Sunday, January 6, 2002		Keeping fit

ALCOHOL seems to have influenced the health and behaviour of society from time immemorial. Poets have waxed eloquent on its exhilarating qualities and its romantic associations. Alcohol is generally considered the pivot of social interaction. It also plays havoc with the health and economic well-being of all strata of society. Although alcohols are a generic group of chemicals which include a number of substances but in general the word alcohol refers to ethyl alcohol, a colourless liquid which mixes well with water. Since antiquity it has been prepared by the fermentation of sugars and starches from various sources in the presence of yeast. In fact, the word alcohol has its origin in the Arabic language and was applied to all distillates and sublimates. When taken alone or with water, it is rapidly absorbed, partially from the food pipe and stomach but mostly from the small intestine. In fact, it is absorbed better when taken along with water and carbonate. It rapidly reaches the blood and is excreted in small amounts through the breath and urine. The main organ, however, which breaks down and excretes alcohol is the liver. It uses an enzyme which breaks it at a constant rate. It follows, therefore, that if taken in an amount which is more than can be broken down by the liver at that rate, the level will build up rapidly and produce some symptoms. In general, the liver can handle up to one small drink per hour. Legally 80 mg per 100 ml of blood makes a person unfit to drive. But it is well known that even at a level of 40 mg, judgement is impaired and this can interfere with activities like driving and working on a machine.

Some people desire relief from anxiety and dissipation of tension and for this they feel some sedation would help. These effects are, however, imaginary for the most part. They are not aware at that stage about its long-term implications. Drinking alcohol is a fairly complex and, to a great extent, a learned behaviour which generally occurs in a social setting. It is also modified by a person’s early training, and psychological needs. Peer pressure at a young age and social interaction later on also plays a role.

The deleterious effects of alcohol are well-known and have been depicted in the literature, the Press, novels and movies. We will come to this later. First let me comment on relatively new knowledge about the effect of alcohol on health. I am referring to the beneficial effects of alcohol which have been noticed in the medical literature for over a decade now. This information has been brought out in the Press here and there and talked about in the social circle and parties and is also a source of many party jokes. It has been observed in many well-conducted epidemiological studies that alcohol can have beneficial effects on cardiovascular diseases like blood pressure, coronary heart disease, strokes and, in general, all cardiovascular complications. A long-term use of alcohol with a maximum of 1-2 drinks per day may decrease the risk of these complications. In a study in the USA, mortality was reduced by 30 per cent among individuals consuming this amount of alcohol as compared to non-drinkers with mortality lowest among those consuming one drink per day. This reduction of risk also applies to ischaemic brain strokes. In a recent paper in the New England Journal of Medicine risk factors for the development of diabetes mellitus among over 1 lakh nurses between the age of 30-35 years, it has been brought out that consumption of alcohol in the range of one to two drinks was indeed, associated with a lower risk of developing diabetes mellitus. Main risk factors were being overweight, lack of exercise and smoking. The explanation for the beneficial effect of small amounts of alcohol may be an increase in the high density lipoprotein cholosterol (HDL), small changes in mechanism of clotting of the blood and possibly the presence of anti-oxidants in the alcohol. The last factor was greatly played up by the producers of red wine who claimed that red wine is superior in that respect to other alcohols. But it seems that alcohol in any form has the same effect.

There is, however, a great risk in accepting this information without safeguards and education. In one of the editorials in the British Medical Journal it was commented that although this information seems to be based on scientific observations, the time still has not come for the doctors to advise their patients to take to alcohol. The paper in the New England Journal of Medicine also cautions in recommending alcohol use since more often it will lead to overuse. A large number of observations, medical and social, show that most people do not stick to that limit and therein lies the danger. A large majority in our country who visit thekas in the evening would not know or like to know anything about "two small drinks". But let me immediately add that this is also true of a vast majority of the educated lot as well. One of my patients told me that after taking two drinks he forgets counting. There are stories like "I have three doctors and each has advised me two drinks". A very intelligent tippler put it more honestly when advised two drinks:

Most of the evidence, therefore, seems to point towards advising the population, particularly young formative minds, to abstain from alcohol. We do, however, realise that alcohol consumption is here to stay. Therefore, it is a must to educate the public at all levels to drink in moderation and keep it down to two small drinks which is basically equivalent to 2 oz. of hard liquor, one glass of beer or 4 oz of wine.