Do you wake up after a big night out vowing to never touch another drink? Or perhaps you’re a bit anxious about your regular ‘wine o’clock’ habit?
Either way, you may be right to be concerned, as research increasingly shows the significant role alcohol can play in our risk of major illnesses, including liver disease, dementia and certain types of cancer.
In fact, alcohol is a direct cause of seven cancers, according to the World Health Organisation (WHO), putting it in the same category as smoking and asbestos.
While it might be easy to assume such dangers are the result of only heavy drinking, specialists are now warning that this isn’t true.
For instance, moderate drinkers – defined as consuming the equivalent of one or two pints of regular strength beer or a large glass of wine a day – have an 80 per cent higher risk of mouth cancer, a 40 per cent higher chance of throat cancer and 23 per cent greater risk of breast cancer compared with non-drinkers, according to a review by the US National Cancer Institute.
Experts also say that regularly drinking just a couple of glasses of wine a night can significantly impact your health long term.
‘Many people drink like this without giving it a second thought,’ says Marsha Morgan, a professor of hepatology at University College London. ‘And they wouldn’t see themselves as having a problem with alcohol.’
‘Yet the reality is that it’s this type of drinking that is leading to increased rates of health problems, from liver disease and memory problems to breast and colon cancer,’ adds Dr Peter Rice, an addiction psychiatrist and chair of the Institute of Alcohol Studies.
In this exclusive series, we help you work out if you are drinking too much (test yourself with our quiz below), with leading alcohol experts explaining what you need to know, from the surprising signs your health might be harmed by your drinking to advice about ways to cut down.
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What it’s doing to your health
‘Alcohol can have far-reaching effects on almost every major organ and body system,’ says Professor Morgan. And the more you drink, the greater your chances of serious damage.
Damage to DNA and cells: Alcohol is a major carcinogen and a recognised cause of seven different cancers: breast, liver, bowel, oesophagus, pancreas, head and neck and melanoma (skin cancer). It damages cell DNA through oxidative stress and other mechanisms. Acetaldehyde, the toxic compound formed when alcohol is broken down, also damages cell DNA.
Weight gain: Most alcoholic drinks are high in calories – a bottle of wine contains 600-700 calories, or the equivalent of nearly three 48g Snickers chocolate bars – which can lead to weight gain, particularly around the middle, says Kevin Moore, a professor of hepatology at University College London.
Liver disease: The rate of premature deaths from alcoholic liver disease increased 60 per cent between 2001 and 2023 in England alone. The majority of people who drink regularly develop fatty liver (where fat builds up in that organ), says Professor Morgan – ‘But this can reverse if alcohol is stopped.’ However, persistent heavy drinking will lead to inflammation, scarring and cirrhosis.
Experts say that regularly drinking just a couple of glasses of wine a night can significantly impact your health long term
Weakened immune system: Alcohol damages key immune cells making it harder for them to fight infection. This makes you more susceptible to infections.
Reduced brain function: Alcohol interferes with brain pathways, affecting mood, concentration and coordination. Long-term excess drinking can also damage brain structure and function, causing brain shrinkage and an increased risk of dementia.
Heart damage: An irregular heartbeat, cardiomyopathy (diseases that affect the heart’s ability to pump blood) and even an increased risk of stroke are linked to excessive drinking. Regularly drinking too much can raise blood pressure, putting a strain on the heart, as well as weakening heart muscle and triggering irregular heart rhythms according to the British Heart Foundation.
Stomach ulcers: Alcohol can irritate the gut lining, leading to inflammation and ulceration of the stomach, oesophagus and upper intestine.
Disrupted hormones: Alcohol can have a significant effect on the reproductive hormones: in women, it can disrupt oestrogen levels, which raises the risk of breast and ovarian cancers; while in men it can reduce testosterone levels, leading to poorer sexual function. Alcohol also crosses the placenta and may cause a Foetal Alcohol Syndrome (FAS) in an unborn child – a range of lifelong physical, behavioural and developmental issues.
Inflamed pancreas: Alcohol is a major cause of inflammation of the pancreas, resulting in pancreatitis. Acute pancreatitis can be life-threatening, while chronic pancreatitis causes abdominal pain, type 2 diabetes and malnutrition.
How quickly that tipple has an impact
The time it takes to have an effect can depend on several factors, including whether you have an empty stomach (food slows absorption), how much body fat you carry (those with more fat process alcohol less efficiently), your ethnicity and hormones.
Within five minutes: Alcohol starts taking effect on your body in two to five minutes of your first sip, passing into your bloodstream after being absorbed through the mucous membrane lining the stomach and intestine. Around a quarter is absorbed via the stomach: the rest is absorbed further along your digestive tract.
Within ten minutes: It’s crossing the protective blood-brain barrier, where it stimulates the release of ‘feel-good’ chemicals such as dopamine and serotonin. ‘These are responsible for that feeling of euphoria we associate with alcohol consumption,’ says Professor Moore.
After 30 minutes: Alcohol is a toxin – and it’s the liver’s job to remove it. It processes it at roughly one unit an hour. ‘This may vary slightly from person to person but is a fixed rate – and can’t speed up even if there is an excessive amount to remove,’ explains Professor Moore.
The enzyme alcohol dehydrogenase (ADH) turns alcohol into the toxic chemical acetaldehyde within 15- 30 minutes of taking a drink, so levels start to build in the body.
‘Acetaldehyde can cause your skin to flush, feelings of nausea and palpitations – and contributes to hangovers the next day,’ he adds.
After one hour: By around 30 minutes your body will have absorbed one unit of alcohol via your gut and bloodstream (the equivalent of a single shot of spirits; a pint of beer is two units and a small glass of wine is 1.5 units), but the concentration of alcohol in your bloodstream peaks around an hour after a single drink, says Professor Morgan.
After four hours: What happens next depends on whether you carry on drinking.
As Professor Morgan explains: ‘While the alcohol is queueing to be metabolised by the liver, it circulates in the bloodstream.’
This means that your blood alcohol levels will continue to back up if you carry on drinking. As alcohol accumulates it slows down brain function. ‘It interferes with several complex networks in your brain and the overall effect is to depress brain activity,’ says Professor Morgan.
For instance, it enhances the calming effects of the chemical messenger GABA – this explains why you might feel very relaxed or stumble as alcohol takes effect.
Alcohol also dampens down glutamate, a chemical messenger that promotes brain activity, contributing to slurred speech, memory lapses and slow reaction times.
After two units (175ml glass of wine or a pint of lower strength beer) you generally start to lose your inhibitions and are more likely to have an accident; by five units (two pints of lower-strength beer), the temptation to take risks or for sillier behaviour increases.
At around ten units (roughly two-thirds of a 750ml bottle of 13.5 per cent alcohol wine) is the time people start slurring and picking arguments.
Alcohol stimulates the release of ‘feel-good’ chemicals such as dopamine and serotonin within ten minutes, but as it accumulates it slows down brain function
At 12 units (roughly five 250ml glasses of 12 per cent wine) you may stagger and have memory problems.
Oblivion or passing out can happen after drinking 25 units (eight pints of premium beer or two and a half bottles of 12 per cent alcohol wine).
After 12 hours: The fact your body can process only a unit of alcohol an hour means you can still have some in your system and ‘explains why people can be over the drink-drive limit the next morning – and why it’s possible to die of alcohol poisoning’, says Professor Moore.
Are you a secret middle-aged binge drinker?
Many of us enjoy what we see as ‘a few drinks’ without ever viewing this as a problem for our health.
But we may be binge drinking and, done regularly, this can lead to alcohol-related disease such as changes in the heart, brain and liver, as it’s the amount of alcohol that goes through your system that counts, says Dr Peter Rice, chair of the Institute of Alcohol Studies.
‘It’s often thought that a binge is drinking several bottles of wine in one night but, from a medical perspective, it’s much lower than that.’
And it’s the middle-aged and older groups who are the ones with the worrying drinking habits, he says.
‘These people usually drink at home – for instance, a regular gin and tonic and a couple of glasses of wine. They may not feel remotely drunk and don’t realise how much their drinking is adding up.’ Researchers define binge or heavy drinking as consuming six units of alcohol in a single session for a woman (the equivalent of two 250ml glasses of 12 per cent wine) and eight units for a man (three pints of 5 per cent beer).
Experts now agree that, medically speaking, there’s no such thing as a threshold below which you can safely drink. ‘But we live in the real world and have to be pragmatic,’ says Marsha Morgan, a professor of hepatology at University College London.
Nearly one in four adults in the UK regularly drinks more than the official limit of 14 units a week, according to the British Liver Trust. This is partly due to confusion about what constitutes a unit.
Alcohol lingers longer in women
Women are generally more sensitive to the effects of alcohol. Not only are they likely to feel its effects quicker, but it also lingers longer in their bodies, says Kevin Moore, a professor of hepatology at University College London.
For example, if an average woman who weighs around 11st (70kg) drinks a standard bottle of wine over an hour, her blood alcohol will peak at 208mg/100ml or two and a half times the legal drink-drive limit (80mg/100ml).
It won’t return to legal limits until ten hours later.
If an average man of the same weight drinks the same bottle of wine over an hour, his highest blood alcohol levels will be 165mg/100ml (twice the drink-drive limit).
It will take his body six hours to return to below the drink-drive limit.
The reason for the difference between the sexes is body composition: women typically have a higher percentage of body fat and less water – alcohol can easily be dissolved and diluted in water but not in fat tissue, leading to higher alcohol concentrations in women’s bloodstreams for longer.
In addition, women tend to be smaller and weigh less, which means that there’s less total water to dilute the alcohol.
Hormones also play a role: oestrogen in particular affects alcohol metabolism and changes in levels (for example, during the menstrual cycle) can influence how effectively alcohol is processed.
Women also tend to have lower levels of the enzyme alcohol dehydrogenase (ADH), so they metabolise alcohol more slowly.
Women are generally more sensitive to the effects of alcohol. Not only are they likely to feel its effects quicker, but it also lingers longer in their bodies
You need to plan how to live your life after drink
It’s not clear why one person develops a physical dependency on alcohol while another does not?
For while regular heavy drinking eventually leads to serious health problems for most people, not all of them are actually physically dependent on alcohol (now known as alcohol use disorder).
‘Many people will be able to stop drinking if they want to, and
won’t suffer from withdrawal symptoms,’ says Dr David Bremner, medical director of Turning Point, which provides addiction services to local authorities in England.
‘Others will have crossed an invisible line and find they suffer unpleasant physical symptoms if they try to stop drinking. These can include shaking, palpitations, severe nausea, diarrhoea, anxiety, headaches, insomnia, sweating and an increased heart rate.
‘This can sometimes lead to seizures and prove life-threatening. It’s a serious condition that requires medical attention,’ he says.
If you need help to control your drinking habits, contact your GP who can refer you to local services.
If you live in England, alcohol support is commissioned by your local authority and often provided by national or local charities.
In Scotland, Wales and Northern Ireland, these services are offered through the NHS, council and charity services working together.
‘Ideally you would be offered sessions with a well-trained therapist – often a specialist in counselling or providing cognitive behavioural therapy (CBT) – but what’s on offer varies enormously,’ says addiction psychiatrist Dr Peter Rice.
Waiting times can also vary, he adds. ‘Often assessment will be offered within two to three weeks, but thereafter the wait for sessions with a therapist or counsellor can be several weeks or longer.’
There’s strong evidence from numerous studies for CBT. Research in JAMA Network Open last year found those who had CBT with trained therapists once a week for eight weeks abstained from drinking significantly more over an eight-month period, compared with those who had standard weekly group counselling.
Medical detoxes may be needed for people who have uncomfortable withdrawal symptoms.
‘A health professional administers drugs to mitigate the side-effects – these can include a five to seven-day course of benzodiazepines such as Valium, which give a sedative effect and protect against seizures,’ says Dr Rice. ‘You will also be given B vitamins to protect against alcohol-related brain damage.’
If you are experiencing physical withdrawal symptoms and have not been able to access medical help from local services, go to A&E immediately as this could develop into a life-threatening condition.
Medical detoxes are available privately as supervised home procedures or at a clinic. Costs range from £800 at home detox and £2,000 to £10,000 per week at a private clinic.
Other drugs are sometimes also prescribed post-detox – these can include acamprosate, which dampens down cravings by stabilising brain chemicals; and naltrexone, which blocks the euphoric effects associated with alcohol, reducing cravings (see above). Both are used as part of a wider recovery programme involving counselling.
‘If you pay privately, check that services are properly accredited [by the Care Quality Commission],’ says Dr Rice. ‘Remember, a detox simply gets the alcohol safely out of your system. After this you need a plan about how to live your life.’
Help is also available from groups such as Alcoholics Anonymous.
From weight loss to better sleep, the health benefits of cutting back
After just a week of not drinking, sleep quality should improve and you should start to feel more refreshed when you wake up in the morning
If you stop drinking entirely you may suffer hangover symptoms for up to 72 hours as your body works to clear the alcohol and its toxic by-products out of your system.
But after this you will undergo a range of positive changes. Here are some of the improvements you could see:
After one week
Sleep quality should improve as you start to enjoy more restorative rapid eye movement (REM) sleep. So you should start to feel more refreshed when you wake up in the morning.
You’ll also be less dehydrated: this should start to be reflected in brighter eyes and clearer skin within a week or two of ditching alcohol, as well as better concentration, fewer headaches, lighter mood and more energy.
Marsha Morgan, a professor of hepatology at University College London, points out however that not all cases of low mood or poor mental health will be due to alcohol consumption (although this will undoubtedly make matters worse).
‘But once you have removed alcohol from the equation you can see if there is a mental health problem that requires medical treatment and get help,’ she says.
‘Your liver enzyme function will also begin to normalise within 24 hours, although you won’t be aware of this.’
The effects of giving up alcohol on blood sugar levels can also be seen quite rapidly.
A study published in Scientific Reports in 2017 found just one week of abstinence in men who drank the equivalent of two and a half glasses of 12 per cent alcohol wine five times a week led to significant improvements (7 per cent drop) in their blood sugar levels.
Two weeks
You may have lost some weight – if you were regularly drinking five bottles of wine a week you could have consumed 6,000 fewer calories at the end of a fortnight, which could equate to a 2lb weight loss.
Your gut may also have started to heal so any bloating, heartburn and stomach pain may start to subside.
Your bowel movements may also become more normal (alcohol irritates the gut, leading to diarrhoea; it can also cause constipation as it’s a diuretic). Your body will also absorb more nutrients as a result of improved gut health.
Gut inflammation will reduce within about three weeks of stopping drinking as the gut lining begins to heal.
One month
By now levels of fat in the liver may have dropped by up to 15 per cent, increasing that organ’s ability to flush out toxins (also leading to brighter eyes and clearer skin).
So long as there are no other factors, blood pressure should also be significantly lower for most people, says Kevin Moore, a professor of hepatology at University College London.
Blood sugar levels can also continue to be better controlled.
As little as four weeks of abstinence can reduce your risk of developing type 2 diabetes by as much as 28 per cent, according to the charity Alcohol Change UK. (Not only are many alcoholic drinks high in refined carbohydrates, but alcohol can also interfere with the liver’s ability to regulate blood sugar.)
Research has also found that 70 per cent of people reported sleeping better and 65 per cent noted a general improvement in their health.
You’re likely to notice improvements in your memory, too – particularly your short-term recall after around a month.
Two months
As well as better sleep, improved skin, mood, concentration and perhaps even weight loss, major organs will be recovering rather dramatically.
‘Alcohol can cause high blood pressure but within six to eight weeks, blood pressure can reduce to within normal limits again,’ says Professor Morgan.
As little as four weeks of abstinence from alcohol can reduce your risk of developing type 2 diabetes by as much as 28 per cent
Three months
In women, rebalanced hormone levels after giving up alcohol leads to more regular periods and ovulation; stopping drinking can help them to preserve their existing ovarian reserve.
These improvements are generally seen three months after cutting out alcohol, as this is the time it takes for a new egg to mature and be released.
Sperm are made over 60 days and Professor Morgan says that 60 per cent of men should see a return to normal sperm test results within three months.
A 2010 study published in Productive BioMedicine Online found that the quality of semen improved dramatically after the men involved stopped drinking, and generally returned to normal even for heavy drinkers after three months.
Skin disorders such as psoriasis and acne rosacea should also be showing a significant improvement by now – and respond better to treatment, says Professor Morgan.
‘In particular, so-called ‘drinker’s nose’, or rhinophyma – characterised by a red, swollen and bumpy nose – can improve quite dramatically in appearance within two to three months of stopping drinking,’ she adds.
Longer-term
Although many cases of liver damage can be reversed if you stop drinking, this isn’t the case if you have developed cirrhosis (scarring).
However, you usually have a near-normal life expectancy so long as you don’t drink alcohol again, says Professor Moore.
‘It is a case of ‘stop and survive’ or ‘drink and die’ – it’s that simple,’ he says.
If you stop drinking alcohol, you’ll reduce your risk of developing some cancers, particularly breast cancer, colorectal cancer, throat and mouth cancer and oesophageal cancer, reported the New England Journal of Medicine in 2023.
- For information and advice about alcohol, visit drinkaware.co.uk; alcoholchange.org.uk; alcoholics-anonymous.org.uk; smartrecoveryinternational.org and wearewithyou.org.uk
