What’s really unhealthier – binge drinking or a small daily tipple? The results of this unique experiment – by identical twin doctors – will surprise you
Chris and Alexander van Tullekens star in a Horizon show
Documentary about alcohol will study effects of 21 units of alcohol a week
Chris drinks them spread out over the week for one month
Alexander drinks them all in one binge session once a week for a month
Will these different drinking patterns affect their health?
Source: Daily Mail
By Dr Alexander van Tulleken For The Daily Mail
18 May 2015
Not long ago, I used to envy people who earn a living reviewing fancy restaurants or taking all-expenses paid holidays in exotic locations. Imagine making money doing stuff the rest of us pay for!
But now I’ve had one of those dream jobs – I was essentially paid to get drunk – and it was horrific.
After just one month I’d caused widespread and serious damage to my entire body, while my blood was being poisoned by bacteria that had leaked from my gut. And if you think this has nothing to do with your life, I’m afraid you’ll have to think again.
My assignment had come about as part of a documentary I’ve made for BBC Horizon with my identical twin brother – we’re both doctors specialising in infectious diseases. We wanted to look at binge drinking and whether it really is as bad as we’re told.
It’s a very important question because it’s how a lot of us like to drink. Many of us can’t afford the time or the money to drink every night. And besides, like many people, if I’m having a drink I like to feel the effects properly – I admit I like more than one glass.
The obvious answer to the question of how bad binge drinking really is, is that it’s terrible. I was an A&E doctor for six months and there were nights when I saw nothing but alcohol-induced injuries: car crashes, falls, domestic violence and more.
But apart from raising your risk of injury, how bad is binge drinking when it comes to your health?
The UK Government defines a binge as double the maximum ‘safe’ daily limit for alcohol intake. For men that means a binge is eight units, or four pints of lower-strength beer; for women it’s six units or two large glasses of wine.
For many of us that isn’t going to land us in A&E. It also doesn’t feel like a binge at all, more like winding down at the end of a long day. For some it might seem like a fairly quiet evening!
So my brother Chris and I undertook an experiment, using ourselves as guinea pigs to assess just what binge drinking does to the human body. Among other things, we wanted to find out if a little daily alcohol is better for you than none at all – and does a gap between binges allow your liver to recover?
These questions are important because the current data on how alcohol causes harm or benefit is contradictory.
Of course, there is abundant evidence that alcohol is bad for you, causing liver disease, brain diseases, heart disease and massive social and psychological problems.
Currently, the UK government recommends that you take 48 hours off after ‘heavy drinking’ and the idea of a ‘liver holiday’ has some medical evidence to back it up.
A study published in the American Journal of Epidemiology in 2006 suggested that drinking on only one to four days per week (and taking a ‘liver holiday’ for the remaining days) is better than daily drinking for male heavy drinkers.
But we don’t actually have very good data for any of our alcohol guidelines. Some studies suggest teetotalers die sooner than alcohol drinkers, while animal studies show myriad benefits from compounds found in wine.
My first binge was 21 shots of vodka in about four hours. The results were first comical and then deeply concerning
We wanted to try to tidy up the mess. For the experiment, Chris and I would drink exactly the same amount each week for four weeks, but in very different ways.
We would stick to the low end of the government guidelines for men, which is 21 units per week or three units per day. Chris would drink three units every day, which counts as moderate drinking, and I would drink exactly the same amount, but in one go on a Saturday night. (We were completely alcohol free for four weeks beforehand, so we started in the same condition.)
I began the experiment feeling confident: I was the twin who was going to have a big binge every Saturday night and I was sure I’d got the better deal. Not least because the liver is an organ that can withstand huge amounts of abuse, so six days seemed like loads of time to recover between binges.
My thinking was I’d have a hangover on Sunday and then I’d be productive the rest of the week. Chris on the other hand would be getting in from work, then drinking his single glass of wine or pint and-a-half.
His liver, brain and heart would never get a break and he’d never have any fun. I was confident that drinking my way would be no more physically harmful and much more enjoyable. And the BBC would underwrite my drinks! What could be better?
My first binge was 21 shots of vodka in about four hours. The results were first comical and then deeply concerning.
Drunkenness is often said to have a number of stages: verbose, grandiose, amicose (the ‘you’re my best friend’ stage), bellicose, morose, lachrymose (the weepy stage), stuperose (the incoherent stage) and comatose. Basically going from chatty to unconscious via being fun and then weepy.
I was a textbook example of each stage: shouting, argumentative, talking gibberish, then trying to get the film crew to come out for dancing and karaoke.
I don’t recall anything after the first two hours, by which time I’d had about 16 shots, so I only know about the next two hours (before I passed out) because Chris filmed them. I had got wildly angry about my shoe laces and spent the final half hour crying inconsolably before slipping into unconsciousness.
It was utterly undignified, the hangover was horrendous and I wasn’t sure I was going to manage three more weeks of this: I never wanted to drink again.
It was all made much worse by having needles stuck in me. For as part of the experiment Chris and I had a range of blood tests devised by one of the best liver teams in the country.
Hepatologists Dr Gautham Meta and Professor Rajiv Jelan, at the Royal Free Hospital in London, used tests that were so advanced they had previously only been undertaken in animal studies – they measured chemicals in our blood called interleukins and cytokines, which are extremely sensitive markers of inflammation and disease.
A few days after my first binge, I had recovered and was back to my usual self, confident that this was doing me no real harm. The next Saturday I did my binge differently – pacing myself with a couple of pints at lunch, afternoon cocktails, and a bottle of wine with food.
Again, all 21 units in one day but a drinking pattern that might not seem so different from what many people get up to over a weekend.
My video diary at midnight was articulate and sensible – no embarrassing singing or irrational behaviour. I couldn’t have driven a car because I was well over the limit, but I didn’t seem drunk. Next day I felt fine and the last two binges weren’t just easy, they were fun.
Chris, meanwhile, was actually faring worse. Having a compulsory three units every day was just enough to make him want more and to disrupt his sleep if he drank it late after a long day at work. But not enough to have fun. He looked forward to the end of the experiment.
I was feeling confident about the results, but the findings were shocking in several ways.
My levels of cytokines and interleukins, those key markers of inflammation, were raised. I’d expected them to be sky high after the first binge – but six days later, just before I was about to start the second binge, they hadn’t gone down at all, and at the end of four weeks they’d soared.
I felt good but my body was still damaged from the binge. Inflammation is linked to a vast array of diseases from cancer and severe infection to heart disease and dementia. This was not a good result.
Perhaps even more disturbingly Chris had almost the same results: the three units per day were doing him significant harm, too. So from that it seemed the amount we were drinking was more important than the way we drank it.
Wrong!
There was one huge difference between me and Chris. The blood tests also revealed I had three times the amount of ‘bacterial endotoxin’ in my blood – what this means is that the binge was so irritating to the lining of my stomach and intestines that they had begun to leak bacteria into my bloodstream.
I was being poisoned by my own gut bacteria and it was doing me serious harm. We don’t yet know exactly how much you have to drink to cause this effect, but it’s likely to be much less than I was drinking.
I had thought that alcohol was safe and probably beneficial in moderate doses. But what our experiment showed was that government guidelines are misleading in several ways.
First, 48 hours off after a binge isn’t nearly enough. We don’t know how long you need, but it is likely to be weeks not days.
Second, there probably isn’t a ‘safe’ lower limit for alcohol. We’ll have more answers soon as the Royal Free is running a larger study looking at what happens when people who routinely drink within the guidelines stop drinking for a month. Now, all this would seem to be contradicted by a steady stream of articles about the health benefits of red wine and other kinds of alcohol.
And there is good evidence to suggest that if you’re a man between 50 and 60, and at some risk of heart disease, the positive effects of alcohol on your heart will outweigh the increased risk of cancer and liver disease.
3 1/2
The number of teaspoons of sugar in a 250ml can of gin and tonic
But – and this is a depressing but – we’re talking about one small glass per day. More than that and the harm seem to outweigh the benefits.
As part of our research, Chris and I also looked at the way each person responds to alcohol – by taking a group of British people with different ethnic origins – Irish, Chinese and Taiwanese – out for drinks. The differences were extraordinary.
There are several genes that control how we break down alcohol and those genes are strongly associated with ethnicity. They affect our risk of cancer, liver disease and hangovers.
Essentially, the genes that process alcohol more slowly are increasingly common as you head east from Europe, with the highest in China and Japan.
Genes from his Irish ancestry helped our volunteer hold his drink better than the others (although this won’t be true for all those with Irish ancestry, and to complicate the picture, our Irish volunteer was of mixed Irish/Indian origin).
What this showed us was the idea of universal government guidelines is misleading: you have to drink right for your body type.
As a rule of thumb: if you go red when you drink, or if your hangovers start quickly and are severe, you’re at higher risk for several diseases. Your body is telling you to cut down for a reason. After all this I haven’t stopped drinking, but I think more about what I get out of each drink.
The fact is, drinking is not all bad: it really does help you make friends, and it helps many of us romantically and socially.
These things are important: friends and partners help us live better and longer. But drinking is not good for our health.
All of us – doctors, patients, publicans, public health officials, multinational drinks companies – love the idea that alcohol might be good for us and binge drinking might not be that bad, and want this to be true. The sobering reality is that it isn’t.