Understanding Alcohol

The WHO (2023) suggests that alcohol contributes to over 3 million global deaths per year. It is responsible for >5.1% of the global disease burden and is also the primary risk factor for premature mortality for people aged 15-49 years. The data show how impactful alcohol is to humans, yet alcohol commonly retains immunity from stigma or regulations. Are the health implications an acknowledged sacrifice we’ve collectively made to preserve the social, cultural, and economic aspects associated with the ancient substance, or is it time for a deeper reassessment? 

What is Alcohol and its Historical Relevance?

Alcohol is a broad category that describes organic compounds containing a hydroxyl (-OH) functional group attached to a carbon. There are many types of alcohol, some are used as sweeteners (Sorbitol and Xylitol), and some as disinfectants (Propanol). When discussing beverages for human consumption, the primary type of alcohol referred to is ethanol. 

Historically, alcohol has had cultural, religious, and social significance spanning millennia. It was discovered independently across many different cultures, and its consumption has been integral to traditions, ceremonies, and communal gatherings. 

Metabolism of Alcohol

Primary metabolism of alcohol occurs in the liver by enzymes such as alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH). Several steps are involved in alcohol metabolism that lead to the conversion of ethanol into acetaldehyde, which is toxic to humans. Acetaldehyde is then broken down into acetate, converted to acetyl-CoA and utilised for energy via the Krebs cycle or stored as fat. For reference, alcohol contributes roughly 29kJ per gram, more than carbs and protein, making excessive drinking a significant contributor to weight gain. 

Genetic Differences in Metabolism 

Alcohol metabolism can differ significantly among races due to genetic variations affecting enzyme activity. For example, East Asian individuals often have a genetic variant causing decreased ADH activity, slowing down ethanol breakdown. This results in higher acetaldehyde levels, leading to facial flushing, nausea, and adverse reactions to alcohol. Conversely, some individuals of European descent show increased ADH activity, facilitating faster ethanol breakdown, and potentially reducing the severity of these adverse effects. These genetic differences emphasise the significant role of genetics in alcohol metabolism and its varying effects across racial groups.

Impact on Key Organs and Systems

Alcohol affects various organs and systems within the body. The liver is the primary site of alcohol metabolism and, therefore is particularly vulnerable. Prolonged and excessive alcohol intake can lead to fatty liver, hepatitis, and even liver cancer. Moreover, alcohol influences the brain, heart, pancreas, kidneys, and gastrointestinal tract, contributing to a range of health conditions.

Short-Term Effects of Alcohol Consumption

Short-term alcohol consumption manifests in varied ways. Its effects are noticeable from the initial euphoria and relaxation to impaired judgment, and coordination, dampened pain responses, and slowed reflexes. It can lead to dehydration, digestive issues, and interference with nutrient absorption. Many injuries and fatalities associated with alcohol stem from impaired judgment, which can lead to dangerous behaviours. 

Long-Term Implications of Chronic Alcohol Abuse

The long-term effects of excessive alcohol consumption are profound. Chronic abuse can lead to severe health complications, including addiction, cardiovascular disease, neurological disorders, increased cancer risk, gastrointestinal problems, and compromised immune function. Nutritional deficiencies, particularly of vitamins like B1, B6, B12, and folate, are also common in chronic alcoholics.

Navigating Alcohol

The historical significance of alcohol contrasts sharply with its detrimental health effects, evident in global statistics and scientific insights. Understanding its metabolism, genetic variations, and impact on physiology reveals immediate impairments and chronic health risks. Addressing this complex relationship requires education, policy interventions, and a shift in societal attitudes to promote responsible consumption and prioritise public well-being. Reevaluating our approach to alcohol is crucial to fostering healthier lifestyles and reducing the burden of alcohol-related health issues globally.