The Definition of ‘Heavy Drinking’ is Different for Women and Men—and it May Surprise You Just How Much is Too Much

According to multiple studies, Americans typically see a sharp increase in their alcohol consumption between Thanksgiving and New Year’s Day. This year is no different, with family gatherings, festive dinner parties and seemingly endless cups of cheer punctuated by the stress from an enduring pandemic. It seems that everyone, everywhere, is drinking more.

Which begs the question: how much is too much?

According to the Dietary Guidelines for Americans, a publication created by the U.S. Department of Agriculture and U.S. Department of Health and Human Services, heavy drinking is defined as consuming 15 drinks or more per week for men and only eight drinks or more per week for women. Put another way, drinking a little over one drink a day for women is defined as heavy drinking. Notably, it does not matter how those drinks are distributed—either one drink a day or eight drinks in one day—both classify as heavy drinking and carry negative health risks.

“I think these guidelines often surprise patients, because alcohol use is so ingrained in our culture—from movies to public figures to ads on television and social media,” said Dr. Annamaria Macaluso Davidson, Vice President of Employee Health Medical Operations at Memorial Hermann Health System. “We don’t often see people limiting their drinks to one or two per day based on their gender, so to learn that having more than this puts your health at risk can be a surprise. Nevertheless, health experts are truly aligned on the negative effects of alcohol and want the public to understand the real risks over-consumption can pose.”

So why the difference between women and men? Dr. Macaluso Davidson explained that although many women are typically smaller than some men, the reason for the discrepancy has less to do with size and more with biology.

“Women absorb and metabolize alcohol differently than men do, which is the primary reason the definition of heavy drinking for men is double that for women,” Dr. Macaluso Davidson explained. “Typically, women have less body water and more body fat than men of similar body weight, which means women absorb more alcohol than men and take longer to metabolize it, allowing higher concentrations of alcohol in the blood despite drinking equivalent amounts of alcohol. Even more, studies have also shown that women produce smaller quantities of an enzyme known as alcohol dehydrogenase, which helps break down alcohol in the body.”

According to information from the Centers for Disease Control and Prevention (CDC), the immediate effects from alcohol also kick in more quickly and last longer in women, a difference that actually makes women more likely to experience long-term negative health effects from drinking.

Dr. Macaluso Davidson noted that for people who choose to drink but want to stay within the recommended parameters, the definition of “one drink” matters, too, as most holiday top-offs are far larger than the standard sizes health experts recommend. According to the CDC, a standard drink is equal to 14 grams of pure alcohol, which translates into the following:

  • 12 ounces of beer (if at approximately 5% alcohol content)
  • 8 ounces of malt liquor (at approximately 7% alcohol content)
  • 5 ounces of wine (at approximately 12% alcohol content)
  • 1.5 ounces or a “shot” of 80-proof liquor ( at approximately 40% alcohol content)

The health risks for overconsumption vary, from the temporary to long-term. One night of heavy drinking, resulting in alcohol intoxication, can result in temporarily impaired brain function, which can cause poor judgment, reduced reaction time, and loss of motor skills. People who are drunk from alcohol are also at higher risk for motor-vehicle crashes, violence or other injuries. Overconsumption can also lead to alcohol poisoning if too much is consumed to quickly, which can be fatal.

Health risks from persistent, long-term heavy drinking, including binge drinking, are also serious. These include increased risk of stroke, chronic diseases including liver cirrhosis, pancreatitis, high blood pressure, psychological disorders, as well as multiple cancers. A new study published in July in the journal Lancet Oncology reinforced the known risks associated with drinking and cancers, showing that, worldwide, at least 4% of the newly diagnosed cases of esophageal, mouth, larynx, colon, rectum, liver and breast cancers in 2020 could be attributed to alcohol consumption. For women, the vast majority of these were breast cancer.

In addition, any alcohol consumption during pregnancy continues to carry extremely high risks to the developing fetus, ranging from fetal alcohol spectrum disorders, developmental delays, and sudden infant death syndrome, known as SIDS.

“Health providers know some of the information out there can be confusing, especially when we consider studies that say moderate drinking, especially of red wine, can have some health benefits,” said Dr. Macaluso Davidson. “Still, the bottom line is that anything more than moderate drinking poses serious health risks, and most of us do not know how little it takes to be considered a ‘heavy’ drinker. That’s why it is so important to understand these guidelines and know the risks.”

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Ali Vise