Alcohol does more damage to women than it does to men, and it does it faster. As drinking by Irish women increases, an epidemic of liver diseaseis imminent, writes Kathryn Holmquist
More and more Irish women are drinking like men, but it's not a level playing-field. Women have a higher personal price to pay. On a purely physical level, alcohol does more damage to women than men, and it does it faster.
Women's drinking habits will soon bring about an epidemic of liver disease, says Dr Gerard Clarke, a specialist in liver disease and gastro-enterology at the University Hospital of Leicester and the Queen Elizabeth Hospital in Birmingham. And when women develop life-threatening problems as a result, they are less likely than men to be diagnosed and treated in time, he says. The prognosis when they are diagnosed tends to be far worse than a man's. If you are a woman, it takes less drink to drink yourself to death.
"Women tend to go to their primary-care physicians more, but when they do they get referred on to specialists less often than men. While men are poorer at accessing primary care, they are more likely to be taken seriously than women are," Clarke says.
Clarke's youngest female patient with cirrhosis of the liver is only 24 years old. She started drinking as a way of blotting out stress. For women, there is absolutely no health benefit in drinking alcohol and there are plenty of risks, he says. While, after the menopause, women at risk of heart disease may theoretically benefit from a glass of red wine a day, Clarke would rather see women taking statins to control high blood pressure.
The Republic's average consumption, for women and men, is 14.2 litres of alcoholic drink per head of the population annually, compared with an EU average of nine litres. While alcohol consumption has dropped in 10 EU countries, it has risen here by 41 per cent in the past decade.
At the Rutland Centre in Dublin, which treats addiction, the average client is as likely to be a young woman as a man. Alcohol may be an "equal opportunity destroyer", as Stephen Rowen, director of the centre, describes it, but there's no equality in physical terms. Foetal alcohol syndrome, unwanted pregnancies and infection by sexually transmitted diseases (STD) all occur while "under the influence". The 165 per cent increase in STD infection among young people is attributed to the alcohol epidemic by the Department of Health's Strategic Task Force on Alcohol.
If a woman consumes more than 14 units per week of alcohol (compared to the equivalent safe level of 21 units per week for a man), she is at risk of progressing to cirrhosis of the liver. In the early stages of this disease, there are no warning symptoms. In the late stage, symptoms are severe: mental confusion, and varicose veins in the stomach and oesophagus that may eventually result in internal bleeding, which can be catastrophic and has a mortality rate of up to 40 per cent.
Yet many women - even well-educated ones - haven't a clue about what one unit of alcohol actually is, Clarke points out. A mere 100 millilitres of wine (at 12.5 per cent alcohol) is one-and-a-half units and 200 millilitres, the amount in a large wine glass, is three units. Drink four large glasses of seemingly innocuous white wine every week and you're already over your limit. A pint of beer is two-and-a-half units, so six pints per week puts the average woman over the safe limit.
It would go a long way to protecting women's health (and men's) if there were warning labels on bottles of alcohol, as they have in the US, Clarke suggests.
"Women believe that if they are not drinking hard liquor, the alcohol is less harmful. But your liver doesn't care where the alcohol comes from," he says. Many women also believe, erroneously, that if they are not intoxicated the alcohol isn't doing any damage. The truth is that once you build up psychological tolerance to the effects of alcohol in the bloodstream, it is quite possible to do damage to your body without feeling drunk.
Women have less body mass, so, drink for drink, they get a higher dosage of alcohol in the bloodstream than men. Women's stomachs also have fewer of the enzymes that detoxify alcohol, so the amount of alcohol that is available to the liver is far higher in women than in men.
IT'S not the alcohol itself that damages the liver; it's the acetaldehyde (a first cousin of formaldehyde), which is a by-product formed when alcohol is broken down by the body. The immune system sees this product as foreign and attacks the cells that contain it. This poisonous process can continue for four weeks after a woman has stopped drinking. Abruptly ceasing to drink alcohol increases blood flow to the liver, which is why many women become extremely ill after they stop drinking. Any habitual drinker should not stop without medical supervision, Clarke warns.
You are at increased risk of damage from alcohol if you have hepatitis C or type 2 diabetes and if you are a carrier of the haemochromatosis gene (as are one in 11 Irish people). Unfairly, some people are genetically protected from the effects of alcohol, but there is no way to know this unless you undergo a thorough screening.
"Unless you are thoroughly well-screened and have a very low Body Mass Index, you can't push the envelope," says Clarke. Drink with caution and, if you're a woman, count your units carefully.
The regular health page columns resume next week.