Healthy Alcohol Intake

Alcohol is drunk and enjoyed all over the world. Most people who drink believe that they do so within safe limits. However, research shows more than one quarter of people regularly drink more than is medically safe. These risks include heart disease, high blood pressure, liver cirrhosis and cancer. It is important to find out if you drink too much because acting now can improve your chances of good health for the future.

Are you putting your health at risk?

If you answer yes to any of the following, you may be putting your health at risk. You should discuss your alcohol intake further with a health professional or consider help from a support organization. The following is only a guide:

If you drink more than 21 units per week (men) or 14 units per week (women) - see sensible drinking limits

• If you drink large amounts of alcohol in one sitting (binge drinking)
• More than 8 units for men
• More than 6 units for women
• If drinking interferes with your performance at work, your mood or your social or family life.
• If you start drinking early in the morning
• If any other person has commented about your drinking, especially if you became angry with them
• If you feel guilty about your drinking
• If you experience withdrawal symptoms such as tremors and shakes.

What to do if you think you have a drink problem

• See GP or other health professional
• Helpline
• Website

Tips for cutting down on alcohol intake

If you have been drinking heavily and regularly for a long time, then you should seek professional advise before stopping or cutting down. This is because of the risk of a serious withdrawal syndrome called Delirium Tremens (DT) that can occur if alcohol is suddenly stopped. Your doctor might prescribe medication to help prevent this.

Always ask for single measures

Drink regular strength beer (3.5%). Ask for the % ABV before you buy

Ask for a small glass of wine

Drink a soft drink between each alcoholic drink

Avoid buying rounds, as you will likely end up drinking more than you would otherwise

Drink slower, pacing yourself

Learn to say know when you have had enough

Sensible Drinking Limits

Sensible drinking involves drinking within recommended limits, although not necessarily at the maximum. If you drink sensibly, you are likely to avoid the harmful effects of alcohol that can occur with higher intake.

Leading medical opinion (that includes the British Medical Association and the Royal College of Physicians) recommends the following safe limits:

• MEN: Maximum 21 units per week (3 units per day maximum)
• WOMEN: Maximum 14 units per week (2 units per day maximum)

One unit is equivalent to 8g or 10mls of pure alcohol, this translates to:

• half a pint (284mls) of regular beer (3.5% ABV)
• standard 25mls (40% ABV) single measure of pub spirits.
• 1 small glass 125mls (8% ABV) wine (note most wine is stronger)

ABV = Alcohol by Volume

Beware of stronger bottled beers, large glasses of wine and double spirit measures. These will add up to more units quickly.

1 pint (568mls) regular beer 3.5 ABV % = 2 units

1 pint (568mls) premium beer/lager (5% ABV) = 2.8 units

1 large can (440mls) super strength larger (9% ABV) = 4 units

1 bottle (330mls) of ‘alcopop' or larger at 5% ABV = 1.7 units

1 small glass wine (125mls) 12% ABV = 1.5 units

1 large glass wine (175mls) 12% ABV = 2 units

1 bottle 5.5% ABV alcopop = 1.5 units

1 double measure (50mls) spirits (40%) = 2 units

Binge Drinking

These levels are only safe providing the alcohol is spread throughout the week, and binge drinking is avoided. The pattern of binge drinking is exceptionally dangerous to your health. An acceptable definition of binge drinking is drinking eight or more units for men and six or more units for women on at least one day in the week. Alternatively, it could also be described as drinking enough alcohol to become intoxicated on one occasion.

Note that the sensible drinking limits are maximum limits. It may be safer to drink slightly less than the maximum, as there is evidence that drinking at the maximum levels can increase the risk of cancer. Practical safe daily limits could be seen as follows.

• Men: 2 units per day
• Women: 1 unit per day

There is also recent evidence that has suggested that women may be at an increased risk of cancer if they drink even small quantities of alcohol on a regular basis.

When to avoid alcohol?

This includes:

• If you are going to drive. Uk law permits 80mg of alcohol per 100mls of blood. It is very difficult to predict how much alcohol is permitted before reaching this limit, as it varies widely between individuals. In any event, evidence clearly shows reaction times are seriously effected, even after a small amount of alcohol. Therefore sensible advice is not to drink and drive, and if you must do both, ensure you stay within the drink-drive limits.
• Operators of heavy machinery
• Before exercise
• Those with severe mental health problems
• Those with certain illnesses or on certain medication - discuss with doctor or health professional first.
• Those who have had problems with alcohol dependency or addiction

Why are the government limits higher?

In 1995, the Department of Health (a government department) suggested higher levels for the daily drinking limits. They have suggested 3-4 units per day in men and 2-3 units per day in women. This represents a 33% rise for men, and a 50% rise for women, when totaled over the week.

The leading medical organisations (including the British Medical Association) in the United Kingdom have not endorsed these higher limits. There is evidence that drinking at these limits may be harmful to health. Therefore leading medical experts feel that the sensible drinking limits mentioned in the previous section should still be used as a guide.

Effects of alcohol on the body

When alcohol is drunk, it enters the blood stream and crosses into the brain, where it has its ‘psychoactive' effect on the brain itself. Many people are familiar with the effects of alcohol, which increase in intensity the more alcohol is drunk at one sitting. These effects often start with a feeling of well-being and elation, but can also impair judgment and delay reaction times at an early stage. Some may even find their mood becomes depressed when drinking, as alcohol has a depressant effect on the brain. If more alcohol is drunk, then excitement can follow, and many will start to stagger and become uncoordinated. Confusion often occurs after this, and if alcohol intake is increased unconsciousness, and even death can occur.

Metabolism of Alcohol

Once alcohol has entered the blood stream, it eventually reaches the liver. There it is acted upon by an enzyme (alcohol dehydrogenase) which breaks it down to a substance caused acetate. This breakdown (metabolism) of alcohol occurs in the liver at a constant rate, and as a very rough guide, approximately one unit of alcohol will be broken down per hour. However, other factors such as gender, weight and height may alter this speed. Acetate then leaves the liver in the blood-stream and is converted to carbon dioxide and water in the tissues of the body. As the liver has to work hard to breakdown alcohol, it is one of the first organs to be damaged.

Damaging effects of Alcohol

Drinking more than recommended weekly limits (see sensible drinking) or regularly drinking significant quantities of alcohol in one sitting (binge drinking) even if the binge drinking does not take you over the weekly limits, causes harm. The longer these bad drinking styles are sustained (eg over months and years), the higher your chance of developing alcohol related illness. Serious health problems from alcohol are rising, and represent an enormous cost to our society.

Too much alcohol over time can lead to alcohol dependence syndrome (which is essentially addiction and its effects), and can also cause physical damage to the body organs.

If you think you are drinking more than the recommended limits or are binge drinking, then discuss this with your doctor or other health professional, as ultimately cutting down or stopping, where appropriate, will equal a healthier lifestyle

Short term problems
When alcohol is drunk in excess in one sitting, various problems can occur that include low blood sugar, injuries, dehydration and even death. Dehydration occurs because alcohol is a diuretic, which means it causes increased urination, and therefore dehydration. The following day, the lack of water in the body causes the symptoms of a hangover. These include feeling thirsty, nausea, vomiting and headaches.

Longer Term Problems
This includes:
Hypertension and heart disease
Cancers
Liver cirrhosis, liver cancer and liver failure
Pancreatitis
Dementia and other serious neurological conditions
Infertility
Gastritis and stomach ulcers
Depression and other mental illness
Vitamin Deficiencies

The Heart and Blood vessels (the cardiovascular system):
Certain groups of people may gain some health benefit to the heart and blood vessels by drinking within the safe limits. However, when higher levels are drunk, or when binge drinking is common, this can lead to heart attacks, strokes, high blood pressure (hypertension), abnormal heart rhythms and a large failing heart.

The Gastrointestinal system (stomach, liver and pancreas, oesophagus)
Up to 20% of heavy drinkers may have liver cirrhosis. This is a condition that can lead to liver failure, liver cancer and death. Fatty liver are early changes to the liver that are reversible if drinking is stopped. However, once cirrhosis sets in, this is irreversible. The treatment for liver failure is a transplant and life long medication

Liver cirrhosis can lead to enlarged veins surrounding the gullet (oesophagus). These enlarged veins (called oesophageal varices) can rupture causing blood to be vomited, which is life threatening.

Inflammation of the stomach lining (or gastritis) is a common problem due to alcohol. This is painful and can lead to bleeding of the stomach and ultimately ulcers can form. These can also be life threatening.

The pancreas is an organ that releases insulin and enzymes that help digestion. This can become inflamed and can lead to serious health emergencies. Acute pancreatitis can cause a severe bout of abdominal pain and vomiting, and can cause death. If the pancreas is affected for a long time, diabetes and poor food digestion occurs.

The brain and the nervous system
Heavy drinkers of alcohol can become deplete in thiamine (vitamin B1). This can lead to serious neurological conditions such as Wernicke's encephalopathy. This presents as unsteadiness, double vision, drowsiness, abnormal eye movements and confusion. This can easily be mistaken for drunkenness. Emergency treatment is intravenous vitamin B1. If this is not administered, then this can cause death, and in survivors can result in a permanent disabling condition called Korsakoff's psychosis can result. This is a disease where new memories cannot be formed

Over time, alcohol use can cause dementia (gradual and progressive memory loss0, as well as problems with the functioning of the nerves in the body (neuropathy).

Mental Health and behavioural problems
Alcohol is responsible for many mental health and behavioural problems that includes antisocial and violent behaviour, depression, worsening of existing mental illness, relationship and family problems, alcohol addiction, including dependence and withdrawal.

Suddenly stopping heavy prolonged alcohol use can occasionally be dangerous. Withdrawal such as headaches, tremors, irritability and sweating may occur. More seriously if the person becomes very disturbed with hallucinations, this is a serious life threatening emergency called Delirium Tremens, and requires urgent hospital treatment. If you drink heavily for prolonged periods, you should consult a health professional before suddenly stopping alcohol use.

Cancer
Although alcohol may have beneficial effects for the heart, if drunk to safe limits, it nevertheless may cause higher levels of cancer, even at lower levels.

Cancers that are more common with alcohol use are cancers of the mouth, larynx (voice box) and oesophagus. In addition liver cancer and breast cancer can both be caused by excess alcohol intake.

Other problems
Include gout, (urate crystals forming in the extremities of the body such as the big toe, and which can be exceptionally painful), obesity (due to the calories in alcoholic drinks), vitamin deficiencies as well as bruising and other skeletal injuries sustained when drunk.

The Reproductive System
Alcohol can cause infertility in men and women. In men, alcohol may also cause lack of libido and failure to get erections. Alcohol use has been implicated in the rise in sexually transmitted diseases, including HIV, as unprotected sexual intercourse is more likely when drunk.

Alcohol, pregnancy and the unborn fetaus
Alcohol, when drunk in pregnancy crosses the placenta, and therefore enters the blood stream of the unborn fetus. It is worth bearing in mind that in the initial stages of pregnancy, complex organs are being formed, and the exact effects of alcohol are unknown. If you drink in pregnancy, then the Royal College of Midwives and the Department of Health recommend a maximum of 1-2 units per week.

However, many health professionals advise avoiding alcohol completely in pregnancy. This is because alcohol crosses the placenta, and the exact effects upon the fetus are not known. Indeed, there is some evidence to suggest that babies are less active when alcohol is drunk. Therefore completely avoiding alcohol is the advice given to women in the United States of America.

Alcohol consumption in pregnancy can cause low birth weight, fetal alcohol syndrome (which causes birth deformities and low IQ) and miscarriages.

Beneficial Effects of Alcohol

Some research has suggested that drinking alcohol within sensible daily limits, and on a regular basis, can reduce the chances heart disease and mortality (death). However, when alcohol is drunk in quantities higher than recommended amounts, these beneficial effects are lost, and harm may be caused instead. It is worth noting, that if you binge drink (ie drinking to become intoxicated), then the evidence suggests the beneficial effects or regular light intake are lost, and you are at higher risk of death from cardiovascular disease.

It seems that these beneficial effects may only apply to men over 40 and postmenopausal women. Some research suggests such benefits only occur if you drink a specific type of drink, such as red wine, but other studies have suggested the benefits extend to any type of alcohol. More research is needed to clarify this further.

It is worth noting that exercise and healthy eating are safe ways that excellent health benefits can be achieved without drinking alcohol.

Problems with the Research

There is contradiction in the research. Some studies have shown harm with any alcohol intake, whereas others report benefit with light to moderate intake. There are many other factors that can be responsible for the improvement in health apart from alcohol. These may be cultural, dietary, genetic factors or specific environmental factors. These factors can be difficult to separate out in trials.

The role of cultural factors can be seen from a study that compared drinking in France and Eastern Europe. In France, drinking some alcohol was shown to protect the heart, but in Eastern Europe, it was harming the heart. The reason for this became clearer when looking at drinking practices. It seems that Eastern Europeans are more like to binge drink, which we know to be extremely harmful. Therefore, we can see that there are often unknown factors when undertaking research that may not always be immediate obvious.

It is also possible that future research may find that the benefits of alcohol may only apply to those born with a specific set of ‘protective' genes. Conversely, we may find that possession of certain ‘harmful' genes may predispose us to the harmful and addictive qualities of alcohol.

Should I start drinking sensibly to get the beneficial effects of alcohol?
Should you start drinking if you have never drunk alcohol in the hope that you may benefit from any good effects of alcohol? The best answer is no. Although alcohol may have some beneficial effects, this is not completely clear from the research. Expert advice suggests not to start drinking. There is always a risk that if you start drinking, your alcohol intake may become harmful.

If you want to reap the benefits of better health, then it is better  to exercise, stop smoking, and eat a healthy diet.

LINKS

Alcohol Concern
http://www.alcoholconcern.org.uk

Turning Point
http://www.turning-point.co.uk/

Down your Drink
http://www.downyourdrink.org.uk/main.php

Alcoholics Anonymous
www.alcoholics-anonymous.org.uk

Institute of alcohol studies
www.ias.org.uk

British medical association
www.bma.org.uk/ap.nsf/Content/Hubhotpbingedrinking

Royal College of Psychiatrists
www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/alcoholanddrugs/alcoholdepression.aspxcal association

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