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412750027305000The Truth About Alcohol’s Damaging Effects. Is it worth the buzz?It is widely established that alcohol is an extremely common drug of choice amongst many age groups, however the level of its consumption differs from person to person. Nowadays, alcohol abuse and alcoholism affect a great percentage of individuals throughout the world. 4984750560705?2011-2018 The Awkward 00?2011-2018 The Awkward Over time, there is the belief that alcohol should be consumed in moderation as it is detrimental to our health. This thought goes so far back that it is even stated in the New Testament by St. Paul, acknowledging that ‘drunkenness barres the gates of Heaven and desecrates the body’. [1]Recently, many countries around the world face a rise in liver disease and deaths caused by alcohol. [1] What is in your drink that makes it a poison to your body though?What is in that drink?Researchers are trying to identify the biological source of alcohol’s properties, effects in our bodies and behavioural involvement, which is also essential for the development of effective therapies using pharmaceutical drugs.According to research findings, the reinforcing properties of alcohol (including the positive emotional state that a few drinks might give you) are due to alcohol and its metabolites, mainly ethanol and its products (such as the toxic substance acetaldehyde, the first metabolite) affecting the central nervous system (CNS). [2] Therefore, when you have a drink, your body tries to eliminate the harmful substances in it, through central (brain) and peripheral (liver) metabolic pathways, process and remove it from your system. [2] What is the relationship between our liver and alcohol?3155950871220Figure 1: Alcohol and its by-products in the body (DiMartini, Andrea, 2015)00Figure 1: Alcohol and its by-products in the body (DiMartini, Andrea, 2015)3016250-51308000When you have a drink, most of the alcohol is metabolised by the liver. It is the main organ that is involved in the detoxification of the body. [3] Even though this essential organ can actually repair itself, long-term alcohol abuse has damaging effects on its functions, as it does not have time to detoxify the body from the harmful metabolites of alcohol. The sooner an alcoholic person quits, the easier it is for the liver to become healthy again. [4]Oxidation is the chemical process for the elimination of alcohol in the liver, it involves the main enzyme alcohol dehydrogenase (ADH) and gives way to other cellular metabolic pathways. This enzyme converts alcohol to acetaldehyde as shown in figure 1, passing through a few steps before the chemical breakdown to CO2 and water. [1]Over time, excessive alcohol consumption together with other risks including genetic, environmental, metabolic and immunologic factors, increases the risk of liver disease and other serious conditions associated with liver function. A diseased liver ranges from steatosis (fatty liver), through steatohepatitis, fibrosis and later cirrhosis, leading to hepatic (liver) failure. The development of cancer is not excluded, as well as the damaging effects in other parts of the body such as the brain. [1] Brain damage due to alcohol: Wernicke-Korsakoff SyndromeThe first and acute phase of Wernicke-Korsakoff syndrome is called Wernicke's encephalopathy (WE) and it is an acute neuropsychiatric disorder due to thiamine (vitamin B1) deficiency in the brain. The condition is commonly (but not exclusively) associated with alcohol abuse and malnutrition of thiamine. [5] It is a reversable disorder if it is treated on time, however if left untreated it progresses to the second and chronic phase, the Korsakoff syndrome, which may lead to mental dysfunction, permanent neurological impairment, and death. [8]According to Girard et al. (1956), the clinical symptoms and outcome of Wernicke’s syndrome and Korsakoff’s disease were similar, therefore the two conditions together is called the Wernicke–Korsakoff syndrome. [6]338455080962500Common symptoms of the syndrome include cognitive symptoms such as memory loss and the triad: ataxia (involuntary muscle movements), confusion and nystagmus (involuntary eye movement) relating to brain neurologic dysfunction. Mental disorientation, apathy, drowsiness, confabulation (neurologic disturbance associated with distorted memories) and sometimes unexplained hypothermia and hypotension are also observed [5,6]Due to the fact that Korsakoff syndrome is hard to distinguish from other causes of dementia, only 20% of people affected by the syndrome experience recovery and up to 25% do not show any mental health improvement and will eventually need institutionalization. [7] What is the role of Thiamine?3448050590550Figure 2: Normal brain on left, Wernicke’s syndrome on right. (McCandless D.W., 2009)00Figure 2: Normal brain on left, Wernicke’s syndrome on right. (McCandless D.W., 2009)Thiamine otherwise called Vitamin B1, is an important nutrient that is required by the human body, especially the brain. Chronic alcohol misuse usually causes an insufficient diet, which later results in thiamine 33274000Table: Recommended Vitamin B1 dosage (Carol Rees Parrish et. Al, 2009)0Table: Recommended Vitamin B1 dosage (Carol Rees Parrish et. Al, 2009)deficiency. [5] The decrease of vitamin levels in parts 324485029845000of the brain causes an alteration in the structure of the brain as seen in figure 2. [6]Thiamine treatment to people with Wernicke encephalopathy is vital in order to avoid development of KS and permanent brain damage, however since there are no universally accepted guidelines regarding the mode, frequency of administration of vitamin B1 and the optimal dose of therapy, new recommendations are continuously being made in the pharmacotherapeutic field. [5]What is the approach of alcoholism detox? Detoxification of alcohol at a rehab facility is the best idea for people that struggle with alcoholism. In the facility these people are encouraged to develop healthier lifestyles, eat regular meals and care for themselves. They are also supplemented daily with multivitamins and oral thiamine. [5] Other drugs that can help with the detoxification process include benzodiazepines to help treat withdrawal symptoms (anxiety, insomnia, and seizures), as well as relapse prevention medications, acamprosate and naltrexone in people with severe alcohol addiction, to help remain abstinent. [10] Disulfiram is also a drug known as second-line treatment, prescribed by a specialist and Nalmefene is known to be helpful in people reducing their alcohol intake. [10]ReferencesDiMartini, Andrea. Alcohol Abuse and Liver Disease, edited by James Neuberger, John Wiley & Sons, Incorporated, 2015. ProQuest Ebook Central, G.A., Brodie M.S., Rodd Z.A. (2011) What is in that Drink: The Biological Actions of Ethanol, Acetaldehyde, and Salsolinol. In: Sommer W., Spanagel R. (eds) Behavioral Neurobiology of Alcohol Addiction. Current Topics in Behavioral Neurosciences, vol 13. Springer, Berlin, HeidelbergMaher, Jacquelyn J. "Exploring alcohol's effects on liver function." Alcohol Health & Research World, Winter 1997, 5+. Academic OneFile (accessed May 6, 2018). to Repair Your Liver After Long-Term Alcohol Use [Internet]. The Recovery Village. 2018 [cited 6 May 2018]. Available from: Latt N, Dore G. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders. Internal Medicine Journal. 2014;44(9):911-915.McCandless D. W. Thiamine Deficiency and Associated Clinical Disorders. Springer Science & Business Media, 29 Αυγ 2009, Contemporary Clinical Neuroscience.Gerridzen I, Moerman-van den Brink W, Depla M, Verschuur E, Veenhuizen R, van der Wouden J et al. Prevalence and severity of behavioural symptoms in patients with Korsakoff syndrome and other alcohol-related cognitive disorders: a systematic review. International Journal of Geriatric Psychiatry. 2016;32(3):256-273.Donnelly A. Wernicke-Korsakoff syndrome: recognition and treatment. Nursing Standard. 2017;31(31):46-53.Carol Rees Parrish, R.D., M.S., Thompson Allan D., Guerrini I., Marshall J.E. Practical gastroenterology, Series Editor. June 2009;21.Sinclair J. Drugs for alcohol dependence. Medicine. 2016;44(12):761-763. ................
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