Battle against Booze

Dynamic Medicare BLOG

Health Article

Peer Reviewed By

Dr.Sajjan Madappady



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Published On: Sunday May 21, 2017


Understanding alcohol and its effects

Music, friends and booze. For a randomly chosen adult, an ideal weekend would consist of all three, preferably at the same time. Be it a classy fundraiser or a noisy game, alcohol remains on the table in one form or another. What makes this beverage a social prerequisite? What does it do the body? Is it really as harmful as they say? Below are listed five FAQs that haunt everyone who has ever been “sloshed”.

Q.1     What am I drinking?

Natural sugars present in fruits, grains or vegetables are subject to chemical breakdown in the presence of yeast. In this process known as fermentation,  yeast (a fungus) digests simple sugars into two major by-products –  CO2 (gas) and Ethanol (liquid). The resultant concentrations of fermented drinks  do not exceed 5-6% (in beers) and 10-20% (in wine) as the high alcoholic content deprives yeast of nutrients causing its death. ‘Hard liquor’ with much higher concentrations of ethanol cannot be made by fermentation alone, hence requiring an additional physical process of separation from water, namely  distillation. Depending on the variables involved, distillation produces the vast variety of spirits such as Vodka, Whiskey, Gin etc that stock a Bar. Alcoholic content of these spirits can range from 40-60% . Apart from drinking, alcohols are also used in everyday life as perfumes, fuel and disinfectant.

Q.2     Why does it make me feel good?

Centuries of research have been conducted to understand what makes alcohol a mood enhancer. It was long known as a psychoactive agent but substantial evidence was found only in the last few decades. A drastic upgrade in medical technology and radiology have helped create a conclusive case against its abuse.

On ingestion, ethanol  is rapidly taken up by the gut and distributed into the bloodstream. Since it is a foreign product, the liver breaks it down, metabolising it primarily into acetaldehyde (the hangover chemical). In lower concentrations, a complete degradation can result in removal of all waste products through urine, sweat or breath. but when the intake exceeds the rate of breakdown, it causes high blood alcohol levels. In other words, the brain gets drowned in alcohol.  This happens because ethanol can easily cross the blood brain barrier and effect neurons directly.

In terms of brain chemistry, an interplay of two neurotransmitters are seen, namely GABA and Glutamate. GABA (gamma-aminobutyric acid) acts as a natural inhibitor (makes you lazy and slow)  while Glutamate acts as a natural activator (makes you alert and active). Ethanol is observed to cause a greater production of GABA and reduction in Glutamate. Thereby, slowing down impulses and responses of the brain. A third NT (Dopamine) is released in the initial stage, which causes a state of euphoria . During  this  “stimulation”,  release of endorphins  reward the brain by giving it a characteristic “buzz”. As concentrations  increase, the second stage begins to unfold. This  is called the “depressive” stage. Herein, initial euphoria is followed by a slowing down of responses observed as slurred speech, compromised judgement and drowsiness.

Q.3     How much is too much?

We are all quite familiar with the stages of inebriation. Urban shorthand has it outlined as  smart, social, vocal, vomit and vamoose (gone for good). Let us understand what these mean scientifically. An average human being metabolizes around one standard drink (29ml of ethanol) per 90 minutes.  Blood alcohol concentrations (BAC) are a useful determinant in mapping the level of drunkenness. BAC is the concentration of alcohol in one’s bloodstream expressed as a percentage. For example, a BAC of 0.10 would mean that for every 100 ml of blood in an individual, there is 0.10g of alcohol.

At 0.03-0.12 BAC, a state of euphoria is experienced. The individual becomes daring and self confident. Face appears ruddy, attention span is reduced,  finer movements become difficult and judgement is compromised.  At 0.09-0.25 BAC , excitement takes over, altered sensorium (hallucinations, unable to accurately identify smell), blurry vision, uncoordinated movements and memory lapses tend to occur. A state of confusion ensues by BAC of 0.18-0.30. The individual is dizzy, emotionally unstable and unable to feel pain. By a BAC of 0.25-0.50, the person is stuporous, can barely move, does not respond to stimuli, goes in/out of coma, and vomits. On reaching a BAC of 0.35-0.50,  the person is unconscious. Body temperature decreases, breathing is shallow, heart rate reduced and pupillary reflexes are absent. Once the BAC is >0.50 , the individual stops breathing and dies.  This is also known as Acute Alcohol Poisoning. It is true that capacity and tolerance of every individual is different and varies with age, weight, type of beverage, volume, rate of intake, and accompaniment by food; but regardless of these differences, if a person is slurring in speech and/or is unable to walk upright, it is clearly time to stop.

Q.4 Why do I have a hangover?

For anyone who has been drunk beyond their wits, a hangover is their worst enemy. As discussed earlier, Liver breaks down ethanol into acetaldehyde which is removed from the body by all means available. A vinegar-like substance, acetaldehyde is toxic to the liver, brain and stomach lining. Nausea is often due to excess of this chemical in the gut. As discussed in the effects of alcohol on brain chemistry, there is a slowing down of responses. Concomitant tiredness tricks the brain into feeling hungry. Hence, the urge to binge eat. Alcohol is a diuretic, causing the body to get rid of water rapidly by extracting it from tissues and organs including the brain. This makes one urinate more frequently than usual. Dehydration caused by this, results in the characteristic “hangover headache” .  Sudden loss of nutrients and water has a detrimental effect on health. Despite an ever-evolving range of hangover cures circulating the market, there is no evidence to suggest that an ideal one exists. The best method available to cure a bad hangover is to rehydrate the body and replenish the nutrients. Rest and removal of toxins allows the body as well as the brain to effectively recover.

Q.5  Is alcoholism even real?

Alcohol Use Disorder (AUD) is a medical condition diagnosed by a physician when a patient’s drinking causes distress or harm. It is of two types – Alcohol Abuse and Alcohol Dependence. In 2012, 3.3 million of all global deaths were attributable to alcohol consumption. WHO identified nearly 200 diseases and injury-related health conditions associated with this disorder. Yes, alcoholism is indeed a grim reality.  AUD is found to result from frequent binge drinking that brings BAC levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. While short term effects, as discussed earlier, may cause death due to overdose, It is the long term effects that significantly contribute to the global disease burden. These include liver damage, brain cell death, weight gain, depression, reduced sexual performance, organ damage(pancreatitis) and  increased risk of cancer. 33-50% of people with AUD exhibit detectable cognitive and motor impairment. As a group, alcoholics share characteristics of Frontal Lobe Dysfunction i.e.  impaired judgement, poor insight, distractibility, cognitive rigidity and reduced motivation. Cumulatively becoming an economic and social burden for the individual.

Conclusion

The sheer universality of alcoholism is enough argument against its abuse. Undoubtedly, alcohol has been found to be beneficial when consumed in moderate amounts (up to 1 drink per day for women and up to 2 drinks per day for men). The benefits being a decreased risk for heart disease, ischemic stroke, and diabetes. But the importance of moderation cannot be highlighted enough. When abused, alcohol not only claims the life of its victims but also those around them. In the wise words of a contemporary poet, “Too much of anything will kill you, just as sure as none at all.”


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References

  1. NIAAA Fact sheet – https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
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Content Credit: Dr.Nikita Pandey, Pune

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