Long term use of alcohol will shrink your brain.

Celebrating Africa Day in Calgary, Alberta. (Dr. Noorali Bharwani)
Celebrating Africa Day in Calgary, Alberta. (Dr. Noorali Bharwani)

A recent article in Natural Communications (March 4, 2022) titled “Associations between alcohol consumption and gray and white matter volumes in the UK Biobank”, says there is evidence to show even moderate drinking is associated with changes in brain volume in middle-aged and older adults.

We know heavy alcohol consumption has been associated with brain shrinkage. The new study shows even moderate drinking will shrink your brain. The study was done in the UK. The researchers used multimodal imaging (MRI) data from 36,678 generally healthy middle-aged and older adults from the UK Biobank.

The study shows the negative associations between alcohol intake and brain shrinking are already apparent in individuals consuming an average of only one to two daily alcohol units, and shrinkage increases as alcohol intake increases.

Alcohol use and abuse is a worldwide problem. There is a significant healthcare and economic cost. Alcohol use disorder is one of the most prevalent mental health conditions worldwide with harmful effects on physical, cognitive, and social function. It contributes to cardiovascular disease, liver disease, nutritional deficiency, cancer and accelerated aging.

How do we define chronic heavy alcohol consumption?

Three or more drinks for women and four or more drinks for men on any day is considered heavy drinking. These individuals have lower gray matter volume of the brain. Chronic alcohol drinking also shrinks the white matter of the brain. The article says, “Further, research suggests that the effects of alcohol consumption on brain volume interact with the effects of aging.”

The researchers found individuals who consumed moderate-to-high amounts of alcohol (14 or more alcohol units per week) showed brain atrophy.

The article concludes by saying this study provides additional evidence for a negative association between alcohol intake and brain structure in a general population sample of middle-aged and older adults.

This finding suggests the general recommendation that it is OK for women to have one drink a day and two for men is not valid anymore. Research showed that a daily drink seems to age the brain by two years compared to the brains of those who do not consume alcohol. And if you take two drinks a day your brain will look 10 years older than that of a teetotaller.

What is Canada’s low-risk alcohol drinking guideline?

Health Canada (2012) guideline says you can reduce your long-term health risks by drinking no more than10 drinks a week for women, with no more than two drinks a day most days and 15 drinks a week for men, with no more than three drinks a day most days. You should plan non-drinking days every week to avoid developing a habit.

Is this recommendation valid anymore?

An article in Lancet (No level of alcohol consumption improves health – August 23, 2018) also rejected the notion that any amount of drinking can be healthy. With the new study findings, should Health Canada change its guideline?

In the last two years, due to stress and loneliness imposed by COVID-19 pandemic there has been huge increase in drug and alcohol consumption in Canada and elsewhere. And the effects of alcohol use on health care, crime and lost productivity were estimated at $14.6 billion – more than tobacco and all other psychoactive substances combined.

Statistics Canada reported alcohol-induced deaths increased in 2020, especially among those under age 65. It is simple. The more you drink, the worse it is for your health. Especially, your brain health. Maintenance of brain health is central to health and wellbeing across the lifespan. Those who are lifetime alcohol abstainers report the highest level of mental well-being and quitting alcohol improves mental well-being.

Finally, we should be careful in recommending moderate drinking that can improve health-related quality of life. Instead of having a drink have an apple. An apple a day keeps the doctor away!

Don’t let your brain shrink. Take care of your gray and white matter. Be safe.

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New Year’s Resolution: Drive Safely and Prevent Motor Vehicle Collisions

Sunrise at Haleakala Volcano Summit in Maui. (Dr. Noorali Bharwani)
Sunrise at Haleakala Volcano Summit in Maui. (Dr. Noorali Bharwani)

“Only I can change my life. No one can do it for me.” -Carol Burnett

Most people are good and responsible drivers. They care about their own safety and they care about others. But some drivers are serious threat to safety.

A recent survey done by the Alberta Motor Association and published in their magazine (AMA Insider – Winter 2017) identified the following five actions to be serious threat to safety while on the road:

  1. Drivers texting or emailing
  2. Drivers talking on the phones
  3. People driving after drinking alcohol
  4. Aggressive driving
  5. Speeding on residential streets

It is estimated that traffic collisions would soon become the third major cause of death worldwide. The major victims of these traffic collisions are people between five and 44 years of age. That is tragic.

Let us briefly look at what Transport Canada has to say about road safety.

Although drivers aged 15 to 34 represent only about 30 per cent of the driving population, they accounted for 40 per cent of the fatalities and 45 per cent of the serious injuries, indicating that younger drivers are at greater risk.

The annual social costs of the motor vehicle collisions in terms of loss of life, medical treatment, rehabilitation, lost productivity, and property damage are measured in tens of billions of dollars. We can certainly use that kind of money treating other health issues.

Here are few examples where we can do better:

  1. Seat belts worn correctly can reduce the chances of death and disability. It is estimated about 300 lives could be saved every year if everyone wore seat belts.
  2. Aggressive driving includes speeding, running red lights, tailgating, weaving in and out of traffic, and failing to yield right of way, among other behaviours should be avoided. Forty per cent of speeding drivers involved in fatal crashes were 16 to 24 years of age.
  3. Young drivers, 16 to 24 years of age, continue to be at higher risk of being killed in motor vehicle collisions. One of the reasons being the use of cell phones or other similar devices while driving.
  4. In 2008, coroners’ testing showed almost 40 per cent of fatally injured drivers had been drinking some amount of alcohol prior to the collision.
  5. Drugs, other than alcohol, are also being found in about one-third of tested fatally injured drivers, similar to the prevalence of alcohol.

There are many other reasons why a driver can be distracted: using electronic devices, reading maps, eating, drinking, talking, or impaired by fatigue.

It is estimated about 20 per cent of fatal collisions involve driver fatigue. Everyone is subject to their body’s circadian rhythms such that they are less alert during certain times of the day, usually 2:00-4:00 a.m. and 2:00-4:00 p.m. Therefore, taking breaks from driving during these times could lower the risk of fatigue related collisions.

Let’s make a New Year’s resolution to drive safely and prevent death and disability.

Have a happy and healthy 2018.

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Auto-brewery syndrome – a rare condition where the body brews its own alcohol.

"Looking Into My Dreams, Awilda," is one of four large-scale portrait sculptures titled "Jamue Plensa: 1004 Portraits," in Millennium Park, Chicago. (Dr. Noorali Bharwani)
"Looking Into My Dreams, Awilda," is one of four large-scale portrait sculptures titled "Jamue Plensa: 1004 Portraits," in Millennium Park, Chicago. (Dr. Noorali Bharwani)

It was reported on CNN and now it is making rounds in the media. A woman in upstate New York was charged with DUI (driving under the influence) hours after her last drink.

The lady blew a blood alcohol level of nearly 0.40. The police procedure is to take the accused to a hospital, as that level is considered extremely life threatening.
The lady’s blood alcohol level in the hospital was 0.30. This was many hours after her last drink.

The lady was charged with DUI but a judge dismissed the charge after being presented with evidence the woman suffered from “auto-brewery syndrome.”

“I’m in touch with about 30 people who believe they have this same syndrome, about 10 of them are diagnosed with it,” says Panola College Dean of Nursing Barbara Cordell, who has studied the syndrome for years. “They can function at alcohol levels such as 0.30 and 0.40 when the average person would be comatose or dying. Part of the mystery of this syndrome is how they can have these extremely high levels and still be walking around and talking.” Cordell was quoted on CNN.

The condition is also known as gut-fermentation syndrome. This rare medical condition can occur when abnormal amounts of yeast in the gut convert common food carbohydrates into alcohol. The process is believed to take place in the small bowel.

The condition was first described in 1912 as “germ carbohydrate fermentation.” Since then, from time to time, it has surfaced in the media. In 2013, a case of a 61-year-old man who had frequent bouts of unexplained drunkenness for years was documented. Subsequently, he was diagnosed with an intestinal overabundance of Saccharomyces cerevisiae, or brewer’s yeast, the same yeast used to make beer.

CNN report says that the lady is treating her condition with anti-fungal medications and a yeast-free diet with absolutely no sugar, no alcohol and very low carbs. The report says that this does not work for everybody.

So I looked it up on Wikipedia.

The condition has been described variously. The self-brewery syndrome, intestinal fermentation syndrome, and gut syndrome fermentation is an intestinal disease and very poorly documented. There is no consensus among specialists.

The condition was described for the first time in 1976 in Japan. One case went unnoticed for 20 years, despite strong alcoholic intoxication following meals high in sugar or high in carbohydrates.

Symptoms of the disease can have a significant impact on daily life, says Wikipedia.  Recurrent symptoms such as dizziness, dry mouth, cold sweats, hangover, disorientation, irritable bowel syndrome, chronic fatigue syndrome, which can lead to other health problems such as depression and anxiety.

Is there a good treatment for it?

In general, the effects of the condition can be alleviated with a very low carbohydrate diet. The antifungal drug, fluconazole, can be an effective treatment against the disease since the drug is able to reduce Saccharomyces cerevisiae, responsible for fermentation in the gastrointestinal tract.

If you think you are suffering from auto-brewery syndrome, then to put it simply, don’t eat and drive.

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What would make the liver quit working?

A cirrhotic liver. (iStockphoto/Thinkstock)
A cirrhotic liver. (iStockphoto/Thinkstock)

Dear Dr. B: What would make the liver quit working? This person did not use alcohol. Could West Nile virus, hepatitis or E. coli possibly affect your liver?

Two most common causes of liver failure in North America are alcohol and acetaminophen use. Acetaminophen is present in over-the-counter pain and cold medications like Tylenol. We will come to this later. Let me first answer your question.

As far as I know, West Nile virus does not cause liver failure. Usually. West Nile fever resolves spontaneously and completely. In a worst case scenario, fatigue, headache, weakness, movement disorders can persist for weeks or months. Severe disease involving the nervous system can result in death or permanent disability. Death is from swelling of the brain and respiratory failure.

Hepatitis does cause liver failure. Hepatitis is a generic term used for inflammation and damage to the liver cells. The liver cells can be damaged by drugs, any kind of toxins, alcohol, inherited diseases, certain metabolic diseases and viruses. Generally speaking, when we say hepatitis, it refers to viral hepatitis A, B, and C. Hepatitis C is the commonest reason for liver transplant in the U.S.

E. coli infection is very common. But it is not a common cause of liver failure. E. coli can cause infection of the urinary tract, gallbladder, bile ducts and the infection, in rare cases, travel to the the liver, brain (meningitis) or lungs (pneumonia). The majority of infected individuals make a full recovery within a week. About six per cent of patients end up having kidney failure (hemolytic uremic syndrome). Of these, between three to five per cent of patients will die.

Alcohol is a poison. Any amount of alcohol can produce damage to the the liver. The liver is very sensitive to alcohol. If you have had previous problems with the liver then the best thing is to avoid alcohol and acetaminophen.

The most common agent causing liver damage is acetaminophen. However, It is considered the safest medication for fevers, aches and pains, but only if taken in small recommended amounts. In large amounts, greater than those recommended, can result in the liver damage or failure. Acetaminophen overdose is a common reason for considering a transplant.

We have five vital organs – the liver, the brain, the heart, the lungs and the kidneys. The liver plays a vital role in the metabolism of fat and carbohydrates, synthesis of proteins, detoxification of poisons and storage of good nutrients. When the the liver fails, either acutely or chronically, these important functions do not occur. Thus, the person faces severe ill health. There are numerous other reasons why the liver can fail. It is impossible to discuss them all here. However, you get the idea. It is easy to damage your liver if you are not careful.

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