A proposed overhaul of Canada’s decade-old drinking guidelines warns of increased health risks from as few as three drinks per week and calls for mandatory labelling of all alcoholic beverages.

In its suggested update to Canada’s Low-Risk Alcohol Drinking Guidelines, the Canadian Centre on Substance Use and Addiction eschews offering a specific daily or weekly limit in favour of outlining a continuum of risk and urging "less is better."

The Ottawa-based centre says risk is negligible-to-low for two drinks per week, moderate for three-to-six drinks per week and increasingly high beyond that.

It’s a stark shift from current guidelines that were released in 2011, which limit alcohol use to 10 drinks a week for women and 15 drinks a week for men.

But the CCSA says a review of more than 5,000 peer-reviewed studies shows that even very small amounts of alcohol can be harmful, with alcohol now recognized as a risk factor for an increasing number of diseases.

The CCSA says that includes at least seven types of cancer, with alcohol to blame for nearly 7,000 cases of cancer deaths each year. It says most cases are breast or colon cancer, followed by cancers of the rectum, mouth and throat, liver, esophagus and larynx.

The report, published Monday, also dispels the notion that drinking in moderation protects against heart disease, pointing to recent research that found drinking a little alcohol neither decreases nor increases the risk and that at higher levels, alcohol is a risk factor for most types of cardiovascular disease.

The CCSA notes that a significant proportion of alcohol-attributable deaths in Canada were among people following the 2011 guidelines.

The CCSA opened online public consultations this week on the report. The survey is open until Sept. 23 to members of the public as well as any experts with suggestions on additions or clarifications.

Dr. Peter Butt, co-chair on the project, says the finalized guidance is set for release Nov. 15.

The report stresses that all levels of alcohol consumption are associated with some risk.

“It is not lost on the experts that this new Guidance on Alcohol and Health, which puts forward a continuum of risk, will be surprising and unsettling to large segments of the population, including the alcohol industry, media and policymakers,” says the report.

“However, people living in Canada have a right to know. Alcohol is a carcinogen related to at least seven types of cancer, including common ones like colon and breast cancer. Furthermore, in contrast to common perceptions, current evidence shows that drinking a little alcohol does not decrease the risk of heart disease.”

The report also calls on Health Canada to require labels on alcoholic beverages that list the number of standard drinks each contains, pointing to research that suggests Canadians have a limited understanding of what constitutes a standard drink.

Currently, containers must display their alcohol percentage by volume but this doesn't help people adhere to advice that is based on the number of drinks one might have, says the report.

"The inconsistency in messaging causes consumer confusion and creates barriers for consumers to adhere to alcohol guidance," it says.

The report also notes that men’s drinking causes disproportionately more injuries, violence and deaths than women's drinking.

However the risks to women's health increase more sharply than for men above low levels of consumption.

The report goes well beyond examining alcohol's health risks by also touching on questions around mental and social harms, including intimate partner violence and sexual violence.

The authors note that it likely requires broader societal and policy changes in order for Canadians to heed advice to drink less, calling for "a cultural shift."

"Therefore, a corollary to the current project is the requirement for governments to design a healthier environment that will help people make difficult decision making about alcohol a little easier."

This report by The Canadian Press was first published Aug. 30, 2022.