Can you spot the danger drinker These brave volunteers kept diaries of a week's drinking so doctors could analyse the health risks. The results were startling
08:08 GMT, 4 December 2012
Many people believe that because they never get drunk they aren't doing their liver any harm
We are among the biggest drinkers in Europe and the Government has announced plans for a minimum price for a unit of alcohol to tackle this.
According to the World Health Organisation, Britons get through on average more than 13 litres of pure alcohol a year — the European average is 12.2 litres.
Alcohol is linked to an increased risk of cancers, stroke and heart disease, not to mention liver damage.
In 2010/11, more than a million people had to be admitted to hospital because of an alcohol-related issue.
Many people assume it’s the young who are the worst.
Yet it is the 45 to 64-year-old age group who are most likely to drink more than the maximum recommended intake — which is three to four units a day (21 a week) for men, and two to three units a day (14 a week) for women, according to figures from the Office of National Statistics.
And many people believe that because they never get drunk — and because they only drink wine with meals — they aren’t doing their livers any harm, says Dr Ashley Brown, a consultant liver specialist at St Mary’s and Hammersmith Hospital London.
‘In fact, the cumulative effect of alcohol on the liver is the same, however you choose to imbibe.’
So are we drinking much more than we think To find out, we asked a cross-section of drinkers of all ages to keep a drink diary for a week.
Dr Brown and Dr Paul Stillman, a GP from Crawley, Sussex, then analysed what — if any — damage these drinkers are inflicting on their health. The results were eye-opening…
WORKING MOTHER: 'Admittedly when I look at my diary it does sound like quite a lot of alcohol'
Weekly intake: 50.5 units
Life coach Margot Bloom, 42, lives in Southampton. She is single and lives with her children, who are aged ten, six and five.
Drink diary: Monday: two large gin and tonics (4 units); Tuesday: three large gin and tonics (6 units); Wednesday: two large gin and tonics (4 units); Thursday: one large gin and tonic (2 units); Friday: three pints of lager, two large glasses of rose, then (at neighbour’s party) four large gin and tonics and a brandy coffee (21 units); Saturday: small glass of rose wine, three small gin and tonics (7.5 units); Sunday: one pint of lager, two small glasses of rose, one gin and tonic (6 units).
Margot says: ‘If this was a typical week, I’d be worried. The truth is I just had a lot of social things on that week.
‘Normally, I have a G&T and maybe a little bit more on a Friday, so typically 12 to 15 units or so a week.
'Admittedly when I look at my diary it does sound like quite a lot of alcohol.
‘I don’t actually drink to get drunk — I work from home and to me having a drink is like a cut-off point for the day. I think I’d worry about it if I was not functioning.
'However I run a business and look after my children without any trouble. I am also incredibly health-conscious, I walk everywhere — I don’t drive — and watch my weight (zumba every couple of weeks and I do yoga every day).’
Experts’ verdict: ‘If this was regular it would constitute hazardous drinking and raise the risk of serious liver damage,’ says Dr Brown.
‘Consistent heavy drinking leads to inflammation of the liver, which in turn causes scarring and cirrhosis — when the liver gets hardened from the fibrous scar tissue, blood flow is restricted and the liver stops functioning normally.
‘Cirrhosis dramatically increases your chance of liver cancer as well as the possibility of the liver failing.
'In the short term, consuming 21 units in a single night, as Margot has done, raises the risk of accidents — unfortunately we will see lots of people over Christmas who’ve had this amount of alcohol and had a terrible accident.’
Dr Stillman adds: ‘Women who drink heavily are thought to be at increased risk of breast cancer —and there are links with mouth cancer and to a lesser extent stomach cancer.
'There is also a link between heavy drinking and osteoporosis — weakened bones — as a result of the fact that alcohol can impair the way nutrients needed for bone health are absorbed from food.
‘Alcohol is a diuretic so will dry out the skin, and it causes the small blood vessels in the skin to dilate, which can lead to unsightly liver spots. This kind of intake, if it was regular, starts to affect the memory because alcohol kills off brain cells.
‘My rule of thumb is that if you wake up not with a massive hangover but with enough of a feeling to think “I drank too much last night”, you will have drunk enough to damage your brain cells.’
RETIRED ACCOUNTANT: 'I am shocked that my drinking adds up to this many units'
Weekly intake: 26.5 units
Retired accountant Jim Reaney, 67, lives in Martock, Somerset, with wife Hilary, 67. They have four grown up children and recently gave up running their own B&B.
Drink diary: Monday: three small glasses of red wine, one whisky (6.5 units); Tuesday to Thursday: 0; Friday, one small glass of white wine, two small glasses of red wine, two glasses of port (6.5 units); Saturday: three small glasses of red wine, two small (70ml) glasses of port (6.5 units); Sunday: two small glasses of red wine, two whiskies (7 units).
Jim says: ‘I am shocked that my drinking adds up to this many units.
'I thought I’d be ok because I had so many alcohol-free days —and this was a lighter week than normal. I normally manage two or three alcohol-free nights a week, which I’ve been doing since the beginning of this year, as I do worry about the effects of alcohol on my health.
‘However, I don’t think my drinking is out of hand.
'I drink no more than my friends — many of them don’t bother with alcohol-free days at all. I drink red wine because I like it. It’s also better for you. I don’t know that I will change my habits.
‘When you get to my age you want to enjoy nice food and wine and I don’t really think my drinking poses much of a risk to my health.’
Experts’ verdict: ‘It’s good to see that Jim had three alcohol-free days,’ says Dr Brown.
‘Alcohol causes acute inflammation of the liver in the same way as sun causes inflammation of the skin. Just like the skin needs time to recover from sunburn, the liver needs time to recover from alcohol — unless there is a break, this can lead to scarring or cirrhosis of the liver.’
Dr Stillman adds: ‘There’s some evidence red wine has a beneficial effect on health, but most studies find benefits at very low levels (around a drink a day); Jim’s intake means his blood pressure could be raised.’
FUN-LOVING STUDENT: 'I don't usually drink much because I live in the countryside'
Weekly intake: 12.2 units
Lucie Evans, 22, is studying sports and exercise medicine at University Campus Suffolk. She is single and lives with her parents, Judy and David (see below).
Drink diary: Monday: two vodka and lemonades (2 units); Tuesday- Friday: 0; Saturday: a 250ml glass of rose (2 units); Sunday: two mini bottles of wine (187ml), two large vodka and lemonade (8.2 units).
Lucie says: ‘Some students drink a lot but by no means all of them. I think it’s partly a generational thing: my dad drinks much more than me, but for his generation meeting after work in the pub was the norm.
‘Alcohol has become much more expensive and lots of pubs have closed, so I don’t think drinking is so normal for a lot of my friends, even those who aren’t as health conscious as me.
‘I also don’t usually drink much because I live in the countryside and have to drive everywhere.
'This is a typical week for me. But I do drink more if I am at a party or something — I can drink up to ten single vodkas if I’m doing that.’
Experts’ verdict: ‘Generally, this is a reasonable intake,’ says Dr Brown.
‘Lucie clearly enjoys alcohol, but is drinking responsibly. However, strictly speaking, consuming more than a third of your weekly units in a single session as she does on the Sunday constitutes binge-drinking, which inflames the liver, so she needs to watch her weekend sessions. However, this weekly level of drinking is unlikely to have any long-term health effects.’
CRIME WRITER: 'I have an alcoholic drink most days'
Weekly intake: 27.9 units
Former quantity surveyor-turned-crime writer, David Evans, 58, lives in Weeley Heath, Essex with wife Judy, a senior midwife. They have one grown up daughter, Lucie.
Drink diary: Monday: two cans of Tetley’s beer, one bottle Directors (5.4 units); Tuesday: one can Tetley’s, one can Bombardier, one bottle Oxford Gold (6.1 units); Wednesday: two cans Tetley’s (3.2 units); Thursday: two cans Tetley’s (3.2 units); Friday: two cans Tetley’s, one bottle of 6X (5.4 units); Saturday: 0; Sunday: one can Tetley’s, two small glasses red wine (4.6 units).
David says: ‘I tell my doctor I drink 20 units a week, but I normally drink more, so the results aren’t surprising.
'I have an alcoholic drink most days — I don’t drink to get drunk but I work from home and do most of the cooking and it’s quite nice to have a beer as I make dinner.
‘However, I have worried it’s becoming habitual.
'Years ago I would have gone to the pub on a Friday and had rose wine on Saturday and that would have been that. But as I have got older and earned more, alcohol has become more accessible.
‘The alcohol-free day on Saturday was the first I’ve had in few weeks and was in part because I was doing this diary so was thinking more about how much I am drinking.
‘I should probably drink less than I do because I have high blood pressure and for the past ten years have been on medication for it.
'Recently a test showed my levels of harmful cholesterol (LDL) are raised, and my dad died of a stroke when he was in his 50s, so I need to be careful.’
Experts’ verdict: ‘David’s drinking slightly more than the Government recommendations,’ says Dr Brown.
‘However, limits are there for a reason — if you stay below the limit, there is no risk to health.
‘At this level of drinking it’s unlikely David would have developed significant fibrosis (scarring) of the liver, though with the combination of this level of alcohol and his high cholesterol — which may be linked to his alcohol intake — there is a good chance he may develop fatty liver.
‘This is when the liver becomes full of fat as a result of alcohol, leading to inflammation — it is the first stage of liver disease and is reversible if drinking habits are changed.
'David knows he probably drinks more than he should and it is becoming habitual. A reduction would benefit his general cardiovascular health, not just liver health.’
Drinking increases blood pressure because alcohol affects receptors in the blood vessel walls, making them constrict, adds Dr Stillman.
‘It can also reduce the action of blood pressure lowering medication, so it has a knock-on effect, increasing the risk of stroke and heart disease.
'David is drinking moderately but consistently — if he had a couple of days alcohol free a week this could get him back to a level at which his drinking is not affecting his health.’
YOUNG CAREER WOMAN
YOUNG CAREER WOMAN: 'I don't drink every day and never drink alone at home'
Weekly total: 43.1 units
Event manager Abby Purdy, 27, is single and lives in Brighton, Sussex.
Drink diary: Monday and Tuesday: 0; Wednesday: two large glasses of red wine (6 units); Thursday: five bottles of cider (11.5 units); Friday: two bottles of cider, one champagne cocktail and two glasses of champagne, one large glass of wine (12.1 units); Saturday: six cocktails (Bellini, Martini, Cosmopolitan and Long Island Iced Tea (12 units); Sunday: one glass of prosecco (1.5 units)
Abby says: ‘This was a real eye opener: it was only when I saw it written down that I realised, wow that’s quite a lot.
'In fairness this was a bad week for me — I just happened to have a lot of things on.
‘The weekend before I barely drank.
'I don’t drink every day and never drink alone at home, but I do like a drink when I see friends.
'Usually my intake is at least half this. I do worry what alcohol does to me a bit and I think about all the calories it has — I am not obese, but I could do with losing a few pounds.’
Experts’ verdict: ‘This constitutes hazardous drinking,’ says Dr Brown.
‘Binge-drinking three nights in a row (Thursday to Saturday) is particularly worrying because of the strain it puts on the liver, which would lead to inflammation and scarring.
‘I’d encourage Abby to review her drinking: she could be storing up health problems for the future such as alcohol dependence, alcohol-related liver disease, hypertension and obesity (if you tot up the calories in her alcohol she probably exceeds her recommended intake).’
Dr Stillman says: ‘Like Margot, Abby may be at risk of cancer and bone problems if she continues with these levels of drinking as a way of life. She would find her skin would age prematurely.’