What Alcohol Does to Your Body, Brain & Health – Part 2

In this second part of the article “What Alcohol Does to Your Body, Brain & Health”, we cover

• Food & Alcohol Absorption
• Alcohol & Serotonin & Depression
• Risk for Alcoholism, Blackouts
• Cortisol & Stress
• Genetic Predisposition for Alcoholism
• Consuming Alcohol Too Young

For the first part of the article, please click here

Food & Alcohol Absorption

Let’s consider some of the other neurochemical effects of alcohol in the brain and body. Indeed, whether people have eaten will factor into this, and we’ll talk about that.

You may have heard, for instance, that if somebody’s inebriated and they want to sober up, they should eat something. Turns out that does not work. Here’s how it does work, however. If you eat something prior to drinking alcohol or while ingesting alcohol, it will slow the absorption of alcohol into the bloodstream. If that meal includes carbohydrates, fats, and proteins, the inclusion of all three major macronutrients seems to slow the absorption of alcohol into the bloodstream far more than having any one of those or two of those macronutrients present.

Now, if you are already inebriated or you’ve had a glass of wine or a beer and you eat something, chances are that alcohol has already made it into your bloodstream because it moves into the bloodstream so quickly. Again, it’s fat-soluble and water-soluble, so within minutes, right? If you have an empty stomach, within five to 10 minutes, that alcohol is going to be within your bloodstream and distributed throughout your body. But if you’re already drunk and you eat something, it’s not going to sober you up more quickly.

Alcohol, Serotonin & Depression

Serotonin is a neuromodulator. It changes the activity of neural circuits, those involved in mood and feelings of well-being. With alcohol there are dramatic changes in the activity of neurons that control the release of serotonin. However, a study that was released showed conclusively that serotonin levels can’t really explain depression and depression-like symptoms.

The key thing is this, SSRIs (Selective Serotonin Reuptake Inhibitors), which have the net effect of increasing serotonins, can help alleviate depression. They support relief from depression by changing neural circuits, not necessarily by increasing serotonin itself.

That is, increasing serotonin changes the neural circuits involved in mood, allowing people to feel better through so-called neuroplasticity, which is the brain’s ability to change itself in response to experience. Therefore, when people are depressed, it’s not necessarily because serotonin levels are low. However, if serotonin levels are increased with things like SSRIs, oftentimes there is, yes, a relief from depression, but that’s probably not because of restoring serotonin levels, per se. It’s probably because serotonin facilitates the changes in neural circuits that need to occur for people to feel elevated mood.

Alcohol, when we ingest it and it’s converted into acetaldehyde, that acetaldehyde acts as a toxin at the very synapses, the connections between these serotonergic neurons and lots of other neurons. In other words, when we ingest alcohol, the toxic effects of alcohol disrupt those mood circuitries, at first making them hyperactive. Therefore, people become talkative, people start to feel really good after a few sips of alcohol, at least most people do. And then as they ingest more alcohol or as that alcohol wears off, serotonin levels and the activity of those circuits really starts to drop, and that’s why people feel less good.

And typically, what they do, they go and get another drink and they attempt to kind of restore that feeling of well-being and mood. Now, typically what happens is that as people ingest the third and fourth, maybe even the fifth drink, there’s an absolute zero chance of them recovering that energized mood, right? Most people, as they drink more and more, will now start to feel more and more suppressed.

The forebrain is now shutting down quite a lot, a lot of the motor cortical areas that control coordinated movement and deliberate movement start to shut down, so people start to slur their speech, people start to shuffle their feet, people forget their posture, people start to lean on things, people start passing out on couches. There’s a great depression, not depression of the psychiatric depression sort, but a depression of alertness and arousal, and eventually people will pass out.

Risk for Alcoholism, Blackouts

There’s a subset of people that have gene variants or who are chronic drinkers, as they ingest the third and fourth and fifth drink, what happens? They become more alert, they start talking more, they feel great, they have all sorts of ideas about the fun they could have that night.

And they’re the ones that, if you’ve ever fallen asleep at a party for whatever reason, or you’re getting tired and you’re yawning, you’re looking around the room and, like, these people are still drinking and partying and they’re having what seems to be this amazing time, those are the future alcoholics in the room, or those are the people that have a genetic predisposition for alcoholism, or those are the chronic drinkers, the people who have the chemical genetic makeup such that increasing amounts of alcohol make them feel better and better and better. And of course, they, too, have a threshold beyond which their nervous system will start to get diminished, and they’ll pass out.

Now, this is important to understand because everyone should know and recognize their own predisposition and kind of risk in terms of developing alcoholism. It’s also important to understand because it relates to the phenomenon of blackout.

Many people think that blacking out is passing out, but blackout drunk is when people drink and they’re talking and doing things, sometimes, sadly, or tragically, they’ll often drive home or walk home or they’ll hop on a bicycle and ride home or they’ll go swimming in the ocean, all, of course, very dangerous activities to do when people are really drunk. These people will do these sorts of things and they do them because they have the energy to do them and they feel good while doing them, but they are doing them while the activity of neurons in the hippocampus, which is involved in memory formation, are completely shut off.

And therefore, the next day, you tell them, “Hey, what happened last night?” And it’s very clear that they have no recollection of all the things they were doing despite being awake.

If you’ve ever been blackout drunk, and certainly if you’ve been blackout drunk more than a few times, you should be quite concerned.

Cortisol & Stress

One very interesting finding is that alcohol changes the relationship between the hypothalamus, pituitary gland, and the adrenals. Hypothalamus is a small collection of neurons about the size of a large gumball that sits above the roof of your mouth, and it houses neurons that are responsible for some incredible aspects of our behaviour and our mindset, things like rage, things like sex drive, things like temperature regulation, very primitive functions, including appetite, thirst, et cetera. Alcohol, because it can go anywhere in the brain, remember it’s water- and fat-soluble, has effects on the hypothalamus.

The hypothalamus normally provides very specific signals to what’s called the pituitary gland. This is a little gland that sticks out of the brain, but it receives instructions from the hypothalamus. And then the pituitary releases hormones into the bloodstream that go and talk to your adrenals, and your adrenal gland sit right above your kidneys in your lower back. And the adrenals release, as the name suggests, adrenaline, also called epinephrine, and a molecule called cortisol, which is involved in the kind of longer-term stress response and it has some healthy effects, too, on the immune system. So, the hypothalamic-pituitary-adrenal axis maintains the physiological balance of what you perceive as stressful and what you don’t perceive as stressful.

People who drink regularly, could be just one or two drinks per night or more, they experience changes in their hypothalamic-pituitary-adrenal axis that result in more cortisol, more of this so-called stress hormone, being released at baseline, when they are not drinking.

People who drink a bit, and when I say a bit, I mean people that are maybe having one drink a night with dinner and maybe on the weekend a few more. Such people experience increases in cortisol release from their adrenal glands when they are not drinking, and therefore, they feel more stressed and more anxiety when they aren’t drinking.

People generally talk about the immediate effects of alcohol, right? And we’ve been talking about some of those effects, effects like reducing the amount of stress. We hear somebody say, “Ugh, I need a drink.” And then they have a drink and they’re, like, calmed down, now they can shake off the thoughts about the day’s work, they can start to think about things in a maybe more grounded or rational way, or at least they believe that, or they can somehow just relax themselves.

Well, while that very well may be true, that it can relax them, when they are not drinking, that level of cortisol that’s released at baseline has increased substantially. Again, this relates to a defined neural circuit between brain and body, and it has to do with the ratio of cortisol to some of the other hormones involved in the stress response.

So, alcohol is kind of a double hit in this sense. It’s causing changes in our brain circuitry and neurochemistry that, at the time in which we’re inebriated, are detrimental, and it’s causing changes in neural circuitry that persist long past the time in which we’re experiencing the feeling of being tipsy or drunk.

Now, again, this is not to demonize alcohol. What is important to understand is that if people are ingesting alcohol chronically, even if it’s not every night, there are well-recognized changes in neural circuits, there are well-recognized changes in neurochemistry within the brain, and there are well-recognized changes in the brain-to-body stress system that generally point in three directions,

1. increased stress when not drinking,
2. diminished mood and feelings of well-being when people not drinking,
3. and changes in the neural circuitry that cause people to want to drink even more to get just back to baseline or the place that they were in terms of their stress modulation and in terms of their feelings of mood before they ever started drinking in the first place.

Genetic Predisposition for Alcoholism

There are a couple of important points about genetic predisposition.

First, what sorts of genes are involved in setting someone down the path of alcoholism or not? It should come as no surprise that the genes that chronic alcohol usage modifies tend to fall primarily in the pathways related to genetic control over serotonin receptors, GABA receptors, and the HPA (hypothalamic-pituitary-adrenal) axis. All of those, of course combined with environment, they combine with patterns of abuse.

We know that if you’re in a social setting where a lot of people are drinking, the likelihood that you’re going to drink is much higher due to social pressures. Some people will use alcohol to self-medicate to try and turn off their thinking or to deal with trauma, et cetera. So, the genes that are in the serotonin synthesis and receptor synthesis pathway, GABA and HPA axis, combine with environmental pressures to give rise to alcohol use disorders.

Alcohol dehydrogenase (ADH) is an enzyme responsible for metabolizing the bulk of ethanol consumed as part of the diet and their activities contribute to the rate of ethanol elimination from the blood.  People that have a lot of the enzyme for metabolizing alcohol, alcohol dehydrogenase, it’s not like they are necessarily the people that become alcoholics. There are people that have such low levels alcohol dehydrogenase that when they ingest alcohol, they get very red, and they just feel sick.

So, if you’re somebody that has a sip of alcohol and you just feel horrible, it makes you feel nauseous, chances are you have gene variants that create a situation where you’re not making very much alcohol dehydrogenase. You just simply can’t metabolize alcohol, so you just get a rapid build-up of the toxic effects of alcohol, the acetaldehyde, you’re not converting it into those empty calories.

But there are people who have a lot of alcohol dehydrogenase, sure, they can drink more, and they’re converting more of that alcohol from its toxic form to a non-toxic form. Environmental factors also play a strong role, because if you can drink more, you’re likely to drink more. If you’re somebody that feels sick immediately from drinking, it’s likely that you’re not going to engage in alcohol consumption, especially if these things are genetically related, and, of course, genes and culture and location in the world tend to run together.

So, do you have the gene for alcoholism? Well, there isn’t one single gene. And since you don’t know which genes you have unless you do genetic testing, and those things are available, but most people aren’t doing that. If you’ve noticed that you or somebody else is somebody who can drink a lot throughout the night and have increased energy and can just drink and drink and drink, and especially if there’s blackout episodes, not remembering things the next day despite being alert throughout the entire night and so on, well, then I would be very concerned that you might actually have a genetic variant predisposing you to alcoholism.

Consuming Alcohol Too Young

The other thing that predisposes people to abuse of alcohol is age. People who start drinking at younger ages are greatly predisposed to developing alcohol dependence regardless of your family history of alcoholism.

Those who start drinking at a young age, so for instance, at 13 or younger or 14 or 15, there’s a much higher probability that they’re going to develop a long-lasting dependence on alcohol.

People who take their first sip of alcohol later, 15, 16, or one would hope even later, you know, if they take their first drink at 21, the probability that they’ll go on to develop full-blown alcohol dependence or alcohol use disorder, as it’s called, AUD, is very low. Now, a subset of them will because they have such a strong genetic predisposition or maybe life circumstances create a pattern in which they become a chronic drinker. Genes matter, but also the age in which somebody starts drinking really matters.

It’s very clear that drinking early in life creates a propensity for the development of alcohol use disorder later in life. And while there is a genetic component to developing alcohol use disorder, I find it very interesting that if people who have those gene variants delay their onset of drinking, well, then the probability that they’ll develop full-blown alcohol use disorder drops as well.

This completes the second part of the article. Please also read the 3rd and final part with more details here.

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References

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