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Doctors call for change to alcohol advice

Doctors have warned, “drinkers should have three alcohol-free days a week if they want to avoid the risk of liver disease,” the Daily Mail reported.

It continued that the Royal College of Physicians (RCP) said that the current guidance must be rewritten as it implies that drinking every day is fine.

The new advice from the RCP is part of a submission to MPs on the House of Commons’ Science and Technology Committee about current alcohol guidelines. This submission discusses their review of the evidence from 1995 as well as more recent research evidence and alcohol intake guidelines from other countries. The RCP concluded that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It adds that the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease.

To address what it sees as a problematic lack of emphasis on the frequency of drinking, the RCP suggests that the current advice on safe limits for alcohol intake should be stated in terms of weekly alcohol intake rather than daily unit limits, and that two or three days in the week should be completely alcohol free. It says that men should consume no more than 21 units a week and women should have no more than 14 units, provided the total amount is not drunk in one or two sessions.

The Department of Health (DH) has reportedly said that it has no plans to change its guidance at present. It recommends that men should not regularly drink more than 3-4 units of alcohol a day, while women should not regularly drink more than 2-3 units. ‘Regularly’ is defined as drinking every day or most days of the week. People are also advised to not drink alcohol for 48 hours after a heavy session to let their bodies recover.

Alcohol abuse is associated with an increased risk of liver disease, cancer and other conditions. Read NHS Choices’ Live Well pages on alcohol to find out more.

Where is the advice from?

The advice comes from a report by the Royal College of Physicians (RCP). The RCP submitted its report to MPs on the House of Commons’ Science and Technology Committee. As such, the advice given is for the government about its policy on recommended alcohol intake limits, rather than being aimed directly at the public.

The RCP believes that government advice on sensible drinking limits can play an important role in dealing with alcohol misuse. It says that it is essential government advice is based on evidence and that it is regularly reviewed. It continues that the last systematic review of the evidence by the government, to which interested parties could submit their views, was in 1995.

The RCP believes that current government guidelines on alcohol consumption could be improved to better reflect the evidence in a number of areas, such as:

  • overall levels of consumption that are ‘safe’ or within ‘sensible limits’
  • frequency of alcohol consumption
  • the physiological effects of ageing
  • the balance of the health benefits of alcohol consumption for coronary heart disease against wider alcohol-related health harm
  • The RCP would also like a clear, independent evaluation of the government’s strategy for communicating its guidelines and the risks of alcohol intake to the public.

What does the RCP advise?

The RCP believes that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It says this is problematic, because the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease. The RCP cites various studies to support its argument.

It also notes that someone drinking four units a day (the current upper limit for men in the UK) would be classed as a hazardous or high-risk drinker on the WHO’s gold standard tool for identifying people at risk of alcohol-related harm.

The RCP says that these potential problems with the current guidelines could be remedied by moving to a weekly limit and adding the recommendation to three alcohol-free days a week.

It recommends that in order that people keep their alcohol consumption within ‘safe limits’, men should consume no more than 21 units a week and women should have no more than 14 units. It says that most individuals are unlikely to come to harm at these levels, provided the total amount is not drunk in one or two sessions, and that there are two to three alcohol-free days a week. It says that above this limit the risk of death from all causes increases as alcohol consumption increases.

The RCP also notes that these recommendations are a best judgement based on the evidence, and were reached after a number of areas of uncertainty and inaccuracy were taken into account.

The RCP also suggests that recommended limits for safe drinking by older people in the UK require further consideration, as older people may be particularly vulnerable to harm from alcohol due to biological changes associated with ageing. It says that current guidelines are based predominantly on evidence for younger age groups and there is concern they are not appropriate for older people.

What evidence is this based on?

The RCP’s advice appears to be based on their review of evidence from 1995, and updated with other research evidence published since 1995.

What is current UK government advice?

Official UK government guidance recommends that men should not regularly drink more than 3-4 units of alcohol a day and women should not regularly drink more than 2-3 units a day. ‘Regularly’ is defined as drinking every day or most days of the week. It is also recommended that people not drink alcohol for 48 hours after a heavy session to let their bodies recover.

Pregnant women and women trying to conceive should avoid drinking alcohol. If they do choose to drink alcohol, they are advised to not drink more than 1-2 units of alcohol once or twice a week and not to get drunk, to minimise the risk to the baby. The National Institute for Health and Clinical Excellence (NICE), advises women to avoid alcohol in the first three months of their pregnancy in particular, because of the increased risk of miscarriage.

How do the UK guidelines compare to other countries?

The RCP notes that comparing alcohol guidelines between different countries is difficult, as there are differences in the size of standard drinks and units. It reports that a recent analysis by the Australian government found that 15 countries recommended lower limits than the UK for men, and 12 countries recommended lower limits than the UK for women. Six countries recommended higher limits than the UK for men and six countries recommended higher limits than there are for UK women.

The RCP notes that although looking at the guidelines from other countries may be of interest, it is important that UK government guidelines are a considered and expert judgement on the risks of alcohol consumption, based on the scientific and medical evidence.

Where can I get more information?

More information on the effects of alcohol is available from the NHS Choices alcohol pages.


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