Thursday, September 23, 2010

4.6 Alcohol, Secrets of a Drinker Doc

Physician's Notebooks 4  - - See homepage
6. Ethyl Alcohol - Update 2 December 2018
The column of headings will help readers using search & find or scrolling down.
About Alcohol We Drink - EtOH
Blood Alcohol Level (BAL), Inebriation & Toxicity
Alcoholic Intoxication
Harm of EtOH – How a Drinker May Prevent It
Pearls for Happy Healthy Tippling to Maximizing Absorption
Specific reasons or times to avoid alcohol

About Alcohol we drink - EtOH is the chemical compound with molecular formula of the ethyl radical (–C2H5) united to hydroxyl radical (–OH) at the 2C position of –C2H5. It may be called “Ethanol” or 'Ethyl Alcohol".
                                       H H
          Ethyl Alcohol  H C-C-OH
                                       H H
Ethyl Alcohol is a stage in fermentation of the fruits' fructose sugar to acetic acid (Vinegar at 5%). The alcohol is 7 calories per gram, but not essential because the body can synthesize ethyl alcohol from simplest sugar.
  Problem with EtOH is it needs too much to give its effect. Aspirin needs 30 mg; EtOH needs 10,000 mg. This large amount causes problems in mouth, esophagus, stomach and intestines and stresses the blood circulation and heart.
    EtOH can act as nutrient, is clearly a drug, may be a medication against heart disease (in controlled, low dose) or a socializing drug or source of stress. In excess, it is toxic to liver, pancreas, heart and brain, and promotes arterial hypertension, heart disease and cerebral atrophy. Also is the cause of many fatal and non-fatal but serious accidents.
   In volume/volume (%), beer is from 3.6 to 6% (in U.S. c.5%), wine from 10 to 15% (listed on label), and “hard” drink like whiskey is measured by its “proof”, which is twice the percentage of its EtOH (40% EtOH is 80 proof). EtOH is rapidly adsorbed from mouth, esophagus, stomach and upper intestine so most is in blood by 30 minutes after you drink. Eating food slows EtOH getting into blood. On entering your blood, most EtOH (excepting EtOH absorbed in mouth) goes on a first pass through the liver which metabolizes it at a time-limited rate to acetate via the toxic acetaldehyde intermediate. Acetate enters the glucose oxidation cycle and is burned to produce caloric chemical energy, or used to synthesize cholesterol, or stored as fat.
   Conversion of EtOH to acetate requires nicotinamide (vitamin B3) at the steps from EtOH to acetaldehyde and from acetaldehyde to acetate, and acetaldehyde is a toxic chemical that causes damage in liver leading to cirrhosis. Since liver cells do not store nicotinamide, its functional oxidized form (NAD+) is quickly depleted even by a single drink of 14 grams alcohol. Thus, more than 1 drink EtOH per hour piles up toxic aldehyde in liver cell; and also it piles up the EtOH in brain cell promoting a rapid drunk state.
Blood Alcohol Level (BAL), Drunkenness & Toxicity: The EtOH in blood in U.S.A. is milligrams percent (mg%, number milligrams EtOH per deciliter blood serum) and referred to as BAL - the Blood Alcohol Level measured by blood test or by breath test of exhaled air. Moment-by-moment BAL is a dynamic measure of EtOH input (amount of EtOH you drink per unit time) minus rate EtOH output unchanged via breathing and in urine, and minus rate of its destructive metabolism (c.10 grams per hour, or about 1 oz of 90-proof whiskey per hour).
   Ethanol’s immediate effect is on brain cell: It stimulates neurons in the cerebral cortex to up your mood (euphoria) and to disinhibit you. This causes the violent or (in men) sexually harassing drunk. Ethanol at slightly higher BAL will disorder the neurons in the cerebellum, which control balance and coordination. So the drunk is clumsy and staggers. At highest BAL, ethanol depresses respiratory center leading to slow breathing and asphyxia and death. If you notice a person lying on street, the way to tell he is in alcoholic coma and not in diabetic coma is to note the respiratory rate: alcoholics in coma breathe very slow, c.10 breaths or less per minute, while diabetics breathe very fast, >20 per minute. Smelling breath, a fruity sweetish odor suggests diabetic coma but types of alcoholic drink may mimic that.
   What is the definition of a drink in alcoholic terms? In U.S.A., it is 14 grams of EtOH, estimated to produce BAL of 30 mg% in one who starts day with BAL of zero. You get it from 12-oz (360 ml) bottle of beer, or 5-oz (150 ml) glass of wine, or one and a half oz (45 ml) “shot” of 80-proof liquor. (One normal size cup contains c.240 ml fluid) The toxic and protective effects of EtOH are based on specified number of drinks per unit time.
   In experiment after some men had 3 quick drinks on empty stomach, the max BAL was 67 to 92 mg%. The wide range is from individual factors that affect EtOH body metabolism (higher body weight has lower max BAL after a drink than lighter one; and also genetic difference in enzyme, and nutritional difference in effect of vitamin level in liver). Women metabolize EtOH slower than men and thus tend to have higher max BAL after drinking same amount of EtOH. (A woman gets drunk easier and quicker than same size man who is same type drinker)

Alcoholic Intoxication is legally defined in most states in U.S.A. as a BAL starting at 80 mg% but recent tendency is to lower it to 50 mg% based on data that suggest it would lower the accident and fatality rate. Experiments show that elevation of the BAL even to 20 to 30 mg% (level at 1 hour after 1 drink) harms fine motor control, impairs judgment and increases impulsiveness. Higher BAL 150 mg% (5 or 6 drinks within 1 hour) causes drunk with staggers and slurred speech. In fatal overdose the average BAL is 400 mg% (13 or 14 drinks in 1 hr) but a heavy drinker can tolerate a higher BAL.
   For an average person (weight, liver function, genetic make up and nutrition), EtOH is metabolized to destruction or excretion at rate where one drink is cleared from blood in 60 to 90 minutes. It means if you could control your drinking to 1 drink each 60 to 90 minutes, you would achieve a steady alcohol state with constant BAL at about 30 mg%, enjoying the high of EtOH yet not being legally drunk, even by the lower 50 mg% definition.

Harm of EtOH – How a Drinker May Prevent It:
EtOH drinking’s worst effects on brain (damages cortex neuron and leads to dementia), liver (cirrhosis and cancer), pancreas (pancreatitis and cancer), heart (promotes arrhythmia and toxic to heart muscle) and bone (speeds osteoporosis of aging) are due to high, prolonged BAL.
   The key to limiting damage from drinking is: Limit EtOH intake to max of 3 drinks wine or beer a day and keep it at no more than 1 drink per 90 minutes to the limit of 3 per 24 hrs. And mix your drink with water! Match each drink with at least 2 times its volume of water.
   Don’t drive or operate machinery for at least 24 hours after last drink. And if you drink, keep high vitamin intake because EtOH blocks absorption from intestine of vitamins you eat with food especially B-complex - thiamine, folic acid and B12, nicotin(amide)(ic acid), and pyridoxine; also calcium; and vitamin C and E. 
Advice for Drinking to Maximizing Absorption: Say you are a drinker who simply desires to get mildly drunk in safest, most efficient way? The EtOH you swallow is rapidly, partly degraded to toxic acetaldehyde by alcohol dehydrogenase in your stomach (up to 25%) and further degraded to more toxic intermediate in the liver. The way to get around this is to use mouth absorption of your liquor by taking small sips and holding in mouth for a minute or two. Mouth absorption goes into small arteries that go directly to brain or into vein directly to right heart and the EtOH molecules are pumped up to the brain, missing the first pass through liver and increasing EtOH availability to brain for your alcohol high and also reducing liver toxicity by lowering acetaldehyde production there. Additionally, protect your liver from EtOH by taking vitamin B3 supplement within 30 minutes before your drinking. The detoxification of acetaldehyde in liver is rate limited by level of nicotinamide enzyme NAD+ which liver cells do not store well. By taking the vitamin supplement just before drinking, you boost your liver cells' supply of NAD+ and increase your rate of rapid conversion of toxic acetaldehyde to nutritious acetate.
   In choice of wine, I advise white wine over red wine for several reasons despite much hype in favor of red wine because of red wine's higher antioxidant polyphenol level. Red wine stains teeth, skin and internal organs and this is worrisome beyond the simple cosmetic effect. Red wine interacts with MAO inhibitors that may be used against depression and this could lead to severe hypertensive crisis and stroke. And vitamin C (ascorbate) is a much safer antioxidant than red wine.

Specific reasons or times to avoid alcohol are if at risk for your heart's atrial fibrillation and especially if you have just been converted from atrial fibrillation to normal sinus heart rhythm by medication or electric shock, or if taking potentially liver toxic drug like acetaminophen (Tylenol). And of course liver, pancreas or kidney disease is a No No for drinking any alcohol. Also persons at risk for dementia, especially showing early signs should avoid alcohol. I stopped routine wine with dinner after my MRI at age 81 showed sign of early cerebral atrophy.

    END OF CHAPTER. To read on next, now, click 4.7 The Remedies

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