Commentary: if you drink alcohol, drink sensibly: is this guideline still appropriate?

Alcohol abuse remains one of the most serious substance abuse disorders in South African society, resulting in inordinately large social, economic and health problems at all levels of society. Alcohol consumers in South Africa are estimated to drink 16.6L per annum with a per capita consumption of 7.1L. South Africa has one of the highest rates of death attributable to crime, violence, traffic accidents, and HIV/AIDS in the world. These rates have been directly related to the high prevalence of alcohol abuse and risky drinking patterns. A food-based dietary guideline that encourages alcohol consumption would appear to be not in the nation's best interest.

We conducted a search of websites supported by the World Health Organization to find published literature on substance abuse in South Africa and also reviewed the website of the Medical Research Council of South Africa for studies on the social impact of alcohol abuse in humans. We used the search terms alcohol guidelines, alcohol abuse, non-communicable diseases, health benefits of alcohol, moderate drinking, alcohol, and intake patterns and reviewed studies that hade been published between 2002 and the current time.

Based on evidence over the past two decades, messages that convey the positive health benefits of moderate alcohol consumption (eg, the increased levels of HDL cholesterol) should be raised and even encouraged for those who are very moderate drinkers (ie, one alcoholic drink/ day for women and a maximum of 2 drinks/day for men). For those who do not consume alcohol at all, even moderate drinking is not encouraged. Nutrition educators should emphasize the negative consequences of alcohol abuse.

The current food-based dietary guideline, "If you drink alcohol, drink sensibly," from the South African Department of Health should not remain as is.