Why not come over for dinner and some binge drinking?’ It might not be the conventional way an invitation is worded, but the reality is that’s often what happens.
People don’t like to acknowledge it, say experts, but the truth is that what many of us shrug off as ‘having a few drinks’ often falls into the binge category.
That could be because we don’t really know what ‘a binge’ is – and in any event, we tell ourselves, it’s something that only younger people do.
Researchers define a binge as six units of alcohol for a woman (that’s two 250 ml glasses of 12 per cent wine, for example) and eight units for a man (that’s three pints of 5 per cent beer).
‘A lot of people assume it’s the younger people, out in the city centres at weekends, who are the problem drinkers,’ says Dr Peter Rice, who spent 30 years in the NHS as an addiction psychiatrist and is now chair of the Institute of Alcohol Studies.
‘But actually it’s the middle-aged and older groups who are the ones with the worrying drinking habits now. They’re drinking at home, having a G&T and perhaps a couple of glasses of wine and they don’t realise how much that adds up.’
Which means that while you might not feel you fit the image, you could well be a binge drinker.
‘What equals a drinking binge easily falls within the amount many people might get through at a dinner party or a casual get-together with friends, but many won’t want to see it as a binge,’ says Dr Stephen Ryder, a consultant liver specialist at Nottingham University Hospitals NHS trust.
Researchers define a binge as six units of alcohol for a woman (that’s two 250 ml glasses of 12 per cent wine, for example) and eight units for a man (that’s three pints of 5 per cent beer)
‘There is a perception of what a heavy or binge drinker is – and people don’t want to think of themselves in this way, he says.
However, millions of people are just that, according to the NHS Health Survey for England in 2022, which found that 19 per cent of men and 15 per cent of women had had a session of binge drinking in the previous week – with rates highest among people aged 55 to 64.
But is having the odd binge really so bad in terms of damage to our liver and overall health?
The UK Government’s guideline – that men and women should drink no more than 14 units of alcohol a week and have at least two days free of alcohol per week – ‘was worked out so that it reduces your risk of an alcohol-related death to less than one in a 100’, says Dr Rice.
The term binge drinking is more arbitrary and ‘was actually introduced decades ago as a term to help researchers compare the drinking habits of the southern and northern Europeans,’ he says.
At that time, the culture in southern Europe was to drink wine with a meal, whereas in the UK or Denmark, for example, it was to have several beers and spirits on a night out.
(In recent years the southern Europeans have shifted away from wine drinking to other forms of alcohol, although their intake remains lower than ours.)
‘But as a term, binge drinking has limited benefit, because people presume it means they must be drunk and as long as they’re not drunk then they’re OK, but that’s not the case,’ says Dr Rice.
Dr Peter Rice, who spent 30 years in the NHS as an addiction psychiatrist, says: ‘It’s the middle-aged and older groups who are the ones with the worrying drinking habits’
Tellingly, he adds: ‘For many people, having six units over an extended period from 6pm to midnight, say, is not going to leave them very intoxicated.’
Yet to develop an alcohol-related health condition, you don’t have to hit binge levels – or even get drunk.
‘It is the amount of alcohol that goes through your system that counts,’ says Dr Rice. ‘So whether you consistently drink every day, or just have binges, if you drink the same amount then the damage might be the same.’
In other words, he says, having two alcohol-free days in a week is meaningless if you then binge at the weekend.
He explains: ‘Some people might never get drunk and yet end up with alcohol-related diseases. A lot of the people I see with liver disease would say ‘I was a social drinker but I never got out of control’ – and yet they had drunk enough to cause damage.’
In fact, there is no safe threshold below which there are no toxic effects of alcohol, according to academics from Imperial College London and elsewhere, who in 2021 suggested that ‘current public health guidelines concerning alcohol consumption may need to be revisited’.
Their research, published in the journal eLife and involving around 10,000 people from the UK, suggested that even drinking within the defined safer limits can lead to ‘structural and functional changes in the brain, heart, aorta [the main artery] and liver’.
But this might be a hardcore view, and many experts are not convinced people can or should be told to give up alcohol entirely.
John Holmes, a professor of alcohol policy at the University of Sheffield, was an adviser to the committee that devised the official guidance changing in 2016 from daily unit limits to the current 14-unit weekly limit.
John Holmes, a professor of alcohol policy at the University of Sheffield, says: ‘During the pandemic, a lot of people drank less but the heaviest drinkers drank more’
‘The main reason for the guidelines changing was that the daily limits were encouraging people to think that they should drink every day,’ he says.
While he agrees there is no ‘risk-free level of alcohol’, he doesn’t believe we need to reduce the level of units any further. ‘There are a lot of things that are risky – but we don’t say people can’t do that thing as a result,’ says Professor Holmes, who is himself a non-drinker (‘I just don’t like the taste, but most people I know in alcohol research do drink’).
He adds: ‘What you do is give people guidance on what a low-risk approach is.’
Yet there are worrying signs that those who enjoy more than the odd drink are paying the price.
‘Although alcohol consumption levels have gone down over recent years, the levels of deaths directly related to alcohol went up by about 20 per cent during the pandemic,’ says Professor Holmes.
‘During the pandemic, a lot of people drank less but the heaviest drinkers drank more,’ he says.
‘And now death rates directly related to alcohol are continuing to go up and we don’t know what’s driving it.’
Some people are known to be more at risk from the ill-effects of alcohol. For example, the guidance for women is that they drink less than men, says Dr Ryder, ‘partly because of a difference in body composition and size but also because of differences in the system for metabolising alcohol’.
For example, women have lower levels of a liver enzyme that breaks down alcohol – meaning more can travel round the body.
And women and men in their 50s, drinking just two units a day were found to have a reduction in white and grey matter in the brain, associated with two years of ageing, according to a study in Nature Communications in 2022.
But it’s not just women who might be advised to stick more closely to the suggested limits – so too should anyone who is overweight.
Most alcohol is broken down in the liver – the cycle of damage and repair that alcohol leads to can cause a build-up of scar tissue there.
‘If you’re overweight [which can lead to dangerous levels of fat building up in the liver] then you may be facing two causes of liver disease rather than one,’ says Dr Ryder.
Those who think they can ‘hold their drink’ are not immune to the ill-effects either – in fact, this can be a red flag, adds Dr Rice.
‘Heavy drinkers tend to develop a high tolerance for alcohol and so even when they have high blood alcohol levels they don’t show signs of being drunk,’ he says.
‘The main reason is that their brain has become used to functioning with a higher blood alcohol level.
‘For many people, feeling drunk is a warning sign that it is time to stop, a bit like a pain signal.
‘But if you build up your tolerance you don’t get that message to put on the brakes.
‘If you can hold your drink it probably means you are drinking too much – don’t take it as a sign of reassurance if you feel sober while everyone else is falling about after drinking the same amount.’
While there are ways to reduce the risks, the type of alcohol you drink is not going to make that much difference, says Dr Rice.
‘There is a halo effect about wine [i.e. an idea that it is somehow good for you] but there is nothing solid to back that up.
‘And shots may be drunk quicker than a pint of beer – but again, how damaging they are depends on how many you drink – the point is, once alcohol is in your body it doesn’t matter what type it is, it all acts the same and can cause the same damage.’
Dr Rice says that what might be more helpful is if people knew the number of units in their favourite drink.
‘A UK unit is 10ml of alcohol – a 500ml can of 4 per cent beer has 20ml of alcohol in it, which is 2 units – as does a 200ml glass of 10 per cent wine,’ he explains.
Lining your stomach may help moderate your drinking, he adds – as drinking on an empty stomach ‘makes you feel drunk quicker and means your judgment is going to be affected, including making a judgment about whether or not you continue drinking – it becomes a vicious cycle’.
Ultimately, says Professor Holmes, ‘the risk of alcohol is incremental – it rises the more you drink, so even if you can’t stick to that 14 units weekly limit, just cutting back, and drinking a little bit less than normal will cut your chance of alcohol-linked harm. It won’t rule it out, but it will bring it down.’
Hour-by-hour, what Christmas booze does to your body – and how to reduce your hangover
Tis the season to be hungover. But, of course, hangovers aren’t exclusive to Christmas – the average Briton spends more than a year of their life nursing one, according to research by cancer charity Macmillan.
A hangover doesn’t just make you feel rubbish physically – new research by the University of Bristol has found that people who drank the night before performed worse in maths and memory tests the next day, and were less able to control their emotions, too.
Dr Craig Gunn, a lecturer in psychological science who led the study, said: ‘Hangovers appear to impact most aspects of executive functions [key skills such as problem solving]. This substantial impact on individuals and wider society should be considered a public health concern.’
Here, we look at how alcohol affects you from the first sip – and how to minimise hangover symptoms.
Two minutes after you start drinking: Alcohol is absorbed though the mucous membrane lining the stomach and intestine, and passes into the bloodstream.
‘About a quarter of it is absorbed via the stomach – the rest is absorbed further along your digestive tract,’ explains Debbie Shawcross, a professor of hepatology and medical advisor to the British Liver Trust.
‘How quickly you absorb the alcohol depends on factors such as its concentration [drinks with a higher alcohol concentration are absorbed faster] or whether your stomach is empty [food slows absorption].’
After five to ten minutes: Alcohol very quickly crosses the blood brain barrier – the protective barrier around the brain – where it stimulates the release of ‘feel-good’ chemicals dopamine and serotonin.
The average Briton spends more than a year of their life nursing a hangover, according to research by cancer charity Macmillan
This alters the balance of these key chemical messengers (which are responsible for regulating mood and rational thought), reducing inhibitions and leading to impulsive behaviour.
After 30 minutes: A single unit of alcohol (roughly a small glass of wine or half a pint of beer) will have been absorbed by the gut and into the bloodstream, which is when you start to feel tipsy.
After one hour: Alcohol is treated as a toxin by the body –something to be removed – which is the job of the liver.
The liver processes alcohol at ‘a consistent rate of 60 minutes per unit’, explains Professor Shawcross. Most of the alcohol is broken down by an enzyme called alcohol dehydrogenase and turned into acetaldehyde.
‘This chemical is what can cause flushing of the skin, nausea and palpitations often associated with drinking,’ she says.
‘Other enzymes then break the acetaldehyde down into acetate, which is further broken down into carbon dioxide and water, and eliminated from the body’ – in urine, for the most part (which is why trips to the loo become more frequent after an hour’s drinking).
‘Some acetate is also expelled in your breath and sweat,’ says Professor Shawcross (the reason you can smell drink on someone the day after a heavy night).
‘The liver can’t speed up this detoxification process, even faced with excess alcohol,’ she adds. ‘So even after you stop drinking, alcohol can stay in your blood for up to six hours and in breath for 12 to 24 hours.’
After two hours: If you carry on drinking, you’ll start to move more slowly, your balance will be affected and speech becomes slurred as the alcohol reduces the production of a chemical messenger called GABA in the brain.
After four hours: As the liver struggles to process the alcohol still coming into your system (further affecting coordination and thought processes), the alcohol acts as a sedative, so you start to feel drowsy or pass out.
Hangover symptoms are the result of the lingering alcohol and acetaldehyde in your body:
Headache: This is mainly the result of dehydration as you urinate more. ‘Passing a lot of urine means you’re also losing electrolytes [such as sodium and potassium], which exacerbates headaches,’ says Dr Gunn.
Nausea: Acetaldehyde irritates the gut lining, which can trigger diarrhoea and nausea.
Aches and tiredness: Following heavy alcohol consumption, the immune system releases cytokines (the same protein makes you feel rubbish when you have a cold) to counter damage caused by acetaldehyde.
‘But this immune response can also promote feelings of fatigue and muscle ache,’ say Dr Gunn.
And as the liver is busy breaking down alcohol, it doesn’t produce as much glucose to maintain normal blood sugar levels, making you tired.
Research by Bristol University found that people who drank the night before performed worse in maths and memory tests the next day, and were less able to control their emotions
Food cravings: Research shows that people tend to make unhealthy food choices the day after drinking, possibly due to low blood sugar and tiredness.
Sleep problems: Alcohol consumption can affect our body clock and cause fragmented sleep, and that has a knock-on effect on mood and tiredness.
In 2019, researchers at the Claude Bernard University in France found that after binge drinking, the body can take several days to return to normal sleep patterns.
Anxiety: Alcohol is a relaxant, so the more you drink, the more relaxing brain chemicals – such as dopamine – are released.
This prompts your confused brain to try to restore the balance the next day by releasing chemicals that have a stimulating effect, such as cortisol. This leads to an increased heart rate and feelings of anxiety.
‘Studies show that people view normally pleasant images – cute bunnies, for example – less favourably when hungover,’ says Dr Gunn. ‘Your normal ability to regulate emotions and how you experience pain appear important – and the more an individual catastrophises pain and emotions generally, the greater severity of hangovers they have.’
Generally, the more you drink the worse you feel the next day.
‘But we now think this is different for everyone and may be related to how drunk you believe you are, rather than simply down to the amount of alcohol consumed,’ says Dr Gunn.
Alcohol also hits women harder as they have lower levels of alcohol dehydrogenase – the enzyme that breaks it down. And hangovers get worse with age because ‘the activity of the enzymes that break down alcohol is reduced, so it is more slowly metabolised and acetaldehyde levels take longer to be dealt with’, says Professor Shawcross.
As for hangover remedies, do any of them work? ‘In short, no,’ says Dr Gunn. ‘The best way to limit a hangover is to consume alcohol in moderation.’
But the following may help:
- Don’t drink on an empty stomach;
- Sip water or non-fizzy drinks between alcoholic ones to reduce the burden on your liver;
- Drink lots of water before bed.
CAROLINE JONES
