Alcohol is classified as a Group 1 carcinogen by the WHO, putting it in the same category as tobacco and asbestos.Illustration by Photo Illustration by The Globe and Mail. Source imagery: Pexels
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Each summer, many of my conversations with patients take a seasonal shift to include discussions about sunscreen, travel vaccines, staying hydrated and – more often than you’d expect – alcohol.
Since Canada’s Guidance on Alcohol and Health was released in 2023 by the Canadian Centre on Substance Use and Addiction (CCSA), many of my patients have come in with questions: “Is two drinks per week really the new limit?” “Why the change?” “What does this mean for me?”
I, too, had these questions, not just as a doctor, but as a person thinking about my own habits and the health of those I care about. After reviewing the guidelines and understanding the reasons behind them, here is what I share with my patients.
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The updated guidance reflects the evidence
Canada’s Guidance on Alcohol and Health doesn’t tell people what to do. It offers a clearer understanding of alcohol-related risks, based on worldwide evidence reviews.
The evidence shows that even small amounts of alcohol carry health risks, including seven types of cancer, heart disease, liver damage, mental health effects and disrupted sleep. Alcohol is now classified by the World Health Organization as a Group 1 carcinogen, putting it in the same category as tobacco and asbestos.
The CCSA says the more alcohol you drink on a weekly basis, the greater the risk and that:
- 1 to 2 drinks per week = low risk
- 3 to 6 drinks per week = moderate risk
- 7 or more drinks per week = increasingly high risk
This guidance isn’t meant to alarm, but to inform responsible decision-making. Just as our understanding of the health impacts of second-hand smoke and processed meat has evolved, so too has our understanding of alcohol.
Reducing intake, even a little, matters
For many people, reducing alcohol intake to one to two drinks per week feels like a major change. I always remind my patients: This isn’t all-or-nothing. The guidance outlines a continuum of risk. Even moving from seven drinks a week to three or four can improve energy, sleep and long-term health.
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Alcohol affects our sleep, mood and metabolism
A common myth is that alcohol helps with sleep. While it might help you fall asleep faster, it disrupts deep restorative sleep and can leave many people more tired the next day.
It can also worsen mental health issues such as anxiety, affect weight (especially abdominal weight gain) and contribute to brain fog. These are health concerns I hear about daily in clinic, often without people realizing alcohol might be playing a role.
Alcohol and perimenopause don’t mix well
One group that often feels the effects of alcohol more intensely are those in perimenopause. As hormone levels fluctuate, alcohol can make symptoms worse and can amplify hot flashes, sleep disruption and increase anxiety and fatigue. For many of my patients in midlife, even small amounts of alcohol can hit differently than when they were younger.
As a perimenopausal woman myself, I have noticed that I’m more sensitive to previously well tolerated amounts of alcohol and its effect on my sleep, so I’ve shifted my intake as a result.
Simple strategies can help
I encourage patients to try small shifts in their consumption habits, including:
- Set a drink limit before going out
- Alternate alcohol drinks with water (1:1 rule)
- Choose alcohol-free days (e.g., skip weekday drinking)
- Try alcohol-free alternatives (there are many choices)
- Be mindful of portions (e.g. a standard glass of wine is 5 ounces, not that generous of a pour!)
Five ready-made, non-alcoholic drinks to enjoy for a refreshing summer
Curiosity is powerful, and so is support
Our evolving understanding of the health impacts of alcohol offers an opportunity to pause and reflect: How often do I drink, and how do I feel when I drink? How do I feel when I don’t?
Not everyone who drinks at higher levels has alcohol use disorder, but high-risk drinking increases the likelihood of developing it. If someone wants to explore their relationship with alcohol, I remind them that this is a health issue, not a moral one. Support is available, whether that’s through your family doctor, counselling, or provincial and community-based resources. Other helpful resources include the Centre for Addiction and Mental Health and the Canadian Centre on Substance Use and Addiction.
Whether your health goal is better sleep, more energy or lowering long-term risks, the updated guidance is an opportunity to check in and make decisions that are in line with those goals.
Dr. Sheila Wijayasinghe is a menopause-certified family physician practising at St. Michael’s Hospital in Toronto and the medical director of primary care outreach at Women’s College Hospital. She is also the resident health expert on CTV’s The Social and co-host of The Doc Talk Podcast.
