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| Friday, 5 September 2003 |
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Alcoholism a family run by Dr. D. P. Atukorale
Children of people with alcoholism have a four-fold increased risk of alcoholism even when adopted by people with no history of alcoholism. Therefore people with family history of alcoholism need to be especially alert for early signs of alcoholism. Ability to "hold ones liquor" is one indicator for genetic risk and is an important screening test for potential alcoholic problems. Alcohol use is by far the most common drug abuse in Sri Lanka, wrecking families and friendships, spurring risky behaviour, suicide and rape and other violence and filling jails. Driving after consumption of alcohol is the commonest cause of road accidents and highway deaths in Sri Lanka. Misuse of alcohol accounts for a large portion of our health bill, as excess alcohol intake has an enormous detrimental effect on nutritional and overall health. On the other hand moderate drinking is said to decrease the risk of heart disease and stroke. The American Medical Association defines alcoholism as an illness characterised by significant impairment directly related to persistent excessive use of alcohol. Impairment can involve physiological, psychological and social dysfunction. Causes of alcoholism include genetic, psycho-social and envionmental factors. Alcohol in the body After a person drinks ethanol (alcohol) his or her blood concentration rises rapidly. Ethanol is rapidly absorbed into blood from all parts of gastrointestinal tract including stomach and it is not advisable for a person to drink on an empty stomach as alcohol absorption depends on the rate of stomach emptying. Food slows the stomach emptying rate and stimulates secretions such as gastric juice which dilutes the alcohol and slows the absorption into blood stream. A social drinker who weighs about 150 pounds and has a normal liver function metabolizes about 7-14 grams of alcohol per day. This is about 8-12 ounces of beer or 1.5 ounces of gin, rum, Brandy, cognac, 4 ounces of red or white wine, 1.5 ounces of Martini or 3 ounces of sour whisky. When the rate of alcohol consumption exceeds the liver's metabolic capacity, the blood alcohol rises and symptoms of intoxication appear. When a man or woman of similar size drinks the same amount of alcohol, the woman retains more alcohol in her blood stream; women cannot metabolize as much in their stomach cells. They also have lower amounts of liver enzymes that metabolize alcohol. In addition, women more quickly develop alcohol related diseases such as hepatic (liver) cirrhosis than men with same drinking history. Alcohol then goes on to affect the brain more than any other organ. Acting as a sedative alcohol tends to relieve the drinker's anxiety, cause slurred speech, reduce coordination in walking, impair judgement and sleep and encourage uninhibited behaviour. Because alcohol lowers inhibition it appears to act as a stimulant, but in fact, it is a powerful depressant. As William Shakespeare wrote "It stirs up desire, but takes away the performance". Because it reduces the secretions of the body's antidiuretic hormone, alcohol increases urination. It also causes blood vessels to dilate releiving the body heat. Alcohol and overall health A high percentage of Sri Lankans both in urban and rural areas consume alcohol and misuse of alcohol in and of itself is one of the most preventable health problems in Sri Lanka. Excessive consumption of alcohol contributes significantly to 5 out of the 10 leading causes of death in Sri Lanka, certain forms of cancer, road accidents and other accidents, suicides and homicides. Tobacco interacts with alcohol in a way that reinforces its effects in causing oesophageal and oral cancer. Excessive alcoholic drinking increases the risk of some types of heart disease, high blood pressure, nerve disease and nutritional deficiencies, damage to a pregnant woman's foetus, abdominal obesity, and many other diseases. A major cause of lasting mental retardation that begins in infancy stems from foetal exposure to alcohol. Social consequences of alcoholism include family violence, divorce, unemployment and poverty. A large number of Sri Lankan children are more likely to develop abnormality in psychological skills and relationships because their parents especially the father abuses alcohol. All these tell us, use alcohol very cautiously and in moderation if at all. Drinking even small amounts of alcohol can lead to alcoholism (alcoholic dependence). Sometimes there is only a fine line between social-drinking and alcoholism. People aged 20 to 50 drink most alcohol. Drinking among Sri Lankans begins earlier, many school boys consume alcohol during the "Big matches" and many University undergraduates start drinking during their varsity career. Earlier in life that alcohol abuse begins, the more likely alcoholism will result. Alcoholic cirrhosis Long-term alcohol use causes liver cirrhosis which is a relentlessly progressive disease, characterized by fatty infiltration of liver. Eventually the fat chokes off the blood supply depriving the liver cells of oxygen and nutrients. Liver cells then die and are replaced by scar tissues. In Sri Lanka, majority of cases of cirrhosis are caused by alcohol consumption. The amount and duration of alcohol consumption genetic factors and nutritional factors and individual differences determine the body's response to alcohol. Once a person develops cirrhosis there is a 50% chance of death within 4 years which is worse prognosis than in many forms of cancer. Most of the deaths from alcoholic cirrhosis occur in people between the ages 40 to 65. There are a number of possible mechanisms that underlie the liver damage from alcohol abuse such as production of free radicals that damage the cells. A major metabolite of alcohol may also contribute to liver destruction. No specific amount of alcohol guarantees cirrhosis. There are some rare people who consume large amounts of alcohol over a long period but do not develop cirrhosis. One observable pattern is that cirrhosis commonly results from 15 year consumption of approximately 80 grams of alcohol per day. This is equivalent to 7 beers per day. A dose as low as 30 grams for men and 20 grams for women per day can cause liver damage. Early stages of liver damage are reversible but advanced stages are not. A nutrition diet help to prevent some of the complications associated with alcoholism but alcohol can cause destruction of liver in spite of as adequate diet. Majority of alcoholic cirrhosis in Sri Lanka occurs in people who take large quantities of alcoholic beverages such as arrack and "Kasippu" without taking a nutritious diet. Deficient nutritious status compounds the problem of cirrhosis as it makes the liver more vulnerable to toxic substances by depleting supplies of antioxidants such as vitamin C which can reduce the free radical damage to the liver if present in adequate amounts. In U.S., neither the Surgeon Generals office, The National Academy of Science nor the U.S.D.A/D.H.H.S. recommends drinking alcohol. All groups caution that if adults do consume alcohol, they should drink alcohol only in moderation with meals (no more than two drinks for men and one for women or those over 65 years of age). Avoid drinking alcohol before or while driving, operating machinery, taking medications or engaging in any other activity requiring sound judgement and avoid drinking while pregnant. Unfortunately however when some of us - allow ourselves to drink, we end up drinking too much. Even moderate use of alcohol is not advisable with a family history of alcoholism. People who regularly take medications such as aspirin or anticonvulsants or who have a family history of breast cancer or other alcohol related-cancers, high blood pressure, high blood triglycerides, diabetes, sleep disorders and gastric ulcers should consult their family physician first before they choose to drink. References: ########## Fair complexioned baby to dark complexioned parents Dr. Zakir Molvi in his book answering a problem posed before him on dissimilarity between father and offspring attributes this to what he calls "skipping of generations". Both the problem and the reply we feel are of general interest to readers. Hence here it is. Problem: A few years ago a tragedy occurred in a family in Pakistan in which the wife was divorced on grounds of infidelity. Here the couple had been an East Pakistani and a Begali girl. A love marriage. The first child born after three years had been in contrast to the complexion of both parents who had been very fair. This change of complexion had aroused suspicion of infidelity on the part of the wife, and the man had divorced her on the ground. Dr. Zakir gives the following medical explanation to this change of complexion. "It is very unfortunate that marriage counselling has not developed in our country (Pakistan) so that expert opinion and advice could be sought in delicate issues of this nature, thus could avoid much pain and misery. In this case the phenomenon can be easily explained on the basis of genetics. Occasionally a child could bear very little resemblance to either of the parents, and show strong resemblance to a member of the early generation. In genetic language this is known as "skipping of generations". Golden hair is a good example of physical attribute that can skip several generations before re-appearing. The gene for golden hair is recessive, dominated by a gene for black hair. It can thus be handed out unnoticed through generations of black haired people.Surprise and suspicion thus could arise when several generations later a golden haired offspring is born to black haired parents. Do you know?: That condoms have a history going back to the 15th century. Here's what Dr. M. Zakir Molvi of Pakistan in his book Marriage Problems says about it. "The condom was produced in the 15th century as a protection against syphilis and was made of linen saturated with mercury solution. Later designs were made of fish bladder and lamb gut. Latest models are made of very thin latex rubber. Dr. Zakir adds this warning The condom if used over a prolonged period, may cause cervical erosions, which may be precursor of carcinoma (cancer) of the cervix - the mouth of the uterus. ########## A mixed bag for good health Tea for heart The results of a US study showing the cholesterol-lowering effect of tea products were published recently in the Archives of Internal Medicine (Arch Intern Med 2003; 163: 1448-1453). The daily intake of flavonoids found in green and black tea appears to produce a significant drop in levels of total and LDL cholesterol. Flavonoids have already been shown to lower cholesterol levels in animal studies. There is also evidence from epidemiological studies that tea consumption can lower such levels and protect against heart attacks. Researchers saw a 16% reduction in LDL cholesterol in the people in the study, all of whom were on a low-fat diet; there were no serious adverse effects. Larger and longer-term trials were recommended to confirm the findings in a more diverse population. ****** Sedentary lifestyle and cancer Recent findings provide yet another reason to modify a sedentary lifestyle. Impaired glucose tolerance (IGT) may promote the development of cancer, especially colon cancer. Insulin has been shown to stimulate cell growth, particularly those on the surface of the colon. A recent report in the american Journal of Epidemiology (Am J. Epidemiol 2003; 157: 1092-1100) argues that this may explain why overweight people are more likely to develop colon cancer. In a study of more than 3000 adults between 1976 and 1980, people with IGT were nearly twice as likely to die from any type of cancer than were those with normal glucose levels. Their risk of dying from colon cancer was more than quadruple that of healthy controls. ******* Ginzeng for blood sugar Results of a study by investigators from the University of Toronto demonstrate that ginseng may help to normalize blood sugar (glucose) levels. Researchers spoke about the implications of their trial during a poster session at the 63rd Scientific Sessions of the American Diabetes Association (Study title: Reduction of HbA1c after long-term administration of American ginseng and konjac mannan fibre in Type 2 diabetes. Abstract 1676). The ginseng did not adversely affect the liver or kidneys and results in people with well-controlled diabetes were comparable to those obtained with other hypoglycaemic agents. However, the researchers emphasized that their preliminary study is not a reason to recommend ginseng to patients. Further study was recommended. ******* Multivitamins for infections While a recent study found that people with diabetes may be able to ward off colds and other minor infections by taking a daily multivitamin (Annals of Internal Medicine 2003; 138: 365-371, 430-431), the reduction in infections was not found in people who did not have diabetes. People with diabetes often do not consume adequate amounts of nutrients and they also have a slightly higher risk of infection. The study showed that people with diabetes were more likely to be deficient in at least one vitamin or mineral. This could explain the beneficial effect of a multivitamin. Only 17% of people with diabetes taking a multivitamin reported having an infection, such as a cold, flu or a gastrointestinal infection, compared with 93% of those who took a placebo. None of the people with diabetes who took a multivitamin were forced to take time off work through minor illness; 89% of people with diabetes who were given a placebo pill reported missing at least one day of work during the one-year study. ******** Cholesterol - what is it? Cholesterol is a type of fat found in all cell membranes, but which can be laid down in excess in the walls of the major arteries which are then predisposed to significant damage. Cholesterol is carried in the blood stream by particles called lipoproteins. A distinction is made between cholesterol carried by low-density lipoproteins (LDL cholesterol, or 'bad' cholesterol) which can be oxidized and is the principal source of arterial wall cholesterol, and that carried by high-density lipoproteins (HDL cholesterol, or 'good' cholesterol) which transfers cholesterol out of the blood and into the liver. The level of total blood cholesterol is the some of HDL and LDL cholesterol levels, together with that of very low density cholesterol (VLDL), the particles which transport fat between the gut or liver and the peripheral tissues. ******* Body Mass Index The Body Mass Index (BMI) is a key index for assessing body weight in relation to height. BMI can be calculated by dividing a person's weight in kilograms (kg) by their height in metres squared (m2). In the West a person is considered overweight when their BMI is a above 25.0 kg/m2, obese when it is above 30.0 kg/m2, and severely obese when it is above 35.0 kg/m2. In Asia the recently recommended corresponding BMIs are 23, 25 and 30 kg/m2 respectively. (Courtesy: Diabetic Voice) Picked for the Health by Chrissy Aloysius, President, Doctors Wives Association. |
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Some studies suggest that as much as 50% of person's risk for
alcoholism comes from genetic factors.
