By Niki Bezzant
It's July again: Cue lots of people being vocal about giving up booze for a month in the name of charity.
While there's nothing wrong with fundraising for a good cause, there are many reasons we should perhaps think about giving up (or at least cutting way back on) alcohol for good, not just for 31 days.
A couple of recent reports have highlighted this. The Heart Foundation released a new position statement on alcohol last month, advising that no amount of alcohol is good for your heart health, and drinking less is a better option.
Research out of Otago University, ranking the country's most harmful drugs, put alcohol in the top position.
Neither of these things should be surprising. Experts have known - and been telling us - for decades that alcohol is bad news on almost every score. We tend to not want to hear it, though, preferring to focus on studies supposedly finding that moderate alcohol consumption is good for us.
Here's some food for thought on why we need to re-think our relationship with our favourite drug.
What's the latest on alcohol and the heart?
The Heart Foundation's Dr Gerry Devlin says alcohol affects heart health in multiple ways, including impacting heart rate, blood pressure and functioning of the cells lining the heart and blood vessels.
"The latest evidence shows an increased risk of high blood pressure, a major risk factor for heart disease and stroke. Alcohol also increases the risk of a range of heart conditions, such as atrial fibrillation and haemorrhagic stroke, and may increase the risk of heart failure."
The evidence on atrial fibrillation (AF) - a common condition in older people - is particularly strong.
"Alcohol can precipitate symptomatic atrial fibrillation", Devlin notes.
"And perhaps more importantly, if you actually have got AF and you reduce your alcohol consumption or cut it out completely, you can reduce your burden from it."
The same goes for high blood pressure. For each 10-gram increase in pure alcohol we have per day (1 standard drink) the risk of high blood pressure increases by 6 percent. A standard drink is a small glass of wine (just 100ml) or one bottle or can of regular-strength beer.
Before you think 'I don't need to worry about my heart', consider this: Heart disease is the number one killer of Kiwis. That includes women, who often think men are more likely to be affected.
Heart disease takes the lives of more than 6700 New Zealanders every year - that's more than one person every 90 minutes.
Why is alcohol the most harmful drug?
New local research published in the the UK's Journal of Psychopharmacology shows alcohol is the most harmful drug for the total population in Aotearoa.
The study's co-author, Dr Rose Crossin, said it might surprise some to learn that alcohol outranked several other illegal drugs.
"Alcohol isn't the most harmful because it's the most widely used drug… it's rated the most harmful because of its association with a huge number of diseases, cancers, psychological disorders and other medical conditions.
"Alcohol also causes more harm to others than to those who use it, including families, friends, communities and wider society."
What are the other harms from alcohol?
It's a pretty grim list. Alcohol, according to the World Health Organisation, is a causal factor in more than 200 disease and injury conditions, and its harmful use is associated with 5 percent of deaths worldwide each year.
As well as heart disease, drinking alcohol is associated with a risk of developing mental and behavioural disorders, including alcohol dependence, and major noncommunicable diseases such as liver cirrhosis and some cancers (at least six different kinds, including breast and colon cancer).
Alcoholic drinks are classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen - the same as asbestos and tobacco.
Alcohol is also a big contributor to injuries, including road crashes, violence and suicide. The burden from these tends to fall on younger age groups.
Speaking of which, around 1800 babies are born with Foetal Alcohol Spectrum Disorder (FASD) in Aotearoa each year, a totally preventable lifelong condition encompassing a range of physical, cognitive, behavioural and neurodevelopmental disabilities.
If the big stuff doesn't have you convinced, there are the many ways alcohol wreaks havoc in our everyday lives.
It destroys our sleep, preventing the deep restful sleep we need. It's bad for our mood - contributing negatively to mood issues and mental health disorders such as anxiety and depression.
And it's terrible for our nutrition, contributing to nutrient deficiencies, physical and mental performance and, because it's so energy-dense, weight gain.
Wait - I thought alcohol was meant to be good for us in moderation?
There have long been studies seeming to show that moderate drinking is better for us than being completely teetotal. It's been something to point to in support of a daily red wine habit.
Devlin says the evidence on which recommendations for one to two glasses of alcohol a day for heart health was based was "pretty flimsy".
Recent research - including a big meta-analysis published in March in JAMA - has firmly put paid to that idea, and found the reverse result.
The researchers looked at over 100 studies covering more than four million people, and found the methodology of many of those studies was flawed, partly because the studies often failed to take into account the other things going on in the lives of those who are both moderate drinkers and non-drinkers.
They concluded that in fact, when they did adjust for those things, there was no benefit to moderate drinking, and there was a significantly increased risk of all-cause mortality (i.e., death) among women who drank around two drinks per day, and among male drinkers who had four or more drinks per day.
So the best advice is… don't drink?
Pretty much. Or if you do, keep it very moderate. And definitely don't start drinking, thinking it's good for your health.
Recently Canada updated its official guidelines for alcohol, warning that no amount of alcohol consumption is healthy.
Devlin says that while the Heart Foundation isn't trying to tell people what to do, he does support a change to New Zealand's guidelines.
"What other reason are we recommending that alcohol consumption is healthy, other than potential cardiovascular benefit? I think the guidelines here certainly do need to be reviewed and redone.
"It's hard to argue that there is any reason to recommend consuming alcohol on a regular basis for health benefits."
OK, I'm convinced. What's the best way to cut back or cut it out?
It can be tough cutting back, especially if we've developed into habitual drinkers (wine every night with dinner) or binge drinkers (a binge is counted as more than four drinks on any one occasion).
Some things that can help:
- De-coupling socialising and alcohol. Find other things to do with friends and family that don't revolve around drinking, like going for a walk or meeting for a coffee
- Taking advantage of the many alcohol-free options around now, like alcohol-free beer, wine and cocktails
- Re-working your environment. Prone to an after-work de-stressing drink? Devlin goes for an zero-alcohol beer. You could also try simply not having your favourite tipple in the fridge ready to go
- Try a reset. Challenges like Dry July, along with religious observances like Lent or Ramadan, can be a good chance to evaluate where you're at with your drinking, and consider how you might change your habits long-term
- If you are drinking, slow it down. Have a water in between drinks. And try not to have more than two or three drinks on any one occasion
Lastly, it's never too early or late to change your relationship with alcohol.
"We are all at different stages," Devlin says.
"Anything we can do to reduce our alcohol consumption - young and old - is beneficial. When we're young, we think we're bulletproof.
"But the things you do now as a 30-year-old, for example, will impact on your health positively, or negatively, in the years to come."