UK drinking guidelines are better for the alcohol industry than the publicBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6023 (Published 27 September 2011) Cite this as: BMJ 2011;343:d6023
- Mark A Bellis, professor of public health, Liverpool John Moores University, Liverpool L3 2ET
Barely a month passes without debate over illness relating to alcohol consumption, or its health benefits when consumed in moderation (BMJ 2011;342:d671, doi:10.1136/bmj.d671; BMJ 2011;342:d3950, doi:10.1136/bmj.d3950; BMJ 2010;341:c5957, doi:10.1136/bmj.c5957). Health professionals as well as members of the public could be forgiven for being confused about how much to drink or how to advise others. For drinkers who wish to protect their own health one of the first ports of call is national drinking guidance (www.drinkaware.co.uk). Recent presentations of such guidance, however, are more likely to increase harms to health.
Many variations of this guidance can already be found on leaflets and websites. Typically it is stated that “men should not regularly drink more than 3-4 units of alcohol per day, and women should not regularly drink more than 2-3 units of alcohol per day. Regularly means drinking these amounts every day or most days of the week.” In supermarkets and on the national “drink aware” website you can find this guidance contorted from a daily maximum into a recommended daily amount. The website says, “Understanding unit guidelines: The recommended daily amount for women is 2-3 units, or . . . 3 x 25 ml shots of whisky.” A supermarket sign says, “Women (units). 2-3. Recommended daily amount.” A woman reading this guidance might think that she should have three shots of whisky a day, in much the same way that she should eat five portions of fruit and vegetables a day. Even undistorted it is difficult to understand how UK guidance constitutes health advice.
Established relationships between consumption and disease risks to populations elsewhere suggests that four units a day for men over a lifetime is consistent with about 1 in 100 such drinkers dying from an alcohol related disease (International Journal of Methods in Psychiatric Research 2008;17:141-51, doi:10.1002/mpr.259). Three units a day for a woman carries a marginally smaller risk. Advocates of UK guidance say that these risks are partly mitigated by protective effects against primarily cardiovascular disease at lower levels of alcohol consumption (BMJ 2011;342:d671, doi:10.1136/bmj.d671). Some of this protection, however, is an artefact of study design (Drug and Alcohol Review 2009;28:441-4, doi:10.1111/j.1465-3362.2009.00052.x). Furthermore, if people have just occasional heavier drinking sessions (for example, consume a 75 cl bottle of wine in a night), any protection against ischaemic heart disease disappears (American Journal of Epidemiology 2010;171:633-44, doi:10.1093/aje/kwp451). The health consequences of occasional heavy drinking sessions are paramount given that UK guidance does not exclude such sessions so long as they are not regular—that is, most nights of the week. In fact, to minimise all cause mortality associated with alcohol consumption, systematic review suggests that people should not consume more than about 4-5 units of alcohol a week, or 5 g a day (Archives of Internal Medicine 2006;166:2437-45). Drinking more than this amount simply increases risks of mortality.
UK guidance also fails to take into account the effects of alcohol consumption on the risk of injury. A drinking session at least once a week in which 10 units (a 75 cl bottle of wine or 3.5 pints of stronger lager) are consumed may add an additional one in 100 chance of lifetime mortality from injury (International Journal of Methods in Psychiatric Research 2008;17:141-51). Overall, then, a man following the current UK daily guidance could legitimately drink 10 units on a Friday and another 15 spread throughout the rest of the week and still stay within the daily guidelines. The total alcohol related lifetime mortality risk for such a sensible drinker may be about one in 50.
Although taking such risks remains a drinker’s choice, making the right choices depends on understanding the risks involved. Rather than explaining such risks, current guidance can read more like an alcohol promotion slogan, but this substance kills thousands of UK citizens each year and leads to more than a million admissions to hospital.
We urgently need revised, evidence based guidelines on adult alcohol consumption in the UK. The evidence is currently the subject of review by parliament’s Science and Technology Committee. However, the window of opportunity for developing, adopting, and communicating revised guidance, with a genuine public health focus, is closing. As part of the government’s responsibility deal, alcohol companies have pledged to place national daily drinking guidance on 80% of all alcohol products by December 2013. The wrong information could increase harms, and changing it may prove an increasingly difficult and protracted process. As the government plans to release a new alcohol strategy later this year, an obvious first step is to ensure guidance uses current evidence which is pertinent to the UK population. To do so is not the action of a nanny state but of one that genuinely wants its citizens to make informed decisions about their drinking.
Cite this as: BMJ 2011;343:d6023
I thank Dr Karen Hughes for help with preparing this manuscript.
Competing interests: The author has acted as an adviser to DrinkAware in the previous three years, and the Centre for Public Health was awarded a grant by DrinkAware to undertake a study of nightlife drinking behaviours.
Provenance and peer review: Not commissioned; not externally peer reviewed.
bmj.com/archive Lobby Watch: The Portman Group (BMJ 2010;340:b5659, doi:10.1136/bmj.b5659)