Do I Drink Too Much?

A while back I gave up sugar and I cut down on carbohydrates

and I've stayed off them both,

but if you asked me to give up alcohol for the rest of my life,

well, I'm not sure I could do that.

And I'm not sure what that says about me and my relationship with alcohol.

'I've been in a relationship with alcohol for over 30 years.

'In my youth we spent rather a lot of time together.

'But now it's a more casual thing.'

I've seen the good,

the bad and the ugly side of booze.

'But actually I know next to nothing about my drug of choice.'

It's the British drug. We've had it for a long, long time.

'It's time to set the record straight once and for all.'

You get into the habit of a glass of wine every night and it's just corrosive.

'I'm going to examine my relationship with alcohol and put

'myself on the line to find out exactly what it's doing to my body.

'I'm sitting here with the moment of truth,

'wondering if my liver is shot.'

I look at the destructive power of drink...

Acetaldehyde's a carcinogen.

..and see how science is trying to measure and manage our love for the hard stuff.

A peak in activation, that was sort of immediately translated into the size of the image.

'The best place to start is at my local pub.

'This is our culture, our tradition.

'We drink, get merry, chat and laugh,

'and some of us take pride in the number of pints we sink,

'but this is not what we should be counting.'

I don't suppose you know how many units are in there?

Yeah, it's about two units in there.

And according to government guidelines, the maximum,

-or the recommended unit for a man...

-Is 14 units a week.

-Which is two a day.

-Yes, it's a pint a day.

-So that's my recommended daily allowance of units for today.

-Yes.

-One pint.

-Mm.

'Well, that's me thoroughly bamboozled.'

I like to think I drink within moderation.

So four days a week I won't drink any alcohol whatsoever.

On three days a week I might have a couple of glasses of wine one night,

maybe the next night a couple of gin and tonics.

The next night maybe a couple of beers.

So I think I drink well within the recommended limits.

That's safe, isn't it?

'The NHS website shows us how to work out the units.

'Multiply the amount of alcohol in millilitres by its strength -

'that is the percentage number listed on the bottle or the can -

'and then divide that by 1,000.

'I've lined up my usual weekly drinks and it's time to crunch the numbers.'

So, 14 units...

..is...

This is ridiculous, isn't it? It's just absolutely baffling.

Oh, for God's sake, why doesn't it just say how many units on it?

Wouldn't that be so much easier?

I'm buggered if I can do this.

'Well, after a lot of head-scratching.'

So, in total...

..we are talking about being just on or just over

my weekly recommended alcohol consumption.

So it looks like I'm drinking between 14 to 18 units most weeks.

That's more than I expected.

Guidelines on alcohol units were adopted in the UK in 1987,

but we've been wetting our whistles for at least 4,000 years

and concerns over how much we consume are nothing new.

Back in the 1830s, the idea that we shouldn't overdo it gained ground in

Wales with the Temperance Movement

and at the end of the 19th century the Sunday Closing Act

came into place and for over 100 years caused controversy.

But the very same initiative that was supposed to curb our drinking

may have given rise to another habit,

as Welsh historian David Howell explains.

What you start to see is a shift away from

drinking in public settings

to perhaps a more private practice of drinking.

I'm not going to say that Temperance is the reason for that,

but it's certainly an influential factor in why people stop drinking

in those more communal social environments.

So you ban drinking, or you try to cut down on drinking in public places, places like pubs.

You restrict the hours and what happens?

People go and drink at home?

I think you can make that association.

The drinking level still seems to be consistent, if not increasing,

as we go through the 19th century.

The truth is that behind curtains and closed doors

we have normalised the consumption of alcohol and we're not always honest about how much we drink.

How many times have you said you've had a glass of wine at night,

knowing that it's really half a bottle or more?

Health surveys indicate that 45% of us are overdoing it,

but according to the sales data, it's more like 75%.

'That means three quarters of us are regularly drinking to excess.'

I guess like everybody, I drink to escape.

To escape the cares and the worries of the day

and just go to a different place to calm down, to chill out.

'The consumption of wine in particular has skyrocketed

'in the past few years, overtaking beer as the country's favourite drink.'

Perhaps it's because we think that drinking wine is sophisticated,

or that perhaps it's good for our health,

and there is some evidence to suggest a little red wine

is good for your heart, but only perhaps one or two units.

And even then only if you're a man over the age of 40 or a postmenopausal woman.

Well, the menopause isn't going to hit me any time soon,

but I am over 40, so for me this should be good news.

However, the goodness in red wine comes from a natural compound called

polyphenols and you can get the same amount from two cups of tea as you

can by drinking a glass of red.

I can drink a fair amount of alcohol and it doesn't really seem to have

that much of an effect on me, or at least that's what I think.

I'm heading to central London this evening to take part in a rather unusual experiment.

As they say, the proof of the pudding is in the drinking.

'Neuroscientists Fred Dick and Iroise Dumontheil

'from Birkbeck University have devised an unprecedented experiment for me.

'It comes in three stages.

'First, a sober MRI scan while I do a cognitive test.

'Then the easy part.

'Half an hour drinking at the university bar.'

-Can I have the same again, please?

-Yeah.

'Because time is short, I'm hitting the hard stuff straightaway.

'I take it back. Downing drink...

'..after drink...

'after drink...

'..is actually quite hard.

'Remember - this is for a scientific experiment.

'Don't try this at home.

'Or in a bar.'

I've just had four double scotches.

I guess that's about eight units or thereabouts.

And I feel very warm all of a sudden and not in the least bit inclined

to climb back into a brain scanner.

'But I've come this far, so I can't chicken out now.'

-How you feeling?

-Well, alarmingly, remarkably normal.

It's terrible, isn't it? 'This the real challenge.

'Stage three of this experiment sees me back in the MRI,

'putting my grey matter to work under the influence.

'The scientists want to look at how alcohol immediately affects my

'behaviour and brain activity.'

We know that the brain is really very affected

by the presence of alcohol itself,

so multiple neurotransmitter systems like dopamine,

serotonin and so on are affected by alcohol.

So there are the lot of uncertainties, but nonetheless,

we'll give it a crack and see how Jamie's brain changes over time.

So I repeat the task I did earlier. It's called a Stroop test.

Basically I need to count how many numbers appear on the screen whilst ignoring the value.

This is as hard as it sounds.

This kind of creates a conflict, what we call it.

You want to answer one, you want to answer four and you have to make the decision between the two.

This type of task where you have to kind of control your behaviour,

it's a bit related to impulsivity

because you have to stop your automatic response

and actually think a bit about it.

'And then it's time to find out if I really am alcohol proof.

'But they keep me in suspense while they analyse the data.'

What's the orange stuff? Why am I seeing my brain turn orange?

So, the grey and white is just the kind of anatomy of the brain.

So what your brain looks like, just a picture.

The orange is showing the difference in blood flow.

So if MRI measures how much and where the blood goes

and that reflects which neurons are working hard.

This prefrontal cortex region involving decision-making

has more blood going there.

It's working harder to get you to solve those difficult trials

than it did before you drunk alcohol.

The proportion is kind of three times harder.

My brain is working three times harder when I'm drunk

to do the same task?

To do the hard bit versus the easy bit.

Kind of really the difference between the two, you know?

So not overall, but to cope with the difficult trials,

it's kind of working three times as hard

to solve those difficult problems.

So you were a good drunk on the outside,

but when you're actually able to look inside of your head,

we can see that alcohol is really having a really profound affect

on the way that you actually accompanying a very basic task

-that you have to do in everyday life.

-All right.

So this is my brain under a lot of strain from one evening of bingeing.

But over the long term this kind of drinking can lead to something a lot

worse - a little-known but devastating condition called ARBD,

or alcohol-related brain damage.

With a clear head,

I meet NHS addiction psychiatrist Dr Julia Lewis.

The main symptom that people will recognise,

and this is the bit generally at which people start presenting,

is when the short-term memory is affected.

That damage is the sort of damage where people can't remember what you said to them.

Can't remember that they've got an appointment tomorrow, those sorts of things.

But what we suspect is that at a much earlier stage

you get damage to the front part of the brain.

Something called the prefrontal cortex,

and this is the part of the brain that controls the rest of the brain.

If that part of the brain is damaged,

you can't make sensible decisions.

You can't integrate the information that you need

to make a reasonable choice.

But also, you can't control your impulses,

you can't motivate yourself

and you can't switch well from one task to another.

But this isn't something that someone that just drinks moderately

needs to worry about, is it?

You need to have been drinking over 35 units a week for a man

or over 28 units a week for a woman for at least five years

to be at risk from this alcohol-related brain damage.

However, there's some suggestion that people at lower,

often binge drinking rather than dependant drinking levels

seem to be presenting with some form of neurological damage.

So it's highly likely that at levels much lower than that,

alcohol is still having an impact on the brain.

And that is bad news for Wales.

People who don't even consider themselves to be heavy drinkers,

like me, are vulnerable.

In fact, it's estimated that one in 200 adults in the UK are affected by

alcohol-related brain damage,

even though we don't tend to hear about it.

Like a lot of us, I often have a glass of wine or two,

sometimes three in an evening.

I've never thought this could be a problem,

but what I've heard has got me pretty worried.

One of the main industry trade associations,

the WSTA, who represent wine and spirit businesses in the UK,

say that moderate and responsible drinking is compatible with a healthy lifestyle.

'I meet Professor of Public Health and expert on alcohol harm

'Simon Moore to hopefully put my mind at ease.'

There is such a thing as moderate drinking and that's OK, isn't it?

-It depends what you call moderate.

-Well, the government guidelines.

Sticking to the government guidelines.

That I would say is at the upper end of what you should be drinking.

You're going to be starting to see effects, I think,

from as little as seven units a week in terms of your health.

Is there a safe limit for drinking?

On balance, no, there isn't.

People should avoid alcohol altogether?

-Yes.

-No alcohol, that's the safe limit?

I would argue that, yes.

It doesn't take very much alcohol to start to see an effect on the human body.

That's pretty devastating, isn't it?

It's a perfect end to a lovely interview, but it's devastating!

'I didn't really want to hear that.

'So why do we keep doing it?

'Perhaps it's the instant gratification.'

Alcohol travels through our bloodstream

and within 90 seconds it hits the brain,

increasing dopamine and endorphin levels to give us a high

that produces pleasure and alleviates stress.

But if we drink too much of it,

our bodies will do their best to reject it and that's because, ultimately, it's a poison.

Maybe it's time to go back to basics.

At Cardiff Metropolitan University,

Dr Jo Welton gives me a biochemistry lesson.

What are we actually drinking?

What are we pouring down our throats?

Anything - beer, wine, spirits -

contains a specific alcohol called ethanol,

and that is made up of two carbons, an oxygen and five hydrogens.

So that's the chemical structure?

This is the chemical structure of ethanol.

I remember this from school now. How dangerous is this?

-How toxic is this?

-Erm, well, the breakdown of ethanol into the next part in the chain,

in your liver, is to acetaldehyde.

The hazard symbols include it as flammable,

and this one here that kind of looks like heartburn

means it's a serious health hazard, so acetaldehyde's a carcinogen.

And this also adds to it, and it's also a symbol for a health hazard.

So if I have a couple of glasses of wine, beers, spirits,

that ends up inside my liver, ultimately?

-Yes, yes.

-So we're effectively pouring poisons down our throat?

Yeah. It's not particularly good for us.

-But if you saw that in the...

-Yeah, you wouldn't want to drink this.

-You wouldn't want to drink that, would you?

-No.

Once ingested, alcohol is mostly processed by the liver,

the organ responsible for filtering toxins from the blood.

'Using liquidised lamb's liver,

'Dr Welton sets up an experiment to show me how a healthy and damaged

'liver react when exposed to a toxin that our bodies produce

'and process every day - hydrogen peroxide.'

So I have to try and do this at the same time, so...

-Wow.

-So, as you can see, in the healthy,

it's reacted much more rapidly compared to with the damaged liver.

You're still getting the enzyme reaction, but it's much slower,

so your body isn't able to process it as quickly as it normally would.

So this shows that a damaged liver doesn't function properly,

and if you regularly drink alcohol,

toxins will build up until the liver stops working altogether.

I've never thought about my liver.

I mean, I'm aware that, you know,

if you drink there are all those terrible diseases -

cirrhosis of the liver and...

..all kinds of liver diseases that you're...

you're gambling with, so I've never had mine tested,

and I've no idea what shape it's in.

'I've been consuming alcohol on a regular basis

'for over three decades.

'That's an awful lot of toxins passing through my liver.

'I'm meeting up with liver expert Dr Andrew Yeoman in Pontypool

'for an unnerving checkup.'

-The moment of truth.

-Indeed.

'Now, in case you're wondering, I'm not pregnant.

'I'm here for a FibroScan liver test which measures if a liver

'is soft and healthy, or stiff and damaged.'

So this is almost like an ultrasound you'd have with a pregnant woman?

Yeah, it uses ultrasound,

but it also uses a vibration wave through the liver.

So you're basically measuring resistance through my liver?

That's right. This is giving us the reading in kiloPascals,

or the liver stiffness measurement that we want.

-So what would be normal?

-Normal is less than seven.

-Yeah.

-Anything between seven and ten can indicate scarring of the liver.

Anything above 11 starts to worry us that somebody might have a lot of

scarring or even cirrhosis of the liver.

This is not a very pleasant experience, if I'm honest with you.

I mean, I am sitting here at the moment of truth,

wondering if my liver is shot, while being filmed.

So you can sit up now, if you want to get comfortable.

I have to say I'm very relieved that's over.

So the long and short of it is what?

The long and the short of it is actually you've got a nice, normal, soft, healthy liver.

So there's no evidence of any scar tissue in there based on those readings.

Which, I have to say, I'm very relieved about.

I didn't enjoy any of that, cos I didn't know what you were going to find.

No, absolutely. And many of our patients find the same when they come into clinic as well.

Why aren't we understanding this problem with alcohol?

I think people think it won't happen to them,

and I think it comes back to the fact that the drink heavily, they don't get symptoms,

and it's only when it's often too late that people realise there's been a problem.

And I think if there's one message you'd want to get across to the general population,

it's that you don't have to be an alcoholic to get alcohol-related liver disease.

Increasingly, we're seeing people with alcohol-related liver disease

and dying from these things who are professional people, holding down jobs,

but are coming home from work drinking a bottle and a half or two bottles of wine a night.

They're not necessarily falling over drunk,

they're not creating social disorder,

and they don't see it as being a problem.

But it is creating a problem for them.

'Fortunately, my liver has a clean bill of health,

'but I'm not about to celebrate with a drink.'

I know alcohol can be fun.

There's a drink out there for every mood.

There's a drink out there for every taste, and every occasion.

Who doesn't enjoy a party more if booze is available?

It can loosen us up,

and help us make new friends.

Even though the average alcohol consumption in the UK has fallen in recent years,

it seems too many of us are still overdoing it.

Perhaps it's because cut-price booze seems to be everywhere in our towns

and cities. But is there a hidden cost to all of this cheap alcohol?

I asked Mark Bellis, the director of Public Health Wales.

Can we quantify the real cost of alcohol abuse to Wales?

Well, we can use figures for the UK,

and for that we talk about a cost around crime,

losses in employment and health, of about £21 billion per year,

and that's about £3.5 billion of that cost falls on the NHS,

about £11 billion falls on criminal justice,

and the rest falls on losses because people don't go to work,

or they're off on long-term sick.

So we can talk about it in terms of pounds,

but we can also talk about it in terms of, for instance,

in Wales more than 50,000 admissions to hospital every year

for alcohol-related problems.

The real cost of alcohol is not reflected in what we're currently charging for it.

What people, when they see cheap alcohol,

they think only of what they're paying for that bottle of wine

or that can of beer, but they are also paying perhaps, as a family,

up to £1,000 a year more to deal with the consequences of alcohol being sold too cheaply.

One way or another, even if you're not the drinker,

you're going to be paying for a lot of cheap,

highly promoted alcohol in Wales.

'A movement for the adoption of minimum pricing per unit of alcohol

'is gaining momentum, but there's still stiff opposition.

'Expert in alcohol-related violence and government adviser

'Professor Jonathan Shepherd is a keen supporter of those proposals.'

The forces of opposition against you, though, are considerable -

the alcohol lobby, and the fact that we all love a drink, don't we?

I think that the alcohol industry in general has been most unhelpful

with regard to their responsibility.

I think that the influence and access that the alcohol lobby had

on the Department of Health to develop health policy was just not helpful.

It's just plain wrong, in my view.

Not to say that there aren't a lot of responsible producers out there,

but at the end of the day it's about the profits and profitability

of the trade and the industry. And the cost of the harm to all of us

has always been a great deal more than the tax take

that the Treasury would get from the duty.

Well, in a statement the Wine and Spirit Trade Association

said they fully supported an attempt to appeal a ruling

in favour of minimum unit pricing.

According to them, evidence shows that minimum unit pricing

will not stop the small minority of harmful drinkers

who are least responsive to price,

but will unfairly punish the majority of consumers

who enjoy alcohol as part of a healthy lifestyle,

especially the poorest.

They go on to state that trends in government data show clearly

that the UK has been drinking ever more responsibly

over the last ten years, with consumption dropping by a fifth,

and this has been in large part achieved by partnership working

between industry and government, in a targeted manner.

Even though the Welsh Government wants to adopt minimum unit pricing

on alcohol, it doesn't have the power to do so.

The Welsh efforts are currently blocked in Westminster.

Perhaps if alcohol does become more expensive, we'll drink less of it,

but with alcohol being such a big part of our culture,

will it really make much difference?

The Welsh like drinking - this is a drinking nation.

When we think of a sense of celebration,

when we go out and watch the rugby or the football

or we gather together for a party...

..we gather together with mates, and what do we do?

We have a drink.

More than one drink.

It almost defines who we are.

When you think of all of our...

..our cultural exports - Richard Burton...

..you know, Dylan Thomas -

those heroes of Wales also have a very troubled relationship

with drinking, and we almost...

..admire them more for it.

It's part of who we are.

It seems impossible to change a whole culture,

but perhaps science and technology

can help us change the way we think about drinking.

Cutting edge research at CUBRIC,

Europe's largest brain imaging centre,

is attempting to do just that.

At the £44 million facility, a consortium of EU scientists

has been mapping and tracking

the brain responses of alcohol dependent patients,

in an attempt to relieve them of their addiction.

The reason I'm dressed in pyjamas

is I'm about to climb into this MRI scanner behind me,

so I'm going to see how my brain responds to images of wine,

beer and spirits.

'The Brain Train clinical trial uses neuroimaging technology

'that's twice as powerful as a conventional MRI scanner.

'This is like I'm stepping into the future,

'but for some reason it's not an entirely comfortable feeling.'

OK, please can you test the squeeze ball for me?

-BEEP

-Thank you.

'Checking up on me is the project coordinator, Professor David Linden.

-Hello, Jamie. Are you OK in there?

-Yeah, I'm fine.

Neutral and alcohol images are now going to be fed to me,

and my brain reacts to them, lighting up different areas.

Very responsive to visual stimulation.

Using this information, the programme determines

what is a visual response and what is a motivational reaction -

a feeling - to the alcohol cues.

This is what we call the network

that's involved in the processing of alcohol-related stimuli.

Well, there's no hiding my fondness for booze,

but then it gets even more interesting.

The images start changing in size,

and it turns out it's my brain that's making that happen.

This is being controlled by the brain activation level.

He's not consciously doing it.

His brain activation

is sort of reflected in the size of the picture.

And then the scientists find my weak spot - wine.

And you saw that - that was a peak in activation

that was sort of immediately translated into

the size of the image.

That's just a very peculiar experience.

You're locked in an MRI scanner, and it's a moment of truth.

It's... There's no way of lying, is there?

Did I stay still enough?

-Indeed you did.

-I've got no...

It so baffling - I've got no idea what I'm looking at.

You're looking at slices through your brain that we acquired every 1.5 seconds,

to look at the changes in the brain activation.

I'm guessing I'm like most people - I saw a shot of the ironing,

and that wouldn't excite me in the slightest,

but I saw a shot of red wine and, you know, I think, great.

I have happy memories, happy thoughts, of a glass of red wine,

so presumably that's not terribly peculiar?

That is... It wouldn't,

and often these areas that you would see are those that are responsive to

other types of rewards as well,

similar to if you were getting monetary reward in a game, for example.

Alcohol cues are so abundant in your environment -

if you want to remain abstinent,

if you have a history of alcohol dependency,

you need to train a way of responding to them.

So are you saying that you can train people's brains

not to be stimulated by the sight of alcohol?

That's the underlying theory here for this trial that we're doing.

-Cutting edge technology for the oldest addiction.

-Indeed.

Well, this has been an eye-opening journey for me.

After all that I've seen and learnt, I can't plead ignorance any longer.

Ultimately, alcohol is a poison

and it can do profound damage to our physical and mental health.

Now, normally any BBC reporter would now give you the balancing statement after what I've just said.

But the thing is, there isn't one.

There isn't any good news about drinking alcohol.

Perhaps we need to readjust our relationship

and make it an occasional treat for the now and then,

rather than every day.

So, "good health," as they say, for some inexplicable reason.