Drink?: The New Science of Alcohol and Your Health

by David J. Nutt

The safe limit of alcohol, if you applied food standards criteria, would be one glass of wine a year.12 Would you take a new drug if you were told it would increase your risk of cancer, dementia, heart disease, or that it shortened your life? You wouldn’t touch it. But alcohol has a special place in our culture.

As the liquid flows into your stomach, it begins to be absorbed through the walls of the stomach, then via the small intestine. The alcohol goes via the bloodstream into the liver, where it starts to be broken down, the main by-product being acetaldehyde. Then this alcohol and acetaldehyde mixture travels through the bloodstream and into the heart and also crosses the blood–brain barrier and enters your brain.

Drink more, and as you go over the drink-driving limit – which is 80 milligrams of alcohol per 100 millilitres of blood (80mg%) – you begin to get the double whammy: as well as stimulating GABA, the alcohol starts to block your glutamate receptors. And remember, glutamate is the neurotransmitter that keeps you awake. As your level gets higher, you’re starting to become properly drunk. If you reach the point of 150mg%, you’ll also start to lose the capacity to lay down memory. This is a blackout. As

We talk about throwing up from alcohol pretty casually but, in fact, vomiting is crucial as it stops you from dying. This survival mechanism is one of the reasons alcohol has survived in our culture for thousands of years. Vomiting gets rid of enough alcohol so you stay alive.

Interestingly, under the Psychoactive Substances Act 2016, every recreational psychoactive substance was banned except ethanol, caffeine, nicotine and tobacco.

One of the ways alcohol is metabolised is by the enzyme alcohol dehydrogenase (ADH). As this enzyme breaks down ethanol, it forms acetaldehyde, a poison and carcinogen.

One study concluded that even a couple of drinks more than four days a week raises your risk of premature death by 20 per cent.2

The causal association is strong enough that alcoholic drinks have been classified as a carcinogen by the International Agency for Research on Cancer . And it’s also why the World Health Organization has decided that no level of alcohol consumption is safe.

According to a World Cancer Research Fund report from that year, just a single drink a day increases the risk of breast cancer .

This may shock you, but drinking causes brain damage. In fact, the leading preventable causes of dementia are head injury and the damage alcohol does to the brain. It’s thought at least one in five cases of dementia is probably due to alcohol.

In a 30-year study – the Whitehall II Imaging Study25 – which involved over 500 people having their brains scanned and their drinking histories taken, there were increased odds of hippocampal atrophy in those drinking up to 14 units weekly, and faster cognitive decline in those drinking up to 7 units weekly. The conclusion? Alcohol consumption, even at moderate levels, is associated with adverse brain outcomes.

As always, there is contradictory evidence, from a cohort study that looked at the drinking habits of 9,000 mainly middle-aged civil servants, and followed them for 23 years. It showed that low levels of alcohol consumption – that is between 1 and 14 units a week – reduced the risk of dementia. In fact, it appears that being teetotal may raise your risk of dementia – though drinking more than 14 units does too.

Does drinking reduce fertility? The short answer is, yes.

Only have two drinks Two drinks will make it very likely you’ll stay within the recommended limits, if you are drinking pints or medium glasses of wine. You may also decide that your limit is three. Aim never to get drunk If you feel drunk, it means you have probably consumed at least five units, maybe much more if you are a heavier drinker with more tolerance.

Book in drink-free days The guidelines say two drink-free days a week is the minimum number to aim for. But even one is much better than none. Two consecutive nights will give your liver time to recover. As before, on the nights you do drink, don’t binge. Use the NHS app Drink Free Days to help you.

Never open a second bottle This is another one for the wine drinkers. If two of you share one 13 per cent bottle of wine you’ll automatically limit yourself to five units each.

Despite repeating their message of ‘sensible drinking’ at every opportunity, the drinks industry wants you to keep drinking. That is its reason for existing. One estimate is that, if everyone drank within recommended limits, the industry would lose £13 billion. That’s a lot of lost profit. Its aim is often aided by the government, which wants the tax income.

After all, in terms of cost to the country, smokers are good value. They pay a huge amount of tax via duty and during their working lives, but many die before they can draw their pension. The cheapest death for the NHS is a heart attack. So, for the good of the national finances, the committee decided not to act on the study .

The report placed alcohol as the fifth most harmful drug to the user after heroin, cocaine, barbiturates and methadone. Tobacco ranked ninth. Cannabis, LSD and ecstasy, while still harmful, ranked lower, at 11, 14 and 18.

first big run-in with authority was early in 2009, with Jacqui Smith, then Home Secretary . In a speech, I compared the 100 deaths a year caused by horse-riding to the 30 deaths a year linked to ecstasy . This may sound like a weird comparison, but the point I was making was that we accept the status quo without question, all the dangerous things we’ve always done, including both horse riding and drinking. But any new drug – at that time it was ecstasy – is banned as it’s thought to be too dangerous. When you look at the evidence, this is illogical.

What you can see is that death rates from (almost) every disorder have gone down since 1970. This is what you’d expect, as medicine improves and society becomes generally healthier due to public health measures. In fact, most disease rates have halved over the 40-year period. But as you can also see, deaths from liver diseases (80 per cent of which are caused by alcohol) have increased fivefold. Successive governments have had access to this data. I can only assume they all decided not to take any steps to cut the rate of liver disease because they didn’t want to stand up to the drinks industry. Instead, what they did or didn’t do compounded the problem. Firstly, they didn’t ensure alcohol prices kept pace with income because they refused to raise duty enough or introduce minimum pricing. In real terms, alcohol now costs a third of what it did in 1970. Secondly, they liberalised access to alcohol by allowing sales in supermarkets and by lengthening licensing hours. The upshot was, over those 40 years, the average per-head consumption of alcohol increased by about 50 per cent. But because of the exponential relation between consumption and liver damage, the number of deaths multiplied by 400 per cent.

In my lifetime, the French government have got policy on alcohol right while, in the UK, we’ve mostly got it wrong. This is a useful comparison, as France isn’t a million miles away and as a nation they’re not that different, genetically . People in France do still drink over the recommended units. But they drink a lot less than they used to. When I was a student, it was rare to see someone in hospital in the UK with liver cirrhosis. But not in France, which is why we called it the French disease. Now, French cirrhosis rates are lower than the UK’s, because their government has acted in the best interests of their people while ours has been suckered by the drinks industry .

Drinking in parliament is rife.26 Many MPs have admitted to being affected and one has even described being too incapacitated by alcohol to be able to walk through the voting chambers.27 I have argued that to allow intoxicated MPs to make decisions on issues of national importance such as going to war is outrageous. In fact, I believe MPs should be breathalysed before being allowed to vote.