The Complete Book of Men's Health - Part 3: Nutrition and Lifestyle

NB In the US, a unit of alcohol is called a drink

The healthy maximum alcohol intake for men is currently accepted as 21 units. Most men tend to overestimate the strength of spirits and underestimate the strength of beer. For example, a man drinking two pints of beer has consumed four units. A man drinking two glasses of wine and a double vodka has also consumed four units.

Some studies are starting to suggest that men can drink up to 30 units per week without increasing their risk of serious disease. Until these studies are verified, however, it is wise to stick to the 21-unit cut off.

Other studies show that men who regularly drink more than three pints of beer a day (six units) are at twice the risk of sudden cardiac death than those drinking moderately (one to two pints/two to four units per day).

Binge drinkers and those who drink heavily only at weekends and holidays are also more at risk of sudden death. There is no doubt that drinking more than 50 units of alcohol per week will seriously endanger your health.

The form of alcohol which seems most beneficial to health, in moderation, is red wine. The US Food and Drug Administration even allows vintners to label red wines as 'good for the health', which is quite remarkable. At least 20 studies around the world have shown that a moderate intake of alcohol (two to four units per day) reduces the risk of coronary heart disease by 40 per cent. Red wine, especially with meals, is particularly beneficial if drunk on a daily basis.

One expert has even stated that, as far as coronary heart disease goes:

A half bottle of good red wine with lunch may be a better preventative medicine than all the cholesterol guidelines combined. Alcohol is a drug that should be used regularly, but at moderate doses.

Comforting words indeed ­ but the alcohol content of wine may not be the sole explanation for these cardio-protective effects. Red wine, non-alcoholic red wine and red grape juice all contain many unusual antioxidants which are thought to prevent oxidation of cholesterol in the blood and discourage furring up of the arteries. They also decrease the stickiness of blood, thereby reducing the risk of a thrombosis (blood clot).

In one study of 129,000 people, the cause of death in participants who died was compared with their usual alcohol preference ­ wine, spirits or beer. After controlling for the number of drinks per day, wine preference was associated with a significantly lower risk of cardiovascular death (a 30 per cent reduction for men and a 40 per cent reduction for women) compared to spirit drinkers. This suggests that components other than the alcohol in wine may be involved.

Another study has also demonstrated that, in the 17 countries where dietary consumption is known, wine is the only 'foodstuff' with a significant protective effect against the risk of premature death.

Research shows that red wine contains antioxidants that are more potent than vitamin E. These include:

Procyanidins ­

found in red wine at concentrations of up to 1 g/litre. These poly- phenols are powerful antioxidants and free-radical scavengers.

Phytoalexins ­

natural anti-fungal agents in the skins of grapes. Red wine involves macerating grape skins longer than for making white wines or champagne, and therefore has a much higher concentration.

It is thought that drinking red wine with meals reduces the harmful effects of dietary saturated fats and also causes food to be absorbed more slowly. This prolongs the protective anti-sticky effect of alcohol and antioxidants on the blood at a time when dietary saturated fats ­ known to increase blood stickiness ­ are being absorbed.

Despite these reassuring findings, it is still a fact of life that over a quarter of all hospital admissions in the West can be blamed on the effects of alcohol. The long-term intake of excessive amounts of alcohol is linked with liver damage, particularly the following four pathological conditions:

1. fatty liver degeneration

2. alcoholic hepatitis

3. liver fibrosis

4. cirrhosis.

Fatty Liver Degeneration

Alcohol is a cell toxin. In order to rid the body of this noxious substance, liver cells (hepatocytes) drop their normal housekeeping metabolic reactions and frantically work overtime to convert alcohol first into acetaldehyde (even more toxic) and then into acetate.

Even a single episode of binge drinking can change liver cell metabolism and trigger fatty degeneration. Liver cell enzymes are diverted to metabolize alcohol and, as a result, dietary fatty acids are not processed or converted into the storage substance glycogen. The liver cells then start to accumulate these unprocessed globules of fat and become abnormally swollen.

The impaired metabolic reactions inside liver cells generates large numbers of damaging free radicals. This increases the negative effects of a continued excessive alcohol intake as liver cells accumulate more and more fatty globules. The liver enlarges and takes on a yellow appearance. It starts to resemble the grossly abnormal, fatty livers of the force-fed geese used to make foie gras.

By this stage the liver cell/enzyme balance is completely disrupted. Enzymes that break down alcohol are present in abundance, and as these can also process certain drugs and sex steroid hormones such as testosterone, more testosterone is broken down and male sex drive and sperm counts fall too. In some males, signs of feminization, such as the development of small breasts (gynaecomastia), occur. At the same time, the liver produces reduced amounts of sugars and proteins and there is an increased need for certain vitamins and minerals. A degree of malnutrition sets in.

Even at this advanced stage of fatty degeneration, changes are reversible. Liver cells have a tremendous ability to regenerate ­ if 90 per cent of a normal liver is cut away, remaining cells can regrow a full-sized organ.

Alcoholic Hepatitis

In a certain proportion of cases, liver inflammation is superimposed on fatty degeneration to cause alcoholic hepatitis. This may be a hypersensitivity reaction to alcohol. Cells start to degenerate and die. Some cells accumulate a glassy-looking material, while others are totally converted into balls of fat. Dead cells attract scavenger white cells (macrophages) from the blood and the patient quickly becomes ill. Fever, nausea and vomiting occur, with pain over the liver area in the upper right-hand part of the abdomen. Yellow jaundice develops as liver inflammation worsens.

Recovery is followed by the formation of liver scar tissue. This process is called hepatic fibrosis.

Alcoholic Fibrosis

A liver full of fatty degeneration will eventually start to lay down scar tissue (fibrosis) even if alcoholic hepatitis has not intervened. If fibrosis is extensive it interferes with the blood supply to the liver and can lead to back pressure on vessels trying to feed blood to the liver. These swell and varicose veins develop in the oesophagus which can bleed torrentially. Fibrosis sometimes becomes progressive and leads to cirrhosis, especially if repeat attacks of alcoholic hepatitis occur.

Cirrhosis

Alcoholic cirrhosis is a serious liver disease. It is most frequent in men over the age of 40 who have drunk excessively throughout their adult lives.

Cirrhosis develops as a result of liver cell death, fibrosis, impaired blood supply and the desperate attempt of some liver cells to regenerate new tissue. The balance between blood supply and regenerating nodules of liver is abnormal, and blood-starved cells continue to die. This triggers more fibrosis, which obliterates more blood vessels. Thus a vicious circle is set up. Islands of regenerating liver cells are separated by bands of scar tissue and the liver takes on a shrunken, knobbly appearance.

Because of inadequate blood supply, these nodules of regenerated tissue fail to function properly. Back pressure on the blood supply from the digestive tract becomes worse and the varicose veins in the oesophagus enlarge. The spleen also becomes distended and fluid accumulates within the abdominal cavity to cause gross abdominal swelling.

Alcoholic cirrhosis eventually leads to death from haemorrhage (often of the oesophageal varices), liver failure or liver cancer. This develops in around 10 per cent of cases as a result of abnormal cell regeneration.

Abstinence from alcohol at this late stage can improve cirrhosis by removing the poison that was causing the liver cell damage. Fluid accumulation is helped by diuretic drugs, and bleeding varices can be surgically improved. In advanced cases, however, a liver transplant is the only chance of a long-term cure. Fifty per cent of men diagnosed as having cirrhosis die within five years.

Drink sensibly. Do not exceed the recommended maximum safe levels of alcohol (at present, 21 units of alcohol per week for a male, which should be spread out evenly over the seven days).

A simple screening questionnaire has been designed by drinking experts to help alert you to a possible alcohol problem:

The CAGE test

Score one point for each YES answer.

• Do you ever feel you should Cut down on your drinking?

• Are you ever Annoyed by people criticizing your drinking?

• Do you ever feel Guilty about your drinking?

• Do you ever drink first thing in the morning ­ i.e. have an Eye-opener?

A total of two or more points means you might have an alcohol problem ­ see your doctor for advice as soon as possible.

Alcohol Addiction

Another useful questionnaire helps to detect signs of alcohol addiction. This was devised in the US and is short, simple and to the point. Answer YES or NO to each of the following 10 questions and add up your scores in the columns.

A score of six or more points indicates you may suffer from alcohol addiction. Seek advice from your doctor straight away. You need a full physical check-up (including blood tests) to see how well your liver is coping.