Alcohol - How Much Is Too Much?

Alcohol has been a component of drinks enjoyed by people for literally thousands of years. It has loosened tongues and warmed the "cockles of the heart", given Dutch courage and "contributed" to many literary works. It is accepted or at least tolerated (and in some cases championed) in most societies and religions around the world. Unfortunately alcohol has killed and continues to kill countless people because of its acute toxic effects when consumed in excessive quantities as well as the cumulative effect on health with excessive intake over long periods of time.

Alcohol (or ethanol) is very quickly absorbed into the bloodstream from within the stomach and the small intestine and then passes directly to the liver where much of it is chemically changed. The remaining unchanged alcohol then travels in the blood throughout the body including lungs where some of it evaporates out into the air we exhale (which is why breathalyzers can be used to "estimate" the level of alcohol in the blood. From the lungs the alcohol remaining in the blood passes to the entire body. It rapidly reaches the brain where it acts as a depressant, NOT as a stimulant as is commonly believed. Initially it depresses those parts of the brain which actually inhibit or control our behaviour. This explains why when we start drinking alcohol we first become relaxed and a bit jovial. With higher levels of alcohol in our blood we become more disinhibited, saying and doing outlandish things.

As we drink more and more alcohol the level of alcohol in the blood continues to rise because we can drink alcohol much faster than the liver can remove it from the blood and "detoxify" it. So as the level of alcohol in the blood rises, more parts of the brain, especially the cerebellum which controls balance and coordination, become depressed. That is why alcohol makes us to become unbalanced and lose our coordination, and of course this contributes to road accidents as well as accidents at home and work. Finally as blood levels of alcohol rise higher we become drowsy and eventually pass out! Very high levels of alcohol will cause convulsions and will stop breathing altogether!

Incidentally, the level of alcohol in the blood will rise for a while AFTER we stop drinking. The liver, when healthy, seems to be able to detoxify or remove about about 10g of alcohol per hour in men, perhaps a little less in women. This means that one may have a level of alcohol in the blood which is considered unsafe for driving (ie. > 0.05%) the next morning after a "heavy night on the slops"!

A high concentration of alcohol in our blood can damage and even destroy our body's tissues. Repeated exposure of our tissues to high levels of alcohol will progressively destroy more and more of those tissues which are particularly susceptible to alcohol-induced damage. These easily damaged tissues include the liver, the brain, the nerves which conduct messages from our skin to the brain and from the brain to our muscles, and the heart.

How Does Alcohol Affect The Liver and Other Tissues

As the liver struggles to detoxify the blood by chemically changing (and neutralising) alcohol its cells swell up and become filled with excessive fat. The liver enlarges and can be felt in the abdomen well below the ribs on the right side. Very high blood levels will actually kill some of the liver cells and scar tissue replaces them. Repeated exposure to very high blood levels will eventually cause the liver to become hard and shrunken and this is called "cirrhosis" ("sirr-o-sis"). The liver can no longer do much of its important work and eventually people with severe cirrhosis will die from liver failure.

If the brain is repeatedly exposed to high levels of alcohol many of its cells can die and gradually alcoholic dementia develops. The cerebellum may be effected more than the parts of the brain which control higher mental functions, and therefore some people develop poor balance and coordination before their memory and logic are obviously affected. The nerves to hands and feet may become permanently damaged resulting in some loss of sensation.

Heart muscle can become damaged with alcoholic poisoning and some degree of heart failure is a common finding in alcoholics. In addition the speciallised fibres of the heart which coordinate its pumping action are sometimes damaged by alcoholic poisoning and then the heart beat becomes very erratic and this makes the pumpic action of the heart quite inefficient thereby adding to heart failure.

How Much Alcohol Is Too Much?

There is a lot of controversy about so-called "safe levels of drinking". To make it simpler to understand, the concept of a "standard drink" has been created. A standard drink is the volume of an alcoholic beverage which contains 10g of alcohol. If a wine contains about 10% alcohol (many have higher levels!) then 100ml of that wine will contain 10g of alcohol and therefore one standard drink of that wine will be 100ml. A bottle of wine (760ml) will therefore have contain 7-8 standard drinks. Using the same process one can work out that a pot (285ml) of full-strength beer and a can (375ml) of lighter beer will equal one standard drink.

Large studies on alcohol consumption has lead to the realisation that for most people there is a level of regular or daily consumption of alcohol which is relatively safe from risks of alcoholic damage to liver, the heart and nervous system. This safe level is different for people of different sizes and gender. A tiny elfin woman will not tolerate anywhere as much alcohol as a huge man, on average.

As a rough guide, a safe level of regular/daily alcohol consumption for women is 1-2 standard drinks and for men it is 3-4 standard drinks. If you drink beyond this amount on most days you are gambling with your health! If women drink more than 4 standard drinks every day or if men drink more than 6 standard drinks a day this WILL eventually cause damage! It is also considered appropriate for everyone to have at least 2 days per week which are completely free of alcohol consumption!

Drinking very heavily ("binge drinking") every so often can be just as dangerous as drinking smaller quantities on a regular basis. Binge drinkers risk having blackouts and severe liver damage, and are particularly prone to having motor vehicle accidents. Getting "totally paralytic" or "plastered" or "having a skinful" are terms commonly used to describe very dangerous practices which are unfortunately all to common in young people who seem unaware of the risks they face.

Who Are You Calling An Alcoholic???

There are many definitions used to define an alcoholic. For example St Vincent's hospital define an alcoholic as anyone who regularly consumes 100g of alcohol! That's 10 standard drinks and many people who wouldn't consider themselves alcoholics regularly drink more than that amount (at great risk to their health!). Other authorities consider that an alcoholic is a person who has suffered damage to their health, their marriage, their personal relationships, or their employment or has been in trouble with the Law due to alcohol-related offences! Others would look more strictly at whether or not a drinker can go more than a week without drinking any alcohol!

There's a lot of stigma associated with the term "alcoholic" and the commonest image is of a skid-row derelict or homeless person, unkept, unwashed and unfed, always with a bottle of something, even metho in their hands or pocket! While there's a lot of truth in this image, most alcoholics are well-fed, employed and in some sort of domestic relationship. And they are endangering their health!


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