Should Alcohol Limits for Men and Women Be the Same?

Check out this answer from Consensus:

The evidence strongly supports maintaining different alcohol consumption limits for men and women. Women are more susceptible to alcohol-related health problems at lower levels of consumption, and current guidelines reflect these differences. Therefore, it is prudent to continue recommending lower alcohol limits for women to mitigate these health risks effectively.

The question of whether alcohol consumption limits should be the same for men and women is a significant public health issue. This topic is crucial because alcohol affects men and women differently due to biological, physiological, and behavioral factors. Understanding these differences can help in formulating guidelines that minimize health risks for both genders.

Key Insights

• Different Health Risks for Women:
  • Women are at a higher risk of certain alcohol-related health problems, such as breast cancer, cardiovascular disease, and liver disease, even at lower levels of consumption compared to men2 4.
  • Women develop alcohol-related medical problems at lower levels of consumption due to factors like lower total body water and differences in alcohol metabolism4.
• Current Guidelines and Consumption Patterns:
  • The 2010 Dietary Guidelines for Americans recommend up to two drinks per day for men and one drink per day for women1.
  • On average, men consume more alcohol than women, with 36% of men and 21% of women consuming alcohol on a given day1.
  • High-volume drinking is more prevalent among men, while lifetime abstention from alcohol is more common among women5.
• Episodic and Heavy Drinking:
  • Episodic heavy drinking increases the risk of death and other health issues, and this risk is present for both men and women3.
  • A significant percentage of men and women exceed the recommended limits, with 8% of men and 3% of women engaging in heavy drinking1.
• Gender-Specific Recommendations:
  • The literature supports maintaining different alcohol consumption limits for men and women due to the higher susceptibility of women to alcohol-related health issues2 4.
  • Specific recommendations for alcohol consumption should consider individual medical history and risk factors, especially for women4.

Should alcohol limits for men and women be the same?

Rachel Visontay has answered Uncertain

An expert from University of Sydney in Alcohol Use, Epidemiology, Mental Health

There are two separate questions here.

First off, does the same quantity of alcohol have different effects for men and women?

The answer here is a near certain yes. In the short-term, women reach higher peak blood alcohol content and display more impairment than men after the same number of drinks. There are a range of biological factors responsible, including the fact that women are on average smaller, have less body water per kilo (meaning less dispersal of alcohol), and metabolise alcohol differently (with men having a better ability to break down alcohol when it first reaches the stomach).

Differences are also evident in long-term health, with modelling from the latest Australian guidelines indicating that “women are at greater risk of dying as a result of their drinking than men at all levels of alcohol consumption… irrespective of how many days drinkers spread their consumption across”.

The next question then, is should these differences be reflected in national safe drinking guidelines?

Here, countries differ in what they think is appropriate. For example, the US currently gives sex-specific recommendations, advising no more than 1 drink per day for women, and no more than 2 for men. On the other hand, Australia’s recently-updated guidelines are uniform for men and women, advising no more than 10 drinks per week (note that this is actually the equivalent of 7 US standard drinks). Modelling indicates that had separate guidelines been issued, the male limit would have only been slightly higher – 12 drinks per week. Simplifying guidelines may also be advantageous when it comes to effective public health messaging.

Mumenthaler, M. S., Taylor, J. L., O’Hara, R., & Yesavage, J. A. (1999). Gender differences in moderate drinking effects. Alcohol Research & Health, 23(1), 55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761697/

Kezer, C. A., Simonetto, D. A., & Shah, V. H. (2021, April). Sex differences in alcohol consumption and alcohol-associated liver disease. In Mayo Clinic Proceedings (Vol. 96, No. 4, pp. 1006-1016). Elsevier.https://www.mayoclinicproceedings.org/article/S0025-6196(20)30926-5/pdf

Thomasson, H. R. (2002). Gender differences in alcohol metabolism. Recent developments in alcoholism, 163-179. https://link.springer.com/chapter/10.1007/0-306-47138-8_9

Should alcohol limits for men and women be the same?

Bob Patton has answered Uncertain

An expert from University of Surrey in Psychology, Clinical Research

The UK’s alcohol guidelines advise that men and women shouldn’t drink more than 14 units of alcohol a week. Previous advice for the British drinker presented a higher threshold for men, so this represents a considerable change. So what was the evidence that the limits should not take gender into account?

Most countries that provide guidelines on alcohol consumption suggest higher threshold levels for men than women. It is well known that, physiologically, women are more vulnerable to the toxic effects of alcohol than men. Pint for pint, women have a greater risk of alcohol related problems such as dependency, certain cancers (liver, mouth and stomach) and other physical and psychological health issues.

A complex interplay of genetics, environment, personality and motivation contributes towards the likelihood of experiencing these conditions. The different risk factors faced by men and women are particularly apparent at higher levels of consumption – what we now call “drinking with increasing risk”. That is, men who regularly drink more than three or four units a day and women who regularly drink more than two or three units a day. But at levels of consumption lower than this, these differences are not as clear cut.

An acceptable risk

The latest guidelines are based on data provided by the University of Sheffield. It shows that anyone who drinks every day and who consumes no more than 14 units of alcohol a week has a less than one percent chance of dying from an alcohol-related health condition at any time.

One percent was adopted by the guidelines committee as the maximum level of risk that would be acceptable to the public. This has been presented as a similar level of risk to the chance of dying in a car accident. (In fact, the chances of dying in a road accident are even smaller – at less than 0.5% over a lifetime.) But most people don’t drink every day and so, for the majority, the situation is a little less clear cut.

So it’s not just how much, but also how often, we drink that counts, with decreasing frequency associated with increased risk. The Sheffield data shows that men drinking 14 units a week on a single occasion have a 4.5% lifetime risk of dying from an alcohol-related health condition. For women drinking at the same level on a single occasion each week, the risk is 2%.

Interestingly, at the new guideline threshold, men have an almost five times (0.99%) greater risk of death than women (0.18%), but still less than 1% overall. If we consider the previous threshold of 21 units a week for men drinking seven days a week, the risk of alcohol-related death increases to 3%. Complicated, isn’t it?

The new guidelines present the message that there is no “safe” level of alcohol consumption but stop short of recommending abstention as the best policy. In fact, the Sheffield data shows that for both men and women drinking up to seven units a week, spread across three or more days, actually has a protective effect on death from an alcohol-related health condition. For men the benefit is very small (a 0.1% improvement), compared with over 2% for women.

A better way to present the data

Given that there are well established and significant differences between male and female responses to alcohol across a range of quantities and frequencies of consumption, it is difficult if not impossible to encompass this diversity into a single recommendation of what represents the optimal limits of consumption with regard to the likelihood of dying from an alcohol related condition.

It might be better to present information on the relative risks associated with increasing use. This allows a comparison with non-drinkers, for example: “Men who regularly drink five units a day have a threefold increased risk of death from cirrhosis of the liver compared with non-drinkers.” In fact, the expert committee that helped to put the guidelines together noted that this might have been a better way to illustrate the relationship between drinking and death.

The situation is complex. Although it’s clear that there are benefits to both health and society by reducing alcohol consumption, the reasoning behind the cut-off of 1%, as an acceptable level of risk, or the underlying assumption that those who drink do so on a daily basis, is unclear.

While the guidelines set out to provide helpful advice about drinking, ignoring the differences between male and female responses to alcohol, is a risky strategy. If the guidelines don’t resonate with those of us who choose to drink, they will simply be ignored, and that won’t do anyone any good at all.

I have adapted this answer from my original article in The Conversation