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- THIS ISSUE OF THE WAY UP NEWSLETTER ADDRESSES THE TOPIC OF ALCOHOL
- Since this topic could take books to cover, will address what I consider to be some of
the more salient aspects. I apologize for the length, just skip to the areas of your
interest.
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Will go out on a limb by assuming most people interested in reading an Alternative
Medicine Newsletter do not drink a substantial amount of alcohol, though you may
enjoy it at times, since 75% of our nation does. Ill also bet most of you know
someone who drinks more than you would like to see, & have at some time been
affected by witnessing the ravages of alcohol upon the human body, soul, & psyche.
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Our society tolerates & condones overdrinking. Though we spend a great deal of
time & money in the war against drugs, alcohol is the most common & dangerous of
the addicting drugs. It is the drug most widely used by vulnerable 12-17 year olds.
In fact many young people drink for the sole purpose of getting drunk. There is a
hidden epidemic of alcoholism in the elderly as well, so all ages are at risk.
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The fear & unrest stirred up by the recent attacks upon our nation may have stimulated some to engage in more escapist behavior, attempting to avoid or to squelch anxiety & emotional pain. This is understandable, but in the long run can cause more anxiety as well as other emotional symptoms, since excessive indulgences can create imbalances in the brain. There is also the risk of other
unwanted health responses.
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- HOW MUCH ALCOHOL IS TOO MUCH?
- Moderate drinking is defined as 1 drink daily for women, & 2 drinks daily for men.
This is not sexism.
Women have lower amounts of the enzymes which metabolize
alcohol.
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One drink is 12 oz of beer, 4 oz of wine, or 1.5 oz of 80 proof liquor. Binge drinking is very dangerous & if the individual has all 7, or 14 drinks one day a week, this has different implications than 1-2 drinks daily.
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Alcohol & its breakdown products, acetaldehyde, acetate, & malondialdehyde are
poisons. So we are really asking, how much poison is too much? This obviously
varies depending upon the basic general health of the individual & how quickly one
drinks their poison. The healthy liver can process or detoxify alcohol at the rate of
1/4-1/2 oz per hour of the 80 proof, 2-4 oz of beer, & 2/3-1 1/3 oz of wine per hour.
Do you know anyone who drinks that slowly? It is drinking faster than the metabolic
clearance rate which causes intoxication, & hangovers.
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As with much in life, moderation & knowing how to protect from damage is the best
approach. We will get to this later. Though moderation works for some, others are
completely physiologically intolerant of any alcohol.
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Others are dangerously & easily addicted, & may have significant genetic
predisposition to alcoholism because of inborn metabolic errors. For those with
high genetic risk, any alcohol can end up being too much. Alcoholism can actually
be bred into strains of animals. Children of alcoholics are 4 times more likely to
develop alcoholism. There is a 25-50% lifetime risk for sons or brothers of severe
alcoholic males. If one identical twin is alcoholic, there is a 55% chance the other will
be, whereas if one same sexed fraternal twin is alcoholic, there is a 28% chance the
other will be. Males have a 4 times greater risk, than females, though the rate is
increasing in women.
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The elderly are at increased risk with: loss of a spouse or significant other, new
onset or worsening of medical illness, loss of social support or retirement, a family
history of alcoholism, & previous alcohol use or abuse. For these people, any
alcohol may be too much.
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Any alcohol is too much for those with serious medical conditions, those with
allergies to the ingredients of alcohol drinks, such as grains, yeast, potatoes, grapes,
juniper berries, etc., & those with candida-related syndromes.
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- Any alcohol is too much for those taking medications contra-indicating simultaneous
use of alcohol. (one should always read the package insert of meds for such
instructions). Those combining alcohol with antidepressants, tranquilizers, or pain
medications need to be particularly careful about additive, disinhibiting, sedative or
behavior changing effects. Interpersonal loss & negative reactions to stress may
trigger drinking with subsequent impulsive destructive behavior toward self &/or
others. Alcohol or drug abuse is associated with more than half the reported
suicides in the world. Five -ten times more alcohol abusers attempt suicides as
compared to non abusers.
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- Any alcohol is too much for those with pre-existing psychiatric disorders. Yet
alcohol abuse is highly prevalent in those with mood disorders, with bipolar patients
having particularly high rates. Substance abuse is in 20% of schizophrenics.
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- WHAT DAMAGE CAN BE DONE BY ALCOHOL?
- The annual cost of alcohol related damage is estimated to be between 90-100
billion., but I dont know how this is calculated since much of alcoholism goes
unrecognized.
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The role of alcoholism in death is certainly under estimated. Dr Janice Phelps
correctly said, Perhaps the saddest thing that can be said of this disease is that
most alcoholics die of alcoholism without ever knowing they have a disease, without
ever knowing that they are alcoholics. Nor does the medical profession know. In a
long term study of 10,000 men, with 199 deaths, Drs said 5% of the deaths were
alcohol related, while the autopsies showed that 31% were alcohol related.
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Chronic alcohol use can damage any organ systems. Besides the well known liver
complications, there can be enlargement of the heart with weakening of the heart
muscle called cardiomyopathy & subsequent heart failure. There is a increased risk
of mouth, throat, stomach, colon, liver, breast & other estrogen related cancers.
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Chronic intake is associated with brain shrinkage, cognitive defects & declines
measured by neuropsychological testing. Even occasional drinking will produce
declines in these tests when tested within a few days of the drinking verses tests
when no drinking. Along with the brain atrophy can go damage to the nerves, with
loss of sensation in the hands & feet, & difficulty walking.
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There can be depressed sexual response, disordered sugar metabolism, &
premature aging.
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Mothers who drink even moderate amounts have a higher risk of producing a child
with the congenital defects called the Fetal Alcohol Syndrome.
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While it is hard to measure all these effects, it is also hard to measure the
involvement in crime, accidents, poor job performance, relationship problems,
broken hearts & broken families.
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Obviously , lasting damage relates to the frequency, amount, & speed of drinking .
Damage is mediated by the presence of adequate nutrients to detoxify the alcohol &
protect the organs from the massive free radical onslaught initiated by alcohol. The
inflammatory reactions initiated by free radical production are involved in much of
the physical damage done by alcohol. For more on this, see the newsletter on free
radicals. Regular alcohol
intake also directly induces many nutrient deficiencies which contribute to chronic &
life threatening illnesses. Damage is mediated by insuring adequate amounts of
these nutrients.
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- WHAT NUTRIENTS ARE DEPLETED BY ALCOHOL?
- An excellent diet can offset some of the problems of alcohol, but those who drink
more usually do not eat perfectly. Do you know anyone who does?
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- Alcohol related deficiencies are caused: by the direct depleting actions of alcohol
detoxification, by decreased digestion & absorption secondary to alcohol induced
changes in the lining of the gastro intestinal tract, changes in the liver, digestive
enzymes & pancreas functions, & by changes in the diet & nutritional intake when
the alcohol replaces other intakes.
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There is decreased absorption of: Vitamin B1, Vitamin B2, Vitamin B12, folic acid,
& amino acids. Alcohol is one of the most common causes of folic acid deficiency in
the U.S.
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Alcohol induces increased urinary loss of Zinc, Magnesium, Calcium, & Vitamin B12.
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The acetaldehyde produced by the breakdown of alcohol destroys Vitamin C,
Vitamin B6 & the amino acids L- Cysteine, & glutathione, which are all used to
counteract the acetaldehyde. It uses up Vitamin B1, & Vitamin B5. The
inflammatory response mobilizes an enzyme ( indoleamine dioxygenase) which
breaks down tryptophan, contributing to a serotonin deficiency. Further, it binds with
the very important brain chemicals, dopamine, serotonin, enkephalins, & endorphins.
These chemicals, called neurotransmitters are critical for maintaining a balanced
good mood. Decreased serotonin can lead to depression, irritability, emotional
volatility, & a sense of dissatisfaction.
Decreased dopamine, norepinephrine,
enkephalins , & endorphins can lead to an inability to feel pleasure, motivation &
drive.
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This is already too long to go into how alcohol can be addictive except a brief
summary. Certain byproducts of alcohol can bind to some of the same receptor
sites in the brain as do the feel good neurotransmitters listed at the end of the above
paragraph. Thus alcohol can produce a similar sense of well being. But that feeling
wears off quickly & have to drink more to keep it going. Repeated false activation of
these receptor sites sends the brain the signal to make less of these essential
neurotransmitters, natural production slows, & an addiction process begins. Also
alcohol depletes the nutrients which make these brain chemicals which further
contributes to the change in neurotransmitters related to the addiction process.
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Those with a genetic predisposition to alcoholism, even if not alcoholic, make twice
as much acetaldehyde. This means they metabolize alcohol faster & thus may drink
more & faster to feel it. It also means they are using up the above nutrients more
quickly.
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Alcohol interferes with Essential Fatty Acid metabolism, causing a depletion of
gamma linoleic acid, commonly know as GLA ( an omega 6 fatty acid) This is found
in Evening Primrose Oil or Borage Oil. Pre treatment with Evening Primrose oil in
pregnant rats given high amounts of alcohol prevented the fetal alcohol syndrome.
GLA is a key component of the human brain. We need more research in humans,
but how do you deliberately have pregnant women drink excessively to see if this
then prevents problems?
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Alcohol depresses the enzyme which converts the amino acid, methionine, to SAMe
(S-Adenosylmethionine) which is important as a liver protector, mood elevator, & in
helping with the pain of inflammation. The deficiency of SAMe can predispose to
cirrhosis.
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Alcohol inhibits melatonin production. It usually induces sleep for the first few hours,
after which the sleep cycle is interrupted & shallow with suppressed dream ( REM)
sleep, & suppressed deep ( delta) sleep.
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- HOW DO YOU PROTECT AGAINST THE DAMAGING EFFECTS OF ALCOHOL?
- When you drink, besides drinking sporadically & slowly, be sure to eat a healthy diet
& supplement the nutrients used up by alcohol. A minimum regular supplement
program would be a good Multivitamin mineral, a Coenzyme B complex, Sublingual
B12/folic acid, & Vitamin C.
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mood
problems etc..
- When there is more than what I have listed as moderate drinking, or when mood
problems exist, you would add 5HTP, L-tyrosine, SAMe, & pyridoxal-5-phosphate
to the basic program.
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anxiety or insomnia..
- When there is anxiety or insomnia, you would add Calcium/magnesium,
Taurine, 5HTP, homeopathic doses of lithium, Inositol, & GABA, to the basic program.
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- HOW CAN YOU MEASURE WHEN ALCOHOL HAS BECOME A PROBLEM?
- Alcoholic patterns of drinking are progressive & do not depend upon the amount of
alcohol imbibed, but upon the way one drinks it & the effect the alcohol has on the
individual.
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Because alcohol is generally so socially acceptable, & because family, friends, &
DRs may collude in the denial which is integral to the issue of alcohol, we need
some objective ways to measure when it becomes a problem.
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Numerous scales, tests, & diagnostic criteria have been used toward this effort of
clarification. No one questionnaire is perfect & all have their false positives & false
negatives. For this reason I am including 3 commonly used & relatively reliable
scales. If one uses them all, the accuracy should be close to 90-100%--if answered
honestly-which is a problem with questionnaires.
CAGE QUESTIONNAIRE
This is simple, quite accurate & can be given to young teenagers as well.
It consists
of four questions. |
1. |
Have you ever felt you ought to Cut down on your drinking? |
2. |
Have people Annoyed you by criticizing your drinking? |
3. |
Have you ever felt bad or Guilty about your drinking? |
4. |
Have you ever had a drink first thing in the morning to get rid of a hangover-an Eye opener? |
One yes means 80% risk, 2 means 90% risk, 3 means 99% risk & 4 means 100% risk for alcoholism |
ALCOHOL USE DISORDERS IDENTIFICATION TEST (AUDIT)
Circle the number that comes closest to the correct answer. |
1. |
How often do you have a drink containing alcohol? |
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0. Never
1. Monthly or less
2. Two to four times a month
3. Two to three times a week
4. Four or more times a week |
2. |
How many drinks containing alcohol do you have on a typical day when you are drinking? |
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0. 1 or 2
1. 3 or 4
2. 5 or 6
3. 7-9
4. 10 or more |
3. |
How often do you have six or more drinks on one occasion? |
|
0. Never
1. Less than monthly
2. Monthly
3. Weekly
4. Daily or almost daily |
4. |
How often during the last year have you found that you were not able to stop drinking once you had started? |
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0. Never
1. Less than monthly
2. Monthly
3. Weekly
4. Daily or almost daily |
5. |
How often during the past year have you failed to do what was normally expected from you because of drinking? |
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0. Never
1. Less than monthly
2. Monthly
3. Weekly
4. Daily or almost daily |
6. |
How often during the last year have you needed a first drink in the morning to get yourself going
after a heavy drinking session? |
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0. Never
1. Less than monthly
2. Monthly
3. Weekly
4. Daily or almost daily |
7. |
How often during the last year have you had a feeling of guilt or remorse after drinking? |
|
0. Never
1. Less than monthly
2. Monthly
3. Weekly
4. Daily or almost daily |
8. |
How often during the last year have you been unable to remember what happened the night before because you had been drinking? |
|
0. Never
1. Less than monthly
2. Monthly
3. Weekly
4. Daily or almost daily |
9. |
Have you or someone else been injured as a result of your drinking? |
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0. No
2. Yes, but not in the last year
4. Yes, during the last year |
10. |
How often has a friend, relative, doctor, or other health worker been concerned about your drinking or suggested you cut down? |
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0. Never
1. Less than monthly
2. About once a month
3. About once a week
4. Several times a week |
A score of 8 or above is considered indicative of a clinical alcohol disorder, and
further evaluation should be performed. In research, the alcohol use disorders
identification test performs well in detecting subjects with formal alcohol disorders
and those with hazardous alcohol intake. |
SHORTENED MICHIGAN ALCOHOLISM SCREENING TEST (SMAST)
Give 1 point for each no answer for the first three questions & 1 point for each yes
answer to the last ten questions.
|
1. |
Do you feel you are a normal drinker? |
2. |
Do friends & relatives think you are a normal drinker? |
3. |
Are you always able to stop drinking when you want to? |
4. |
Does your family ever worry or complain about your drinking? |
5. |
Have you ever attended an AA meeting? |
6. |
Has drinking ever created problems between you & family members? |
7. |
Have you ever gotten into trouble at work because of drinking? |
8. |
Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking? |
9. |
Have you ever gone to anyone for help about your drinking? |
10. |
Have you ever been in a hospital because of drinking? |
11. |
Have you ever been arrested, even a few hours, because of drunk behavior? |
12. |
have you ever been arrested for drunk driving? |
A score of 2 or more highly suggest problems with alcohol abuse. |
HOW DO YOU ACTUALLY DIAGNOSE ALCOHOLISM?
The International Classification of Disorders (ICD-10) uses the following criteria:
HAZARDOUS ALCOHOL INTAKE.
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Men: |
Three to seven drinks almost every day or seven or more drinks at least three times a week |
Women: |
Two to five drinks almost every day or five or more drinks at least three times a week |
HARMFUL ALCOHOL USE |
(a) |
Clear evidence that the substance use is responsible for (or is substantially contributing to) physical or psychological harm |
(b) |
The nature of the harm is clearly identifiable and specified |
(c) |
The pattern of use has persisted for at least one month or has occurred repeatedly within the 12 month period |
(d) |
The subject does not fulfill criteria for alcohol dependence |
ALCOHOL DEPENDENCE (ADDICTION) - at least three items required |
1. |
Strong desire or sense of compulsion to take the substance |
2. |
Impaired capacity to control substance taking behavior in terms of onset, termination, or levels of use |
3. |
Physiological withdrawal state when substance use is reduced or
stopped or use of the substance to relieve or avoid withdrawal
symptoms |
4. |
Evidence of tolerance to the effects of the substance |
5. |
Other pleasures or interests being given up or reduced because of the substance use |
6. |
Persistent substance use despite clear evidence of harmful consequences |
You can see that actual diagnosis of alcoholism is quite lenient, again demonstrating the over tolerance of our society & unwillingness to seriously evaluate the true health costs of excessive alcohol. |
OTHER RESOURCES
For further help for those who want or need to stop drinking, read the book , Seven Weeks to Sobriety, By Dr. Joan Matthew Larson, or see this Web Site - http://alcoholism.about.com/od/about/.
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