The difference between Spain’s recommended alcohol threshold and that of other European countries is raising eyebrows among health experts. Spain’s Health Ministry recommends that men drink no more than four standard alcoholic drinks a day and women no more than two – twice what is recommended in France (two standard drinks for men and women) and four times the limit in the Netherlands (one drink each).
The limit for low-risk alcohol consumption is outlined in the ministry’s 2016 Health Promotion Strategy, which defines a standard drink as 10 grams of alcohol – around one beer or a glass of wine.
Limits for alcohol consumption should be lower than those recommended in most current guidelines
Dietician Angela Wood
Interestingly, the difference between Spanish and European standards was revealed by British multinational alcoholic beverages company Diageo, which collected official data from countries across the world and brought it to a seminar it sponsored with the National Association of Health Informers (ANIS). Antonio Luis Villarino, director of the Institute of Drug Addiction at the Complutense University of Madrid, highlighted the lack of consensus and how this could impact the public’s perception of what constitutes low-risk alcohol consumption.
“Of course we’re not going to recommend anyone to drink, but we want to be able to tell people who do drink what is the level that will do them the least harm,” he said.
The table includes data from 56 countries. No country tops Spain’s recommended limits for men, although some countries (such as Japan and South Korea) set the same amount. Spain also has some of the laxest limits for women, beaten only by Malta and Belgium. While some countries (Spain, the United States, the United Kingdom, among others) set different limits for men and women, others like France, the Netherlands and Belgium, have the same cap. An interesting decision, says Villarino, given women “have different tolerance to alcohol, because they typically weigh less, are shorter and have different distribution of fat and lower proportion of alcohol dehydrogenase enzymes,” that help the body to metabolize alcohol.
Establishing a common norm for what constitutes a standard drink is important to making any health recommendation. In Spain, for example, a standard drink is 10 grams of alcohol but this amount is much higher in the Philippines, Mexico and Macedonia.
This issue raises the question of how alcohol affects a person’s health and whether any amount of alcohol is healthy. A growing trend argues that the recommended consumption of alcohol should be zero. While there is consensus that pregnant women, minors, drivers and people with certain illness (such as people with psychiatric or heart problems) should not drink any alcohol, not everyone agrees this limit should be applied to the general population.
Spain’s recommended threshold is four times higher than in the Netherlands
The main problem is that it is impossible to conduct a direct clinical trial, where one half of a group is encouraged to drink two glasses a day. But there are multiple population studies that have linked life expectancy to drinking and smoking habits. British dietician and scientist Carrie Ruxton for instance looked at Seventh Adventist in the United States – a group often studied because of their refusal to smoke or drink – and found that the relationship between alcohol and mortality is “practically neutral in the beginning or even in favor of those who drink a little when compared with those who strictly abstain.” The curve however jumps upwards “in a j-shape,” showing that alcohol is a clear cause of death.
An investigation by Angela Wood from the University of Cambridge also found that alcohol was linked to a higher mortality rate. The study, published in The Lancet, looked at 83 studies of nearly 600,000 people who consumed alcohol and found that “in current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 grams per week.” In the case of people with cardiovascular disease however, “there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk.”
“These data support limits for alcohol consumption that are lower than those recommended in most current guidelines,” the study concluded.
While Wood’s study recommends a threshold below 100 grams a week, Spain’s limit is 280 grams for men and 170 for women. In Denmark, the limit is 168 grams for men and 84 for women, in Estonia, 160 grams and 80 grams respectively, and in New Zealand, 150 grams and 100 grams. Many countries do not have a weekly estimate but instead multiply the daily limit by seven, leading to numbers that far exceed the recommended threshold.
The debate over what is a healthy amount of alcohol is likely to continue with the World Health Organization arguing there is no healthy threshold for alcohol consumption.
English version by Melissa Kitson.