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Setting achievable goals & the ‘dose effect’

19 Feb

Paracelsus 2Mentioning either ‘units’ or the ‘guidelines’ alone can trigger a sceptical response from a drinker. I’m sure you’ve heard someone protest that “units are confusing” or that they “don’t believe the guidelines”. How should we respond to such statements or beliefs?

Firstly we should accept that people may have ambivalent attitudes about their drinking and may appear dubious or dismissive of health advice we may offer. They may also be right; units can be confusing and hard to keep track of, and we can’t take a ‘one size fits all’ health guideline too literally.

However the principle behind understanding units and applying these to the guideline is important. Consuming any drug – including alcohol – can be considered in terms of the ‘dose effect’ (or the dose-response relationship). Essentially, the greater the dose consumed, the greater the chance of unwanted (as well as perhaps wanted) effects. The recommended guidelines therefore set out the approximate ‘dose’ (in units) which alcohol can be consumed with a low risk of negative effects.

how muchA crucial consideration here is that there is no clear ‘threshold effect’, or no point at which the dose the longer matters. Put simply, the more you drink, the greater the risks . This is important because even if someone says ‘forget the guidelines, I’m never going to stick to them’, they still may be open to considering the fact that 5 pints is still less risky than 6.

There is evidence that some people who drink to get drunk only consider their ‘limits’ in terms of behaviour and whether they are ‘in control’. As such, health guidelines may not feel relevant for them. But emphasising that reducing health or behavioural risks still applies in terms of how much they drink. One message that has been found to be possibly more appealing is to try and ‘drink 2 less’, rather than perhaps ‘only drink 2’! And perhaps more importantly, it may feel much more achievable.

The alcohol calorie catastrophe

19 Jun

A single drinking occasion can lead to a multiple calorie catastrophe that can really undermine attempts at weight loss or healthy lifestyles. So even if health or other risks aren’t a concern for someone, its hard not respect the extra calorie count that alcohol can ramp up. But its not simply the calories in drinks themselves to be aware of…calories

First off, the calories in alcohol itself – an average UK drinker may consume 10% of their total calorie intake through alcohol alone. Per gram, alcohol has nearly the same calorie content as fat (7 calories per gram for alcohol and 9 per gram for fat).

And its not just beer that’s calorie loaded – a large glass of wine can have as many calories as a pint of lager. That’s around 180 calories, significantly more than a  packet of crisps (130 kcal in a 28g bag). So whilst someone on a diet would presumably never consider three bags of crisps in one go, three glasses of wine on a weekend occasion might not get a second thought.

There’s then there’s the possibility of a drink induced food binge. Alcohol is thought to interfere with the brain in way that can lead to hunger cravings, despite the body not needing more food. It is also thought that alcohol reduces the amount of fat the body burns for energy.

The final nail in the great calorie catastrophe is what might follow the next day – a recent study said drinking more than three large glasses of wine can push people to consume up to 6,300 extra calories in the following 24 hours. The survey found that around half of people consuming over 9 units consumed an extra 2,051 calories the next day on top of their usual diet. In addition, many stayed in bed, watching TV and using social media while hungover – instead of doing anything active.

Of course the additional downside is that alcohol calories are empty calories – there is not real nutritional value. So no, cider does not count towards your five a day!

Adding it all up…

So the alcohol calorie catastrophe can be a quadruple whammy of:

  • The calories in the drink itself
  • The extra calories consumed due to alcohol induced hunger (or perhaps loss of self-control!)
  • Alcohol reducing the amount of fat the body burns for energy
  • The extra calories consumed or not burned the following day

So it’s not surprising that many people might be more motivated to cut back on the drinks for reducing calories above reducing longer term health risks. This might be especially true for younger people, where more immediate issues like appearance or saving money might have stronger appeal.

One concern sometimes raised is young people aware of alcohol’s high calorie content opting to skip meals to compensate. Certainly a worrying issue and unfortunately sometimes there is little parents or professionals can do to prevent young people taking such risks. But adopting motivational brief intervention approaches, supporting and encouraging a person to reflect on the pros and cons of any risky behaviour can help.

But generally, cutting back on alcohol consumption for reducing calories can still bring many other benefits. When it comes to changes in drinking, it’s often a world of vicious -or virtuous – cycles.

Aim for an extra ‘alcohol free day’?

5 May
Mocktail anyone?

Mocktail anyone?

‘Brief advice bullets’ are motivators or tips to offer to people contemplating cutting down their drinking, like improved sleep, switching to lower strength drinks or reduced hangovers. However one of the most achievable goals for many drinkers seems to be to aim for an extra alcohol free day or two within the week.

Adding an extra alcohol free day often works best for those who have got into a ‘regular’ drinking pattern, perhaps without realising it.  The biggest trend in alcohol consumption has been the rise in home drinking, often synonymous with ‘a glass of wine to relax at the end of the day’.

Many such drinkers may have assumed that because they are not ‘binge drinking’, there are not significant health risks. Yet someone drinking an average of 2 medium glasses of 13% wine each night is clocking up around 32 units a week. Adding just two alcohol free nights will bring that down to around 23 units, much closer to the weekly guideline of 21 for men.

However since the recommended guidelines were changed from a weekly to a daily guideline, one of the concerns is that the message of at least two alcohol free days has been lost. Do most people realise that ‘not regularly exceeding 2 to 3 units (women) or 3 to 4 units (men)’ means having at least two nights of a week off the sauce? Even drinking five nights of the week within the daily guidelines seems a little too close to a ‘habit’ for my comfort. Perhaps the forthcoming change to the alcohol consumption guideline will better account for alcohol free days.

Of course like all ‘ brief advice bullets’, aiming to add an extra alcohol free night or two won’t appeal to everyone. But over the course of a week, a month, a year.. those health, financial or functioning improvements could really add up.

Brief Advice bullets: reducing hangovers?

4 Sep

Not everyone gets hangovers – a study from Boston University found that  as many as 30% of people may be immune to them. But for those of us that are susceptible, one must assume they act as a powerful preventative agent.

ow my headSo the appeal of reducing those painful after effects could be a useful ‘brief advice’ bullet for a risky drinker to contemplate. This may be especially powerful considering that there appears to be no evidence that hangover cures actually work.

So asides from the more serious risks of heavy drinking, like over 60 medical conditions and diseases, feeling fresher the next day may be a good reason for some to think about change. In fact a popular moderation movement originating in Australia called Hello Sunday Morning has based itself on this idea.

Of course many drinkers are still likely to experience those uncomfortable after effects of excessive alcohol from time to time. In which case, advising to drink water or soft drinks during and after is still the most sound advice to avoid the dehydrating effects. It has also been touted that soft drinks before and during drinking sessions may slow down drinking by quenching thirst or leaving less room for booze.

But remember, each to their own. Ask a drinker what their reasons for change might be, and perhaps offer suggestions rather than ‘advice’ per se.

See here for a Guardian article busting the myth of hangover cures, or a Drinkaware page on dealing with hangovers.

See here for previous ‘brief advice bullets’.

Brief advice bullets: try lower strength drinks?

12 Jul

As recently explored, highlighting the negative impact of alcohol on sleep is a winner for motivating risky drinkers to cut down. But punchy ‘brief advice’ strategies to actually help the drinker to do so are perhaps a bit harder to find. Many people may be unenthusiastic about to switching to weaker drinks or alternating with soft drinks.

So can lower-strength drinks play a role in reducing consumption? A recent report from John Moore’s University has urged caution from a policy perspective. It found that although lower strength drinks will help reduce harm where people swap them for stronger drinks, they may also create more drinking occasions where alcohol consumption is introduced. For instance, a weaker lager may make a lunchtime tipple more acceptable.

This conveniently reminds us that keeping an eye on the number of drinking occasions we have, as well as how much we drink when we do, is key for keeping as close to lower risk drinking as possible. But actually I did recently try a 2.8% ‘extra pale’ lager that was actually quite satisfactory. Not something I was expecting if I’m honest!

Brief advice bullets: alcohol disrupts sleep

9 Jul

There are some valuable bits of ‘brief advice’ that are more likely to resonate with all risky drinkers who engage. The negative effects of alcohol on sleep is surely one of those because everyone needs sleep and everyone wants to sleep well. I often speak to people who have cut down on their alcohol use, and improved sleep is probably what I hear volunteered most often as a positive outcome.

So whilst many risky drinkers might believe alcohol ‘helps’ them to sleep, they’re unaware the quality of the sleep is affected and so is less regenerating – even if they slept for as long. Alcohol reduces the capacity for deep re-energising sleep because as blood alcohol level declines, the body becomes more alert (known as the “metabolic rebound” effect). There must be something about waking up to go to the toilet too!

A recent study has found that even moderate consumption disrupts sleep. This and the fact that there seemed to be less of an impact on lost sleep time amongst heavier drinkers might negate the value of this particular benefit. Either way, alcohol isn’t good for the deep sleep we need. I know that the best shot I have of feeling fresh and well rested is to have an alcohol-free night – which is why I always aim for that on a school night!