A Night of Serious Drinking: The Results

"A systematic review of the next‐day effects of heavy alcohol consumption on cognitive performance"

The latest scientific rundown on the ramifications of hangovers, in the journal Addiction, can be found HERE.

 

Single Bout of Binge Drinking Linked to Immune System Effects

The hazards of a leaky gut.

Biology for $1000, Alex: An integral part of the cell walls of Gram-negative bacteria, these toxic compounds can trigger inflammation and other immunological responses after a single episode of heavy drinking.

Answer: What are endotoxins?

The outer membranes of gram-negative bacteria contain toxic elements known as endotoxins, or lipopolysaccharides. An endotoxin is released when a bacterial cell wall is breached, allowing virulent proteins to enter the bloodstream. When endotoxins engage with the immune system, the result is inflammation—a necessary part of healing, yet potentially damaging to surrounding cells and tissue. When you come down with a cold, those aches and pains come are caused by your immune system inducing inflammation to fight the virus. Chronic inflammation is not a good thing. Higher levels of circulating endotoxins have been linked to numerous health issues.

Binge drinking: Almost everybody does it now and then, and some drinkers do it every day. So what is binge drinking, anyway? The NIAAA defines it as a drinking pattern that results in a blood alcohol level of 0.08 or above. This means about four drinks for women and five for men over a period of about two hours. “In chronic alcohol use activation of the inflammatory cascade is a major component of organ damage in the brain and liver,” according to researchers at the University of Massachusetts Medical School.  “Alcohol binge can cause altered immune functions that can also contribute to immunosuppression and reduced immune-mediated host defense to pathogens.”

Nobody ever claimed binge drinking was good for you. But the work done by researchers at the University of Massachusetts Medical School on a small group of drinkers shows that a single episode of five drinks or more “can cause damaging effects such as bacterial leakage from the gut into the blood stream,” said Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The work was funded by the National Institutes of Health (NIH). The study “tested the effects of acute binge drinking on serum endotoxin and bacterial 16S rDNA in normal human adults.” Led by Gyongyi Szabo, a professor at the University of Massachusetts Medical School, the study in PLOS ONE  documented increases in endotoxin levels in the blood and evidence of bacterial DNA from the gut.

The investigators found that the concentration of endotoxin observed in the serum after an acute binge had significant biological activity, in particular a “significant induction of inflammatory cytokines.” In a prepared statement, Szabo said: “We found that a single alcohol binge can elicit an immune response, potentially impacting the health of an otherwise health individual. Our observations suggest than an alcohol binge is more dangerous than previously thought.” Fever, hypotension, and septic shock may develop due to endotoxins.

Compounding the harm to internal organs caused by alcohol is “gut permeability,” meaning that toxins have a better chance of escaping through the intestinal wall, wandering to other parts of the body, where they do harm. When you combine greater gut permeability with increased levels of circulating endotoxins, you get alcohol-related liver damage and other problems. Binge drinking, the researchers believe they have shown, is a good way to speed up that process.

In short, binge drinking helps gram-negative bacteria break the gastric barrier, escape the stomach, and colonize the small intestine, which puts them into systemic circulation. Bad news. The only bacteria that should be colonizing the small intestine is your neighborhood-friendly graham-positive Lactobaccilus, which aids digestion.

Unfortunately, the study also added to the growing mountain of evidence showing the ways in which alcohol affects women differently than men (See my report on gender-specific alcohol treatment in Scientific American.) Binge drinking showed a greater effect on women with respect to both endotoxemia and bacterial DNA levels.

According to the report: “Compared to men, women showed a slower decreased in blood alcohol levels (BAL), and even 24 hours after the alcohol binge BALs were higher in women than that in men…. Serum endotoxin levels were also higher in women after alcohol intake and a significant difference in endotoxin level was observed at 4 hours between men and women.”

Bala S., Marcos M., Gattu A., Catalano D. & Szabo G. (2014). Acute binge drinking increases serum endotoxin and bacterial DNA levels in healthy individuals., PloS one,  PMID: 24828436

Binge Drinking in America

And the numbers are… fuzzy.

Public health officials in the UK have been wringing their hands for some time now over perceived rates of binge drinking among the populace. In a 2010 survey of 27,000 Europeans by the official polling agency of the EU, binge drinking in the UK—defined as five or more drinks in one, er, binge—clocked in at a rate of 34%, compared to an EU average of 29%. Predictably, the highest rate of UK binge drinking was found in people between the ages of 15 and 24. This still lagged well behind the Irish (44%) and the Romanians (39%). Scant comfort, perhaps, given the historical role drinking has played in those two cultures, but still, clearly, the British and the rest of the UK are above-average drinkers.

Or are they? And what about the U.S. How do we rank? For comparative purposes, we can use the “Vital Signs” survey in the United States from 2010, performed by the Centers for Disease Control and Prevention, and published in CDC’s Morbidity and Mortality Weekly Report, results of which are pictured above. Using almost the same criteria for binge drinking—five drinks at a sitting for men, four drinks for women—the study concludes that the “overall prevalence of binge drinking was 17.1%. Among binge drinkers, the frequency of binge drinking was 4.4 episodes per month, and the intensity was 7.9 drinks on occasion.”

By the CDC’s definition, the heaviest binge drinking in America takes place in the Midwest, parts of New England, D.C., and Alaska. Survey respondents with an income in excess of $75,000 were the most serious bingers (20.2%), but those making under $25,000 binged more often and had more drinks per binge than other groups, the report says. And binge drinking is about twice as prevalent among men. Binge drinking, the survey concludes, is reported by one of every six U.S. adults.

Even so, it appears that the U.S. does not have the same level of binge drinking as the UK. However, astute readers have no doubt noticed that actual binge drinkers in the U.S. were consuming almost 8 drinks per bout, well above the official mark of four or five drinks at one time. The problem is that there is no internationally agreed upon definition of binge drinking. A 2010 fact sheet from the UK’s Institute of Alcohol Studies (IAS) maintains that “drinking surveys normally define binge drinkers as men consuming at least eight, and women at least six standard units of alcohol in a single day, that is, double the maximum recommended ‘safe limit’ for men and women respectively.”

But referring to binge drinking as “high intake of alcohol in a single drinking occasion” is misleading, says IAS. The problem is biological: “Because of individual variations in, for example, body weight and alcohol tolerance, as well as factors such as speed of consumption, there is not a simple, consistent correlation between the number of units consumed, their resulting blood alcohol level and the subjective effects on the drinker.”

Furthermore, the report charges that “researchers have criticized the term ‘binge drinking’ as unclear, politically charged and therefore, unhelpful in that many (young) people do not identify themselves as binge drinkers because, despite exceeding the number of drinks officially used to define bingeing, they drink at a slow enough pace to avoid getting seriously drunk.”

There you have it. As currently defined and measured, binge drinking is a relatively useless metric for assessing a population’s alcohol habits. “The different definitions employed need to be taken into account in understanding surveys of drinking behavior and calculations of how many binge drinkers there are in the population,” as the UK report wisely puts it. Take the above chart with a few grains of salt.

Photo Credit: CDC

The Economic Cost of Heavy Drinking

Some food, or rather, some drink for thought.

A recently released study conducted for the CDC Foundation estimates that the economic costs of excessive drinking in American totaled $223.5 billion in 2006.  Binge drinking accounted for 76.4%, or $170.7 billion of the total costs, according to the report. Binge drinking is defined as 4 or more drinks for women and 5 or more drinks for men within a two-hour period.

The report estimates that the per capita cost of excessive drinking was approximately $746 for every man, woman, and child in the United States in 2006. 

Here is a breakdown of the cost of excessive drinking:

·         72.2% ($161.3 billion) - Lost productivity
·         11% ($24.6 billion) - Healthcare
·         9.4% ($21.0 billion) - Criminal Justice
·         7.5% ($16.7 billion) - Other costs (e.g., property damage)

(The study was conducted for the CDC Foundation, a nonprofit enterprise that creates programs with the Centers for Disease Control for fighting threats to health. The study analyzed 2006 costs obtained from national databases.)

Graphics Credit: http://cdc.gov

Drug Links, Various

It’s summer vacation. Did I turn off the stove?


Some recent posts I wrote before ending my run as editor of TheFix.com News Blog:

Drugging the Elderly
Why seniors take too many of the wrong medications at the wrong dose.

Never Heard of Kratom? You Will.
A plant from Thailand with opiate-like properties is the latest "designer drug" speeding its way through America.

How Binge Drinking Causes Fetal Damage
Studies in mice show that alcohol is toxic to DNA in the absence of two specialized enzymes.

Senators Blast Feds for Border Scandal
Botched gun-smuggling scheme put weapons in the hands of Mexican drug thugs, endangered informants, and may have gotten agents killed.

Testimonials to Betty Ford
In the wake of Mrs. Ford’s death, celebrities and politicians tell their personal stories about her work in raising awareness of addiction and recovery.

New Synthetic Marijuana Arrives to Replace Spice, K2
Designers are already busy with the second generation of cannabis-like drugs.

Crack and Coke Will Finally Receive the Same Legal Penalties
Civil rights leaders charged that the legal system's intense obsession with crack amped up minority arrests, but had no scientific basis. Turns out they were right.

Miracle-Gro Goes After the Medical Marijuana Market
It’s just quasi-legal cooperative organic gardening, right? All $1.7 billion of it.

(R.I.P. Amy Winehouse)

Study Probes Military’s “Culture of Binge and Underage Drinking”

Problems continue after active duty.

A University of Minnesota study found a level of underage binge drinking in the military that the study’s lead author called “dangerous to both the drinkers and those around them.” Mandy Stahre, the epidemiologist who headed up the study, said the results were disturbing, “given the equipment and dangerous environments commonly encountered by active duty military personnel.”

The article, “Binge Drinking Among U.S. Active-Duty Military Personnel,” appears in the March issue of The American Journal of Preventative Medicine. Researchers at the University of Minnesota and the Centers for Disease Control analyzed the results of an anonymous health survey of 16,000 military personnel conducted in 2005. (The group defined binge drinking as four or more drinks in one session for men, and three or more drinks for women.) In an interview with a University of Minnesota radio station, Stahre said that 43 percent of the active respondents reported binge drinking in the past month. Stahre said the figure represents “a total of 30 million episodes of binge drinking, or 32 episodes of binge drinking per person per year.” 5 million of those episodes, Stahre said, involved active duty personnel under the age of 21.

These figures are scarcely surprising, but the implications are no less nerve-wracking. Stahre said military binge drinkers were five times more likely to drive while drinking, compared to non-binge drinkers. Moreover, binge drinking is chronically under-reported in the military, Stahre said, cautioning that the conclusions in the study “may be conservative.” She called for an increase in alcohol excise taxes, stricter military enforcement of a minimum drinking age of 21, and “greater efforts at screening and counseling for alcohol misuse” in the military.

What can a study of this nature accomplish? Stahre said she hopes it will provide “further evidence that binge drinking is a major public health problem in the U.S. and in the military. And the military may be in a unique position to help reduce this problem in the general population, particularly given that nearly 13 percent of U.S. adults report current or past military service.”

Last summer, a study published in the August 13 issue of the Journal of the American Medical Association (JAMA) demonstrated that Reserve and National Guard combat personnel returning from the wars in Iraq and Afghanistan were at increased risk for “new-onset heavy drinking, binge drinking and other alcohol-related problems.” The article also found a strong association between posttraumatic stress disorder (PTSE) and substance abuse among returning veterans.

photo credit: http://navyformoms.ning.com/

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Economy Down, Addictions Up?

Do people drink more or less during a recession?

According to a report from Mintel, a consumer research firm, "sin stocks" historically have performed well during times of economic recession. "Chocolate, cigarettes and alcohol again seem relatively recession-proof," comments Marcia Mogelonsky, senior analyst at Mintel.

Lest anyone think that somehow the tobacco dragon has been tamed after 45 years of public health announcements (surely no one can afford cigarettes anymore?), Mintel documents that "cigarette and tobacco product sales increased 44% from 2003 to 2007 to $103 billion.” Moreover, “as price and tax increases continue to take hold, Mintel projects that the cigarette and tobacco market will grow 28% through 2011 (to $132 billion).”

There is also a bull market for chocolate: “Innovative, dark and premium chocolates are extremely popular, so Mintel expects Americans to continue indulging in this favorite treat. The market research firm predicts 4% annual sales increases each year for the next six years.”

As for alcohol, a mixed picture: “Motivated by high gas prices and expensive bar tabs, more Americans are opting to drink at home. But that doesn't mean they're drinking less. New research from Mintel reveals the market for at-home alcohol is expected to reach $77.8 billion in 2008, a 32% increase from 2003.” Mintel expects in-home alcohol sales to rise as much as 5% per year.

However, earlier studies of the matter have been inconclusive. Melissa Healy reported in the Los Angeles Times that the connection between “hard times and hard drinking isn't clear. In the U.S., a state's alcohol consumption declined by 3% for every one percentage point increase in that state's unemployment rate, according to one study. But another study found that rates of binge drinking went up 8% when unemployment rose 5%. The increase in binge drinking was concentrated most heavily among adults who were still employed.”

In the Los Angeles Times article, Andrew Barnes of the UCLA School of Health Services, estimates that “during this economic decline, those who drink alcohol will consume 12% less (10% less nationally), there will be a 13% reduction in alcohol-impaired driving, and a 1.2% decrease (1% nationally) in the number of people who drink at all. The probability of being a heavy drinker (consuming 60 or more drinks per month) is predicted to decline in California by 31%.”

Graphics Credit: www.bloggingstocks.com

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Book Review (Part Two): "Women Under the Influence"

The Rise of the Binge Grrls

“Women get drunk faster, become addicted more quickly, and develop alcohol-related diseases—such as hypertension and liver, brain and heart damage—more rapidly than men.” --The National Center on Addiction and Substance Abuse at Columbia University


Today, about one out of every four American girls has had one or more alcoholic drinks by the age of 13, according to “Women Under the Influence,” a book by Columbia’s National Center on Addiction and Substance Abuse. In the 1960s, only 7 percent of girls reported having consumed alcohol by that age.

80 per cent of college women living in sororities engage in regular bouts of binge drinking, compared to 35 per cent of non-sorority college women. While most women are moderate drinkers, the Center estimates that at least six million girls and women meet the DSM-IV criteria for alcohol abuse and dependence.

When it comes to alcohol, the study turned a few common assumptions upside down. For example, the more education a woman has had, the more likely she is to be a drinker. Surveys indicate that 36 per cent of women with less than a high school education drink alcohol, compared to 60 percent of women who attended college. White adult women are more likely to be drinkers than African-American, Hispanic, or Asian-American women. And while men traditionally drink more than women, women are fast closing that gender gap. Among high school seniors, the percentage gap between heavy-drinking boys and heavy-drinking girls was 23 percent in 1975. By 2003, the difference was only 12 percent, and among very young teenagers, girls have closed the gender gap completely. In addition, older women have higher rates of late-onset (over age 60) alcohol abuse than men.

Teenage girls whose mothers drank regularly during pregnancy are six times more likely to report alcohol use than girls whose mothers did not drink. Whatever the cause, or most likely causes, no such maternal relationship has been demonstrated for teenage boys of drinking mothers. And—bearing in mind that such estimates are fraught with peril—the Center concludes that genetic factors account for as much as 66 percent of the risk for alcohol dependence in women. As evidence, women who are alcoholics are somewhat more likely that male alcoholics to come from a family with a history of alcohol abuse.

Women metabolize alcohol differently than men do. With less water and more fatty tissue in their bodies, blood alcohol levels are higher for women than for men, given the same number of drinks. After two beers, women are more likely than men to exceed legal levels of alcohol in the bloodstream. Women get drunk faster and have heavier hangovers, and the reason may stem from differences in ADH enzyme activity in breaking down alcohol into its byproducts. (More research is needed.) Female alcoholics also develop liver diseases like cirrhosis more frequently than alcohol-abusing men, and at lower levels of alcohol intake.

From the sociocultural point of view, women are targeted heavily in alcohol advertising, primarily through promotion of the idea that alcohol will relax sexual inhibitions and improve communication with men. Alcohol advertising has increasingly zeroed in on selling beer to women—“beer’s lost drinkers,” as one brewery spokesman put it. Only about 20 per cent of women currently drink beer regularly. Ironically, the alcohol industry’s official code of ethics forbade the use of women in alcohol ads until 1958. And as recently as 2003, the Code of Responsible Practices of the Distilled Spirits Council of the United States specifically prohibited any ads or marketing materials that “degrade the image, form or status of women…”

All of the foregoing pales in comparison to the potential for damage among pregnant women who drink. The fact that alcohol is dangerous to fetal development is not a recent discovery. Aristotle pointed out that “Foolish drunken or harebrain women for the most part bring forth children like unto themselves.” While warning signs on alcohol containers and tavern doors have become a common sight, the study group estimates that about 10 percent of pregnant women still drink. (That number is quite likely higher, given the reluctance of patients to accurately report their alcohol intake). “Drinking during pregnancy,” according to the Center, “is the single greatest preventable cause of mental retardation” in America today. Indeed, the number of birth defects caused by alcohol in one year exceeds the total number of recorded thalidomide births.

Tragically, “As many as 60 percent of pregnant women who drink do not discover their condition until after the first trimester.” In addition to the well-known Fetal Alcohol Syndrome (FAS), there is also a range of other neurobehavioral deficits to the fetus associated with drinking during early pregnancy. Pregnant women who drink heavily suffer three times the normal risk of miscarriages and stillbirths. In fact, to this day, no safe level of alcohol intake during pregnancy has been established. The American Academy of Pediatrics continues to advise women who are pregnant or thinking of becoming pregnant to abstain for alcohol completely.

Part Two of Three

Women Under the Influence--purchase info