The Complex World of Alcohol and Health

Alcohol and health can be confusing. We are bombarded with complex information that is difficult to reconcile with our own experiences, and often those personal experiences contain contradictions. Here are a few conundrums:

• Alcohol appears to act as a stimulant and depressant; makes me go to sleep and keeps me awake; makes me euphoric and sad; aggressive and friendly; amorous and impotent. These effects are contradictory. What is actually going on?
  
  
• If the UK Government and health authorities recommend a maximum 14 units per week (1), why do most drinkers I know - and those I see portrayed on TV – appear to have lifestyles that consume well in excess of this? For those in the middle ground – above 14 units per week but not drinking vodka every morning – what are their health prospects? I don’t see a negative impact among my immediate group of friends, so isn’t this recommended limit just scare mongering?
  
  
• Why do other countries have different alcohol limit recommendations - for men in the US it’s 24.5 per week, in Spain it’s 35 - more than double the UK (2)? Surely the science is the same whatever our nationality
  
  
• What are specific alcohol and health risks for me – they always seem a bit vague, generalised and far into the future?
  
  
• Why does alcohol and mental health get less coverage than alcohol and physical health, such as liver damage? Media coverage also appears to be dominated by the rules (14 units per week etc) rather than explaining the reason behind the rules or the implications for health in a meaningful way.
  
  
• I get more from alcohol - fun, sociability, celebrations, relaxation, taste – than it takes away, so why should I worry?

UK Government’s Advice on Alcohol

Government advice on alcohol and health appears to take a “Nanny State” attitude, recommending ultra-safe limits (lower than most other countries), and ignoring the typical lifestyle of a sociable drinker. This leads to many drinkers simply ignoring the advice as scare tactics that can be dismissed.

The Government and health organisations need to take a more nuanced approach to communication, recognising the inherent scepticism in drinkers and their default state that assumes the advice is not for them. Drinkers think (to borrow from Shane Warne), “fun police, get stuffed”. There’s an analogy with speed awareness courses for drivers caught speeding but wanting to avoid points on their license. I participated once, and never have I seen such a sceptical and reluctant audience. Recognising this, the course moderator used a subtle blend of practical, empathetic and impact techniques to win the audience over. This approach is needed for alcohol and wellness advice.

The Risk Factor and the 14 Unit Limit

Consumption of alcohol is not certain to cause harm (apart from at extremely high levels where it can instantly kill by alcohol poisoning). It is a risk factor. Jumping off the top of a 16-story building will definitely cause physical harm. Drinking three pints of beer every day may cause health problems, it may not. Drinking a bottle of gin every day will almost certainly cause health problems, but when, and how bad, are unclear. Our personal judgement on alcohol and health must be taken in the context of how much risk we are prepared to take.

The UK Government’s recommended limit of 14 units of alcohol per week is based on an acceptable daily risk level, similar to the risk in driving (specifically, a 1% risk of dying due to alcohol consumption in a lifetime (3)). Most things we do have some level of risk – driving, gardening, flying etc – so we must accept a low level of risk to participate in normal everyday activity. This is the risk level of 14 units of alcohol per week. There is a risk, but it’s small and comparable to other things we do regularly without thinking of the risks. 

Unfortunately, the relationship between the amount we drink and the increase in health risk is not linear, it’s exponential (4). So, if someone doubles the amount they drink, the health risk doesn’t double, it can increase by about 5-times. The risk, therefore, of drinking 56 units per week is something like 25 times greater than drinking 14 units per week. It’s still only a risk, but significantly higher than those everyday risks like crossing the road.

Judging our own susceptibility to the risk is hard. We know that being overweight, smoking, taking no exercise and having a poor diet will exacerbate the risk. But our genes, age, weight and sex are also a factors. One might live a model lifestyle, drink half a bottle of wine a day, and still succumb to alcohol induced health problems, because our genes can make us vulnerable. Alcohol consumption is a gamble – we are all balancing risk and reward.

The Specific Health Risks

We know heavy drinking can cause liver damage, but that’s not the only risk. Alcohol impacts physical health in many ways. Health risks include cancer, diabetes, cardiovascular damage, liver disease and brain damage (4). There are many different ways alcohol can get us. 

Alcohol and mental health is also a problem. Alcohol is highly addictive, potentially leading to severe mental health consequences. Even small amounts of alcohol can have a negative effect on mental wellbeing, such as lack of sleep, anxiety and mental fatigue.

Alcohol impairs judgement, potentially leading to high risk behaviour like jumping off buildings, diving into shallow swimming pools, risky sexual activity and violence. Alcohol weakens coordination and balance, which can lead to falls and other accidents. Alcohol also reduces our ability to lay down memories. This is not necessarily a health risk, but what’s the point of all the fun when we can’t remember the detail? Alcohol and wellness has many inter-relating dimensions, but taken as a body of information, we should recognise the profound implications for our wellbeing.

Alcohol and Lifestyle

Alcohol consumption is woven into the fabric of our social lives. It oils the wheels of social interaction and fuels celebrations such as birthdays, weddings and sporting achievement. Alcohol helps us meet people, overcome shyness; it is an excuse to get together and can help us relax after a hard day. Alcoholic drinks are a brilliant accompaniment to food, enhancing epicurean pleasure. If alcohol is part of one’s life, it is difficult to avoid without taking away many other pleasures.

The dilemma is: how do we reconcile the long-term risk of health damage from alcohol with the short-term pleasure it can provide?

Practical Steps to Improve Health

The exponential correlation between alcohol consumption and health risk works in reverse. Cutting alcohol consumption by, say, half will reduce health risk by about 80%. There are a number of techniques that make it easy to reduce alcohol consumption without sucking the fun out of life.

1. Mentally assume you have a finite number of drinks over your life. Treasure each one. This means never drinking poor quality, such as warm beer. Don’t drink just because it’s free - drink because you want to. Savour each drink, don’t guzzle. Getting rid of these “wasted” drinks is an easy start to reducing consumption.
2. Try alcohol-free days. Initially it might be difficult to break habits, such as a drink after work, but these habits will fall away over time and be replaced by good habits. People often find they sleep much better after not drinking. This can be a positive benefit and lead to good habits such as a number of dry days per week that improve sleep, energy and wellbeing. These immediate benefits of not drinking can be more motivating that the fear of distant health issues far into the future. Being selective also helps make drinking more special.
3. Try starting to drink later on an evening. And finishing drinking earlier at the end of an evening (that last drink before bed does not add to an evening’s enjoyment, it only increases the impact of a hangover). One challenging thought is: what do we really get from drinking into the early hours of the morning? It’s fun at the time, as we are drawn in by alcohol’s persuasive, addictive properties that reduce our judgement and instil a craving for more. On reflection though, how enjoyable are those really late nights (if, indeed, we can remember with any accuracy), and at what cost? A wise rugby coach once said, “nothing good happens after midnight”.
4. The link between alcohol and socialising is tough to break. In this context alcohol and mental health can have a positive relationship because socialising benefits mental health. Socialising should not suffer just because we are trying to cut down on alcohol consumption. The drinks industry has been slow to respond. Alcohol-free drinks – alcoholic drinks with the alcohol removed, such as alcohol-free beer – are common, but many people reject these on the basis of quality. They simply don’t taste as good as the alcoholic versions. Soft drinks are not the answer, being too sweet and child-like for many, not really fitting with adult social occasions. A new drinks category is emerging called “Social Softs”, led by the new drinks brand ZAG. Social Softs do not copy alcoholic drinks - they are distinctive products in its own right, designed for “grown-ups” who want to socialise without alcohol. Social Softs do not rely on sweetness for appeal. Their flavour is more challenging than soft drinks, designed for adults with a more developed palette. Social Softs, like ZAG, can often be an acquired taste. ZAG is pioneering the new Social Softs category as an alternative to alcoholic drinks on social occasions.
5. Drinks pacing is a good technique to reduce alcohol consumption. ZAG is an ideal pacer for beer and Social Softs in general can be adopted as pacers. Water is well known as a pacer for wine over a meal. Conversely, rounds, shots, someone topping up our drink and drinking alone are good to avoid.
6. In general, if we are more conscious of our alcohol drinking – relying on considered choices rather than habituated, unthinking behaviour – the easier it is to reduce consumption without impacting our lifestyle. It’s a win-win. We feel better, we look better and we still enjoy social drinking (arguably more, because it’s more special).

ZAG Drinks

ZAG is pioneering the new drinks category: Social Softs. Our aim is to provide better choice for consumers who want to reduce their alcohol intake but still continue socialising. Launching a new drinks category (Social Softs) as well as a new drinks brand (ZAG) is an ambitious challenge because there is no frame of reference for retailers or consumers – people are comfortable with familiar ideas that fit into established frameworks.

The drinks industry – and the drinks categories that define it – are not keeping up with changing consumer behaviour. Increasingly, consumers are reducing or completely avoiding alcohol consumption, but are still keen to socialise. Consumers are increasingly rejecting soft drinks as too sweet and unhealthy. Adults of all ages want “grown-up” drinks, with interesting flavours (that are not copies of alcoholic drinks) targeted at them, not the sugary soft drinks designed for kids. These consumers want Social Softs.

ZAG is hopefully the first of many Social Softs that will help improve our relationship between alcohol and health.

Further Reading

The book Drink? The New Science of Alcohol and Health by Professor David Nutt covers many of these alcohol and wellness issues in lots of detail, with plenty of supporting scientific evidence. It’s a powerful book that provides clarity and provokes thought on the relationship between alcohol and health.

Have you considered the additional health issues of the sugar content in your drinks? Find out more about hidden sugars in drinks here. 

References

1. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-12-alcohol
2. https://www.theguardian.com/news/datablog/2016/jan/08/how-do-the-uks-new-alcohol-guidelines-compare-with-the-rest-of-the-worlds
3. https://www.theguardian.com/society/2016/jan/08/mens-recommended-maximum-weekly-alcohol-units-cut-14
4. Drink? The New Science of Alcohol and Health (Chapter 2) by Professor David Nutt