Alcohol: What we know now

I was asked to address an audience of seniors on the topic of “Strategic Aging.” Around 150 showed up. They wanted to know how to live longer, and better.I spoke about the relevance of family history: the benefits of physical exercise and a lean body habitus, the need to avoid smoking, alcohol and illicit drugs, the utility of vaccinations and reality of loneliness in the elderly. I emphasised the importance of restricting alcohol intake. This might seem odd, me being a Scottish immigrant and all. My father was a master whisky blender, the manager of Bowmore Distillery Islay and the director of Chivas in Scotland. But he never drank scotch. He had a nose that could distinguish the best combination of grain and malt distillates, and thus create some of Seagram’s best products. If he did taste whisky, he was quick to spit it out. What he didn’t know was its cellular toxicity. We have to abandon the old adage of 14 units of alcohol a week for men, nine units a week for women. When COVID came along, there was an increased demand for this socially acceptable, prescription-free anxiolytic. The alcohol-related death rate rose 18%-to-28%. This isn’t surprising, as alcohol was easily available in the grocery store and the liquor-mart. One might expect that chaos generated by world politics will lead to increased stress, and a further increase in liquor consumption. The only saving grace is that booze consumption is not encouraged in youths (unlike vaping).So, let’s think about alcohol for a moment. I remember those court-room dramas, when we were told by the smart attorney, “alcohol is colourless, tasteless and has no scent.” This is true. But what we drink is not just alcohol, it’s a cocktail of esters, aldehydes and ketones that confer upon it flavour, colour and aroma. Who can’t distinguish vodka from single malt whisky, or chardonnay from a Mexican beer? How do humans metabolize these exotic additives? Sure, we have alcohol and aldehyde dehydrogenase in our livers—enzymes that detoxify, systems that eliminate, and mechanisms that limit damage. These functions can be overwhelmed, of course, and may not work that well if you have underlying fatty liver or cirrhosis. The toxic by-product of alcohol metabolism is acetaldehyde, which damages DNA and interfere with cell repair. Alcohol is believed to mimic GABA’s effect in the brain, binding to GABA receptors and inhibiting neuronal signalling. It also inhibits the major excitatory neurotransmitter, glutamate. It damages the dendrites in the cerebellum, and impairs communication between neurons.Repeated shots of Jack Daniel’s could overwhelm your capacity to contain chemical injury, leading to a pickled heart (alcoholic cardiomyopathy), pancreatic damage (pancreatitis), gut and liver dysfunction (peptic ulcers, alcoholic hepatitis and cirrhosis), and brain injury (cerebral and cerebellar dysfunction). We know it also contributes to hypomagnesemia, to social disarray (partner violence, job loss, car accidents), Wernicke’s encephalopathy (preventing thiamine absorption and storage), and falls. It doesn’t do anything for immune competence or your complexion, or your medicinal drug pharmacokinetics. As we challenge our metabolism, we are slowly being “pickled”— just as a dead frog might be when fixed by an embalming agent.But most importantly, alcohol ingestion contributes to cancers of the breast, esophagus, larynx, liver, mouth and throat. In fact, it is one of the biggest risk factors for breast cancer, given that it is as toxic as cigarette smoking. The WHO has stated that there is no safe level of alcohol consumption. Dr Ferreira -Borges, WHO Europe’s program manager for alcohol and illicit drugs, has stated, “Simply put, alcohol is toxic. It harms every organ while it passes through the body.” Our government earns tax revenue from the sale of booze, as it does from tobacco and cannabis. It is moving forward to advice the public about the carcinogenic potential of alcoholic beverages. Of course, 19% of the population of Canada still smokes, this statistic representing millions of unfortunate nicotine-addicted individuals. They are tumbling down the road towards COPD, CAD, stroke and cancer—some 70 years after we knew smoking was lethal. Alcohol consumption will continue to be commonplace and “acceptable” for decades to come. It will continue to be the dis-inhibitor of choice, and the cause of needless illness.As physicians, we need to understand the complexity of our society, and why patients make the decisions they do. Personally, I wonder if a bedtime anxiolytic might be a safer option than a nightcap of Bailey’s, or a happy hour G&T. I don’t get the message that lorazepam is a cancer-risk agent. Or that zopiclone rots your liver. Should we be selling alcohol in grocery stores? Should we be telling our patients it puts them at risk of cancer? Should we put images of cirrhosis, or cancer, on the bottle? Should we limit advertising, as we did with cigarettes? Societal norms are now being challenged by political mayhem: jobs will be lost, and the cost of living may spiral upwards. We will see increasing sales of beer, tequila, scotch, gin, vodka and wine. I enjoy a glass of prosecco on Sunday night when I play bridge. After my second glass, my bidding and card-play suffer, so my weekly allowance is clearly defined. I hope my liver, heart, brain and pancreas will thank me for this restraint.

Alcohol: What we know now

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