Why alcohol rules should be rewritten so that men over 55 can drink more
But put down your glass, ladies – you need to knock back LESS!
Confused by the advice about alcohol intake? Join the club. for almost 30 years we’ve been told not to drink more than 21 units of alcohol a week if you’re a man or 14 if you’re a woman — in daily amounts, men shouldn’t have more than three or four units and women no more than two or three.
But many people, if not most, are perplexed by what a unit actually is. for instance, does a large G&T you pour at home count as 1½, two or three units? does a glass of red have the same number of units as white?
And that’s just the start. Are these limits based on sound science? What about studies that suggest moderate alcohol intake may be good for middle-aged men and postmenopausal women?
The good news is that perhaps the confusion may all soon be resolved. That’s because the department of Health is in the middle of the first major review of the alcohol consumption guidelines for 20 years, with a draft report due out for consultation later this year. Could this mean changes to the unit system?
‘We want information for the public to be clear, and the unit of alcohol was introduced in 1987 as a way of helping people to understand how much alcohol they are drinking,’ said a spokesperson for the department of Health.
‘But we want to keep our guidance up to date, which is why our Chief Medical officer is reviewing all the guidelines.’ The bad news, say some experts, is that the new guidelines will probably fall short of what is needed to protect consumers.
furthermore, people of all ages will have to stick to the same, one- sizefits-all limits, which ignores the fact that different ages are at different risks — and when there i s good evidence that a particular group, men over 55, could actually have their limits raised.
SO WHAT EXACTLY IS A UNIT OF ALCOHOL?
Before weekly units were introduced, the Health education Council set the ‘safe limit’ for alcohol at 18 ‘standard drinks’ for men, and nine for women. A standard drink was defined as eight grams, or 10ml of alcohol. In 1987 this became the unit we know and struggle with today.
The units system requires the sort of maths that few are likely to manage off the cuff — especially after a couple of drinks.
Take a 750ml bottle of wine with a strength of 12 per cent alcohol by volume ( ABV). That means 90ml of the wine is pure alcohol — so the bottle contains nine units (remember: a unit is 10ml of alcohol).
A 175ml glass of this wine, which is around a quarter of a bottle, counts as 2.1 units.
But a 750ml bottle of a different wine, such as a potent 14 per cent ABV red, would contain 10.5 units, so that 175ml glass would give you 2.5 units.
Things got even more confusing in 1995, when the department of Health changed the guidelines from weekly to daily totals: men could have up to three or four units a day and women two or three.
The small print said people should not drink this amount regularly (the weekly guideline l i mits had not changed), but such is human nature, people took this to mean that instead of 21 units a week, it was all right for men to drink up to 28.
Women, previously limited to 14 units, could apparently drink 21. Health groups were horrified.
for the consumer, the picture became even more muddled in 2007 when richard smith, a former editor of the British Medical Journal, suggested that the original weekly unit guidelines weren’t based on any firm evidence.
‘It was a sort of intelligent guess by a committee. They were plucked out of the air,’ he said.
‘ They most certainly were not,’ retorts Professor Marsha Morgan, a liver specialist at university College London. Like dr smith, she was a member of a panel at the royal College of Physicians that f i rst recommended the ‘sensible’ weekly limits of 21 and 14 units.
‘They were based on reviews of all the epidemiological data that was available at the time,’ she told Good Health.
In fact, at the same time two other groups — from the royal Colleges of General Practice and Psychiatry — had worked independently on the same problem. ‘And the remarkable thing was that all three colleges independently came up with the same figures,’ says Professor Morgan, ‘
Indeed, in the days after his comment, dr smith said: ‘The suggestion that the guidelines were “useless” is not what I meant at all. That would be a very serious misinterpretation.’ More recently he has described his original statement as ‘clumsy’.
IT’S YOUNGER PEOPLE WHO ARE MOST AT RISK
BUT if the idea of units is based on the best evidence there was at the time, the studies on which they were based have long since been overtaken by other research and an urgent update is needed, says Professor Morgan.
And if she and other health experts were to hold sway, that would mean limits would be lowered for those under 44 — but possibly raised for some older drinkers.
In 2008, Professor Morgan was invited by the department of Health to present the l atest evidence on alcohol harm.
The ‘biggest eye-opener’ was a major study published in the British Medical Journal in 2002, which found that in all drinkers — even people who drank lower than the recommended intake — there was a substantially greater risk of dying from all causes, including cancer, heart disease, suicide and road accidents. Younger people were particularly at risk.
Professor Morgan highlighted evidence that showed limits should be much lower for men and women up to the age of 45.
‘I pointed out there are very, very different risk levels in relationship to age which has never been accounted for in the units guidance,’ she said.
The BMJ research had showed that men aged between 16 and 34 who drank 21 units a week were about 20 per cent more l i kely than nondrinkers to die from any cause. for women, the increased risk was closer to 10 per cent.
Based on statistical calculations on alcohol- r elated deaths, t he researchers suggested different ‘sensible’ limits across five age groups for men and three for women. To be on the safe side, for men between the ages of 16 and 34, the weekly limit should be no more than seven units; between the ages of 35 and 44, the limit could rise to 14; between 45 and 54, men should have no more than 21 units ( c urrently t he recommended weekly limit for men of all ages); over 55, the limit could be 28 units. Women should limit themselves to seven units a week right up to the age of 44. only then should they consider 14 units a sensible weekly amount to drink.
These limits show how the current ‘ one - size - fits - all ’ guidance is dangerously wide of the mark, says Professor Morgan.
But when she presented all this to the department of Health in 2008, it told her: ‘It’s too complicated, we want one size fits all.’
Professor Morgan suspects the new guidelines due later this year will stick to this formula — possibly with lower weekly limits.
SHOULD DRINK LABELS CARRY WARNINGS?
reGArdLess of what happens to units, at the very least experts want the focus to shift to alerting consumers to the precise risks they face from excessive drinking.
Most people associate alcohol with cirrhosis of the liver. In fact, while most people who die f rom l i ver disease are drinking at ‘the heavier end of the spectrum’ (on average having 120 units, equivalent to 12 bottles of 14 per cent ABV wine a week), the risk of developing cancers begins at much l ower l evels of drinking, says Professor nick sheron, head of clinical hepatology at the university of southampton.
‘If a woman drinks on average a single bottle of wine each week throughout her life, that will increase her risk of getting breast cancer by 10 per cent,’ he says.
‘And yet that is well within the drinking guideline.’
A major global review carried out in 2007 by the World Cancer research fund and the American Institute for Cancer research looked at hundreds of studies and found ‘ convincing evidence’ linking alcoholic drinks with
cancers of the breast, mouth, pharynx, larynx, oesophagus, liver, colon and rectum.
It still isn’t completely clear how alcohol can cause cancer, but one theory is that the chemical acetaldehyde, produced as the body processes alcohol, damages DNA.
BUT ISN’T SOME ALCOHOL HEALTHY?
THOUGH most people know about the risks of liver disease, the link to cancer is far less widely recognised. Just 50 per cent know that alcohol could trigger mouth or throat cancer, and a mere 31 per cent that it was associated with breast cancer, according to a survey last year by the Alcohol Health Alliance (AHA), a group of 40 health organisations.
But what about t he benefits of alcohol?
As Dr Alexander van Tulleken has reported previously in these pages, following an investigation for BBC Horizon, there’s evidence to suggest that if you’re a man between 50 and 60, and at some risk of heart disease, ‘the positive effects of alcohol on your heart will outweigh the i ncreased risk of cancer and liver disease’.
But — and this is key — this means just one small glass per day as ‘more than that and the harm seems to outweigh the benefits’.
Professor Sheron believes that the very real harm of drinking should be highlighted on alcoholic drinks with graphic, tobacco-style health warnings.
The current unit-based guidelines are ‘too simplistic’, he says.
‘It’s much better to treat people as intelligent human beings and inform them of the actual nature of the risks. I would like to see the guidance be specific about the harms that alcohol can cause, namely high blood pressure, cancer, liver disease and dependency.’
Ideally, he says, these warnings would be mandatory as they are for cigarette packets, he says.
But he believes this is unlikely to happen because the Government is committed to its Responsibility Deal, under which the drinks i ndustry has avoided tougher regulations by committing to a range of voluntary actions.
In 2011 some of the biggest industry players including Diageo, Heineken and Carlsberg, pledged to have labels with clear unit content, NHS guidelines and a warning about drinking when pregnant on 80 per cent of products.
When the pledge was unveiled in December 2010, representatives of public health groups such as Alcohol Concern, the British Medical Association and the Royal College of Physicians, resigned from the Responsibility Deal’s alcohol group in disgust. By allowing the industry to propose such ‘ halfhearted pledges’, the Government had ‘clearly shown that when it comes to public health, its first priority is to side with big business and protect private profit,’ said Don Shenker, of Alcohol Concern, at the time.
Currently, the voluntary message on alcohol labels advises consumers only to ‘please drink responsibly’.
‘ There is little evidence to suggest that “Please drink responsibly” works,’ says Emily Robinson, deputy chief executive of Alcohol Concern.
WHAT THE LIVER EXPERTS DRINK
PROFESSOR Sheron says that as well as highlighting the dangers of alcohol, the new guidelines should make it clear that people who drink every day ‘are more likely to suffer harm and much more likely to become dependent on alcohol — so it is very important to have at least two to three alcohol-free days each week’.
Like his fellow professionals who see the effects of alcohol daily, Professor Sheron takes his own drinking advice very seriously.
‘I’m not aware of any liver specialists who drink outside of recommended guidelines,’ he says.
Professor Morgan says she is ‘not much of a drinker’, and sticks to ‘beer with Indian and Thai food and the odd glass of wine — on average, about ten to 14 units a month’.
Whether the new guidelines clarify the confusion over drinking limits, the message from these liver experts, based on their own habits, is unambiguously clear.