UK doctors are recommending men and women who drink should have two or three alcohol-free days a week to give the liver time to recover. The Royal College of Physicians (RCP) says the government guidelines should be amended as they imply daily drinking is safe.
The RCP has been giving oral and written evidence this month to the House of Commons Science and Technology Select Committee’s inquiry into the evidence base for alcohol advice. The Select Committee launched the inquiry on 18 July to find out, among other things, whether the evidence base and sources of scientific advice to Government on alcohol could be improved.
The current government advice, issued by the Chief Medical Officers recommends that men should not regularly drink more than 3-4 units of alcohol a day and women should not regularly drink more than 2-3 units a day. The guideline explains that “regularly” means drinking every day or most days of the week, and that people should also take a break for 48 hours “after a heavy session” to let the body recover.
The RCP says this implies it is OK to drink every day or nearly every day. They disagree with this, saying the liver needs time to recover, even from small amounts of alcohol. There is a higher risk of liver disease for people who drink alcohol every day or nearly every day compared to people who drink less frequently, says the RCP.
Sir Ian Gilmore, RCP’s special adviser on alcohol wrote recently to the Daily Mail about the importance of limiting frequency as well as quantity:
“In addition to quantity, safe alcohol limits must also take into account frequency. There is an increased risk of liver disease for those who drink daily or near daily compared with those who drink periodically or intermittently.”
Gilmore said the RCP recommends “a safe limit of 0-21 units a week for men and 0-14 for women provided the total amount is not drunk in one or two bouts and that there are two to three alcohol free days a week. At these levels, most individuals are unlikely to come to harm.”
In answer to the question of whether the evidence base and sources of scientific advice to government on alcohol could be improved, in its written evidence to the Committee, the RCP said it believes the government’s guidelines coud be improved to better reflect the evidence in a number of areas, such as:
- Overall levels of consumption that are “safe” or within “sensible limits”,
- Frequency of alcohol consumption,
- The physiological effects of ageing, and
- The balance of the health benefits of alcohol consumption for coronary heart disease against wider alcohol-related health harms.
In its letter to MPs, the RCP says the current government guideline implies daily drinking is low risk, but this “runs against evidence which suggests that frequency of drinking is a significant risk factor for the development of alcohol dependency, and the development of alcoholic liver disease“.
In the list of points about the evidence for including alcohol-free days, it notes:
“Although the mechanisms for alcohol related liver damage are not fully delineated, further studies have shown an increased risk of cirrhosis for those who drink daily or near daily compared with those who drink periodically or intermittently.”
One of the studies the RCP refers to is a Japanese study that showed heavy drinkers who consumed their alcohol over 5 to 7 days had higher rates of death than those who consumed it over 1 to 4 days.
The letter also refers to another study published in 2009 that found increases in liver deaths in the UK were the “result of daily or near -daily heavy drinking, not episodic or binge drinking, and that this regular drinking pattern is often discernable at an early age”.
In the section on frequency of alcohol consumption the letter concludes that:
“The government guidelines should recognise that hazardous drinking has two components: frequency of drinking and amount of drinking. To ignore either of these components is scientifically unjustified. A very simple addition would remedy this problem namely a recommendation that to remain within safe limits of alcohol consumption that people have three alcohol-free days a week.”
You can read the full written evidence from the RCP to MPs here.
Written by Catharine Paddock PhD