Health chiefs warn ‘no safe level of drinking’ – here are the latest guidelines in full

No level of regular drinking is without risks to health, the UK’s chief medical officers have said as they published a raft of changes to advice on alcohol.

The new guidance sweeps away 1995 recommendations and takes account of new evidence on the increased risk of developing cancer from drinking as well as the harms from binge-drinking.

The guidance says pregnant women should avoid alcohol altogether as there is no evidence for a “safe” drinking level.

Men should consume no more than 14 units of alcohol per week, down from the previous 21 units, bringing them into line with the recommendation for women.

People should have several booze-free days a week but not “save up” their 14 units for a binge.

When drinking on a single occasion, the chief medical officers say people should drink more slowly, consume alcohol with food, and alternate with water.

Furthermore, people should avoid “risky places and activities” and ensure they get home safely to reduce some of the biggest harms from binge-drinking – accidents and injuries.

The new guidance also says evidence that alcohol – such as red wine – is beneficial for health “is considered less strong than it was”.

Only women aged 55 and over may benefit from the protective effect of drinking on heart health, the research suggests.

A report informing the new guidance says the risk of getting cancer “starts from any level of regular drinking and rises with the amount being drunk”.

Even drinking at low levels is linked to cancers of the lip, oral cavity, pharynx, oesophagus and breast.

At higher levels, there is an increased risk of bowel and liver cancer.

Modelling for the study shows that, compared with non-drinkers, women who regularly drink two units a day have a 16% increased risk of developing breast cancer and dying from it.

Those who regularly consume five units a day have a 40% increased risk.

For every 1,000 women who do not drink, 109 will develop breast cancer. This rises to 126 women for those who drink 14 units or less per week, and 153 women for those who drink 14 to 35 units a week.

Among men, for cirrhosis of the liver, those who regularly drink two units a day have a 57% increased risk of dying from the disease compared with non-drinkers.

Among non-drinking men, 64 in every 1,000 will develop bowel cancer and this stays the same for those drinking 14 units or less per week, but rises to 85 for those drinking 14 to 35 units per week.

For oesophageal cancer among men, six out of every 1,000 non-drinkers will develop it, but this doubles to 13 for those drinking 14 units or less per week and rises to 25 for men drinking 14 to 35 units per week.

The report said drinking regularly over time can lead to a wide range of illnesses including cancers, strokes, heart disease, liver disease, and damage to the brain and nervous system.

Nevertheless, it says drinking 14 unit or less per week keeps “the risk of mortality from cancers or other diseases” – such as liver disease – low.

The new guidance says pregnant women should not drink at all as a precautionary measure, removing the previous clause which said they should drink no more than one to two units of alcohol once or twice per week.

“Despite little evidence of harm from low levels of drinking, it is not possible to say that such drinking carries no risks of harm to the foetus at all,” it says.

Chief Medical Officer for England Dame Sally Davies said: “Drinking any level of alcohol regularly carries a health risk for anyone, but if men and women limit their intake to no more than 14 units a week it keeps the risk of illness like cancer and liver disease low.

“I want pregnant women to be very clear that they should avoid alcohol as a precaution. Although the risk of harm to the baby is low if they have drunk small amounts of alcohol before becoming aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant.

“What we are aiming to do with these guidelines is give the public the latest and most up- to-date scientific information so that they can make informed decisions about their own drinking and the level of risk they are prepared to take.”

Experts welcome new alcohol guidance

Health experts and charities have welcomed new guidance on safer drinking levels.

Professor Linda Bauld, Cancer Research UK’s expert on cancer prevention, said: “The link between alcohol and cancer is now well established, and it’s not just heavy drinkers who are at risk. There is no ‘safe’ level of drinking when it comes to cancer – the less you drink, the lower your risk.”

Baroness Delyth Morgan, chief executive of Breast Cancer Now, said: “This is a real step in the right direction on alcohol in the UK.

“It’s imperative that men and women fully understand the risks involved and that clear information about the alcohol content of all drinks is now provided.”

Matt Field, professor of addiction at the University of Liverpool, said: “One of the most important changes is that there is no ‘safe’ level of alcohol consumption: any amount of drinking is associated with increased risk of a number of diseases; the often-reported ‘protective’ effects will not apply to the majority of people and where they do apply, they refer to very low levels of drinking.

“So, any amount of alcohol consumption carries some risk.

“However, it is important to bear in mind that most activities that people undertake on a daily basis (eg driving to work) carry some risk, and people need to make informed choices about the level of risk that they are prepared to accept.”

Dr John Holmes, senior research fellow from the Sheffield Alcohol Research Group, said: “Having the same guidelines for men and women reflects that there are only very minor differences in alcohol-related health risk between the sexes at this level of consumption (ie up to 14 units per week).

“At higher levels of consumption, health risks from the same level of drinking are greater for women than for men.”

Dr Holmes added that, while many scientific studies suggest moderate drinking can be good for the heart, researchers are increasingly concerned that problems with those studies mean any protective health effects have been substantially over-estimated.

Those problems include inadequately accounting for influences on health other than alcohol – for example, whether a person smokes or has a poor diet.

“Our analyses did take evidence of protective health effects at face value but still found that, after accounting for the health risks of drinking, any remaining protective effect was small, associated with very low levels of alcohol consumption and only likely to benefit specific groups in the population even if it was genuine.”

Naveed Sattar, professor of metabolic medicine at the University of Glasgow, said: “For years, many have been seduced into drinking more than they should in the belief that alcohol protects them from heart disease.

“However, this apparent ‘protection’ is now open to question and, with the other evidence demonstrating even small amounts increase other health risks including but not limited to weight gain and cancers, then it’s clear that for many the less alcohol drunk the better.

“Hopefully these new messages will be a wake-up call for many and motivate them to moderate their intakes, with resulting improvement in health.”

Professor Kevin Fenton, national director of health and wellbeing for Public Health England, said: “Alcohol can harm individuals, their families and the community and it’s crucial that we look more widely at what affects drinking behaviour in this country, such as marketing methods and pricing.

“Public Health England will soon be providing a report to Government on how we can reduce the harms caused by alcohol.”

Professor Mark Bellis, the Faculty of Public Health’s lead spokesperson for alcohol, said the guidance “sends out a clear message that there is no safe level of drinking alcohol”.

He added: “We’d also like to see government help protect people’s health by introducing a minimum unit price for alcohol.”

A statement from the Portman Group, which represents the industry, said: “What is surprising is that the UK is breaking with established international precedent by recommending the same guidelines for men and women. It also means that UK men are being advised to drink significantly less than their European counterparts.”

Camra chief executive Tim Page said: “We are uncertain whether there is sufficient agreement among experts to support these new guidelines.

“We will be consulting with our members and other consumers to find out their views on the guidance and will feed back their opinions to the Chief Medical Officer.”

Latest guidelines on drinking alcohol – in full

Here are the full guidelines on consuming alcohol from the UK’s chief medical officers.

On regular drinking:

• You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level.
• If you do drink as much as 14 units per week, it is best to spread this evenly over three days or more. If you have one or two heavy drinking sessions, you increase your risks of death from long-term illnesses and from accidents and injuries.
• The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis.
• If you wish to cut down the amount you’re drinking, a good way to help achieve this is to have several drink-free days each week.

On drinking on any single occasion:

Men and women can reduce risks by:

• Limiting the total amount of alcohol you drink on any occasion.
• Drinking more slowly, drinking with food, and alternating with water.
• Avoiding risky places and activities, making sure you have people you know around, and ensuring you can get home safely.

The sorts of things that are more likely to happen if you do not judge the risks from how you drink correctly can include: accidents resulting in injury (causing death in some cases), misjudging risky situations, and losing self-control.

As well as the risk of accident and injury, drinking alcohol regularly is linked to long-term risks such as heart disease, cancer, liver disease, and epilepsy.

On drinking in pregnancy:

• If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.
• Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.
• The risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy.

Women who find out they are pregnant after already having drunk during early pregnancy, should avoid further drinking, but should be aware that it is unlikely in most cases that their baby has been affected.

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