Frequently Asked Questions about the LRDGs

About the Guidelines

1. Why were the Low-Risk Drinking Guidelines developed?

2. Who are the Guidelines for?

3. What do the Low-Risk Drinking Guidelines say?

4. What is a "standard" drink?

5. Why do the Guidelines set weekly drinking limits?

6. Why are the weekly limits lower for women?

7. Why do the Guidelines set daily limits?

8. Why do the Guidelines include hourly limits?

9. Why don't you advise people to refrain from drinking at least one day a week?

10. You say people with "certain health problems" should drink less. Who are you referring to exactly?

11. What types of medications can become dangerous when combined with alcohol?

12. You say people under any legal or other restriction on drinking should drink less or not at all. How do you define "legal or other restrictions"?

13. How much can I safely drink if I'm driving?

14. Are there other situations when it's not advisable to drink?

15. Will women who are pregnant or breastfeeding have babies with fetal alcohol syndrome if they have a small amount to drink?

16. Aren't there different daily drinking limits for problem drinkers?

17. What is the link between alcohol consumption and chronic disease?

18. I've heard that red wine is good for the heart. Should I be drinking red wine?

19. What is the link between alcohol and heart health?

20. Should I start drinking to improve my health?

21. If I drink, but not every day, should I consider becoming a more regular drinker?

22. What if I decide to have all my drinks in one night?

23. What should I do if I am considering a change in the amount I now drink?

24. What if my doctor tells me to drink?

25. It seems every week there's a news item about the benefits of alcohol. Where can find credible research on alcohol and (heart) health?

26. Who developed the Low-Risk Drinking Guidelines?

27. Other countries have higher drinking guidelines. Why are Canada's so low?

28. Isn't it dangerous for public health groups to admit that drinking has some health benefits?

29. Are you encouraging drinking?

30. You say that the Guidelines are based on current research and will be reviewed from time to time. How often are you going to change them?

About the Guidelines

1. Why were the Low-Risk Drinking Guidelines (LRDGs) developed?

Many people have heard mixed messages about alcohol's effects on health. The Low-Risk Drinking Guidelines help healthy adults make informed decisions about the amount of alcohol they consume. The Guidelines include both daily and weekly drinking limits. They also describe drinking practices that balance the health benefits of alcohol while minimizing its risks. Examples of short- and long-term problems associated with alcohol include: drinking and driving, injuries, suicide, violence, liver disease, alcohol dependence and certain types of cancer.

2. Who are the Guidelines for?

The Low-Risk Drinking Guidelines are directed at the general population. They reinforce the drinking practices of approximately 74% of drinkers in Ontario who comply with the combined daily and weekly drinking limits. They also try to moderate the drinking behaviour of the approximately 26% of drinkers who exceed the Guidelines.

3. What do the Low-Risk Drinking Guidelines say?

The LRDGs advise healthy people who choose to drink and who are of legal drinking age, to:

• Drink no more than 2 standard drinks on any day.
• Limit their weekly intake to 14 or fewer standard drinks for men; 9 or fewer standard drinks for women.
• Drink slowly to avoid intoxication, wait at least one hour between drinks, take alcohol with food, and have non-alcoholic beverages.

The Guidelines also recommend:

• Don't start drinking alcohol, or increasing the amount you drink, for its protective effect against heart disease. There are less risky alternatives such as exercise, better nutrition and quitting smoking.
• If you choose to drink, the protective effect of alcohol can be achieved with as little as one drink every other day.
• If you are seeking help for a drinking problem, follow the advice of your counsellor or health professional.

Finally, the Guidelines note that there are some people who should not use alcohol, or who should drink less than the above daily and weekly limits. These include:

• people with health problems such as liver disease or certain psychiatric illnesses
• people taking certain medications such as sedatives, sleeping pills and pain killers
• people with a personal or family history of serious drinking problems
• people with a family history of cancer or other risk factors for cancer
• women who are pregnant, trying to conceive, or breast-feeding
• people who are or will be operating vehicles such as automobiles, motorcycles, boats, snowmobiles, all-terrain vehicles or bicycles
• people who need to be alert. For example, those responsible for the public order or the safety of others, people who are or will be working with machinery or dangerous equipment, or those who will be doing challenging physical activities
• people who are under any legal or other restriction on drinking – personally or because of the environment they're in.

These guidelines are based on current research and will be reviewed and revised as necessary by the Centre for Addiction and Mental Health and its partners.

4. What is a "standard" drink?

Refer to Low-Risk Drinking Guidelines - "Standard Drink".

5. Why do the Guidelines set weekly drinking limits?

As a person's average weekly alcohol consumption increases, so does the risk of health problems such as diseases of the liver, pancreas and nervous system, as well as cancers of the upper respiratory and digestive systems, liver, colon and breast. For these health problems, risk increases with each increase in alcohol intake. Compared to people who drink alcohol, abstainers are at the lowest risk for developing these health problems.

At the same time, alcohol can also lowers the risk of stroke and ischemic heart disease - the single most common cause of death in Canadians over 45. Men who drink fewer than 14 drinks a week on average are at lower risk of early death than men who do not drink alcohol. However, the risk of premature death begins to increase above 14 drinks a week for men and 9 drinks a week for women. An average intake of no more than 14 standard drinks per week for men and 9 standard drinks per week for women does not appear to be linked to an increased overall risk of long-term health problems.

6. Why are the weekly drinking limits lower for women?

Women have lower gastric alcohol dehydrogenase activity and water content in the body than men. This means they can achieve higher blood alcohol levels when consuming the same amount of alcohol as men. There is also evidence of an association between alcohol intake and breast cancer.

7. Why do the Guidelines set daily drinking limits?

The number of drinks consumed in each drinking day is as important as the average number of drinks a week. A day of heavy drinking can have several adverse consequences. One is an increase in blood pressure, which affects the pumping action of the heart and increases the risk of stroke. In addition, as blood alcohol content (BAC) increases, so does the risk of preventable injury and death. For example, a driver with a BAC of .08 is three times more likely to be involved in a motor vehicle crash than a driver who hasn't been drinking. A heavy drinking day also increases the risk of social problems related to home life, work, the law and finances. Sometimes, people who normally drink within the Guidelines will exceed the recommended maximum of two drinks a day. On occasions such as parties or weddings, extra precautions should be taken to avoid intoxication. Food, non-alcoholic drinks, and safe transportation should be available. Also, alcohol should not be mixed with potentially hazardous activities such as sports.

8. Why do the Guidelines include hourly limits?

The guideline of drinking no more than one drink an hour takes into account research showing that a person weighing 70 kg (154 lbs.) can eliminate roughly 8 to 10 g of absolute alcohol per hour (less than the 13.6 g of alcohol in one standard drink). It's important to note that the same amount of alcohol affects individuals differently based on tolerance, setting, personality, emotional state and other factors. Spacing drinks, alternating alcoholic and non-alcoholic beverages, having alcohol with food, and drinking low-alcohol beverages can slow the absorption of alcohol. Please note that hourly limits are not meant to replace the low-risk daily limit of 2 standard drinks.

9. Why don’t you advise people to refrain from drinking at least one day a week?

An inability to go without alcohol, or a perceived need to drink daily, is a sign of potential problems. However, for the average healthy person who stays within both the daily and weekly limits, the risk of dependence is low. As well, spreading the weekly limit over seven days reduces the risk of problems. Therefore, we have not recommended a minimum number of alcohol-free days per week. Drinkers would be wise to ensure that they can comfortably go without alcohol from time to time. Those who feel they can't go without alcohol should seek help. Also, people who have been advised by a physician or counsellor to take days off from drinking because of previous problems should follow this advice.

10. You say people with "certain health problems" should drink less. Who are you referring to exactly?

The Low-Risk Drinking Guidelines may not apply to people with health problems such as:

• disorders associated with increased bleeding
• undergoing recovery from an injury or operation
• gastritis, ulcers and liver disease
• cancer
• uncontrolled high blood pressure
• diabetes
• depression and anxiety
• serious psychiatric illness

If you have one or more of these conditions, or are concerned about how drinking may affect your health, please consult your doctor.

11. What types of medications can become dangerous when combined with alcohol?

Combining alcohol with some prescription drugs and over-the-counter medications can result in serious problems. These medications include anti-depressants, sedatives, sleeping pills, painkillers, and heart pills such as anticoagulants and intropic drugs (e.g. digitalis). Consult a physician or pharmacist, and read medication labels and inserts carefully.

12. You say people who are under any legal or other restriction on drinking should drink less or not at all. How do you define "legal or other restrictions"?

For safety reasons, people in certain occupations — airline pilots, for example — may be forbidden from using any alcohol before or while working. Others are forbidden to drink by a court order. The Liquor Licence Act of Ontario prohibits anyone under the age of 19 from purchasing or consuming alcohol. The Low-Risk Drinking Guidelines are intended for an adult audience. Those under the legal drinking age should be particularly cautious. Younger age groups are at higher risk of occasional heavy drinking and related problems such as traffic crashes, injuries, alcohol poisoning, violence, suicide, etc.

13. How much can I safely drink if I'm driving?

Impaired driving is a major public health and safety problem in Canada. As little as one drink affects neuromotor function, judgment and the performance of skilled tasks. The risk of a motor vehicle crash increases with each increase in the blood alcohol content (BAC) of the driver. The Criminal Code of Canada prohibits anyone with a BAC of .08 or more from operating a motor vehicle. The Highway Safety Act of Ontario allows police to temporarily suspend the licence of a driver with a BAC of more than .05. A 175-lb. man age 25 who has three standard drinks in one hour would have a BAC of about .056 (.061 in the case of a 60 year-old man). A 150-lb. woman who has three drinks in one hour would have a BAC of .086. Furthermore, BAC levels can accumulate to .05, even when the one drink per hour rule is applied. BACs also peak 30 to 90 minutes after drinking. This means that waiting an hour before driving may not prevent legal consequences. The safest course is never to drink before getting behind the wheel of a car, snowmobile, boat, motorcycle, bicycle, or any other vehicle.

14. Are there other situations when it's not advisable to drink?

Studies have documented alcohol's involvement in injuries and deaths related to falls, fires, drowning, hypothermia and other events occurring at home or during leisure activities. Heavy drinkers are not the only ones who may experience problems as a result of drinking. The risk of preventable injury or death increases with every drink beyond the person's usual amount. Anyone responsible for public order or safety, operating machinery, working, studying or entering into potentially dangerous activities should not drink.

15. Will women who are pregnant or breastfeeding have babies with fetal alcohol syndrome if they have a small amount to drink?

There is no known safe level of alcohol use in pregnancy. Therefore, it is not advisable to drink any alcohol during pregnancy. Research has shown that prenatal alcohol use can cause adverse effects on the physical and mental development of the infant. It can also increase the risk of congenital defects. The spectrum of disorders is referred to as Fetal Alcohol Spectrum Disorder (FASD), and includes conditions known as Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). These conditions are sometimes found in the children of mothers with serious alcohol problems.

Alcohol should be avoided during breast-feeding. Alcohol consumed by the mother passes readily into her milk and can affect the infant (e.g. there is some evidence that children feed less well if breast milk contains alcohol, and limited evidence that alcohol can impair child development). For this reason, women are advised to avoid drinking alcohol during the months they are breastfeeding. However, if a woman does drink, it is recommended that she plan to feed the baby (breastfeed or pump breast milk) before she drinks.

We advise women not to drink while they are pregnant in order to ensure that the fetus is protected, and not to drink while breastfeeding. However, women should not be alarmed if they have consumed small amounts before they found out they were pregnant. For more information, women should consult their doctors. Additional information about alcohol and pregnancy or breastfeeding can also be found on the websites of MotherRisk, and Best Start: Ontario's Maternal Newborn and Early Child Development Resource Centre.

16. Aren't there different daily drinking limits for problem drinkers?

In the case of problem drinkers, research has shown that men who limited themselves to four drinks on drinking days and women who limited themselves to three drinks (slightly higher daily limits than the guidelines for the general public) consistently reported that they no longer had social, financial, work-related or legal problems linked to their alcohol use.

Although there are many drinking guidelines in use, among the most popular are the ones developed by researcher Martha Sanchez-Craig. Intended for use in treatment settings, they advise women to restrict their drinking to 3 standard drinks on any day, and men to 4 standard drinks on any day. They also recommend at least one alcohol-free day a week and no more than 12 drinks a week. Finally they recognize instances when drinking is inadvisable for health or safety reasons.

In 1997, the College of Family Physicians of Canada officially endorsed the Low-Risk Drinking Guidelines for the primary prevention of alcohol problems among the general population, and the Sanchez-Craig Guidelines for use with people whose drinking puts them at risk of alcohol problems (secondary prevention).

17. What is the link between alcohol consumption and chronic disease?

Alcohol consumption is associated with a number of acute or traumatic events as well as chronic diseases. Some of the latter are not as well known. These include cancers, neuropsychiatric conditions, cardiovascular conditions, gastrointestinal conditions and maternal and perinatal conditions.

The following are examples of the chronic diseases or conditions that have been associated with alcohol:

• Cancers – Head and neck cancers as well as cancers of the gastrointestinal tract, liver cancer, and female breast cancer.
• Neuropsychiatric conditions – Alcohol-dependence syndrome, alcohol abuse, depression, anxiety disorder, organic brain disease.
• Cardiovascular conditions – Ischaemic heart disease, cerebrovascular disease.
• Gastrointestinal conditions – Alcoholic liver cirrhosis, cholelithiasis, pancreatitis
• Maternal and perinatal conditions – Low birth weight, intrauterine growth retardation.

It is important to note that in some cases, e.g., certain cancers, drinking two drinks a day over several years has been associated with moderate increase in risk.

18. I've heard that red wine is good for the heart. Should I be drinking red wine?

A large number of studies have been conducted to try to determine what ingredient in alcoholic beverages results in a reduced risk of heart disease. As a result of these studies we now know that it is not the colour, type or brand of the beverage but the alcohol itself that is associated with reduced risk of heart attack or certain types of strokes. Any form of alcohol may help your heart; it doesn't have to be wine. Reduced risk of heart disease and stroke appears to be limited to men above the age of forty and women past menopause. People need to follow the Guidelines because drinking above the recommended levels (0-2-9-14) does not provide heart health benefits. However, it is important to note that benefits to the heart can also be achieved through exercise, a healthier diet, and by quitting smoking.

19. What is the link between alcohol and heart health?

Research has shown that life-long abstainers (people who have never consumed alcohol) have higher rates of coronary heart disease (CHD) than moderate drinkers. Some scientists believe that alcohol provides a level of protection against CHD by interfering with the formation of blood clots and slowing down the build-up of plaque in the arteries. Despite well-publicized claims singling out red wine, the effect is the same for white wine, liquor or beer. Because CHD is rare among young people, there is not likely to be any benefit from drinking for younger men and for women who have not reached menopause.

Major reductions in the risk of CHD can be achieved by other means. For example, not starting or giving up smoking has a greater effect on lowering the risk of CHD than moderate drinking. Regular exercise also reduces the risk of CHD. Eating a low-fat diet may also be beneficial. For more information on other ways to improve heart health, visit the Heart and Stroke Foundation website.

20. Should I start drinking to improve my health?

People choose not to drink for many valid reasons – medical, religious and personal. People who drink generally do so for social and personal pleasure, or to "drown their sorrows." A decision to begin drinking should not generally be made for medical reasons. Would-be drinkers need to recognize that there are many risks associated with drinking, even at moderate levels. For example, when people start drinking, regardless of the amount, their chance of being injured or killed in a car crash increases. They also face a greater risk of suffering from hypertension (high blood pressure) The risk of breast cancer increases with greater alcohol consumption. Research shows for every 10 grams/day (1 Canadian standard drink = 13.6g) of alcohol consumed, there is a 7-10% increased risk of breast cancer in women (Ellison et al. 2001). About 4% of new cases of breast cancer are linked to alcohol; using this conservative number, 700 cases of breast cancer/year in Canada could have been attributed to alcohol (Aronson, 2003).

21. If I drink, but not every day, should I consider becoming a more regular drinker?

The reduced risk of coronary heart disease (CHD) has been observed in people who drink as little as one drink every other day. Occasional drinkers who start drinking every day may not improve their odds against CHD, but will in many cases increase the risk to their overall health. The idea of recommending a limit of two drinks a day is not to get everybody drinking that much, but to get people who drink more than that amount to reduce their consumption. After two drinks a day, any reduced risk of CHD is overshadowed by increased risk of death resulting from accidents and violence, certain cancers, liver cirrhosis, and hemorrhagic stroke. For these and other alcohol-related causes of death, the risk grows with increasing alcohol consumption.

22. What if I decide to have all my drinks in one night?

More studies are needed to show how different patterns of drinking affect the ability of alcohol to lower the risk of coronary heart disease. However, no beneficial effect on heart disease is likely to result from "binge" drinking. On the other hand, we do know that excessive drinking often results in violence, injuries and death. The LRDG recommend spreading the weekly limits over several days and not on one occasion. People who drink should avoid getting intoxicated or drunk. In most places in Canada, it is against the law to serve alcohol to someone who is already intoxicated.

23. What should I do if I am considering a change in the amount I now drink?

A general rule for drinkers is "less is better" — smaller quantities on each drinking occasion, and fewer drinking occasions. People who are thinking of consuming more alcohol for health reasons should consult their doctor. Doctors can identify reasons why drinking may not be a good idea. They can say which medications interact with alcohol, and they can offer advice on alternate ways of reducing the risk of coronary heart disease.

24. What if my doctor tells me to drink?

In 1997, the College of Family Physicians of Canada distributed a document called Moderate Drinking: the good, the bad and the unknown to help family physicians talk to patients about alcohol and health. It advises family physicians to:

• determine patients' current level of alcohol consumption
• check for contraindications to drinking such as peptic ulcer disease, gastritis, cirrhosis or active hepatitis, use of psychoactive medications, diabetes, seizure disorder, etc.
• advise problem drinkers to follow the Martha Sanchez-Craig Guidelines and those who are dependent on alcohol to quit drinking advise those currently drinking within the Low-Risk Drinking Guidelines not to increase their consumption because any additional heart health benefits will be outweighed by greater risk of other health and social problems.
• advise patients who want to improve their health to quit smoking, exercise regularly, eat a healthier diet and continue any course of treatment.

In 2005, the Canadian Hypertension Society released their lifestyle recommendations for preventing and controlling hypertension in healthy adults (except pregnant women). Among other things, they advise that:

• Abstinence from smoking should be advised
• Canadians in the population-at-large attain and maintain a healthy body mass index, exercise regularly and follow the Low-Risk Drinking Guidelines by limiting their alcohol intake to 2 or fewer standard drinks per day, up to a maximum of 9 drinks a week for women and 14 drinks a week for men.
• Hypertensive patients follow a program of individualized therapy that emphasizes weight loss for overweight patients, abstinence or moderation in alcohol use, regular exercise, restriction of sodium intake and, in appropriate circumstances, individualized cognitive behaviour modification to reduce the effects of stress.

These recommendations are also available for downloading.

25. It seems every week there's a news item about the benefits of alcohol. Where can I find credible research on alcohol and (heart) health?

A good place to start is the Resources section of this website. Another recommended resource for researchers is the APOLNET Resources/Databases section. It includes links to several searchable online databases, including Alcohol and Alcohol Problems Science (ETOH), and PubMed.

26. Who developed the Low-Risk Drinking Guidelines?

The Low-Risk Drinking Guidelines were developed by a committee of medical doctors and researchers invited by the Ontario Ministry of Health to assess the scientific evidence and develop common Guidelines on low-risk drinking. The committee was chaired by Dr. Mary Jane Ashley, formerly of the University of Toronto, and included representatives from the Addiction Research Foundation (now part of the Centre for Addiction and Mental Health), the University of Toronto Centre for Health Promotion, the Ottawa Public Health Department, the Public Health Branch of the Ontario Ministry of Health and Long-Term Care and the Ontario Addictions Coordinating Group. Their recommendations are contained in the 1996 discussion document entitled, A Report of the Committee to Recommend Draft Guidelines on Low-Risk Drinking for the Province of Ontario. They were reviewed by the World Health Organization, the Mensana Corporation, the Canadian Centre on Substance Abuse, and the National Centre for Research into the Prevention of Drug Use (Australia). Since their official release in October 1997, the Guidelines have also been published in peer-reviewed journals such as the Canadian Journal of Public Health.

27. Other countries have higher drinking guidelines. Why are Canada's so low?

Guidelines currently in use around the world were reviewed. These Canadian guidelines are very similar to those used in the United States and the United Kingdom. However, the amount of alcohol contained in a "standard" drink often differs from country to country. These different measurements account for some of the apparent discrepancies between our guidelines and those used in other countries.

28. Isn't it dangerous for public health groups to admit that drinking has some health benefits?

No. The scientific evidence presented on the health benefits of alcohol have been reviewed and discussed for the past few years. It is acknowledged that many people enjoy drinking alcohol. However, people need to remember the potential harm caused through the inappropriate use of alcohol. Through these guidelines, both the pros and cons of alcohol use are made clear to the general public.

29. Are you encouraging drinking?

We are not encouraging drinking. People who currently abstain should not start drinking in an attempt to get the limited health benefits of alcohol. And there are many other people, identified in the Guidelines, who also shouldn't drink either. The primary purpose of the LRDG is to clarify any confusion that might exist about alcohol and health and to help people make informed choices about their use of alcohol.

30. You say that the Guidelines are based on current research and will be reviewed from time to time. How often are you going to change them?

We don't anticipate changing the guidelines very often. However, we recognize that research will continue in this area, and that we will continue to learn more about alcohol and health.

Frequently Asked Questions About Promoting the LRDGs