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The 99% sober movement: should January be kept dry all year round?

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IIf you’re halfway through a dry January and counting the days until you can drink again, the latest news from Canada might make you rethink. Its new alcohol guidelines suggest people drink no more than two alcoholic beverages a week. Two small glasses of wine or a pint and a half of beer a week is what Canadian health experts consider low risk – a big drop from previous guidelines of no more than 10 glasses a week for women and 15 for men – while no alcohol at all is the only safe limit.

In the UK, our limits are more generous, although they veer towards those of Canada. When they last updated in 2016, the upper limit for men and women was set at 14 units: the equivalent of seven pints of less strong beer or nine small glasses of wine (125ml). Previously, men were advised to stay below 21 units per week. The UK’s chief medical officers have also clarified that “there is no level of regular consumption which can be considered completely safe”.

Should we then follow Canada’s example and significantly reduce the upper limit? A spokesperson for the Department of Health and Social Care said there were “no current plans to update the alcohol limit guidelines”.

However, Richard Piper, chief executive of Alcohol Change, a charity which campaigns to reduce the harm from alcohol, says: “There are some elements of the Canadian guidelines that we should definitely copy. The first is the clear statement that the less you drink, the better, from a health perspective. The second thing that I think is incredibly helpful is that they introduced a scale. This shows, he says, “increasing risk as you drink more, in a stepwise approach.”

In the UK, with the emphasis on 14 units, there may be a tendency to think ‘more than 14 is bad; under 14, fine,” he continues. “But actually the Under 14s can be bad if all those units are in one night. I understand that the UK’s chief medical officers are trying to present something really simple, but I think that simplicity is too crude. I think the Canadian guidelines are simple, but more helpful. They let people decide, Piper says. “To say, ‘I really like alcohol, I’m going to take moderate risk.’ They tell you what the levels of risk are at different levels and leave it up to you to make that choice.

That’s why he’d like to see better and clearer alcohol labeling – not necessarily the scary images that cigarette manufacturers have been forced to adopt, but a health warning and a clear indication of the number of units. “I think guidelines and labels are part of the same story,” says Piper.

A pint and a half of beer on a pub table
A pint and a half of beer: Canadian experts say this should be your weekly maximum. Photograph: Colin Bowling/Alamy

With alcohol at the heart of British culture, could we ever get to the point where two drinks a week are considered normal? This is already happening among large swaths of the population, Piper points out. “Twenty percent of the population does not drink at all; 60% drink less than 14 units per week and often much less. So you’ll probably find that the majority of the population drinks close to two drinks a week, or even less. If you walk into most UK homes, most adults won’t have a drink on most evenings.

At least 130,000 people take part in Dry January each year, and young people are drinking less. There have been low-drinking trends, such as “mindful drinking”, the “curious sober” movement, and people becoming “99% sober” – those who drink infrequently, but make occasional exceptions. This can make sense for people who don’t want to put pressure on themselves to give up completely. So there might not be quite the uproar that politicians fear if our upper limits were reduced significantly. Either way, Piper says, “That’s where they should delegate it to the chief medical officer, just like they did during the pandemic: let science lead the way.”

It is “absolutely reasonable” to conclude, says Gautam Mehta, associate professor of hepatology at University College London, “the safest amount of alcohol to drink is zero”. There is no absolute safe level of consumption – the data is good on this. There is a very small benefit in ischemic heart disease, with a very small volume of alcohol, but this is completely outweighed by cancer and other risks.

The problem is to know to what extent is this known to the public? “Probably not very widely,” Mehta says. “The guidelines are definitely having an impact. I don’t think we should be afraid that there is no safe limit – this message needs to get out. We have a problem with alcohol in this country. After the pandemic, the number of alcohol-related deaths in the UK increased by 20%. Is the upper limit of 14 units too high? “I think education, rather than top-down guidance, is the best way to keep people engaged,” Mehta says.

We know, like we didn’t even know 10 or 20 years ago, how harmful alcohol can be. “Alcohol raises blood pressure, [which can lead] strokes and heart disease,” says Mehta. Alcohol is linked to cancer, including “cancers of the digestive tract; breast cancers represent an important part [alcohol-related] harm. Overall, there are over 200 diseases with which alcohol is associated, but these are the main ones: cancer, heart disease, stroke. Liver disease occurs at higher levels, so if you were drinking within current guidelines, liver disease wouldn’t be a major concern if you didn’t have other risk factors.

Binge drinking is worse for you than spreading the units out over the week (those “99% sober” drinkers should be wary of it if they intend to drink large amounts, even occasionally). “How you drink matters,” says Mehta. “It impacts the gut. We think the gut is very important in many chronic diseases and underlies inflammation. You induce what we call ‘leaky gut’, which basically means that there’s more inflammation from protein that should stay in the gut, but it doesn’t.When you cross the threshold, on a relatively regular basis, we think you’ll have long-term consequences. The definition of “bulimia” is probably lower than you think: “It’s about six units for women – it’s only two tall glasses of wine – and eight units for men.”

Mehta participated in a study comparing dry January drinkers, who previously drank about 20 units a week, with a control group who didn’t give up. “The changes have been quite marked,” he says, describing how people’s blood pressure went down by about the same amount you would expect if they had taken blood pressure medication. Their risk of diabetes fell by about a quarter and they lost weight. “We also found changes in cancer-related growth factors. You can’t drastically reduce your cancer risk in a month, but cancer-related proteins have dropped by about 70%, a huge reduction. This was the most numerically striking finding. There were many potential benefits, and although Mehta acknowledges that this was a short-term study (and small in terms of participants), “you would expect, if you continued this, that this translates into real health benefits.”

It’s a wonder anyone drinks anything. But many of us do, including Mehta (and me). “I’m having another drink,” he said. “It’s about knowing those risks.” If you drink alcohol and enjoy it – perhaps socializing with friends, which has its own significant health benefits – that’s something to think about during your weekly pint-and-a-half.

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