For years, official medical advice has warned of the dangers of drinking too much alcohol in one sitting. Recent findings from Denmark, however, suggest that, in the right conditions and as part of a pattern of sensible drinking, the occasional binge may not be as damaging as had been assumed. Erik Skovenborg MD examines the latest thinking on alcohol and health

When you ask bar staff or restaurateurs to volunteer a definition of binge drinking, the answer they usually offer is, "Drinking with the intention of getting drunk." Around the world, governments are looking to be a little more precise with their official guidelines. The UK government, for example, recommends that men should not regularly drink more than 3-4 units and women not more than 2-3 units of alcohol a day, but it does not give any specific advice on binge drinking. The British parliament's House of Commons Science and Technology Committee is currently examining the medical evidence behind the guidance. In a recent submission to the committee, Nick Heather, a professor of alcohol and drug studies at Northumbria University, suggests that a "bingedrinking limit" could be set at 8 units a day for men and 6 units for women. There is, however, no consensus about what the cutoff should be, and the various proposed cutoffs have been criticized for being too simplistic and lacking a basis in science.

Who are the binge drinkers?

Teenagers and young adults are the binge-drinking champions; however, binge drinking covers a wide age group. The General Household Survey in the UK found that 21 percent of men drank more than 8 units and 10 percent of women more than 4 units in one day at least once in the preceding week. "If people are going to get hammered, they tend to start on beer, then move on to shots," a bar manager told MCM Research. A big night out would often involve mixing drinks, but wine rarely comes into the bingedrinking picture. Across the world, the media has focused on the role of alcopops or flavored malt beverages in binge drinking among girls who have a less developed palate for alcohol. However, a scientific review found sparse evidence of an association between the consumption of alcopops and the negative health effects of binge drinking.

Protective or hazardous drinking?

To binge or not to binge is never really in question if you heed the warnings of health authorities. Severe hangovers lie in wait; and in the short term, binge drinking is associated with physical injuries and engaging in unplanned sex. In the long run, binge drinkers do not get the protective increase of HDL cholesterol enjoyed by regular drinkers; on the contrary, the level of dangerous LDL cholesterol is increased. A study of alcohol intake patterns in Northern Ireland and France showed that regular and moderate intake of wine throughout the week - the typical pattern of consumption in middleaged men in France -- is associated with a low risk of coronary heart disease, whereas the binge-drinking pattern more prevalent in Belfast doubled the risk of developing myocardial infarction. We are left then with the question of where the boundary lies between protective and hazardous drinking. Most studies do not assess drinking patterns over the whole spectrum of total alcohol intake, and it is difficult to measure the confounding effects of smoking.

Embedded binge drinking

Recent findings from the Danish National Cohort Study, a nationally representative public-health survey, have cast some new light on the matter of binge drinking. A total of 10,870 men (83.7 percent) and 12,465 women (90.4 percent) from the DNCOS were light to moderate drinkers, defined as drinking up to and including 21 units per week for men and up to and including 14 units per week for women (1 unit is equal to 12 grams of alcohol). Among light to moderate drinkers reporting occasional binge drinking, the risk of coronary heart disease and total mortality showed no difference compared to light to moderate drinkers reporting no binge drinking after control for total alcohol intake. How do we explain this rather interesting finding? Does the definition of binge drinking fail to reach the necessary level of disambiguation? What we can say is that it is probably not helpful to lump together those who have drunk six to nine glasses of wine with their meal with those who have drunk considerably more on an empty stomach and are extremely intoxicated. Among the participants in the present study with occasional binge drinking embedded in a moderate and sensible drinking pattern, the mean intake was 13.9 drinks per week with a median of nine drinks per drinking day among men, and 9.8 drinks per week with a median of seven drinks per drinking day among women. This might be too low for adverse effects on the heart to occur. A healthier lifestyle among frequent drinkers could also be an explanatory factor.

All things in moderation

The surprising news from Denmark should not be seen as an endorsement of binge drinking. Alcohol is causally related to around 100 diseases and conditions, and it contributes considerably to the global burden of disease. So, when you are wined and dined by friends with well-stocked wine cellars, it is well worth recalling the "rules to be followed in getting drunk" in The Praise of Drunkenness (1714) by the French author Albert de Sallengre: Do not force someone to drink; do not drink too often; always drink good wine in good company at the right time; and, last but by no means least, know your limits There is, however, no consensus about what the cutoff should be, and the various proposed cutoffs have been criticized for being too simplistic and lacking a basis in science.

Who are the binge drinkers?

Teenagers and young adults are the binge-drinking champions; however, binge drinking covers a wide age group. The General Household Survey in the UK found that 21 percent of men drank more than 8 units and 10 percent of women more than 4 units in one day at least once in the preceding week. "If people are going to get hammered, they tend to start on beer, then move on to shots," a bar manager told MCM Research. A big night out would often involve mixing drinks, but wine rarely comes into the bingedrinking picture. Across the world, the media has focused on the role of alcopops or flavored malt beverages in binge drinking among girls who have a less developed palate for alcohol. However, a scientific review found sparse evidence of an association between the consumption of alcopops and the negative health effects of binge drinking.

Protective or hazardous drinking?

To binge or not to binge is never really in question if you heed the warnings of health authorities. Severe hangovers lie in wait; and in the short term, binge drinking is associated with physical injuries and engaging in unplanned sex. In the long run, binge drinkers do not get the protective increase of HDL cholesterol enjoyed by regular drinkers; on the contrary, the level of dangerous LDL cholesterol is increased. A study of alcohol intake patterns in Northern Ireland and France showed that regular and moderate intake of wine throughout the week - the typical pattern of consumption in middleaged men in France -- is associated with a low risk of coronary heart disease, whereas the binge-drinking pattern more prevalent in Belfast doubled the risk of developing myocardial infarction. We are left then with the question of where the boundary lies between protective and hazardous drinking. Most studies do not assess drinking patterns over the whole spectrum of total alcohol intake, and it is difficult to measure the confounding effects of smoking.

Embedded binge drinking

Recent findings from the Danish National Cohort Study, a nationally representative public-health survey, have cast some new light on the matter of binge drinking. A total of 10,870 men (83.7 percent) and 12,465 women (90.4 percent) from the DNCOS were light to moderate drinkers, defined as drinking up to and including 21 units per week for men and up to and including 14 units per week for women (1 unit is equal to 12 grams of alcohol). Among light to moderate drinkers reporting occasional binge drinking, the risk of coronary heart disease and total mortality showed no difference compared to light to moderate drinkers reporting no binge drinking after control for total alcohol intake. How do we explain this rather interesting finding? Does the definition of binge drinking fail to reach the necessary level of disambiguation? What we can say is that it is probably not helpful to lump together those who have drunk six to nine glasses of wine with their meal with those who have drunk considerably more on an empty stomach and are extremely intoxicated. Among the participants in the present study with occasional binge drinking embedded in a moderate and sensible drinking pattern, the mean intake was 13.9 drinks per week with a median of nine drinks per drinking day among men, and 9.8 drinks per week with a median of seven drinks per drinking day among women. This might be too low for adverse effects on the heart to occur. A healthier lifestyle among frequent drinkers could also be an explanatory factor.

All things in moderation

The surprising news from Denmark should not be seen as an endorsement of binge drinking. Alcohol is causally related to around 100 diseases and conditions, and it contributes considerably to the global burden of disease. So, when you are wined and dined by friends with well-stocked wine cellars, it is well worth recalling the "rules to be followed in getting drunk" in The Praise of Drunkenness (1714) by the French author Albert de Sallengre: Do not force someone to drink; do not drink too often; always drink good wine in good company at the right time; and, last but by no means least, know your limits