How bad is alcohol for you really?
According to NHS statistics, just under half the adult population drink at least once a week. The millions of us who enjoy a tipple make a health decision each time we uncork wine or order a pint. Alcohol comes with risks – indeed, there are 200 medical conditions associated with it. The more you consume, the more serious those risks become.
As Dr Richard Piper, the chief executive of Alcohol Change UK, explains: “Getting drunk has been part of the human condition for millennia and it is a normal thing to do. But alcohol comes with risks, and it is a normal and sensible thing to do to ask questions about what those risks are, so you can make informed decisions when you use alcohol.”
Is binge drinking much worse than drinking a little every day?
Former government drug tsar David Nutt, a professor of neuropsychopharmacology at Imperial College London, says that binge drinking (defined as more than six units for women and more than eight units for men in one session) is worse for your brain and more likely to kill you quickly, due to accidents and risks such as suffocating on vomit, while drinking every day is more likely to harm your heart and liver in the long term.
Nutt is the author of Drink? The New Science of Alcohol and Your Health and co-founder of GABA Labs, which developed Alcarelle, a compound designed to replicate the upsides of alcohol without the harms. He says: “Binge drinking is more likely to kill you because it makes you more likely to do crazy things like drive and have accidents. Really heavy binge drinking, where people go on weekend benders and drink bottles of vodka, can also cause an acute type of liver damage, so overall, binge drinking is worse.”
Alcohol is a toxin, so by definition all consumption is harmful. The risks, however, are low if you stick to the UK chief medical officer’s drinking guidelines of a maximum of 14 units a week (reduced from up to 28 units two decades before), with several drink-free days. Adhering to these guidelines gives you a 1 per cent chance of dying from an alcohol-related condition. But in the UK we find it hard to keep within the safe limits, and ONS figures from 2017 show that 28.7 per cent of men and 25.6 per cent of women admitted to bingeing alcohol on their heaviest drinking day.
Piper says that drinking every day is more likely to lead to dependency. “Several million adults in the UK have a low to moderate level of dependency on alcohol because they drink between five and seven days a week,” he explains. “So that after-work glass of wine might not be so harmless if it becomes several and habitual.”
Is it better to drink in the day or the evening?
There is no evidence to suggest that daytime drinking is any better or worse than nighttime drinking, according to Piper. “It makes no difference what time of day you are drinking. The physical reaction is the same,” he says.
Indeed, while it sometimes feels that alcohol affects us more if we drink in the day, this is most likely because it feels more illicit than drinking in the evening, and also because generally we have things to do afterwards that feel harder as a result of the alcohol, so it seems as though we are more intoxicated.
There are physiological factors however. In his book, Nutt points out that the sleepier you are, the more likely it is that alcohol will put you to sleep, which is why people mix stimulants with alcohol, sometimes in the form of vodka and Red Bull or espresso martinis. He also recommends that starting to drink later in the evening may help you drink less. A study in the Netherlands found that people who started drinking between 8pm and 9pm drank far more than those who started later and that late starters were less likely to try and catch up by bingeing.
Which is less harmful, red wine, beer or spirits?
Brewed alcohol products provide some nutritional benefit. Beer contains protein, B vitamins and antioxidants, but those benefits are significantly outweighed by the harmful effect of the alcohol.
As Prof David Nutt explains: “It’s hard to demonstrate any health benefits from vodka or alcohol per se, but if there are benefits in any beverages, they will come from brewed rather than distilled products. If anything, beer is less harmful than spirits and wine because it contains a range of vitamins and other substances.”
Dr Richard Piper disagrees. “It makes no difference whether you are drinking neat alcohol or a bottle of vintage wine,” he says. “Alcohol does the same damage, no matter the format it’s delivered in. Some are higher in calories, such as beer or wine, which are empty calories with no nutritional value.”
Which is better, ale or lager?
There are pros and cons to both. Real ale contains more compounds that would have health benefits on their own, but also contains more calories. Lager is lighter, less calorific and more gaseous, which means you tend to drink less of it because you feel fuller quicker.
Rhiannon Lambert is a registered nutritionist and the author of The Science of Nutrition. She says: “Ales contain more beneficial compounds like antioxidants and fewer additives than lager. It’s predominantly down to personal preference. If your focus is on calories, opt for a lager; if you’re more interested in what’s in the drink, go for an ale.”
Is it true that one glass of good red wine a day has health benefits?
This red wine claim, part of what’s known as the French paradox, is the idea that the relatively low rates of heart disease among wine-loving French adults (who are also considered to eat a significant amount of saturated fat) may be attributed to the beneficial plant compounds known as polyphenols found in red wine, particularly resveratrol, which might help prevent inflammation, lower bad cholesterol and prevent blood clots.
The effect is more likely to be environmental, however, according to Nutt. “Red wine is great provided you live in France and drink it in Provence, so you get all the other benefits: the sunshine, the vitamin D, the omega 3-rich diet, the fresh fruit and vegetables. The paradox is the Mediterranean diet. Red wine won’t offset a bad diet.”
Lambert adds: “Red wine has some beneficial properties, but these benefits are only optimised when it is consumed in moderation, a detail that often gets overlooked. While a small glass of red wine may offer health-promoting properties, indulging in an entire bottle makes these advantages redundant.”
Don’t crack open the champagne just yet, however, as there remains a lot of uncertainty over whether even moderate drinking confers any health benefits. For a long time it was thought that red wine provided some protection against stroke. A 2018 review published in The Lancet, however, concluded “no level of alcohol consumption improves health”. It said that although there may be a partial cardiovascular benefit, particularly for women, the amount of alcohol optimal to provide this protection is very low, and the benefit to the heart was outweighed by all the other risk factors, most notably cancer.
Lambert adds that recent research suggests the quality of the wine makes a difference to our unique gut microbiome. This is because different production methods can increase the levels of polyphenols in the wine, and these can improve beneficial gut bacteria. However, alcohol can actually kill off the beneficial bacteria in our gut, as well as compromising stomach acid production, making it harder for us to break down food and get the nutrients from it.
Is beer before wine really fine?
According to the saying “beer before wine, feel fine; wine before beer, feel queer”, the order in which you consume drinks can influence the severity of your hangover. Nutt believes there is some truth in this, but not because of any chemical interplay between the drinks. It’s simply because beer is filling and lower in alcohol volume, so if you drink that first, you get fuller quicker and you’re less likely to drink a lot of anything afterwards.
Lambert, however, is more cautious: “Consuming your drinks in a specific order is not a reliable predictor of how you will feel the next day. The key to minimising the effects of a hangover is drinking responsibly, staying hydrated and being mindful of your limits,” she says.
While the severity of the hangover is largely dictated by the amount of alcohol consumed, drinking clear spirits may produce a lesser hangover compared to drinking darker aged distilled spirits because the ageing process develops more complex alcohol compounds called congeners, which are believed to exacerbate hangover symptoms. One study concluded that bourbon created a worse hangover than vodka, for example.
Is drinking with food better for you?
Food delays the absorption of alcohol and flattens peak levels of alcohol in the blood, which in turn lessens the risks associated with consumption. If you drink with food, the same amount of alcohol enters the system but it won’t affect you so quickly.
“Peak levels – where alcohol enters the bloodstream quickly because there is nothing in the stomach to soak it up – are more damaging both to the brain and the body. They also produce more withdrawal symptoms,” says Nutt.
The ‘lady petrol’ effect: does white wine really create such a dramatic reaction in women?
There is some truth in this concept as women get more drunk than men on the same amount of alcohol. This is because generally women have more fat as a proportion of their body mass and alcohol doesn’t permeate fat, leaving higher levels in the bloodstream.
But it’s not purely wine that acts as “lady petrol”. “Women get drunk on everything,” says Nutt. “It’s just that they are seemingly more likely to drink white wine.
“Interestingly, women are less likely to come to harm when drunk than men,” he adds. “We don’t entirely know why that is, although they don’t tend to do crazy things like men when they are drunk, like jump off balconies or get into fights.”
What’s behind the drinking gender divide?
Men generally consume more alcohol than women, but the gap between genders has narrowed in recent years, particularly among younger drinkers where the rates of consumption between men and women, and the rate of bingeing, is similar and, in some cases, higher among young women. Men drink more frequently than women and are more likely to exceed the weekly limits, with 37 per cent of men aged 45-64 and 19 per cent of women in the same cohort drinking over 14 units of alcohol in a week, according to 2021 research.
This, Nutt believes, is largely due to cultural factors.
“I don’t think women tend to go out to get drunk in the way men do,” he says. “For some men, the ambition when they go out drinking is to get drunk, for women that’s less so. They go out to have fun and alcohol is just one factor in this.”
What’s the best low-calorie drink option?
Beers and sugary cocktails contain the most calories per unit. Spirits contain less calories but tend to be consumed with mixers, which often contain extra calories, so Lambert recommends choosing light versions of mixers, such as sparkling water or slimline tonic.
“Another good option is prosecco. It’s about 80 calories per glass and an alternative to the high alcohol content in spirits,” she says.
At the other end of the scale are cream liqueurs such as Baileys, which contain higher levels of alcohol, sugar and fats.
Is it better to stick to one kind of alcohol?
While Nutt maintains that “alcohol is alcohol” and the risks are the same in any form, there may be advantages to sticking to one drink because it can be easier to monitor how much you’ve had. Switching between different types and volumes can lead to you having lots more without noticing.
Am I allowed to drink on antibiotics?
Alcohol does not affect the way antibiotics work, but it dampens the immune system, which is also an important element in fighting an infection.
“Alcohol doesn’t directly affect the chemical action of the drug,” explains Nutt, “but it does affect your body. Antibiotics are part of the process. You also need your immune cells to work on the infection, so by drinking alcohol you undermine the efficacy of the process.”
Why do some people get drunker than others on the same amount of alcohol?
Several factors influence how drunk a person will get. These include body composition, size and tolerance levels. Bigger people, for example, tend to be able to drink more as they have more mass in which to dilute the alcohol, although this isn’t the case with obese people.
Alcohol alters brain activity by disrupting neurotransmitters and neurochemicals in the brain. There are genetic factors that can also affect this process. One study found that men with a family history of alcoholism appear to have a higher tolerance to alcohol’s effects than those without this family history. It is not fully understood how the inherited pattern comes about and why it appears to only affect men, but Nutt explains that it leaves the sons of male alcoholics at greater risk of alcohol misuse.
“Paradoxically this tolerance makes them more vulnerable to alcohol risks because they can take more than their peers and drink more as a result,” he says.
Do hangovers get worse as you get older?
Many factors affect the severity of hangovers. Dehydration is one because alcohol changes the hormones that regulate water in the body. Another is the direct toxic effect alcohol has on the brain. Most of the alcohol in common drinks comes in the form of ethanol which is broken down in the liver into a toxic compound called acetaldehyde, a known carcinogen. Alcohol also causes inflammation, which releases other toxins.
Liver function does decline with age, as studies show, and so it is believed this affects the severity of hangovers. Dr Niall Campbell, a consultant psychiatrist at The Priory Hospital Roehampton, says the idea that hangovers get worse with age is no myth – and has a lot to do with the body’s changing metabolism, as well as prescription medications.
Nutt believes lifestyle factors may be more relevant. “When you are younger, you may be able to stay in bed and sleep it off for longer, whereas when you are a 40-year-old parent woken by your children early in the morning, you have less time to recover and a hangover feels much worse,” he says.
Are hangovers worse if you’ve drunk sugary cocktails?
Hangovers often feel worse when you’ve drunk several cocktails, but this is more likely to be because of the volume of alcohol you’ve consumed, rather than the ingredients of the drink.
As Piper explains: “I’ve not seen any evidence that hangovers are worse on cocktails, but if they are it’s probably a volume problem. It’s difficult to hold six pints of beer in your stomach, whereas you can very easily take in the same amount of alcohol by drinking spirits and cocktails, so you tend to drink more.”
Nutt also adds that in some aged distilled spirits, the alcohol converts to other more intoxicating and inflammatory compounds.
And Lambert says that while the alcohol in cocktails causes the hangover, sugar can leave you feeling fatigued and sluggish, even when alcohol isn’t in the mix. “This gives rise to what’s known as a sugar hangover, which kicks in within a few hours, making you even more dehydrated when you drink alcohol and causing worse headaches and tiredness,” she says. She advises picking cocktails with less sugar and drinking plenty of water.
Does hair of the dog work?
In short, yes, but it’s not a good idea. “It stops withdrawal, and alcohol is a painkiller but it’s dangerous. It’s relief drinking,” says Nutt. “Once you start drinking to deal with the consequences of being drunk, you are on a very slippery slope. If you find yourself doing that you need to stop because you have opened the door to becoming an alcoholic.”
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