Archive for January, 2012

Alcohol

Saturday, January 21st, 2012

My wife and I recently returned from a wonderful weekend up in Sonoma County, where we indulged in a little wine tasting. While I’m actually not much of a drinker, learning about wine and winemaking is always fascinating. Upon our return, we’ve plunged into this season of holiday parties, with alcoholic drinks being served at most. All of this has started me thinking about the physiology of how alcohol affects our bodies.

Whether or not we are aware of it, the first sips of an alcoholic beverage result in the immediate impairment of brain function, and the more that we drink, the more that function deteriorates. The rate of deterioration may be affected by how empty or full our stomach is; our gender, age and weight; and race. Certain medicines, such as aspirin, slow the breakdown of alcohol and greatly increase the blood alcohol level. Cognitive abilities such as conduct and behavior are the first to go. There can be a mild euphoria and loss of inhibition. The most vulnerable brain cells are associated with memory, attention, sleep and coordination.

Alcohol affects the heart. Our pulses quicken after very little is consumed. Alcohol is a vasodilator, meaning that it makes the blood vessels relax in order to allow more blood to flow through the skin and tissues. This results in a drop in blood pressure, so in order to get sufficient blood to organs and tissues, the pulse speeds up. After a significant intake of alcohol, the heart develops “holiday heart syndrome,” in which the heart goes into an irregular rapid heart rhythm (atrial fibrillation). This can lead to weakness and shortness of breath, and an increased risk of stroke.

The lungs are involved because alcohol speeds up the breathing rate. However, at higher levels of intoxication, the stimulating affects are replaced by an anesthetic effect, which actually depresses the central nervous system. (Note that as our blood passes through our lungs, a proportional amount of alcohol passes into the air that we exhale. This is why Breathalyzers can accurately detect the blood alcohol level.)

The digestive system is affected. As a rough guideline, it takes as many hours as the number of drinks consumed to burn up the alcohol. Alcohol is absorbed through the stomach and small intestine. Even small amounts can irritate the stomach lining, and larger quantities of alcohol can block absorption of essential vitamins and minerals. Only a few weeks of heavy drinking can lead to pancreatitis.

The kidneys are affected because alcohol is a diuretic. It promotes urine production, which then leads to dehydration. Due to this stimulation, the kidneys are working overtime.

Alcohol affects the skin. It increases blood flow, making us feel warm and look flushed. Since it also dehydrates, it increases the appearance of fine lines.

The destructive effects of alcohol on the liver are well known. Large quantities can lead to both acute and then chronic liver disease. It is in the liver that alcohol is metabolized, and as it breaks down, its by-products (including acetaldehyde) are formed. Some of these by-products are even more toxic to the body than the alcohol. Even a single episode of heavy drinking affects the delicate balance of enzymes in the liver and fat metabolism. Over time, drinking can lead to the development of fatty globules that cause the liver to swell, ultimately leading to cirrhosis.

On top of all of this…is the hangover! Its precise cause is unclear. There are many theories, including hypoglycemia, dehydration, acetaldehyde intoxication, and glutamine rebound. Some symptoms may actually be due to alcohol withdrawal. They include fatigue, headache, body aches, vomiting, diarrhea, flatulence, weakness, elevated body temperature and heart rate, hyper-salivation, difficulty concentrating, sweating, anxiety, dysphoria, irritability, sensitivity to light and noise, erratic motor function, tremors, trouble sleeping, severe hunger, halitosis, and lack of depth perception. Hangovers may include psychological symptoms including depression and anxiety. Symptoms usually begin after the intoxicating effects of alcohol wear off; typically, a hangover is experienced the morning after a night of drinking. Of course, these symptoms vary from person to person, and it’s possible that up to 30% of drinkers may actually be resistant to hangover symptoms.

With long-term heavy drinking, the picture gets pretty ugly. It leads to a drop in testosterone, impotence, testicle shrinking, infertility in both men and women, and permanent damage to the brain by damaging the connections between nerve cells. It is a depressant, and can trigger anxiety and lethargy. It leads to anemia, and is linked to an increased risk of a number of cancers. Drinkers can die from bleeding ulcers, or from swollen blood vessels in the intestine. Eventually drinking can lead to “alcohol dementia,” poor coordination, cirrhosis, and liver and kidney failure.

So as we bid farewell to 2011 and welcome in 2012, let’s remember to practice moderation and treat our body with the respect it needs and deserves. Let me also take this opportunity to remind all of you not to drink and drive.

Happy holidays to you all!

Vitamine D

Saturday, January 21st, 2012

Lately, when I perform physical exams, I’ve been including Vitamin D levels with the routine lab tests. Very frequently, these levels come back low. Is this important? What does it mean to have a low Vitamin D level, and what impact does that have on our health?

Vitamin D is actually a group of five fat-soluble vitamins known as D1, D2, D3, D4, and D5. Of these, D2 and D3 are the most important to us. Known as the sunshine vitamin, Vitamin D is synthesized in the body from sun exposure, and is also consumed in the diet from food and/or supplements. Vitamin D is well known for preventing rickets in children and osteomalacia (softening of the bones) in adults. Together with calcium, it protects adults from osteoporosis.

Some of us live in areas with very little sunshine, or restrict our sun exposure for health-related reasons. To make up for that, we can increase our intake of Vitamin D-rich foods, including some fish (salmon, mackerel, tuna, sardines), fortified milk and fortified orange juice, beef liver, and eggs. Vitamin D supplements are also readily available, and it is included in most multivitamins. Note that because Vitamin D is a fat-soluble vitamin (as are Vitamins A, E, and K) it is stored in the liver and fatty tissues, and does not need to be replaced every day. Because it is stored, however, it poses a greater risk for toxicity if too much is taken. Nevertheless, I generally recommend that adults take a Vitamin D supplement of 1,000 IU per day.

The beneficial effects of Vitamin D on health are not all clearly proven, but current studies indicate that:

•It is crucial for the absorption and metabolism of calcium and phosphorus, which have various functions, especially that of maintaining healthy bones.

•It plays an important role in immune system regulation. During months of little sunshine when our production of Vitamin D is low, there is a higher prevalence of flu and other viral infections. Many factors may be in play, and researchers are investigating further.

•Researchers have found a correlation between Vitamin D levels and memory function. It may play a role in helping us maintain our mental agility. Stay tuned!

•There may be a correlation between levels of Vitamin D and adolescent and abdominal body fat. This has opened the doors to more studies on using Vitamin D supplements to aid weight loss.

•Low levels of Vitamin D have been linked to more severe asthma attacks in children. Taking supplements has been linked to fewer and milder attacks.

•Various studies link low levels with some cancers, but supplements do not appear to help.

•Low blood levels of Vitamin D are associated with increased mortality in general. Vitamin D3 supplements appear to decrease all causes of mortality, especially in elderly women.

•Also under investigation is the theory that Vitamin D might have a protective effect against multiple sclerosis. Multiple sclerosis occurs at high rates in regions of the world with long periods of little sunlight, and thus far less Vitamin D production in the body.

However, too much of a good thing can be harmful! Vitamin D toxicity, also called hyper-vitaminosis D, is a potentially serious but treatable medical condition. Toxicity comes, not from too much sunlight, but from too many supplements. The body can generally handle up to 10,000 IU (International Units) per day, but sustaining that level of intake for several months may lead to toxic symptoms.

We are more likely to become toxic if we have certain underlying problems, such as hyperparathyroidism. Symptoms of Vitamin D toxicity include nausea, frequent urination, weight loss, poor appetite, constipation, weakness, irregular heart rhythm, kidney stones, headaches, dehydration, fatigue, irritability, and muscle weakness. Treatment includes stopping all supplements and restricting calcium intake in the diet.

I wish for all of us good health and plentiful Southern California sunshine!