According to the Australian Bureau of statistics newly released figures show worrying rises in the incidence of problem drinkers. The proportion has risen from 8.2 percent of the population in 1995 to 13.4 percent in 2004-05. Risky drinking has risen greatest in women, almost doubling from 6.2 percent to 11.7 percent. The greatest increases are seen in the baby boomers now approaching retirement. Ten years ago, around 7.5 percent of people aged 55 to 64 were risky drinkers whereas today more than 15 percent of people in this age bracket are drinking too much alcohol. Perhaps we have become too complacent, as we are told that some types of alcohol, such as red wine, are high in antioxidants and have health benefits; but this does not mean excess amounts are healthy. Alcohol of any type if drunk in excessive amounts is toxic to the liver and nervous system. The most worrying trend of alcohol abuse is seen in women and we now see women in their 30s and 40s dying of alcohol induced liver failure.

So what is safe alcohol ingestion?

Many people enjoy a glass of wine or other alcohol on regular occasions to be social or to unwind and thus it is a common question for those who have a fatty liver or indeed any liver disease – can I still drink alcohol? Most people are aware that excess alcohol consumption over many years can cause serious liver disease (called cirrhosis), and therefore ask about alcohol with reservation. They usually expect a resounding no as the response. However those of you who like the odd drink will be pleasantly surprised! Alcohol in moderation can be enjoyed BUT (well you knew there had to be one but!) there are some guidelines.

The types of drinks that can be enjoyed cover two issues:

1. The toxic effects of the alcohol on the liver itself Alcohol as it is consumed is not what causes the damage to the liver – it is the substances known as metabolites that form during the breakdown of alcohol. Ethanol (pure alcohol) is broken down in the liver to form acetaldehyde along with highly reactive and damaging oxidative species – you may know them as ‘free radicals’. So it is wise to allow time between alcohol intake to allow the liver to fully metabolise and render safe the toxic metabolites of alcohol breakdown – for this reason it is recommended to only drink every second day. In healthy people alcohol consumption should be kept below 40 grams in a 24 hour period (40 grams equals 1.1 liter of beer, 0.44 liter of wine, and 0.11 liter of spirits.) Intakes above this have been associated with increased liver weight and increased incidence of fatty liver disease. For those with liver disease I believe that this amount of alcohol is too much and should be reduced to one drink every 2 days. Women are far more susceptible to alcohol induced liver damage and therefore intake should be kept to no more than 20 – 30 grams of alcohol daily.
2. The effects of the alcohol on your weight and blood sugar levels (Syndrome X) Alcohol has little effect on insulin resistance and Syndrome X in low doses – in fact it actually has been found in some studies to be beneficial and heart protective (2). This is thought to be due to low intakes of alcohol encouraging the production of HDL (healthy cholesterol). High Density Lipoproteins (HDL) are the substances that carry excess unhealthy cholesterol out of the body via the bile and the bowel actions. So the excess production is thought to be a compensatory mechanism employed by the body to maintain healthy blood fat levels. However, with the excess consumption of alcohol, the benefits of this compensatory mechanism are lost and actually swing to the production of VLDL (bad cholesterol). Moderation is the key. The best results were found in people that drank 1 – 3 days per week – so it is recommended to have days in between where no alcohol is consumed. This also gives the liver a chance to break down the metabolites of alcohol which, as stated, are the most harmful aspect of the alcohol consumption.

What Types of alcohol should I choose?

The best type of alcohol to choose in regards to those with a fatty liver, diabetes or those who are overweight is spirits – such as gin, rum, vodka, brandy, scotch and whisky, as these have no carbohydrate content – however be very careful not to undo this benefit when choosing a drink mixer, as soft drinks including colas and lemonade, tonic water and other fizzy mixers can be very high in refined sugars. Better options are water, “on the rocks” (straight on ice) or soda water. If you miss the sweet taste of the mixer, you could try adding a little “Stevia’’ powder and citrus juice to the water or soda water. Full strength beer and cider should be avoided or greatly minimized, as 1 pint contains on average 12 - 15 grams of carbohydrate. Also avoid pre mixed drinks such as wine coolers and spritzers and sugary liqueurs. Carbohydrate Content of Alcohol Please Note: all carbohydrate values are approximate Alcohol Item (serving size)     Carbs (g) Beer, regular (12 fl oz)     13 Beer, light (12 fl oz)     4.5 Wine, red (3.5 fl oz)     1.75 Wine, rose (3.5 fl oz)     1.5 Wine, white (3.5 fl oz)     1 Cider, dry (1 pint)     15 Gin, Rum, Vodka, Whisky (1 fl oz)     0 Sherry (2 fl oz)     3 Port (2 fl oz)     6 Guinness (1/2 pint)     4
References
Alcohol Clin Exp Res. 1993 Oct; 17(5):1112-7.
Moderate Alcohol Consumption Has Beneficial Glycemic Effects Diabetes Care 2003; 26:1971-1978.