alcohol

Drinking more than a small amount of alcohol can cause cognitive decline in middle and old age a new study has confirmed.

The decline increases with the amount of alcohol we drink above a low threshold and rises with age. The UK guidelines suggest no more than 14 units (140ml) of alcohol a week.

The new study, however, caused a stir because it found the negative effects begin above 9 units a week, five units below the current guidelines.

Professor David Spiegelhalter, a statistician and communicator at Cambridge University says a graph in the study simply confirms 14 units a week, or 16g a day, is where decline is least (see chart). 

“It’s not as straightforward as looking at the graph,” says Professor Simon Moore, one of the study’s authors, who says its lower threshold comes from the calculation involved in fitting the curve to the data.

The debate was fueled by Sun newspaper coverage of the study which came under a headline saying a pint a day might increase our risk of dementia. It seems to be correct:

A daily pint of 5% lager comes to a total of 16 units of alcohol a week, above both the official low-risk limit as well as the lower one suggested by the new study. ■

Conservative MP Nicola Blackwood, who as health minister ordered a strategy to help the children of alcohol dependent people, narrowly lost her Oxfordshire seat to a Lib Dem in last week’s parliamentary election.

There is no mention of the strategy in the Conservative or LibDem manifestos, while an explicit commitment to it appears in Labour’s. Labour champions of developing a strategy, Jonathan Ashworth and Liam Byrne, were re-elected.

Blackwood’s replacement as minister with responsibility for public health has yet to be named. Ashworth was re-appointed Shadow Minister for Health on Wednesday.  ■

Jurisdictions trying to introduce health warning labels on alcoholic drinks face a daunting battery of legal challenges intended to discourage them and others, say experts.

Hardly any country or province currently provides labels warning people that drinking alcohol increases the risk of a range of mental, physical and social problems, including cancer, heart disease, birth defects, anxiety and depression.

Jurisdictions which try to change this face the threat of being hit by “legal big guns”, according to analysis published last week.* The most recent case was in the sparsely-populated Yukon territory in Canada which halted a trial in December after receiving worrisome legal warnings.

“The raising of legal doubts, threats of litigation and the actual commencement of litigation have the potential to sway all but the most resolute and well-resourced governments from prioritising public health over industry interests,” the paper says.

The law allows the alcohol industry to make legal challenges at the national, supranational or international courts, as well as tribunals. Australia’s defence of plain tobacco packaging, the paper says, drawing a comparison, has been costly and time-consuming, although it seems set to be successful.

Thailand was the first to hear the drumbeat of possible litigation from the alcohol industry after proposing graphic warning labels in 2010. It planned to introduce labels warning that drinking alcohol causes liver cirrhosis and can undermine sexual performance.

But Thailand’s labels never appeared after they were discussed in the World Trade Organisation’s Technical Barriers to Trade Committee, a diplomatic forum. Concerns raised by the EU, US, Australia and New Zealand may have been taken as the signs of impending legal action.

Jurisdictions can have some confidence courts will take their side when their labels are designed to reflect “good scientific evidence”, the paper explains, but opponents can play on nagging doubts by introducing the prospect of long and expensive litigation.

The alcohol industry may, the paper argues, be looking for a “domino effect” in which governments lose their resolve to introduce alcohol labels. Dr Margaret Chan, a former director-general of the World Health Organisation, described the tobacco industry using this strategy in 2015.

The alcohol industry will be “extremely pleased” to halt the Yukon trial (pictured), says Professor Robin Room of Melbourne University, one of the authors of the paper. It also saw the disappearance of a label in place for 27 years warning that drinking while pregnant can cause birth defects.

“We are still a little hopeful that our study may resume in some capacity,” Erin Hobin, a researcher on the trial, told Alcohol Companion. Supporters of plans for health labels in Australia and Ireland, meanwhile, say they are undaunted by Yukon’s legal difficulties.

Continuing to use trade and investment treaties to launch legal action, the paper says, would be “substantially against the public interest and public health”. With overwhelming public support for health labels, the dominos could yet fall the other way. ■

*Paula O’Brien, Deborah Gleeson, Robin Room, Claire Wilkinson; Commentary on ‘Communicating Messages About Drinking’: Using the ‘Big Legal Guns’ to Block Alcohol Health Warning Labels, Alcohol and Alcoholism, https://doi.org/10.1093/alcalc/agx124

Recent headlines saying alcohol drinking “cleans brains” should not persuade humans to drink more.

“It is by no means a green light for people to drink more alcohol,” says Dr Claire Walton, research manager at the UK’s Alzheimer’s Society, about a study on mice which has triggered coverage hinting otherwise.

It is a “big leap” to take a research finding for mice and apply it to people, she said. “There are just too many differences between mice and people to do this.” Drinking more than 14 UK units (140ml) of alcohol a week, meanwhile, definitely increases human alcohol-related dementia risk.

The study investigated the mouse’s brain waste-disposal system which might play a role in the development of Alzheimer’s disease. “This is a relatively new area of research, where there is a lot still to be learned.”

Alcohol had a long history of use as a medicine, but it has since been found to be counterproductive in all cases and fraught with other risks. It is no longer put to any medical use other than as a sterilising fluid because of its ability to kill cells.

Dubious ideas that alcohol drinking can have health benefits can help support our decisions to drink, in what is known by health professionals as alcohol’s false “health halo”. ■

[Some detail exploring the underpinnings of this brief blog post.]

by Nicole Lee, Curtin University

 Reports of a study linking different kinds of alcoholic drinks with different mood states were making the rounds recently. The research used 30,000 survey responses from the Global Drug Survey and found that people attached different emotions to different alcoholic drinks.

For instance, more respondents reported feeling aggressive when drinking spirits than when drinking wine.

We all have friends who swear they feel differently when drinking different types of alcohol. But can different drinks really influence your mood in different ways?

Alcohol is alcohol
Let’s cut to the chase. No matter what the drink, the active ingredient is the same: ethanol.

When you have a drink, ethanol enters the bloodstream through the stomach and small intestine and is then processed in the liver. The liver can process only a limited amount of alcohol at a time so any excess remains in the blood and travels to other organs, including your brain where mood is regulated.

The direct effects of alcohol are the same whether you drink wine, beer or spirits. There’s no evidence that different types of alcohol cause different mood states. People aren’t even very good at recognising their mood states when they have been drinking.

So where does the myth come from?

Grape expectations
Scientists have studied specific alcohol-related beliefs called “expectancies”. If you believe a particular type of drink makes you angry, sad or sexed up, then it is more likely to.

We develop expectancies from a number of sources, including our own and others’ experiences. If wine makes you relaxed, it’s probably because you usually sip it slowly in a calm and relaxed atmosphere. If tequila makes you crazy, maybe it’s because you usually drink it in shots, which is bound to be on a wild night out.

Or if you regularly saw your parents sitting around on a Sunday afternoon with their friends and a few beers, you might expect beer to make you more sociable. Kids as young as six have been found to have expectancies about alcohol, well before any experience of drinking.

We build conscious and unconscious associations between alcohol and our emotions every time we drink or see someone else drinking.

We could even be influenced by music and art. “Tequila makes me crazy” is a common belief, which also happens to be a line in a Kenny Chesney song, and Billy Joel’s Piano Man might reinforce the idea that gin makes you melancholy.

It’s the ‘how’ more than the ‘what’
Other chemicals, called congeners, can be produced in the process of making alcohol. Different drinks produce different congeners. Some argue these could have different effects on mood, but the only real effect of these chemicals is on the taste and smell of a beverage. They can also contribute to a cracker of a hangover.

But there is no evidence that these congeners produce specific mood or behavioural effects while you are drinking.

The critical factor in the physical and psychological effects you experience when drinking really comes down to how you drink rather than what you drink. Different drinks have different alcohol content and the more alcohol you ingest—and the faster you ingest it—the stronger the effects.

Spirits have a higher concentration of alcohol (40%) than beer (5%) or wine (12%) and are often downed quickly, either in shots or with a sweet mixer. This rapidly increases blood alcohol concentration, and therefore alcohol’s effects, including changes in mood.

The same goes for mixing drinks. You might have heard the saying “Beer before liquor, never been sicker; liquor before beer, you’re in the clear”, but again it’s the amount of alcohol that might get you into trouble rather than mixing different types.

Mixing a stimulant (like an energy drink) with alcohol can also mask how intoxicated you feel, allowing you to drink more.

You can reduce the risk of extreme mood changes by drinking slowly, eating food before and while you drink, and spacing alcoholic drinks with water, juice or soft drink. Stick to drinking within the Australian alcohol guidelines of no more than four standard drinks on a single occasion.

Party animals and bad eggs
Alcohol is a central nervous system depressant, which means it slows the brain’s functioning. Alcohol’s effects include reducing activity in the part of the brain that regulates thinking, reasoning and decision-making, known as the prefrontal cortex. Alcohol also decreases inhibitions and our ability to regulate emotions.

“In vino veritas” (in wine there is truth) is a saying that suggests that when drinking we are more likely to reveal our true selves. While that’s not completely accurate, the changes in mood when someone is drinking often reflect underlying personal styles that become less regulated with alcohol on board.

Studies of aggression and alcohol, for example, show that people who are normally irritable, cranky or low in empathy when they are not drinking are more likely to be aggressive when their inhibitions are lowered while drinking.

As with all drugs, the effect alcohol has on your mood is a combination of the alcohol itself, where you are drinking it and how you’re feeling at the time.

So does alcohol make you crazy, mean or sad? If it does, you were probably a bit that way inclined already, and if you believe it enough it may just come true. ■

Nicole Lee, Professor at the National Drug Research Institute, Curtin University.

This article was originally published on The Conversation.