Dr harold Gunatillake

Alcohol what it does when consumed


Few weeks back I wrote an article on the beneficial effect of alcohol to prevent dementia. Let us delve deeper into alcohol nutrition and discuss what happens to that glass of alcohol you enjoy, in your constitution.

It is a fact there is no social event without alcohol flowing. It relaxes the participants and brings mates together for a relaxed enjoyable evening with conversations, at a party or celebration.

When, even taking two small drinks a day has its added health benefits, but the negative consequences that it brings when taken in excess has problems to self and family.

Alcohol is not an essential food like the carbs, protein fat, vitamin, minerals and water you consume daily. Alcoholic drink primarily consists of water, alcohol and sugar. The calories come from alcohol and sugar are referred to as, ’empty calories’ because of the lack of any nutrients.

Though in most countries people drink alcoholic beverages, the percentage of addiction seems to be small, as most drink only on occasions. People below the poverty line seems to drink more than the affluent.

Alcohol is made through a process of fermentation when sugar breaks down into ethanol (alcohol) and carbon dioxide. At the next stage carbon dioxide gas bubbles escapes into the air, leaving alcohol and water. Then, through a distillation process water is separated from the alcohol.

When we talk of just one drink, we mean a 12-ounce glass of beer, a 5-ounce glass of wine, and a 1.5-ounce shot of liquor and all contain a half ounce of pure alcohol.

Metabolism of alcohol

Alcohol unlike carbs, protein and fat is not stored in the body. Hence the liver metabolises alcohol as a priority in preference to any food you consume.

20 per cent of the alcohol you consume is absorbed directly from your stomach into the blood stream and goes directly into your brain. The rest of the alcohol enters the small gut and is absorbed with the other food. Alcohol is then metabolised in the liver and is excreted through your sweat, saliva, urine and your breath.

Metabolism of alcohol solely occurs in the liver and those who indulge in excess cause liver problems. Alcoholic fatty liver is quite a good example, and with further daily indulgence makes the liver harder (cirrhosis) and lead to failure of functions.

Alcohol is made less toxic through a process of detoxification in the liver, is removed through a process called oxidation.

Excess alcohol damages your liver

One of the severe side effects of alcoholism is liver damage, may lead to death.

Alcohol is converted into acetaldehyde a toxic enzyme that can damage liver cells and cause fibrosis (scarring). It is also a carcinogen. Alcohol dehydrates the body and the liver requires water to function correctly. When the body lacks it, the liver requires to force to pull in water from other sources.

It is very important to hydrate yourself by drinking plenty of water or any sweet drinks after a heavy session of drinking alcohol.

Your liver can become fatty, or cause inflammation (alcoholic hepatitis) and end in cirrhosis with regular excessive drinking.

In a fatty liver there is infiltration or build up of fat in the liver cells when you drink too much of alcohol more than the liver can cope. Fat infiltration causes inflammation of the liver cells and results in alcoholic hepatitis.

Alcoholic hepatitis is caused by excessive drinking alcohol for a long time. Ultimately the liver cells are replaced by scar tissue (fibrosis) and the term cirrhosis is used.

When you are diagnosed with cirrhosis you need to stop alcohol totally and the liver cells may repair and attempt to function normally. If it is in the irreversible phase unfortunately stopping alcohol may not help.

Generally, it is important to eat a healthy diet to lead a healthier liver. Avoid eating processed foods, sugars and saturated fat to ease the burden on the liver.

Most people drink less as they grow older, as the hangovers they experience day after could be a misery. Some people tend to drink more as they get older due to loneliness, losing a loved one, reduced income and so on.

As you get older the ability of the liver to metabolise alcohol declines. Older people drinking the same amount of alcohol as younger people, the blood concentration of alcohol seems to remain longer among the old, as the elimination is slower.

Age related changes and alcohol

Age related changes like your eyesight, hearing and reflexes may get accelerated with chronic excessive alcohol consumption. These changes will make you feel dizzy, unsteady on your feet and alcohol related falls, automobile accidents and so on.

Your medication that you take for your age-related illnesses including heart disease, hypertension, diabetes, among others may have deleterious effects on your body. Please do not mix medication with alcohol. It is advisable not to drink alcoholic beverages when you are on any medication.


Those who drink excessively do not seem to eat nutritious food, because alcohol replaces foods. You may get ill-nourished or malnourished when the essential nutrients do not get into your body. It brings vitamin deficiencies like B1, folate, B12, A, and minerals like calcium.

Amino acid absorption

Proteins you eat in your food is broken down into amino acids and absorbed in the small gut. Alcohol can disturb the normal digestion of food and amino acids may not be absorbed from the proteins in your food.

In situation of a chronic failing liver this can lead to complications, like decreased albumin in your blood causing ascites (fluid in your abdominal cavity, swelling of legs called oedema.

Portal hypertension

Cirrhosis of the liver also causes obstruction to the flow of blood from the gut through the portal veins. The veins get distended and we call the condition as portal hypertension.

Veins in relation to the lower oesophagus and the stomach can get distended and varicosed. These delicate veins can rupture and cause vomiting of blood (haematemesis)

This is an irreversible stage of cirrhosis that causes the veins feeding the liver to distend and rupture.

Fluid collects in your abdominal cavity (ascites), and varicosed veins are seen on the abdominal wall. Legs start swelling and your life is in danger.

How much alcohol can you drink to avoid complications.

For healthy men up to age 60- no more than four drinks in a day and no more than 14 drinks a week.

For healthy women and healthy men over 60-no more than three drinks ina day or seven drinks in a week.

Asians being smaller made should restrict to two drinks a day.

New research, which was presented at the American Association for the Advancement of Science’s annual conference, has found that moderate drinking is linked to a longer life. Drinking about two glasses of wine or beer a day was linked to an 18% drop in a person’s risk of early death—an even stronger effect than the life-preserving practice of exercise, according to the researchers.

A 2015 study of people with mild Alzheimer’s, found that moderate drinkers were less likely to die during the study’s follow-up period than teetotalers. A large 2017 study also found that light and moderate drinkers were less likely to die from cardiovascular disease than those who never sipped. Red wine, in particular, is often singled out for its anti-aging benefits, usually because of a compound called resveratrol — though that explanation may be a little oversimplified, and more research is needed.

A large 2017 study looking at alcohol and heart health, however, was designed to eliminate the possibility of abstainer bias. It still found that moderate drinking may protect against heart attacks, strokes, chest pain and fatal heart disease. (ref: TIME HEALTH-by Jamie Ducharme).

New findings: No healthy level of alcohol consumption, says major study
Governments should consider advising people to abstain entirely, say authors. Article appears in The Guardian-written by Sarah Bosely.

The article states, “Even the occasional drink is harmful to health, according to the largest and most detailed research carried out on the effects of alcohol, which suggests governments should think of advising people to abstain completely.

The uncompromising message comes from the authors of the Global Burden of Diseases study, a rolling project based at the University of Washington, in Seattle, which produces the most comprehensive data on the causes of illness and death in the world.”

Conclusions: If you understand the word ‘moderation’ you are qualified to have a drink or two, daily. Abstaining would be better. Then, studies show that people who drink moderately live longer. Take your pick.
Ref: Alcohol and Nutrition by Betty Kovacs Harbolic

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Good advice by Dr. Harold-Why do most people neglect to check their blood pressure regularly?

Strokes, cardiovascular events, peripheral vascular disease among others, are quite prevalent among our people, as they age.

One question to be asked is,” Do you check your blood pressure regularly?” and the answer would be in the negative, in most cases.

Preventable diseases lead to death due to ignorance and being not health conscious.

Investing in a digital blood pressure monitor should be the responsibility of every household.

Most people would say there were no symptoms to see the doctor. That is quite right, because high blood pressure does not occur overnight to give symptoms. The onset is insidious, and the body gets used to the higher pressures until one day a shocking complication occurs, as described above.

High blood pressure is called the silent killer, because, as mentioned, gives no warning signs or symptoms until a stroke or heart attack occurs. I have repeated this to emphasise the importance of knowing what blood pressure is and take precautionary measures to prevent illnesses, caused from hypertension: the simplest action would be to check your BP regularly with your own monitor in home surroundings.

How does one get high blood pressure? When you are young, your peripheral arteries are tender and elastic and not resilient to the pressure from the contractions of the heart (left ventricle). Their inner lining is smooth so the blood flows with no friction.

As one gets older the peripheral arteries become thickened and we name that condition, “arteriosclerosis”. In addition, plaques tend to build up in most vessels atjunctions, bifurcations and curves where the pressure of the blood turbulence is maximum. This condition we call, “atherosclerosis”, or simply plaques.

Both these conditions develop as one gets older, and the blood vessels become more resilient to the pressure from the contractions of the heart.  More forceful contractions of the left ventricle will result to distribute the oxygenated blood to the periphery. These resulting forceful contractions cause the high blood pressure.

Increased persistent blood pressure can cause aneurysms- a bulge at some weak point of the arteries. They can rupture and cause life-threatening internal bleeding.

One could easily assess the thickness of coronary arteries due to high blood pressure and other causes, by palpating the radial artery at the wrist joint. When you roll two fingers over your radial artery you could feel whether the artery is soft, more elastic, or thickened and feels firm. The latter findings reflect the situation of the coronary arteries, indirectly.

Taking fish oil capsules daily seem to keep your peripheral vessels more elastic. Lifestyle changes, such as less alcohol consumption, eating a low fat and low carb diets, regular exercise, meditation and less stressful life all contribute to keeping your blood vessels more elastic.

Medications could cause high blood pressure

Certain medications can cause high blood pressure. For instance, certain pain and anti-inflammatory medications can cause retention of water, resulting in kidney problems and increasing your blood pressure. Examples are non-steroid anti-inflammatory drugs (NSAIDs),

Certain antidepressants may cause your blood pressure to raise. These antidepressants work by changing your body’s response to brain chemicals, including serotonin, norepinephrine, dopamine and others. The chemicals in these drugs can increase your blood pressure.

Birth control pills and other hormonal birth control devices containing hormones may increase your blood pressure by narrowing smaller blood vessels.

Those who drink coffee, many cups a day can increase their blood pressure caused from caffeine. 200 to 300 milligrams of caffeine can temporarily raise your blood pressure.Medicine taken for colds such as decongestants seems to narrow your blood vessels, increasing your blood pressure. Good examples are Sudafed and neo-synephrine.

Be aware that most herbal supplements can increase your blood pressure. Good examples are Arnica, bitter orange, gingko, ginseng, liquorice, Senna, St. John’s wort and so on.

Certain immunosuppressants can raise your blood pressure, possibly because of the ways immunosuppressants affecting your kidneys.

Taking long term cortisone tablets orally, like prednisone can increase your blood pressure due to water retention.

There are in total about 22 medications that can give you high blood pressure. If you are on any of the above and other medications (not mentioned), it is advisable to record your blood pressure, weekly. Any changes, please contact your doctor.

Uncontrolled high blood pressure can weaken your blood vessels of the brain. Then, they can get narrowed, or rupture with a slow leak. High blood pressure can cause blood clots in the arteries and lead to a stroke, and dementia.

With uncontrolled high blood pressure, your left ventricle muscles of your heart can increase in size (hypertrophy), leading to an enlarged heart seen on plain x-rays of the chest (cardiomegaly).

With further uncontrolled blood pressure, the strain causes your hypertrophied heart muscles to weaken and work less efficiently. Eventually, the muscles weaken and leads to irreversible heart failure.

Just by checking your blood pressure regularly you could avoid life threatening heart failure.

Damage to the brain caused by high blood pressure

Atherosclerosis, a condition that thickens your blood vessels, as described earlier can cause a mini-stroke called Transient ischaemic attack (TIA). It is caused by the release of a blood clot from an atheromatous plaque in the inner lining of the carotid arteries in the neck. TIA is a warning that you are at risk of a full- blown stroke.

The symptoms of TIA are the same with a full-blown stroke, but it can be reversed by prompt medication. You need to be admitted to your local hospital without delay and the clots in the brain can be dissolved with blood thinners (heparin).


This is the most frequent illness caused by neglecting to check your blood pressure regularly. It occurs when part of your brain is deprived of oxygen and nutrients, causing brain cells to die.


In this situation one finds it difficult to think, speak, reasoning, memory loss, vision problems and unstable movements. This occurs due to narrowing and blockage of arteries due to uncontrolled high blood pressure.


Doctors classify high blood pressure as primary (essential) and secondary causes due to other pathological situations. What has been discussed so far is the primary situations where underlying causes cannot be found, other than the factors mentioned earlier.

Among the causes of secondary high blood pressure, kidney disease ranks highest. It can be triggered by tumours of the adrenal glands (glands sitting on each kidney like caps). These tumours secrete hormones that elevates the blood pressure.

Renal artery stenosis

When doctors cannot find a cause for the underlying high blood pressure, narrowing of the renal arteries needs to be ruled out. Stenosis is the word we use for narrowing of blood vessels, and the commonest cause is atherosclerosis, a process in which plaques made up of cholesterol and other material builds up on the inner lining of the blood vessels. If you suffer from primary hypertension, your doctor should investigate and rule out renal artery stenosis.

Abdominal scan studies are done to rule out renal artery stenosis.

Normal blood pressure

If you are diagnosed having high blood pressure you need to bring down the pressures to normal range – less than 120 (systolic) and 80 (diastolic).

In stage 1 hypertension the BP may be 130-139 (systolic) and 80-89 (diastolic)

In stage 2 the systolic is above 140 and diastolic above 90.

In a crisis your systolic pressure could be over 180 and diastolic higher than 120.

If you are diagnosed that you have high blood pressure, it would be your responsibility to take measures to reduce it.

Remedial actions

Walk regularly- Do 20,000 steps a day.

Reduce your sodium intake. Eating tasty restaurant foods are full of salt. Avoid them as much as possible until your p is controlled.

Drink less alcohol

Eat foods containing potassium

Reduce your coffee drinks

Learn to manage your stress

Lose weight

Eat veggies that brings down your BP, such as beetroot, and a variety of other foods and fruits.

Bottom line

Controlling your blood pressure is simple.  Purchase your own BP monitor and check your BP regularly.

Checking your BP regularly can avoid other chronic illness mentioned before.

The author’s personal experience is that walking 30,000 steps at intervals daily, would dilate your blood vessels to reduce your high blood pressure, without medication. Further, that would be the quickest way to get rid of your accumulated ‘triglyceride’ stores in your fat cells to reduce weight. The best way to wash off your unhealthy visceral fat that cause heart disease, would be that way.

Hope this article was of value from a health-point.

About the author: Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey). Government scholar to UK for higher studies








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