Perhaps it’s a bottle (or two) of sauvignon blanc with dinner most evenings. Or a well-deserved sherry in the late afternoon, followed by a gin and tonic while cooking.
It might even be a couple of pints with friends in the pub several days a week – and more on match days at the weekend. And on holiday? No one’s counting. When The Mail on Sunday’s Dr Ellie Cannon asked readers to write to her in confidence about their alcohol consumption, concerned that most people were not honest with their GPs about how much they drank, these were the typical stories that flooded in.
Most admitted to 'probably drinking too much’ every day and also, as Dr Cannon suspected, to lying to their doctors about doing so for fear of being judged, lectured or even labelled an 'alcoholic’.
And the truth is, of course, that – like it or not – in almost all of these scenarios you’d be drinking above the 14 units a week recommended for both men and women by Government health chiefs. It’s less than most people think: roughly equivalent to six pints of beer, a bottle and a half of wine or 14 single measures of spirits.
The guideline was introduced back in 2016 by then Chief Medical Officer Dame Sally Davies, following a review of the evidence of the harms caused by drinking too much alcohol.
’Drinking in moderation and healthy eating are key,’ says Professor Sir Chris Whitty, Chief Medical Officer
The update, which saw Dame Sally branded a 'killjoy’, reduced the limit for men from three to four units a day to 14 units spread over a week, advised everyone to have several completely alcohol-free days, and recommended pregnant women drink no alcohol at all.
Given the recent headlines which suggest just one glass of wine a day puts us at higher risk of cancer and liver damage, and equally concerning links emerging between alcohol consumption and dementia risk, many experts argue this is a reasonable approach which reflects the evidence and makes those risks very clear. Most agree that, even if the guidelines appear 'nannying’, the UK’s escalating drinking culture is causing us harm.
But how worried do we actually need to be if drinking at or even above 14 units a week – and have the risks been overstated?
While the harm alcohol causes to our health is very real, from heart attacks and strokes to cancer and even dementia, some experts say the risk from drinking moderately is so small as to be almost meaningless – and equivalent to the risks we face every day from a host of other mundane behaviours which we don’t consider risky.
Indeed, as Dame Sally’s successor, Professor Sir Chris Whitty, said recently, 'drinking in moderation’, along with stopping smoking, healthy eating and exercise were key to staving off illness and disability in later life. Professor Sir David Spiegelhalter, who was one of a group of experts consulted as part of the guideline update in 2016, gave a more detailed view: 'An hour of TV watching a day, or a bacon sandwich a couple of times a week, is more dangerous to your long-term health.
’There’s no such thing as a safe level of drinking,’ argues Professor Dame Sally Davies, the former Chief Medical Officer
’In contrast, an average driver faces much less than this lifetime risk from a car accident. It all seems to come down to what pleasure you get from moderate drinking.’
In other words, it’s a risk like any other – and only you can say what you feel comfortable with.
John Holmes, professor of alcohol policy at the University of Sheffield, whose team in the Sheffield Addictions Research Group produced modelling work which informed the 2016 guidelines, is similarly reassuring about the evidence.
’There is no magic number here – no cliff edge where, if you drink below that level you’re safe to drink, and over that and you’re going to die,’ he says.
’Broadly speaking, the risk increases with each additional drink you consume, and it increases particularly sharply for higher levels of consumption. Ultimately, it’s just a guideline not a limit, as it’s often described.’
Decades of scientific research has now proven links between alcohol and at least eight different types of cancer, dementia, heart attacks, strokes and liver cirrhosis.
In particular, the role of alcohol in increasing the risk of breast cancer has been much more clearly established in recent years. Former breast surgeon Liz O’Riordan has written in the MoS about her fear that alcohol might have caused her breast cancer, which has now returned twice.
Prof Holmes says the updated Government guidance was intended to convey a message about the increased evidence of harm, while advising people how to consume alcohol at the lowest level of risk.
It was based on a simple principle also used in developing alcohol guidelines in Australia: namely, that people see a risk of one in 100 as broadly 'acceptable’.
The team worked out, based on the evidence, how much an average person would have to drink every week across their lifetime to get to a point where one in every 100 died of an alcohol-related problem.
Their conclusion was that it was 'roughly’ 14 units.
But Prof Holmes explains: 'There’s a lot of uncertainty in the ’14 units’ figure, and probably a range which is acceptable, which might be up to 21 units.
’But it’s set at 14 because we also had to consider what we wanted the new guideline to do in terms of changing behaviour. We needed it to be easily understandable, something we could defend scientifically, and it had to communicate this message that the evidence of risk from alcohol had increased since the previous guidelines.
Professor Sir David Spielgelhalter, statistician and expert on risk, claims 'an hour a day of watching TV is more dangerous to your health’
’If you want to keep your risk low, the idea is you keep this number in mind. If you have 15 to 16 units a week, you’ve slightly increased your risk, but it’s not huge. If you’re having 20 to 30 units a week, you’ve substantially increased your risk.’
It’s a view echoed by Prof Spiegelhalter, who told the Mail on Sunday: 'The UK recommended limits are described as 'low-risk’, but this does not mean that anything above this is 'high-risk’.
’It would be wrong if people thought that drinking anything above the recommended limits is necessarily harming them — they could perhaps be considered as aspirational targets.’
To put this into context, Prof Spiegelhalter has pointed to a major study published in the Lancet in 2018 which was based on 600,000 drinkers and examined 40,000 deaths.
’The study estimated that, compared with people drinking within current UK guidelines, those that drank up to twice the current guidelines had, on average, around six months lower life expectancy,’ he said. 'Of course, any effect of additional alcohol will vary hugely between people, but this gives an idea of the magnitude of the trade-off.’
In other words, it’s small.
He illustrates this further by analysing another large US study, which made headlines around the world by suggesting one drink a day was enough to increase the risk of death. But again, the statistics provide important context, Prof Spiegelhalter points out. If 100,000 15- to 95-year-olds drank no alcohol in a year, 914 of them would develop a health problem which can also be caused by drinking, the study shows.
If all of them drank one alcoholic drink every day during that year, 918 of them would develop such a problem – an extra four people.
It means, Prof Spiegelhalter says, that 25,000 people would have to collectively consume 400,000 bottles of gin in a year to get one extra serious alcohol-related health event.
And if those same drinkers instead had two drinks a day, or 2.5 units of alcohol – equivalent to 17.5 units a week, and 25 per cent more than the UK guidelines – 977 would develop a problem. That’s an extra 63 people. 'This still indicates a very low level of harm in drinkers drinking just more than the UK guidelines,’ he concludes.
Of course, there is still the risk of harm if you regularly consume a lot more than the guidelines and women are more at risk than men. At moderate levels, the risk is equal, which is why the guidelines are set at 14 units for both men and women.
Government health chiefs recommend 14 units a week for both men and women. It’s less than most people think: roughly equivalent to six pints of beer, a bottle and a half of wine or 14 single measures of spirits
But the more women drink, the higher the risk, partly because alcohol levels remain higher in women’s blood for longer. Women have higher rates of liver disease, heart damage and cancer from lower levels of drinking. The expert group advising the Government on the 2016 guideline update briefly discussed introducing different categories of risk depending on how much alcohol you drank – but ultimately decided this would prove too confusing. It is, however, a useful guide for both male and female drinkers. Prof Holmes explains it is based on categories often used in research, which splits consumption into three layers of risk: low risk is up to 14 units a week; hazardous, or increasing risk, is between 14 and 35 units for women and between 14 and 50 for men; and harmful or high risk is over 35 units for women and 50 for men.
’Whereas 14 units a week corresponds to a one in 100 risk of dying from alcohol, if men drink 50 units a week that risk increases to roughly one in six or seven,’ Prof Holmes says.
Each person’s individual risk will also be different depending on their genetics, their age and how healthy they are.
As for alcohol-free days, the evidence is even weak on whether this is beneficial. 'There’s some evidence that, if you’re a heavy drinker, having a few days off can help the liver recover,’ explains Prof Holmes.
’But, broadly, making this recommendation part of the guidelines was about frequent drinking being habit-forming, which might push up consumption – not because we have evidence that drinking every day is worse for you. I mean, the suspicion is it isn’t great, but the evidence is far less certain.’
It is, however, not all good news. It is looking less likely that there are protective effects from drinking alcohol in small amounts. That 'medicinal’ glass of red wine may not be beneficial after all.
The theory was based on older studies which compared the health of teetotallers with other drinkers, and which found those who do not drink could be as unhealthy as those who drank more heavily.
There seemed to be a mild protective effect for the heart in those who consumed a small amount of alcohol. Drink more than that, and those benefits were lost as the increased risk from cancer and other problems took over.
But some research failed to account for the fact that some teetotallers are former heavy drinkers, or don’t drink because of poor health.
Prof Holmes says: 'We’re pretty confident now that we’ve been overestimating any benefits, and they may not exist at all,’ he says.
Research suggests that updating the guideline has not, in any case, had much of a lasting impact on our alcohol consumption.
Professor Robert Dingwall, a sociologist at Nottingham Trent University, says: 'The risks for most people are trivial. What you do have is a concentration of people for whom alcohol is a real problem and the public health challenge is how you get to that group, rather than change the advice for the population as a whole.’
Prof Holmes says: 'The way I often describe it is that most people have been given a pretty good hand, and there’s a good chance they’ll win the bet when it comes to their risk from alcohol. But you’re betting against the house. It’s up to you whether you fancy your chances or not.’
