Know your limits

It’s hard to keep track of the recommended limits for alcohol consumption. When Marvel Comics introduced Batman to the world in 1939, prohibition had been over for 6 years, the USA was in The Great Depression and Alcoholics Anonymous had started setting up shop. The only limits on alcohol consumption were ones born from moral and religious principles.

The idea of counting alcohol units was first introduced in the UK in 1987 to help people keep track of their drinking. One unit equals 10ml or 8g of pure ethanol, which is around the amount the average adult liver can process in an hour.

Other countries (including Australia, Canada, New Zealand and the US) use the concept of a standard drink, the definition of which varies from country to country. So, taking 500ml of 5% ABV (alcohol by volume) beer as an example, this is equivalent to 2.5 units in the UK, 2 standard drinks in Australia, 1.4 standard drinks in the US and 1 standard drink in Japan.

Viewed worldwide, the variation in recommended limits is surprising, even after conversion into UK units.

The last review of the advice in the UK was in 1995, when the recommended limit for men was 28 units, and for women, 14 units. A UK Department of Health review in 2013 decided that enough is enough and recommended a level of 14 units for both sexes.

UK males weren’t impressed by this infringement on their liberty and the Chief Medical Officer for England, Professor Dame Sally Davies, was accused of nanny statism.

Professor Sir David Spiegelhalter, Winton Professor of the Public Understanding of Risk at Cambridge University, suggested that drinking the maximum allowance set by Davies would be no more dangerous than eating bacon sandwiches or watching films, effectively silencing further debate.

No less dangerous than 14 units of alcohol

I’ve always wondered where these recommended limits come from. Definitely not from NICE – doctors can never agree on the risks vs. benefits of drinking.

“An alcoholic? That’s just someone who drinks more than a doctor.”

An easy, but uncomfortable, joke. A 2012 study by University of Washington researchers found that one in six surgeons met the criteria for an alcohol use disorder.  1 in 15 doctors in the UK may suffer from some form of dependence on alcohol and/or other drugs. This equates to approximately 13,000 doctors. GPs are particularly at risk of stress and burnout. The fitness to practice of all of these is likely to be impaired.

One of Sally Davies’s more trenchant comments was: “I would like people to make their choice knowing the issues, and do as I do when I reach for my glass of wine and think, ‘Do I want the glass of wine or do I want to raise my risk of breast cancer?‘ I take a decision each time I have a glass.”

She was criticised for that, too. But perhaps that’s what we should all be considering – and not just for breast cancer, but for cancers of the mouth, larynx, oesophagus, stomach, liver, colon, as well as for stroke, heart disease, diabetes, dementia … well, the list goes on.

Which brings me to the inevitable question: is any amount of alcohol safe?

The Global Burden of Disease study, published in the medical journal The Lancet in 2018, looked at levels of alcohol use and its health effects in 195 countries, including the UK, between 1990 and 2016.

Analysing data from 15 to 95-year-olds, the researchers compared people who didn’t drink at all with those who had one alcoholic drink a day. They found that out of 100,000 non-drinkers, 914 would develop a health problem such as cancer or suffer an injury. An extra four people would be affected if they drank one alcoholic drink a day.

For people who had two alcoholic drinks a day, 63 more developed a condition within a year, and for those who consumed five drinks every day, there was an increase of 338 people who developed a health problem.

One of the study authors, Professor Sonia Saxena, a researcher at Imperial College London and a practising GP, said: “One drink a day does represent a small increased risk, but adjust that to the UK population as a whole and it represents a far bigger number, and most people are not drinking just one drink a day.”

Professor Spiegelhalter had something to say about the Global Burden of Disease study, too:

“There is no safe level of driving, but the government does not recommend that people avoid driving.”

“Come to think of it, there is no safe level of living, but nobody would recommend abstention.”

Academics get paid for clever soundbites – particularly Gresham professors who make a habit of being in the public eye.

As the doctor who (fibro)scanned the broadcaster Adrian Chiles put it, “It’s not a choice between living a good, long life or a good, slightly shorter life; it’s about making your declining years as bearable as possible.”

I have objective evidence of the harm that alcohol has already caused my liver. So, I know my limits without any official recommendation. No bacon sandwiches, of course, and plenty of box sets of romantic comedies. And alcohol? Simples! It’s a big, fat zero for me.

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