Alcohol’s silent killers: What advisers need to know about everyday drinking and hidden health risks

In the years since the Covid-19 pandemic, alcohol-related deaths in the UK have continued to climb, highlighting not only the familiar spectre of liver disease but also a set of less obvious health risks.

While headlines often focus on the dangers of binge drinking and cirrhosis of the liver, there is growing recognition that everyday drinking habits – often seen as moderate or social – are driving an increase in conditions like high blood pressure and diabetes.

For advisers who help customers protect themselves and their families through insurance products, understanding these hidden impacts is increasingly important.

“The common perception is that alcohol risk is mostly about heavy drinking and liver problems, but in truth that tends to affect a very small proportion of people,” says Nicky Bray, chief underwriter at Zurich.

“Even moderate alcohol consumption can result in things like high blood pressure, heart rhythm or pulse rate abnormalities such as atrial fibrillation, and also diabetes.”

These are often areas that customers may not disclose or downplay or may not realise are an issue.

When applying for cover, customers are asked whether they have high blood pressure or have seen a doctor, nurse or other health professional about it in the past five years. They are also asked if they currently have or have ever had diabetes, raised blood sugar or sugar in the urine.

While applicants might genuinely be unaware of some medical details, most people have a clear sense of how much they drink, so any inaccuracies in this area are more likely to result from underestimating or (to use insurance industry terms) non-disclosure.

It is therefore essential that advisers emphasise the importance of answering questions about alcohol consumption honestly, to provide an accurate picture of not just how much a client drinks but also how frequently.

“In our previous piece on alcohol and underwriting, we explained how we assess risk based on declared consumption,” says Bray.

“It’s worth revisiting that article for a reminder of the questions we ask about alcohol, why drinking patterns matter and when we would start to apply premium loadings.

“That article also looked at the link between alcohol, mental health conditions and drug use. This time, we’re focusing on some of the more insidious effects – like how alcohol can gradually raise blood pressure or interfere with glucose regulation, increasing the risk of type 2 diabetes.

“We’re worried about all these different types of risks. Some of them can be eminently treatable – reducing alcohol lowers blood pressure and reduces risk of diabetes. We’d rather know about all these risk factors when underwriting customers than find out at claims stage.”

Consumption and outcomes

Office for National Statistics data shows a stark upward trend in alcohol-specific deaths since lockdown in 2020. Deaths from alcohol-specific causes, such as alcoholic liver disease, mental and behavioural disorders due to the use of alcohol and accidental alcohol poisoning, rose by 70% in the 20 years to 2022, with about half of that increase occurring between 2019 and 2022 alone.

This reflects a wider pattern observed across North-western Europe over recent decades, where ‘alcohol-attributable’ causes of death – including various cancers, high blood pressure, heart rhythm abnormalities like atrial fibrillation and diabetes – have become increasingly common.

While these links are well recognised by health professionals, they are often overlooked by the general population.

One of the most striking aspects of the statistics is the demographic split in alcohol consumption and related outcomes.

In 2022, 30% of men exceeded the recommended weekly limit for alcohol intake – twice the proportion of women, at 15%. While men still accounted for around two-thirds of alcohol-specific deaths, the death rate among women has increased significantly in recent years.

Frequent drinking is also more common in older age groups than many advisers might expect. More than 10% of people over 45 reported drinking on five or more days per week in 2022. Meanwhile, among those under 25, twice as many women as men reported drinking this frequently.

“We’re seeing a pattern with women and alcohol that we haven’t seen before,” says Bray.

“While men may still be more prone to binge drinking, women are increasingly drinking more regularly during the week. That ‘wine o’clock’ culture may seem innocuous, but over time it will be contributing to rising levels of alcohol-related and alcohol-attributable claims across the industry.”

There is also a clear socioeconomic gradient in drinking habits – one that challenges stereotypes. In 2021, men in the least deprived areas were 11 percentage points more likely to consume over 14 units of alcohol per week compared to those in the most deprived areas. The same pattern was observed among women, with a 9 percentage point difference.

“We often assume that the greatest harm from alcohol occurs in the most deprived communities – and it’s true that alcohol-related death rates are highest there,” says Bray.

“But when it comes to overall consumption, it’s the more affluent groups who are more likely to exceed recommended limits, probably because they can afford to buy alcohol more regularly. “It’s a reminder that advisers shouldn’t assume lower alcohol-related health risks just because someone has a higher socioeconomic status,” she adds.

A silent killer

One area where advisers can play a role in helping customers recognise risk is high blood pressure – sometimes called a ‘silent killer’. While many people think of blood pressure as potentially genetic or lifestyle-related, alcohol is a major contributor.

“The mechanisms are complex, but we know that alcohol stimulates the nervous system, increases heart rate and narrows blood vessels, all of which raise blood pressure,” explains Bray.

“Over time, alcohol disrupts the brain’s ability to regulate blood pressure, while also triggering hormonal systems that encourage the body to retain sodium and water. The result is more circulating blood volume, which further increases pressure on artery walls.”

Interestingly, alcohol has a biphasic effect. In the first 12 hours after drinking, blood pressure may dip even as heart rate rises. But after this initial period, studies show that both heart rate and blood pressure climb – and can stay elevated for days if drinking is frequent.

“Many people assume that only large quantities of alcohol are harmful, but research shows the risk of high blood pressure starts to rise at around 1.5 units per day. That’s equivalent to just a small glass of wine or half a pint of beer,” says Bray.

Blood pressure readings consistently above 135/85 mmHg – lower than the clinical threshold for hypertension of 140/90 – have been shown to increase the risk of heart attack and stroke. Women appear to be more vulnerable to these effects.

“For women, the rise in blood pressure happens more rapidly as consumption increases,” says Bray.

“The good news for both men and women is that blood pressure is one of the more modifiable risk factors. If the intake reduces, blood pressure falls.”

She urged advisers to speak to customers about getting their blood pressure checked, which can be done for free at a pharmacy.

The diabetes connection

The relationship between alcohol and diabetes is less well-known but equally important. The liver acts as the body’s glucose reservoir and is responsible for keeping blood sugar levels within a narrow range. Consuming alcohol can inhibit the liver’s ability to release glucose into the blood as it focuses on metabolising the alcohol.

“Alcoholic drinks can cause an immediate spike in blood glucose levels due to the sugar and carbohydrate in them,” says Bray.

“The impairment of the liver by alcohol can last for several hours after drinking, especially if a high number of drinks are consumed in a short period of time.”

While some studies have shown a beneficial effect of low-to-moderate alcohol consumption on insulin sensitivity and reduced risk of developing diabetes, regular binge drinking or chronic heavy drinking can lead to insulin resistance. That makes it harder for the body to regulate blood glucose and can contribute to the development of type 2 diabetes.

Implications for advisers

For advisers, the implications are clear. While underwriting typically asks about declared consumption, a more nuanced conversation can help customers see the broader health context – and understand how regular drinking affects their protection needs.

“Life cover, critical illness policies and income protection all rely on accurate health disclosures,” says Bray.

“When customers appreciate that drinking isn’t just about liver disease – but also affects blood pressure, heart attack and stroke risk and diabetes – they may be more motivated to share information and make changes.”

Bray also stresses the value of revisiting alcohol discussions periodically, especially as life circumstances change.

“Someone who drank very little in their 30s may be in a different pattern by their 50s,” she says. Ultimately, as awareness of the wider health impacts grows, advisers have a role to play in helping customers make informed choices – both about protection and their long-term wellbeing.

“We’ll be returning to the topic of high blood pressure in more depth later this year,” Bray adds.

“But for now, it’s worth remembering that modest drinking can have significant, sometimes hidden effects. That’s something every adviser and client should be aware of.”