The Decibel - A new measure of unhealthy drinking

Episode Date: September 1, 2022

If you have three or more alcoholic drinks in a week, you’re putting your health at risk. That’s according to a new report from the Canadian Centre on Substance Abuse and Addiction (CCSA). The government of Canada’s current recommendations are more than a decade old. Armed with new information from almost 6,000 studies, the CCSA is proposing an update to Canada’s low-risk drinking guidelines.Dr. Catherine Paradis is the interim associate director of research at the CCSA. She’s also the co-chair of this new report. She tells us what we’ve learned about how alcohol impacts our health, the new guidelines the CCSA hopes Canadians will follow and why they want mandatory portion labels on alcoholic drinks.

Hi, I'm Mainika Raman-Wilms, and you're listening to The Decibel, from The Globe and Mail. Do you remember the last glass of rosé you poured? Or the last beer? It may have been the first drink you had this week, or the seventh. But it would still be within Health Canada's current guidelines. That's 10 drinks a week for women and 15 for men. The thing is, though, those guidelines are probably out of date. Earlier this week, the Canadian Centre on Substance Use and Addiction, or CCSA, released a new report that says we actually increase risks to our health with just three drinks or more per week. And no, a tall can of beer doesn't count as one drink. We're not the alcohol police that's going to go around the country and tell people not to drink.

No, that's not what it is at all. We really were tasked to review all the evidence. And now we're sharing the results of that with people so that they can make informed decisions. Catherine Paradis is a sociologist, co-chair of this report, and the interim associate director of research at the CCSA. She'll tell us why these numbers have changed so much in the last decade, what the different risks are for men and women, and why new labeling on alcohol could help us make more informed decisions. This is The Decibel. Katrin, thank you so much for joining me today. Thank you for having me. I think a lot of Canadians, frankly, will be surprised to see the numbers in your new report here.

No more than two drinks a week to be at low risk. Why are these numbers such a big change from the previous alcohol guidelines that were released like a decade ago? You just said it. It was a decade ago. And so we have had a tremendous increase in our understanding and our knowledge on the association between various dimensions of alcohol use and diseases, conditions, injuries. That knowledge has increased tremendously in the past decade. So it is for those reasons that it was in 2019 that the original group who had came up with the guidelines in 2011 met, we met with representatives from Health Canada and from the Public Health Agency of Canada. And we thought, you know what, we're ready. It's time to update.

Can you just give me a sense of the kind of research and information that went into this report? Oh, my goodness, there was so much research. So most of our analysis are focused on the relationship between alcohol and physical health. And to do so, we collected data and appraised the quality of data coming out from nearly 6,000 studies, I think 5,946 to be precise. That's a lot of information then. That is a lot of information. And that is information in the past several years. We also built on the work of the Australians. Australia had updated their guidelines two years ago, and they had also done an amazing job at screening

all the literature. So we also built on their findings. And so all of these studies touch on various outcomes. It can be cancer, it can be heart disease, dementia, and lots of them. But for each condition that the WHO has identified as a condition that is caused, that can be caused by alcohol, for each of these conditions or disease, out of the 6,000 study, we extracted the absolute best study, the highest quality study that assessed that relationship. And so from that best study, we extracted a risk function that we then gave to our mathematical modelers who were then able to produce those risk curves that tell us what is the relationship between an average amount of alcohol you use on a weekly basis and your risk of harm. Okay, so tell me about this risk level scale then. What are the different risk levels here? Okay, so our risk curves allowed us to identify various points on the curve. And what we found is that if you take one or two standard

drinks per week, your risk of harm in the form of premature death will be negligible to low. Three to six standard drinks per week, you are in a moderate risk zone. If you take more than six standard drinks per week, you're really entering a high risk zone. And each additional drink you take increases that risk, even exponentially. Okay, and when we're talking about risk here, what exactly do we mean here? What are we at risk of? You're at risk of over 40 type of conditions. So it can be heart disease, it can be cancer, it can be dementia, it can be injuries, it can be road accidents. It's all of these outcomes, which again, we do know can be caused by alcohol. And how much does your risk go up when you cross from like the moderate to the high risk category there? It's difficult to really give a specific number like that, but I can give you

some maybe more concrete example. For example, if you're concerned about breast cancer, we do know that in Canada, the moment one woman in 35 will die of breast cancer. If you take more than 600 drinks per week, you increase your chances by 10% of being that woman. If we talk about colorectal cancer, for example, among men, we know that one in 48 men will die of colorectal cancer in Canada this year. And if you take six drinks per week or more, you increase by 7% your chances of being that man. But it's not so much necessarily about size of that risk. But I think that it's all about the right to know. And for a long time, all of these types of risks have been overlooked and sometimes even

unknown to the public. So they use alcohol not knowing that it can cause cancer. It can increase your risk of a heart disease. It can cause dementia or liver diseases. So it's just about presenting those facts to the population so that they can make informed decisions. You know, we're not regulators. We're not the alcohol police that's going to go around the country and tell people not to drink. No, that's not what it is at all.

We really were tasked to review all the evidence. And now we're sharing the results of that with people so that they can make informed decisions, so that they can talk with a health professional if they wish to, so that they can decide to maybe move toward the left-hand side of those risk zones and see how that goes for them. Because that's also very important to know is that it's one thing to have this information, but a very encouraging fact associated with this new evidence is that every standard drink counts and any reduction in alcohol use is beneficial.

That's it. Actually, I was just going to ask you, like if you change, if you've been maybe drinking a bit more now and you decide to change your habits after seeing this information, is that actually going to make a difference then? It is. And that's really the good news of this project. Also, you know, research demonstrates that many harms related to chronic disease caused by alcohol are reversible. So it's encouraging. So we also hope that by presenting people with risk zones, instead of very strict recommendations, you should not take more than X by really presenting risk zones that people will be encouraged. Do we know how many Canadians right now are in that higher risk category? It's 40%. And some people are surprised by that.

But yeah, we already have 60% of Canadians who either do not drink, drink one or two standard drinks per week, or three to six. So we have 60% who already take less than six drinks per week. So when we're hearing, oh, this is impossible, those six drinks a week, no one will listen to that. Well, 60% are already there. I know in your report, basically found that even in small amounts, alcohol is not good for our health here. But I guess it just makes me think about all these other studies that I know we've heard before about, you know, a glass of red wine a day can be good for you. What happened with that information? Like, is that not, I don't know, is that still stuff that we can listen to?

Well, actually, you know, most of the science is pretty consistent. Alcohol causes or contributes to more than 40 diseases. Heavy average consumption is strongly associated with problems, as is drinking to the point of impairment or intoxication. What is becoming a bit clearer is that alcohol can be harmful at relatively low levels of consumption, including increasing the risk of several types of cancer and heart disease. But I hear you that, you know, from week to week, sometimes we hear a single data. What you have to know is that in our research, we used the best meta-analysis. These are analysis studies that combine all the studies together. And from there, we really only keep the absolute best one and

extract the rest functions. So we kind of did the job for you of, you know, what you don't have to read or listen to every story that comes out every week, we've done the job for you. And this is where we're at in terms of our knowledge, of our understanding of the relationship between alcohol and health. And when we're talking about, you know, being in like that high risk category there, I guess we should make a distinction between that and alcoholism as well, because there's kind of there's there's a difference there, right? Absolutely. These are completely two different things. And thank you for asking that. Because for a very long time, in the population, there's been this belief that alcohol problems were a yes or no question.

Either you were not having problem or you were having an alcohol use disorder, what we sometimes call being an alcoholic. And that as long as you were not having an alcohol use disorder, you were not experiencing any problems. That's not the case. There's really a lot of harms that can be associated with alcohol use, and you can impact your health and your well-being way before reaching that stage of having an alcohol use disorder. I'm wondering about the differences between men and women

in these results. Are there differences in the updated risks for both men and women? So that's the second surprising result of this project. The first one being finding out the extent to which a little alcohol is not good for your health. So that was our first surprise. The second one is when we did the mathematical modeling, of course, we produce two sets of analysis, one for males and one for females. And what we found is that when looking at the risk of premature death, we found that the amounts of alcohol

associated with low or moderate risk were actually the same for males and females. That being said, what is very important to point out is that once you take more than six standard drinks per week, women need to be aware that the risk becomes much higher for them. And this is due to body weight and size differences, physiological differences, and differences in the way that alcohol is processed by the body in males and females. In addition to that, it's important to point out also, and my colleagues would want me to emphasize that, that we should not overlook the fact that in Canada, men often drink more heavily than women. And actually, men are more likely to cause or suffer alcohol-related deaths than women. Men are more likely than women to cause harm in the sense of peer-to-peer violence or domestic violence. And that's an important message also there. We need to change

the culture. Boys and males need to rethink their relationship to alcohol, what it can do to others, how they can harm to others, and change their behavior. And what about mental health? Because we've been talking about all the physical things here, but what about the relationship between alcohol and mental health? Yeah, so alcohol and mental health, we really wanted to include mental health in our modeling. We wanted to, and also at the beginning of our project, we did a public consultation. And when we asked Canadians what they would want those updated guidelines to focus on, they told us that mental health was really a priority for them. But we didn't find any study that met our high quality criteria. And therefore, we were not able to include mental health in our modeling.

And that was really disappointing to us. So that's really a next step that the whole scientific community will need to think about, will need to be better in our methods to evaluate that relationship so that moving forward, when we update those guidelines in another five or 10 years, or when other countries do, they can include mental health in there, because it's a big one. So it's something that you're hoping to basically have more information on in the future then. You've mentioned before that this is not just Canada that's doing this. A lot of countries seem to be reducing their guidelines here.

And one of the things that your report recommends is to actually change the labeling on our bottles of alcohol in Canada to reflect the number of servings that are actually included in that bottle of wine or that can of beer. Why could putting information on the label make a difference? Well, because we're asking people to count their drinks and no one knows what a standard drink is. Well, some do, some do, but it's very difficult. So not only is it difficult for some to limit their alcohol use, but on top of it all, even if you luck measuring that. But in concrete term, a standard drink is a 12 ounce beer at 5%, a five ounce glass of wine or a 1.5 ounce shot of liquor. But when you open a bottle of wine, people don't know that. They don't have that information. So we need that information at the point of pour so that people can count their drink if they want to. There's

also been the craft movement as developed in Canada in the past decade. We now have all those craft breweries and those micro distilleries, And they have a wide range of products that vary a lot in terms of alcohol content, but also container size. I've had a friend who, you know, was having a beer and suddenly was feeling very tipsy. I was like, gee, what's going on? I've had a beer and I'm tipsy, you know? Well, I looked at it, you know, and this was the equivalent of two standard drinks. So this was a beer with a very high alcohol content in a large serving size in a large can. So yeah, you're thinking you're having a beer, but you're having two. So these things can happen. It's all about consumers' right to know, you know? We have calories, we have nutrition label on all the food we eat. Why not alcohol? Health Canada guidelines, if you look online, which we did, they still recommend

10 drinks a week for women, 15 for men at a max. So those are much higher than the recommendations that are that are in your report. But based on what you found in the work that you've done here, do you expect Health Canada in the future to actually change their recommendations? It's totally normal that this is still the information provided on Health Canada website, because these are the 2011 guidelines. And what was released on Monday were not the finalized guidelines. On Monday, we launched an open consultation on the work we have done to date. We are entering the last stage of our scientific work where we're seeking feedback on the science. Those finalized guidelines will be released on November 15. So it is from that date that we hope that health organizations around the country, including Health Canada, will start reviewing the

information that they have been sharing for the past 10 years. Katrine, thank you so much for taking the time to speak with me today. Thank you for having me. That's it for today. I'm Maina Karaman-Wolmes. Our summer producer is Zahra Kozema. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Kasia Mihailovic is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.