Bad spirits

CHENNAI: While regular drinking is considered a vice, and every religion does make alcohol consumption a cardinal sin, lifestyle changes have made social drinking the norm.

As in, a peg here or a cocktail there, and even an occasional glass of wine a few times a month is encouraged.

And those who indulged in the so-called acceptable standard of drinking are known for quoting ‘studies’ and ‘culture’ where a glass of alcoholic beverage is healthy.

Not anymore, says a recent Lancet study, which revealed that there was no safe level of alcohol consumption.

Plus, it did not find any clear data about the benefits of a certain quantity of alcohol. The study says that alcohol is harmful irrespective of factors like the quality, pricing or the number of drinks consumed, as it’s a Group 1 carcinogen regarded by the International Agency for Research on Cancer decades ago.

Additionally, the World Health Organization (WHO) stated that alcohol, in no amount, has any benefits and every drop of it, in the form of any beverage, is harmful.

No safe level

WHO stated that alcohol causes at least 7 types of cancer, including bowel cancer (most common) and female breast cancer because of the ethanol content.

The biological mechanism of ethanol increases the risk of cancer, as the compound breaks down in the body, and makes it unsafe or unhealthy for consumption in any quantity, claim doctors. The risk of health complications is higher for people with comorbid conditions.

“The so-called ‘healthy’ alcohol consumption is defined as one drink (or 14 g alcohol) per day for women and two drinks (or 28 g alcohol) per day for men. But this cannot be a presumed benchmark for safe drinking,” Dr Cyriac Abby Phillips, The Liver Institute, Centre of Excellence in Gastrointestinal Sciences at Rajagiri Hospital. “These numbers are helpful to distinguish between Alcohol Use Disorder (AUD) and acceptable use. Factors like diabetes, obesity and certain genetic mutations put people at higher risk of developing alcohol-related liver damage and cirrhosis even with mild to moderate drinking. There is no safe level that’s beneficial in humans.”

A 2018 study published in The Lancet revealed that the level of alcohol consumption that minimised harm across health outcomes was zero standard drinks per week.

Dr Phillips added, “High quality studies have shown that very little alcohol use, such as one or two units daily, was associated with reduced brain volume in humans and other types of cancers affecting stomach, food-pipe and breast in women. For every 10 grams of alcohol consumed daily after a cancer diagnosis and treatment, the risk of developing a second cancer is 1.09-fold higher. These points should be enough to realise that there is no safe level of alcohol consumption.”

Dr Carina Ferreira-Borges, Acting Unit for Non-communicable Disease Management and Regional Advisor for Alcohol and Illicit Drugs, WHO regional office for Europe, in her statement said, “We cannot talk about a so-called safe level of alcohol use. The risk to a drinker’s health starts from the first drop of any alcoholic beverage. The more you drink, the more harmful it is.”

No health benefits

The WHO statement on the study quotes Dr Jurgen Rehm, Regional Director for Europe’s Advisory Council for Non-communicable Diseases, saying, “Potential protective effects of alcohol consumption suggested by some studies are tightly connected with the comparison groups chosen and the statistical methods used, and may not consider other relevant factors.”

The biggest myth is that a mild to moderate level of alcohol use is healthy. Alcohol is a known poison and a Group 1 carcinogen.

“Another myth is regarding the type of alcohol. People who tend to drink heavily and are sobering, inaccurately feel that wine or beer are safer variants while moving away from hard liquor. They do not understand that beer and wine too are the same alcohol, differing only in content. Any daily drinker who consumes very little alcohol presumes that they’re enjoying certain health benefits – when in fact, such benefits have never been conclusively described,” added Dr Phillips.

Liver cirrhosis

Alcohol-related liver injury and chronic liver disease can present at any age. The age at presentation largely depends on the amount, duration and additional risk factors for cirrhosis, opined the doctor.

Regular consumption of alcohol in extreme levels can lead to liver cirrhosis in around 16-20% of individuals. Even with mild consumption, the proper metabolism of alcohol will stay in the liver. In the early stage, they may seem active but they’re more prone to fibrosis and cirrhosis.

According to medical science, the safest level of alcohol intake is 30 ml, 3 days a week but most people are dismissive of this, said Dr M Malaiappan, director, Institute of Mental Health. “They gradually increase the quantity and enable the body to get accustomed to it. This is increasing among youngsters,” he added.

Perhaps one of the reasons why doctors have been getting patients under 30 years with the end stage of liver deterioration. “Everyone has a different metabolism genetically; so, no level of alcohol can be considered as ‘safest level’,” stated Dr Joy Varghese, director - hepatology & transplant hepatology, Gleneagles Global Health City.

“First, they get fatty liver, next fibrosis, and then cirrhosis and finally liver cancer. Studies have proven that there’s no accurate level of alcohol that wouldn’t deteriorate the liver. So, it’s better to stay away from it,” added Dr Joy. “Women are at higher risk of contracting liver disease. Even 10 grams of alcohol is not good for women.” Young obese men or women with diabetes are at higher risk of developing alcohol-liver disease. Binge drinkers can contract alcohol-associated hepatitis.

Behavioural changes

The consumption of alcohol also impacts mental health, and it can quickly lead to addiction if regular consumption is not controlled.

Experts say that consuming alcohol enhances the release of dopamine. So, alcohol or any substance that releases enormous amounts of chemicals in the brain, is detrimental to holistic health. It can also lead to addiction and adversely impacts behaviour. “Alcohol primarily affects sleep cycle and appetite. It can lead to mood disorders and anxiety attacks. Since there’s no proven prescribed level, it varies with every individual,” Dr Vasanth, consultant psychiatrist at Fortis Malar.

Alcohol dependence can affect brain function and leads to tremors, precipitate seizures, and epilepsy. Also, expect substance-induced psychotic patterns in their behaviour as well.

“With regular consumption of alcohol, they’ll begin hallucinating, hear voices, become suspicious of everyone and also suffer delusional episodes. They’re quick to anger, irritable all the time and intolerant to even the mildest form of stress,” he added.

IN A NUTSHELL

• No safe level of alcohol consumption - Lancet study.

• Harmful irrespective of pricing, quality of the drink and quantity consumed.

• Causes at least 7 types of Cancer, including bowel cancer (most common) and female breast cancer due to ethanol content – WHO.

• Alcohol dependence can affect brain function and leads to tremors, precipitate seizures, and epilepsy.

• Presumed benchmark of safe drinking a myth.

• Wine and beer not safer variants than hard liquor.

• Regular consumption in high levels leads to liver cirrhosis in around 16-20% of drinkers.

• Those with co-morbidities at higher risk of developing liver damage and cirrhosis even with mild to moderate drinking.

• Women are at higher risk of contracting liver disease.

(With inputs from Lakshmi Priya)