What happens when you drink alcohol? How does the body handle it? Why do you get drunk? How is the alcohol detoxified? These are a few of the many questions presented by thinking people.
O.
K.
, so you slurp down a few at a party - what happens? Unless the aim is poor, they end up in that marvelous receptacle, the stomach.
Alcohol is quickly absorbed by the lining of the stomach, called the gastric mucosa.
Fortunately, nature puts the skids on this gastric absorption rate in a hurry, and a good 90 percent alcohol absorption takes place when it hits the small intestine.
Generally speaking, the speed in which someone gets "crocked" depends upon the blood alcohol level he or she develops, and this in turn depends upon how quickly the alcohol is dumped into the small intestine.
Therefore, anything that slows down the emptying time of the stomach, slows down the absorption process.
O.
K.
, now what slows down the emptying time of the stomach? The main factor is food.
If you eat when you are drinking, the process is delayed up to several hours.
Alcoholics learn this simple fact early in the game.
They have never heard of a gastric emptying time or alcohol blood levels, but they know that if they drink on an empty stomach, they are bombed very quickly.
What else slows the absorption time? The higher the concentration of alcohol ingested, the slower it is emptied.
Cold temperatures slow it down.
High sugar concentrations slow the process down.
The big factor, however, is food - carbohydrate, protein, and fat.
Now, let us assume that our beloved C2H50H has escaped from the stomach and is proceeding merrily down into the small intestine.
Alcohol doesn't last very long in the small intestine.
It is absorbed quickly and into the blood it goes.
Essentially it stays there and is diffused through our tissues until our good buddy, the liver, gets hold of it.
We do get rid of some alcohol through the lungs and the kidney, but the liver handles the job to the tune of over 90 percent.
This remarkable organ provides some 500 odd functions.
It is truly a unique piece of equipment.
Now, friends, we come upon one fact that we should dwell upon.
The rate at which the liver metabolizes alcohol is almost constant, regardless of the blood alcohol content.
What is the sign drunkeness? Well, it means that you are not going to sober up until the liver gets rid of the alcohol; and the liver will take its own sweet time, regardless of what you do.
Oh, there are some intravenous mixtures, such as fructose, which speed things up; or you could always hook up to a kidney machine.
But generally you can stand on your head, drink nine quarts of tomato juice or burn incense to Buddha; no matter, the rate of detoxification proceeds at the same pace.
We pointed out that on any given day the rate at which an individual detoxifies alcohol remains the same, and there is little we can do about it.
As time marches on, however, and the liver gets more and more practice, its efficiency picks up.
The rate at which it can dispatch booze may double.
Let me tell you, an alcoholic 's Iiver gets one hell of a lot of practice.
This is important for two reasons: It is one explanation why it takes more booze to gain the effect an individual desires.
Since many other drugs use these same metabolic pathways, it is a reasonable explanation why these drugs disappear from the system so quickly.
The central nervous system learns, too.
As it is subjected to constant depression by alcohol, it learns to operate at blood levels higher than the average.
These two factors explain why some people can drink enormous quantities and still appear to be sober.
Of course, their bodies may be shells from the direct damage of alcohol, but they can still operate to a point.
Remember that the liver can handle just so much; after that, alcohol just builds up in the system.
One phenomenon should be mentioned.
As the chronic alcoholic progresses, he seems to hit a point where the pendulum swings the other way in regard to quantity versus intoxication.
Indeed, if there is liver damage, then this organ cannot detoxify the alcohol as it used to, and blood levels rise quickly.
Why this phenomenon occurs in subjects without liver damage, I cannot explain; but most alcoholics eventually experience a reversal of tolerance.
I suppose this is as good a place as any to mention the dehydration principle.
Everyone, including the physician, assumes that when the alcoholic stops drinking, he is dehydrated.
He needs flu ids.
As a general principle, this is entirely wrong.
Occasionally, we see a chronic addictive, skid-row type who is in and out of jail and hasn't eaten for days and is found flat on his back in the gutter.
He indeed may need fluids; but the other 99 percent are usually overly hydrated.
Ever get up in the morning after a prolonged drinking bout? Your mouth feels like the Russian army walked through it.
Alcohol, being blown off by the lungs, has been expired through it for many hours.
This dries the mouth out.
The salivary glands have cut down their fluid production as a direct result of ethanol insult.
Alcohol acts as an astringent.
It shrinks up the blood supply.
Smoking dries the mouth out too.
Small wonder the mouth is all puckered up! The doctor looks in the oral cavity and says to himself, "This guy needs fluids! " Another factor should be mentioned that is slightly more complicated.
Most alcohol is consumed in a fluid vehicle.
As all this fluid is being consumed, the body naturally strives to get rid of it.
The pituitary gland secretes a hormone called ADH antidiuretic hormone.
As you may have guessed, when this hormone is released, fluid is retained.
Alcohol does not allow this hormone to be released as long as the blood alcohol level is rising.
In other words, as our friend is getting plastered, he keeps running to the bathroom.
However when he stops drinking, nothing prevents the pituitary from releasing the hormone, and all of a sudden the fluid is being conserved.
The ADH goes to work and puts the skids under the kidneys.
In cutting down on the fluid loss, valuable minerals like potassium, sodium, chlorides and magnesium are conserved.
There is no dehydration unless there is protracted vomiting, diarrhea, profound malnutrition, or infection.
A sad commentary is that many physicians are totally unaware of the complications of alcohol ingestion.
It really isn't their fault, either.
Less than 10 percent of the medical schools teach anything about alcoholism!
O.
K.
, so you slurp down a few at a party - what happens? Unless the aim is poor, they end up in that marvelous receptacle, the stomach.
Alcohol is quickly absorbed by the lining of the stomach, called the gastric mucosa.
Fortunately, nature puts the skids on this gastric absorption rate in a hurry, and a good 90 percent alcohol absorption takes place when it hits the small intestine.
Generally speaking, the speed in which someone gets "crocked" depends upon the blood alcohol level he or she develops, and this in turn depends upon how quickly the alcohol is dumped into the small intestine.
Therefore, anything that slows down the emptying time of the stomach, slows down the absorption process.
O.
K.
, now what slows down the emptying time of the stomach? The main factor is food.
If you eat when you are drinking, the process is delayed up to several hours.
Alcoholics learn this simple fact early in the game.
They have never heard of a gastric emptying time or alcohol blood levels, but they know that if they drink on an empty stomach, they are bombed very quickly.
What else slows the absorption time? The higher the concentration of alcohol ingested, the slower it is emptied.
Cold temperatures slow it down.
High sugar concentrations slow the process down.
The big factor, however, is food - carbohydrate, protein, and fat.
Now, let us assume that our beloved C2H50H has escaped from the stomach and is proceeding merrily down into the small intestine.
Alcohol doesn't last very long in the small intestine.
It is absorbed quickly and into the blood it goes.
Essentially it stays there and is diffused through our tissues until our good buddy, the liver, gets hold of it.
We do get rid of some alcohol through the lungs and the kidney, but the liver handles the job to the tune of over 90 percent.
This remarkable organ provides some 500 odd functions.
It is truly a unique piece of equipment.
Now, friends, we come upon one fact that we should dwell upon.
The rate at which the liver metabolizes alcohol is almost constant, regardless of the blood alcohol content.
What is the sign drunkeness? Well, it means that you are not going to sober up until the liver gets rid of the alcohol; and the liver will take its own sweet time, regardless of what you do.
Oh, there are some intravenous mixtures, such as fructose, which speed things up; or you could always hook up to a kidney machine.
But generally you can stand on your head, drink nine quarts of tomato juice or burn incense to Buddha; no matter, the rate of detoxification proceeds at the same pace.
We pointed out that on any given day the rate at which an individual detoxifies alcohol remains the same, and there is little we can do about it.
As time marches on, however, and the liver gets more and more practice, its efficiency picks up.
The rate at which it can dispatch booze may double.
Let me tell you, an alcoholic 's Iiver gets one hell of a lot of practice.
This is important for two reasons: It is one explanation why it takes more booze to gain the effect an individual desires.
Since many other drugs use these same metabolic pathways, it is a reasonable explanation why these drugs disappear from the system so quickly.
The central nervous system learns, too.
As it is subjected to constant depression by alcohol, it learns to operate at blood levels higher than the average.
These two factors explain why some people can drink enormous quantities and still appear to be sober.
Of course, their bodies may be shells from the direct damage of alcohol, but they can still operate to a point.
Remember that the liver can handle just so much; after that, alcohol just builds up in the system.
One phenomenon should be mentioned.
As the chronic alcoholic progresses, he seems to hit a point where the pendulum swings the other way in regard to quantity versus intoxication.
Indeed, if there is liver damage, then this organ cannot detoxify the alcohol as it used to, and blood levels rise quickly.
Why this phenomenon occurs in subjects without liver damage, I cannot explain; but most alcoholics eventually experience a reversal of tolerance.
I suppose this is as good a place as any to mention the dehydration principle.
Everyone, including the physician, assumes that when the alcoholic stops drinking, he is dehydrated.
He needs flu ids.
As a general principle, this is entirely wrong.
Occasionally, we see a chronic addictive, skid-row type who is in and out of jail and hasn't eaten for days and is found flat on his back in the gutter.
He indeed may need fluids; but the other 99 percent are usually overly hydrated.
Ever get up in the morning after a prolonged drinking bout? Your mouth feels like the Russian army walked through it.
Alcohol, being blown off by the lungs, has been expired through it for many hours.
This dries the mouth out.
The salivary glands have cut down their fluid production as a direct result of ethanol insult.
Alcohol acts as an astringent.
It shrinks up the blood supply.
Smoking dries the mouth out too.
Small wonder the mouth is all puckered up! The doctor looks in the oral cavity and says to himself, "This guy needs fluids! " Another factor should be mentioned that is slightly more complicated.
Most alcohol is consumed in a fluid vehicle.
As all this fluid is being consumed, the body naturally strives to get rid of it.
The pituitary gland secretes a hormone called ADH antidiuretic hormone.
As you may have guessed, when this hormone is released, fluid is retained.
Alcohol does not allow this hormone to be released as long as the blood alcohol level is rising.
In other words, as our friend is getting plastered, he keeps running to the bathroom.
However when he stops drinking, nothing prevents the pituitary from releasing the hormone, and all of a sudden the fluid is being conserved.
The ADH goes to work and puts the skids under the kidneys.
In cutting down on the fluid loss, valuable minerals like potassium, sodium, chlorides and magnesium are conserved.
There is no dehydration unless there is protracted vomiting, diarrhea, profound malnutrition, or infection.
A sad commentary is that many physicians are totally unaware of the complications of alcohol ingestion.
It really isn't their fault, either.
Less than 10 percent of the medical schools teach anything about alcoholism!
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