Alcohol's Influences On Various Disease States - medical conditions, such as diabetes and hyperlipidemia can be worsened by the use of alcohol

Alcohol Research & Health,  Wntr, 1999  by Ron Weathermon,  David W. Crabb

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Many people who are being treated for chronic health problems, such as diabetes and high blood pressure (i.e., hypertension), consume alcohol, whether occasionally or regularly. As described in the main article, alcohol consumption, even at moderate levels, may interfere with the activities of many medications prescribed for such conditions. In addition, however, alcohol use may contribute to or exacerbate certain medical conditions.

Diabetes

In people with diabetes, control of the levels of the sugar glucose in the blood is severely impaired, either because these people lack the hormone insulin, which plays a central role in blood sugar regulation, or because their body does not respond appropriately to the insulin they produce. Alcohol consumption in diabetics can result either in higher-than-normal blood sugar levels (i.e., hyperglycemia) or in lower-than-normal blood sugar levels (i.e., hypoglycemia), depending on the patient's nutritional status (Emanuele et al. 1998). Thus, long-term (i.e., chronic) alcohol consumption in well-nourished diabetics can lead to hyperglycemia. Conversely, alcohol consumption in diabetics who have not eaten for a while and whose glucose resources are exhausted (i.e., who are in a fasting state) can induce hypoglycemia. Both hyperglycemia and hypoglycemia can have serious health consequences. Diabetes medications that substitute for or stimulate the body's own insulin production (e.g., insulin or sulfonylureas) also may lead to hypoglycemia.

Alcohol-induced hypoglycemia occurs in the fasted state, when the diabetic's blood sugar levels are already low and the body depends on the production of new glucose molecules (i.e., gluconeogenesis) to maintain sufficient blood glucose levels. Gluconeogenesis, which occurs in the liver, requires certain compounds whose levels are regulated by a substance called reduced nicotinamide adenine dinucleotide (NADH). Alcohol metabolism in the liver generates excessive NADH levels and thus reduces the levels of the compounds needed for gluconeogenesis, thereby contributing to a further drop in blood sugar levels. This response is particularly critical in diabetics taking medications that can cause hypoglycemia. Consequently, these patients should be advised to drink alcohol only with or shortly after meals.

Diabetics who consume alcohol also must be alert to the fact that the symptoms of mild intoxication closely resemble those of hypoglycemia. Accordingly, diabetics should check their blood glucose levels whenever they are uncertain about whether their symptoms are caused by hypoglycemia or alcohol intoxication (for additional recommendations for diabetics who consume alcohol, see the textbox). Finally, patients using certain diabetes medications (e.g., chlorpropamide) should be cautioned that the medications can cause a disulfiram-like reaction when alcohol is consumed.

Hyperlipidemia

In people with hyperlipidemia, the levels of fat molecules in the blood - particularly molecules called triglycerides - are higher than normal. This condition can be associated with an increased risk of various health problems, the most serious of which is cardiovascular disease. Alcohol consumption may exacerbate hyperlipidemia, because the same metabolic alcohol effects that inhibit gluconeogenesis also inhibit fat metabolism. As a result, the production of certain molecules called very low density lipoprotein (VLDL) particles is increased. Thus, people with elevated triglyceride levels in the blood should probably abstain from alcohol to determine if alcohol consumption is contributing to their elevated lipid levels.

Hypertension

Elevated blood pressure is a risk factor for cardiovascular disease, including heart attacks. Alcohol is known to cause a dose-dependent elevation in blood pressure (Beilin 1995). Researchers do not yet know exactly what levels of alcohol consumption cause hypertension (for more information, see the article by Klatsky, pp. 15-23). However, all patients who are diagnosed with high blood pressure should be questioned regarding their alcohol intake before being started on antihypertensive therapy. In some of those patients, cessation of drinking alone may reduce blood pressure and thus obviate the need for pharmacological treatment. Furthermore, patients taking certain kinds of cardiac medications (e.g., isosorbide [Isordil[R] and Ismo[R]], terazosin [Hytrin[R]], doxazosin [Cardura[R]]) should be warned that alcohol consumption in combination with those medications may cause lower-than-normal blood pressure. These important potential risks associated with even moderate alcohol consumption (i.e., one or two standard drinks(1) per day) must be considered when discussing the cardiovascular benefits associated with moderate drinking (e.g., reduced risk of heart attacks and certain kinds of strokes.)

Hepatitis C Infection

Infection with the hepatitis C virus, which can result in serious and even fatal liver damage, is common in the United States and around the world. The only effective treatment to date involves a substance called interferon-[Alpha], often in combination with an agent called ribavirin, and has a cure rate of approximately 40 percent. Heavy alcohol use in patients infected with hepatitis C accelerates the rate of liver damage and increases the risk of cirrhosis. Moreover, heavy alcohol use appears to reduce the number of hepatitis C-infected people who respond to treatment with interferon-[Alpha]. Researchers do not yet know how alcohol consumption exacerbates disease progression and interferes with treatment. Nevertheless, people infected with the hepatitis C virus probably should avoid using alcohol, particularly during interferon-[Alpha] treatment.