I would like to advise as well as warn those people who like to consume alcohol. No doubt, alcohol can give a momentary pleasure but at the same time it gives you a punishment for life. Today we are here to explore, how alcohol consumption can become a hazard. For this, today we have our Ayurvedic expert, Dr. Parmeshwar Arora in our studio.
Q. We are here to discuss alcoholic liver diseases. Please tell us about what exactly, it is?
As the name itself suggests, alcoholic liver disease refers to disorder or disease of liver, caused by alcohol consumption. When somebody consumes alcohol regularly, then we determine a particular amount. We believe that about 80 grams of ethanol consumed per day, will cause cirrhosis of liver in 20 years. We observe this in a very good percentage of people who consume alcohol i.e. 60-80% of such people develop cirrhosis of liver if they consume 80 grams of ethanol per day for 20 years. And let me tell you, this figure is actually for European countries. It is worse in Indian aspect. In India, as we believe, the quality of alcohol is relatively inferior, the body frame is relatively weaker, the nutritional value is also relatively lower, and immunity too, is comparatively weaker. Thus this period of 20 years actually becomes much less if we consider Indian population. They have a weak body frame and to make it worse, they still consume alcohol.
Q. But what they believe is, they become stronger by consuming alcohol.
Here I would repeat your words……it’s a momentary pleasure but a punishment for life. This is a truth….it’s just a pleasure of a moment or two. See, alcohol when consumed in small amount does stimulation and you forget your fatigue or tiredness but in the long run it ultimately damages your body internally. I would like to mention one more thing here. The amount of alcohol which we’ve fixed is not always consistent. There are many cases where a person has no tolerance and he consumes just 20 grams ethanol per day and he develops cirrhosis of liver in only 10 years time(forget 20 years).
Q. Does it depend upon the immunity?
Absolutely. One more fact is, in case of women, this quantity and period is much less. In India, we observe the culture where a woman is made to stay away from alcohol consumption. This practice is because of the above mentioned fact. We generally observe that if a woman (whether European or Indian) consumes alcohol even in lesser amount and for less duration of time, she is much more affected as compared to men.
Q. Some men, though they consume alcohol once a week but the amount that they consume is quite large. It is observed that such men develop liver problem earlier than those who consume alcohol daily (or regularly) but in controlled amount. Why is it so?
In people, who consume large amount of alcohol occasionally, we observe that they have chances of acute alcoholic intoxification. Sometimes, even severe hepatic failure is seen in such patients. In general, alcohol increases oxygen consumption in the body. Whenever the consumption of alcohol increases, a hypoxic condition is created for hepatocytes. In other words, the liver cells do not get enough oxygen. So there are chances of hypoxic injuries to liver. Apart from this, as you would have seen that when somebody consumes alcohol in excess, he is not able to digest or metabolize it properly. As a result, such patients have gastric irritation, vomits and sometimes they develop ulcers also. So, such symptoms of acute intoxification can be seen in people who consume large quantities of alcohol. But in case of people who consume alcohol routinely, the symptoms could be in milder form but then they would be persistent. When someone consumes alcohol routinely, the alcohol creates some chemical changes in his liver. For example, it slows down the oxidation process of fatty acids thus increasing the uptake of fatty acids. This process progressively converts liver into fatty liver.
Secondly, such cells try to absorb too much of triglycerides (which are moving around in our blood). This results in formation of 3-4 times bigger hepatocytes. Such cells get converted into fatty cells. At the same time, it causes an increase in release of an enzyme called xanthine oxidase which generally helps in free radical production. It results in formation of free radicals in liver which damages liver by causing injuries to it. Similarly, there is one more enzyme called glutathione. The secretion of glutathione gradually decreases as an impact of alcohol consumption. This enzyme is responsible for removal of toxins (i.e. it acts as scavengers). So, as an impact of alcohol, while the formation of free radicals has increased, there is being no removal of toxins. Also, alcohol when metabolized, gives rise to acetaldehyde. Acetaldehyde stimulates lipocytes which store fats and are directly responsible for formation of fibrous tissue. Thus the process of fibrosis gets enhanced in our body, especially in liver. At the same time, there is an enzyme called collagenase which is responsible for breakdown of fibrous tissues or collagen fibres. As an impact of alcohol consumption, the activity of collagenase gets reduced.
Thus, in a way, alcohol is reversing all the good processes. On one hand, it induces the process of fibrosis and on the other hand it reduces the activity of collagenase thus reducing degradation of collagens. So the liver progressively becomes fibrous which results into cirrhosis of liver. So these kinds of injuries are occurring consistently. Sometimes patients enter into a situation of hyperglycemia and sometimes they enter into situation of hypoglycemia. You would see that, often uric acid increases rapidly in the people who consume alcohol. This is because xanthin oxidase increases production of uric acid. Since the xanthin oxidase increases because of regular consumption of alcohol, so there is resultant increase in uric acid. ATP breakdown increases secretion of purine and this also increases uric acid. Alcohol consumption will cause metabolic acedosis and as an impact, the excretion of uric acid through kidneys would stop. So, under the impact of alcohol, the production of uric acid increases while its excretion decreases. This makes you a patient of gout.
What I intend to say here is, alcohol can disturb the entire metabolism. It can increase your sugar as well as it can decrease it too. It can increase uric acid. It can convert your liver into fatty liver first and then bring a condition of hepatitis wherein the liver cells start breaking (we call this process as necrosis). So, it induces necrosis in liver. And lastly, by initiating the process of fibrosis, it can make you a patient of cirrhosis of liver. As you know cirrhosis of liver is an irreversible process and it becomes very difficult to treat a patient of cirrhosis of liver.
Q. I understand and I am sure that now all our viewers understand it too. As you said, consumption of alcohol can be fatal, can affect our liver badly and can make us a patient of other diseases. But those who love to drink alcohol in the form of whiskey, wine or bear, I am sure they wouldn’t be liking our show at all. But I would say that somehow, I want them to see our program and know that though alcohol affects gradually but ultimately it acts as a slow poison for our body. What kind of symptoms do we see in those who consume alcohol, which indicates that their liver is being affected?
If we talk about symptoms then as initial symptoms, there is loss of apetite, weakness in body and digestion related problems also start. Sometimes there can be jaundice. See, the educated people who consume alcohol, regularly get their liver markers checked and regularly get an ultrasound done for their liver. Even they simultaneously consume tablets for strengthening liver. I would like to tell such people and I generally say this to my patients too, please understand that it’s a concept like boiling of milk. Possibly your current test reports suggest that everything is normal but who would give you a guarantee that your next report is going to be normal too. Your next ultrasound may report an initiation of cirrhotic disease in your liver. I would repeat myself here, it is like boiling of milk. At one point you notice that it has not yet boiled but the next moment, as your attention gets diverted it boils over. Similarly, although you get an yearly ultrasound done and even the reports are coming out to be normal, year after year. But if you continue to consume alcohol regularly, suddenly one of your reports may suggest early cirrhotic changes. That’s where your life turns upside down. The life becomes quite painful as the patient begins to have ascites, accumulation of water in stomach, portal hypertension, bleeding through mouth etc.. Thus, I would say that alcohol is not a good thing and would advise everyone to stay away from it.