New alcohol guidelines









Table 1






There are some other problems with the model.


Figure 11








Alcohol graph







Systematic review


















27 thoughts on “New alcohol guidelines”

  1. Glad I’m not the only one to wonder where the detail is – and as always with these sorts of analysis the devil is in the detail. The document also fails to mention reporting bias – self reported alcohol units are almost always underestimate intake which will affect the outcomes. One of the things that I would have liked to see in the report would be better labelling of alcohol units on bottles and on bar prices lists and wine lists. Would have been good to know how many units I got through with my beer yesterday evening without getting my calculator out! (It was 1)

    1. There’s actually quite a detailed discussion of the problem with self reports of alcohol consumption systematically underestimating real consumption, but it’s not in the main document. It’s on pages 56 to 58 of the Sheffield report.

      But the conclusion is that they don’t adjust for it, just recognise it as a limitation.

    2. The percentage alcohol on the label is the number of units in a litre. A pint is just over half a litre. So if you don’t want to use a calculator, just divide by two and add on a bit. A pint of 4.5% beer would actually be 2.5 units because a UK pint is actually 0.56L. 33cL bottles of lager are obviously easier because you just divide by 3. A bottle of wine is 75cL therefore 12% wine contains 9 units per bottle, so stop when you get half way down. Hope that helps.

  2. A truly excellent analysis. Di Castelnuovo et al. also did individual all-cause mortality graphs by geographical area. The J-curve was most favourable for Europeans (men especially), showing an intake of about 70g/day equals teetotal death rates. It’s all in my book ‘The Good News About Booze’ – a populist title to mask the fact that it’s a fairly academic tome.
    Di Castelnuovo has emailed me about the new UK guidelines, calling them “misleading”. His message ? “Unless they are at high risk of alcohol-related cancers, healthy adults who are currently regular light to moderate alcohol consumers should not be discouraged from continuing.”

  3. A very good reading and scrutiny of the guidelines and their background evidence.

    It would seem to me, based on the decent amount of research (including a systematic review) showing the potential for moderate daily drinking to reduce risks, that the government has elected for the simple approach.

    1. Bob – no they haven’t! The article shows that there are provable, repeatable and multiply sourced studies clearly demonstrating that, *all other factors taken into account*, people who drink (yes, within a range and obviously less than a fairly predictable point), *live longer than people who don’t drink*. The “guidelines” (rules, actually, because they use the word ‘limit’ rather than ‘guideline’) could conceivably raise death rates if everybody adhered to them.

  4. Thanks for this SG. The more I look at this, the more angry I get. It’s beginning to look like deception rather than incompetence. I have a few comments. You say


    This reliance on models rather than empirical data is typical of the Public Health Industry and is common to many of its studies. Most famously, its claims that heart attack incidence decreases following smoking bans.

    You then say


    Most would agree that’s the important question, “Is it killing me?”

    I believe that what they modelled was the risk of premature death FROM ALCOHOL CONSUMPTION due to alcohol consumption. They needed this figure for the “Australian approach”. Firstly, this is of little interest as it excludes the possibility that higher alcohol consumption may substantially decrease the risk of death from other causes, resulting in a lower overall risk of premature death (as seems to be the case from actually looking at total mortality). Secondly, they can then excuse the use of a model because there will be little or no relevant data available.

    The Australian approach itself seems similarly irrelevant.

    “In Australia, an alternative approach was used which focused on the absolute mortality risk due to
    drinking compared to the mortality risks from other causes. Thus the Australian guideline was set
    such that if the population all drank at that level, 1% of annual deaths would be attributable to

    For example, if alcohol attributable deaths all occurred at the age of 90, then surely the more of them, the better, the better?

    As you imply, “Why not just look at Di Castelnuova’s graph and Ronskley’s sensitivity analysis?” The obvious answer is that they need “evidence” to recommend lower guidelines; and that is not where to find it. The way to find it is to construct an opaque model, whose details are secret, with so many imprecise inputs, themselves the outputs, chosen by themselves, of not even first hand, but second hand (meta) statistical analyses, in total including hundreds of systematic biases, confounders, robustness questions and misclassification errors (see pages 25 and 26 of the Sheffield study).

  5. Very good analysis

    One additional point that might have been made is that assuming a linear relationship between consumption and harm has a paradoxical effect. Alcohol-related diseases are most likely to occur in those who drink a lot. This is a small group. But if there is a linear relationship, then even those at low consumption have some degree of risk, and this is a big group. The result is that more deaths by number occur in lower drink categories than in higher. More women who drink very little suffer alcohol-related breast cancer than women who drink a lot, simply because although their risk is lower there are many more women in the lower-drinking group. So diseases that are most likely to be caused by heavy drinking claim more lives in low-drinking groups. That’s why it’s possible to claim such a high risk even for modest drinkers.

  6. I always think how the knowledge of units consumed is researched. If the researcher is just asking the individuals, it would not be reliable. Who tells the truth, even to themselves, if they are heavy drinkers. The temptation to ‘minimise’ is hard to resist.

  7. The main fault of the guideline is, in my opinion, that they are giving suggestions about ALCOHOL consumption in general.

    From this point of view, I find that it’s OK from the government point of view to play on the safe side. To use a worst case scenario.

    The problem is that literature is used to confirm or to criticise these guidelines. In reality there is not a systematic and general study on the matter.

    Maybe If I repeat the studies in more detailed way I will find different conclusions depending on the drink types.

    Maybe drinking 21 units given in the form of red wines will save my life. Drinking 21 units in the form of vodka will do less so.

    Beer, Wine, Ciders, etc are not just diluted alcohol. They come with lots of other compounds that may be very healthy.

    Distillates may loose these compounds (or may recover some when aged in barrels, like whisky). Not sure.

    There is such a variety of drinks and compounds involved in this subject that capping everything under the “ALCOHOL” problem is a bit generalist if not wrong.

    Government guideline should reflect these differences. Proper studies should be performed to understand the matter. And guidelines should reflect these findings.

    Governement could at least differentiate between feremented beverages and super-alcoholic/distillate beverage.

    Maybe we can afford 14 units of alcohol if assumed in form of distillates, but afford 30 if assumed in form of red wines.

    The matter is complex and deserve investigation before scaring people. Until things are clearly understood, I agree with the Government in playing on the safe side. After all, these are just guidelines and I am not forced to confess my ‘sins’ to my GP 🙂

    1. It’s certainly an interesting question to ask whether the beneficial effects of drinking are a result of the alcohol or a result of other things that you find in wine.

      As far as I can tell, there is no strong evidence that any one type of alcoholic drink is any better than any other, and it seems that the alcohol itself is the important thing, but it’s very hard to know for sure.

      Here’s one (now rather old) paper that looked at this issue:

      1. Re alcohol types, it all depends on the particular health benefit. For example, risk of heart disease, diabetes and kidney cancer shows an inverse relation with all alcohol types, but wine seems to be most favourable for e.g. dementia, macular degeneration and lung cancer. Crucially, the all-cause mortality J-curve is dramatically different in wine drinkers, with the maximum health benefit at 2 to 4 units/day. Indeed some wine studies show the J-Curve morphs into a U-curve. You’ll see one of them in my book The Good News About Booze. Astonishingly, one study has shown a straight-line inverse association between mortality risk and wine intake. I didn’t include that one.

  8. Great analysis and I hope you don’t mind that I added you piece (in further reading) to my post . The Sheffield group analysis seems to be blackbox with the desired outcome they had in mind. We hope that a government funded body has the desire to tell the truth, but the truth has been surely twisted here for motives of funding etc. Cheers and have a nice glass of Malbec (high in resveratrol) Richard.Norton

    For those interested see:

    Blood alcohol concentration and other factors plus a damning verdict on the latest CMO recommendations

    For more info on resveratrol in wine etc.

  9. One thing that bothers me is the conflation in the govt. advice between “death from alcohol-relatable illness” and “premature death from alcohol-relatable illness”. As far as I can see, it’s (strictly speaking) consistent with the figures in the mortality risk percentage chart that heavy drinkers live roughly the same length of time as non-drinkers (or even longer), but die of different causes. If I die of liver failure at the age of 102, am I an “alcohol-related fatality”? Or has the data been adjusted so it only takes account of deaths significant earlier than that person’s life expectancy? Conversely, I could produce a chart showing that not-drinking increases the risk of death from non-alcohol-related causes, using exactly the same data. After all, everyone dies of something – flat risk of death not really a good measure, as overall I’d say that risk is 100% for everyone!

  10. I wonder if there’s an axe being ground in Sheffield? I seem to remember earlier reports supporting minimal unit pricing and others along the lines of this report that looked like the wilfully ignored earlier work that established the J curve.

    Presumably the research commissioning process went through the usual govt. procurement processes, as required by EU.

    Shame about the Australian input. I thought that they used to have a good approach, which specifically distinguished between acute risk from getting drunk vs longer term health impact.

  11. Surely the whole basis upon which the Sheffield model rests is irretrievably flawed for the simple reason that nobody entering hospital for alcohol-related causes (or indeed any cause) carries with them a dosimeter showing how much alcohol they consumed and when.

    Without this information, how can the model be anything other than an algorithm based on guesswork?

  12. You had me rolling in the aisles! It was a great read this Monday morning (after wine with dinner last night). Keep up the good work debunking crap.

  13. Prof Ian Gilmor has a history of prohibition related activity, he was a leading light in creating the smoking ban in the UK, this ban had the same problem with looking at Relative Risk of no significance as with these guidelines and perceiving it as harm when in fact the full body of evidence was discounted.
    They used information from select universities with input from paid lobby groups to create a view that there is no safe level of SHS, even though the HSE could not produce epidemiological evidence that SHS is significantly harmful, see HSE OC255/15 article 9, the smoking ban was not brought in by the HSE but under the Health Act 2006, this so it did not have to be an evidence based ban, these people use and twist select studies to suit their end game, which is to make drinking the same as smoking, I have no links to either the drinks industry or tobacco industry but have studied since 2006 the corrupt manner that has been used.
    ASH and similar paid lobby groups and institutions left a wake of closed pubs bingo halls and a social apartheid between smokers and non smokers.
    Christopher Snowdon (author) has analysed all this in depth in his books one being Iron Glove Velvet Fist.

  14. A beautifully written, incisive piece. I particularly liked this:


  15. May be too late here but…..isn’t the daily risk graph trying to capture the ‘war of attrition’ on the body from alcohol consumption over a lifetime rather than what happens on a particular day? Alcohol is like cigarettes, pizza, mars bars in that continuing consumption of things that are not good for you is not a good idea. The comments by your readers on the J Curve read a bit like special pleading by drinkers to me. The idea that alcoholic drinks can really be ‘good for you’ seems a bit grasping at straws really!
    I want to continue drinking 25-30 units a week but am not sure this convinces me it is ok to do do!

    1. No, if you’re talking about the graph with the straight lines that I refer to as the first graph in my piece above (figure 11 from the Sheffield report), then it’s specifically looking at the acute effects of alcohol, eg getting drunk and falling over and breaking bones).

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