BEER CLINIC :: Alcohol, Part 2—Some Sobering Thoughts

by Dr. Carol Westbrook on November 11, 2011

Up ’til now we’ve been singing the praises of beer. But as you know, drinking has its dark side.

Picture the lovable old drunk. He’s sitting at the bar, sipping his beer, telling funny stories that he seems to be making up as he goes along. His speech is a bit slurred, eyes shaky, and a bit unsteady on his feet. Maybe he just had a bit too much tonight, but he’s a great guy, everybody’s friend, and doesn’t seem to be having any problems at all.

Right? Wrong! This man has a lot of problems! He is showing the classic signs of Korsakoff’s Syndrome, an incurable brain disease that is caused by a lack of Vitamin B6 (thiamine). It’s hard to imagine anyone with a vitamin deficiency nowadays, but chronic alcoholics are especially susceptible to B6 deficiency because they may go for days “drinking their dinner” without eating any fresh produce, and alcohol interferes with absorption of B6. Thiamine is necessary for brain metabolism, and the parts of the brain necessary for coordination of speech, vision, and balance and for memory are affected the most. The classic Korsakoff person shuffles with wide-spread legs, falls frequently, slurs his speech, and may have very shaky, wandering eyes. And, of course, memory problems.

One of the most fascinating (and endearing) symptoms of Korsakoff’s Syndrome is called “confabulation,” or falsification of memories, in which a person makes up stories about his past, which he can’t remember. Combine this with slurred speech and an outgoing personality, and you get the lovable old drunk of TV and movies.

During my hospital residency, every suspected alcoholic had a yellow intravenous bag drip–the color was due to thiamine, to help prevent Korsakoff’s syndrome. When you saw a patient with a yellow IV, you knew he was an alcoholic. It was also a tip-off to watch out for the DTs.

We’ve all heard the term DTs, and know it stands for Delirium Tremens, but you probably don’t know what it means–other than the name of a delightful high-alcohol Belgian beer with a pink elephant on the label. DTs are the symptoms of alcohol withdrawal.

In a chronic alcoholic who stops drinking, the DTs usually start about 2 days after the last drink. “Delirium” refers to mental confusion, and “tremens” refers to shaking or convulsions, and that’s exactly what happens. The delirium almost always includes disorientation, confusion, and hallucinations. The tremors go along with restlessness, fever, and sweating; eventually, full convulsions may occur. It’s not pretty.

DTs are serious business. They are treated in a hospital intensive care unit, with sedatives and anti-seizure medications, and they take about a week to resolve. Most alcoholics know that you can prevent the shakes if you have another drink, but this only delays the inevitable. If you come across someone who you think has the DTs, DO NOT GIVE THEM A DRINK! Get them to a hospital. It can be fatal!

So what about those pink elephants, anyway? Jack London was the first one to use the term in his 1913 autobiographical novel John Barleycorn. He described him as “the man whom we all know, stupid, unimaginative, whose brain is bitten numbly by numb maggots…who sees, in the extremity of his ecstasy, blue mice and pink elephants. He is the type that gives rise to the jokes in the funny papers.”

Hallucinations are common with many recreational drugs during the “high,” but with alcohol they occur after the high is over, with withdrawal. Hallucinations during the DTs are visual but also tactile–feeling that something is crawling on the skin. Ughh. More common than the DTs, and much less fatal, is “alcoholic hallucinosis,” which starts 12-24 hours after drinking stops. Unlike with the DTs the hallucinating drunk is conversant, conscious and oriented, and fully believes his hallucinations are real. The apparations are usually visual and auditory, most commonly taking the form of accusing or threatening voices. They may be accompanied by a Disney sound track as the pink elephants float by. Fortunately, this condition is self-limited and, unlike the DTs, it won’t kill you.

But there are other fatal complications of demon rum, such as liver damage. The liver filters all the alcohol you drink, and it can get hit pretty hard by a big drinking binge. The result may be a few days of alcoholic hepatitis, with belly pain, nausea, and jaundice (yellow skin & eyes). It’s not fatal and will resolve in a few days. But chronic drinking can also lead to permanent liver damage in the form of cirrhosis of the liver.

In alcoholic cirrhosis the liver does not function properly. It can’t process your food, leading to jaundice and weight loss. It stops making blood-clotting factors, and you become a bleeder. It can’t drain the abdomen and fluid builds up. Ever see a guy with a big swollen belly, skinny arms and yellow skin? That’s the classic picture of cirrhosis though, in all fairness, there are other causes of cirrhosis besides drink. Cirrhosis doesn’t go away, and it can kill you. If you develop it, you might be waiting a long time for a liver transplant.

Unfortunately, you don’t have to be a frank alcoholic or even a drunk to develop cirrhosis. You just need to drink. A lot. Daily. This is probably why the French have a much higher rate of cirrhosis than Americans–as a nation they drink a lot of wine, with almost every meal, but are rarely intoxicated. Estimates are that 3-4 or more drinks per day increases the chance of cirrhosis, if kept up over a decade or more.

Where does that leave us? Ready to take The Pledge and give up alcohol completely? I hope not. The purpose of this article was not to dissuade you from drinking, but to give you enough knowledge to understand what it means to drink responsibly, and to help your friends do the same.

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