Units: they don't always add up

I recently enjoyed a long afternoon-into-evening drinking session with my colleagues. OK, it started off as our departmental Christmas meal (and, yes, I know it's only just turned December) and then turned into a moderately-sized pub crawl. There were bottles of Leffe on the table with the meal, lagers whilst playing pool and pints of dark, viscous real ale as the evening wore on. The next morning, I felt shocking. Some bastard have given me a stinker of a cold, complete with sandpapered-throat and on-fire sinuses. The booze hadn't bothered me at all.... which in turn was worrying. The volume imbibed had been fairly immoderate, to be sure. And it contained probably more alcohol units than are supposed to be good for me.

Health campaigners and the UK Government have put an increasing emphasis on alcohol units as part of their awareness raising campaigns recently. Advice from the NHS suggests that men should drink no more than between three and four units per day, each unit being equal to 8g (or 10 ml) of pure alcohol. Over eight units in a day - i.e. twice the recommended intake - is classed as binge drinking. Well, I drank four 330ml bottles of 6% beer over a period of three hours at the restaurant; apparently I was a binge drinker before we got to the first pub.

In the good old days, I seem to remember that binge drinking was when you had all of your 21 unit weekly allowance in one fell swoop. That advice changed from a weekly to a daily allowance back in 1995 as a way of persuading drinkers not to 'stockpile' their 'allowance' and then get tanked up in just one evening. In doing so, it created a recommended unit range for the first time, actually increasing the maximum number of weekly units (between 21 and 28 for men , 15 to 21 for women). Why did the government increase the recommended maximum number of weekly alcohol units by 33%? Perhaps it was recognition that the original 1987 figures were flawed.

Those limits were set out in 'A Great and Growing Evil: The Medical Consequences of Alcohol Abuse', a report by the Royal College of Physicians whose title references their submission in 1726 to the House of Commons on the same topic. Richard Smith, former editor of the British Medical Journal and member of the working party that produced the report, said the limits were borne of “a feeling that you had to say something”. However, a lack of detailed data meant it was impossible to say what was safe and what wasn't. “Those limits were really plucked out of the air," admitted Mr Smith. "They were not based on any firm evidence at all. It was a sort of intelligent guess by a committee.”

In the years that followed, unit-related research increased. In 1993 a study of 12000 middle-aged, male doctors by team at the Radcliffe Infirmary, Oxford found that the lowest mortality rates were among those drinking between 20 and 30 units of alcohol each week. The level of drinking that produced the same risk of death as that faced by a teetotaller was 63 units a week. Within two years of this study, others had been published showing that moderate alcohol consumption gave some protection against heart disease and premature death.

The limits seemed to be confounded further by the WHO’s International Guide for Monitoring Alcohol Consumption and Related Harm, published in 2001. This set out drinking ranges that qualified people as being at low, medium or high-risk of chronic alcohol-related harm. For men, less than 35 weekly units was low-risk, 36-52.5 was medium-risk and above 53 was high-risk. Women were low-risk below 17.5 units, medium between 18 and 35 and high above 36. Note, however, that page 52 of the report makes it explicit that those levels were not intended "to be applied in advice for Low Risk drinking advice to the public".

There's plenty of debate to be had about what may be an appropriate number of alcohol units per day/week. But such debate will be rendered pointless without informed insight as to how many units there are in your tipple of choice. Only 3% of alcoholic bottles/cans have full labels showing alcohol content and units, according to the Public Accounts Committee. That's down to a voluntary code; there's no such code for non-bottled alcohol. The NHS Units website has a host of calculators and guidelines. But I'll be using a table that I lashed together (at the top of this story) that takes into account the wildly differing alcohol strengths and draught/bottle sizes that I encounter.

In the meantime, I'll be acting on two pieces of what seem to be eminently-sensible advice; ensuring I have two alcohol-free days in a week and no longer consuming alcohol close to bedtime. This reluctant scooper isn't getting any younger and it's starting to show.

The NHS Units website:
http://units.nhs.uk/

Local Alcohol Profiles for England:
http://www.nwph.net/alcohol/lape/index.htm

Drinkaware (with interesting stuff about alcohol and sleep)
http://www.drinkaware.co.uk