Chapter 9-How Does Alcohol Affect Your Health?

What about Alcohol? How Does It Affect Your Health? | The “Good” Effects of Alcohol | The Influence of Alcohol on the Mind | Alcohol Not a Stimulant But a Depressant | It Can Be Useful as a “Tonic” | Alcohol as a Food | The Effect of Alcohol on the Circulation | Alcohol Can Be Used to Improve Circulation | Moderation Is the Key | Does Alcohol in Any Way Benefit the Coronary Arteries? | Alcohol Can Relax Tension in Heart Cases | The Injurious Effects of Alcohol | Alcohol Can Be Harmful to the Emotions and the Mind | The Effects of Alcoholic Excess | Chronic Alcoholism | The Brain | Wernicke’s Disease | Marchiafava- Bignanis Disease | Delerium Tremens | Polyneuritis | Korsakoffs Psychosis | What Does Alcohol Do to the Liver? | What Are the Conclusions for You?

WHAT ABOUT ALCOHOL? HOW DOES IT AFFECT YOUR HEALTH?

Alcohol is both a blessing and a curse, a poison and a food, a 'pick-me-up' and a 'lay-me-down', both an appetite stimulator and a destroyer; it is truly a mass of contradictions.

The very name whiskey originates from the ancient Gaelic word "usquebrugh"—water of life! Over 65 per cent of the United States population (more than 100 million Americans) drink alcoholic beverages. Of these, 76 per cent are men and 24 per cent are women. The occasional drinkers total 48 per cent; 27 per cent of men and 8 per cent of women are regular drinkers—that is, people who drink moderately or heavily at least three times a week. There are over 3 million heavy, constant drinkers, and over 750,000 alcoholics or addicts of "hard liquor".

Billions of dollars are spent each year on alcohol in the U.S.A. alone, more than is spent by Americans for their own health and medical care. All figures show the growing increase in the drink­ing habit as part of life and social custom in our country. Let us then take a scientific look at the 'uses and abuses' of alcohol, particularly where our health is concerned.

THE "GOOD" EFFECTS OF ALCOHOL
The Influence of Alcohol on the Mind

The poet says, "What wonders does not wine! It discloses secrets, ratifies and confirms our hopes, thrusts the coward forth to battle, eases the anxious mind of its burden, instructs in arts. Whom has not a cheerful glass made eloquent. Whom not quite free and easy from pinching poverty."

Alcohol Not a Stimulant but a Depressant

The most im­portant chemical effect of alcohol is on the brain and the nervous system. Although it is called by the public a "stimulant," it is actually a depressant that tends to lower inhibitions and results in impulsive behavior.

Alcoholic beverages have been advised in moderate amounts for many years by physicians to relax nervous or high-strung patients, to calm their anxieties, and generally to sedate them. Very often just the psychological idea of a glass of wine, beer, or whisky is enough to suggest or induce relaxation in many people, particularly at a social function. Alcohol is often used as an out-and-out sedative, narcotic, or analgesic to relieve pain or distress or fatigue. But in order to avoid toxic effects, the amount must be kept small to moderate.

The temporary release from the nervous and physical strains of daily living, which most people get by taking one or two drinks before dinner, is well-known to all. And as for that relaxant drink before bedtime—I prescribe it for many of my patients upon whom it acts as a helpful sedative.

It Can Be Useful as a "Tonic"

Alcohol is used extensively in compounding prescriptions, particularly as a tincture. Not only is it an excellent solvent and preserving agent, but it stimulates the appetite through increasing the gastric juices, it relaxes the stomach muscles, and enables greater quantities of food and drink to be taken. In older patients, the prescriptions contain­ing alcohol serve additionally as dilators of the blood vessels and seem to be helpful to the circulation.

Alcohol in small or moderate amounts is a mild stimulant to the kidneys, causing an increase in the output of urine. Alcohol also tends to increase the heart rate and the metabolic rate. As is universally known, alcohol is an excellent antiseptic, and exerts a cooling effect on the skin.

Alcohol as a Food

The caloric counts of the various alcoholic beverages are described in the chapter on calories and are self-explanatory. One can readily gain weight by indulging in those extra drinks daily. But these are "empty calories" being burned up or oxidized in the form of heat and are not developed into use­ful, healthy bodily tissue. Alcohol is sometimes given intrave­nously, especially following surgical operations, to supply a concentrated form of calories and energy.

The Effect of Alcohol on the Circulation

Alcohol has been used extensively as a vasodilating agent—that is, one that "opens up" and increases the flow of circulation by widening the peripheral blood vessels on the body surfaces and extremities such as in the face, the hands, the legs and the feet. Through this vasodilation the rise in skin temperature after two ounces of whiskey is as great as 9° to 12° Fahrenheit. The florid face of the drinker, the red nose of the tippler, and the traditional method of "warming up" with a "few good ones under the belt" are well-known to all of us.

New drugs have been introduced for vasodilatation in the treatment of arteriosclerosis and atherosclerosis of the legs and feet and Buerger's disease, and I have prescribed many of them. These diseases often give rise in many individuals to severe pain or crippling effects (even gangrene) of the legs and feet, particularly if complicated by other illnesses such as diabetes or simply by advancing years.

In my experience, none of these new drugs has matched the physiological effects on the peripheral circulation that alcohol gives. I have seen and helpfully treated with alcohol many sufferers from arteriosclerosis of the legs who were unable to walk and at times faced gangrene and amputation of the toes or feet.However, to be effective the alcohol must be given judiciously at frequent intervals, in the correct amounts and in combination with other vitamin and dietary supplements. This must be done in a manner best judged only by the physician, because of the frequently delicate balance in which the peri­pheral circulation is maintained. This varies from person to person. The factor of alcoholic addiction must be constantly kept in mind by physician, patient, and family. The needs of each individual case should be determined by the doctor and judged accordingly.

Alcohol Can Be Used to Improve Circulation*

Like many other doctors, I have found the use of alcohol in moderation to be an excellent means of improving the circulation. One patient of mine, Mr. J., is a 48-year-old successful advertising executive who is subject to an unusual amount of tension and harassment in his business. Mr. J. was getting severe attacks of angina (chest pain from poor circulation in the coronary arteries) every time he had lunch and supper. It was apparent that he had to eat in order to live, and yet he was afraid to eat for fear of dying - the anginal pain was so severe.

After a loss of over 30 lbs. and a problem of underweight, 1 urged Mr. J. to take one brandy or whiskey before each meal and to have 2 glasses of wine at lunch and supper. This man had always been a teetotaler; he had a particular aversion to alcohol due to a childhood broken home caused by a drunken father. After much personal persuasion and great trepidations, Mr. J. tried the new "treatment."

Miraculously, the pain disappeared. Normal weight was re­stored and a great change took place in Mr. J.'s personality. Clearly the alcohol had become an effective "tranquillizer." He was now much at ease, ate his food in a relaxed manner and enjoyed it, and the anginal pain had disappeared. This clearly showed how nervous tension blocks normal digestion and thus places a severe strain on the heart.

One of my earliest series of experiments to demonstrate this occurred some 20 years ago. I called for a group of volunteers among my heart patients. Five of them volunteered for the experiment—two men and three women of courage and with interest in medical science. After two years of constant ex­perimentation, I devised a series of balloons that could be swal­lowed and blown up in the stomach. At the same time, I con­structed the balloons (made from ordinary toy balloons) so that I could measure and control the pressure in the stomach and record the movements of the stomach walls. In addition, I ar­ranged matters so that I could simultaneously record the heart action by electrocardiograms.

For the first time it was possible to simulate indigestion and examine its effects on the heart. To my great surprise, I was able to measure all kinds of bad effects on the heart from distention in the stomach, a very common daily occurrence with many individuals. But to my consternation, in one of my vol­unteers, the effects on the heart distention were so dramatic that the heart suddenly stopped beating, and the patient fainted —as I almost did! We revived him quickly by releasing the "gas pressure" in the stomach, and of course the heart immediately resumed its normal beating.

What a dramatic way to show how acute indigestion can and does kill a person! Fortunately, when the American Medical Association published the results of my research in its Journal, it stimulated further research in this field, such as that which showed how gallbladder conditions will also provoke heart symptoms and heart attacks. But even after reviving my courageous volunteer patient, a reviving drink of brandy did much to relax and improve his circulation—and mine too!

Moderation is the Key

Now all this does not mean that I ad­vocate "tippling" or addiction to alcohol. Alcohol should always be taken with discretion and in moderation. In most cases, "the man who is a drinker before 40 is either sick or a fool." And the man who doesn't take a drink after 40 may become either sick or foolish!

There were many pathologists who believed that alcohol acted as a "solvent" in the arteries against cholesterol and the fatty deposits that make for arteriosclerosis and atherosclerosis. But to get the proper amount of alcohol in the blood stream to induce this ideal state would require a continuous alcohol bath in the arteries, or a "pickling" process, that not only would dissolve the cholesterol in the arteries, but would surely dissolve the liver first. This we see in the unfortunate victims of cirrhosis of the liver associated with alcoholism! So with alcohol, as with so many other things, follow the ancient Greek advice: "All things in moderation!"

Does Alcohol in Any Way Benefit the Coronary Arteries?

Finally, we come to the possible benefits of alcohol on the coro­nary arteries. It was formerly thought that alcohol was beneficial in dilating the coronary arteries and that all patients with heart disease should drink alcohol regularly.

Many patients found from experience that they had less heart pain, as from angina, if they took alcohol before and during meals and in between, as often as feasible. Repeated and recent research has found that these results (from drinking moderate amounts of alcoholic beverages) in relieving chest pains due to heart conditions such as coronary artery disease, are not due to any improvement or dilation in the coronary circulation of the heart.

The relief and improvement in pain was found to be due to two things: 1) the analgesic or "narcotic" pain-alleviating effect of alcohol which raises the threshold at which pain is felt, and 2) the ability of alcohol to allay worry and anxiety and induce psychic as well as physical relaxation. This also tends to raise the threshold of pain tolerance.

The analgesic quality of alcohol has an element of risk in­volved. Some heart patients may overexert or strain their hearts while under the influence of the alcohol, since it may have re­moved Nature's warning signal—pain!

One of my patients, Mr. N., when he first consulted me regarding his anginal pains following his coronary attack, insisted that a few highballs before his lunch and his supper diminished the number and severity of his attacks of angina. His wife, who accompanied him to my office, turned to me and said, "But Doctor, I keep telling Jim that ever since he started taking these highballs, he falls asleep after his meals, and is quite groggy even when he awakens from his *naps\ And since he loves to smoke his pipe right after meals, he has already set himself on fire several times when falling asleep! I really think he gets 'drugged* after his highballs.  Don't you?"

Mrs. N. puts her finger precisely on the diagnostic spot. Mr. N., it was true, felt less pain after his drinks. But in Mrs. N.'s words, it was an abnormal or 'drugged' kind of relief. It came as a result of the narcotic action of alcohol in deadening his pain, and stupefying his senses. It actually did nothing in any way to improve or relieve the strain on his heart.

Alcohol Can Relax Tension in Heart Cases

On the whole, however, I find that alcohol, when used wisely, is helpful to most heart cases and is an excellent way to relax the tension that many heart patients consciously or unconsciously experience.

THE INJURIOUS EFFECTS OF ALCOHOL

Now, having considered the beneficial effects of alcohol, we come to the injurious ones.

I shall mention here only in passing the well known blights of the excessive use of alcohol on the home, the individual, and society. Volumes have been written on the devastating effects of alcoholic excess on crime, suicide, divorce, general misery in the home and to the individual, venereal disease, juvenile delinquency, traffic accidents, economic and industrial losses. Here we are concerned only with alcohol as it affects your health.

The effects of alcohol have been so profound that it is startling to consider that the United States of America exists today prob­ably as a result of alcoholic excess!  In the words of the "father of our country," the British were defeated on Xmas eve, after the epochal crossing of the Delaware, because "Cornwallis* men had drunk not wisely, but too well!" What would have happened to the cause of world democracy and freedom if Washington's tattered, frozen, and decimated men had faced a sober and efficient fighting army instead of a band of drunken soldiers!

Let us now consider briefly some of the main systems of the body and the effects of alcoholic damage upon them.

Alcohol Can Be Harmful to the Emotions and the Mind

Since we began this discussion with the beneficial effects of alco­hol on the psychic and mental processes, let us now see what the pharmacologists like Sollman find in their texts on the subject.

The habitual, even moderate, use of alcohol (not even to the point of intoxication) induces relaxation, the easing of strain (tension), of maladjustments, of excessive inhibitions, indeed euphoria, all of which may be beneficial. But it also leads to diminished efficiency, especially in accuracy, im­paired judgment, increased liability to auto accidents, loss of self-reliance, perhaps diminished resistance to disease, danger of excesses, higher incidence of venereal disease and general disrespect for law and order.

In answer to the popular notion that alcohol is a "stimulant," the principle that alcohol is actually a depressant was first advanced in 1883 by the noted German pharmacologist, Schmeideberg. The following quotation is from the American translation by Doctors R. N. Harger, H. R. Hulpieu and G. N. Thompson:

The subjective and objective states and manifestations, from which alcoholic drinks are considered stimulants, are usually attributed to the stimulating effect of the alcohol. One refers to the manifestations which we observe under these conditions, namely to certain exaltations of the psychic functions resulting in loud and profuse speech, and vivacious acts, also to accelerated pulse rate, engorgement and flush­ing of the body surface and the face, and a sensation of increased warmth. However, a closer consideration of these manifestations shows that they are the results of a beginning paralysis of certain parts of the brain, (italics mine)!

Since this finding was first expressed in 1883, the idea that alcohol acts as a stimulant to the nervous system has been dis­proved in a host of pharmacological laboratories by countless scientists. To continue:

In the psychic sphere there is first lost the finer grades of attention, judgment, reflection, and ability to comprehend. This serves to explain the typical behaviour of persons under the influence of alcoholic drinks. The soldier becomes more courageous since he observes the danger less, and reflects upon it less. The speaker is not tormented and in­fluenced by the proximity of the public; he, therefore, speaks freer and with more animation. One's self-appraisal rises greatly. Often one is astounded at the ease with which he expresses his thoughts and with the keeness of his judgment in matters which are beyond his mental sphere when sober, and is later ashamed of this delusion. The drunken indi­vidual attributes to himself great muscular strength and wastes this through unaccustomed and useless exhibits of strength without thinking of the harm which may ensue, while the sober person willingly spares his strength.

This conclusion is now verified and accepted by all present-day pharmaceutical experts in the field of medicine and drugs. Even the public is thoroughly versed in the excessive effects of alcohol in causing poor or double vision, the unsteady, clumsy gait, the impairment of muscular coordination, the delayed reaction time, and the loss of normal judgment and self-control.

The Effects of Alcoholic Excess

It is remarkable that the source of relief with which man most frequently seeks to relieve his nervous tension, with which to relax, should be so free from poisonous or toxic effects when used in moderation. The fatal dose of alcohol is often very difficult to determine because of the wide variability of its action and its tolerance. In those cases where death has occurred from acute alcoholism, it usually is impossible to get the exact information from the companions of the departed one, since they have been too befuddled to give an intelligible account of the events preceding death, including the amounts of liquors drunk.

As a rule, however, to those unaccustomed to alcohol, approximately 2 to 3 ounces of alcohol will result in acute symptoms of alcoholism and three times this quantity usually produces stupor in the average 150 lb. man! A fatal dose of alcohol ranges from 1 pint to 1 quart of whiskey, or 8 to 16 ounces of pure alcohol. Children seem to have a particular sus­ceptibility to acute alcoholic poisoning due to their smaller body weight and low tolerance. Most cases of fatal alcoholic poisoning will show blood alcohol levels between 0.3 per cent and 0.5 per cent; that is, only a fraction of 1 per cent! The intoxicating blood level of alcohol, as generally used in drunk-driving tests, is generally 0.1 per cent or only one-tenth of one per cent!

Medical journals are filled with reports of silly wagers by would-be heroes anxious to show their virility and drinking prowess. Their post-mortem studies, after the coma, show that death is usually due to paralysis of the respiratory center, even though the heart may continue to beat for a while after breath­ing ceases. In these cases the brain, when opened, usually has the faint odor of alcohol, is swollen and often bulges over the edges of the opened skull.

Chronic Alcoholism

I shall not attempt to discuss the social and economic evils of this disease; it is universally con­demned, while being universally talked about. But unlike the weather, something is being done about it.

A. The brain: The changes in this organ are often those re­lated to vitamin B and C deficiencies. Hemorrhages frequently are found throughout the cerebral tissue in chronic alcoholism. The brain is particularly susceptible to injuries, such as a blow on the head. Rupture of the blood vessels with subsequent death is a frequent close to an alcoholic bout where the victim has been lodged in the "drunk tank" overnight at the local jail, and has either fallen on his head or sustained a knock on his "noggin."

B. Wernicke's disease. Back in 1881, Dr. C. Wernicke in Ger­ many first described three alcoholic patients with paralysis of the eye muscles, uncoordinated walk, clouding of the conscious­ness and finally, coma. Such cases are caused by a destruction of certain brain tissue and are common. I have had this kind of patient during my ward service in Philadelphia and Los Angeles County General Hospitals.

C. Marchiafava-Bignani's disease. This is a rather unusual disorder, occurring only in those who drink the common Italian red wine without proper food intake and is seen especially in Italy. Destruction of the brain tissue here is also characteristic, the patient usually being excited, confused, and finally psychotic.

D. Delirium Tremens. This interesting condition was first described in 1813 by Sir Thomas Sutton and is associated with a "wet brain." An alcoholic complication that is very frequent, it is characterized by confusion, anxiety or terror, auditory and visual hallucinations, and delusions.

Some patients I have seen and treated for this disorder are obsessed with snakes, others with animals, and still others with people following, watching, or persecuting them. Violent tremors and shaking frequently join with delirious episodes in this devastating form of alcoholic disease.

I shall never forget an experience during my internship days with an alcoholic suffering from delirium tremens. He was in terror of the usual "pink elephant," animals, and insects crawl­ing all around him, the walls of his room, and on his own body. This unfortunate man had lost his business and his wife and children. They had to leave him because of his abnormal be­haviour and his chronic alcoholism. He had become psychotic, shook like a leaf, and now had severe hallucinations.

When my "chief (the attending physican) and I entered his room at the hospital together with the floor nurse, the patient was lying quietly in bed. He looked up at us and let out a blood-curdling scream. He leaped out of bed, seized the necktie around his physician's neck and tried to yank it off, strangling the doctor in the process and letting out a salvo of piercing shrieks strong enough to awaken the dead. After we had wrestled him free and sedated him, it came out that he had imagined the doctor's necktie to be a snake. He had only attempted to yank it free and had heroically tried to save the doctor's life! The realism of these hallucinations to the patient with D.T.'s is pathetic, and their terror and suffering tragic to see.

E. Polyneuritis. This most frequent complication of chronic alcoholism is caused specifically by changes or destruction, in the peripheral nerves of the body due to lack of vitamin B. The feet are usually numb, tender, or painful and frequently para­lyzed so that walking may become impossible.  This is called "foot drop," and is often associated with other complications of chronic alcoholism.

F. Korsakoffs Psychosis. This disease is also believed to result from a vitamin deficiency and is a most curious one. The patient is highly suggestible to any idea and is completely with­ out any judgment regarding its credibility. He tells incredible stories that outdo Baron Munchausen; he can imagine the tallest of tall tales.

One case of this bizarre condition that stands out in my memory is that of a waiter whom I took care of some 25 years ago. He had been a chronic alcoholic for many years and was installed in the psychiatric ward for observation and commitment.

One day, during my ward rounds, he informed me that he had just learned I was leaving for London, on a fellowship in medicine and wished me good luck. Then to my surprise he dis­cussed and advised me in the greatest detail imaginable about many of the hotels in London and their advantages and disadvan­tages for an American. He knew with the knowledge of a con­noisseur the virtues of certain restaurants and pubs, transporta­tion facilities, entertainment spots. He reminisced fondly over many enjoyable hours and delightful memories of his life in London. And yet his family assured me with utter finality that he had never left the United States, and was never seen to read a book!

In the case of this psychotic patient, it was his extraordinary imagination that gave to his stories the ring of conviction and truth. I finally discovered that this patient had worked for years with a bartender at a restaurant. During slow periods many an hour was passed drinking with this bartender, a "Cockney" who regaled my patient with endless reminiscences of his life and experiences in London. But the patient, who was exceedingly suggestible (like many normal individuals under hypnosis), believed completely that he himself had lived through these past experiences of another person.

WHAT DOES ALCOHOL DO TO THE LIVER?

Cirrhosis of the liver is a sequel to chronic alcoholism. It is basically a nutritional dis­ease, brought on by inadequate and improper diet coupled with excessive alcoholic intake. In this disease, the liver is usually swollen and enlarged at first, but later it becomes small, shrunken, and atrophied. It is accompanied by a series of signs and symptoms that are characteristic. These range from nerv­ousness, fatigue, dyspepsia, vomiting and passage of blood, chest and abdominal pains and swelling, to jaundice, coma, and death.

Some years ago I introduced a program of treatment for this condition based on a high protein diet, nutritional and vitamin supplements, and certain injections of liver and vitamins. I reported in various medical journals the results of this tempo­rarily effective treatment for over 100 cases with this disease, and it was used extensively by physicians in the country and abroad.

Psychiatric care did not help in 95 per cent of the cases I have described. However, Alcoholics Anonymous was a tremen­dous help in at least half of them, a striking demonstration of the value of group psychotherapy and a blessing to countless unfortunate victims.

Moderation in drinking alcohol is a term with very wide latitude. Some people have only to take the proverbial whiff from the cork of a whiskey bottle, and they already feel 'giddy.' Others seem to have the 'hollow wooden leg,' and feel no effects from alcohol unless they have had 5 or 10 times the amount re­quired by the average person to feel their drink. Usually, an average of one or two highballs or cocktails, or glasses of wine or beer, once or twice a day is regarded as drinking in modera­tion. The main thing to remember is that drinking is not to be indulged in to the point of excess, where intoxication occurs, or where the critical judgment, the physical or mental faculties are in the least way impaired or interfered with.

WHAT ARE THE CONCLUSIONS FOR YOU?

What are the conclu­sions to be gained from all the descriptions of these "medical chambers of horrors"? Simply that drinking alcoholic beverages in moderation is a great help to relax you, to put you at ease from your cares and worries; and in general it is good for your cir­culation. If you find that you cannot stop at "moderation," then before it's too late don*t touch it again! And if it is too late for that, then see your doctor for further help, and join Alcoholics Anonymous!

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