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Ever woken up the next morning from a heavy night of drinking, feeing nauseous with a headache, asking yourself, “What happened last night?” Now you’re regretting those extra drinks you probably didn’t need. So is your liver. Our liver is an organ that plays a central role in the body’s metabolic processes; it converts carbohydrates, proteins and fats into usable substances, and helps break down and remove harmful substances from the body.1 Over time, heavy drinking can progressively damage this organ, leading to a fatty liver, increased toxicity, inflammation, alcoholic hepatitis, and the final stage of alcoholic liver disease, cirrhosis.

As the organ struggles to process the ethanol that is in alcohol, a build-up of fat can occur, due to lipid accumulation and decreased fatty acid oxidation.2 This is one of the most common liver diseases, affecting 1 in 10 Australians.3 A nutritional deficiency can also become problematic, due to ethanol’s lack of vitamins and amino acids. Thiamine (Vitamin B-1) deficiency arises from over-drinking, and can lead to a serious brain disorder, known as Wernicke-Korsakoff’s syndrome.

As one continues to drink, the liver becomes swollen and tender. This inflammation, known as alcoholic hepatitis, results from a build-up of toxic chemicals, which are products of ethanol metabolism.4 This toxicity damages healthy cells and prevents an adequate nutrient supply in the liver. Permanent abstinence from alcohol can reverse a fatty liver and mild hepatitis; however, more severe alcoholic hepatitis is life-threatening. Continued drinking and an already damaged liver can cause irreversible scar tissue to develop, leading to cirrhosis. The liver hardens and shrinks, affecting blood and fluid flow through the organ.5 This can lead to a back-up of blood flow in other bodily veins, the consequence being bulging blood vessels and possible bleeding into the body. Continued drinking at this stage will rapidly accelerate one’s chance of liver cancer, liver failure and death. In the case of liver failure, only will a liver transplant be considered if the patient stops drinking and experiences complications due to cirrhosis. Should one choose to continue drinking, diagnosis is grim, with patient’s having less than 50% chance of living for five more years.6

What’s Really in Your Cup?

Attention women! You could be at higher risk!

Studies reveal a woman’s body needs longer to metabolise alcohol, and they show signs of liver disease

quicker than men. Drink in moderation as your intake can

determine the outcome of your liver!

Healthy liver Unhealthy liver with Cirrhosis

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More often than not, heavy drinking can lead to a hangover the next morning. A more serious alcoholic though, may develop a severe brain disorder, Wenicke-Korsikoff Syndrome (WKS). A Vitamin B-1 (VB-1) deficiency, it unfolds due to a number of reasons: alcohol reduces the ability to absorb nutrients, as well as inadequate dietary intake.7 This disease causes brain lesions, leading to symptoms like loss of muscle coordination, abnormal eye movements, and memory loss.8 Progressed WKS is more profound, it impairs long-term memory and the ability to make new ones.9 Oral or intravenous administration of VB-1, in addition to treatment of alcoholism and sticking to a healthy balanced diet, may slow or stop its progression.

Chronic alcohol misuse impairs the ability to absorb and store nutrients, including VB-1. The figure to the left depicts the essential role thiamine plays in the Krebs Cycle, which is the process of converting glucose to usable energy, ATP. Without this crucial ingredient, energy wouldn’t be produced and a cascade of cellular functions would be affected.10

Often, hangovers induce a sense of hunger. Alcohol temporarily reduce one’s blood sugar levels, and in compensation, the body may crave satisfying foods.11 Following a night of excessive drinking, one may reach for a nutritionally-depleted burger, as opposed to healthier options. B1-rich foods, like spinach, oats and nuts should be incorporated into one’s diet; especially an alcoholics’; not only will it keep you feeling fuller for longer, but ensure this vital nutrient is sustained in the body. WKS is a long-lasting and debilitating condition, that all alcoholics should be made aware of. Emphasis should be placed on its prevention, such as cutting out alcohol or drinking in moderation, so as to reduce the prevalence of such a serious neurological disease.

During alcohol detoxification, several medications may be prescribed to manage withdrawal symptoms, ranging from emotional instability, sweating, and seizures.12 Three effective drugs are currently approved in Australia for treating severe alcoholism: 1. Naltrezone reduces the reinforcing reward feeling of alcohol and is aimed at patients wanting

to reduce heavy drinking or with the goal of abstinence.13 2. Acamprosate is prescribed to decrease withdrawal cravings and the euphoric sense of

reinforcement that comes with alcohol intake.14 3. Disulfiram produces an unpleasant reaction in a person if they drink alcohol, such as vomiting. Other medications may be recommended for use during detox programs, such as: • Benzodiazepines, like Valium, are used to prevent short-term serious symptoms of withdrawal.15 • Oral carbamazepine is used to prevent and control seizures. • In the case of hallucinations or paranoia, antipsychotics may be prescribed. The journey doesn’t stop there. Following the detox, patients should then transition into programs that offer support and rehabilitation, thereby addressing the root cause of the addiction.

Fortunately, in Australia, treatment can be accessed through a variety of ways, to help an alcoholic get their life back on track: • Support groups • Rehabilitation facilities • Counselling sessions • Drug therapy • Detoxification processes to

remove toxins and manage symptoms of withdrawal

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References

1 Pub Med Health. 2016. How does the Liver Work. U.S. National Library of Medicine. USA. Viewed 8 May 2018. <https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072577/> 2 Baraona, E. and Lieber CS. 1979. ‘Effects of ethanol of Lipid Metabolism. NCBI: Pub Med. Vol. 20. Issue 3. Pp. 289-315. 3 Love Your Liver. n.d. Loving your liver: Alcohol. Website. Australia. Viewed 8 May 2018. <http://loveyourliver.com.au/alcohol/> 4 Burke, D. 2017. Alcoholic Hepatitis. Medically reviewed website. Health Line. USA. Viewed 8 May 2018. <https://www.healthline.com/health/alcoholic-hepatitis> 5 Healthline Editorial Team. 2015. Cirrhosis. Medically reviewed website. Health Line. USA. Viewed 8 May 2018. <https://www.healthline.com/health/cirrhosis> 6 National Health Services: Choices. 2015. Alcohol-related liver disease. Government website. UK. Viewed 8 May 2018. <https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/> 7 Krause, L. and Roth, E. 2017. Wernicke-Korsakoff Syndrome (WKS). Website. Healthline. Viewed 3 May 2018. <https://www.healthline.com/health/wernicke-korsakoff-syndrome> 8 Shelat, A. and Zieve, D. 2016. Wernicke-Korsakoff Syndrome. Government website. Medline Plus. Viewed 3 May 2018. <https://medlineplus.gov/ency/article/000771.htm> 9 Kessels, R. and Kopelman M. 2012. ‘Context Memory in Korsakoff’s Syndrome.’ Neuropsychology Review. Vol. 22. Issue 2. Pp. 117-131. 10 Martin, P., Singleton, C., and Hiller-Sturmhofel, S. 2004. ‘The Role of Thiamine Deficiencies in Alcoholic Brain Disease.’ Alcohol Research and Health. Vol. 27, No. 2. Pp. 134-142. 11 Miller, Korin. 2016. Why You’re So Hungry the Morning after Drunk Eating. Website. Self Magazine. New York, USA. Viewed 3 May 2018. <https://www.self.com/story/why-youre-so-hungry-the-morning-after-drunk-eating> 12 Guarnotta, E. 2018. Alcohol Detox Treatment Programs and Process. Recovery.org. Viewed 4 May 2018. <https://www.recovery.org/topics/alcohol-detox-treatment/> 13 Crowley, P. 2015. ‘Long-term drug treatment of patients with alcohol dependence.’ Australian Prescriber. Vol. 38. Issue 2. Pp. 41-43. 14 Crowley, P. 2015. ‘Long-term drug treatment of patients with alcohol dependence.’ Australian Prescriber. Vol. 38. Issue 2. Pp. 41-43. 15 Eyer, F. et al. 2011. ‘Carbamazepine and Valproate as Adjuncts in the Treatment of Alcohol Withdrawal Syndrome: A Retrospective Cohort Study.’ Alcohol and Alcoholism. Vol. 46. Issue 2. Pp. 177-184. Figure references Beverage image: Roi and Roi. Beer glass vector cartoon illustration isolated on white background. Shutterstock. Viewed 8 May 2018. <https://www.shutterstock.com/image-vector/beer-glass-vector-cartoon-illustration-isolated-594073736?src=Qgg5TleCOrnofR4x5hbQwg-1-0> Liver image: Viva pura Superfoods. 2011. Healthy and Unhealthy Liver. Viva Pura superfoods. Viewed 8 May 2018. <https://vivapura.wordpress.com/2011/03/04/liver-flush/> Thiamine diagram: Gaffera. 2013. Thiamine and lactic acidosis. Tangents. Viewed 8 May 2018. <http://morningreporttwh.blogspot.com.au/2013/09/lactic-acidosis.html>