Episode Transcript
faith: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Sally.
Recent surveys show that more than 60% of Americans drink alcohol. But is there such a thing as a safe amount of alcohol? How does alcohol affect your health?
I’m joined this week by the Chief of Gastroenterology and Hepatology at NewYork-Presbyterian and Weill Cornell Medicine, Dr. Robert Brown. It helps explain the risks associated with excessive alcohol consumption and gives recommended dosages for men and women.
belief: Hello Dr. Brown!
Dr. Brown: Hello
belief: Thanks for joining us once again. The last time you were here at Health Matters, we talked about Dry January and the many, many positive effects we experience when we stop drinking for a month. This time I want to dive a little deeper into the effects of alcohol on our liver. But first, can you give us a general idea of the recommended intake for men and women when it comes to alcohol consumption?
Dr. Brown: So I think it’s important to know that no alcohol use is healthy. That being said, unlike cigarettes, there is an accepted safe limit for alcohol intake. And that’s usually seen as about one drink a day for women and two drinks a day for men.
And it is important to know what a drink is. right You know, you watch these cartoons, I only have one drink a day and the glass is bigger than your head. So I like to start with beer being the easiest. A standard beer, it is 12 oz. Malt liqueur would be less because it is stronger.
For wine, it’s four to five ounces. So there are five glasses in one bottle. So if you and your partner share a bottle, one of you is drinking too much.
And then for the spirits, which are often the hardest, it’s an ounce and a half or a shot, a standard shot glass, hard liquor. And that’s harder to do because in a lot of bars in New York and other places, when you order a cocktail, there might be two or three drinks in that cocktail, even though you’re only ordering one.
belief: Eha.
Dr. Brown: And it has to do with metabolism, because you can safely metabolize alcohol at a certain rate, and when you exceed your ability to metabolize, then liver damage can occur. So part of it is amount and of course part of it is time. There are other risk factors that increase the likelihood of liver damage. But generally, if you stay below these safe limits, you can enjoy a drink with your friends or family without too much worry. But you can understand how easy it is to exceed these limitations.
And for people who have a problem, who develop a tolerance to alcohol, to the psychoactive effects of alcohol, the loss of inhibition, the sedative aspects of it, they don’t really develop as much tolerance to the toxic effects. And so then the drinking pattern can escalate into a dangerous mode.
belief: Dr. Brown, you said the L word – liver. So can you elaborate on what specifically happens to our liver?
Dr. Brown: So, the liver is the center of attention when it comes to alcohol damage, although alcohol can affect many organs in your body, including your brain, red blood cells, even your heart. But because alcohol is metabolized in the liver, it is the one that will be left to protect the rest of you. And that’s where most of the damage occurs. And if we think about alcohol-related deaths in the United States, about half of them are due to liver disease. The other half, also preventable, is due to traffic accidents and other things people do that are dangerous when intoxicated.
When you drink too much alcohol, the first strange thing that happens is that it accumulates fat in the liver. Alcohol turns into fat in the liver if you want to think about it in the simplest sense. And this fat can damage liver cells. And when that damage occurs, there is inflammation. So, first there is inflammation. And it’s reversible. Fats and inflammation, you stop drinking, it disappears.
belief: Well, that’s good news!
Dr. Brown: It is. Over time, anything that inflames an organ leads to scarring, so you can think of it as the body trying to contain the inflammation, which it always thinks of as a foreign invader. If you’re sore, it used to be, if you think about ancient man, because of an infection, you surround it with a scar. So if your liver is inflamed for whatever reason, you’re going to leave scar tissue, and that scar tissue as it gets more advanced distorts the liver and its function and when it gets to that period, we call it cirrhosis. So cirrhosis is from Latin cirrhosiswhich is scarring and this is an advanced stage of liver scarring and it is the scarring that causes the problem in the liver.
belief: Can cirrhosis be reversed by stopping drinking?
Dr. Brown: yes In a very advanced stage you probably reach a point of no return but as long as your liver is functioning normally if people stop drinking I tell all my patients if you stop now you will be able to live your life with the liver God gave you. Your liver will stabilize or improve to a point where you can live for the rest of your life, even with some liver scarring, as long as it is not too advanced.
belief: Our liver sounds very brave. They are our first line of defense and actually sound very hearty.
Dr. Brown: As a liver doctor, of course, I consider the liver to be the most noble organ!
belief: Obviously – don’t tell others! [laughs]
Dr. Brown: [laughs] So everything you eat, everything you put in your mouth and goes into your gut, goes to your liver first. So the liver is your barrier of entry and it determines what’s healthy and what’s not healthy, it processes your food and says, food is good, we’re going to build the building blocks of your body. Bacteria, toxins, viruses – nothing good. We’re going to get rid of them, and this barrier function that the liver performs is why it’s so important, but also why it tends to be among the first, um, in the line of fire when bad things enter your body, whether these are infections or toxins. You know, the only other way into your body is obviously breathing it in or through your skin.
belief: Are there any other health risks associated with regular alcohol consumption that you’d like to outline for us that aren’t necessarily focused on the liver?
Dr. Brown: Excessive use of alcohol can affect all organs of the body. We are most concerned about the effects on the brain over time. Significant alcohol use can lead to an actual dementia-like illness in its most severe forms, and in its acute form, an almost psychotic-like condition.
And they get worse if alcohol substitutes calories and people are malnourished. So vitamin deficiencies, especially thiamine, can worsen the mental effects of alcohol. Excessive alcohol is also toxic to the heart, and there is alcohol-related cardiomyopathy, or heart disease associated with heavy alcohol use.
It suppresses the formation of healthy red blood cells. And it can also affect the reproductive organs, especially in men, where it leads to loss of testosterone. This is why men who drink excessively can develop larger breasts, smaller testicles and lose their fertility.
belief: Oh ok. And what about women? Will you explain to me why women are at greater risk of alcohol consumption?
Dr. Brown: It’s really about size, mostly, probably some genetic differences in metabolism that are hormonally based, but most of it is about size. The bigger you are, the bigger your liver is, the more you can metabolize. Much of the gender difference is based on size, but there are clearly other factors that make women more prone to alcohol-related liver damage.
And certainly when we look at alcohol-related liver disease, it increases at the highest rate in women. Although men still have more liver disease and alcohol-related liver disease than women because consumption has not yet been matched.
belief: So a woman will metabolize alcohol more slowly, right? If her liver is smaller?
Dr. Brown: Yes
belief: Okay, now that you’ve rethought my entire assessment of the liver, I really understand why it deserves reverence!
Dr. Brown: You’re preaching to people!
belief: Thank you so much for joining us.
Dr. Brown: You also. Beware.
belief: Many thanks to Dr. Robert Brown. I’m Faith Sally.
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Dr. Brown: I am the Chief of Gastroenterology and Hepatology here at Weill Cornell Medicine in New York, New York.
belief: So close to a herpetologist. Just, just a few letters!
Dr. Brown: Yeah, and that’s a problem because I—I like snakes. And thankfully, eventually spell check stopped changing my “hepatologist” to “herpetologist” every time I typed it. But me, originally I wanted to be a veterinarian, so I guess a herpetologist—
belief: You?
Dr. Brown: – not so bad! Yes, I did it.
belief: A herpetologist also studies amphibians, which are cuter and more agile.
Dr. Brown: Yeah, I guess I can be wide for the reptile and amphibian world.
