[05Feb12] Today’s BBC article “Campaign warns of drinking ‘little too much’ alcohol” reiterates it again: “People should not regularly exceed the daily limit of 3-4 units for men and 2-3 units for women”. This is also reflected in the current Department of Health (DoH) alcohol advice guidance.”
This is on the back of previous media articles from last year, where it was also advised to, for example, ‘give your liver a break’ from alcohol for at least 3 days a week (see more here and a BBC News video here).
These reports came up after the Royal College of Physicians (RCP) started a briefing meeting on minimum pricing of alcohol in 2009 and following various lobbying and alliance efforts, when their Science & Technology Select Committee published evidence to the inquiry on alcohol guidelines in 2011. More information on th RCP article can also be found here on NHS Choices.
Though a glass (of red wine) in moderation was thought to be cardio protective, latest research into alcohol consumption and particularly cancer (but also various other diseases) correlated the ‘little bit too much’ then the ‘moderate’ one glass (= 125ml). Cancer Research UK (CRUK) pointed out that around 9% of cancers in the UK may be linked to unhealthy diets and around 4% are linked to alcohol consumption. This was based on a study in December 2011 from Parkin et al.
Alcohol is well established as a cause of cancer. Also published around the same time from Parkin in the Journal of Cancer, it was estimated that around 12,500 cancer cases in the UK each year are linked to alcohol consumption. This was highest for cancers of the oral cavity and pharynx (around 30%), although bowel cancers accounted for the greatest number of linked cases (around 4,650 cases). 
Risk of cancers of the upper aerodigestive tract (oesophagus, oral cavity, pharynx and larynx) increases linearly with quantity of alcohol consumed above 25g/day. Someone drinking 100 g/day has a 4-6-fold increased risk of these cancers compared to light or non-drinkers. 
Further information on ‘Diet, alcohol and cancer in the UK – statitics’ can also be found on the CRUK website. Alcohol consumption has also considerable psychotropic effects, and can be linked to mood disorders and psychological distress. Long-term consumption of alcohol produces alcohol dependence with comorbidity such as mood disorder, schizophrenic disorder and neurotic disorder. 
If dependency is becoming an issue, it may be best to get help either from a trained professional or via group work. There are various UK bodies that offer help, e.g. see here.
Overall, one could perhaps say that ‘proper’ moderation is everything. This means not only ‘how much’ we drink, or ‘what’ we drink, but also ‘how’ and ‘when’ we chose to drink. It is clear that each of us may metabolise alcohol differently depending on genetic variation and individual environmental, metabolic and emotional circumstances. But e.g. chosing some very good quality (preferably organic and sulphite free) red wine with a good nutrient dense meal (with good amounts of vegetables and fish and other good fats, bit Mediterranean style) chatting animatedly among friends, will likely be better metabolised then pouring down some cheap pub wine with a bag of crisps in one hand and a fag in the other hand after work… There may be a lot of social peer pressure, particularly in the UK culture, however, drinking alcohol should be a ‘choice’. Keeping it to ‘one’ glass (=125ml) is often not easy for many people. Though when sitting down for a proper meal and chatting with friends this may be easier. If you still find it hard, try a ‘wine spritzer’ (50% with sparkling water). If you prefer normally spirits as you don’t cope well with red wine, perhaps you can tolerate a small white wine spritzer better.
If you like to get help on how to track your units and find out more about alcohol consumption guidelines, also check out the NHS Live Well pages here. If you don’t know what a unit of alcohol is – in the picture blow you can roughly see what it would be, depending on choice of drink. For a more thorough calculation, there are various alcohol unit calculators available online.
If you require a litte more help than just knowing how to drink ‘safely’, how to put it into action and combine it with a healthy lifestyle, considering your various lifestyle choices, pressures and other potential stress factors, feel free to contact us for a suitable personalised nutrition or therapeutic coaching programme.
Here’s to good health!
 Parkin, D.M., Boyd, L., Walker, L.C. (2011) The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Summary and conclusions. Br J Cancer, 6 Dec; 105 (S2):S77-S81; doi: 10.1038/bjc.2011.489
 Parkin, D.M. (2011) Cancers attributable to consumption of alcohol in the UK in 2010. Br J Cancer, 6 Dec; 105 (S2):S14-S18; doi: 10.1038/bjc.2011.476
 Boffetta, P. and Hashibe, M. (2006), Alcohol and cancer. Lancet Oncol, 7(2): p. 149-56.
 Shibasaki M, Kurokawa K, Ohkuma S. (2011) [Functional homology between alcohol dependence and mood disorder]. [Article in Japanese] Nihon Arukoru Yakubutsu Igakkai Zasshi. Jun;46(3):337-46.
The Good, The Bad and The Ugly
[28-Jan-12] The year 2012 started with some turbulences in the Nutrition Health arena (in the USA and European-wide), with media articles and various blogs running over with comments and opinions from both public and different health care professionals. Most of our clients often seem confused, with a common question: “I just want to eat well and be healthy, what’s the big fuss and what really IS the difference between a dietician, nutritional therapist (NT) and nutritionist?” (a place to find out may be here and here).
And why all this competitive bickering when ideally we should all aim to work together, specialising in our own areas of expertise, while respecting and enhancing each others strenghts – together – rather than against each other? There was a nice e-bulletin last week on ‘Recognising Diversity‘ between these professions. Reading through some of the blog comments (Which?, FSA, and various others online), it poses the question – is this predominantly about egos, politics, and vested interests while it should really be about the patient and consumer seeking better long-term health outcomes?
Some of the bias made by the recent Which? article was recently reviewed succinctly by a well respected Nutrition Consultant (MSc Nutritional Medicine, University of Surrey) here, who also did a very good job at responding to critical comments from Which? panelists and well-known professional anti-NT camp bloggers. Also a recent article of the British Medical Journal (BMJ) tried to bash Nutritional Medicine, while even the medical professions’ own lot, for example experts like Dr Mike Stroud (FRCP Consultant Gastroenterologist and Senior Lecturer in Medicine and Nutrition, Southampton, and Chair of the NICE GDG on Nutrition Support) was expressing his opinion about the article.
The point is that there are indeed ‘good’ and ‘bad’ practitioners in all professions. Ideally sifting out the ‘bad’ and the ‘ugly’ from the ‘good’ should of course be a priority in ensuring patient interest and safety. However, it appeared that the Which? article contained many inaccuracies and biases. There was an enlightening article published this week, aiming to explain the difference between main-stream dieticians and nutritional therapists, giving insight into current challenges in ‘Evidence-Based Medicine’ in the current scientific paradigm and the ‘new’ (well, more than 30 years old…) Functional Medicine paradigm for improved and integrative medicine (also with a a video link to Dr Jeffrey Bland, Institute for Functional Medicine (IFM)):
As we pointed out in our article on the recent Which? investigation of nutritional therapists (NTs) in the UK, NTs and dieticians are very different animals. Although the Which? article contained many inaccuracies and biases, what shone out clearly from the investigation was that anyone visiting a dietician with a particular condition would likely receive very different advice if they went to see an NT. But why is this? This article attempts to shed some light on the different approaches of NTs and dieticians… Read more…
One of the comments was particularly intersting from a non-NT/non-dietican and non-healthcare professional (‘just’ a PhD Physics with 25 years of R+D experience; at the time of writing comment number 570!): Guy says,
“… In terms of confirming the effectiveness of NT, the orthodox method would be to carry out randomised trials. However these are not a suitable measurement method since NT practitioners will make a set of recommendations which are suited to each patient and in most cases these contain several different dietary/ [lifestyle and]/ supplement changes. To judge NT in a reductionist manner based on randomised trials (with a single variable) would be about as relevant as testing a car by how well it runs on rails. In the industry that I work in (IT hardware/consumer electronics) there are numerous examples of where product testing methods have been hijacked by one particular company/cartel in order to ensure their products stand out amongst rivals. Thus government regulations often end up protecting the industry against the public rather than protecting the public against the industry … The sickness (healthcare) industry is massively falling behind public opinion now that the internet has made information free to all. People are no longer accepting poor advice but are now taking control of their own healthcare. This ‘Arab Spring’ revolution in continuing to gather momentum. It would be great if the NHS could really get on board with this so that the ‘G’ in ‘GP’ can finally start to mean ‘general’ (as opposed to ‘generating wealth for pharmaceutical shareholders’).”
Other ‘anti-dietician’ documents are now appearing, questioning how up to date the profession’s evidence and science-based practice is and claiming vested interests from big food and pharma companies (one of them here). To the consumer’s eye, this must seem like an embarrassing and petty call for a competitive media stunt, aiming to tarr a whole profession that in their growing numbers are working all over the world now (many with excellent BSc(Hons), MSc and PhD degrees), becoming an increasing threat to the once sole professionals ‘allowed’ to give nutrition advice…
The final conclusion of the recent ANH article makes some valuable comments: “Dietetics and nutritional therapy are two different theories and worldviews that attempt to bring some sense to the immensely complex area of human nutrition. We shall see in time which approach turns out to be the more valid, effective and ‘evidence-based’, and also which provides the most appropriate answer to the complex epigenetics facing modern humans. In the meantime, we encourage prospective patients to follow their instincts and choose the nutritional path that feels the most appropriate to their circumstances. And to remember that the rapport between the patient and the practitioner is a key part of the process, so take time to choose the right practitioner too.”
For ‘patient’s’ sake, can’t we just all work together utilising the ‘good’ and positives in what all of us are striving to do?
Rather than just pointing to the ‘bad’ and the ‘uglies’ offering largely ‘generalisations’, ‘deletions’ and ‘distortions’ for our existing worldviews (‘realities’)? Would it be good if we actually moved forward AND keep improving in line with latest scientific findings for individual patient needs, keeping common goals in mind rather than just the differences? It will be the informed and educated patient and consumer who will ultimately drive demand for their own needs, whatever that may mean to them…
I believe we can.
28-Oct-10: The Michael Pittilo Essay Award is presented annually for the best student essay on integrated health and care. In line with Michael Pittilo’s vision of integrating conventional and complementary approaches, the award is open to both medical and complementary therapy students. Excitingly, Dr Michael Dixon presented me with a merit award today, at the launch of the new College of Medicine, (fittingly) in the Cabinet War Rooms of the Churchill Museum, London. Dr Dixon’s comments on the achievements: “Ladies and Gentlemen”, pointing at the winners, three medical students (UCL, Imperial, Newcastle) and a now graduated nutritional therapist (Middlesex), “you are looking at the future of healthcare.”
My essay was entitled “Nutritional Therapy For Integrated Health: Creating Sustainable Behaviour Changes”. For more on the essay and full access, have a look at the article section.
The event was packed with prominent speakers and attendees.
Sir Graeme Catto (President of the College of Medicine, and former president of the General Medical Council (GMC), 2001-2009), Dr Michael Dixon (Chair of Council, and Chairman of the NHS Alliance), Sir Donald Irvine (College’s Advisory Council and a former GMC President), Professor Mustafa Djamgoz (Professor of Cancer Biology at Imperial College, London and a member of Council), Professor Andrew Miles (Deputy Vice-Chancellor of the University of Buckingham, Professor of Clinical Epidemiology and Social Medicine, and is a member of the College’s Science Advisory Council), Professor Jane Plant (Professor of Geochemistry at Imperial College, London, Chair of the College’s Patients’ Council), Professor George Lewith (Vice-Chair of the College of Medicine, and leader of the internationally respected Integrated Medicine research group at Southampton University), Professor David Peters (Clinical Director of the School of Integrated Health at Westminster University, member of Council and former Chair of the British Holistic Medicine Association), Simon Mills (Medical herbalist and project lead for the Department of Health’s Integrated Self Care in Family Practice research project, and MD of SustainCare), Professor Aidan Halligan (former Deputy Chief Medical Office for England, member of Council and leads the Faculty for Homeless Care).
For more on the programme, speakers and their biographies, see here.
The new College of Medicine brings is a new college that aims to bring together doctors, nurses and other health professionals with patients and scientists. No other health body does that. The College is unique – aiming to redefine what good medicine means. That includes a renewal of the traditional values of service, commitment and compassion. Their mission is to focus on patients, believing that science, systems and structures must fit patients’ needs – rather than forcing patients to fit the needs of technology and administration. It aims to ensure that patients are at the centre of medicine and of all of healthcare policies and systems. The College promises to support a new breed of health professional who respects the culture, belief and choices of every patient, and promotes self-healing and health improvement wherever possible. Full members can be statutory registered health professionails as well as professions regulated by the Health Professions Council (HPC). Certain Complementary Medicine Practitioners can join as Associate members, subject to some rigorous requirements and criteria. With a Patients’ Panel there will also be scientist members and student members.
24-Sep-10: As explained in my previous thread (“Eat Fat! Beauty comes from Within…”) – where I talk about ‘good fats’ (e.g. omega 3 from fish other sources) here another recent scientific journal article from the American Journal of Clinical Nutrition, which shows that saturated fats (e.g. butter, milk, animal sources) are not necessarily linked to heart disease http://bit.ly/bNQ9me
Yes, ok it’s in Japanese men that are thought to have still a better diet and lifestyle (and probably gene pool) then us here in the West – BUT it’s another study that could crush the still popular myth that ‘FAT’ (=saturated fat) and dietary cholesterol is ‘bad’ for your heart. Good news! It isn’t! [Though of course you should watch your intake of it if you are overweight and if you planning to have it as your main source of calorific intake ].
Dr Briffa offers again some great thoughts and explanations around this new study: http://bit.ly/9gy10Z
So why ‘heart disease’? Forget the ‘cholesterol’ myth when thinking about eggs. Eggs are a fantastic protein food, but choose organic free-range (ideally ‘omega-3′) versions. Only roughly 20% of dietary cholesterol may be absorbed. The rest you produce ‘in-house’. Some of the biggest factors of increased cholesterol levels are stress and excess sugar in your diet. There are other markers and tests that can helpf identify your cardiovascular risk. However, overall, multifactorial factors are involved. This can include genetic factors – but often chronic inflammatory processes are some of the underlying causes. Having a family history of cardiovascular events could certainly encourage you to go get your heart health checked. Ask a qualified nutritional therapist (BANT registered) in your area for a healthy dietary approach. If you have serious concerns, go to your GP and request a routine check.