Canada’s New Alcohol Guidelines for Women Are…Intense

There are tons of articles about the benefits of alcohol swirling around the internet. A little bit of alcohol is good for your heart! Red wine is better for you because of the antioxidants! A glass of wine at dinner is totally harmless! But according to the new Low-Risk Alcohol Drinking Guidelines, which were recently released by the Canadian Center on Substance Use and Addiction (CCSA), it’s time to put a cork in it.

The new guidelines encompass two years of research and more than 5,000 peer-reviewed studies, and their main takeaway is that it’s now clear any alcohol consumption at all can have negative health consequences.

“There is no absolute ‘safe’ amount of alcohol,” says Dr. Jennifer Wyman, the medical director of Substance Use Service at Women’s College Hospital in Toronto. “Less is always better.”

For those who love to unwind with a glass of pinot at dinner, like every dinner, or throw back tequila shots on Friday and Saturday nights, this is not welcome news… Let’s unpack it.

Wait, how are the new alcohol guidelines different from the old ones?

Probably the most difficult to swallow: the CCSA now recommends that Canadians have no more than two drinks per week—yes, week—in order to avoid “negative alcohol consequences.” The report says three to six drinks per week increases your risk of developing certain cancers, including breast cancer and colon cancer, and if you have more than seven drinks per week, your risk of heart disease, several types of cancer and liver cirrhosis among others illnesses “exponentially increases.”

For reference, the Health Canada guidelines from 2011, which were also created by the CCSA, state that “low-risk” is a maximum of 10 drinks per week and two drinks per day for women (three for men). But those were based on research from more than a decade ago, and “science is evolving.”

It’s important to note that the size of one standard drink is 5 oz. for wine (which is a typical restaurant pour, but home pours are often larger), 12 oz. for beer or cider and 1.5 oz. for a shot of spirits, so you might want to return that XL margarita glass from Party City.

Why are the new alcohol guidelines lower for women in particular?

Alcohol’s health consequences hit women’s bodies harder; the guidelines state the health risks “increase more steeply” for women above that two-drink low-level drinking limit. And it’s not just that men can drink more than women because of their size—there are actually a whole host of biological differences that set us apart. “Alcohol is processed by women’s bodies differently,” according to the report. That’s “due to body size, body fat/water ratio, hormonal effects and differing actions of enzymes that break down alcohol.” This means women are more vulnerable to “faster intoxication, more risk for disease (including breast cancer), and more long-term harm (such as liver damage and injury) in lesser amounts.”

However, the report states that disproportionately more injuries, violence and deaths result from men’s drinking.

What’s the link between alcohol and cancer?

Alcohol has and will always be a Group 1 carcinogen, meaning it’s a substance capable of causing cancer. For context: In Canada, alcohol use was linked to 7,000 new cancer cases in 2020, most of them breast cancer (24 per cent) and colon cancer (20 per cent), followed by rectal, oral and liver cancers, according to a 2021 World Health Organization study.

Here’s another staggering statistic: drinking 3.5 drinks per day increases your risk of breast cancer by 1.5 times, according to the Canadian Cancer Society.

“There are definitely people who will look at the science and say, ‘Wow, that’s shocking. I wouldn’t smoke, so why would I put alcohol in my body?’ thinking about all of the cancers that it’s associated with,” says Wyman. “It’s pretty terrifying.”

What do the guidelines say about drinking while pregnant or breastfeeding?

The new guidelines are clear: “There is no safe level of alcohol use in pregnancy,” the report states. It says it’s safest not to consume any alcohol while pregnant or pre-conception, due to possible increases in miscarriage, hypertensive disorders of pregnancy and placental abnormalities, as well as fetal brain injury, birth defects, behavioral problems and more. Crucially, “These adverse effects are also observed at relatively low levels of exposure.”

It’s a contentious topic, in no small part because of Emily Oster, an economics professor and pregnancy and parenting author. In her blockbuster debut book, Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong—and What You Really Need to Know, she analyzed around 200 studies on alcohol and pregnancy and found no credible evidence that the occasional glass of wine while pregnant causes harm to the baby. She wasn’t talking about binge drinking (fetal alcohol syndrome is undeniable)—just a few sips of your favorite sauv, up to one glass a day during the later trimesters.

Oster acknowledged that during the first trimester, more than two drinks a week increased the chances of having a miscarriage. “People ask, ‘Why take the risk?’ since [drinking while pregnant has] no benefit to the baby,” she wrote in a 2013 slate article. “But this ignores the fact that we are always making choices that could carry some risk and have no benefit to the baby. Driving in a car carries some risk to your baby, and your fetus does not benefit from that vacation you took.”

The new guidelines also address drinking while breastfeeding, cautioning that it can negatively affect milk production and infant sleep patterns, as well as expose infants, who are unable to metabolize it, to alcohol passively through milk.

Will these new guidelines change the way Canadians drink?

“No lo creo. I think this is getting a serious eye-roll from the Canadian public,” says Ann Dowsett Johnston, a Toronto-based psychotherapist and author of the bestselling Drink: The Intimate Relationship Between Women and Alcohol. “Two drinks is nothing. It is a wake-up call, but whether people take it seriously is another question. People don’t see it as a drug, they see it as a food group.”

It’s hard not to. Drinking is ingrained in our culture, from “mommy juice” memes to book clubs that turn into wine clubs, and it’s only increased since the pandemic.

A cultural shift is needed to see any real change in the way we drink, according to Dowsett Johnston. Many people are thinking: “How dare you try to take away my wine. What I do on a Friday night is none of your business.”

I drink a glass of wine with dinner a few nights a week, but otherwise I have a pretty healthy lifestyle. Should I be worried?

The message is: More than two drinks a week puts your health at risk. However, “hard alcohol may be harder on the liver, especially for women, when compared to wine,” says Wyman. “Having alcohol along with food is also less damaging to the liver. Food doesn’t protect the liver, there just may be less harm to the liver when drinking moderately and mixing it with food.”

Instead of focusing on the specific number of drinks you have, Wyman encourages people to reassess their relationship with alcohol—ask themselves how they drink and why they drink. “We shouldn’t need alcohol,” says Wyman. “Ingraining the glass of wine at the end of the day as the thing that helps you relax and manage all of the stresses in life is really problematic.”

I’m not ready to stop drinking altogether. What can I do to reduce my risk?

“Take off one or two days a week,” says Wyman. “It’s actually harder to decrease the amount that you’re drinking in an evening than just not opening a bottle at all.”

Dowsett Johnston recommends physically measuring out your drinks (ie 5 oz. of wine) and being conscious about how much you’re actually consuming. “You should also keep a drinking diary and write down what you’re planning on drinking that day and see how often you can keep to your promises,” she says.

With the rise of the sober-curious movement and more non-alcoholic drink options hitting the shelves, there has never been a better time to experiment with sobriety—or at least scale drinking back. Look into delicious low-alcohol or non-alcoholic beers, ciders, wines and spirits that are an upgrade from the lemon soda water of yore. Challenge yourself to go on a date that doesn’t stir around alcohol; reconsider those “wine mommy” events.

Plus, find stress-management techniques that don’t stir around alcohol—like yoga, going for a walk in nature, turning your brain off with a trashy reality TV show or speaking to a loved one or a therapist.

If you’re finding it difficult to reduce your drinking or stop altogether, then it’s important to really take a look at your drinking habits and speak to a trusted healthcare provider, advises Wyman.

“You need to ask yourself if you’re numbing with alcohol,” adds Dowsett Johnston.

What’s next for the alcohol guidelines?

Going forward, the authors of the report are asking Health Canada to introduce mandatory labeling on alcohol, so we may soon see health warnings, serving size and nutritional information on bottles of wine, beer and spirits, similar to the ones on packets of cigarettes or cannabis.

The guidelines are open for public feedback until September 23, which will hopefully help the CCSA tweak the messaging to be more meaningful to people before the final version is solidified later this fall. “The way that the guidelines are framed, people will dismiss them,” says Wyman. “If there’s no safe amount, how am I supposed to believe that? People may tune it out.”

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