Monthly Archives: January 2015

‘Women on the wagon’ club together to cut back on drinking

So it’s almost the end of Dry January and you’ve made it through!  Firstly congratulations 🙂 And if you wonder if it’s worth it – wrap your lug holes around this! 45 seconds of a Professor of Hepatology telling you all the good things you just did for your liver in that month off!!

Now are you going to start drinking again tomorrow or are you rethinking your relationship with booze entirely?  If you are rethinking things then a common cry is what will happen to my social life?

Never fear the answers are appearing as if you’d wished for them and someone had heard you 😉 Groups and websites are springing up to help the 43% of women who feel alcohol is affecting their lives – and membership is booming!!

At the beginning of January I read this article that looked at ‘women on the wagon’ clubbing together to cut back on drinking here.  Not keen on the title but the article was well worth a read and hoorah for my friend Rachel too 😀

Feeling that wine o’clock is starting to dominate the day? Want to cut down but perhaps unwilling to give up entirely? Join the club – no, really. A new wave of clubs and websites is springing up to support the growing numbers of women who are worried about their alcohol intake and want help to cut back.

Forget the wine-soaked book club meetings: joining the rise and rise of WoWs (Women on the Wagon) is a distinct trend for 2015.

A recent study by the government-funded Drinkaware campaign found that one in five adults want to cut back on their drinking. Research by parenting website Netmums found that 43% of women wanted to drink less, a figure that rose to 83% among women who were already drinking over the recommended guidelines. The most common reason for drinking quoted by women was “to wind down from a stressful day”.

One in six British women are developing health problems caused by alcohol and nearly a quarter (24%) admitted to an NHS survey in 2012 that they had drunk more than twice the lower-risk guidelines in the previous week. The 21st century might not have seen women achieve equal pay or representation in government, but it has seen a closing of the gender gap on drinking alcohol. Women born after the second world war are twice as likely to binge-drink and develop alcohol disorders than their older counterparts.

But now there are tentative signs that could be changing, as health messages get through and women increasingly find their own ways to put the glass down. Blogs and online communities have been springing up. Lucy Rocca, founder of Soberistas, launched her website two years ago and has written four books on the subject of women and alcohol. She has seen an explosion in the numbers of women keen to join the site and share their stories.

Former politician and businesswoman Laura Willoughby has just opened Club Soda ( to offer support to anyone, male or female, who wants to give up or cut back on their alcohol intake and is organising countrywide events to encourage people to socialise without alcohol. They plan future campaigns to persuade pubs to offer more soft drinks and to keep coffee and tea available for sale in the evenings.

“Lots of people do still want to go to pubs, even if they don’t want to drink,” she says. “I couldn’t believe how little was out there when I decided to give up three years ago. My dad had died from drinking and I could see a bit of a pattern emerging with my own drinking that I didn’t like.”

Club Soda has conducted an online survey about people’s attitudes to reducing their drinking and found the top three reasons to reduce drinking were to improve health (52% of all respondents), cut calories (42%), and save money (21%). Women were a little more likely than men to list cutting calories and saving money as reasons for reducing drinking. They also found 84% of men want to cut down, and only 5% to quit completely, while among women 43% want to cut down, 32% stop for a short time and 25% quit.

The figures have been showing for some years that younger people are rejecting the alcohol-binge behaviour of their parents, while the drinking habits of older women, especially those in managerial or professional jobs, are a cause for concern. Those working in male-dominated environments have an increased risk of alcohol disorders.

From the gin-swilling monsters of William Hogarth’s paintings to the ladettes of the 90s, women and drink have often attracted a sniffy attitude down the years and a lot of drinking habits stayed hidden in the home.

But concern over women’s drinking is not sexism, says Alcohol Concern. “It’s not a male conspiracy. Women’s bodies have less water and more fat. Alcohol is more concentrated in the female bloodstream and the liver has to work harder to break it down.”

Up to 15% of breast cancer cases are related to alcohol consumption, and deaths from liver disease have risen 20% in a decade. The number of alcohol-related admissions of women to NHS hospitals in England has continually risen over the past decade, from 200,000 in 2002 to 437,000 in 2010.

A spate of confessional books on the subject in recent years, written by professional women about what is often described in terms of a “love affair” with drink, has helped break down taboos, allowing women to talk more openly about alcohol use.

Rachel Black, author of Sober is the New Black, writes a popular blog about her own journey to sobriety. She says it is harder for women to admit to having a problem and that they have been left behind by men in being offered the tools they need to tackle their drinking.

According to a recent survey, 43% of women want to cut down on drinking and 25% to stop entirely.

“Alcohol has such a grip on us because it is an integral part of society, socially acceptable when in fact it is an addictive drug disguised as a sophisticated experience,” she says. “Those susceptible to addiction do not realise it until they are already too far into its clutches. As drinking in general becomes more widespread, there will be a proportional increase in the number showing addiction or dependence.

“The effect on women throughout their 20s, 30s and 40s probably is different and I would guess it becomes increasingly important with age. Not until turning 40 do you really acknowledge your own mortality and want to prolong your life and its quality.

“If you’re a mother there is an additional selfless need to do the best for children, which isn’t possible if your prime concern is alcohol. Again, if you drink but it’s not a problem, you will quite happily minimise it to prioritise your children. If, however, it is a problem, managing these two areas of life becomes difficult and conflicting.”

Last year, another book called Her Best Kept Secret became a bestseller in the US. In it, journalist Gabrielle Glaser caused controversy by suggesting that women in particular find a new approach to tackle problem drinking.

“We need to take advantage of 21st-century science. We’ve learnt a lot about how the brain works since the founding of AA in 1935 and we need to acknowledge what nearly every research study has found in recent years. One size could not possibly fit all,” she wrote. “Women who have achieved success with AA or other 12-step approaches should consider themselves lucky and keep attending meetings. But for those for whom it doesn’t work, it’s worth searching for other answers.”

“Women,” she concluded, “are drinking more because they can.”

It’s true, says Willoughby, who believes the traditional route to sobriety – Alcoholics Anonymous – is not always attractive for women. “We’re certainly not against AA, but AA wasn’t for me. I don’t, like a lot of women, identify with the word alcoholic but I knew I was drinking too much.

“A lot of women I’ve spoken to in doing research before setting up Club Soda were saying the same kind of thing. We give people a whole suite of options to pick and mix, because if you’re changing something about your behaviour then everyone has a different way that they can do that best.

“We did a snapshot of @DryJanuary followers and one in 10 mention what they drink in their [Twitter] profile – for example “wine lover” – or have a photo of themselves with a drink. We did not do a gender split, but having looked at over 5,000 Twitter profiles in the last few weeks I can tell you that they are mostly women,” says Willoughby.

“So one of our quick five-minute kickstarts [to help club members] for the new year will be: change your Twitter and other public profiles.”


■ Plan something else to do at your drinking “trigger time”. If you usually open a bottle of wine around 7pm, arrange to be doing something else.

■ Have a glass of water with every alcoholic drink. It gives you something to sip and slows down your intake. Look for low-alcohol wine and beer when shopping and make sure there’s soda water or lemonade around for spritzers.

■ Take a break – test your dependence on alcohol by making sure you have two or three days off each week. It helps your body lower its tolerance and makes it easier to cut back.

■ Make known your aim to drink less – the more people you tell, the more support you should receive.

So even if you’re not planning on stopping completely there are some great tips for cutting down and one way to do so would be to have one or two social events a month that weren’t booze centric and Club Soda could help you with that 🙂

I hosted the first Club Soda Social in Cambridge last Sunday and met Laura, the founder.  It was a brilliant evening of great food and alcohol free drinks with lovely company – 7 of us in total.  I’m going to be hosting them once a month so if you’d like to join me then please do and if you’d like to hear Laura explaining a bit more about it then you can do so on yesterday’s edition of the Women’s Hour on Radio 4 which you can access here 🙂

Effectiveness of web-based self help interventions with alcohol

There is growing research on the effectiveness of web-based self-help interventions. A meta-analysis by the World Health Organisation (WHO) showed that, for people with hazardous and harmful use of alcohol, computerized self-help is approximately as effective as a face-to face brief intervention. It is also likely to be cost-effective. Online self-help might be the first part of stepped care and it offers an option when health professionals are scarce.

With that in mind, we are coming towards the end of Dry January and Dryathlon.  If you’ve stopped throughout January, are feeling great and weighing up whether to start again again why not sign up for my Udemy course here or just click on the gift icon at the top of the right hand side bar?  It’s currently half price at only $50 (£32) too 😉

Here are what others, who all gave 5 star reviews, having done the course said:

five stars

If you are serious about stopping drinking alcohol – or significantly cutting down – the course will help you plan, action and sustain this momentous change.

The information given is an accessible mixture of evidence-based theory from a nursing perspective, and personal experience. The lectures, resources and support included in the course comprise a powerful yet compassionate package.

It’s not easy getting your life back from alcohol’s clutches when you have been drinking too much for too long, but this course will help you do it. Highly recommended.

packed full of information and tools!
What I liked most about this course is that it’s written by someone who has been through addiction herself and is passing on her understanding and tools using the benefit of her professional background. It’s written really clearly and speaks hard truths in a sympathetic and matter of fact way.If you are wondering whether your life could be improved by changing your relationship with alcohol this course will guide you through that decision making process and give you the techniques and support you need to make that change. Highly recommended.
Helpful for Anyone Affected by Problem DrinkingLouise Rowlinson has combined her professional background and personal experience to create a course to provide guidance to those who are worried about their drinking habits, or those who know they have a drinking problem and are not sure how to get help. She addresses moderation, along with abstinence, in a course packed with useful information, resources, and referrals to online communities dedicated to reduce alcohol abuse. The course materials are presented in an easy-to-follow and honest manner. I feel it is helpful not only to those with a drinking problem, but to those who are family members or friends of problem drinkers. It explains the effects of alcohol use on the body and mind, which makes the often misunderstood issue of alcohol abuse easier to comprehend. Would definitely recommend this course.Fantastic course !

This is a very good course , very informative giving factual information and practical advice . I would highly recommend it to anyone who is looking to address their alcohol consumption . The follow up call from Louise was also a great help and was very motivating. Thanks Louise

Do avail of the extra support from Louise

I found this course really informative, interesting and easy to follow. I have been sober for a while but was suffering from a bout of PAWS or just a wobble. I emailed Louise a few times and set up a phonecall with her. How fantastic and easy it was to chat with Louise. It really re-motivated me and inspired me. Thanks so much Louise

Don’t take my word for it, go take a look at the free preview material and see if this course could change your relationship with alcohol forever 🙂


Labour MP Bill Esterson’s Ten Minute Rule Bill on alcohol labelling

This was covered in the BBC News earlier in the month and was reporting on Labour MP Bill Esterson’s Ten Minute Rule Bill on alcohol labelling.

You can watch the footage of his presentation to Parliament here

Introducing his bill in the House of Commons, Mr Esterson it was known heavy drinking during pregnancy increased the risk of Foetal Alcohol Syndrome, but there was “a lack of consensus” on the potential effects caused by a small amount of alcohol.

“Much scientific evidence suggests that there is no safe limit when it comes to drinking in pregnancy but sadly not everyone is aware of the dangers,” he told MPs, and warned that small amounts of alcohol could cause “mild brain damage” in an unborn child.

But Mr Esterson raised concerns about the “apparent contradiction and advice given by the chief medical officer”.

He said: “Now not everyone whose mother drinks during pregnancy suffers damage that affects their life chances and this is certainly not an attack on women.

“But the damage done by alcohol to too many children shows the need for action and shows that too many of us do not understand the potential risks of drinking alcohol at any point during pregnancy.”

His bill, he explained, would avoid “confusing or conflicting advice, whether from government or elsewhere” and introducing mandatory “clear” labelling “that cannot be easily missed and that gives the best advice”.

“That advice must be not to drink at all while pregnant or trying to conceive. Such a system of labelling should be designed to help cut the number of children damaged at great cost to themselves and to society,” he added.

However, the Labour MP also counselled that better labelling was “only part of the answer”, and stressed the benefits of education.

Citing Canada as an example, he told MPs children as young as four are taught about the harmful impact alcohol can have on unborn babies, and that posters about Foetal Alcohol Syndrome are displayed in shops, train and airports and surgeries.

Mr Esterson called on the drinks industry to make changes to their labels without legislation, and urged the government to update its guidance.

His bill received an unopposed first reading – allowing it to proceed to the next stage – and is scheduled to be debated by MPs on 6 March 2014.

However, it is unlikely to become law due to lack of parliamentary time.

Nice try Bill ……

Reblogged: Technology and Recovery within the Homeless Population

This is reblogged from the excellent the in2recovery online community and website managed by Michaela Jones, who is also one of the founder members of the Dry Umbrella Bar in Manchester.

I’ve reblogged it because I think it says great things about the use of technology to support recovery online and reaching hard to reach groups such as the homeless population.

Guest Blog, Dr Caral Brown: Technology and Recovery within the Homeless Population

After completing a research project that used an online recovery programme and spending copious amounts of my own time on line using my various social networks I do sometimes wonder how I would cope without constant access to the internet. 

After I attended some conferences on technology in recovery and asked the audience about their own use of technology and social media I wondered how those who did not use it coped with their lack of connection.

Especially after my research revealed that many vulnerable homeless drug users use the internet frequently and are part of different social networks. Aside from that many more use technology in various ways and indeed on a regular, often more than daily basis.

But of course they do, they aren’t terribly different from any of us without an addiction.

Importantly though there are many who need a little helping hand to get online/ involved in technology. 

At these conferences I have learned that there are many more recovery communities, groups and software available on the internet than I previously thought.

There are also many service providers who are keen to enable service users and help them get involved but just don’t know how or feel a bit too constrained or busy.

My advice here is to just do it, grab a computer and explore, encourage someone to get online or take that step and do it yourself. Once that first door is opened, it’s likely many more will follow.

Building connections is important and there are lots of supportive connections online. Using technology in recovery is clearly a way forward, for all addictions.

Some key messages are that first, there needs to be good quality access to computers and the internet. Second, dealing with sensitive issues can be incredibly difficult and so privacy is important and third, for those who are not software engineers, a little help and advice along the way might mean the difference between giving up and sticking with it.

Dr Caral Brown – Research Fellow, Oxford Brookes University

Alcohol Poisoning Kills 6 Americans a Day

Time Magazine UK ran an interesting report earlier this month looking at deaths in the US caused by alcohol poisoning with findings that 6 people were being killed a day.

Here’s the full article:

CDC says alcohol poisoning deaths are a greater problem than previously thought

America has a drinking problem, with 2,200 people dying each year from alcohol poisoning. That’s an average of six alcohol-related deaths a day, a new Centers for Disease Control and Prevention (CDC) report says.

Alcohol poisoning happens when people drink an excessive amount of alcohol in a short amount of time, causing high levels of alcohol in the body to interfere with and even shutdown parts of the brain that are critical for controlling vitals like heart rate, body temperature, and breathing. Eventually, that can lead to death.

Over 38 million Americans binge drink an average of four times a month, and consume an average of eight drinks per binge, according to the new CDC Vital Signs report. Interestingly, the report shows that the majority of alcohol poisoning deaths happen in adults between the ages of 35 and 64, and 76% of those who die are men, revealing binge drinking is not a behavior solely observed among young people. The CDC reports that while the most deaths occur among non-Hispanic whites, American Indians and Alaska Natives have the most deaths per million people. The death rates also vary widely state to state. For example, alcohol poisoning deaths in Alaska add up to 46.5 deaths per million residents, and in Alabama it’s 5.3 per million residents.

The CDC says the report shows alcohol poisoning deaths are a greater problem than previously believed, and that the numbers are likely an underestimate since alcohol-related deaths are known to be under-reported. Alcoholism was a factor in 30% of the deaths and other drug use was a factor in only 3%.

“Alcohol poisoning deaths are a heartbreaking reminder of the dangers of excessive alcohol use, which is a leading cause of preventable deaths in the U.S.,” CDC principal deputy director Ileana Arias said in a statement.

In response, the CDC is calling for more members of the medical community to screen and talk to their patients about alcohol, since numbers show only one in six U.S. adults has reported ever talked about their drinking with a health professional. States with stronger alcohol policies also have less binge drinking, and should partner with community workers including police and health workers for better programs, CDC says.

I find that figure quite shocking myself and would be interested to hear what my sober American friends think in the comments.

Alcohol hotspots of Great Britain revealed

This article was in the Daily Mail in early January and reported on some research carried out by NHS Health Scotland in a study looking at the alcohol hotspots of Great Britain.  If you would like to read the research article you can do so here.

The news feature contained this nifty map (click to enlarge) which shows the damage alcohol is causing around the country”.  Edited highlights of the article below:


The study, by NHS Health Scotland, was the first to analyse alcohol sales data, an indicator of alcohol consumption, as well as alcohol-related deaths.

It found people in the South West, Central Scotland, North East, North West and Yorkshire were the biggest boozers, with higher levels of alcohol sales per adult than the average for Great Britain.

The high volume of sales in South West England (19 per cent higher than the national average) was mostly due to spirits and cider sold through pubs and restaurants, but sales of wine through supermarkets and other off-licences were also high.  However while the South West region had the joint highest consumption level, it had one of the lowest alcohol death rates.  Researchers at NHS Health Scotland and the Glasgow Centre for Population Health suggested that this could be due to tourism.  The South West, which was defined by the study as mainly Devon and Cornwall, had one of the smallest populations but also one of the highest rates of second homes.  People who visit this area but do not live there would increase the sales figures for alcohol and would not show up for alcohol-related deaths.

There is also a nice table that shows market share percentage of spirits, beer, wine and cider/perry sold in each region too which is interesting and worth a look

All previous studies have looked at alcohol consumption for regions in Great Britain based on self-reported data, which can be biased because of low response rates, the sample taken not being representative, and because people do not accurately report how much they drank.

The use of alcohol sales data is a more accurate and objective way to estimate how much the country is really drinking.

However, researchers warned this data is still subject to its own biases, such as wastage and spillage; consumption by tourists; and unrecorded alcohol, which includes homebrew, smuggled alcohol and alcohol intended for industrial and medical use.

The study’s lead Mark Robinson, of NHS Health Scotland, said: ‘Our study provides support for the relationship between alcohol consumption and alcohol-related mortality across regions in Great Britain, which hasn’t always been the case using survey data to estimate consumption.  Future studies should consider the use of data from a range of different sources to provide a better understanding of alcohol consumption in GB, its relationship with alcohol-related harms, and the impact of different alcohol policy approaches.’

This was an interesting read and I had not even thought of the impact of tourism on rates of consumption locally.  Variation in types of drinks also confirmed regional favourites with Scotland having higher spirits sales, the North more beer,  East Anglia, South East and London more wine and the Southwest more cider and perry.

84% of motorists support alcohol immobilisers on cars

Almost 84% of UK motorists would support the introduction of technology designed to immobilise vehicles if sensors detect that the driver is over the legal blood alcohol content (BAC) limit. 

The result comes as part of a motoring safety innovations survey by National Windscreens. 

This figure makes particularly interesting reading for insurers looking to reduce the costs of drink driving related incidents and is especially significant when combined with the fact that 66% would specify additional technologies when buying a new vehicle, specifically to benefit from discounted insurance premiums.

The level of support for alcohol detection devices is in stark contrast to the 39% of respondents who stated they would support the introduction of technology designed to make it impossible to exceed the speed limit.

These findings are very timely with the recent reduction of the BAC limit for drivers in Scotland earlier this month and the festive season’s imminent arrival, putting drink driving high on the national agenda.

National Windscreens commercial director, Pete Marsden said: “These results clearly demonstrate the high level of support for innovation designed to minimise drink driving. There is a clear opportunity for insurers to capitalise on this support with premiums that differentiate between vehicles with and without this safety feature.”

According to the Department for Transport, despite significant reductions in recent years there were still 230 UK deaths attributed to drink driving in 2012. And with alcohol cited as the cause for 6630 road accidents per annum, in addition to the human cost this issue obviously has huge financial implications for the motor insurance industry.

Marsden added: “Drink driving is still a significant cause for concern for both motorists and insurers – our survey suggests that any innovations which can help reduce the number of accidents caused by alcohol would be welcomed by drivers throughout the UK.”  

 Read the full story here
I think it’s great this technology is being considered but wonder whether the 84% who were supportive had thought about the repercussions not only to their night time driving but their early morning driving too?  Particularly when a fifth of drivers said that take the wheel after a heavy night’s drinking despite the risk of still being over the drink-drive limit.
Daisy recently shared this brilliant guide to how long it takes for the body to metabolise alcohol and these BAC monitors will impact on driving irrespective of what time of day it is …….
alcohol clear time
What do you think?  How do you feel about the BAC monitors?  I’d be happy to declare I was teetotal if it meant lower car insurance premiums 🙂

Alcohol-related Disease – Questions to Parliament

Ever wondered what politicians and Lords do all day when they’re busy at Westminster?  Well now you can find out and follow along.

This is a debate that went on in December regarding ‘alcohol-related disease’ where questions were put to Parliament in the House of Lords and you can see it here:

To ask Her Majesty’s Government what action they are taking to address the increase in alcohol-related disease.

So if in the future you ever want to know what our Govt is debating and doing about issues related to alcohol – now you know where to look 😉


Is Alcohol Abuse Part of Being British?

This is an interesting post by Castle Craig Blog entitled ‘Is Alcohol Abuse Part of Being British?’  Castle Craig Hospital is a residential alcohol and drug rehab clinic in Scotland.

Here’s their blog from December:

The UK has the reputation of a country with an alcohol problem. Widespread violence after weekend alcohol abuse binges have become a stereotype of British society. 

A recent British Council survey showed that 27 per cent of people abroad think that British people “drink too much alcohol”. The survey, titled “As Others See Us”, was based on 5,000 individual interviews with young people in Brazil, China, Germany, India and the US.

However, a recent study by the World Health Organisation (WHO) on alcohol consumption around the globe shows something different: the UK is not even in the top 20 of the world’s heaviest drinking countries. According to the WHO report, the average global citizen consumes 6.5 litres of pure alcohol every year. Belarus came top of the list at 17.5 litres a head, Moldova came second (16.8)and Lithuania third (15.4).

The UK was 25th on the list with an average consumption of 11.6 litres, which is less than Portugal where they drink 12.9 litres per year, France and Australia where they knock back 12.2 litres a year and Germany where the figure is 11.8 litres.

The “British problem” is not actually the amount of alcohol being consumed but the fact that it is associated with high levels of antisocial and violent activity. There are plenty of countries where people drink more than in the UK, where drinking isn’t associated with violent behaviour.

Is it the way Brits are “programmed” to drink?

According to the Institute of Alcohol Studies “there is no simple theoretical model that adequately explains the relationship between alcohol and violence. The vast majority of drinking episodes does not lead to violence, and most violence does not involve drinking.”

It’s not that British people have a different chemical reaction to alcohol, but they have a different attitude towards drinking. Social anthropologist Kate Fox says: “the British believe that alcohol is a disinhibitor, and specifically that it makes people amorous or aggressive…Our beliefs about the effects of alcohol act as self-fulfilling prophecies – if you firmly believe and expect that booze will make you aggressive, then it will do exactly that.”

Can people in Britain change their approach to drinking? Can they become more like the more mild-mannered drinking cultures? Most commentators think this is unlikely.“Britain will never have a Mediterranean drinking culture” writes Ed West in the Daily Telegraph. He points out that this has been a problem for centuries: “at no point in history have northern Europeans, and the British in particular, been known to drink sensibly – as far back as the early medieval period, continental observers spoke with horror about the Anglo-Saxons and their hopeless drunkenness.”

A review of several studies about culture and alcoholism found that there is a big gap in our knowledge and more research is needed: “Although European countries are among the world’s highest consumers of alcohol, the literature review showed that very little research has focused on social and cultural aspects of drinking in Europe…There is a clear and urgent need for large-scale systematic research on social and cultural aspects of drinking in Europe, and for continuous monitoring of shifts and changes in mainstream European drinking-cultures.”

Maybe the UK will never become a Mediterranean drinking culture, but maybe it doesn’t need to. But to kill the myth of the drunk British hooligan another myth needs to die: that binge drinking is as British as fish and chips.

What do you think readers of Caslte Craig’s view and the ‘lager lout’ moniker we seem to not be able to shake?


The Lancet Commissions: Screening at risk liver patients

Back in December a conversation in the comments between myself and Lori happened after this post.  I said that I would write a post where I go into greater detail about liver blood tests for her and share it here for anyone else who is interested.  These recommendations detailed below are taken from The Lancet Commission that was discussed in this post and focuses predominantly on primary care screening for at risk liver patients.

Panel 11: Recommendations for engagement of primary care

1 Liver disease should be positioned in primary care within the so-called Big Five chronic, preventable lifestyle-related diseases that share common lifestyle risk factors with cardiovascular disease, diabetes, chronic lung disease, and renal disease to maximise the effects from generic lifestyle interventions and to coordinate chronic disease management with the introduction of an appropriate funding mechanism.  The shared lifestyle risk factors provide an opportunity to expand the breadth of existing disease monitoring, but without a substantial increase in workload (eg, annual cardiovascular, renal, or diabetic checks that already commonly include liver blood tests)

2 Liver function tests should include measurement of the aspartate aminotransferase (AST) value to allow the calculation of the AST to alanine aminotransferase (ALT) ratio in all samples with an increased ALT and in the proposed diagnostic pathway, with serum γ-glutamyl transpeptidase concentrations and incorporation of liver elastography as a confirmatory test for hepatic fibrosis would distinguish between patients who are most likely to develop progressive liver disease from those who are not, thereby establishing appropriate referral for secondary care.

Key to our proposed diagnostic pathway is the routine inclusion of AST and GGT into the standard panel of tests for liver function when liver disease is clinically suspected. The AST value will enable calculation of the AST/ALT ratio (panel 9), and a score in the non-invasive
algorithm APRI and others in patients with non-alcoholic fatty liver disease. GGT concentration is a marker for alcohol intake and had the highest predictive value in terms of subsequent liver disease and mortality in a large community study. Abnormalities in this enzyme can also be used to motivate positive changes in behavioural in people who drink to excess because GGT concentrations rapidly decrease with abstinence from alcohol

Furthermore, the addition of liver elastography to the screening process is very cheap. When a practice nurse uses a portable machine, the cost of elastography is about £20 per scan, less than a tenth of the cost for outpatient referral to a specialist and targeted programmes of screening in the community have been successful (panels 9 and 10).

Use of liver elastography in the diagnostic pathway

Transient liver elastography is the gold standard in the assessment for liver fibrosis. Transient liver elastography directly measures liver stiffness by use of a fibroscan or a modified ultrasound machine and is predictive of liver-related events and death. In a meta-analysis of 7000 patients in more than 50 studies shows the area under the curve analyses (AUROC) for cirrhosis (0·94),severe fibrosis (0·89), or early fibrosis (0·84).

At present, most GPs do not have access to the machines to do liver elastography. However, most new ultrasound machines can be adapted to do liver elastography. This form of assessment should, in our opinion, be included as part of the standard operating procedure for all liver examinations by use of ultrasound requested from primary care. Additional time to include liver elastography per examination is low at possibly 5 min, and extra training needed for the workforce will be small. Furthermore, rapid access assessments by nurses for liver elastography could be organised in the same way that rapid access endoscopy is made available to GPs. Elastography will need to be promoted to the radiological and ultrasound community by the Royal College of Radiologists and British Medical Ultrasound Society. Additionally, portable elastography could be used in the community as reported in the Southampton and Nottingham studies (panel 10). This approach formed part of the very successful Love your Liver workshops organised around the UK by the British Liver Trust successfully raised awareness.

At present the capacity to substantially expand the engagement of GPs in such programmes is restricted, and funding issues will need to be addressed. The Quality and Outcomes Framework (an annual reward and incentive programme detailing GP practice achievement introduced in 2004) is being scaled back rather than expanded and the introduction of a new clinical domain is deemed unlikely. Additionally, valuable lifestyle advice indicators were removed in the governments’ budget of April, 2014, including the targets of giving people with hypertension advice about smoking cessation, safe quantities of alcohol consumption, and a healthy diet.

Development of clear protocols and schedules for investigation, clarification of referral criteria, and additional training programmes will improve the confidence of primary care workers in the management of liver disease. Identification of liver disease in patients at high risk in communities at an early stage will enable effective behavioural interventions
and treatments and will prevent the inexorable progression of liver disease in many cases. Furthermore, by using simple algorithms of existing blood tests to exclude severe liver disease in non-alcoholic fatty liver disease and using portable elastography services led by
nurses to identify severe liver disease in primary care, expensive referrals to specialist secondary care clinics can be used more efficiently (panel 11).

You can read the full report here where the panels mentioned and references are detailed in full:

Lancet commissions addressing liver disease in the uk 2014

These recommendations are very straight forward, do not involve a huge amount of additional cost or work, apart from staff training costs which I’m sure could be off-set if liver screening was included into QOF funding clinical domain schedules.  Alas what is actually happening in primary care is the opposite – these are being reduced not increased and alcohol IBA funding is also being removed so there is no financial incentive for GP’s to be engaging in alcohol induced liver health issues.

So to summarise (in non-medical speak!) you need to make sure that your blood test includes AST levels, and ideally GGT levels.  In the UK LFT’s (liver function tests) usually routinely include ALT levels, alkaline phosphatase, bilirubin, total protein and albumin levels.  Also when the blood results are received by the surgery ask for a copy of them!  These are your health records and you are quite within your rights to have a copy of your own blood test results.

And if I could go down to my GP surgery and ask for anything to reassure me about my liver health it would be a liver fibroscan.  I’ll be looking out for the next British Liver Trust ‘Love Your Liver’ UK roadshow and will be stalking them to get this non-invasive diagnostic test done as the likelihood of this being available at my GP surgery anytime soon has two hopes, Bob Hope and no hope ……..