Chances are you consider yourself a moderate drinker.
Perhaps it’s the odd bottle of wine after work in the evening. Or a few pints with friends in the pub.
But while some of the dangers associated with excessive drinking are obvious, others can appear much more subtly.
Leading experts have rowed about the harms of moderate drinking for decades.
The NHS recommends people drink no more than 14 ‘units’ of alcohol — around six glasses of wine, or pints of beer — per week.
This itself has been watered down over the past few decades in light of studies illustrating the health dangers of alcohol.
So how do you know when your drinking has slipped into something more harmful? We ask the experts…
Perhaps it’s the odd bottle of wine after work in the evening. Or a few pints with friends in the pub. But while some of the dangers associated with excessive drinking are obvious, others can appear much more subtly
Feeling tired all the time
Experts claim pouring yourself a tipple before hitting the sack will only leave you groggy, dehydrated and potentially battling a pounding headache.
Booze interrupts the rapid eye movement (REM) stage of sleep. This phase — the deepest of four we all go through every night — is vital for memory, learning and creativity.
Ian Hamilton, who specialises in addiction at the University of York, said this part ‘provides rest and restoration for the brain’. This is the reason you can wake up during the night after drinking, which can leaving you feeling less refreshed.
Dr Melissa Oldham, from the University College London (UCL) Tobacco and Alcohol Research Group, explains this is due to the body metabolising alcohol later in the night.
After enjoying a tipple, people may nod off faster due to alcohol’s sedative effect, which can increase relaxation and sleepiness.
But after alcohol is absorbed into the bloodstream from the stomach and small intestine, it is metabolised slowly throughout the night.
‘This can lead to people waking up more frequently and feeling more tired the next morning,’ she said.
However, it’s not just the lack of REM sleep that leaves you feeling unrested — alcohol’s dehydrating effects will also leave you feeling weary the next day, experts say.
It can cause drinkers to wake up in the night in need of water, as well as needing to go to the bathroom.
Long term alcohol use also impairs absorption of vitamin B and folate, which is necessary for healthy red blood cells.
‘Excess alcohol [can cause] macrocytic anaemia, where the red blood cells are enlarged but ineffective and break down quicker than healthy red blood cells,’ says Dr McLaughlan.
‘Symptoms can include tiredness, loss of balance, pins and needles, mood disturbance and stomach upsets.’
Sex drive changes
Experts, equally have long warned that drinking heavily over a long period of time can lead to a lower sex drive, or libido.
Alcohol may initially have a bolstering effect on hormones such as serotonin, dopamine and testosterone, which can seemingly boost our sex drive.
‘However, over time, these levels will reduce, which lowers the amount of sexual drive a person will experience and could potentially lead to incidences of depression or anxiety,’ adds Penman.
The NHS recommends people drink no more than 14 ‘units’ of alcohol — around six glasses of wine, or pints of beer — per week. This itself has been watered down over the past few decades in light of studies illustrating the health dangers of alcohol
According to Drink Aware, for men, alcohol depresses the central nervous system which means it can make it difficult for some men to get, and keep, an erection.
Drinking may also prevent or delay orgasm and over an extended period can even turn a temporary condition into longer term impotence.
Like men, women may also find it more difficult to have an orgasm, or find they have orgasms that are less intense after drinking alcohol.
Low mood and anxiety
Alcohol is a depressant that can initially produce a calming effect.
However, as Lisa Gunn, mental health prevention lead at Nuffield Health, explains: ‘When this wears off, we typically see a rebound effect where anxiety levels spike.
‘This is partly because alcohol disrupts the balance of neurotransmitters and chemical messengers in the brain.
‘There is also a social aspect to this. When we drink, we become inebriated and ‘carefree’, which can cause us to say and do things we wouldn’t do when we’re sober.
If we go into ‘blackout’ (periods of alcohol-induced memory loss) during a period of acute intoxication, we are even more likely to wake up with feelings of anxiety, fear, worry, and dread.’
Vision problems
Dizziness, blurred vision, or even double vision are common temporary effects of indulging in booze.
But drinking can also cause ‘symptoms associated with dry eye’, Stephen Hannan, clinical services director at Optical Express, says.
‘These can include red eyes as a result of swollen blood vessels in the eyes, otherwise known as a bloodshot look, itchiness, irritation or discomfort, and fluctuation in vision.
‘Although these are only minor issues, long-term alcohol abuse can actually permanently damage the optic nerves within our eyes, which are the connections responsible for sending visual information from the eyes to the brain,’ he adds.
Research has linked alcoholism to an increased risk of developing macular degeneration — a condition that affects the middle part of your vision — and optic neuropathy, when blood flow to the eye’s optic nerve is disrupted.
The exact relationship between alcohol abuse and these diseases isn’t known, but scientists suggest it may be due to a vitamin A deficiency, which is often correlated with alcoholism.
Dizziness, blurred vision, or even double vision are common temporary effects of indulging in booze. But drinking can also cause ‘symptoms associated with dry eye’, Stephen Hannan, clinical services director at Optical Express, says
‘Cutting out alcohol, or drinking less, will allow your body to over time reverse and put the brakes on many of the short and long-term effects of drinking,’ Mr Hannan says.
‘For example, after just 24 hours of no alcohol, your blood sugar levels will normalise and blurred vision caused by alcohol intake will disappear.’
Weakened immune system
Our immune system helps keep us healthy.
But drinking can weaken this system, leaving us vulnerable to infections and diseases.
Carolina Goncalves, superintendent pharmacist at Pharmica, says: ‘Short-term alcohol consumption can hinder the activity of immune cells such as macrophages, T-cells, and B-cells, which are essential for identifying and combating pathogens.
‘This impairment increases the body’s susceptibility to infections and diseases.
‘Moreover, alcohol immediately affects the gastrointestinal system, the first point of contact before entering the bloodstream.
‘The gut microbiome, a community of microorganisms aiding in gut function and immune system maturation, is altered by alcohol.’
She adds: ‘Research shows that alcohol disrupts communication between gut microbes and the intestinal immune system.
‘It also damages epithelial cells, T-cells, and neutrophils in the GI tract, compromising the gut barrier and allowing microbes to leak into the bloodstream.
‘Finally, alcohol can impact cytokine production — proteins which control inflammation — leading to an imbalanced immune response.’
Changes to your menstrual cycle
Studies also suggest binge drinking can disturb your menstrual health.
Ms Goncalves says: ‘More research has found that the ethanol in alcohol can disrupt how the pituitary gland, which produces hormones, interacts with the hypothalamus, the region of the brain responsible for emotional regulation, and the ovaries.
‘These interactions are collectively referred to as the ‘hypothalamic-pituitary-gonadal (HPG) axis’.
‘Alcohol consumption can disrupt the secretion of luteinising hormone (LH) and follicle-stimulating hormone (FSH), both of which are part of the HPG axis.
‘This can impact the maturation of ovarian follicles and how ovulation is triggered, resulting in hormonal and physiological changes that may cause irregularities in menstrual cycles.’
Fertility problems
Drinking can also make women less fertile too, according to the British Fertility Society.
It causes imbalances in hormones that control reproduction, and even small amounts can affect a woman’s periods and reduce the chance of conceiving.
The UK Chief Medical Officers’ recommend that women trying to have a baby, or pregnant women, should not drink alcohol at all to keep health risks to the baby as low as possible.
Latest data, gathered by the World Health Organization and compiled by Oxford University’s platform Our World in Data, shows the UK’s wine consumption has soared to 3.3 litres of pure alcohol annually (2019), up on the 0.3 litres recorded almost 60 years earlier in 1961. It now accounts for over a third (33.7 per cent) of all alcohol consumed across the country and sits almost level with beer (36 per cent) which has plummeted from the 5.8 litres logged in 1961 to 3.5 litres today
One Danish study showed drinking between one and five drinks a week can reduce a women’s chances of conceiving, and 10 drinks or more decreases the likelihood of conception even further.
Evidence also suggests that drinking more than 14 units per week lowers testosterone levels and sperm quality and quantity in men.
That’s because men who regularly exceed the guidelines are at risk of destroying sperm-producing cells in the testicles, affecting the quality of their sperm.
Dr David McLaughlan, consultant psychiatrist specialising in addiction treatment at Priory Hospital Roehampton, also says: ‘Excess alcohol reduces testosterone production in men, as well as disrupting other hormones which in turn damages the number and quality of sperm produced by men.
‘In women, alcohol disrupts ovulation and implantation of the fertilised egg.’
High blood pressure
Indulging in a tipple can affect blood vessels too.
‘This can cause them to become narrower. When your blood vessels are narrower, the heart has to work harder to push blood around your body, increasing your blood pressure,’ Nathan Penman, clinical manager at Nuffield Health, says.
High blood pressure, or hypertension, puts extra strain on organs including the blood vessels, heart and brain, it can increase the risk of heart attacks, strokes and dementia.
The condition, which affects around one in four adults in the UK, does not usually trigger symptoms.
However, those with a very high reading may suffer headaches, blurred or double vision, regular nosebleeds or shortness of breath.
DO YOU DRINK TOO MUCH ALCOHOL? THE 10 QUESTIONS THAT REVEAL YOUR RISK
One screening tool used widely by medical professionals is the AUDIT (Alcohol Use Disorders Identification Tests). Developed in collaboration with the World Health Organisation, the 10-question test is considered to be the gold standard in helping to determine if someone has alcohol abuse problems.
The test has been reproduced here with permission from the WHO.
To complete it, answer each question and note down the corresponding score.
YOUR SCORE:
0-7: You are within the sensible drinking range and have a low risk of alcohol-related problems.
Over 8: Indicate harmful or hazardous drinking.
8-15: Medium level of risk. Drinking at your current level puts you at risk of developing problems with your health and life in general, such as work and relationships. Consider cutting down (see below for tips).
16-19: Higher risk of complications from alcohol. Cutting back on your own may be difficult at this level, as you may be dependent, so you may need professional help from your GP and/or a counsellor.
20 and over: Possible dependence. Your drinking is already causing you problems, and you could very well be dependent. You should definitely consider stopping gradually or at least reduce your drinking. You should seek professional help to ascertain the level of your dependence and the safest way to withdraw from alcohol.
Severe dependence may need medically assisted withdrawal, or detox, in a hospital or a specialist clinic. This is due to the likelihood of severe alcohol withdrawal symptoms in the first 48 hours needing specialist treatment.
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