Drinking Guidelines Around the World: An Overview of the Current Situation,” Addictive Disorders & Their Treatment 19:4 (2020), pp.218–27.
8. SJ Bondy, J Rehm, MJ Ashley, G Walsh, E Single, R Room, “Low-Risk Drinking Guidelines: The scientific evidence,” Canadian Journal of Public Health 90 (1999), pp.264–70. ▉
