The truth about alcohol

Alcohol abuse is becoming more and more common in women. But how much is too much? And is drinking in moderation safe?

More and more women appear to be drinking more alcohol than is good for them. In the long term, this can lead to serious health problems. Unfortunately, women are more prone to the ill-effects of alcohol than men. Alcohol is also fattening, providing around 7 kcals per gram – almost as much as fat! In addition, many drinks also contain sugar, which provides additional calories – even more reason to treat it with respect. So take our advice and try only to drink in moderation.

How alcohol affects the body
Alcohol is rapidly absorbed from the stomach, reaching maximum blood concentration within around 40 minutes. It starts affecting the brain within one minute, however. And although women subjectively tend to feel less mentally affected by alcohol than men, the reverse is actually true. Alcohol reduces the speed at which we detect visual stimuli - such as traffic signs - more than in men, and we develop more body sway and other signs of impairment than men would at the same alcohol concentrations.

Not surprisingly, the risk of accidents increases with the amount of alcohol consumed, but the risk of injury seems to be significantly higher for women than for men. This effect becomes more pronounced as we get older. Drinking alcohol at the age of 50 produces significantly higher blood-alcohol concentrations than would occur when drinking the same amount at the age of 20 - probably due to metabolic changes, especially after the menopause.

Alcohol affects women more than men partly because they tend to weigh less – a petite female can tolerate the same dose of alcohol much less than a tall, stocky male. We also have lower concentrations of the enzyme that starts breaking down alcohol in our stomach (gastric alcohol dehydrogenase), so more alcohol is absorbed into our circulation intact. Researchers have found that a woman absorbs a third more alcohol than a man of the same size when they have consumed equal amounts.

Effects on the body
Once in the circulation, alcohol is distributed in our body fluids and, as women typically contain 10% less water than men, alcohol concentration remains higher in our body. As alcohol has a diuretic effect, this reduces body fluids further and can quickly lead to dehydration and a hangover.

Excess alcohol poisons the brain, irritates the intestines and leads to dehydration, which together can cause symptoms such as headache, irritability, jumpiness, shakiness, vertigo, nausea, vomiting, indigestion and diarrhoea. It can also lead to inflammation of the stomach (gastritis), pancreas (pancreatitis) and liver (hepatitis).

Women are also more vulnerable to developing alcoholic liver disease than men. This could be because the way we metabolise fatty acids is less efficient, so fats are therefore more likely to accumulate in liver cells, leading to changes such as fatty degeneration and liver inflammation.

The short-term effects of a hangover partly depend on additional substances present in drinks (known as congeners) that add flavour and colour. In general, the darker a drink, the more congeners it contains. Among the spirits, vodka and gin are kindest, while Cognac, brandy, bourbon and whisky contain the highest percentage of congeners and can trigger the worst hangovers. Similarly, red wine contains tyramine, a chemical that can produce a severe headache in some people.

Can drinking in moderation be good for you?
Drinking in moderation can be beneficial. Having one or two units of alcohol per day seems to reduce stress levels and may reduce the risk of a heart attack – partly through the beneficial antioxidants found in some drinks, such as red wine. Even so, recent research suggests that drinking just one unit of alcohol daily may increase the risk of breast cancer in women.

In general, the rate of alcohol-consumption-related health problems are around 50% lower in women than men. Maximum safe intakes for women are no more than two to three units of alcohol per day (versus three to four units for men), with some alcohol-free days per week. Overall, women should try not to drink more than 14 units per week overall (21 units max for men).

One unit of alcohol is equivalent to ½ pint normal-strength beer, one single-measure (25ml) spirit, one small glass of wine (100ml) or one pub measure of sherry.

The amount of alcohol that damages health varies and not everyone who drinks heavily will suffer the same physical effects. Only 20% of heavy drinkers develop cirrhosis of the liver, for example; in others the brain and muscles may be affected more than the liver. This effect seems to be genetically determined.

It is generally accepted that drinking more than 35 units of alcohol per week is dangerous for women (50 units for men). Alcohol addiction tends to develop within three to four years for susceptible women, compared with longer - up to 10 years of heavy drinking - for a susceptible male.

Alcohol in pregnancy
Even small amounts of alcohol can harm a developing baby during pregnancy – especially if there is a high intake around the time of conception or during the first three months of pregnancy.

Alcohol readily passes across the placenta and, because the fetal liver does not break down alcohol very effectively, becomes more concentrated in fetal cells than in maternal cells, to produce powerful toxic effects. This can lead to fetal alcohol syndrome, so try to avoid alcohol during pregnancy if you can.

On a night out
Drink according to your size If you drink on a full stomach, and aim to drink more slowly, alcohol will enter the circulation more slowly, so the liver can keep pace in metabolising it before it can build up in your bloodstream to affect the brain; more will also be broken down by gastric alcohol dehydrogenase Avoid too many sparkling alcoholic drinks (eg Champagne, or rum and Coke) as the bubbles speed up alcohol absorption and get you more drunk more quickly.

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