Alcohol and health

[jdaw1]

Liver disease is now the country's fifth biggest killer and cases of alcoholic liver disease in the under-30s have risen by half in the past 10 years, says the Department of Health. The coalition wants a "drink strategy" with input from both the health lobby and the drinks industry, but can they work together?

Victoria White was lying in a bed at Liverpool's Royal Hospital, her skin yellow in colour, her belly badly swollen and her life hanging in the balance.



Ms White's liver disease is the result of heavy drinking.

She began drinking as a teenager and before her most recent hospital stay she had been consuming at least a bottle of brandy a day.

Doctors say her case is not unusual. According to government figures, a quarter of the adult population are thought to be drinking too much alcohol.

"Some people go their separate ways from alcohol. I didn't, I just carried on with it. You are selfish through drink. As long as you are all right, you just do not care," Ms White said.

Her mother, Debbie White, has watched alcohol slowly take over her daughter's life.

"When she was about 16 she started lying saying she had not had a drink but you could smell it on her. We would start finding bottles of vodka, bottles and bottles of cider hidden under her bed," she said.

Ms White was hospitalised in the past because of alcohol and nearly died five years ago. She was warned then that she needed to stop drinking.

"I was OK at first. I would just have a couple and leave it and then as the days went to weeks I just started drinking again. And here I am today," she said from her hospital bed.

In agreeing to be interviewed in such ill health, she urged others to learn from her mistakes.

Ms White's doctor, liver specialist Paul Richardson, said his colleagues are seeing similar cases of irreparable damage.

"Both locally and nationally, people who work in hepatology have noticed an increase in alcoholic liver disease in a younger population," he said.

Overall consumption is falling but alcohol-related hospital admissions have doubled in a decade.

In 2010, there were more than a million admissions, according to hospital statistics.

Professor Sir Ian Gilmore is chair of the UK Alcohol Health Alliance, which campaigns to increase awareness about alcohol.

"It's very difficult to know why our culture has changed so radically, but all the evidence suggests that the big drivers for the amount people drink are the price, the availability and the marketing and that is what we have been trying to push governments to look at."

The health and financial costs of alcohol abuse led the coalition government to create a working group that included both the drinks industry and the health lobby.



Brokering a strategy has been challenging.

Health groups, including the British Medical Association, decided to withdraw from the government's consultation process in March, citing the influence of the drinks industry on policy-making.

Anne Milton, the Minister for Public Health, said she was disappointed by their decision. "I am sad that people stopped talking to us because it is never productive," she said.

Gavin Partington of the Wine and Spirit Trade Association, said the industry is very willing to help limit alcohol abuse, and large companies are increasingly aware of their social responsibilities. "It is important for them to be seen to implement policies that are going to be tackling what is a very real problem."

But he said the industry believes in voluntary codes of practice rather than legislation to limit the availability, price or advertising.

He also added that people consuming dangerous and irresponsible levels of alcohol are in the minority.

The government's alcohol strategy report is expected later this year.

There is also a video, shot in a hospital, showing lots of people who had not been drinking properly-decanted vintage port.

[jdaw1]

Background

Observational studies have documented inverse associations between moderate alcohol consumption and risk of premature death. It is largely unknown whether moderate alcohol intake is also associated with overall health and well-being among populations who have survived to older age. In this study, we prospectively examined alcohol use assessed at midlife in relation to successful ageing in a cohort of US women.

Methods and Findings

Alcohol consumption at midlife was assessed using a validated food frequency questionnaire. Subsequently, successful ageing was defined in 13,894 Nurses' Health Study participants who survived to age 70 or older, and whose health status was continuously updated. ‟Successful ageing” was considered as being free of 11 major chronic diseases and having no major cognitive impairment, physical impairment, or mental health limitations. Analyses were restricted to the 98.1% of participants who were not heavier drinkers (>45 g/d) at midlife. Of all eligible study participants, 1,491 (10.7%) achieved successful ageing. After multivariable adjustment of potential confounders, light-to-moderate alcohol consumption at midlife was associated with modestly increased odds of successful ageing. ! Meanwhile, independent of total alcohol intake, participants who drank alcohol at regular patterns throughout the week, rather than on a single occasion, had somewhat better odds of successful ageing !

Conclusions

These data suggest that regular, moderate consumption of alcohol at midlife may be related to a modest increase in overall health status among women who survive to older ages.

[RAYC]

If the inference from this is that 45 grams of alcohol per day is considered moderate and beneficial (or not detrimental) to health, that gives a fairly generous guilt-free daily port allowance...

Density of alcohol (ethanol) at room temperature (21 degrees) = 0.7886 g/ml.

A daily allowance of 45 grams = 57ml of alcohol.

57ml of alcohol = just over one third of a bottle of port per day (assuming 750ml bottle and 20% abv, more precisely 0.38 of a bottle or 19/50ths)

Since their study was on women, I am going to presume (unscientifically) that this allowance could safely be scaled up to a respectable 1/2 bottle for a big strapping man, though their finding that the daily allowance cannot be saved up like pocket money and spent on the occasional orgy of port is a pity (but not unexpected!).

[jdaw1]

All hail Dr Coombes!

[jdaw1]

Amy Winehouse's father has said his daughter was trying to overcome an addiction with alcohol, but not drugs, before her death.

Mitch Winehouse said she had been clean of illegal drugs for three years before she died in July.

He told Newsbeat she had replaced her previous drug problems with addictions to exercise and shopping.

But added: "Then it was drinking and unfortunately that's not quite so easy to over come."

[jdaw1]

We know that drinking too much alcohol is bad for us. It gives us hangovers, makes us feel tired and does little for our appearance - and that is just the morning afterwards.

Long term, it increases the risk of developing a long list of health conditions including breast cancer, oral cancers, heart disease, strokes and cirrhosis of the liver.

Research shows that a high alcohol intake can also damage our mental health, impair memory skills and reduce fertility.

The direct link between alcohol and the liver is well understood - but what about the impact of alcohol on other organs?

Numerous heart studies suggest that moderate alcohol consumption helps protect against heart disease by raising good cholesterol and stopping the formation of blood clots in the arteries.

Toxic

However, drinking more than three drinks a day has been found to have a direct and damaging effect on the heart. Heavy drinking, particularly over time, can lead to high blood pressure, alcoholic cardiomyopathy, congestive heart failure and stroke. Heavy drinking also puts more fat into the circulation of the body.

The link between alcohol and cancer is well established, says Cancer Research UK. A study published in the BMJ this year estimated that alcohol consumption causes at least 13,000 cancer cases in the UK each year - about 9,000 cases in men and 4,000 in women.

Cancer experts say that for every additional 10g per day of alcohol drunk, the risk of breast cancer increases by approximately 7-12%.

For bowel cancer, previous studies show that increasing alcohol intake by 100g per week increases the cancer risk by 19%.

A recent report in BioMed Central's Immunology journal found that alcohol impairs the body's ability to fight off viral infections.

And studies on fertility suggest that even light drinking can make women less likely to conceive while heavy drinking in men can lower sperm quality and quantity.

Why alcohol has this negative effect on all elements of our health could be down to acetaldehyde - the product alcohol is broken down into in the body.

Acetaldehyde is toxic and has been shown to damage DNA.

Dr KJ Patel, from the Medical Research Council's laboratory of molecular biology in Cambridge, recently completed a study into the toxic effects of alcohol on mice.

His research implies that a single binge-drinking dose of alcohol during pregnancy may be sufficient to cause permanent damage to a baby's genome.

Foetal alcohol syndrome, he says, "can give rise to children who are seriously damaged, born with head and facial abnormalities and mental disabilities".

'Clear dose relationship'

Alcohol is a well-established cancer causing agent, he says.

"You cannot get a cancer cell occurring unless DNA is altered. When you drink, the acetaldehyde is corrupting the DNA of life and puts you on the road to cancer.

"One of most common genetic defects in man is our inability to counteract the toxicity of alcohol."

Dr Nick Sheron, who runs the liver unit at Southampton General Hospital, says the mechanisms by which alcohol does damage are not quite so clear cut.

"The toxicity of alcohol is complex, but we do know there is a clear dose relationship."

With alcoholic liver disease, the greater the alcohol intake per week the greater the liver damage and that increases exponentially for someone drinking six to eight bottles or more of wine in that period, for example.

Over the past 20 to 30 years, Dr Sheron says, deaths from liver disease have increased by 500%, with 85% of those due to alcohol. Only in the last few years has that rise slowed down.

"Alcohol has a bigger impact than smoking on our health because alcohol kills at a younger age. The average age of death for someone with alcoholic liver disease is their 40s."

'More harmful than heroin or crack'

Alcohol is undoubtedly a public health issue too.

Earlier this year, NHS figures showed that alcohol-related hospital admissions has reached record levels in 2010. Over a million people were admitted in 2009-10, compared with 945,500 in 2008-09 and 510,800 in 2002-03. Nearly two in three of those cases were men.

At the same time the charity Alcohol Concern predicted the number of admissions would reach 1.5m a year by 2015 and cost the NHS £3.7bn a year.

Last year, a study in The Lancet concluded that alcohol is more harmful than heroin or crack when the overall dangers to the individual and society are considered.

The study by the Independent Scientific Committee on Drugs also ranked alcohol as three times more harmful than cocaine or tobacco because it is so widely used.

So how much alcohol is too much? What can we safely drink?

The government guidelines on drinking are being reviewed at present. They currently say that a women should not drink more than two to three units of alcohol per day and a man three to four units a day.

But Paul Wallace, a GP and chief medical adviser of Drinkaware, says people are just not aware of the alcohol content of a large glass of wine.

"Most of us don't realise what we're drinking and you can very easily slip beyond acceptable limits."

Katherine Brown, head of research at the Institute of Alcohol Studies, says the current guidelines and how they are communicated may be giving the public misleading information.

"We need to be very careful when suggesting there is a 'safe' level of drinking for the population. Rather, we need to explain that there are risks associated with alcohol consumption, and that the less you drink the lower your risk is of developing health problems.

"We hope the government use this as an opportunity to help change perceptions about regular drinking being a normal, risk-free practice."

Dr Wallace wants the government to do a better job on the message it sends out by explaining the alcohol guidelines in units per week, rather than per day - no more than 21 units for men, 14 units for women per week.

Dr Sheron agrees: "There is no such thing as a safe level, but the government has got to draw a line somewhere. It's a balance.

"People like having a drink, but they have to accept there's a risk-benefit ratio."

[jdaw1]

A very interesting article, including brief descriptions of some interesting experiments.

Many people think heavy drinking causes promiscuity, violence and anti-social behaviour. That's not necessarily true, argues Kate Fox.

!


The problem is that we Brits believe that alcohol has magical powers - that it causes us to shed our inhibitions and become aggressive, promiscuous, disorderly and even violent.

But we are wrong.

In high doses, alcohol impairs our reaction times, muscle control, co-ordination, short-term memory, perceptual field, cognitive abilities and ability to speak clearly. But it does not cause us selectively to break specific social rules. It does not cause us to say, "Oi, what you lookin' at?" and start punching each other. Nor does it cause us to say, "Hey babe, fancy a shag?" and start groping each other.

The effects of alcohol on behaviour are determined by cultural rules and norms, not by the chemical actions of ethanol.

There is enormous cross-cultural variation in the way people behave when they drink alcohol. There are some societies (such as the UK, the US, Australia and parts of Scandinavia) that anthropologists call "ambivalent" drinking-cultures, where drinking is associated with disinhibition, aggression, promiscuity, violence and anti-social behaviour.

There are other societies (such as Latin and Mediterranean cultures in particular, but in fact the vast majority of cultures), where drinking is not associated with these undesirable behaviours - cultures where alcohol is just a morally neutral, normal, integral part of ordinary, everyday life - about on a par with, say, coffee or tea. These are known as "integrated" drinking cultures.

This variation cannot be attributed to different levels of consumption - most integrated drinking cultures have significantly higher per-capita alcohol consumption than the ambivalent drinking cultures.

Instead the variation is clearly related to different cultural beliefs about alcohol, different expectations about the effects of alcohol, and different social rules about drunken comportment.


This basic fact has been proved time and again, not just in qualitative cross-cultural research, but also in carefully controlled scientific experiments - double-blind, placebos and all. To put it very simply, the experiments show that when people think they are drinking alcohol, they behave according to their cultural beliefs about the behavioural effects of alcohol.

The British and other ambivalent drinking cultures believe that alcohol is a disinhibitor, and specifically that it makes people amorous or aggressive, so when in these experiments we are given what we think are alcoholic drinks - but are in fact non-alcoholic "placebos" - we shed our inhibitions.

We become more outspoken, more physically demonstrative, more flirtatious, and, given enough provocation, some (young males in particular) become aggressive. Quite specifically, those who most strongly believe that alcohol causes aggression are the most likely to become aggressive when they think that they have consumed alcohol.

Our beliefs about the effects of alcohol act as self-fulfilling prophecies - if you firmly believe and expect that booze will make you aggressive, then it will do exactly that. In fact, you will be able to get roaring drunk on a non-alcoholic placebo.

And our erroneous beliefs provide the perfect excuse for anti-social behaviour. If alcohol "causes" bad behaviour, then you are not responsible for your bad behaviour. You can blame the booze - "it was the drink talking", "I was not myself" and so on.

But it is possible to change our drinking culture. Cultural shifts happen all the time, and there is extensive evidence (again from carefully controlled experiments, conducted in natural settings such as bars and nightclubs) to show that it doesn't take much to effect dramatic changes in how people behave when they drink.


These experiments show that even when people are very drunk, if they are given an incentive (either financial reward or even just social approval) they are perfectly capable of remaining in complete control of their behaviour - of behaving as though they were totally sober.

To achieve these changes, we need a complete and radical re-think of the aims and messages of all alcohol-education campaigns. So far, these efforts have perpetuated or even exacerbated the problem, because almost all of them simply reinforce our beliefs about the magical disinhibiting powers of alcohol.

The drinkaware website, for example, warns young people that a mere three pints of beer (ie a perfectly normal evening out) "can lead to anti-social, aggressive and violent behaviour", that "you might start saying things you don't mean and behaving out of character", that alcohol is implicated in a high percentage of sexual offences and street crimes, and that the morning after "you may wonder what you did the night before".

I would like to see a complete change of focus, with all alcohol-education and awareness campaigns designed specifically to challenge these beliefs - to get across the message that a) alcohol does not cause disinhibition (aggressive, sexual or otherwise) and that b) even when you are drunk, you are in control of and have total responsibility for your actions and behaviour.

[jdaw1]

People seeking cheap alcohol as part of new year celebrations have been warned by council trading standards teams about the dangers of counterfeit vodka.

Fake vodka recently seized had high levels of methanol, which can cause blindness, and industrial solvents.

Misaligned labels and liquid with an odour resembling nail varnish are among telltale signs of counterfeit vodka.

The Local Government Association in England and Wales warned that fake vodka could be deadly.

[jdaw1]

Giving up alcohol or going on a detox for one month is pointless, especially after the excesses of the festive season, says a liver charity.

Instead, the British Liver Trust says drinkers should make a decision to stay off alcohol for a few days every week throughout the whole year.

Experts agree that a short period of complete abstinence will not improve liver health.

A longer-term attitude to alcohol is more desirable, the charity said.



Andrew Langford, chief executive of the British Liver Trust, said that people tend to believe the hype about rejuvenating their liver by detoxing in January.

"People think they're virtuous with their health by embarking on a liver detox each January with the belief that they are cleansing their liver of excess following the festive break.

"A one-hit, one-month attempt to achieve long-term liver health is not the way to approach it.

"You're better off making a resolution to take a few days off alcohol a week throughout the entire year than remaining abstinent for January only."

The thinking behind this approach is that total alcohol intake per person is kept down and the liver is given time to recover each week.

Providing the liver has no lasting damage, it can repair itself very quickly, taking as little as 24 hours to go back to normal.

Dr Mark Wright, consultant hepatologist at Southampton General Hospital, said detoxing created its own problems.

"Detoxing for just a month in January is medically futile. It can lead to a false sense of security and feeds the idea that you can abuse your liver as much as you like and then sort everything else with a quick fix.

"It makes about as much sense as maxing out your credit cards and overdraft all year, then thinking you can fix it by just eating toast in January. The figures just don't stack up," said Dr Wright.

The British Liver Trust is launching a campaign called 'Love Your Liver' to encourage people to maintain a healthy liver.

As part of the campaign, it also advises eating well and exercising regularly.

"If you are overweight you increase your risk of liver disease by three times if you drink alcohol too.

"Cutting down on your daily food indulgences and not overloading on sugary drinks will all help to optimise your liver function," the Trust's website says.

Interesting.

> Providing the liver has no lasting damage, it can repair itself very quickly, taking as little as 24 hours to go back to normal.

So the message is that either the liver has permanent damage, and there’s nothing you can do about it, or it hasn’t, in which case, carry on.

[jdaw1]

Drinking "just a little more than they should" puts people at risk of serious illness including heart disease, stroke and cancer, the government is warning.

A TV advertising campaign is being launched to press home the message.

It warns regularly drinking two large glasses of wine or two strong pints of beer a day triples mouth cancer risk and doubles high blood pressure risk.

People "should not regularly exceed" the daily limit of three to four units for men and two to three for women.

Doubtless a separate campaign, also billed to the taxpayer, will explain the difference between this campaign and scare-mongering.

[jdaw1]

The NHS alcohol page leads to a page entitled Hangover cures, which comes close to my view: ‟Dehydration is what causes many of the symptoms of a hangover”. My guess is the primary route by which alcohol does any harm is dehydration: CH₃CHâ‚‚OH + enough water does little or no harm.

[DRT]

Is a bottle of Graham's Six Grapes one more than your 5 a Day?

[jdaw1]

Not alcohol, more post-alcohol.

As part of his investigation into why British people are on average nearly three stone (24kg) heavier than 50 years ago, Jacques Peretti attempts to eat what is thought to be one of Britain's biggest fried breakfasts.

A reflection of the rise in popularity of super-sizing food, Jester's diner in Great Yarmouth serves a breakfast that includes 8 eggs, 12 rashers of bacon, 12 sausages, potatoes, mushrooms, hash browns, black pudding, beans and 12 slices of bread.

It is called the "Challenge Kidz Breakfast" because it weighs the same as a small child, around 9lbs.

It’s free if finished in an hour. Even the proprietor admits ‟Obviously that’s not something you should eat every day.”

[jdaw1]

BBC: Where are you on the global fat scale?

[Andy Velebil]

BBC: Where are you on the global fat scale?

Your numbers
Obesity Index
24bmi
BMI is an estimate of how "overweight" or "obese" a person is


National
Below average
You have a lower BMI than 85% of males aged 30-44 in your country

Global
Below average
You have a lower BMI than 54% of males aged 30-44 in the world


WOOHOO, I am below the national and global average. I can drink more port now.

Though the BMI is WAY off. My body fat is about the 9-10% range at the moment. Hardly corresponds to a BMI that is one point away from being considered overweight.

*edit: for me getting below about 7% is not good (been tested lots due to cycling) as I get nose bleeds, headaches, and look like I've been starved.

[jdaw1]

The shape of your glass is probably the last thing on your mind when you are down the pub.

However, researchers at the University of Bristol believe the shape of beer glasses affects the speed people drink.

[Andy Velebil]

The shape of your glass is probably the last thing on your mind when you are down the pub.

However, researchers at the University of Bristol believe the shape of beer glasses affects the speed people drink.

Yes. One must drink quickly before it gets too warm.

[jdaw1]

getting below about 7% is not good (been tested lots due to cycling) as I get nose bleeds, headaches, and look like I've been starved.

Note to self: cycling = unhealthy.

[Andy Velebil]

getting below about 7% is not good (been tested lots due to cycling) as I get nose bleeds, headaches, and look like I've been starved.

Note to self: cycling = unhealthy.

That's why I drink plenty of Port. It helps keep the weight on

[Glenn E.]

BBC: Where are you on the global fat scale?

My BMI is 23. My body fat, as determined by one of those scales that uses electrical resistance to determine it, is 17%. I'm below average in the US (92% of males 45-59 have a higher BMI than I do) and below average worldwide (68% of males 45-59 have a higher BMI than I do). I'm most like an average 48-yr old male from Gambia.

That's bad. I don't think they have much Port in Gambia.

[marc j.]

I also have a BMI of 23, which means that I haven't been drinking enough Port...

Obesity Index

23bmi
BMI is an estimate of how "overweight" or "obese" a person is National
Below average
You have a lower BMI than 91% of males aged 45-59 in your country Global
Below average
You have a lower BMI than 67% of males aged 45-59 in the world

[jdaw1]

I do not know my BMI. I do not want to know my BMI. That has me most like males in the UK. This is good, as there is Port in the UK.

[jdaw1]

More NHS money is spent treating alcohol-related illness in baby boomers than young people, a study says.

The Alcohol Concern report found the cost of hospital admissions linked to heavy drinking 55 to 74-year-olds in 2010-11 was more than £825m.

That was 10 times the figure for 16 to 24-year-olds.

In total, nearly £2bn was spent on alcohol-related in-patient admissions in England, the report found.

This comes as more than 10 million people in England are drinking above the recommended levels, according to the report.

An American definition, vaguely recalled, said that Baby Boomers were those born after WW2, but old enough to remember the first moon landing. And there’s fancy detail at www.alcoholconcern.couldthisbe.com.

Also see the video report.

[Glenn E.]

An American definition, vaguely recalled, said that Baby Boomers were those born after WW2, but old enough to remember the first moon landing.

1946-1964, according to the United States Census Bureau. There's some argument that the "Baby Boomer" generation is actually two separate groups that have been lumped together, with the alleged split occuring in 1955. If you believe in the split, the latter half is sometimes refered to as Generation Jones, as-in "keeping up with the Joneses."

[jdaw1]

Catherine Collins says she would probably recommend more carbs, and "it would probably be good for him to have a couple of alcohol-free days".

That might be difficult for a man who accompanies every meal with alcohol, except breakfast, when he drinks black coffee.

"When he starts a meal, he probably has a vodka with a starter and then he goes on to wine, probably finished up with champagne," explains Edward Biddulph.

But Bond's regular drinking is "never excessive", says Ms Collins, and would be unlikely to cause much harm, or stop him from feeling too sluggish to perform his duties.