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Is there any need for drink guilt?

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The basis for government guidelines for women and drinking turns out to be less than scientific. Crack open a fruity Pinot Noir and read on...

Those units mount up, don’t they? A glass of wine here, a shot of vodka there, and before you know it, you’ve hit your recommended daily allowance of two to three units, and Oh my God! We're all doomed for liver disease! Well, maybe not, but most of us are certainly familiar with that niggling feelings of guilt that accompany a rewarding glass of Pinot after a hard day’s work.

But should we be feeling guilty? Experts are in significant doubt that the daily guidelines we’ve had hammered into our heads as scientific certainty might hold less weight than the government has led us to believe. Dr Nick Sheron, hepatologist and vice chair of the Alcohol Health Alliance UK, spoke against the daily unit limits introduced by the government in 1995, labeling them meaningless, potentially harmful and devised by “civil servants” with “no good evidence”.

He’s not the only one casting doubts. Richard Smith, a member of the Royal College of Physicians Working Party and one of those responsible for the government drinking guidelines of 1995 recently confessed the research team that created the unit based it on “an intelligent guess”.

Units, meaningless? Music to our ears… pass the G and Ts. Why not, says Smith. “You could argue that the whole idea of units is simple- minded,” he says. “Back in 1987 [when the concept was first introduced], they were a crude measurement, based on the few limited studies that were around at that time. There was certainly very little formal data to go on.” However, he does value the 1995 report that set the daily quota, saying it was based on many more studies than his team had access to 22 years ago, and that a wide range of medical and social organisations were consulted. But are those units currently watertight? “No,” he admits. “It’d be almost impossible to say categorically how much you, individually, should drink.”

We're all different

Even the Department of Health admitted in its 1995 report that “by definition, [guidelines] are not applicable to all individuals. There is considerable variation in many individual characteristics – for example, body weight – and general advice needs to be considered in the light of these differences.” Which is why, it seems, the guidelines deliberately give a range of units (two to three units a day for women, which, at the upper range, is 21 units a week) to take account of different people’s make-up.

So how can you know if you are a two- or three-unit woman? Can we have a BMI index for booze?

“Individual guidelines would be great, but it’s almost impossible to give them as there are so many different factors coming to bear on how healthy one is,” says Dr Seabrook. Body mass plays a part, which should not be confused with how fat one is, but rather how genuinely big-built you are. The more tissue you have, the greater the area is to absorb the alcohol, and the less pressure there is being placed upon the liver and other organs. Metabolism is another factor. The faster it is, the better the body will be at processing alcohol. “If you’re in generally good health, your body is going to be better equipped at processing alcohol, but it would be wrong to say that as long as you eat well and keep fit, you can drink over the limits,” she adds.

So we’re not automatically headed for liver disease just because we have a cocktail more than our limit? “Liver damage should be a worry for people who are drinking quite a bit most nights,” says Dr Seabrook. “Drinking 30 units a week is probably not going to cause liver disease, but 40 would be very risky.”

The liver is very good at recovering, as long as it's not scarred.

That said, if you’re one of those exceeding the recommended alcohol limit at least once a week, which apparently more than a third of British adults are, Mary Longley at NHS Drinking Service in Camden, London, would recommend you take a liver function test. The centre has what they call the 30/30 rule – if you’re 30 or older and drinking more than 30 units a week (more than double the recommended amount), and you’re drinking every day, they suggest you get tested, or if you’re under 30 and drinking 50 units a week, you should also get checked out.

Knowing exactly how much you’re drinking will also help. Government research has shown 77% of people don't know how many units are in a typical large glass of wine (between 2.5-3.5 units) leading to confusion over how much is too much. Drinkaware. co.uk has a unit calculator to help you figure out your totals. Also, measure your wine serving a few times so you get used to how a standard 175ml glass looks – if you’re used to bucket-sized glasses, you’ll be shocked at how small it is. Finally, look at your overall drinking patterns and don’t worry overly about the odd night here and there. Although the government’s unit guidelines are now given as a daily amount, most experts say that the weekly guidelines (14 units) are more helpful, and that daily guidelines were created simply to ensure that people didn’t save up their quota and binge drink all their allowance in one night.

Risk assessment

But, as Dr Seabrook explains, alcohol affects many different parts of the body, not simply the liver, including increasing the risk of a number of cancers, stroke, heart disease and dementia and, while the risk of liver damage escalates only once you pass 30 units per week, for other diseases, such as cancer, your risk goes up proportionately with the amount of alcohol that is consumed.

Physical health isn’t the only concern for regular drinkers. “Undoubtedly one of the biggest concerns for the government and for doctors is the so-called social impact of drinking, the risky behaviour that it encourages,” she says.

Smith, who was on the original panel, agrees. “Alcohol predominantly causes social problems, and to a lesser extent medical problems.”

And if you can’t shake the drink guilt after guzzling over your limit? The Royal College of Physicians advises taking two or three nights off drinking a week. “The liver is very good at recovering, as long as it’s not scarred,” says Dr Seabrook.

The experts Stylist spoke to agreed that serious damage was caused by long-term drinking over the limit and not the odd night of debauchery. But, of course, keep it in perspective. As Smith says, “Look, if you’re drinking a couple of units more than the advised amount, you’re not doomed, but it’s all about an overall risk approach. It’s a question of degree. How healthy do you want to be? That’s the question you have to ask yourself.”

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