Alcohol Associated diseases

 

Alcohol  Associated diseases

Arterial hypertension (→ hypertension )

 

There is a direct relationship between high blood pressure and increased alcohol consumption. Some studies suggest that the blood pressure increasing effect already sets in with an alcohol dose of 30 g.

 

It is difficult to guess how much alcohol consumption reduction will affect blood pressure. Even 24 hours of abstinence seem to act positively. In addition to daily consumption, consumption independent of meals is also associated with a significantly higher incidence of hypertension than weekly consumption or alcohol consumption with meals.

 

It is mostly unclear which mechanisms are responsible for the hypertensive alcohol effects. Stimulation of the sympathetic anxious system and the renin-angiotensin-aldosterone system, increased cortisol levels, inhibition of the nitric oxide effect in the blood vessels, electrolyte changes (increased potassium and magnesium excretion) as well as influences on insulin sensitivity are discussed.

 

Simultaneously, regular alcohol consumption also reduces the effectiveness of antihypertensive drugs and is one of the most significant causes of hypertension that is difficult to control. Chronic, continuous consumption changes the distribution, metabolism, and breakdown of drugs. The effect of beta-blockers, in particular, can be impaired as a result, so that a correspondingly higher dose is necessary to lower blood pressure effectively. However, this is also associated with more severe side effects, impairs patient compliance.

 

These observations lead to the recommendation to limit daily alcohol consumption to 20 g (men) or 10 g (women).

 

Diabetes mellitus (→ diabetes mellitus )

 

·        Acutely high consumption carries the risk of severe and potentially dangerous low blood sugar (hypoglycemia), leading to alcohol-associated ketoacidosis (through gluconeogenesis inhibition, resulting in reduced glycogen stores).

·        The release of sugar is disturbed from a blood alcohol level of 0.45 per mille.

·        In type 2 diabetics, oral antidiabetic drugs or insulin therapy also increase the risk.

·        Late diabetic complications occur more frequently with chronically increased consumption.

Lipid metabolism disorders (→ dyslipidemias )

 

·        If the total energy supply exceeds the energy requirement, ethanol promotes increased fat levels ( triglycerides ) in the blood.

·        If only elevated cholesterol levels are present, moderate consumption can support normalization.

·        If the triglyceride level is already high, alcoholic beverages should be consumed with caution and limited to exceptions.

·        If a liver disorder causes the increased triglyceride value, alcohol should be avoided altogether.

Fatty liver (→ fatty liver )

 

If the total energy supply exceeds the energy requirement, ethanol promotes fats (VLDL) in the liver.

With chronic over-consumption, the liver enlarges; an (alcoholic) fatty liver develops. Reversible up to a particular stage and can recede with abstinence.

Acute gastritis, enteritis

 

Ø  Acute gastritis occurs due to the direct toxic effect of large quantities, which is exacerbated by certain drugs such as anti-inflammatory drugs.

Ø  Severe changes in the gastrointestinal mucosa with the appearance of pronounced injuries to the mucous membrane and bleeding are possible.

Ø  The mucous membrane of the minor intestine is damaged, resulting in malabsorption of vitamins (especially thiamine) and amino acids, and fats.

Ø  Due to the increased permeability, toxins are absorbed via the portal vein system and supplied to the liver.

Acute and chronic hepatitis

 

·        Acute alcoholic hepatitis is life-threatening. The trigger is an excess of chronic abuse.

·        Consumption leads to an accelerated course in patients with chronic hepatitis since the virus and ethanol damage the liver via the same pathomechanisms.

·        It results in an increased incidence of liver cirrhosis and primary hepatocellular carcinoma ( HCC ).

·        If the hepatitis B infection has healed without any histological findings, there is no absolute contraindication to moderate consumption.

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Coronary heart disease

 

Ø  Amounts above the acceptable intake can damage the coronary arteries.

Ø  Excesses increase the risk of heart attack and stroke, and mortality.

Ø  Chronic abuse increases the risk of cardiac arrhythmias.

Ø  Alcoholic cardiomyopathy results from a direct toxic effect (> 1.4 g / kg body weight daily) and can be influenced by constitutional factors, accompanying substances, and viral infections.

Ø  The cardioprotective effect of small amounts (approx. 10 g / day) observed in studies is independent of the alcoholic beverage. Short-term excessive consumption is not preventive, even if intake is moderate over a long period.

Cirrhosis of the liver

 

Ø  Any consumption - whether low, moderate, or heavy - increases cancer risk.

Ø  The occurrence of malignant tumors in the oral cavity, pharynx, larynx, esophagus, liver, female breast, and intestine is causally related to the amount of alcohol.

Ø  Therefore, the International Agency for Research on Cancer classified ethanol in alcoholic beverages as a carcinogen for humans in 2007.

Ø  There is no threshold dose beyond which the toxicity or carcinogenicity increases clinically. Adding effects from certain lifestyle factors such as an unhealthy diet or smoking probably increases cancer risk.

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Osteoporosis (→ osteoporosis )

·        In large quantities, ethanol inhibits the development and maintenance of bone substance (reduced osteoblast activity, impaired vitamin D metabolism, and increased parathyroid hormone levels) and promotes the risk of osteoporosis.

·        In the presence of osteoporosis, it contributes to a worse prognosis.

Pancreatitis (→ pancreatitis )

 

Chronic pancreatitis can occur after a few years with regular high consumption.

1 to 4% of all alcoholics develop chronic pancreatitis, and 30 to 60% show organ damage.

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