Drinking just the one to your health

Recent studies show that one in four of us are drinking alcohol at a level likely to damage our health. Below, in the second of a three-part series on alcohol, is your guide to the health problems that can be avoided by drinking less, writes Dr Muiris Houston

Up to 28 per cent of inpatients at the Mater Hospital, Dublin, had a drinking pattern which had led or was likely to lead to health problems, according to a recent study. Some 9 per cent of patients screened had a diagnosis of alcohol abuse, which means they were repeatedly using alcohol despite clear evidence that they were suffering significant harmful consequences.

Hazardous drinking is defined by the Royal College of Psychiatrists and Physicians as drinking more than 21 units of alcohol a week for a man or more than 14 units a week for a woman. A unit of alcohol is a small glass of wine, one measure of spirits, or a half pint of beer.

Drinking alcohol is not necessarily bad for your health. There are a number of statistics which show that non-drinkers and heavy drinkers have a higher death rate from all causes than those who drink in moderation. Recent research in the British Medical Journal further pinpointed the level of alcohol consumption that carries the lowest death rate by linking it with age and sex Hazardous drinking has immediate effects.When the alcohol level in the blood rises above 80 milligrams per 100 millilitres, co-ordination is affected and feelings of euphoria begin.

When it is more than 100mg/100ml, slurred speech and unsteadiness kick in, and when it rises to more than 200mg/100ml, aggression, tearfulness and/or vomiting are likely to follow.

Drinking heavily to produce a level more than 300mg/100ml is likely to bring on a coma and the respiratory centre in the brain (which ensures automatic breathing) may become depressed, leading to death.

The longer-term effects of alcohol on specific organs in the body include the following:

Liver: Alcoholic liver problems (affecting 46 per cent of heavy drinkers) include hepatitis, which means the inflammation of the liver cells. Continuing to drink heavily can lead to cirrhosis of the liver, in which cells die and are replaced by new cells that cause a hardening of the liver tissue (fibrosis).

The main effect of cirrhosis is to block the smooth flow of blood through the liver. Blood backs up and seeps into the abdomen, which swells. Blood may also be forced into a detour around the gullet, the veins of which can fill and even burst, causing a fatal haemorrhage.

Liver cells normally produce proteins, blood-clotting factors and vital vitamins. When cirrhosis sets in, this "factory" element of the liver fails and the patient is left with blood-clotting problems and other knock-on effects. As the process of cirrhosis continues, the liver becomes a hard lumpy rock incapable of sustaining life.

Stomach and gullet: Alcohol strips the lining from the stomach, giving rise to a condition called gastritis.

Severe gastritis can lead to internal bleeding, and the patient may bleed from the back passage or vomit up blood.

Alcohol also contributes to the development of both stomach and duodenal ulcers. Varicose veins may develop around the gullet, leading to overwhelming haemorrhaging into the gastro-intestinal system.

Pancreas: People with alcohol problems often develop both acute and chronic pancreatitis. Acute pancreatitis may occur as an isolated attack of severe stomach pain and is distinguished from the chronic form of the disease by the absence of continuing inflammation and destruction of the gland.

As well as producing insulin, the pancreas is the source of enzymes that are normally released into the intestine to help digestion. When pancreatitis occurs, these enzymes turn on the pancreas itself, causing cell death and damage to blood vessels. Pancreatitis can have a high death rate; it is estimated that 42 per cent of deaths from acute pancreatitis are associated with alcohol. Diabetes mellitus can also occur if the part of the pancreas which produces insulin is affected.

Brain and nervous system: Excess alcohol causes both physical damage to the brain and psychological effects.

Apart from acute alcohol withdrawal - commonly known as the DTs (delirium tremens) - which can cause brain damage and even death, longer-term consumption also contributes to brain disease.

Memory loss is a feature of alcoholic brain disease and is linked to a deficiency of the vitamin, thiamine, in vulnerable people.

When cell death occurs in the part of the brain called the cerebellum, the victim develops an unsteady gait.

Chronic brain damage from alcohol abuse leads to dementia (a decline in cognitive function). The body's peripheral nerves are damaged in up to 15 per cent of patients, leading to symptoms such as pins and needles and numbness.

Alcohol causes a whole range of psychological problems, including self- deception, guilt, anxiety and depression.

Sex organs: Heavy drinking causes shrinking of the testicles in a minority of men, while even moderate amounts of alcohol can decrease the capacity for erection.

Among the life-threatening conditions that can be sparked by alcohol are:

Cancer: Certain cancers occur more often in people with problem drinking; generally, they have a cancer rate 10 times higher than that of the general population.

The mouth, throat, gullet, stomach and pancreas are among the sites with a greater incidence of cancer.

Heart disease: While moderate drinking appears to prevent heart disease, excess alcohol consumption most definitely damages the heart.

There is a strong link between heavy drinking and high blood pressure, which is in turn linked with coronary heart disease and stroke. Binge drinking is associated with the development of an abnormal heart rhythm.

A condition known as cardiomyopathy, in which the heart muscle is damaged, is linked to chronic heavy drinking. The affected muscle cannot pump as well as before and eventually the chambers of the heart enlarge to the point where the valves cannot function properly and heart failure occurs.

Other effects of heavy drinking include alcoholic myopathy, a term given to painful and swollen muscles caused by alcohol. Chronic drinking can also decrease the production of white blood cells, leading to an increased risk of infection.

While alcohol affects different individuals in different ways, we can say for certain that many of the damaging effects of alcohol can be reversed by ceasing to drink in a harmful way. The earlier you stop excessive drinking, the more likely it is you will avoid permanent damage.

Women should limit their drinking to one unit a day up to age 44, two units a day to age 74 and three units a day aged over 75.

Men are advised to limit themselves to one unit of alcohol a day to age 34, three units to age 54 and five units a day at age 85.