Humans have had a relationship with alcohol for a very long time.  That relationship has been both healthy and unhealthy.  This week we will explore the relationship between alcohol and both physical and mental health.  Just as with sugar, alcohol itself is not evil or bad, but an imbalanced relationship with alcohol can have life altering, or ending, consequences.

While sensational headlines tote the health promoting benefits of the resveratrol in red wine, they fail to cover the very real dangers of alcohol consumption and seem to insinuate that heavy drinking is a normal behavior.  In fact jokes about overindulgence are quite common and sell quite a few products.  

As an aside, resveratrol isn’t hard to come by in your diet.  It can be found in grapes, peanuts, pistachios, blueberries, chocolate, cranberries, and others.   

The History of Alcohol and Humans: 

Alcohol is created when microscopic yeasts digest sugars.  This process is called fermentation and is used to create drinks like beer, wine, and kombucha, all with different levels of alcohol.  Naturally fermented beverages have an upper limit of around 13% alcohol before the yeast dies, fermentation stops, and spoilage begins. 

Every culture around the globe has a history of consuming alcoholic beverages.  The varieties depended upon what was available locally: grapes, rice, barley, millet, bananas, sugar, etc.  Each creates their own unique beverage with its own flavor profile and alcoholic content.  

When water couldn’t be trusted to be safe, drinking beer and wine was a safer alternative.  Things got even more interesting in the 9th century C.E. when distillation was invented in the Middle East.  Through this process, alcohol was concentrated, forming spirits like brandy, rum, vodka, whiskey, and others.  This stronger alcohol was vital for month’s long ocean voyages.  Beer and wine would spoil on these extended trips, but spirits did not.  Spirits could also be added to the ship’s fresh water supply to prevent it from harboring disease.  Spirits played major roles in trade as well. 

What started as fermented fallen fruit that would make animals and then people a bit loopy quickly transformed into a household chore and then an international trade commodity.  We humans sure are good at spreading ideas and products around! (1)

When you read tales of days gone by that included drinking mugs of beer out in the fields or children drinking watered down wine at festival dinners, remember that alcohol was much less potent than what we drink today.  It was also necessary to avoid contracting diseases like cholera from contaminated water.  Modern water treatment and sanitation make this much less of an issue these days!

Health Effects of Alcohol Consumption: 

Now that we have taken a little historic detour to explore how we have the alcohol of today, let’s look at the effects of alcohol on our health.

First, remember that alcohol is a mild poison.  Our body must metabolize and remove it from our system.  When we drink alcohol faster than our body can metabolize it, we develop symptoms such as intoxication, hangovers, blackouts, and death from alcohol poisoning.  Over the short term, as long as we do not fully poison ourselves, our bodies can accommodate this, but over the long run we develop more and worse problems.

Alcohol’s Immediate Effects on the Body: 

Let’s explore some of what happens when we consume an alcoholic beverage: 

1. Alcohol is absorbed into your bloodstream in the stomach; this is why it’s not a good idea to drink on an empty stomach, as you will become intoxicated much faster.  It’s also why intoxication occurs pretty rapidly, within minutes. (2)

2. Once alcohol is in the blood, your body gets to work trying to get rid of it.  Up to 10% is eliminated through sweat, urine, and your breath. (2)

3. What cannot be directly eliminated must be broken down by enzymes made by your liver.  How well you are able to do this depends on your genetics and your nutrient status.  For instance, if you are deficient in zinc, your body will have a hard time making enough of the needed enzymes. 

4. The first step of alcohol metabolism creates a toxic chemical called acetaldehyde.  This is broken down into a less harmful substance for removal, but while it is there, tissues in the liver, the pancreas, the digestive tract, and the brain are damaged.  This happens every time you drink alcohol. (3)

5. Alcohol itself is a diuretic meaning your kidneys are triggered to release water.  This leads to dehydration which has issues of its own that we will cover next week when we talk about water. 

6. Dehydration, alcohol itself, and the tissue damage caused by alcohol metabolism result in intoxication.  While intoxicated one’s inhibitions are lowered, learning ceases, and sleep is disrupted.  This translates to people acting in response to their emotions and immediate wants and needs without the safety net of judgement and forethought.  Basically, when people are drunk enough, they act like a bunch of large toddlers without any guardians and access to bigger, more dangerous toys.

7. Lastly, the presence of alcohol in the body is inflammatory.  If you already have a condition that creates chronic inflammation, alcohol consumption will only worsen it.

All of this explains the lovely side effects of too much alcohol consumption - hangovers, poor decisions, and possibly life-changing consequences for those who overindulge and the people around them. 

Long-Term Effects of Alcohol:  

Over the long-term, damage to the digestive tract, liver, pancreas, and brain increase.  The more people drink and the more frequently they do so, the more this damage builds up and leads to more severe disease:

Addiction: 

Perhaps the most well known and researched medical condition associated with alcohol consumption is addiction.  There are strong genetic factors involved here, making those with a family history of alcoholism more likely to develop this disease themselves. 

Alcoholism isn’t a condition of weakness nor is it solely a mental health issue, it changes a person’s brain chemistry making them dependent upon alcohol.  It is a tricky and life-altering disease that breaks family bonds and destroys lives.  

If you or someone you love is at risk of alcoholism, one of the most loving things you can do is choose to abstain from alcohol.  It is a tough decision to make in our culture, but more and more people are making this choice.

Liver Disease: 

After alcoholism, the most obvious disease of long-term alcohol use is liver disease.  This starts out with liver damage resulting in deposits of fat within the organ itself.  Healthy, working liver cells are replaced by fat which cannot perform the same functions that liver cells do.  Once a liver cell has been replaced by fat, that cell can no-longer regenerate itself and begins to produce more local inflammation.  

Over the long-run, this fatty liver disease can progress to hepatitis - an inflammatory disease where the function of the liver is further damaged and liver cells continue to die.  Eventually, the liver’s ability to make fat is even compromised and fatty deposits are transformed into scar tissue.  

The end stage of liver disease is cirrhosis where the liver is hard, shrunken, and full of scar tissue.  Our livers have many, many different functions and the loss of these results in death.  

A few of the more dire consequences result from a loss of the ability for blood to clot and the backup of blood in the liver resulting in swelling of the heart, abdomen, and the blood vessels of the esophagus.  A common cause of death in end-stage liver disease is a rupture of the blood vessels in the esophagus resulting in a tragic, scary, and messy death from exsanguination. 

I’ve worked with patients with advanced liver disease, I’ve listened to patient stories of losing their loved ones in this fashion, and my aunt lost her battle with alcoholism in this manner.  Unfortunately, it’s not as rare as one might think.

Gastrointestinal Disease: 

Chronic alcohol consumption can result in long-term inflammation of the digestive tract all the way from the mouth to the anus.  GERD (reflux/heartburn) is a common consequence of alcohol consumption.  Other issues include gastritis (a painful inflammation of the stomach lining), ulcers, and worsening of any pre-existing inflammatory bowel disorders such as Crohn’s disease. 

Brain Disease: 

In addition to the damage done to brain tissue by alcohol itself, alcohol depletes several key nutrients needed for nervous system function.  Vitamin B1 (thiamine) is of particular concern.  When this nutrient is significantly depleted, first a reversible form of brain damage, known as Wernicke encephalopathy, can develop.  Symptoms include confusion, problems with vision, lack of coordination, an inability to regulate one’s temperature, low blood pressure, and coma.  If thiamine levels are not replenished, the disease can progress to Korsakoff syndrome which adds irreversible memory changes to the picture.  On a personal note, I have an uncle who suffers from this diagnosis and is no longer able to care for himself and must now live in a care facility.  It is a heartbreaking condition. 

Pancreatic Disease: 

The pancreas is another site of alcohol metabolism that gets damaged with each drink.  In the short term, this can cause the dangerous situation of acute pancreatitis where the blood vessels of the pancreas and the tissue itself becomes inflamed.  Signs include mild to severe abdominal pain, nausea and vomiting, difficulty breathing, jaundice (turning yellow), fever and confusion.  Hospitalization and testing is sometimes necessary to diagnose this condition.  

Over time, chronic pancreatitis can develop.  In this situation, the inflammation does not resolve and worsens over time leading to organ damage.  This can lead to an inability to produce the enzymes and hormones of the pancreas which can cause chronic malnutrition and diabetes. 

Cardiovascular Disease: 

Alcohol consumption can also lead to damage to the heart muscle, blood pressure problems, issues with the electrical system of the heart, and even stroke.  One of the more common problems with the heart muscle is an overstretched and enlarged heart (cardiomyopathy). (5)

Cancer: 

Alcohol is a known human carcinogen. (6)  This means it is a substance that causes cancer. (6,7)  This effect is strongest in those who drink while smoking and those who drink large amounts of alcohol regularly.  We will cover the different levels of consumption in the applications section, so stay tuned for that information. 

The types of cancer strongly associated with alcohol consumption include: head and neck, esophagus, liver, breast, and colorectal cancer.  Evidence is also showing an association between alcohol and pancreatic and prostate cancers, melanoma, and a return of cancers that have already been conquered.  (7)  

Immune System: 

Autoimmune conditions and other chronic inflammatory diseases are made worse by alcohol consumption.  Alcohol itself is inflammatory.  Additionally, alcohol consumption will weaken an immune system over time, making people more susceptible to diseases like pneumonia and tuberculosis. (5)

Applications: 

Alcohol consumption is a choice just like sugar consumption and other potentially harmful activities.  Some people have an easier relationship with alcohol, and others have a very difficult one where they do not feel in control.  I personally have a very strong genetic predisposition to alcoholism and must be very careful about my alcohol consumption, otherwise it gets away from me before I even notice.  It’s not something to be ashamed of, but it is something to be proactive about.  For the most part, I do not drink; that is the healthiest choice I can make for myself.

If you currently aren’t drinking alcohol, the USDA’s dietary guidelines for Americans recommends that you do not start. (8)

If you are drinking alcohol, it is recommended that you keep your drinking habits at or below a moderate level of drinking.  Typically, for female-bodied people, the recommendation is one or fewer drinks a day on days when alcohol is consumed.  For male-bodied people, the recommendation is two or fewer drinks a day on days when alcohol is consumed.  Anything above this level is considered heavy drinking.

For reference, a drink is: 

• 12 oz of a beverage containing 3-5% alcohol - wine cooler or domestic beers

• 8 oz of a beverage containing 5-7% alcohol - most microbrew beers or malt liquors 

• 5 oz  of a beverage containing 7-12% alcohol - wine, sake, etc.

• 1.5 oz of a liquor containing 13-40% alcohol - whiskey, vodka, brandy, rum, etc.

To be clear, no level of drinking is without risk.  Even drinking at a moderate or low level will still increase your risk of cancer and other health conditions.  Staying within the low to moderate level is one way to have a healthier relationship with alcohol if you choose to consume it. (9)

Perhaps at your next gathering, you will choose to offer some yummy herbal mocktails in addition to any alcoholic beverages.  This can help cut down on binge drinking and is more inclusive of your guests who choose not to drink. 

As someone who avoids alcohol, it can be a bit disheartening to only be offered alcohol, water, or soda.  I love water, don’t get me wrong, but when everyone else is celebrating and enjoying something special, it’s nice to be able to join in!  

If you are attending a gathering that will include alcohol, and you don’t want to imbibe, it can be helpful to bring a favorite non-alcoholic beverage with you, and if you bring enough to share, you may make someone else’s day too!  

Next Week: 

Next week we will continue the beverage theme and take a look at water. 

References

1. Phillips, R, “A Brief History of Alcohol”  Ted.com January, 2020 https://www.ted.com/talks/rod_phillips_a_brief_history_of_alcohol Accessed 3/29/2021

2. Bowling Green State University, “Alcohol Metabolism”, https://www.bgsu.edu/recwell/wellness-connection/alcohol-education/alcohol-metabolism.html Accessed 3/29/2021

3. National Institute of Alcohol Abuse and Alcoholism, “Alcohol Metabolism: An Update” https://pubs.niaaa.nih.gov/publications/AA72/AA72.htm Accessed 3/29/2021

4. National Institute of Alcohol Abuse and Alcoholism, “Hangovers: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/hangovers Accessed 3/29/2021

5. National Institute of Alcohol Abuse and Alcoholism, “Alcohol’s Effects on the Body”, https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body Accessed 3/29/2021

6. National Toxicology Program - US Department of Human Services, “RoC Profile: Alcoholic Beverage Consumption”, https://ntp.niehs.nih.gov/ntp/roc/content/profiles/alcoholicbeverageconsumption.pdf Accessed 3/30/2021

7. National Cancer Institute, “Alcohol and Cancer Risk:, https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet Accessed 3/30/2021

8. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov. 

9. Centers for Disease Control and Prevention, “Facts about Moderate Drinking”, https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm Accessed 3/30/2021