Alcohol
Alcohol has a long and somewhat mixed relationship with both football and medicine.
Partly blamed for the problem of Football Hooliganism in the 70s and 80s, alcoholism also has a high prevalence in the medical profession. Indeed, the definition of a heavy drinker used to be said to be someone who drinks more than their doctor!
Throughout history many high profile footballers and managers have unfortunately had an unhealthy relationship with their chosen poison, and I use that word on purpose because that is how your body initially views alcohol, as a neurotoxin, damaging both the brain and central nervous system.
Until the body gets used to it, and builds up a tolerance, even small amounts of alcohol can induce vomiting and a “hangover” from hell.
Yet, there is no denying for most people alcohol is indeed the poison of choice, especially where football is concerned. Just witness how many football fans meet in the pub before a game and enjoy a pint or two and catch up on the latest team news or gossip with their mates, helping them to relax and get in the mood for the festivities ahead.
Moreover, on those rare occasions when their team actually wins something or avoids relegation, every fan can saviour and cherish those “champagne moments” to sustain their enthusiasm for the season ahead.
These social events and bondings over an alcoholic beverage, by and large, have positive effects for Premiership Health.
As a Doctor though, I have seen both sides of the coin, the good and the bad.
The damaging effect alcohol can have on people and families, from the physical to the emotional:
Liver disease is the only major cause of mortality and morbidity that is on the increase in England. Korsakoffs dementia, nerve damage, increase risk of certain cancers: The World Cancer Research Fund and American Institute for Cancer Research states that there is convincing evidence linking alcohol to cancer of the mouth, pharynx, larynx, oesophagus, and breast.
Most A&E’s on a Friday or Saturday night can feel more like a drunken battle zone than a place of healing. Bodies strewn across the floor, blood stained clothing from the alcohol fuelled fights and accidents, and the casualties effing and blinding at the attending medical staff.
Then you have the innocent victims of car accidents caused by drunken drivers and perhaps, the most tragic of all, babies born suffering from fetal alcohol spectrum disorder due to their mothers drinking excessively during pregnancy, leading to many long term health problems for the baby.
Approximately 1 in 100 babies born in the UK every year are believed to suffer in this way, that’s over 8000 innocent lives adversely affected.
And, let’s not forget the emotional damage it can cause; depression, anxiety, break up of relationships, verbal and physical violence, addiction and dependency.
There is no way alcohol would pass any modern day health and safety review.
Yet, as a society we have been drinking fermented beverages like alcohol for thousands of years, and the debate still goes on about whether it is good or bad for us.
The reality for everyone and every team is different. Yes, it can be both a poison and a tonic, a relationship builder and a relationship destroyer, it can help you to play well it can help you to play badly.
The difference depends on the dose and the individual circumstances, and once again a Premiership Health manager needs to take responsibility for their own personal drinking habits and ensure they are not harming, both their team or anyone else’s.
After all, Shakespeare believed alcohol to;
“increaseth the desire but taketh away the performance”
“Everything in moderation” is an often used phrase, but in terms of alcohol, what is moderation and how much is too much?
For some, too much might be one drink – as in the case of many alcoholics – AA counsel abstinence to avoid temptation. For others it might take a lot more before they start feeling the adverse effects.
The latest NHS guidelines suggest this level is no more than 1 1/2 drinks a day (2-3 units or 25g) for both men and women.
Whilst these are fair and commendable, after all, one of the principles of the sacred medical Hippocratic Oath is first to do no harm – as guidelines they need to apply to the population as a whole, so they are naturally going to err on the side of caution.
However, they might not be the best tactics for every team, a lot depends on the individual circumstances; gender, body mass, genetics, the game situation and because good medicine is a combination of art and science, rigid guidelines don’t always offer the best way forward or the best style of play.
The human body is so intricate and varied, that as I keep emphasising, one size or one prescription does not fit all. The mistake is trying to make everyone support the same team, it just won’t happen.
If you look at all the available research and studies on alcohol, you get to see there is also a good side to alcohol, provided of course you drink in moderation.
Take Cardiovascular Disease for instance.
There are lots of studies which show an inverse relationship between moderate drinking and risk of a heart attack.The so called “French Paradox” – low rates of heart disease despite high intake of fat, is often attributed to the beneficial effects of red wine and resveratrol, a powerful anti-oxidant.
Indeed, this benefit seems to be fairly consistent with between a 25% – 40% reduction in risk of a stroke or heart attack for both men and women and applies to those, with or without cardiovascular risk factors like high blood pressure or diabetes.
If you accept the cholesterol hypothesis for heart disease (though more and more doctors are beginning to question the numbers) it would seem to have a good scientific basis, as moderate amounts of alcohol have been shown to increase the levels of good cholesterol HDL and offer protection to your CardioTeam.
It could of course be related to other changes induced by alcohol; better sensitivity to insulin or a reduction in clotting factors in the blood which contribute to the formation of small blood clots and plaques in the arteries, these can dislodge and cause blockages, the cause of heart attacks and the majority of strokes.
Perhaps, the beneficial effects of alcohol are not just related to the physical effects of antioxidants or the synthesis of good fats. Perhaps, there is a more emotive explanation; it makes you feel more relaxed, socially less inhibited, able to make more connections, both intimate and social and create positive emotions of joy and happiness.
Maybe this is how alcohol, biologically and emotionally helps you to write your own story.
Evidence for this explanation can be seen in a 20 year study carried out by Grossarth-Maticek, which looked at over 2000 people who drank regularly and moderately (around 2 pints a day) and asked them if they drank for pleasure or because of pain/stress.
Over the 20 year period those that drank for pleasure were considerably healthier than those that didn’t drink at all.
However, those that drank to drown their sorrows were the unhealthiest of the lot.
It would seem that the positive emotions produced in most people by drinking is the real reason alcohol in moderation improves health.
The benefits of moderate drinking aren’t just limited to the heart either.
Other studies have suggested it can reduce the risk of many varied medical diagnoses; gallstones, type 2 diabetes, osteoporosis, stomach cancer, prostate cancer, rheumatoid arthritis, the common cold and even dementia.
This reduction in dementia is an interesting one because alcohol is a neurotoxin and too much can actually lead to a form of dementia called Korsakoffs, but, research carried out in Germany on 3202 people aged 75 or over, controlling for many co-factors like; smoking, age, and education, determined that moderate alcohol consumption could reduce the risk of dementia by 30% (Alzheimer’s was reduced by 40%).
However, as I have already alluded to, the results of one study, good or bad, do not justify sweeping generalisations or recommendations about how you should play your game.
My own belief (Billy Beliefs alert coming up) is that a modest amount of alcohol can help to reduce anxiety and stress, especially in middle age, which is believed to be a factor in causing dementia.
Alcohol reduces anxiety by playing with the NeuroTeam and kicking a few balls to a membrane player called GABA, whose main role is to reduce NeuroTeam activity, similar to drugs like benzodiazepines – diazepam (Valium).
It therefore has a sedating, relaxing effect, as well as reducing muscle tone – one of the reasons you don’t hurt yourself so much if you fall over when drunk!
Once you start playing around with these “bad boys” however, you can quickly get addicted, resulting in the need to drink more and more alcohol to get the same relaxing effect (tolerance).
Unfortunately, if you then take the alcohol away, you risk your players having a fit and experiencing a medical condition known as delirium tremens, which you might know better as the “DT’s.”
This is why drinking in Moderation is so important.
The GenoTeam lineup is also crucial when deciding how safe alcohol is for your team.
Some people (a large number in Asia/china) don’t really have the genetics to deal with alcohol, often deficient in an enzyme called alcohol dehydrogenase which helps to break it down.
Interestingly, one form of this enzyme does its job very quickly, whilst another does it much more slowly. If you have 2 copies of the gene for the slow-acting enzyme, your risk of heart disease is much lower than if you have 2 copies of the fast acting one.
Presumably, because alcohol has less time to work its magic!
Unfortunately, most of us aren’t privey yet to our GenoTeam lineup (though I suspect this information will be arriving soon). So, I suggest you slow down the metabolism of alcohol by drinking slowly and having it with food.
And remember not to overload your players with too much alcohol too often.
By taking a few days off on a regular basis you can allow those liver cells to recover and continue to play well.
Now, take a pause before proceeding and answer the following questions honestly.
Physical: Is alcohol having any detrimental effect on your health. Any Liver problems? (might be worth having a blood test if any concerns). Relationship problems, including impotency?
Mental: Is alcohol effecting your mood in a negative way, making you depressed, anxious, or angry?
Don’t ignore those Hooligans either:
The belief that one more drink won’t hurt me, or I can stop if I want to.
I can remember watching an interview with the late great George Best, after he had his second liver transplant and was once again drinking, the interviewer asked him what was the trigger for drinking this time after going so long without alcohol?
He replied, he had met another man who had a liver transplant and was still drinking and this had changed his belief that he too could start drinking again.
Bad Tactic: Are you spending money on alcohol that could be put to better use for your team?
Bad Tactic: Are you binge drinking on a regular basis?
With my GP hat on, if you answer yes to any of these questions you need to be seriously reassessing your drinking habits:
FAST – Fast Alcohol Screening Test.
Here are a few Tips to help you play better:
Don’t drink alone – drinking has always been about socialising.
Enjoy what you drink, with who you drink, when you drink and how you drink.
Don’t binge drink more than half a bottle of wine or 3-4 pints of beer a day.
Biological clock – best time for your liver to handle alcohol is after 6 pm so don’t make a habit of drinking during the day.
Also consider the stage of your teams development – younger players are unlikely to enjoy any health benefits from alcohol and are more likely to succumb to the negative affects by becoming victims of violence, drink driving, addiction and liver damage.
There has been a huge increase in the number of young adults treated in hospital with serious alcohol induced liver problems over the last decade, some as young as 15.
Indeed, Sir Ian Gilmore, the former president of the Royal College of Physicians, believes cirrhosis has reached epidemic levels in England, particularly among the young, with many 11 -16 year olds drinking on a regular basis. There were even 293 cases of children under 11 admitted to A&E with alcohol related conditions in 2012/13.
By and large, in my humble opinion, the risks in terms of physical health, exceed the benefits until you reach middle age, when cardiovascular disease begins to account for an increasingly large share of the burden of disease and death.
Here again, it’s a calculation that needs to be made at an individual, personal team level, so I’ll leave that decision to your Premiership Health Manager.