How much alcohol is too much?

We meet once a month after work on the veranda of a beachfront hotel. Six busy women, juggling careers, family, partners and the demands of running a home. That hour or two between the office and dinner is the only time we get to see each other and somehow that sense of blissful relaxation wouldn't be as satisfying were we to swap our bottles of chilled chardonnay for, say, a pot of tea.

"If I don't have a glass after work I'd kill my husband and kids," said Annabel, slugging her second.

But what about the health warnings? Every other day there's another one jumping out at us from the pages of newspapers and magazines. Breast cancer, osteoporosis, diabetes, infertility, liver damage... if you drink too much you could end up with a life-threatening disease.

So how much is too much? I asked Dr Charles Parry, director of the Alcohol and Drug Abuse Research Group at the Medical Research Council (MRC); and Willie Pienaar, professor of psychiatry at Stikland Hospital, to debunk a few booze myths:

How many glasses of wine can I safely drink in one week?

"The MRC's Food-Based Dietary Guidelines on alcohol recommend no more than four standard units of alcohol per day for men and no more than two units for women, with at least two alcohol-free days per week. A standard unit is defined as one 340ml can of beer containing 12g of alcohol, a 120ml glass of wine, or a 25ml tot of spirits," says Parry. In other words, a woman should drink no more than 10 glasses a week, spread over several days - no bingeing.

Those who should not drink at all include children; women who are not able to restrict their drinking to moderate levels; pregnant women; those operating machinery or taking prescription medicines; and women with a genetic tendency to alcohol dependence.

What's healthier? Wine, beer or spirits?

Wine gets the thumbs up.

Is alcohol ever good for me?

Yes, but it depends on who you are and how much you consume. A restricted alcohol intake may protect against heart disease in older people (men over the age of 35 and postmenopausal women) but benefits are also achieved through giving up smoking, eating a balanced, low-fat diet and taking aspirin.

"Drinking to intoxication, which is fairly common among many drinkers in South Africa over weekends, is likely to negate any health benefits," says Parry.

Will drinking make me fat?

Beer will make you fattest.

Why is it that the older I get, the less tolerance I have for alcohol?

As you get older, says Pienaar, your metabolism slows down and your absorption rate speeds up. Simply put, you get drunker, quicker.

Beer makes me aggressive, tequila makes me giggle. Why the difference?

It could be, says Pienaar, that what is being reflected is your mood before you started drinking. It's unlikely different kinds of alcohol will affect you differently. Some people get jolly when they've had too much, others fall over, others go to sleep. These traits may be genetic. In fact, some races display significantly lower tolerance levels for alcohol than others.

A glass of wine after work relaxes me. Is there anything wrong with that?

"Probably not but I would be concerned, at least from a psychological point of view, if someone showed a strong dependence on alcohol and was not able to function in the absence of such a drink," says Parry.

Is it true that men can drink more than women? Why?

Yes, it's true. Women get drunker, quicker even when the amount of alcohol consumed is adjusted for body weight. There are three possible reasons for this:

  • Women have lower total body-water content than men of comparable size. After consumption, alcohol diffuses uniformly into all body water, both inside and outside cells. Because of their smaller quantity of body water, women achieve higher concentrations of alcohol in their blood than men after drinking the same amount.
  • An enzyme involved in the metabolism of alcohol is less active in women than men.
  • Scientists believe fluctuations in hormone levels during menstruation may affect the rate of metabolism of alcohol. However, research is still inconsistent. Mary Dufour, Deputy Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in the US, says most men have to drink a lot for 15-20 years to get cirrhosis but some women get it after only two or three drinks a day for five to ten years. "And when women get cirrhosis, it's more likely to be fatal. Other long-term risks are brain and heart damage, and infertility."

Beware the damage

Heavy drinking has been blamed for causing an increased risk of liver disease, heart disease, ulcers, osteoporosis, memory loss and pancreatitis.

Alcohol disturbs blood sugar levels: even brief periods of low glucose levels (hypoglycaemia) can cause brain damage, says the National Institute on Alcohol Abuse and Alcoholism. Heavy drinking can interfere with diabetes medication.

Alcohol impairs fertility: alcohol has been shown to lower testosterone levels in men and upset menstrual cycles in women.

Alcohol and breast cancer: the jury's still out on this one. Some studies suggest that risk increases when a woman consumes 30g or more of absolute alcohol daily but other studies do not concur.

What makes us drink?

Family history: there is a greater likelihood of problem drinking if there is an associated family history: studies of twins over time have concluded genetics play a major role.

Peer or spousal pressure: scientific studies show adolescent girls are more strongly influenced by peer drinking than boys, and that group exposure contributes significantly to heavy drinking among teenage girls. Women are also more easily influenced by those around them and older women are particularly influenced by their partners at home. "More women than men with alcohol abuse or dependence have spouses or significant others who are problem drinkers," says Gomberg.

Depression: epidemiologists have found that depression precedes drinking problems in 66% of co-occurring depression and alcoholism cases.

Stress, distress and coping: these are pivotal in development of problem drinking, but while traumatic life events (such as divorce, miscarriage or death in the family) and a response to childhood abuse have been cited as probable causes, more research needs to be done.

Roles in life: your age, your employment (or lack of) and happiness in your job, your living conditions and marital status, your age, your social patterns and the use of prescription antidepressants and tranquilisers all affect drinking patterns.

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