HOW much is too much? We’ll leave that question for now and dive into the excesses of alcohol consumption. The medical profession has long been captive to the delusion that once an individual is aware of the harm or health benefit of a behaviour (e.g. smoking) they will change. Unfortunately, study after study demonstrates that knowledge and behaviour don’t always correlate.
“I’m afraid your liver function is not good.” I say euphemistically to my patient.
The impact of these words is unpredictable. It depends for how long alcohol has been a part of life, how much is consumed each time, and what the other drives in life are.
“How bad is it?” the reply comes.
This is often a good sign, and indicates some level of concern. Concern for one’s health may indicate the priority health has in an individual’s life, and potential for change should this be required. This is not always the case. Indeed in alcoholism, as in any addiction, many people have insight into the problems of alcohol use. The issue is the inability to stop despite the pain being inflicted.
“Well your liver function is high – GGT is several hundred, but your albumin and blood clotting appear normal, so in my opinion, you have inflammation of the liver, but no scarring – yet.”
The liver is like any other organ. Take skin for example. It cops a beating. Sun exposure, cuts and scratches, the odd scar or mole, a burn to boot. Sunburn causes redness. A scratch, laden with soil and bacteria during a fall, often becomes infected resulting in pus and lots of pain. If large enough, the skin will scar. Similarly with the liver. A big night on the booze, and liver inflammation will occur. It’s swollen and somewhat tender, a consequence of the direct toxicity of alcohol to the liver cells, and you feel vaguely nauseous, ‘off’, which can drag on for a day or two. Do this time and again and you’ll end up with chronic inflammation in the liver – so-called ‘fatty liver’. Both conditions give abnormal liver function results.
The key for our patient is to make the connection between alcohol consumption and health. There are many cultural barriers to this. Perhaps it’s the fun of debauchery in Phnom Penh, or the necessity of socialising with colleagues, the pressure of not being left out. Not uncommonly other more sinister drivers may be the cause – a recent divorce, the loss of a job or depression.
My ears often prick up when patients report these latter, worrying issues. These are ‘high risk’ situations.
Alcohol addiction is another story altogether. Others may be the first to notice. Perhaps not showing up to work after a big night, a hand tremor (shaking) in the morning, craving for a drink earlier in the day, or being unable to have an alcohol-free day.
Addiction to any substance results in brain changes. A rewiring of sorts so that the emotional centres of the brain (those responsible for desires, pleasure, euphoria, depression) drive the decision-making frontal lobes of the brain – instead of the other way around. The brain becomes ‘hijacked’, controlled by emotions as rationality flies out the window and a cycle of self-destruction and loss of potential eventuate.
More commonly, regular binge drinking – so-called ‘problematic use’ – is the issue. Blackouts, memory loss, massive hangovers, fighting (verbal or physical), or relationship issues indicate that perhaps alcohol is winning, and consumption needs to be curbed. In some cases this means no alcohol.
So back to our concerned candidate. He’s going to be OK. The abnormal liver function made him realise he was drinking too much. In fact, much more than he would have back home. The alcohol is too cheap, the booze flows too freely and the culture requires a certain adherence to this celebratory goddess.
But it took some doing – and telling friends – before he was able to cut back. He started drinking later, made sure he ate before he drank and alternated with juice or water as the night wore on. And he had several alcohol-free days a week. In the process he lost 4kg. In fact, he saw through the sobering light of a non-alcoholic night that his friends were also drinking too much. Confronting, but validating.
So how much is too much? It’s hard to say. Medically, two alcohol-free days a week and no more than 20g–40g of ethanol (that’s 1.5 – 3 cans of beer or 2 – 4 small glasses of wine) is recommended, depending on your gender. And be careful. Drink more than four to six drinks on the occasional night and your liver function is sure to be abnormal.