Bodily harm; the health effects of excessive drinking

Bodily harm; the health effects of excessive drinking

Evelyn Zamula

Bodily Harm: The Health Effects of Excessive Drinking

Dylan Thomas didn’t make his own exit in quite that way. Mind numbed by drugs given to relieve his DTs, the poet meekly slipped into that good night at the age of 39. The cause of death listed on the certificate was “acute alcoholic insult to the brain.”

Short of this dramatic development, which happens when the brain’s respiratory center has been depressed by an alcohol overdose, a whole array of ills await those who use alcohol heavily and habitually. Even those who drink moderately know they can expect some ill effects on occasion, ranging from a mild hangover to vomiting or other unpleasantness.

Since that first pot of fermented honey (mead) or fruit juice (wine) was drunk thousands of years ago, alcohol has been an important part of almost every culture. Some historians suggest that mankind’s fondness for alcohol may have been a factor in the development of agriculture. Our ancestors of long ago may have stopped roaming and settled down to farming not only for food, but also to have a steady supply of barley and other grains to make alcohol. Bread may have come first, but beer wasn’t far behind.

Throughout the ages alcohol has played many roles. Besides its use as a beverage, at one time or another alcohol has functioned as a form of money, a sacrament in religious ceremonies, and as an instrument of subjugation–our forefathers used firewater to subdue native Americans. As a drug it has been used as a mind-altering substance, antidote against snake-bite poisoning, anti-emetic, topical disinfectant, anesthetic, diuretic, tonic, and a purported all-purpose cure-all. Wars, like Pennsylvania’s Whiskey Rebellion of 1794, have been fought over alcohol taxes. The 18th Amendment to the Constitution, which, from 1920 until its repeal in 1933, prohibited the manufacture, sale and transportation of intoxicating liquors, precipitated another type of war, whose lingering effects are still felt today.

Today about two-thirds of Americans 18 or older drink alcoholic beverages, and about three-quarters of students in the 10th and 12th grades also indulge. It is doubtful whether many of them know exactly what alcohol does to the body.

Once consumed, alcohol quickly and easily makes its way through the body. It doesn’t even need to be digested, as it can be absorbed into the bloodstream directly from the stomach and small intestine (also from the lungs by inhalation, or from the rectum by an enema). The amount of alcohol in the blood determines its effects. This, in turn, depends on the quantity that is drunk and how fast it gets into circulation.

When a half-ounce of ethyl alcohol–the amount in the average glass of wine, mixed drink, or can of beer–enters the stomach, about 20 percent of it is absorbed into the bloodstream through the stomach walls. The rest is absorbed into the blood from the small intestine. Five percent to 10 percent of the alcohol is eliminated unchanged via the urine, perspiration and the breath, which is why the police can measure it with a breathalyzer. The remainder of the alcohol circulating in the blood is metabolized, or burned up, mostly by the liver–generally at the rate of about a quarter-ounce per hour, though there are considerable individual variations in this rate. The more alcohol in a person’s system, naturally, the longer it will take for the body to metabolize it.

The rate at which alcohol is absorbed from the gastrointestinal tracts is influenced by a number of factors. Food in the stomach, especially proteins, slows absorption. Diluted drinks, like wine and beer are absorbed more slowly than straight hard liquor; carbonation, as in mixers and champagne, appears to speed absorption.

The effects of alcohol on the body vary from person to person and from time to time. People who are tired and under stress may feel the effects more quickly than usual. Body weight is another factor. A couple of drinks will hit a 140-pound man harder than one weighing 200 pounds, because the heavier person has more blood and body fluids and thus the alcohol is less concentrated.

The amount of body fat also plays a role in how alcohol is distributed in the body, since alcohol is poorly soluble in fat but readily soluble in water. Because fatty tissue holds less water than muscle tissue, a man weighing 200 pounds with a fair amount of body fat will reach a higher blood alcohol concentration and feel alcohol’s effects more keenly than a muscular man of the same weight. This is why a woman, who generally has more fatty tissue than a man, will attain a higher blood alchol concentration than a man weighing the same.

Alcohol is distributed by the blood to virtually every cell in the body. In nursing mothers it rapidly enters the breast milk. In pregnant women it crosses the placenta and thus reaches the unborn child as well.

The most visible effects of alcohol are on the central nervous system. Though alcohol is basically a depressant, a low level of alcohol in the blood–say, from a glass of wine or can of beer–produces a mild tranquilizing effect. Moderate intoxication can loosen the tongue and break down inhibitions, because alcohol first affects that part of the brain that deals with learned behavior patterns, such as self-control. Some people may become melancholy or mean.

As the level of alcohol in the blood climbs, the depressant action of the drug on the brain becomes more apparent. An individual is considered legally drunk in most states when one part of every thousand parts of blood is composed of pure alcohol, expressed as 0.1 percent blood alcohol concentration. But even before a person reaches that point, reaction time slows because the motor areas of the brain are affected. At around 0.1 percent, speech is slurred and the person becomes clumsy. At 0.2 percent (five or more drinks in a short time), the midbrain is affected. The person is very drunk, staggers, or lies down to sleep. The emotions are affected and the person may laugh or cry easily. At 0.3 percent, the individual may be in a stupor or confused. At 0.4 percent, most people become comatose, some requiring hospitalization.

When a blood alcohol level of 0.5 percent is reached, death usually occurs, caused by respiratory failure.

Ordinarily, blood alcohol concentrations above 0.4 percent are unlikely, because it takes more drinking than most people can manage. Since every half-ounce of alcohol raises the blood alcohol level about 0.025 percent (though body weight and food in the stomach cause variations), it would be necessary to drink 20 martinis, 40 bottles of beer, or five bottles of wine within an hour’s time to raise the blood alchol level to the lethal point.

Death may be caused at levels lower than 0.4 percent in some persons particularly sensitive to alcohol. Death can also occur if a large amount of straight liquir is drunk in a short time, as occassionally happens when barroom athletes show how well they can hold their liquor, or at colelge initiation ceremonies. Most who drink that heavily only escape death because large amounts of alcohol trigger vomiting, which protects the body from absorbing any more alcohol.

Most people don’t drink until it kills them, but many drink enough to get a hangover the next morning. A hangover often includes a throbbing headache, nausea, dry mouth, vertigo, diarrhea, fatigue, and various other symptoms. No one knows exactly what produces a hangover, except that overindulgence is a prerequisite. Alcohol itself can dilate the blood vessels in the brain, producing the characteristic headache. But some experts think that flavorings in alcohol or congeners–natural byproducts of the fermentation process, such as tannic acid and fusel oil–are the culprits. Others believe that a combination of nervous, metabolic, psychologic and hormonal factors may be responsible, or perhaps physical factors enter in, such as an inner ear disturbance or gastrointestinal irritation.

Whatever the cause, only time will cure a hangover. Someone desperate for relief can try analgesics such as aspirin and acetaminophen for the headache, antacids for the upset stomach, any of a number of over-the-counter medications for the diarrhea, or the doctor, if things get really bad. (Alcohol interferes with the effectiveness of some OTC and prescription drugs. For more information, see the June 1979 FDA Consumer article “Liquor May Be Quicker But …”)

Some dedicated drinkers are in for more trouble than a hangover. If they stop drinking for any reason, or even if the blood alcohol level falls a little, they may be faced with withdrawal symptoms. Beginning 12 to 48 hours after the dependent drinker stops drinking, the mild withdrawal syndrome includes nausea, irritability, weakness, sweating and vomiting.

More serious complications can result from the severe withdrawal syndrome, commonly known as the DTs (delirium tremens), which usually develops 48 to 96 hours after drinking stops. Here the alcoholic’s blood pressure, heart rate, and temperature go up. He feels confused and afraid and often suffers from auditory and visual hallucinations. He frequently sees animals in the shadows or thinks the room is rotating. His whole body shakes, and a convulsion or fit may occur. The DTs can be fatal–The Merck Manual states that mortality may be as high as 15 percent.

There is evidence that heavy drinking injures the brain to the point where it affects intellectual functions. In a Danish study of 37 alcoholic men under 35, standard tests revealed that more than half showed some signs of mental deterioration, including forgetfulness, difficulty in concentration, confusion and disorientation.

Severe damage to the brain and nervous system is represented by Wernicke-Korsakoff syndrome, a type of beriberi caused by excessive alcohol intake and an acute deficiency of the B vitamins, especially thiamine. Besides producing general muscular uncoordination, paralysis of the eye muscles, and mental confusion (Wernicke’s encephalopathy), it results in a type of amnesia (Korsakoff’s psychosis) in which recent memory is impaired. The Korsakoff patient can’t remember what happened 10 minutes ago, but can recall his kindergarten teacher’s name. Fabrication is another part of this syndrome. If asked what happened yesterday, the patient will give one story. If asked the same question five minutes later, he will respond with an equally believable–and sincerely belived–but totally different story. Without treatment for the vitamin deficiency, permanent damage to the brain occurs.

The malnourished alcoholic sometimes suffers from damage to nerve tissue outside the brain and spinal cord. This disorder, known as alcoholic peripheral neuropathy, is characterized by numbness, muscle weakness, and a curious burning sensation in the hands and feet.

Although alcohol affects the central nervous system most dramatically, it has a number of serious effects on the organs of digestion, especially the liver. It is the liver’s job to detoxify alcohol, which is poisonous to the body. In the process, it may become damaged itself.

When four or five drinks daily are consumed for several weeks, changes in the way fats are metabolized in the liver cause fat to accumulate in the liver cells. The condition is known as alcoholic fatty liver. If the person stops drinking for just a few days, the liver’s remarkable regenerative powers come into play. New cells are produced to replace damaged ones, the liver perks up, and it’s business as usual again.

But if heavy drinking continues for a long time, about a fourth of male and half of female alcoholics go on to develop alcoholic hepatitis, where the liver becomes inflamed and some of its cells die.

The most severe form of liver disease induced by alcohol is cirrhosis, where functioning liver tissue is replaced by scar tissue. The first person to describe this condition was a French physician in Napoleon’s army named Rene Laennec, also inventor of the stethoscope. At autopsies the observed livers that were hard, scarred and yellow, and named the disease after the Greek word kirrhos, meaning tawny.

Not all people with alcoholic hepatitis develop cirrhosis, nor even all heavy drinkers. About 10 percent of people who have been heavy drinkers for 10 years or more will be afflicted. Nutritional and genetic factors may also influence who gets cirrhosis and who doesn’t, with some individuals showing exceptional resistance to the disease. Yet cirrhosis is responsible for about 11,000 deaths in this country each year.

For years, experts weren’t sure whether it was the alcohol that damaged the liver or the poor diet followed by many heavy drinkers. It is now known that alcohol damages the liver no matter how nutritious the heavy drinker’s diet. Malnutrition, common in alcoholics because of loss of appetite and the empty calories in alcohol, compounds the damage.

Alcoholic drinks contain a substantial number of calories–a 12-ounce can of beer has about 160 and a 4-ounce glass of wine about 100–so it’s perfectly possible for alcoholics to get all the calories they need each day from alcohol. Many do, but they lose out on essential nutrients. The rich home-brewed wines and beers of times gone by contained vitamins and minerals as well as carbohydrates, but modern brewing and distilling methods don’t leave enough of these nutrients in beer and wine (and only rarely in hard liquor) for adequate nutrition.

Heavy drinkers who don’t eat eventually experience severe nutritional deficiencies, as in the Wernicke-Korsakoff syndrome. Others who do eat may develop an aversion to meats and other protein foods, because the ailing liver doesn’t process protein well. One analysis of Chicago’s Skid Row alcoholics showed that their usual diet consisted of jelly doughnuts and alcohol, says Dr. Richard Selzer in his book Mortal Lessons. Even when some attention is paid to diet, existing liver damage may interfere with proper storage and use of vitamins and minerals. Also contributing to a loss of nutrients are the vomiting and diarrhea that go along with heavy drinking.

The digestive tract takes a beating in other ways. A pleasant glass of wine or an aperitif before dinner is said to stimulate the appetite, perhaps because alcohol in low concentrations promotes the secretion of stomach juices. But a higher level of alcohol can inhibit digestive enzymes and irritate the stomach lining, causing nausea, vomiting and stomach distress. Chronic intake of alcohol is associated with cancers that follow the path of digestion–mouth, esophagus, liver, pancreas, large intestine and rectum. About 75 percent of cases of chronic pancreatitis–inflammation of the pancreas–occur in heavy drinkers. Heavy drinkers develop peptic ulcers more frequently than non-alcoholics.

A low blood alcohol level doesn’t greatly affect the heart; it produces only a temporary slight rise in blood pressure and an increased pulse rate. But larger doses interfere with the ability of the heart to contract, causing arrhythmias (irregularities of the heartbeat) that can cause sudden death. Heavy alcohol consumption can also directly damage the heart muscle, causing a condition called cardiomyopathy, which can lead to heart failure even in the relatively young. The major symptoms are shortness of breath, swollen ankles and fatigue.

Though there’s been a lot of talk recently about a drink or two being good for the heart, not all experts agree on this score. Dr. Edward Eichner argues persuasively in The American Journal of Medicine that it’s the generally healthier lifestyle that moderate drinkers lead–with attention paid to diet, weight, exercise and other health factors–that is responsible for their lower rate of coronary artery disease. Eichner states that new data reveal that those who don’t drink or smoke have the lowest incidence of heart disease of all. He also notes that drinking aggravates high blood pressure and diabetes, two risk factors in heart disease. Whether or not moderate drinking is beneficial to the heart, those who don’t drink at all have no reason to begin doing so, while those who drink small amounts of alcohol probably have nothing to fear, in the absence of health problems.

The blood, too, suffers from heavy drinking. Many alcoholics have poor resistance to disease because the number of their white blood cells, the infection fighters, is reduced. Anemia, caused by nutrient deficiencies and damage to the bone marrow, is often another problem.

Alcohol also affects the endocrine system, the glands that produce and secrete hormones. Anyone who drinks knows that alcohol produces increased urination. This happens not only because large amounts of fluid are consumed, but because alcohol actually inhibits the release of the anti-diuretic hormone vasopressin from the pituitary gland. Alcohol in the blood also appears to cause the pancreas to produce more insulin than usual, while simultaneously inhibiting the normal production of glucose by the liver. This may result in temporary hypoglycemia, or low blood sugar. Diabetics who take insulin can die if they drink too heavily.

One final indignity. It was noted by Shakespeare in Macbeth: “It [alcohol] provokes the desire, but takes away the performance.” William Penn put it more succinctly. He said: “Drunkenness…unmans men.” Though many people belive that alcohol is a sexual stimulant–and it may function as one of it releases inhibitions–even moderate drinking can depress erection and inhibit ejaculation. Chronic, heavy alcohol consumption produces impotence or reduced sexual drive in about 70 percent to 80 percent of alcoholic men. By reducing the production of the male hormone testosterone and increasing the levels of estrogens (female hormones), alcohol causes some men to become feminized. Fifty percent of alcoholic men develop feminine pubic hair patterns, and 20 percent develop enlarged breasts. In many cases, the testicles become soft and atrophy.

Female alcoholics don’t escape endocrine changes either. Instead of becoming more feminine, as might be expected from alcohol’s effects on males, heavy drinking may cause women to be less so because they lose characteristic fatty tissues from the hips and breasts. Sometimes menstruation stops and the ovaries fail to function, resulting in infertility.

Women who drink heavily while pregnant often have babies of low birth weight, which is associated with increased risk of infant death. The most severe alcohol-induced injury to the unborn child is fetal alcohol syndrome, a condition characterized by defects of the face and head, growth retardation both before and after birth, and central nervous system abnormalities, such as mental retardation. Heart defects are often present as well.

Long-term alcohol abuse lops 10 years or so off the lifespan and prematurely ages the brain by about the same. It raises havoc with the appearance, too. Alcohol withers the limbs and swells the belly. Spidery red lines crawl over the nose and cheeks, the face sags, the hands tremble, and the eyes water, maybe with regret for the person who might have been.

COPYRIGHT 1986 U.S. Government Printing Office

COPYRIGHT 2004 Gale Group