Alcohol Help

Women are advised to drink no more than 2–3 units of alcohol a day

Women who drink within the recommended limits are still putting their health at risk, according to The Daily Telegraph. It said new research shows that less than one small glass of wine a day increases the risk of breast cancer.

This large, well-conducted study assessed women’s drinking habits over many years. It found that even low levels of alcohol were associated with a small increase in breast cancer risk. Women who drank three to six drinks a week (5–9.9 grams of alcohol a day) had a 15% greater risk of breast cancer than women who did not drink alcohol. The risk of cancer increased with the amount of alcohol consumed.

The study has a few limitations. For example, it relied on the women to report their own alcohol consumption over yearlong periods, which introduces the possibility of error. Despite this, the link between breast cancer and alcohol is not a new one, and the findings back up the results of several previous studies.

The increase in risk for women who drank low levels of alcohol was modest. Individuals will need to weigh up the modest increase in risk against the pleasure of occasional drinking and the potential benefits for cardiovascular health. There is currently no definite evidence that stopping drinking altogether will reduce a woman’s risk of breast cancer.

Where did the story come from?

In the UK, women are currently advised to drink no more than 2–3 units (16–24g) of alcohol a day.
A standard glass (175ml) of wine is just over 2 units while a pint of premium lager or bitter contains about 3 units.

The study was carried out by researchers from a number of centres in the US, including Brigham and Women’s Hospital and Harvard Medical School, Boston. It was funded by the National Institutes of Health.

The study was published in the peer-reviewed Journal of the American Medical Association.

The report was covered accurately in the media, and most papers included comments from independent experts, which put the significance of the research into context. Most of them also noted that even women who drink within the current recommended limits may be at modest risk.

What kind of research was this?

This prospective cohort study followed nearly 106,000 women for 28 years to evaluate the association between alcohol consumption and breast cancer. Cohort studies that follow large groups of people for long periods of time are often used to look at the effects of lifestyle on health outcomes, although they cannot prove cause and effect.

The researchers point out that many studies have linked alcohol consumption to breast cancer risk, but that the risk of consuming smaller amounts of alcohol has not been well quantified. Their aim was to look at the association in more detail, including the quantity and frequency of alcohol consumption, and the women’s age at the time.

What did the research involve?

The researchers used data from a large US study, called the Nurses’ Health Study, which began in 1976 and involved 121,700 female US nurses aged 30 to 55 years old. The women completed a questionnaire at the beginning of the study that included questions about risk factors for cancer and cardiovascular disease. They were sent follow-up questionnaires every two years to provide up-to-date information and to record any diseases they had developed.

For the present study, researchers analysed data from 1980 onwards, when alcohol intake was first assessed. After they excluded women who had died or developed cancer since 1976, or who did not respond to questions on alcohol, the researchers had data on 105,986 women. Information on alcohol consumption was taken from a food frequency questionnaire in which women were asked to report their drinking during the previous year. Their reported number of drinks a day and type of alcohol consumed were used to estimate their daily alcohol consumption in grams. These data were updated seven times over the next 26 years, and the cumulative average alcohol intake was assessed for this period.

Data on the participants’ current drinking patterns and those during their earlier adult life were first collected in the 1988 questionnaire, which included 74,854 participants. In 1988 (and at three further follow-up points), participants were asked to provide the number of days they drank alcohol in a typical week and the largest number of alcoholic drinks that would be consumed in one day in a typical month. In the 1988 assessment only, they were asked about the number of alcoholic drinks they had each week at three different age periods: 18–22, 25–30 and 35–40 years old.

The participants were categorised according to how many grams of alcohol they consumed a day: none, 0.1–4.9g, 5–9.9g, 10–19.9g, and more than 20g of alcohol a day.

Throughout follow-up, each questionnaire asked participants whether they had been diagnosed with invasive breast cancer and, if so, when. These reports were confirmed using medical records. In their analysis, the researchers only looked at data on alcohol intake before a diagnosis of breast cancer.

The researchers used standard statistical methods to analyse the data, and the results were adjusted for other established risk factors for breast cancer, including whether they had reached the menopause, family history of breast cancer and use of hormone replacement therapy.

What were the basic results?

From 1980 to 2008 (during 2.4 million person years of follow-up), 7,690 cases of invasive breast cancer were diagnosed. The researchers calculated the association between breast cancer and cumulative alcohol intake (a person’s average lifetime alcohol intake, taken from an average of their intake at each follow-up point). They found that:

Women who consumed 5.0–9.9g of alcohol a day (equivalent to 3–6 drinks a week) had a 15% greater risk of breast cancer compared to women who did not drink at all (relative risk [RR] 1.15, 95% confidence interval [CI] 1.06 to 1.24). The size of the increase was small. Among women who drank no alcohol at all, breast cancer occurred at a rate of 281 cases per 100,000 person years. Among women who drank 3–6 drinks a week, the rate was 333 per 100,000 person years (an extra 52 cases).
The size of the risk progressively increased with each of the four intake categories, so that women in the highest consumption category, who consumed on average 30g or more daily (at least two drinks a day) had a 50% greater risk of breast cancer than non-drinkers (RR 1.51, 95% CI 1.35 to 1.70).
No significant risk was associated with the lowest consumption of 0.1–4.9g of alcohol a day (equivalent to one to three drinks a week).
When the researchers looked at two broad age categories – earlier life (ages 18–40) and later adult life (40 or over) – alcohol intake in both these separate periods of life was associated with risk.

How did the researchers interpret the results?

The researchers say their results highlight the importance of considering lifetime exposure when evaluating the effect of alcohol on breast cancer risk. They say that alcohol may affect breast cancer risk by increasing blood levels of the hormone oestrogen, which is implicated in many but not all types of breast cancer.

Conclusion

In this large, well-conducted study, women were followed over a long time and their alcohol intake was assessed during different age periods. This gives a comprehensive evaluation of the effects of alcohol throughout a woman’s life. The observed link between breast cancer and alcohol is not new, and alcohol is already an established risk factor for breast cancer. This study provides valuable, in-depth data on the effects of a woman’s average lifetime alcohol intake and the risks associated with different levels of consumption.

One unavoidable limitation of this study is its reliance on women remembering and reporting their alcohol use over the past 12 months. There is a risk that average alcohol intake may have been categorise wrongly, particularly as the cumulative intake was estimated using an average of the intakes reported at each follow-up point. It is possible that women inaccurately reported their intake or that their intake did not remain the same over time. As one independent expert pointed out, it is common for people to underestimate their alcohol use in questionnaires (although the authors say the study took measures to validate the participants’ responses). A second limitation of this type of study is that other factors might be associated with both alcohol intake and risk of breast cancer (called confounders). The authors made careful attempts to adjust their analyses for established risk factors for breast cancer (such as use of hormone therapy, family history of breast cancer, age at first period and menopause). However, it is still possible that other unknown or unmeasured factors could have had an effect.

This study found that even a low level of alcohol consumption, assessed from information throughout a woman’s lifetime, slightly increased the risk of breast cancer, and that the risk increased with the amount of alcohol consumed. Alcohol consumption has already been associated with several cancers, including breast cancer. As the authors point out, women will need to weigh up the modest risks of light alcohol consumption against both the pleasure of occasional drinking and the potential benefits for cardiovascular health.

An accompanying editorial to this study also addresses an important question: as breast cancer risk increases with age, should postmenopausal women consider stopping drinking altogether to reduce their risk? The author of the editorial says that a woman’s individual risk factors for breast cancer should be taken into account, but notes that currently “there are no data to provide assurance that giving up alcohol will reduce breast cancer risk.”

Further research looking at the relationship between risks and benefits is warranted.

NHS Choices

Doctors advise two to three alcohol-free days a week

Doctors have warned, “drinkers should have three alcohol-free days a week if they want to avoid the risk of liver disease,” the Daily Mail reported. It continued that the Royal College of Physicians (RCP) said that the current guidance must be rewritten as it implies that drinking every day is fine.

The new advice from the RCP is part of a submission to MPs on the House of Commons’ Science and Technology Committee about current alcohol guidelines. This submission discusses their review of the evidence from 1995 as well as more recent research evidence and alcohol intake guidelines from other countries. The RCP concluded that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It adds that the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease.

To address what it sees as a problematic lack of emphasis on the frequency of drinking, the RCP suggests that the current advice on safe limits for alcohol intake should be stated in terms of weekly alcohol intake rather than daily unit limits, and that two or three days in the week should be completely alcohol free. It says that men should consume no more than 21 units a week and women should have no more than 14 units, provided the total amount is not drunk in one or two sessions.

The Department of Health (DH) has reportedly said that it has no plans to change its guidance at present. It recommends that men should not regularly drink more than 3-4 units of alcohol a day, while women should not regularly drink more than 2-3 units. ‘Regularly’ is defined as drinking every day or most days of the week. People are also advised to not drink alcohol for 48 hours after a heavy session to let their bodies recover.

Alcohol abuse is associated with an increased risk of liver disease, cancer and other conditions. Read our Live Well pages on alcohol to find out more.

Where is the advice from?

The advice comes from a report by the Royal College of Physicians (RCP). The RCP submitted its report to MPs on the House of Commons’ Science and Technology Committee. As such, the advice given is for the government about its policy on recommended alcohol intake limits, rather than being aimed directly at the public.

The RCP believes that government advice on sensible drinking limits can play an important role in dealing with alcohol misuse. It says that it is essential government advice is based on evidence and that it is regularly reviewed. It continues that the last systematic review of the evidence by the government, to which interested parties could submit their views, was in 1995.

The RCP believes that current government guidelines on alcohol consumption could be improved to better reflect the evidence in a number of areas, such as:

# overall levels of consumption that are ‘safe’ or within ‘sensible limits’
# frequency of alcohol consumption
# the physiological effects of ageing
# the balance of the health benefits of alcohol consumption for coronary heart disease against wider alcohol-related health harm

The RCP would also like a clear, independent evaluation of the government’s strategy for communicating its guidelines and the risks of alcohol intake to the public.

What does the RCP advise?

The RCP believes that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It says this is problematic, because the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease. The RCP cites various studies to support its argument.

It also notes that someone drinking four units a day (the current upper limit for men in the UK) would be classed as a hazardous or high-risk drinker on the WHO’s gold standard tool for identifying people at risk of alcohol-related harm.

The RCP says that these potential problems with the current guidelines could be remedied by moving to a weekly limit and adding the recommendation to three alcohol-free days a week.

It recommends that in order that people keep their alcohol consumption within ‘safe limits’, men should consume no more than 21 units a week and women should have no more than 14 units. It says that most individuals are unlikely to come to harm at these levels, provided the total amount is not drunk in one or two sessions, and that there are two to three alcohol-free days a week. It says that above this limit the risk of death from all causes increases as alcohol consumption increases.

The RCP also notes that these recommendations are a best judgement based on the evidence, and were reached after a number of areas of uncertainty and inaccuracy were taken into account.

The RCP also suggests that recommended limits for safe drinking by older people in the UK require further consideration, as older people may be particularly vulnerable to harm from alcohol due to biological changes associated with ageing. It says that current guidelines are based predominantly on evidence for younger age groups and there is concern they are not appropriate for older people.

What evidence is this based on?

The RCP’s advice appears to be based on their review of evidence from 1995, and updated with other research evidence published since 1995.

What is current UK government advice?

Official UK government guidance recommends that men should not regularly drink more than 3-4 units of alcohol a day and women should not regularly drink more than 2-3 units a day. ‘Regularly’ is defined as drinking every day or most days of the week. It is also recommended that people not drink alcohol for 48 hours after a heavy session to let their bodies recover.

Pregnant women and women trying to conceive should avoid drinking alcohol. If they do choose to drink alcohol, they are advised to not drink more than 1-2 units of alcohol once or twice a week and not to get drunk, to minimise the risk to the baby. The National Institute for Health and Clinical Excellence (NICE), advises women to avoid alcohol in the first three months of their pregnancy in particular, because of the increased risk of miscarriage.

How do the UK guidelines compare to other countries?

The RCP notes that comparing alcohol guidelines between different countries is difficult, as there are differences in the size of standard drinks and units. It reports that a recent analysis by the Australian government found that 15 countries recommended lower limits than the UK for men, and 12 countries recommended lower limits than the UK for women. Six countries recommended higher limits than the UK for men and six countries recommended higher limits than there are for UK women.

The RCP notes that although looking at the guidelines from other countries may be of interest, it is important that UK government guidelines are a considered and expert judgement on the risks of alcohol consumption, based on the scientific and medical evidence.

NHS Choices

The leader of a gang of six criminals involved in stealing a £1.8 million in excise duty has been jailed today following a complex investigation by HM Revenue & Customs (HMRC) into the sale of illicit alcohol.

The gang, masterminded by Paramjit “Pete” Bagri, from Holywell, North Wales, bought alcohol from legitimate bonded warehouses under the pretence of shipping them to the continent. They then illegally diverted the shipments to various locations within the UK, selling on the drink without paying the duty owed.

Mike O’Grady, Assistant Director of Criminal Investigation for HMRC, said:

“This was a calculated attempt to defraud the public purse and to personally profit from the illegal trade. HMRC is committed to protecting public finances from attacks by organised crime, and the extra £917 million invested in HMRC will help us step up this fight. Anyone with information relating to this type of crime should contact the Customs Hotline on 0800 59 5000 to help us stamp it out.”

Gang members Richard “Gerry” Ellis, 52, and Mohammed Ajmal Tariq, 51, are both currently in prison following convictions in July 2011 for their parts in the fraud. Ellis, a former pub landlord, ran a logistics company which collected the consignments of alcohol. He had paid a £120,000 ‘movement guarantee’ to HMRC allowing him to legally move alcohol between bonded warehouses which he abused in order to illegally divert the shipments without arousing suspicion. Tariq ran Direct Plus Distribution which dealt in the supply and sale of alcohol – he was linked to at least six alcohol diversions stealing well over £600,000 from the public purse.

On sentencing, His Honour Judge Steiger said:

“This was an ingenious and complex fraud and I am satisfied that Bagri was top of the tree”.

Bagri and three men, Nadim Iqbal, Mohammed Vaqas and Baldeep Singh Tahkar, pleaded guilty before the start of their trial. Richard Gerrard Ellis and Mohammed Tariq were found guilty by a jury at Manchester Crown Court in June 2011.

Confiscation proceedings are now underway involving the analysis of how key figures in the gang attempted to evade taxes and hide the cash gained from their illegal trade. The evaded UK duty alone was given as over £1,799,448 in court. However, the confiscation will look to determine other tax evasion and criminal benefits associated with their activities.

HM Revenue & Customs

Women should drink no more than 2-3 alcohol units a day

A study has found that “middle-aged women who indulge in an alcohol drink or two a day are boosting their chance of good health in their seventies”, The Daily Telegraph reported.

This study was in 13,894 nurses in the US. Their alcohol consumption in midlife (average age 58 years) was monitored and compared with their chances of being free from major chronic disease and mental impairment in later life. Light to moderate alcohol consumption (about 0.6 to 3.75 units per day) during midlife was associated with a small (2.1%) absolute increase in the chance of being free of these conditions at age 70 compared with drinking no alcohol. The study also found that those who spread their midlife drinking over the week experienced more benefit than those who concentrated their alcohol consumption on just one or two days.

Overall, this research is consistent with other research showing that low to moderate alcohol consumption may be associated with improvements in some areas of health. However, it is important to remember that the harmful effects of drinking heavily are well established. See our Live Well pages on alcohol for the UK recommendations on consumption and other advice.

Where did the story come from?

This study was carried out by researchers from the Harvard School of Public Health and Harvard Medical School. Funding was provided by grants from the National Institutes of Health and Boston Obesity Nutrition Research Centre.

The study was published in the open-access peer-reviewed journal PLoS Medicine.

The news coverage of this story was generally accurate. The Daily Mirror report may have given readers the mistaken impression that the study looked at drinking in old age, when it actually looked at the effects of drinking alcohol in midlife on the likelihood of healthy survival in old age.

What kind of research was this?

This study examined the effect of alcohol consumption during midlife on women’s chances of being free from major chronic disease and mental impairment in later life. The researchers focused on aspects of what they called “successful ageing”, which they defined as “being free of 11 major chronic diseases and having no major cognitive impairment, physical impairment or mental health limitations”.

The authors state that previous research has found that moderate alcohol consumption reduces the risk of premature death. However, it is largely unknown whether moderate alcohol intake is also associated with overall health and wellbeing among populations who have survived to older age.

This research looked at a subset of women taking part in a prospective cohort study in the US called the Nurses’ Health Study. A cohort study is an appropriate and feasible study design for assessing the relationship between alcohol consumption in midlife and successful ageing later on.

What did the research involve?

The Nurses’ Health Study was established in 1976 when it enrolled 121,700 female nurses. Every two years afterwards the women were sent questionnaires asking them about their lifestyle and medical history.

Consumption of beer, wine and liquor at midlife (average [median] age 58 years) was assessed using a validated food frequency questionnaire. The alcohol consumption results from the 1980 and 1984 questionnaires were then averaged to determine each woman’s daily midlife alcohol use. One drink was defined as a 355ml bottle or can of beer, a 118ml glass of wine or a shot of liquor.

These same women were followed up at age 70 or older and their health status checked to see if they had “successfully aged” as the researchers put it. Successful ageing was considered to be being free of 11 major chronic diseases (including cancer, diabetes and heart disease) and having no major cognitive impairment, physical impairment or mental health limitations.

In the Nurses’ Health Study, 21,202 were 70 years or older and free of stroke in 1995-2001. These women were invited to participate in the study. The researchers excluded women who drank more than 45g of alcohol a day (5.6 units) at midlife. They also excluded women who already had chronic diseases at the start of the study; had been diagnosed with alcohol dependence, chronic liver disease or cirrhosis; had missing information on health outcomes or alcohol use; or reported having substantially reduced their alcohol consumption when asked in 1980 (as this could indicate problems with alcohol). This left 13,894 female nurses for the current analysis.

The statistical analysis took into account a range of factors that could have potentially influenced the relationship between midlife alcohol consumption and successful ageing (confounders). These were: age; body mass index; physical activity; smoking status; level of education; husband’s level of education; marital status; postmenopausal hormone use; family history of heart disease, diabetes or cancer; personal history of hypertension or high cholesterol; use of aspirin and dietary intake of fruit and vegetables, wholegrains, fish and red meat.

What were the basic results?

Of the eligible participants, 10.7% achieved “successful ageing”. A quarter of women did not drink in midlife, while 62.1% drank about one drink a day, 9.8% drank about one to two drinks a day and 9.8% drank two to three drinks a day. The vast majority of women who drank in midlife drank wine.

The researchers found that, after taking into account the influence of a range of potential confounders:

Light drinkers in midlife (5.1-15g of alcohol per day, or 0.6 to 1.9 units) were 19% more likely to age successfully (odds ratio [OR] 1.19, 95% CI 1.01 to 1.40) than non-drinkers. The absolute difference between the proportion of women who had successfully aged who drank lightly (11.6%) compared with non-drinkers (9.6%) was small at 2%.
A higher proportion of light to moderate drinkers in midlife (5.1g to 30g of alcohol, or 0.6 to 3.75 units per day) aged successfully (11.7%) compared with non-drinkers (9.6%). The absolute difference was 2.1%.
Moderate drinkers in midlife (15.1-30.g of alcohol per day or 1.9 to 3.75 units) were 28% more likely to age successfully (OR 1.28, 95% CI 1.03 to 1.58) than non-drinkers. The absolute difference between the groups was 2.2%.
There was no statistically significant benefit in those who consumed higher levels of alcohol (30.1-45g of alcohol or 3.75 to 5.6 units per day) compared with non-drinkers.

After taking into account total alcohol consumption, these differences were more pronounced in people who drank alcohol more regularly throughout the week, rather than on fewer occasions. This was demonstrated by the finding that people who drank on one to two days a week had the same chances of successfully ageing as non-drinkers. Those drinking on three to four days in midlife were 29% more likely to have successful ageing than non-drinkers (OR 1.29, 95% CI 1.01 to 1.64). Those who drank on five to seven days per week in midlife were 47% more likely to have successful ageing than non-drinkers (OR 1.47, 95% CI 1.14 to 1.90).

How did the researchers interpret the results?

The researchers state that “these results suggest that regular, moderate consumption of alcohol at midlife may be related to a modest increase in overall health status among women who survive to older age”. In addition, they say their results “suggest the potential importance of drinking pattern in the relationship between alcohol use and successful ageing”.

Conclusion

The results of this analysis of a large prospective cohort study of female nurses suggest that light to moderate alcohol consumption during midlife is associated with a modestly improved overall chance of being free of major chronic disease and mental impairment at 70 years of age. In addition, they suggest that those who spread their drinking out over more days of the week may be more likely to achieve successful ageing than those concentrating consumption over just a few days.

While this study has some strengths, such as its size and prospective data collection, the following issues need to be considered when interpreting the results:

It is possible that at least some of the women who did not drink might have not done so because of ill health or alcohol problems. This would mean that the non-drinking group would be less likely to be healthy in old age as they were already sick in midlife. Although the chances of this may have been minimised by excluding people with major chronic diseases and known alcohol dependency at the start of the study, it may not have been eliminated entirely.
There may have been residual confounding. This means that other factors that weren’t measured, such as wealth, could potentially have influenced the relationship between alcohol consumption and successful ageing. This was minimised in this study by adjusting for a large range of confounders in the statistical analysis, including educational attainment, which can give some indication of wealth. The researchers suggest that their findings should be interpreted cautiously because of this possibility.
The research was in registered nurses of European ethnic origin. Hence, these results cannot be generalised to men or women of other ethnic backgrounds, or of different socioeconomic status, who may have different drinking patterns and health outcomes.
As with all studies of this type, accurately assessing the level of alcohol consumed can be tricky, as it relies on people estimating how much they drink.

Overall, this research provides evidence that light to moderate alcohol consumption, in the region of one to two drinks per day, is associated with an increased chance of ageing successfully in women of European origin. This is consistent with other research showing that light to moderate drinking may be associated with improvements in some areas of health. It is more difficult to be certain that the drinking itself is causing these improvements, and not other factors.

However, it is important to remember that the harmful effects of drinking heavily are well established. The current UK recommendations are that people who drink should drink no more than three to four units of alcohol per day for men (approximately one pint of high strength larger) and two to three units for women (approximately one standard size glass of wine).

NHS Choices

A nationally recognized alcohol awareness program that has been clinically proven to reduce student alcohol abuse is now in place at WPI.

AlcoholEdu, developed by a Newton, Mass.-based entrepreneur, is an online education and self-examination program that uses videos, surveys, quizzes and other tools to help students make more informed decisions about alcohol and better cope with alcohol-influenced behavior.

Erica Tolles is assistant director of the Student Development & Counseling Center and also serves as coordinator of alcohol and drug programming. She initiated a reevaluation of WPI’s online alcohol education options after attending a January conference and identifying three strong candidates. In the end, AlcoholEdu carried the day–though it’s actually a return engagement, Tolles revealed.

“WPI did use AlcoholEdu in the past. Because of the high cost the decision was made to try a new online education program,” she said. Despite the price tag, Tolles reconsidered AlcoholEdu after learning of other universities’ success with it. “I spoke with several other schools that made the switch to AlcoholEdu from other programs. They described their experience with (AlcoholEdu) versus what they previously used as night and day – and they made it clear that you get what you pay for.”

What makes AlcoholEdu superior, according to Tolles, is that it is designed for population-level prevention, in that it is personalized for individual students – from non-drinkers to heavy drinkers – based on their responses. She noted that data generated by this program will be helpful in gaining information about first-year students, so targeted education can be developed to meet their needs.

She added that AlcoholEdu is the only such program whose effectiveness in producing behavioral change has been documented in several published studies. The Boston Globe reported that a study involving 30 colleges that implemented AlcoholEdu experienced “significantly reduced common alcohol-related problems among freshmen, including binge drinking and sexual assault.” Students who completed the program were also less likely to get into arguments or have problems with authorities.

Tolles stressed that AlcoholEdu is only part of WPI’s approach to alcohol awareness. Other components include Step Up, a bystander-intervention program; BASICS, which helps students examine their own use of alcohol; and peer-education programs.

Worcester Polytechnic Institute

The Daily Express reported today that “a nap can be spoiled by a nightcap” and that “a wee dram before bedtime…causes insomnia and robs a night’s rest of its restorative powers”.

This research evaluated the impact of drinking before going to bed on heart rate and sleep. The study involved 10 university students, who were given low levels, high levels or no alcohol to drink before bed. Drinking higher doses of alcohol was found to reduce the amount of REM sleep, and resulted in a shallower sleep during the latter half of the night. It also appeared to adversely affect the part of the brain that usually controls the body during sleep. From this, the researchers concluded that the alcohol had disturbed the restorative effects of sleep.

This was a small alcohol study, and it has several limitations, which mean that its results are not conclusive. Further research involving more subjects and using a different study design is needed.

Alcohol is already known to cause poorer quality sleep. Further study would be useful to establish the extent of this effect, and how much alcohol would be needed to cause an effect (such as whether a ‘nightcap’ is enough as reported here). Read the Live Well section on Insomnia for useful tips for a good night’s sleep.

Where did the story come from?

The study was carried out by researchers from the Akita University School of Medicine, the Saiseikai Nagasaki Hospital, and the Akita Kaiseikai Hospital in Japan. Information on funding was not provided.

The study was published in the peer-reviewed journal Alcoholism: Clinical and Experimental Research.

The newspapers accurately covered this research, with the Express and the Daily Mail accurately reporting that the researchers found a dose-dependent relationship, in which the negative effects were mainly seen in those who drank a high dose of alcohol.

What kind of alcohol research was this?

This was a human experimental study, which examined the effects of alcohol on the relationship between sleep and heart rate. To do this, the researchers used a technique that assessed “heart rate variability”, which evaluates fluctuations in the timing of heartbeats.

The researchers chose to examine heart rate variability because previous research has shown that it provides an indirect measure of autonomic nervous system activity. Nervous system activity can be difficult to measure directly, but it influences many human functions, including heart rate. The researchers thus used observable changes in heart rate to draw conclusions about the activity of the autonomous nervous system. This system, among other things, controls the “automatic” functions of our organs, including heart rate, breathing and digestion. It is comprised of:

the sympathetic nervous system, which controls our stress, or fight-or-flight response
the parasympathetic nervous system, which controls our body’s functioning while at rest

During normal, healthy sleep, the parasympathetic nervous system’s activity increases, while the sympathetic nervous system’s activity decreases. By measuring heart rate variability (which is controlled by the autonomic nervous system), it should show the relative activity of these two systems.

The researchers say that alcohol decreases parasympathetic nervous system activity and increases sympathetic nervous system activity while we’re awake. The study examined whether this was also true during sleep, and what impact any change in autonomic nervous system activity levels had on the quality of sleep.

What did the alcohol research involve?

The researchers recruited 10 male university students to take part in the study, and tested the effects of drinking alcohol on their heart rate variability and sleep quality. The volunteers were not allowed to drink alcohol for the two weeks before the study, and were instructed to get seven to nine hours of sleep per night on a regular schedule during those two weeks.

During the experiment, the researchers gave the students one of three doses of alcohol: a control dose (0 grams), a low dose (0.5 gram per kg of body weight) or a high dose (1 gram per kg of body weight). Each participant repeated the experiment with each of the doses. A device that measures heart rate called an electrocardiogram (ECG) was attached to each individual on the day of the experiment for the 12 hours before consuming alcohol and while they were asleep. The subjects were given dinner three hours and 40 minutes before going to bed, and were instructed to consume the alcohol one hour and 40 minutes before going to bed. The researchers took blood samples 30 minutes before the students went to sleep, and then again 20 minutes after they woke up to measure blood alcohol content. Each participant completed the sleep study on three separate occasions, each three weeks apart, and consumed a different dose during each experiment.

Heart rate variability was used as a measure of autonomic nervous system activity while the individuals were asleep. In addition to the ECG, measurements were taken for muscle activity, breathing, body position and snoring, to determine the depth and quality of sleep.

The collected data was analysed to determine the level of activity of both the sympathetic (fight-or-flight) and parasympathetic (rest) nervous systems, and whether or not drinking alcohol affected these activity levels. The parasympathetic nervous system is usually dominant when we are asleep. The researchers evaluated the effect of the alcohol during the three hours before and after drinking the alcohol, the first three hours of sleep, and the last three hours of sleep.

What were the basic alcohol results?

The researchers found that the high dose of alcohol increased the amount of time taken for the volunteers to reach the REM sleep stage. The REM stage tends to be shallow sleep, and is the time during which we dream.

After drinking the high dose of alcohol, sleep patterns were altered during the first part of the night. When the students drank the high dose of alcohol they:

experienced less REM sleep than after the low dose of alcohol
moved less than after the low dose of alcohol
woke up less than after no alcohol
had a significantly higher heart rate than after no alcohol.

After drinking the high dose of alcohol, sleep patterns were altered during the second part of the night as well. When the students drank the high dose of alcohol they:

experienced less REM sleep than after the low dose of alcohol
spent more time in Stage 1 sleep (the beginning of the sleep cycle, a light sleep) than after no alcohol
woke up more often than after no alcohol
had a significantly higher heart rate than after no alcohol or the low dose alcohol.

Overall, when volunteers drank the high dose of alcohol they experienced a decrease in REM sleep throughout the night, and shallower sleep during the last half of the night.

In terms of autonomic nervous system functioning, when volunteers drank the high dose of alcohol they showed:

less parasympathetic nervous system (rest) activity compared to those who drank no alcohol
less sympathetic nervous system (fight or flight) activity compared to those who drank no alcohol
more sympathetic and parasympathetic nervous system activity in the second half of the night compared to the first half.

When the volunteers drank the low dose of alcohol they also exhibited less parasympathetic nervous system activity compared to those who drank no alcohol.

How did the researchers interpret the alcohol results?

The researchers concluded that when alcohol is consumed before going to bed, the activity of the parasympathetic nervous system is reduced during sleep, allowing the sympathetic nervous system to be dominant. Alcohol also increases the level of wakefulness during the last half of the night when consumed in high doses.

They also say that their results show that drinking higher levels of alcohol interferes with the relationship between sleep and the autonomic nervous system.

Finally, they say that the results suggest that alcohol disturbs the restorative effects of sleep, preventing the heart rate from decreasing and the parasympathetic nervous system from becoming dominant.

Conclusion

This was a small sleep study, which examined the impact of drinking alcohol on the quality and depth of sleep. The fact that this study was in only 10 people is an important limitation, as it increases the possibility that these results are due to chance alone.

The study has other weaknesses. The researchers say that it may be difficult to determine whether the poor sleep observed was due to the alcohol or due to trying to sleep while attached to multiple electrodes and monitors. It is likely that the volunteers would have found the first night under these conditions the most difficult to sleep in. Because all participants received the same amount of alcohol on the first night, this could mean that the results for this first night are not reliable. A better design would have been to randomly assign participants to different orders of receiving the drinks, so that this “first night effect” would affect all the different drink levels equally.

Heart rate variability is also an indirect measure of nervous system activity. Therefore attributing changes in this measure to changes in nervous system functioning should be done cautiously. The researchers say that alcohol has been shown to impact the activity of the heart. When using an indirect measure such as heart rate variability, it is difficult to say whether the changes seen indicate changes to the functioning of the autonomic nervous system or changes to the activity of the heart itself.

Also importantly, the study did not ask the participants how restful they found their sleep, so we cannot determine whether they felt the effect of any of the changes seen.

Overall, further research involving more subjects and using a better study design is needed. It is already known that alcohol affects sleep, and can lead to poorer quality sleep. Further study to establish the extent of the effect that alcohol has on sleep, and how much alcohol is needed (such as a ‘nightcap’) to cause an effect would be useful.

NHS Choices

A new report by Alcohol Concern looks at how children and young people are at risk of being exposed to alcohol marketing and pro-drinking messages via the internet.

The report New media, new problem? reveals the growing importance to alcohol companies of social networking sites (SNSs) like Facebook and video sharing sites such as YouTube as a means of promoting their products, and the inadequacies of online age verification pages aimed at preventing under 18s from accessing content intended for adults.

It also highlights the frequent practice of users of SNSs posting pictures and descriptions of themselves drinking and being drunk, and asks why so many of us choose to publicise our alcohol consumption in this way. The report found that:

# According to a recent survey, 37% of children aged 13-15 year olds have seen photos of their friends drunk on social networking sites.
# 8% of year 9 pupils and 25% of year 11 pupils in Wales have been drunk at least 4 times, whilst 14% of year 9 pupils and 31% of year 11 pupils in Wales drink alcohol every week.
# Almost half (49%) of children aged 8-17 in the UK have set up their own profile on a SNS. Despite the fact that the minimum age for most SNSs is 13 years, 27% of 8-11 year olds who are aware of such sites state they have a user profile.

Alcohol Concern Chief Executive, Don Shenker said:

“The alcohol industry has very effectively taken advantage of internet technology as a means of promoting its products. Most of the leading drinks companies have a presence on Facebook or Twitter, plus their own websites which often contain content likely to be attractive to young people, such as games and videos, competitions and prizes.

“There’s a real danger of children and young people being exposed to alcohol marketing on such sites, particularly given that age verification mechanisms are largely ineffective. This is especially worrying given that research shows that alcohol advertising and marketing have a significant impact on young people’s decisions about alcohol.

“It’s also increasingly common for young people to use sites like Facebook and YouTube to document their parties and nights out, posting details of their heavy drinking and discussing their favourite drinks. Many Facebook groups about drinks also mirror official drinks industry advertising and make use of official drinks logos. Much of this can be easily accessed by users of any age. The sharing of pro-drinking messages in this way fuels the normalisation of alcohol – the more people who are regularly exposed to images and descriptions of excessive consumption, the more normal and acceptable this behaviour appears.”

Alcohol Concern makes the following recommendations:

# Given the strong appeal of social networking sites to young people, official alcohol marketing should not be permitted on them.
# Alcohol producers and site administrators should take steps to end the unauthorised use of drinks logos and advertising images on social networking sites.
# Age affirmation pages are ineffective at restricting young people’s access to websites containing alcohol-related content. More work is needed to find better ways to control access, and in the meantime alcohol brand websites should only contain straightforward factual information about products.
# Health bodies need to counter official alcohol marketing and pro-drinking messages on the internet by fully embracing and utilising new media themselves as a means to promote alcohol-related health messages.

Alcohol Concern

In a bid to get the government to take a tougher stance on alcohol advertising in the UK, a private members bill is to be proposed by the Totnes MP, Dr Sarah Wollaston to limit the exposure of children to alcohol marketing. The second reading is scheduled for Friday 9th September 2011 in the House of Commons.

The bill will mirror long-standing French legislation, which bans alcohol promotion on television before 9 pm and internet ploys such as ‘advergames’ which disguise alcohol marketing.

At a time when alcohol-related hospital admissions continue to be too high for young people action is needed now to stop the endless exposure of our children to alcohol marketing. In 2008 there were 2843 deaths among 15-24 year-olds in England and Wales, and almost one in four (23 per cent) of these are attributable to alcohol.

Please contact your MP and ask them to support this bill, which could make a significant difference.

Alcohol Concern

There have been a number of reports today suggesting that the number of people alcohol drink-driving has increased since last year. But is this really what the figures show?

“The number of people getting behind the wheel whilst under the influence of alcohol or drugs has risen since last year…The number of under 25′s has risen by 15 per cent.”

There have been a number of reports today concerning the release of data on alcohol drink-driving in the UK by the Association of Chief Police Officers (ACPO). However there seems to be some confusion over whether the actual number of alcohol drink-drivers in the UK has increased in a year, or whether the figures show an increase in the percentage caught after being tested.

So what do the figures show?

Analysis

The press release, published this morning by ACPO, details the results of the organisation’s summer alcohol drink and drug driving campaign, which looked at the number of people who failed breath tests in June 2011 compared to the same month last year.

The release states that the alcohol figures “show that although there were a smaller number of tests compared to last year, there was an increase of 8 per cent who tested positive for driving under the influence compared to the year before”.

The figures provided in the release do show that the total number of breath tests conducted fell by just over 12 per cent on the same time last year. They also show that of those tested, the percentage who failed or refused a breath test increased by 8 per cent.

However, the actual number of people who have failed a breath test has actually fallen by nearly 5 per cent, from 5652 to 5373.

Looking at the figures there are clear problems with the way they were presented on the Today programme. Firstly, they do not cover “the number of people getting behind the wheel whilst under the influence of alcohol or drugs”, but the number of people failing tests on these grounds.

This is important because, despite the lower number of tests, the increase in the rate of failed/refused tests isn’t necessarily the result of increased alcohol driving under the influence.

The press release quotes a Chief Constable who suggests that the trend is due to more effective targeting of offending drivers by the Police, rather than an increase in drivers under the influence of drink or drugs.

When we contacted ACPO for clarification they explained that targeted policing involved using police resources at logical locations- and times of the day- in order to prevent the alienation of innocent drivers, whilst still catching as many offenders as possible.

There is also a problem with the reporting of trends for drivers under the age of 25.

While the Today programme reported that the number had risen, the figures in the tables show that whilst the percentage of those under 25 who failed their alcohol tests increased, the actual number of people who failed a test fell by 8.7 per cent.

However this problem may stem from the way the figures were described by ACPO. The APCO release originally stated that ‘the number of under 25 year olds that also tested positive continued to climb this year with an increase of 15 per cent compared to 2010 figures’

Therefore the press release itself actually presented an inaccurate statement in its summary which do not seem to correlate with the figures provided. We contacted ACPO and the statement has now been corrected to ‘percentage’ rather than ‘number’.

The Independent also reported on this story today, referring to the figures correctly as percentage change, emphasising that the data concerned the percentage of those who ‘were breaking the alcohol drink-drive law when they were pulled over’ by Police.

But the snapshot published by ACPO today is not the only source of data on breath tests. The Department of Transport’s annual road casualty statistical bulletin contains figures covering a longer time period.

The bulletin offers a fuller picture looking at some of the other indicators of alcohol drink driving, such as accidents and casualties where the consumption of alcohol was deemed to have been a factor. Likewise the Ministry of Justice has figures for the number of drink/drug driving cases brought to court as well as for the number of people found guilty.

Conclusion

The confusion surrounding the figures on alcohol drink-driving would appear to have been exacerbated by the wording of the press release by ACPO. Whilst the number of those who failed tests as a percentage of the total tested increased, both the number of tests and the number of those failing the tests fell, just not by the same proportion.

ACPO suggests that the reason that the number of tests being used has fallen is due to more targeted and effective policing of offenders. If this is accepted as a possibility, the rising percentage of people failing could be taken to say more about the success of targeted policing than it does about, as the BBC suggests, more people getting behind the wheel whilst under the influence.

Full Fact

Despite its stated intention to tackle alcohol harm, the current government has massively increased drinks industry representation on the Government and Partners Alcohol Working Group, which is intended to have a key role in formulating the government’s alcohol strategy.

This represents a significant shift in the way health policy in this area is developed, allowing businesses which rely on profits from sales of alcohol to have a much greater say in whether there should be limits on how alcohol is sold or marketed.

Alcohol Concern Chief Executive, Don Shenker said:

“There is nothing wrong with governments choosing to listen to different stakeholders, but this government seems increasingly willing to involve the drinks industry in the formation of alcohol health policy.

“Ministers are misguided or even naive if they think major drinks producers and retailers are about to change their business practice of selling high volumes of alcohol. The only way this country will reduce its alarmingly high levels of alcohol harm is through more effective regulation of sales and promotion which the drinks industry is naturally in the business of blocking. Inviting the drinks industry to form alcohol health policy is an inherent contradiction which only ministers seem to be blind to.

“The government needs to decide if it really does want to get to grips with the significant levels of alcohol harm in the UK, or stick with the status quo of allowing the drinks industry to call the shots. It can’t have it both ways.”

Alcohol Concern