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The good, the bad, and the ugly

The real deal on alcohol


By Eduardo Gonzales, MD


What is in alcoholic drinks that makes you drunk? What’s the real score on alcohol—is it good or is it bad for the health? —

The active ingredient that makes you drunk in alcoholic beverages is ethanol, a form of alcohol. It is produced when yeast ferments the sugar contained in certain foods, such as grapes or grains.

Ethanol, the most popular legal recreational “drug” in the world, has almost immediate and very powerful effects on mood and mental state. It can lessen inhibition, making it easier to socialize, but it can also impair judgment and make one do things that he/she may end up regretting.

Alcohol’s long-term effects on health

Alcohol’s long term health effects are quite complex.  They vary between individuals, and depend on the amount consumed and the type of alcoholic beverage. In general, moderate alcohol consumption is beneficial to health but heavy consumption is catastrophic. Incidentally, people in lower income communities are more susceptible to the adverse effects of alcohol than people in higher income communities. This phenomenon is called the alcohol harm paradox.

The bad and the ugly in alcohol

Alcoholism or the regular intake of substantial amount of alcohol over a period of months or years results in a host of health problems. It contributes to the development of high blood pressure and atherosclerosis, major risk factors for heart attack and stroke. It can likewise lead to fatty liver or alcoholic hepatitis, that predispose to cirrhosis, which in turn gives rise to esophageal varices (enlarged veins in the esophagus that can rupture and bleed), liver failure, and liver cancer. Aside from liver cancer, alcoholism equally increases a person’s risk for cancers of the mouth, esophagus, throat, and breast.

Drinking too much alcohol similarly makes the pancreas produce toxic substances that eventually lead to pancreatitis. It also brings about abnormalities in protein metabolism, blood coagulation, and production of some hormones. Furthermore, it weakens the immune system, making the body a much easier target for disease.

Alcoholism can also produce “chronic alcohol brain syndrome” which is characterized by erratic behavior, memory and recall problems, emotional instability, and difficulty in maintaining balance.

In pregnant women, alcohol abuse causes birth defects in the baby.

Alcoholism has economic and psychosocial complications too. Alcoholics tend to neglect their job, responsibilities, and other activities. Often, they become financially ruined and their interpersonal relationships deteriorate and they become depressed.

To predisposed individuals, alcohol is addictive, and causes alcohol dependence, a condition characterized by craving to drink; not being able to stop drinking once drinking has begun; alcohol tolerance, which refers to the need to drink greater amounts of alcohol to feel the same effect, and  alcohol withdrawal syndrome. Alcohol withdrawal syndrome usually begins six to 24 hours after the last drink. Its presentation can vary from mild symptoms such as nausea, sweating, shakiness, anxiety, and sleep disturbances to severe and life-threatening ones such as delirium, hallucinations, and autonomic instability.

The good in alcohol

The positives of alcohol are few but very significant. Moderate alcohol consumption is linked to reduced risk of cardiovascular disease. It also may decrease one’s risk for type 2 diabetes.

While chronic alcohol abuse can impair brain function permanently, moderate drinking may have benefits for brain health, especially among elderly people.

Moderate drinking and wine is likewise linked to reduced weight gain, but heavy drinking is linked to increased weight gain.

The bottom line

The health effects of alcohol range from “probably good” to “absolutely disastrous.” Moderate alcohol consumption may increase life expectancy, while heavy alcohol intake or alcohol abuse is a strong risk factor for premature death.

Moderate drinking, should at worse, only result in mild intoxication, which is characterized by loss of inhibition and a sense of warmth and euphoria. It is defined as “no more than four drinks on any single day and no more than 14 drinks per week for men, and no more than three drinks on any single day and no more than seven drinks per week for women.”  A drink consists of 12 oz. of regular beer, 5 oz. of wine or 1 ½ oz. of distilled spirit (80 proof).

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