In this article, Doctor Richardson discusses the impact that alcohol can have on our health. Is it safe?…. How much is too much?…. Do you care?
I recently read Esther Walker’s interesting and thought-provoking article ‘My drinking habit’ in the Sunday Times (1). In this, she describes her personal relationship with alcohol as being like an old man living in her head (imagine Father Jack from Father Ted) that wakes up at 6pm and shouts “DRINK” and doesn’t shut up until she has had one! Esther Walker is not an alcoholic but has an unhealthy and habitually dependant relationship with alcohol which she would rather not have.
Does this sound like you or someone you know?
I was struck by how many of my patients and friends might identify with Esther’s drinking habits and her difficulty in controlling them. Should we be looking for answers in a pill like Naltrexone? My initial reaction was NO but on reflection I thought why not? Is this something we should consider in the same way as Ozempic or Wegovy are being prescribed for people living with obesity. But what are the risks and benefits?
Willpower and lifestyle changes are always the best way but what if (like Esther) you keep slipping back into your bad habits? To be clear I am not offering this medication, but I think it is a good thing to debate these issues as I believe we should always keep our minds open to change.
To provide context, here are some of the facts about alcohol and its negative effects on our health and wellbeing.
Is alcohol harmful?
In short yes, but as always there are many ways you can look at data. The World Health Organisation now deems that there is “no safe level of alcohol consumption” but the risks associated with alcohol are known to increase proportionally with the amount of alcohol consumed.
So, let’s put this into perspective. Light or moderate alcohol consumption DOES NOT carry positive health benefits but any overall risk to your health that may exist at lower levels of drinking are minimal. A recent well respected journal review (2) (a systematic review and Meta-analysis of 107 smaller studies on this subject) concluded that daily low or moderate alcohol intake (0.5 to 2.5 UK units per day) was not significantly associated with an improvement or worsening in all-cause mortality (a term that refers to death from any cause) when compared to lifetime non-drinkers. They also concluded that there is an increased risk at consumption levels higher than this and that this started at lower levels for women than men.
So, what does this mean? There is little doubt that all levels of alcohol consumption carry some health risk particularly an increased risk of cancers. However, the risks are small and do not increase your all cause mortality if your alcohol consumption is low and you do not regularly binge drink, more than 4 units in one sitting!
Here are the negative effects of alcohol on health and wellbeing
Cancer
There is an increased risk of cancers, particularly of the digestive tract (3). The risk seems linear (risk goes up fairly proportionately with quantity of alcohol consumed) unlike smoking for example where a disproportionate amount of risk is associated with the first few cigarettes. Other cancers associated with alcohol use are Liver and Breast. The risk of cancer increases with ANY alcohol use and risk is multiplied if combined with smoking.
Liver disease
The liver filters toxins (it is part of the body’s waste disposal system) alcohol is a toxin and can cause chronic (long term damage) or acute inflammation of the liver. If too many liver cells die it can stop functioning, resulting in a condition called Cirrhosis.
Chronic brain illnesses
Chronic brain illnesses such as Dementia (4) as well as direct brain injuries such as Wernickes encephalopathy and Korsakoffs syndrome.
Cardiovascular disease
Cardiovascular disease through high blood pressure, cardiomyopathy (heart muscle disease).
Weight gain
Not only is alcohol a carbohydrate containing quite a lot of calories, a standard glass of wine can also contain up to 158 calories, and some pints of stronger lager can contain up to 222 calories. But they are also simple sugary carbs which are the worst type and alcohol is often taken in the evenings which is the worst time to take in carbs for weight gain.
Sexual and reproductive health
The side effects increased drinking can have on sexual and reproductive health include erectile dysfunction and reduced fertility.
General Wellbeing
Alcohol (once it wears off) makes you feel rubbish. It is terrible for sleep quality even in small amounts and would contribute to low energy levels, tiredness and all the things that come with lack of sleep.
As well as everything else associated with alcohol, including important individual and societal problems such as relationships, physical injury, financial and mental health issues.
IN SUMMARY
So, as a doctor what do I recommend?
Firstly, you should treat alcohol with respect and have an honest conversation with yourself about how much you drink. But ultimately this is about personal choice, and I respect that.
You are likely to feel better if you drink less alcohol. All alcohol is associated with some health risk but in small quantities these are low and possibly insignificant at safe drinking levels. This means less than 14 units a week and minimal or no binge drinking which is more than 4 units in one sitting.
If you are worried about your own relationship with alcohol and would like confidential support and advice, we are here to help. Our clinicians are professional and totally non-judgemental.
- https://airmail.news/look/issues/2024-8-2/alcohols-worst-enemy
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802963
- https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer/how-does-alcohol-cause-cancer
- https://www.alzheimersresearchuk.org/news/alcohol-later-life-dementia-risk/