Alcohol’s Effects on The Body

April is Alcohol Awareness Month sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The organization recently published an article on common alcohol-related issues that will be summarized in this blog.

Key Takeaways¹

1. Alcohol is a leading cause of morbidity and mortality.
2. There is no perfectly safe level of alcohol consumption.
3. Alcohol is a carcinogen.
4. Many organs and body symptoms are impacted by alcohol use.
5. Patients may be unaware that their alcohol use could be contributing to their medical problems and risks.

Alcohol’s harmful effects on multiple organs contribute to more than 200 health conditions and more than 178,000 deaths in the United States annually.

Medical Complications by Body System¹

Liver Disease

90% of absorbed alcohol is metabolized in the liver. The liver is exposed to the alcohol but also to the alcohol metabolites that can cause acute and chronic injury. Alcohol-associated liver disease (ALD) is a major and growing group of diseases in the U.S. with increasing rates of mortality. ALD covers a broad spectrum of liver diseases as described:

• Steatosis, or fatty liver, is the earliest sign of liver injury and is present in 95-100% of people who drink heavily.
• Steatohepatitis occurs when fatty liver, lobular inflammation, and hepatocellular damage are present.
• Fibrosis and Cirrhosis involved collagen deposits that form a “chicken-wire” pattern typically seen around the terminal hepatis vein and along the sinusoids. Advanced fibrosis impairs liver architecture and blood flow leading to liver cirrhosis.
• Alcohol-Associated Hepatitis is a clinical syndrome that develops suddenly and is characterized by a rapid onset of jaundice, liver dysfunction, and liver decompensation.

Pancreatitis

Alcohol is the leading cause of chronic pancreatitis and the second leading cause of acute pancreatitis. Acute pancreatitis causes about 291,000 hospital admissions annually.

Gastrointestinal Tract

Alcohol can damage the epithelial lining of the GI tract promoting inflammation and bleeding.

Gastroesophageal Reflux Disease (GERD)

Alcohol use is associated with an increased risk of GERD with risk increasing as alcohol volume and frequency increases.

Immune System

Alcohol use alters the cytokine signaling system of immune cells that provide a response to injury or infection thus weakening the body’s immune response.

Endocrine System

Heavy alcohol use can cause disturbances across all components of the endocrine system, including, for example, peripheral endocrine glands controlled by the hypothalamic-pituitary axis (such as the thyroid, adrenal glands, and gonads) as well as the endocrine components of organs such as the pancreas and adipose tissue. Because these disturbances permeate every organ and tissue in the body, they can contribute to endocrine-related health conditions including diabetes, thyroid diseases, dyslipidemia, and reproductive dysfunction.

Pulmonary System

Alcohol impairs ciliary function in the upper airways, disrupts the function of immune cells (i.e., alveolar macrophages and neutrophils), and weakens the barrier function of the epithelia in the lower airways. Often, alcohol-provoked lung damage goes undetected until a second insult, such as a respiratory infection, leads to more severe lung diseases than those seen in nondrinkers.

Cardiovascular System

Alcohol consumption can negatively impact the cardiovascular system in a variety of ways causing high blood pressure, cardiac arrythmia, cardiomyopathy, myocardial infarction, and stroke.

Hematological System

Heavy alcohol use can cause anemia, leukopenia, and thrombocytopenia as well as macrocytosis.

Musculoskeletal System

Alcohol abuse raises the risk of skeletal muscle myopathy, bone fractures, and gout.

Neurological System

• Central Nervous System damage to the white and gray matter in the brain can occur causing decline in cognitive functions.
• Peripheral Nervous System damage includes neuropathy, a sensory loss in the extremities along with painful burning in the feet.
• Wernicke’s Encephalopathy develops from a reduced food intake and malabsorption of thiamine causing mental confusion, vision problems, gait coordination problems, low blood pressure, lethargy, and coma.
• Korsakoff Syndrome occurs when Wernicke’s Encephalopathy goes untreated and is characterized by amnesia, worsening gait coordination, and false memories.

Fetal Alcohol Spectrum Disorders

Prenatal alcohol exposure can cause lifelong physical, behavioral, and cognitive impairments.

Cancer

Alcohol and its metabolite, acetaldehyde, are carcinogens linked to increased risk of cancer of the oral cavity, pharynx, larynx, esophagus, colon, rectum, liver, and breast.

Discussion

Given that alcohol contributes to over 200 diseases and conditions, it is important for physicians and patients to be aware that developing or worsening medical conditions may reflect an unrecognized alcohol problem. Current research indicates there is no safe drinking level, underscoring the message to patients that “the less, the better” when it comes to alcohol. The health risks associated with alcohol reinforce the need for regular alcohol screening for all patients. When warranted, as part of a brief intervention, physicians can raise their patients’ awareness about their specific alcohol-related health consequences, which may help motivate them to cut back or quit as needed.

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