Dying for a drink: 1.4 million of us - and that's just the bingers
You don't have to be an alcoholic to be a binger. But the effect on health and the damage to those around us are as alarming. And women are most at risk.
By Paul Rodgers
Take a sip of vodka. You may notice a burning sensation on your tongue. That's the alcohol hitting pain receptors wrapped around your taste buds, the same nerves that warn you of high temperatures. From the moment it passes your lips, alcohol is setting off alarms and, mostly, causing damage.
English and Irish women drink more heavily than any others in the world, as our front page today shows. Whatever their reasons, the science suggests they are taking more risks than men.
The latest research shows that women become drink-dependent more quickly than men. If a man and a woman drink the same amount of alcohol, her body will suffer more harm.
Women also have to worry about breast cancer, unwanted pregnancies, and causing brain damage and skeletal deformities in their unborn babies. All these are linked to drinking.
Alcohol is so popular because it lets us have more fun at pubs, clubs and parties by working on the central nervous system to suppress inhibitions. But it also injures organs in both sexes, from the brain to the pancreas.
Officially, 8,000 deaths a year in Britain are directly linked to alcohol, more than double the figure 15 years ago. And some charities estimate that the real number may be five times higher. Drink is, for example, involved in 40 per cent of fatal fires, 15 per cent of drownings and 65 per cent of suicides.
The costs are not just to individual bodies. The NHS spends £1.7bn a year dealing with the effects of alcohol abuse. Drink causes 17 million lost working days a year, costing the economy £20bn.
Beyond the physical and financial, the effects of alcohol can be felt throughout society. More than one million adults are alcoholics. An estimated 1.4 million are binge drinkers. And 1.3 million children are affected by alcohol abuse. Drink is also involved in 40 per cent of domestic abuse cases. You only have to walk through a town centre on a Saturday night to find evidence of alcohol-related violence and vandalism.
The first difference between male and female drinkers, albeit a small one, comes when that nip of vodka splashes into the belly. There, a tiny amount of the alcohol is broken down by an enzyme called alcohol dehydrogenase. A man has slightly more of this than a woman, meaning that his body is already dealing with the vodka more efficiently.
But for both sexes it is not the stomach that does most of the work, says Professor Ian Gilmore, president of the Royal College of Physicians and chairman of its alcohol committee. Most alcohol enters the blood through the walls of the small intestine. That's why eating while drinking is so important; it slows the movement of liquor into the bowels and hence into the blood. Alcohol is a simple molecule, small enough to cross into any cell. It is also a solvent, able to dissolve lipids, the fatty molecules that make up cell membranes. Women have more fatty tissues than men - for example, the breasts - which may be one reason they are more susceptible to drink.
From the intestines, alcohol is taken by the portal vein to the liver, the body's chemical factory and the main filter for toxins. Here, again, alcohol dehydrogenase gets to work.
The enzyme comes in several different, genetically-determined forms, called polymorphisms. These variations explain why some people - usually men - can tolerate more drink than others. But even in the most efficient males, the enzymes can break down only about one unit of alcohol - eight grams - an hour.
There is a downside to the process. It produces a poison, namely acetaldehyde, a chemical relative of the formaldehyde used by Damien Hirst to pickle his cows. This is what makes you feel sick after a heavy drinking session. It is in turn broken down by a second set of enzymes, becoming water and carbon dioxide, but the process takes time. Before the liver finishes its work, the poisons from even a single unit of alcohol may have been round the body more than 100 times.
The liver clears alcohol out of the blood, but is not immune itself to alcohol damage. About a third of heavy drinkers, such as the late George Best, end up with liver disease. Who gets it and who doesn't probably comes down to a genetic lottery. Some people are just more vulnerable than others.
As the liver cells are destroyed, they are replaced by scar tissue, a process called cirrhosis. This has two effects. First it reduces the amount of chemical processing and decontaminating that can be done by the liver. Second, it reduces the blood flow through the organ. In time, the circulatory system finds ways to bypass the damaged liver, taking unpurified blood directly to the heart. This can kill you.
Only half of heavy drinkers are physically dependent on alcohol. The others could easily cut back or quit altogether. "They're waiting for an early warning," says Professor Gilmore. But they're not likely to get one. The first outward sign of cirrhosis of the liver is a distended belly and yellowish pallor. By then, the disease has reached its end stage.
In many cases, only a transplant can save the patient. But potential recipients far outnumber donors. Eleven thousand women a year are admitted to hospital with cirrhosis of the liver, but fewer than 1,000 organs are available for transplant.
As the vodka moves through the blood from the liver to the heart, there is a shot of good news, though. Small amounts of alcohol are known to reduce levels of so-called bad cholesterol that clog and harden arteries, leading to high blood pressure and heart attacks. Unfairly, the benefits are more marked in men.
"But as a nation we're drinking well above these cardio-protective levels," says Professor Gilmore. For heavy drinkers, the benefits are quickly outweighed by the risk of cardiomyopathy, a weakening of the heart muscles.
Binge drinking can interfere with the sympathetic nervous system so that the heart beats irregularly, a condition that doctors call "holiday heart" because it is so common among people who spend their time off from work knocking back pints. In some cases, it can lead to sudden death.
From the heart, alcohol in the blood is pumped to every other organ, including the brain, within a couple of minutes of it entering the blood stream. And unlike many other toxins, it can slip into the brain.
The immediate effect on the brain is to shut it down. Our inhibitions are the first to be depressed, hence the pleasure. But soon afterwards, we lose the ability to make the decisions and judgements necessary for safe driving, and eventually even basic functions such as walking or standing up become impossible.
By the time blood alcohol levels reach 360mg/ml - four and a half times the legal driving limit - most people are unconscious; by 400mg/ml, all but the most hardened drinkers are dead, usually because the alcohol has depressed the part of the brain that controls respiration. The victims simply forget to breathe. Women, because they are, on average, smaller than men, reach this level with fewer drinks.
And even if they don't die suddenly, heavy drinkers can suffer from brain damage. Research using CT brain scans at the University of Heidelberg showed not only that brain mass was lower among alcoholics, but also that women suffered the same percentage decrease even though they had drunk far less.
"There is evidence for a faster progress of the events leading to dependence among female alcoholics and an earlier onset of adverse consequences of alcoholism," said Professor Karl Mann of the University of Heidelberg. "This suggests that women may be more vulnerable to chronic alcohol consumption."
Other less-well known drink-related illnesses include chronic pancreatitis, a painful condition that reduces the ability to digest food and leads to diarrhoea and diabetes. Bone marrow - where blood cells are grown - can be damaged, leading to poor clotting in wounds and reduced immunity to infection.
Osteoporosis, a weakening of the bones already common in older women, can be made worse. And skeletal muscles, like those of the heart, can be weakened. The movement of the tiny hairs in the lungs that sweep contaminants out can also be impaired, making chronic drinkers more prone to diseases such as pneumonia.
The danger of having an accident while inebriated is obvious, but other risks are more subtle. For instance, 80 per cent of women report that alcohol was involved in their first sexual experience. That lowering of inhibitions can also lead to unprotected sex, unwanted pregnancies and sexually transmitted diseases, including HIV/Aids. Research shows that 81 per cent of rape victims have been drinking before the attack; undoubtedly many attackers have been drinking too.
For many women, one of the greatest fears is foetal alcohol syndrome. During the first three months of a pregnancy, foetal stem cells are changing into forms specific to particular organs. Drugs such as alcohol that cross the placental barrier during this period can have dire effects, including severe brain damage and other birth defects.
For women who drink, the problem is twofold. Early in a pregnancy, they may not ever realise that they are carrying a child and should be abstaining. There is no known minimum safe level. One drink at the wrong time can damage the baby.
And then there is cancer. Areas that come into contact with concentrated alcohol, such as the mouth and throat, are more likely to develop tumours, as are organs with a high proportion of fatty tissues, such as the breasts.
People have been boozing since the dawn of civilisation - the earliest evidence is from 9,000-year-old fragments of neolithic clay pots found in northern China. Some archaeologists have speculated that agriculture itself may have been invented to provide crops for making beer. Attempts at prohibition in America early in the last century were such dismal failures that no one seriously thinks they can stop people from drinking.
Fortunately for those who enjoy an occasional tipple, the doctors aren't demanding that every woman climb on the wagon. Professor Gilmore would like to see alcohol become more expensive and harder to find, but says that, unless you are pregnant, moderate drinking is not a problem. Moderate means 14 units a week. You do the maths.
Your health: How alcohol affects the body
STOMACH: eating while drinking slows the rate at which alcohol enters the blood from intestines
LIVER: vital in removing poison, the organ is itself scarred by alcohol. Cirrhosis hits without warning
HEART: can benefit from low levels of alcohol, but heavy drinkers risk 'holiday heart' attacks
LUNGS: become more vulnerable to pneumonia. Too much alcohol and the brain will forget to breathe
PANCREAS: most cases of the painful disease pancreatitis are linked to alcohol abuse
BRAIN: women suffer the same percentage of cell death as men, but after drinking less alcohol
BONES: both sexes suffer marrow damage, but women are more prone to osteoporosis
BREASTS: women have more fatty tissues, where alcohol accumulates, raising cancer risks
WOMB: babies can suffer birth defects including brain damage if the mother drinks during pregnancy