Women And Beer: How Much Is Too Much?

Alcohol consumption is a complex and multifaceted topic, and it's important to understand the potential risks associated with drinking. When it comes to women and alcohol, there are several factors that come into play, including biological differences, social pressures, and the unique challenges faced by women in today's society. While drinking guidelines provide a general framework, individual variations and health considerations also play a role in determining safe levels of alcohol consumption for women.

Women's blood alcohol concentration is higher than men's

Firstly, women generally have a higher body fat percentage and lower water content than men. Since alcohol is dispersed in body water, women tend to reach higher peak blood alcohol concentrations (BAC) than men after consuming the same amount of alcohol, even when adjusted for body weight. This means that a woman's blood alcohol level will be higher than a man's at any given dose.

Secondly, there are gender differences in alcohol pharmacokinetics, which is how a drug is processed by the body. Women appear to have faster alcohol disappearance rates than men, meaning they eliminate alcohol from their bodies more quickly. This is because women have a higher clearance of alcohol per unit of lean body mass compared to men.

Additionally, women have lower levels of alcohol dehydrogenase, an enzyme that breaks down alcohol before it reaches the bloodstream. This further contributes to the higher BAC observed in women compared to men after consuming equivalent doses of alcohol.

The higher BAC in women can lead to increased vulnerability to alcohol-related problems and health risks. For example, research suggests that women are more likely than men to experience hangovers and alcohol-induced blackouts at comparable doses. Women who regularly misuse alcohol are also more likely to develop alcohol-associated liver conditions and are more susceptible to alcohol-related heart disease than men, even if they consume less alcohol overall.

Alcohol-related health problems

• Increased Risk of Certain Cancers: Research has shown a link between alcohol consumption and an increased risk of breast cancer in women. Even one drink per day can increase a woman's risk of breast cancer by 5% to 15% compared to non-drinkers. Alcohol is also associated with an increased risk of other cancers, including those of the mouth, voice box, throat, food pipe (oesophagus), and liver.
• Alcohol Use Disorder (AUD): AUD is characterised by a person's inability to stop or control their alcohol consumption despite adverse social, occupational, or health consequences. Women are less likely than men to receive treatment for AUD.
• Liver Disease: Alcohol-related liver disease can range from reversible fatty liver disease to permanent liver damage, such as cirrhosis. Women who regularly misuse alcohol are more likely to develop alcohol-associated hepatitis, a potentially fatal liver condition.
• Cardiovascular Disease: Heavy drinking can lead to heart conditions such as congestive heart failure and an increased risk of heart attacks. Women are more susceptible to alcohol-related heart disease, even if they consume less alcohol over their lifetime than men.
• Brain and Nervous System Damage: Alcohol can cause brain damage, including Wernicke's encephalopathy and Korsakoff's dementia. It can also increase the risk of traumatic brain injuries from falls or accidents, as it impairs coordination and thinking abilities.
• Alcohol-Induced Blackouts: Women are more susceptible to alcohol-induced blackouts, which are gaps in memory during intoxication.
• Fetal Alcohol Spectrum Disorders: Drinking during pregnancy can cause physical, cognitive, and behavioural problems in the developing fetus, including fetal alcohol spectrum disorders and an increased risk of preterm labour.
• Other Health Issues: Excessive alcohol consumption can also lead to digestive problems, immune system dysfunction, malnourishment, vitamin deficiencies, osteoporosis, and mental health issues such as depression and anxiety.

Alcohol-induced blackouts

Blackouts are more likely to occur when alcohol enters the bloodstream quickly, causing a rapid increase in blood alcohol concentration (BAC). This is more likely to happen if someone drinks on an empty stomach or consumes large amounts of alcohol in a short amount of time. As women generally weigh less than men and have less water in their bodies, they tend to reach higher peak BAC levels than men with each drink, and do so more quickly. This is why being female is considered a risk factor for blackouts.

There are two types of blackouts, defined by the severity of memory impairment:

• Fragmentary blackout: The most common type, characterised by spotty memories for events, with "islands" of memories separated by missing periods of time in between. Also known as a greyout or brownout.
• En bloc blackout: Complete amnesia, often spanning hours, during which no memories of events are formed and typically cannot be recovered.

Blackouts are not necessarily a sign of alcohol use disorder, but experiencing even one is a cause for concern and should prompt a person to re-evaluate their relationship with alcohol and seek advice from a healthcare professional.

Alcohol and pregnancy

During pregnancy, alcohol can pass from the pregnant person to the fetus and affect its development. The baby's brain is developing throughout pregnancy and can be affected by exposure to alcohol at any time. Growth and central nervous system problems (for example, low birth weight, behavioural problems) can occur from alcohol use at any time during pregnancy.

If you are pregnant or trying to get pregnant and cannot stop drinking, get help from your healthcare provider, local Alcoholics Anonymous, or a local alcohol treatment centre.

Alcohol-related liver disease

There are three main stages of ARLD:

• Alcoholic fatty liver disease: Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver, causing an enlarged liver. This stage rarely causes any symptoms but is an important warning sign that an individual is drinking at a harmful level.
• Alcoholic hepatitis: Alcoholic hepatitis is a potentially serious condition that can be caused by alcohol misuse over a longer period. It is characterised by inflammation of liver cells, followed by permanent scarring. The liver damage associated with mild alcoholic hepatitis is usually reversible if the individual stops drinking permanently. However, severe alcoholic hepatitis is a life-threatening illness.
• Cirrhosis: Cirrhosis is a stage of ARLD where the liver has become significantly scarred. It is generally not reversible, but stopping alcohol consumption immediately can prevent further damage and increase life expectancy.

ARLD is often diagnosed during tests for other conditions or at a stage of advanced liver damage, as it typically does not cause any symptoms until the liver has been severely damaged. Symptoms can include:

• Jaundice (yellowing of the whites of the eyes or skin)
• Swelling in the ankles and tummy
• Confusion or drowsiness
• Vomiting blood or passing blood in stools

The most effective way to prevent ARLD is to stop drinking alcohol or stick to the recommended limits. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) advises that women should have one drink or less per day. Drinking more than this amount is associated with an increased risk of alcohol-related health problems.

If you regularly drink alcohol, it is important to be aware of the signs and symptoms of ARLD and to seek medical advice if you have any concerns.

Frequently asked questions