Is your drinking dangerous?
Emma Doran is hardly a poster girl for the temperance movement, but as far as drinking in Ireland goes, she’s not far from a model of restraint. For example, she doesn’t drink during the week, and she usually drinks just one or two nights at weekends. Not a saint then, but at best, a down-table sinner.
The 34-year-old comedian and mother-of-three, who lives in Dublin, explains: “I’d drink at least once a week. Sometimes I wouldn’t get the chance but, mostly, at a minimum, I would have a bottle of wine on a Friday or Saturday night at home and then maybe a gin and tonic. I could drink two weekend nights. My average weekly consumption would be a bottle of wine and two or three gin and tonics, and the top end – on a bad week – would be two bottles of wine and a few gin and tonics.
“I wouldn’t really drink Monday to Friday. And I wouldn’t have one glass of wine with a meal, but I would probably drink to get drunk.”
Emma’s drinking habits mirror those of many Irish women, with wine being the drink of choice for 60pc of women over 25, according to the Health Research Board’s 2013 National Alcohol Diary Survey.
Dr Deirdre Mongan, Research Officer with the HRB, who conducted the surveys, says: “There has been a move to home drinking in recent years. Women were more likely than men to consume alcohol at their own or someone else’s home (71pc versus 59.5pc). Compared to other European countries, people in Ireland tend to drink on a fewer number of days each week. However, when Irish people do drink, they drink in larger amounts; 75pc of alcohol in Ireland is consumed as part of a binge and our drinking would be characterised as being predominantly binge drinking, which is a much more harmful way to drink, compared to spreading your drinking out over a greater number of days.”
The WHO defines a binge as six or more standard drinks in one session, three pints or more than six pub measures of spirits. (The ‘standard drink’ has replaced the old unit measure in the new nomenclature, but the values do not correspond exactly and can differ from country to country, e.g. a standard drink in Ireland contains 10g of pure alcohol, but only 8g in the UK.)
With Emma’s habits so closely in line with those nationally, surely there could be nothing here to concern the clinicians? After all, who doesn’t have a few glasses of wine and perhaps a couple of G&Ts?
When I put this to Professor Frank Murray, consultant in hepatology and gastroenterology, and Chair of Alcohol Health Alliance Ireland, he disabuses me of this notino quickly. Very quickly.
“That’s a lot,” he insists. “That’s about twice the low-risk limit of 11 standard drinks a week on what she calls ‘a bad week’, so that’s hazardous drinking.”
Hazardous drinking is defined as being above the low-risk guidelines, but hasn’t yet done harm. After that, you’re into harmful drinking. This is because, when calculated according to the HSE’s online drinks calculator, Emma is drinking around 10.5 standard drinks per week (7.5 in a bottle of wine and three for each G&T, assuming pub measures). But on a bad week, that is increasing to roughly 19 standard drinks – 7.5 x 2 = 15 plus four G&Ts = 19.
The online drinks calculator also provides the caloric value of this consumption, which weighs in at 1,444 calories.
This week is the EU’s Action on Alcohol Week and Prof Murray says, in general, most Irish people vastly underestimate the danger of this kind of drinking.
“When I came back to Ireland, I was shocked at the numbers of people – young people, particularly women, with irreversible liver failure and dying from alcohol,” he recalls. “They were not ‘problem’ drinkers, but they were having a couple of glasses of wine during the week, and a couple of bottles at weekends. That’s liver failure territory,” he adds.
“A lot of people who drink two bottles of wine a week – say in two sittings – will have fat in their liver. It would be unusual for people to get liver failure with that level, unless they have other susceptible factors, but if you double that or increase it by 50pc, it’s quite common to see substantial liver disease,” Prof Murray says. But it seems we are culturally predisposed to consider this level of drinking normal. If there is, as new guidelines suggest, no safe level of drinking, why do most of us – only 20pc of Irish people don’t drink – believe this is fine, or at least suppress those niggling suspicions that it might not be?
“There are two big myths,” says Prof Murray. “One is that your liver can recover, and the second is that people say, “I know loads of people who drank more heavily than I did and haven’t gotten into trouble”. And that’s true – there is individual susceptibility. But deaths from liver disease are not just from cirrhosis, there are two other categories – cancers and incidents, accidents which occur from the event of drinking.”
In fact, the real danger with the much-mythologised ‘self-healing’ liver is that much liver disease is mostly symptomless until it’s too late.
“Most people who present with irreversible liver failure, and who are going to die without a transplant, have had no preceding significant warning.
“So you arrive in and it’s game-up time. People have this myth that the liver can regenerate, but that’s not true – there’s a point you cross when it’s irreversible.”
He also points out that one in eight breast cancers is attributable to alcohol.
“Risks of breast cancer start with very low levels of consumption, even as little as one standard drink a day,” he says.
So far, so terrifying. But Emma Doran shows a far higher degree of self-awareness than most. “A lot of people my age have the ‘innocent’ glass of wine on Friday night, but it’s not a glass, it’s a bottle,” she says.
“And it is quite a lot of alcohol – the first two glasses are grand and you feel a bit euphoric. And then something happens between the third and the fourth glass and you kind of black out.
“I’m quite a small person anyway – I’m only 5ft 2in – so I really notice if we drink a bottle of wine in someone’s house and go out after. I will actually tend to nurse one more drink because I don’t feel comfortable being out that drunk.
“But I would say many people I know drink more than me. I’m actually not that pushed.”
So if we are going to drink, how do we reduce our risk of liver disease?
Prof Murray says: “The first point to make is that there is no safe level of drinking, but to reduce your risk, you should stay well within the low-risk guidelines.
“There should be at least two to three days drink free and avoid binges.”
They seem like stringent guidelines but, as Prof Murray says, the risks are too sobering to overlook…
To check if you’re under or over the low-risk guidelines, go to askaboutalcohol.ie/your-drinking/drinks-calculator/
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