EFFECTS OF ALCOHOLISM

Quick Stats

• 80% of ppl in Western countries have consumed EtOH
• ~66% have been drunk in the previous year
• Serious repetitive EtOH issues: 20% of men, 10% of women
• Decreases lifespan by about 10 years on averge
• 1-2 drinks/day may benefit, anything more nullifies and hurts

Alcohol and nutrition

• 1 drink = 70-100Cal
• No minerals, proteins, vitamins, etc.
• Can interfere with absorption of  vit. B1, B3, B6
• Also Folate, vitamin A;  decr. in liver storage
• Beriberi, Wernicke-Korsakoff syndrome (B1)

Neural Effects

• Increases GABA-related action:
• Sleep-induction, anti-anxiety, muscle relaxation
• Until it doesn't (desistance) - then does OPPOSITE
• Problems sleeping, anxiety, many withdrawal symptoms 

Neural Effects

• Similar idea with Dopamine (pleasure):
• Important in alcohol use, craving, relapse
• ACTH and Cortisol incr. during intoxication, later decr.
• EtOH impacts serotonin and Acetylcholne receptors
• Basically, feels great, then terrible (duh)

Tolerance

• Three compensatory mechanisms:
• PK or metabolic (30% better liver metabolism - 1-2 wks)
• PD or cellular (neurochemical - normal physiologic fxn)
• Learned/Behavioral (people adapt to alcohol behaviorally)
• Short term withdrawal (intense): 5 days, otherwise 4-6 mnths

Chronic issues

• Major sleep disturbance - REM sleep, nightmares, snoring
• Peripheral neuropathy
• Low incidence (1%) but can degenerate cerebellum
• Also low: Wernicke's and Korsakoff's syndromes
• Cognitive/memory problems lasting weeks or months

Chronic Issues

• Acute pancreatitis 3x higher in alcoholics
• Impairs gluconeogenesis in liver: fall in glucose produced
• increased lactate produced, decreased oxidat. of fatty acids
• increase in fat in liver; cirrhosis, EtOH-induced hepatitis
• large increase in various cancers as drinking increases

Chronic Issues

• Increases MCV through effect on stem cells:
• Possibly lengthens G2 phase, inhibits mitosis (mech. not known)
• Also, folate deficiency: hypersegmented neutrophils
• Decreased production of WBCs, mobility of granulocytes
• Basically, decreased immune function  

chronic issues

• Hypertension, 6x increase in coronary disease
• Increased LDL cholesterol, cardiomyopathy (direct effect)
• Arrythmias, hypocontractility, LV impairment, heart failure
• Alcoholic Myopathy, low bone density, osteonecrosis of femoral head
• overhydration (up/down reg. of vasopressin, net effect incr.), hypothyroid

LASTly

• Be aware that alcohol issues can look like diabetes mellitus
• glucose intolerance, hypoglycemia (acutely) 
• ketoacidosis: decreased fatty acid oxidation, vomiting, poor diet
• Can look like diabetic ketoacidosis (increased ketones, glucose), BUT...
• large anion gap and increase in lactate [I think...]

Treatment...for another day