Trip Answers

Question answered:19/02/08

The CKS guideline on alcohol (problem drinking) notes:

 

“Safer drinking limits
• Safer (sensible) drinking limits were defined in the Government White Paper The Health of the Nation (1992) as a weekly alcohol consumption of no more than 21 units for men and 14 units for women. However, this was changed (by the government in Sensible Drinking Guidelines) to provide daily benchmarks for drinking (reflecting the potential risk to an individual's health of excessive consumption of alcohol in single episodes) [DH, 1995]:
o Consistent drinking of 4 or more units a day by men and 3 or more units a day by women is not advised, as this carries a progressive health risk.
o Binge drinking and intoxication should be avoided. If such episodes do occur, it is advisable to then refrain from drinking for 48 hours.
• A joint review of safe limits by the Royal Colleges of Psychiatrists, Physicians, and General Practitioners concluded that the defined limit of a weekly alcohol intake of no more than 21 units for men and 14 units for women should remain unchanged [Royal College of Physicians et al, 1995].

 

• Safer drinking during pregnancy:
o Pregnant women or women trying to conceive should avoid drinking alcohol. If they do chose to drink, to minimize the risk to the baby, they should not drink more than one to two units of alcohol once or twice a week and should not get drunk [DH, 2007].” [1]

 

We consulted the 1995 Department of Health’s report on sensible drinking, referred to in the CKS guideline, and this contains a discussion on the harmful effects of alcohol and cites epidemiological evidence for an association between different levels of alcohol and risk of harming health or increase in developing various diseases. The report also cites evidence in support of the beneficial effects of alcohol. Please note the full text of the report can be accessed by full at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084701. Due to the constraints of space, we will just reproduce what we consider to be the most pertinent points. The original text contains the references.

 

Long-term effects Cirrhosis of the Liver
6.6 In 1992 there were 3,056 deaths (1,753 men and 1,303 women) from cirrhosis of the liver in England and Wales. Of these, 967 (56%) of the cases in men and 540 (41%) of the cases in women were alcohol related.

 

6.7 A number of prospective studies of general populations have examined the relationship between daily consumption at the start of the study and subsequent mortality at time of follow up. The results show that the risk increased steadily with increasing daily consumption, but do not allow a consensus about a precise threshold of consumption below which there is no risk of development of cirrhosis.

 

6.8 Between 8 and 30% of long term heavy drinkers identified in the clinical population of problem drinkers ever develop cirrhosis. One UK authority considers that around 20 units of alcohol daily for 5 years is probably the minimum associated with significant liver damage. it appears that the likelihood of light to moderate drinkers developing cirrhosis is very remote.

 

Cancer
a. The epidemiological evidence supports the view that drinking alcohol causes a dose-related increase in the risk of squamous carcinomas of the upper aerodigestive tract as a whole, and for cancers of the oral cavity, pharynx, larynx and oesophagus. There is less information for cancer in these sites in women, but the available data show similar risks in both sexes. The epidemiological data suggest that alcohol causes cancer independently of smoking. Relative risks, at heavy drinking (>70g ethanol/day)**, after controlling for the confounding effects of smoking, vary between 3-15 fold depending on the tumour site. There is convincing evidence of an increase in relative risk at intakes above about 40g ethanol per day. The evidence is less convincing at intakes between 20-40g ethanol/day. The epidemiological data do not allow a quantification of relative risk at lower levels of drinking, but it is not possible to exclude a small increase in relative risk at intakes below 20g ethanol/day. The tumour types causally associated with alcohol are relatively rare and thus the number of cases which could be attributed to low levels of drinking would be very small.

 

**A unit of alcohol is 8 grams: the amount contained in half a pint of ordinary beer or lager or in a small glass of wine, or in a standard measure of spirits

 

Hypertension
6.16 A number of studies have shown that each increment of 10g (1.25 UK units) of alcohol drunk per day increases systolic pressure by an average of 1-2mmHg and diastolic pressure by 1mmHg. That said, it is not possible on the basis of the literature to establish the exact point, in terms of alcohol consumption, at which the health advantages, for those age groups for whom they apply, offset the disadvantages of raised blood pressure. However, a generally accepted clinical view would be that for men the rise in blood pressure produced by 4 units a day (about 6mmHg systolic blood pressure and 4mmHg diastolic) would give rise for concern.There is also mounting evidence that “binge” drinking is particularly associated with significantly raised blood pressure.

 

Reproduction, Pregnancy and Infant Development
4. Most studies agree that 2 drinks [16g of ethanol] per day and above may be associated with reduced birthweight which is one of the most sensitive parameters. Some studies have found effects at lower levels, but most have not. However, there is no good evidence that 1 or 2 drinks [8 or 16g of ethanol] per week has any adverse effect.

 

Mental Illness and Neurological Disorders
6.22 Extremely heavy drinking - which is defined here and elsewhere, unless otherwise specified, as consumption levels in excess of 80g (10 units) a day - over long periods of time, is strongly associated with a number of significant psychiatric disorders. These include clinical depression which may lead to attempted suicide or suicide, personality deterioration, sexual problems, amnesia, cognitive dysfunction (intellectual impairment), dementia, alcoholic hallucinosis, alcohol dependence syndrome and delirium tremens. Together with dietary insufficiency it is also associated with a number of neurological disorders including epilepsy, peripheral neuropathy (damaged peripheral nerves) and the Wernicke-Korsakoff Syndrome (this condition is very rare but can result in irreversible damage to the central nervous system)…

 

Mortality
… The evidence we have studied for men of all ages identifies a band of minimal mortality associated with a weekly consumption of between about 7 and 28 units a week. We emphasise that this band of minimal mortality cannot be entirely risk free, and reflects consumption levels which still carry a low risk of conditions such as some cancers, and some diseases related to raised blood pressure (see para 6.9).

 

8.7 It is not possible to weigh up definitively all these contrasting factors and produce an authoritative statement about women and alcohol. The scientific evidence simply does not, at present, allow that clarity. It does appear though that, on balance, there is sufficient indication from the physiology and the patterns of illness for women overall to be advised to drink at lower levels than men, and to take this into account when making their individual choices. This view was endorsed in all the expert evidence taken by the Group.” [2]

 

References
1. CKS. Alcohol – problem drinking. May 2007. (http://www.cks.library.nhs.uk/alcohol_problem_drinking/)
2.  Department of Health. Sensible Drinking. 1995. (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084701)

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