Monday 20 November 2017

Fancy a drink? The whole truth about Ireland's relationship alcohol from Dr Michael Mosley

You feel you deserve a glass of wine with lunch, yet do you know how your body will be affected? Kicking off our drink special, Dr Michael Mosley, health guru and creator of the 5:2 diet, reveals some unexpected effects of the way we drink.

Cheers: Dr Michael Mosley raises a glass to some of the surprising findings about drink in surveys.
Cheers: Dr Michael Mosley raises a glass to some of the surprising findings about drink in surveys.

Over the rest of our drink special, our writers look at other aspects of our nation's drinking, including drink and sex, the way we drink, young people and alcohol, regulations surrounding our boozing, and Twink tells her personal story about why she decided to give up her beloved glass of wine.

The heavy drinking singer Frank Sinatra once said, "Alcohol may be man's worst enemy, but the Bible tells us to love our enemy". And that neatly encapsulates our love-hate relationship with the demon drink.

Humans have been getting intoxicated for thousands of years, but what do we really know about this time-honoured ritual?

Time, I think, for a bit of scientific enlightenment

Alcohol is bad for us. Really?

When I was at medical school I was told that the definition of an alcoholic is someone who drinks more than their doctor, and my fellow medics were certainly hard drinkers. I don't think anyone would be surprised to learn that alcohol, drunk in large amounts, and particularly if you binge, is bad for you. But what is the impact on health of modest, steady drinking?

Well, the UK's Chief Medical Officer Sally Davies recently claimed that there is no safe level of drinking. If you are drinking 14 units of alcohol a week, the equivalent in Ireland of 11 standard drinks, then apparently you are still increasing your chance of dying by around 1pc.

So does that 1pc figure sound scary?

Sir David Spiegelhalter, Professor of the Public Understanding of Risk, at Cambridge University, has crunched the numbers and put some context on the "1pc chance of dying" claim.

"An hour of TV watching a day, or eating a bacon sandwich a couple of times a week, is more dangerous to your long-term health", he says. "It all seems to come down to what pleasure you get from moderate drinking."

But is the report, anyway, right to claim that moderate drinking is worse for you than total abstention?

Critics point to numerous studies which have shown that while heavy drinkers die younger than non-drinkers, moderate drinkers (those averaging 1-2 drinks a day) tend to live longer than total abstainers.

The main reason is that while moderate alcohol consumption raises your cancer risk (by a very small amount) it also appears to reduce your risk of heart disease.

It does this by making your arteries expand (therefore reducing your blood pressure) and by making your blood less "sticky" (so it is less likely to clot). So the overall impact of moderate drinking seems to be positive.

A recent study in the US, for example, which followed more than 14,000 adults aged 45 and older for 24 years, found those who drank up to 12 units per week had a lower risk of developing heart failure than those who never drank alcohol.

Yet even with big studies like this you can never be quite sure that it is the alcohol drinking that is providing the benefit and not something else. Perhaps the non-drinkers were in poorer health to start with?

The best way to measure the impact of moderate drinking would be to take a group of abstainers and randomly allocate them to alcohol or water, then follow them for many years.

Well, a study along those lines was recently published in the Annals of Internal Medicine. Researchers at Ben-Gurion University in Israel took 224 teetotal volunteers (all of them type 2 diabetics) and randomly allocated them to either a medium-sized glass (150ml) of red wine, white wine or mineral water for their evening meal, every evening, for two years.

The wine and water were provided free of charge and the empty bottles collected afterwards to make sure they really were drinking regularly.

So what happened? Well, red wine drinkers will be delighted to hear it was the group drinking red wine who came out on top, with the white wine drinkers a close second. They saw significant improvements in their cholesterol levels (their levels of HDL, the "good" cholesterol, rose) and the quality of their sleep also improved, compared to the water drinkers.

Interestingly, the people who got the biggest benefit (and the only ones who saw improved blood sugar control) were those whose livers broke down alcohol particularly slowly, meaning the alcohol hung around in their systems for longer

This was a smallish study done for a relatively short period of time, but it adds to what I think is compelling evidence that the occasional glass of wine is unlikely to do harm and may well do good.

What does alcohol actually do to your body?

When you chug down a glass of alcohol it swiftly passes into your stomach. If your stomach is empty then alcohol will irritate your stomach lining, making blood vessels swell, increasing the speed and amount of alcohol that is absorbed into your blood.

If, however, you have something to eat before you drink, particularly something that is fatty, then this will act as a physical barrier to the booze. Instead of being absorbed in the stomach, the alcohol passes through a valve called the pyloric sphincter and into your small intestine.

The small intestine is where most alcohol is normally absorbed. It takes much longer to get into your blood stream, and so to your brain, by this route than by stomach, which is why you get drunker faster if you haven't eaten.

If you drink on an empty stomach then your brain typically gets a peak alcohol hit somewhere between 30 and 60 minutes after drinking. If you eat before you drink then peak levels are delayed by at least an hour, maybe more

Once alcohol hits your brain it depresses your inhibitory centres. Contrary to what it may feel like, alcohol is not a stimulant. When I drink I normally have about an hour of uninhibited fun, before I go into a slump. Drinking doesn't make me good company.

With alcohol in your system, your liver now gets to work, busily breaking it down. First it turns it into a mildly toxic substance called acetaldehyde. This then gets converted into vinegar (acetic acid) and eventually into carbon dioxide and water.

It is the build up of acetaldehyde (which is more toxic than alcohol) that causes flushing and makes hangovers such a painful experience.

Your liver can break down roughly one unit of alcohol an hour. Drink faster than that and you will get smashed. Keep on drinking heavily and you will eventually destroy your liver.

Does alcohol affect us all in the same way?

Well, no. If you or your ancestors are from North East Asia, then chances are that you will have a less effective version of an enzyme called acetaldehyde dehydrogenase, which speeds up the removal of acetaldehyde. If you can't clear acetaldehyde from your system pretty swiftly then you will find booze hard to handle.

I, like about 10pc of Europeans, have the inefficient version of this enzyme. Considering how bad alcohol sometimes makes me feel, my wife is astonished that I drink at all.

My wife is not a big drinker, which is just as well. If a woman decides to try and match a man drink for drink, she will normally get drunker, quicker. That is partly because women tend to be smaller, but also because they have less muscle and more body fat. Some alcohol gets absorbed by your muscles, removing it from your system, but fat and alcohol simply don't mix.

Hormones also play a part in metabolising alcohol and a woman who goes drinking just before she has her period will find she needs less booze to have the same effect

In men booze tends to add to sexual desire, but take away from performance. In women the effects are subtly different. They not only become less inhibited when they drink heavily, but the alcohol also causes a small rise in testosterone. That's why the loudmouth pick-up artist in the bar who was so obviously repellent at the beginning of the evening, begins to look far more alluring after a few drinks.

Does mixing drinks make you drunker?

Broadly, no. How drunk you get is mainly down to how much alcohol you drink, though fizzy drinks are the exception. If you decide to start your evening with a glass of champagne (or sparkling wine) then the carbon dioxide in the drink will open the pyloric sphincter valve linking your stomach to your small intestine. When that happens the alcohol passes into your system faster, and you get drunk faster.

This, of course, may encourage you to go on drinking. But it could also mean you drink less.

In an experiment we did recently for my BBC series, Trust Me I'm a Doctor, we decided to test out a plant extract called kudzu, which has been used by the Chinese to treat alcoholics for at least a thousand years. The claim is that the plant increases blood flow to the brain, so people feel the effects of alcohol far more quickly. They will then, so the theory goes, unconsciously slow down their drinking.

But is this really what happens? To find out we recruited a group of young men and women willing to have two nights out in the name of science. Before starting we gave them all pills to swallow: some got kudzu - others a placebo. None of them knew which they had taken

A couple of hours after taking the pills, we gave them free access to a bar for 90 minutes, with a choice of beer, wine or spirits.

We carefully recorded what they drank before sending them home. A week later we did it again, except this time those who had had the placebo got kudzu, and vica versa. So what did we find?

Well, when they swallowed a placebo they averaged seven units of alcohol a head. And when they took kudzu it was 5.5 units, 20pc less. This is broadly in line with other lab based studies that have been done in the US

But before you rush out to buy kudzu extract, beware. Our test, and those in the US, involved giving each volunteer 500mg of the active ingredient. But in the UK we couldn't find any brands of kudzu that, when tested, contained what they said on the label. Some contained almost nothing. So, maddeningly, kudzu does seem to be safe and appears to reduce excess boozing, but there isn't yet a reliable product on the market.

Is there an effective hangover cure?

Yes and no. Although kudzu may reduce the amount you drink, there is no evidence that it, milk thistle, or any of the other herbs and potions that are touted around as hangover cures have any significant impact once the evil throbbing begins. The best way to treat a hangover is to take pre-emptive action.

Firstly, if you are planning on drinking to the point where a hangover seems probable, then avoid dark-coloured drinks. The darker the drink, the more likely it is to contain chemicals called congeners that will add to near-death experience some of us are familiar with. Vodka is the binger's friend

If I have had too many drinks (in my case that means more than two pints of beer or a couple of large glasses of wine), then I drink plenty of water and take a couple of paracetamol before heading for bed. The head-splitting headache that accompanies a typical hangover is partly caused by dehydration.

The next morning, soon after I stagger out of bed, I gulp down lots of tea, water and another couple of paracetamol. I have an orange (to try and replace a bit of vitamin C), and if I'm up to it, a greasy breakfast. Then, with a silent vow of "never again" I take the dog for a long walk.

Dr Michael Mosley is author of 'The Fast Diet'. His latest book, 'The 8-week Blood Sugar Diet', has just been published by Short Books. Twitter @DrMichaelMosley

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