So how many glasses of alcohol are there?

What about the Canadian Standards on Alcohol and Health developed by the Canadian Center on Substance Abuse and Addiction (CCSA)? Has this body gone overboard by setting a low-risk drinking limit of two drinks per week (no, no, not per day, per week!). While some doctors strongly criticized the paper, the Quebec Public Health Association, an independent organization that brings together experts in the field, welcomed its findings.

Several commentators saw this as a sign of the moral drift towards an increasingly refined world where the “healthy ayatollahs” want us to grow old, but without pleasure.

In fact, do not look for the concept of pleasure in the summary for the general public. Instead of the famous SAQ taste labels, you’ll find dots from green to red, which will let you estimate how risky your consumption might be. But don’t look for the moral police either: these “markers” are just that, markers. About the risks. Not commitments about what can be “consumed”.

Like many of you, I enjoy a good wine and the idea of ​​giving it up completely or drinking only 1 or 2 glasses a week doesn’t excite me. The recommendation set by Canada in 2011 seemed more appropriate to me, with a lower risk limit of 10 “standard drinks” per week for women. For men, the step is even steeper: now we are talking about 2 glasses a week … 15! There’s something about finding it steep.

Still, these new CCSA numbers seem to make a lot of sense. I’ll explain why, but also what you really need to remember.

Calculate the risk

First, what kind of risk are we talking about: dying prematurely or becoming disabled due to alcohol, depending on the amount consumed. This can happen, for example, with cirrhosis, breast cancer or an accident that you might not otherwise have – because alcohol increases the risk of all of these. The CCSA calculated what alcohol consumption would correspond to the risk that the public would consider “acceptable” for a voluntary act. For this, the organization used the same scale as the UK, Europe and Australia, ie a 1 in 100 risk of death related to alcohol consumption, which comes from a number of studies that have already been established since the 1960s. 2011 was used for recommendations.

In other words, the CCSA’s experts did not set particularly low levels of risk, even though many people assumed they did.

CCSA’s approach is explained in the document Alcohol-related lifetime risk of death and disability and based on mathematical modeling. Great Britain, Europe and Australia also use this method.

choose the words

Since 2011, Canada has defined thresholds that separate “low-risk” consumption from “moderate-risk” consumption, rather than defining what can be “consumed”, for example, France, the United States or Australia.

But rather than calling these publicly available “limits” or “guidelines,” as in 2011, the CCSA has set “price guidelines.” This may seem like a very subtle distinction, but it’s a recent trend internationally (explained very well in this document from French public health) that aims to inform the public about what alcohol research says, rather than telling the public what to do. This new strategy was first piloted by the CCSA during a consultation and found to be acceptable.

At the moment, the message to the public has clearly not gone through: we have taken the “benchmarks” as if they told us to respect the low risk threshold, but that is not really the idea. .

In their analysis, the CCSA observed the famous J-curve, which represents the evolution of the risk of alcohol-related death by consumption per day. However, the Center’s experts, like their French or Australian colleagues, believe that the lower part of the curve corresponding to the protective effect of low-dose alcohol should be interpreted with great caution, since the benefit margin is less. wrong, and if we trust the latest research, less and less.

CCDUS, like France, Great Britain or Australia, therefore preferred to consider all alcohol consumption as a health risk.

Like these other countries, Canada has included recommendations in its criteria for reducing consumption: take at least one alcohol-free day a week – which allows everyone to regularly check their level of dependence – and no more than two drinks a day. .

The United States still follows the instructional model. In their 2020-2025 guidelines, they recommend not exceeding “moderate” consumption, which is a maximum of two cups a day for men and one cup a day for women, not every day. However, they note that the latest research shows that the risk of certain cancers increases with less than one drink per day, and therefore urges the public to be careful with the guidelines. In other words, their message is: this is what you can drink, but be careful, it can still be too much (without saying how much).

Smart numbers

After careful calculations (see sidebar), the CCSA arrived at a low-risk threshold of two drinks per week for both men and women in Canada. France and Australia hit 10 drinks a week for their population…compared to 7.4 in Canada. Indeed, it should be noted that there is no universal definition of “standard glass”.

For historical and cultural reasons worthy of an article in its own right, the capacity of a standard glass is expressed in grams in public health jargon everywhere, but depending on the country, a glass contains between 8 and 20 g of alcohol. . Therefore, we should be careful about comparisons. As in Australia, a standard drink in France contains 10g of alcohol, while in Canada it contains 13.45. For example, for beer, this corresponds to 250 ml in France (here we call it a half in bars) and 341 ml in Canada (here we call it a pint).

Using the same method, the Netherlands reached a lower risk threshold corresponding to 5.2 drinks per week in Canada.

In short, the threshold set for Canada is lower than those of these other countries (but not by much). This may be because some of the systematic reviews reviewed by the CCSA are more recent, including one showing that low doses of alcohol increase the risk of breast cancer more than other studies. The gap may be explained in part by differences in population susceptibility to diseases that alcohol may increase risk for, for example, due to age or ethnicity.

Underestimated effects

Either way, the most important message to take away from these criteria is the one written in big, bold letters in this document: Drinking less is better. Indeed, if there’s one thing all researchers agree on, it’s that we tend to underestimate the risks of alcohol.

According to the CCSA, alcohol caused 18,000 deaths in Canada in 2017. The cost of alcohol consumption in the country at the time was $16.6 billion, including $5.4 billion in health care costs. It’s nothing. In the United States, the National Institute on Alcohol Abuse and Alcoholism estimates that alcohol kills 100,000 people each year and costs $224 billion. French public health causes 41,000 deaths every year in this country.

In 2020, each person in Quebec drank 494 “standard glasses” of alcohol. That equates to 8.4 liters of pure alcohol, slightly more than the Canadian average of 8.3 litres. And it’s less than the last maximum of 8.9 liters in Quebec in 2013. Quebecers drink less than Americans (9.3 liters of pure alcohol per year) and the French (10.4 liters per year). But they are above the low risk threshold of all countries considered.

Interpreting science

In Canada, in 2011, an update of the guidelines issued by the CCSA (an independent organization then called the Canadian Center on Substance Abuse) seemed necessary: ​​in recent years, the link between low doses of alcohol and several cancers has become increasingly apparent. is clearly reflected in the scientific literature. And since 2011, several countries, including France, the United Kingdom and Australia, have developed stricter rules than Canada’s. CCSA experts began reviewing the evidence to determine their criteria. Hundreds of thousands of published studies on the relationship between alcohol and health have been compiled through thousands of systematic reviews over the years. The researchers identified systematic reviews published up to February 2021. After two sorting steps, they retained 239.

Then, among them, they kept those that met the criteria set by the WHO, among others, that is, they could be used to carry out mathematical modeling of the consumption threshold. These studies should specifically demonstrate a true causal relationship between alcohol and increased risk and include a dose-effect curve. They found 16 people with injuries and illnesses. These 16 studies form the basis of the CCSA benchmarks.

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