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Alcohol: to drink or not to drink?

Many of us have heard that drinking a glass of red wine is good for our hearts but there are also a lot of messages in the media that alcohol is bad for our health. Should we enjoy a daily tipple or avoid drinking altogether?

The two faces of alcohol

 

Some studies suggest that moderate alcohol consumption may help protect against heart disease by raising good cholesterol and stopping the formation of blood clots in our arteries.(ref) Other studies have reported that the daily consumption of alcohol, particularly red wine, is related to improvements in our cognitive function and may keep our brains healthier longer.

 

Unfortunately, there is even more evidence to show a clear link between alcohol and numerous forms of cancer, heart damage, liver damage, foetal abnormalities, premature death and more. In fact, when I was training as a dietitian I was shocked to learn that alcohol affects every organ system in our body negatively and wondered why no one had ever told me how bad it really was for my health. Maybe, like everyone else, I selectively chose to ignore the bad news as alcohol is so normalised in everyday life – either as a social lubricant at a gatherings of friends and family or as a relaxation tool to unwind at the end of the day.

A strong link with cancer

 

There is strong scientific evidence that all types of alcoholic drinks are a cause of several types of cancer. The World Cancer Research fund published a report in 2018 (click here to read it in full) where they concluded that alcoholic drinks increase the risk of cancers of the mouth, pharynx and larynx; oesophagus (squamous cell carcinoma), breast (pre and postmenopause), colorectal cancer, stomach cancer, liver cancers and kidney cancer.

 

In fact they conclude that, “alcohol doesn’t have any benefits in terms of cancer prevention – in fact, drinking any amount increases your risk. So, to protect yourself against cancer as much as possible, we suggest not drinking alcohol at all.”

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Additional health risks

 

In addition to the cancer risk, drinking alcohol comes with additional health risks.

 

A large research review, published 3 years ago in the Lancet, based on nearly 700 existing studies on global drinking prevalence and nearly 600 studies on alcohol and health found that alcohol was the seventh leading risk factor for premature death in 2016, contributing to 2.8 million deaths worldwide (2.2% of female deaths and 6.8% of male deaths in 2016). These premature deaths were due to car accidents, domestic violence, self-harm or accidents in the home.

 

The researchers also found correlations between drinking and cancer (breast, colorectal, liver, oesophageal, larynx, lip, oral and nasal cancers), cardiovascular problems (strokes, high blood pressure, heart disease, heart damage), some chronic diseases (cirrhosis of the liver due to alcohol use, diabetes, epilepsy, pancreatitis, and alcohol use disorders) or passing on of infectious diseases such as tuberculosis.

 

They found a dose dependent relationship – i.e. the more you drink the greater the health risk. Compared to non-drinkers, people who had one alcoholic drink per day had a 0.5% higher risk of developing one of 23 alcohol-related health problems, and those that had two drinks per day had a risk 7% higher. At five drinks per day, the risk was 37% higher.

 

What about the health benefits?

 

There is data that supports links between moderate drinking and lower total mortality and a decreased risk of heart disease. Other researchers have contested that even just moderate drinking is good for our hearts.

 

Additionally, there is an ongoing debate in the research community that historical studies showing heart health benefits may be tainted by an ‘abstainer bias’. The studies included non-drinkers that refrained from drinking due to other health problems (or they were recovering from addiction) and this may have skewed the data. It made non-alcohol drinkers look less healthy and so not a legitimate comparison group.

My thoughts

 

Considering the evidence, and that the health risks of drinking alcohol far outweigh the health benefits, my advice would be to limit how much you drink and avoid alcohol if you can. Sorry its not better news!

 

The Department for Health recommends that you should not drink more than 14 units per week, spread the units evenly over three days or more, you should have several drink free days each week. I used to use the guidance of moderation but given a glass of wine at the pub is now 250ml so it can be hard to know what moderation looks like these days or even to count units.

 

Of course, we all enjoy the occasional tipple and it has become the social norm to drink when you are at social gatherings but it is important to realise that there are health risks attached with this and to try drink as little as you can.

Tips on managing your alcohol intake

 

The British Dietetic Association have pulled together some useful tips;

 

  • Set yourself a limit on how much you are going to drink on a night out or set yourself a budget of how much money you will spend.
  • Let your friends and family know you are trying to cut down so they can support you.
  • Always try to eat before you have a drink – eat before you go out for the evening or have a meal while you are out. Even a snack at work will help, for example vegetable and bean soup, oatcakes or a smoothie.
  • Don’t drink alcohol when you are thirsty.
  • Avoid salty snacks such as crisps and salted nuts because these make you thirstier (as well as being high in fat and salt)
  • Have some non or low-alcoholic drinks through the evening instead.
  • Always have a glass or bottle of water with you or a jug of water on the table as well.
  • Think about the strength of your drink – choose beers or lagers that have a lower abv.
  • Sip a drink slowly so it lasts longer.
  • Don’t top up the glass before it’s finished so the volume consumed can be monitored more accurately.
  • Try white wine as a spritzer mixed with sparkling water.
  • Choose half pint, small can, small glass, single measure.
  • Use a smaller wine glass.

What about if you have IBS or are on the low FODMAP diet?

 

There is evidence that alcohol may make IBS symptoms worse so it is advisable to stay within the guidelines (or avoid it entirely if you know it is one of your triggers).

 

If you are on the low FODMAP diet then the following amounts are allowed (of course these amounts do not consider the link with other health risks so bear this in mind!);

 

  • 149ml white wine, red wine, sparkling wine
  • 377ml beer
  • 29ml gin, vodka, whiskey

Sasha Watkins

Registered dietitian and co-founder of Field Doctor

IG: @sashadietitian

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