From a colleague at TMC- Social drinking and occasional bingeing is just as bad in the long run.How far is death?

Social drinking and occasional bingeing is just as bad in the long run. City docs offer sobering facts. Mumbai Mirror today

We’re all guilty of the two drink diet at social dos. It may seem reasonable and one would imagine it to cause minimum damage to the liver. But Dr Aabha Nagral, gastroenteritis, Bhatia Hospital says that it depends on how you define the word ‘reasonable’. “Earlier, most doctors went by the British Society of Gastroentology, which suggested that consuming more than 30 grams (for women) or 40 grams (for men), can cause liver disease,” she says. But since these numbers were defined for the West and the concentration of alcohol too would vary, it was much higher than the permissible limit. Nagral offers an India-specific thumb rule: women must not consume more than three units and men must restrict themselves to less than four.

“Anything more than two units (60 ml) consumed on a regular basis (daily) can lead to various health issues,” she says. In drinker math, this means that three glasses of beer or three small pegs (30 ml each) of whiskey consumed daily are sufficient to cause significant health concerns. “Alcoholrelated ailments used to surface after 8-10 years of drinking but now we’ve seen patients develop liver cirrhosis in five,” says Nagral.

And just because you aren’t pouring yourself a peg every evening, doesn’t mean you are safe. According to Nagral, abstaining from alcohol for a period of time before a binge drinking session is equally hazardous. “A single episode of binge drinking can cause acute pancreatitis (a sudden inflammation of the pancreas) which can even be fatal sometimes,” says Nagral.

Alcohol in the system

To understand the effects of alcohol, we first need to understand what happens on consumption. Different enzymes in the body break down alcohol and metabolise it. “This process varies across races and depends on the genetic predisposition of a person. For example, the Japanese tend to develop a reaction to alcohol similar to a rash,” Nagral explains.

This is why some people may be more affected with just three units of alcohol, while others may not even after five. Also, women are more prone to develop alcohol-related conditions. “This is because women are deficient in an enzyme called alcohol dehydrogenase that metabolises liquor in the body,” explains Dr Akash Shukla, assistant professor of gastroenterology, and hepatologist, KEM Hospital. Also, the female hormone, estrogen increases the permeability of the intestines putting your liver directly in the line of fire.

The initial signs

The first stage is fatty liver. “This can happen over a night of binge drinking. If one quits alcohol at this stage, the state of the liver can be reversed. But few people manage to get diagnosed as the condition is largely asymptomatic,” says Shukla. This condition is caused when the triglyceride fats accumulate in the liver cells via abnormal retention of lipids. The silver lining, if you quit drinking, the condition is treatable with adequate restrictions and medication.

Occasional (think once a month) drinking can also lead to acidity, ulcer formation, nausea, weight gain, poor nutrition and an increased risk of pneumonia. Ignoring the initial signs of liver damage can be fatal. “If you are diagnosed with a fatty liver, you need to quit alcohol immediately. Not doing so would be mean that the fat would go through peroxidation and lead to cirrhosis within 8-10 years,” warns Shukla.

How far is death?

If it has been five years since you started drinking, you are right to start worrying. “Within five years of drinking, one can acquire alcoholic hepatitis which can be fatal,” says Nagral. Other terminal conditions that start off at the 10-year mark include liver cirrhosis and liver cancer.

It’s bad news for those who stay sober on weekdays but exceed the permissible number of pegs on weekends as well. Drinking high levels of alcohol over a short period of time can lead to permanent damage of the brain. “Alcohol causes damage to the cerebellum, the part of the brain responsible for balance. People who drink heavily will struggle with balance, even when sober,” says Shukla.

Alcohol causes brain toxicity, which can lead to memory loss and dementia, in addition to its effect on the spinal chord, lungs, pancreas, muscles and bone. According to Shukla, half the patients of chronic alcoholic hepatitis and those suffering from acute alcoholic pancreatitis have a high chance of mortality.

The C scare

Dr Pankaj Chaturvedi, Professor and Head and Neck Cancer Surgeon, Tata Memorial Hospital, who has been studying the relation between alcohol and cancer for years considers hard liquor to be a close contender to tobacco. “From the two billion people worldwide who consume alcohol, 76.3 million suffer from nearly 60 types of alcohol related diseases and injury. Alcohol causes 1.8 million deaths (3.2 per cent of total),” says Chaturvedi.

Alcohol is also related to cancers of the mouth, oropharynx, liver, oesophagus and breast. It causes dependence syndrome, cirrhosis, pancreatitis (acute and chronic), gastritis, polyneuropathy, hemorrhagic stroke, psychoses, epileptic seizures and other mental conditions.

Chaturvedi explains the cancer connection, “When you consume alcohol, an enzyme alcohol dehydrogenase is metabolised to create highly toxic acetaldehyde in the oral cavity. Among the two, the activity of aldehyde dehydrogenase is lesser than that of alcohol dehydrogenase, which leads to an accumulation of cytotoxic acetaldehyde in the oral tissue and makes one susceptible to cancer.”

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