Pouring on the pounds………Should alcoholic drinks carry health warnings?

As far as I’m concerned, yes!

How much should we be drinking?

Current Government ‘lower risk guidelines’ for drinking alcohol state men should have no more than 3-4 units a day and women no more than 2-3 units a day. Consistently drinking more than this is linked with a progressive increase in risk to our health.  Specific recommendations have been set for pregnant women or those planning pregnancy, who should drink no more than 1–2 units of alcohol once or twice a week and should avoid heavy drinking sessions.

But what does this really mean in terms of an actual drink(s)? There is no single or simple answer because drinks vary in strength and volume. One unit = 10 ml of pure alcohol. It takes the average adult around 1 hour (for the liver) to process and eliminate this from the body.  Alcohol content is also expressed as a percentage of the whole drink, or alcohol by volume (ABV). Drinks typically range from 3.5%-40%, a lager for example of 5%ABV contains 5% pure alcohol.

 Source: the Daily Mail (2011)

The Calorific value of alcohol

When having an alcoholic drink, more than likely we have no idea what the drink is providing  in terms of our energy, or Calorie intake.  In fact much of the population completely discount the Calories they are getting from alcohol. I am not sure why this is; is it because it’s a drink rather than food, so we think it’s ‘free’? Whatever the reason we need to be aware that alcohol is in fact almost as calorific as fat! At 7 Calories per gram, alcohol makes it very easy for us to exceed our daily Calorie requirement.  The 10ml of alcohol in each unit provides 56kcal but other ingredients in the drinks, like sugar, cream and fruit juice add more calories. No wonder it’s making us fatter!

Current advice says alcohol should contribute no more than 5% of our Calorie intake. This equates to 100 Cal for women and 125 Cal for men, which is not a lot! Studies in the UK however have shown that alcohol actually accounts for nearly 10% of our calorie intake amongst adults who drink (that’s 200 Cal for women and 250 Cal for men). As we shall see in a moment though, it is very tricky to get a clear picture of exactly how much we are drinking.

Here is a list of typical drinks with their unit and calorific values (To do this I used the Drink Aware Unit and Calorie Counter):

Picture1

Another way to look at alcohol is the equivalent food we would be eating with each drink. For example,

  • 1 x 125ml glass sparking wine = 1 chocolate digestive
  • 1 large glass (250ml) red wine = 1 slice of cake
  • 1 pint beer = 1 large slice of pizza
  • 2 alcopops = 1 burger

On a night out I would never dream of eating 2 slices of cake and a biscuit after my meal (well perhaps if it had been a day from hell!) Particularly if you are drinking in a group and the tendency is you drink one after another, after another, you lose track of what you are having. It is easy for calories from alcohol to add up quickly and unnoticed. Pub measures have increased in size (a single can be 25 or 35ml, so doubles can be 50 or 70ml!) and there is often the temptation to ‘go large’ as it’s better value for money. Also be aware that alcohol is an appetite stimulant causing us to overeating at mealtimes and snack late at night.

Now if someone was to say “have a piece of cake”, then offer you another and another, I imagine you would (eventually) turn it down, especially if you are ‘watching your weight’. Visualising the food equivalents can be very effective to help you moderate your intake and is even a good deterrent.

Now I like a drink as much as the next person, especially at the weekend but the fact is, much of the UK population are drinking too much.  If we want to know exactly how much we are drinking however, we have a slight problem. Well, quite a big one really. We don’t exactly know how much people are drinking  because we have a tendency to under-report alcohol consumption. The reasons for this include us drinking more at home which is more difficult to record and when we do drink at home, we seem to adopt the ‘continental free-pour approach’ and therefore drink more than we intended as we are unaware of the volumes and strength of the drinks we have.

Do you know what  a unit looks like? You can buy a Unit measure cup to help you moderate your drinking at home.

Drinkaware have also developed (just launched today!) a free iphone app to help you keep track of your units and Calories which sounds brilliant. Just a shame I have an android phone, otherwise I would be downloading it, although the android version is coming early 2015. Details can be found here.

Surely alcohol isn’t that bad?

Well no, providing you drink sensibly, responsibly and within the lower risk guidelines.

As we have seen, alcoholic drinks contain a considerable number of calories. These Calories come from the sugar that is converted into alcohol. This conversion does not cause the Calories to magically evaporate away, it increases the Calories from 4 Cal / gram found in sugar to 7 Cal / gram found in alcohol.

Apart from alcohol, there is really nothing else in an alcoholic drink that provides anything useful. This is why we refer to alcohol as ’empty calories’. Now I admit that there is a little bit of protein in most drinks and beer and wine contain small amounts of some vitamins and minerals.  These are not in sufficient quantities however to justify having a drink for nutritional purpose, no matter what is being claimed!

Source: Daily Mail (2011)

How much are we really drinking?

University College London made an effort last year to calculate how much we underestimate how much we drink. In 2012, they suggested 75% of men and 80% of women were drinking above the daily limit! The study also showed that when under-reporting is taken in to account, ~50% of men and women could be classed as ‘binge drinkers’ (defined by the Department of Health as consuming more than eight units of alcohol in a single session for men, and more than six units for women). Now even if these figure are ‘a little out’ due to the nature of the problem (and getting accurate data), it is not hard to see that many of us are drinking too much.

Often the term ‘alcohol misuse’ is used when discussing our consumption or the impact of drinking in excess. I think we detach ourselves from the word ‘misuse’ but in fact this is the norm for many of us. One of the problems we have in our society is that we are all becoming reclusive drinkers.   Driven by tight budgets and the high cost of alcohol in pubs and restaurants, we take advantage of the bargain barrels offered in our supermarkets. We drink more than we ever used to at home: off-license sales continue to increase as on-license sales decline. We often drink as a reward; that we’ve made it to the end of the week, because its Wednesday, because it’s Sunday; a last chance to drown out sorrows before going back to work again.  Oh its pay-day, let’s have a drink, I’m stressed out; I need a drink….and so on. The public need to be made more aware of the impact alcohol can have when we think we drink ‘normally’.

Why do we drink when we are stressed?

We live high pressured lives with a 24 -7 attitude.

Workers in the UK currently work the longest hours in Europe, take the shortest lunch breaks and enjoy the fewest public holidays. Childcare is expensive and difficult to find, care for older people is of inconsistent quality and financial support during family-related leave is lower than in some other parts of Europe. (Trades Union Congress, 2014)

We need to think about effective de-stressing; finding an alternative to ‘I need a drink!’ As much as we think having a drink will help us relax (it’s depressant action slows down the body), it is really avoidance ‘therapy’. In the long term, alcohol will not solve the cause of your stress, it will only contribute to feelings of anxiety and depression and ultimately make stress harder to deal with. There a a huge pool of evidence that says those who drink more heavily are more likely to suffer mental health problems.

Why are we so worried about how much people are drinking?

Excessive alcohol consumption is a major cause of preventable premature death, accounting for 1.4% of all deaths registered in England and Wales in 2012 (ONS, 2014) This latest ONS (Office for National Statistics) report also revealed the over 65’s drink more regularly than the under 40’s (sherry being the favourite tipple) whilst 16-24 yr olds are the heaviest drinkers. 1 person is killed every hour by alcohol yet according to the Government’s reducing harmful drinking, 83% of people who regularly drink above the guidelines don’t think their drinking is putting their long-term health at risk. Is this being in denial or just being naive?

Alcoholic liver disease was responsible for the majority (63%) of alcohol-related deaths in 2012 and whilst the public may be aware of the link between alcohol and liver disease, we seem much less informed about the many other health risks such as increased risks of developing cancers, diabetes, high blood pressure, heart disease and stroke; diseases that we associate with (sugary and fatty) food rather than drink. As liver disease is what we call a ‘silent’ disease, most people are actually completely unaware they may be damaging their liver through alcohol. The liver is a hugely capable organ; it can tolerate a considerable amount of work, partly because it has the ability to regenerate, given an opportunity. There is a limit however – by the time someone shows symptoms that their liver is struggling, around 2/3 of it will have been damaged. This is a long way down the road to severe liver damage before anyone knows about it. The public need to be made more aware of the variety of health problems caused by exceeding the safe drinking guidelines.

So what is to be done?

Basically a lot more needs to be done if we are to reduce the impact that excessive alcohol consumption is having on our society. The All-Party Parliamentary Group on Alcohol Misuse have submitted a manifesto asking political parties to commit to 10 recommendations to minimise alcohol-related harm in the UK: I am picking on just 3 of the 10 (click on the link above to read the manifesto and see all 10) but agree there needs to be a ‘blanket approach’ to this problem.

1. Make reducing alcohol harms the responsibility of a single government minister with clear accountability

2. Introduce a minimum unit price for alcoholic drinks

7. Include a health warning on all alcohol labels and deliver a government-funded national public awareness campaign on alcohol-related health issues

Starting with no.1 and no.2, I will be honest to say I am not confident. David Cameron scrapped the plan to introduce a minimum price for alcohol last year claiming there was not enough evidence that the policy would reduce excessive drinking.  The problem is the government receives significant revenue from alcohol sales so it would not be in their best interests to curb consumption?

Moving on to no.7, this is the one that I am personally most interested in and also the one that I think will really help, if it happens. Currently the only information provided on most bottles or cans of drink is the volume strength (ABV) and unit content. New food and drink legislation will come into force in December of this year but alcohol is exempt from this i.e. the calories will not need to be declared. This is a massive missed opportunity. Why have they refused consumers their right to know what is in their drinks? European institutions must address this loophole and ensure alcoholic drinks carry this information so we know how many calories as well as units we are drinking.  This is very much about helping the public make informed choices.

Health warnings are a familiar and prominent feature on cigarette packets and yet the UK seem to be lagging behind other countries that have adopted stronger approaches. The WHO say pictures “significantly enhance the effectiveness” of warning labels but we have yet to make this step. Perhaps because there is also a pool of evidence that says negative messaging is unhelpful. Does the ‘shock factor’ have the right impact? Is it enough to change our habits? Why do we always think ‘it’ will never happen to us?

I would be really interested to know what you think about labels on drinks.

Would something like this help? (Source NY Huffington Post)

Or this? (Source: Faculty of Public Health)

 

 

 

 

Finally should we be looking to lower our drinking guidelines (as well as the drink-drive limit) to encourage the UK population to drink less? An interesting study was published in the BMJ (2012) that suggested “the optimum consumption for drinkers is about half a unit a day, which would avert or delay between 2544 to 6590 deaths per year”.

To end on a positive note, here are 10 tips on how to drink sensibly 🙂

  1. Don’t drink on an empty stomach (food slows down the absorption of alcohol so you are less likely to feel so intoxicated so quickly)
  2. Set yourself a limit before you go out and tell your friends you are ‘trying to be good’ so they can support you.
  3. Alternate an alcoholic drink with a soft drink or water (this will stop you getting too dehydrated and feeling rough the morning after) and if having a meal, have a glass or jug of water with any alcoholic drinks.
  4. Dilute alcoholic drinks with a soft drink – add soda or lemonade to wine to make a weaker ‘long’ drink.
  5. Go for smaller measures – small glass of wine instead of a large, half instead of a whole pint (often you are not asked what size).
  6. Try not to get caught up in big rounds when you might be persuaded to drink much more, more quickly. Also finish your drink before someone ‘tops it up’ for you – this way you can keep a more accurate measure of what you are drinking.
  7. Avoid binge drinking – just because you don’t drink in the week, it doesn’t mean you can ‘save it all up’ for a blowout at the weekend – lots of alcohol stresses your liver
  8. Find an alternative to alcohol to help you de-stress: try a different distraction like exercise, chatting on the phone, reading, cooking or having a bath.
  9. You should avoid alcohol for 48 hrs after a large amount to drink; everybody should aim for 2 drink-free days a week
  10. Don’t drink alcohol when you are thirsty  – it will make you drink more and drink too quickly. Quench your thirst with water first (and avoid salty snacks like peanuts, crisps and pretzels as they will make you more thirsty).
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