The social normality of alcohol consumption in students - and how we can help

Dietetic student Kyle Kennedy discusses binge drinking among students, how alcohol affects the body and how to spot the signs of alcohol misuse.

Binge drinking. It is a phrase most will have heard, but could the majority define it? Some may not believe or know that they binge drink and simply place it under an alias: ‘socialising with friends’, ‘casual drinks with friends’, or ‘going on a night out.

From experience, people feel comfortable with self-deception as excessive drinking is considered normal, by the majority, as a component of ‘student life’. According to the NHS, binge drinking usually refers to drinking lots of alcohol in a short space of time or drinking to get drunk.¹²

As binge drinking is so prominent in Scotland, the NHS definition of binge drinking likely aligns with many nights out for a student.¹² Further, according to the Scottish Health Survey, one in four people drink at a hazardous or harmful levels (drinking more than 14 units per week).  The National Records of Scotland say there were 1,190 deaths due to alcohol in 2020: 69% men, 31% women.^{10, 15}

This article will focus on alcohol’s physiology and effects in conjunction with smoking, the increased risk of weight gain caused by excessive alcohol consumption, the importance of reducing alcohol consumption and the work we as a population can do to help those who misuse alcohol or drink alcohol excessively.

Alcohol’s digestion, physiology, and smoking's effects in conjunction with alcohol

Alcohol absorption begins in the mouth and continues through the stomach to the primary site of absorption: the small intestine.⁸ Further, the absorption of alcohol can be sped up in the absence of food.

On the lining of the gut, there are commensal bacteria (gram-negative) and when large volumes of ethanol (alcohol) are consumed frequently, this may promote commensal bacterial growth and increased gut permeability.² Therefore, there is a greater chance that harmful molecules, e.g., lipopolysaccharides, from the bacteria can enter the bloodstream and enter the liver.^{2, 4} These molecules then interact with cells called Kuppfer cells which release inflammatory markers into the body causing inflammation, which can lead to cirrhosis of the liver (end-stage liver disease) which essentially prevents the liver from functioning correctly. It causes several symptoms, from loss of appetite to oedema and jaundice.^{2, 13}

Additionally, when combined with smoking, alcohol can increase the risk of disease. Alcohol can increase the absorption of carcinogenic chemicals, and as tobacco is highly carcinogenic, this can increase the uptake of carcinogens into the cells, thereby causing diseases such as oesophageal cancer.¹

Increased risk of weight gain

Hangovers, anxiety, depression, pancreatitis, liver disease, diabetes, infertility, weight gain and cancer are only some of the short and long-term diseases and ailments caused by binge drinking.⁶ Focusing on weight gain, when alcohol is ingested, the body converts the alcohol into energy.⁹ Per gram of alcohol, this translates to seven kilocalories and in conjunction with alcohol's appetite-stimulating properties, this can lead to a swift and unnoticed weight gain.³ Also, when drinking alcohol, people are more likely to make unhealthy food choices, and therefore consume more energy-dense foods.¹⁶

The advantages of reduced alcohol consumption

Being aware of the potential disease and health issues associated with alcohol consumption is important. However, it is crucial that some of the advantages of reducing alcohol content, in line with the Chief Medical Officers' recommendations of no more than 14 units per week, are highlighted:⁵

1. Increased mental clarity. Alcohol may make you fall asleep, but the quality of that sleep is way less enriching than a non-alcohol-induced rest. Due to this decreased quality of sleep, most will wake up unable to focus, decreased mental clarity and are dazed.⁷ What follows is a continuous cycle of poor-quality sleep. Consequently, the quality of your work is likely to be negatively impacted as well as your mental health, opening the possibility for many different mental health issues. By keeping in line with the UK’s Chief Medical Officers' recommendations, this can be avoided.
2. Increased physical health. Alcohol damages a number of the body's systems and organs. It can also make you feel lethargic and unproductive, which could result in a lack of physical exercise such as skipping the gym.⁷ This could form a negative habit pattern and decrease a person’s physical wellbeing over time. Reducing alcohol in the diet will lead to better physical health outcomes. By staying within the Chief Medical Officers' recommendations, you can maintain your physical health and keep your body healthy and fit.
3. Financial benefit. Alcohol is expensive. According to NHS Digital, those in England aged under 30 spend £6 a week on alcohol; that is an extra £312.86 per year.¹⁴ By reducing your alcohol content you can increase your finances and purchase something more fulfilling, such as investing in a new hobby.

So, what can we as members of the public, dietetics students, and dietitians do to fight the social norm of binge drinking?

Instagram, Facebook, Snapchat, Twitter. All are powerful tools for adolescents to empower, express and evolve ideas. They can be used as channels for positive information and potentially life-altering facts.

So, why not take advantage of social media and use it to share factual and important content concerning binge drinking? Creating your dietetic page or account to blog or spread awareness of dietary and nutritional problems such as binge drinking, interacting with interested users and pointing them in the correct direction for further information such as Drinkaware or simply sharing others’ information has the potential to be incredibly beneficial for some people.⁶ But before sharing any information, it is important that it is sourced credibly and reliably before sharing and adding references where necessary.

Further to the internet stream, it is crucial to recognise the signs of alcohol misuse in those around you such as family, friends and yourself. Some of the symptoms of alcohol misuse include:

• Requiring a drink the day after, as soon as you wake up
• Consuming more than 14 units per week
• Missing university, work or appointments due to drinking
• Being unable to remember the previous night¹¹

If consumed regularly over a period of time alcohol can cause mental, physical and potentially financial issues and ultimately decrease quality of life. Therefore it is important to follow the Chief Medical Officers’ guidelines as this will reduce the likelihood of morbidity and mortality.

Sources

1. Anoop P., Kenneth O., Joel H., 2014. The synergistic effects of alcohol and tobacco consumption on the risk of esophageal squamous cell carcinoma: a meta-analysis [Online]. [Viewed 14/03/2022]. Available from: https://docksci.com/the-synergistic-effects-of-alcohol-and-tobacco-consumption-on-the-risk-of-esopha_5ae5097ed64ab283f8d979df.html
2. Armando Hasudungan, 2016. Alcohol Physiology. [Online Video]. 13 April 2016. [Viewed 14/03/2022]. Available from: https://www.youtube.com/watch?v=T8k8SgfpQ9k.
3. British Dietetics Association, 2019. Alcohol Facts [Online]. [Viewed 14/03/2022]. Available from: Alcohol facts | British Dietetic Association (BDA)
4. Courtney S., Michael J., Carols D., Bartlett C., Amy L., Mary M., Lynell W., Geoffrey M., 2009. Alcohol metabolites and lipopolysaccharide: roles in the development and/or progression of alcoholic liver disease [Online]. [Viewed 23/03/2022]. Available from: Alcohol metabolites and lipopolysaccharide: Roles in the development and/or progression of alcoholic liver disease - PMC (nih.gov)
5. Department of Health, 2015. UK Chief Medical Officers’ Alcohol Guidelines Review [Online]. [Viewed 14/03/2022]. Available from: UK Chief Medical Officers’ Alcohol Guidelines Review: Summary of the proposed new guidelines - January 2016 (publishing.service.gov.uk)
6. Drinkaware, 2022a. Health Effects of Alcohol [Online]. [Viewed 14/03/2022]. Available from: Health effects of alcohol | Drinkaware
7. Drinkaware, 2022b . Hangover Symptoms [Online]. [Viewed 18/03/2022]. Available from:What does a hangover feel like? | Drinkaware
8. Institute of Human Anatomy, 2021. What Alcohol Does To Your Body [Youtube Video]. [Viewed: 24/03/2022]. Available from: (33) What Alcohol Does to Your Body - YouTube
9. Lynn Klees, 2019. Nutrition 100 Nutritional Applications For A Healthy Lifestyle [Online]. [Viewed 14/03/2022]. Available from: 13.2 – Alcohol Metabolism – Nutrition 100 Nutritional Applications for a Healthy Lifestyle (unizin.org)
10. National Records of Scotland, 2021. Alcohol-related deaths in Scotland [Online]. [Viewed 19/03/2022]. Available from: https://www.nrscotland.gov.uk/files//statistics/alcohol-deaths/2020/alcohol-specific-deaths-20-report.pdf
11. NHS, 2018. Alcohol Misuse [Online]. [Viewed 14/03/2022]. Available from:  Alcohol misuse - NHS (www.nhs.uk)
12. NHS, 2019. Binge Drinking [Online]. [Viewed 14/03/2022]. Available from: Binge drinking - NHS (www.nhs.uk)
13. NHS, 2020. Symptoms of Cirrhosis [Online]. [Viewed 19/03/2022]. Available from: Symptoms of cirrhosis - NHS (www.nhs.uk)
14. NHS Digital, 2020. Statistics On Alcohol , England 2020 [Online].[Viewed 14/03/2022] Available from: Part 7: Expenditure and affordability - NHS Digital
15. Scottish Health Survey, 2019. Alcohol consumption in Scotland [Online]. [Viewed 19/03/2022]. Available from: https://www.gov.scot/collections/scottish-health-survey/.
16. Rosalind A., Chiung M., Barry I., Tova J., Ashima K., 2013. Diet of drinkers on drinking and non-drinking days [Online]. [Viewed 23/03/2022]. Available from: Diets of drinkers on drinking and nondrinking days: NHANES 2003–2008 | The American Journal of Clinical Nutrition | Oxford Academic (oup.com)