Thursday, September 13, 2007

Problem-Based Learning : File Case (2) - Alcoholism And Obesity

After the first trigger last week, we have our second case coming this week. This time,our case file revolves around this Mr Anthony, who is a 56 years old retiree.He has the weight of 90kg at a height og 160 cm. Not only that, he has a habit of drinking 6 cans of beer per day. Doing nothing except sitting on sofa and watching movies everyday, he has become a total social recluse.So, we have a 56 years old married guy who has problem of obesity and alcoholism.


After some research, we found out lots of informations regarding alcoholism and obesity. We started to discuss about alcoholism. It's always the best to know the whole mechanism on how alcohol is being absorped our body, how it is being distributed and how our body eliminate them. Alcohol (ethanol)is a very small molecule (very volatile) which has acidic properties that can dilutes easily with water. It can be taken into the body by any of the common routes of administration for drugs, but most effectively, by oral ingestion.As soon as it enters our mouth and throat, it actually already started to diffuse into our cells and to our blood vessels. Once enter to our stomach, it is being given ''1st class treatment'' where it can be absorped directly through the wall of our stomach, as it is small in saiz, without being digested by different enzymes.20% of the alcohol will be absorped in our stomach whereas the rest of it will be absorped by the small intestine, where a rapid absorption is being carried out. If the alcohol concentration is very high, the pylorus valve that connects the stomach to small intestine can go into spasm, as a way to protect the rapid absorption of concentrated alcohol through the wall of small intestine, since our liver cells have a certain rate in breaking down the alcohol that enter our body and too high concentration of alcohol in blood stream can cause coma or more severe effect, death and that's why alcohol stays in our stomach for a prolonged period. The rate at which the alcohol is being absorped in our stomach usually depends on a few factors, such as concentration of alcohol consumed, type of beverages (carbonated drinks speed up the process), gender, body fat tissues, food ingested and etc. Once enter our blood stream, alcohol will be distributed to all the parts of our body - brain, liver, kidney, lungs and etc.The alcohol concentration in our blood is measured by BAC / BAL (blood alcohol concentration/blood alcohol level). Alcohol will be carried to all cells (except fat cells)of body and enter to the cells together with water, since it's soluble in water but not in fat. Our body eliminate alcohol through our body main detoxification organ , the liver. Our liver cells are able to break down alcohol molecules by converting them to other molecules. The mechanism is as follow:

The Breakdown of Alcohol
The breakdown, or oxidation, of ethanol occurs in the liver. An
enzyme in the liver called alcohol dehydrogenase strips electrons from ethanol to form acetaldehyde. Another enzyme, called aldehyde dehydrogenase, converts the acetaldehyde, in the presence of oxygen, to acetic acid, the main component in vinegar. When ethanol is oxidized to acetic acid, two protons and two electrons are also produced. The acetic acid can be used to form fatty acids or can be further broken down into carbon dioxide and water.
Other than this chemical method, our body also eliminates alcohol through other organs like kidneys and lungs. Kidney eliminates 5% of the alcohol in urine whereas the lungs exhale 5% of the alcohol in our breath,which explains why the smell in our breath after we drink beer,or any alcohol beverages.


The effects of alcohol on our body can be divided to short term effects (immediate effects) or long term effects. The effects are dependent on a variety of factors,such as age, weight, sex, amount of food and alcohol consumed and etc. After drinking alcohol, the short term effects can be differentiated to 6 stages, which are euphoria (0.03-0.12% BAC), excitement (0.09-0.25% BAC), confusion (0.18-0.30% BAC), stupor (0.25-0.40% BAC), coma (o.35-0.50% BAC) and lastly death (more than 50% BAC). So, at low doses, basically it impairs our brain cells' functions, and thus significantly affect our normal judgement, interpretation, coordination, self-control, and all sorts of brain functions. One has to realize that alcohol is actually a drug that depresses our central nervous system, just like sedatives and definitely not a stimulant. Although there are drinker who actually become more daring, more aggreasive and feel more emotional, and actually these ''stimulations'' occur only because alcohol affects parts of brain which control brain judgement, and these '' stimulations'' are actually a depression of self-control by our brain. Not only alcohol affects our brain cells, it also causes dulled hearing, slow time reaction, impaired vision, slurred speech, hazy thinking, weakened muscles, fogged memory and hangover effects (including nausea, headache, thirst, dizziness and fatigue).


Long term effects, on the other hand, are far more dangerous than short term effects. It affects most of our vital organs. Long term exposure of alcohol on our liver can cause our liver cells death and the hardening of tissue (cirrhosis of the liver) due to overworked and increased activity of liver cells. The brain cells will die also, and with each drinking episode, our central nervous system functions deteriorate in a predictable sequence, start with intellectual functioning, followed by disturbances in sensory and motor control. Last affected will be the automatic biological functions, such as breathing and beating of heart. Brain is the most affected organ by alcohol, and most noticable effects are memory lost, confusion ,augmentation (is a physiological response to alcohol which results in hyper-alertness to normal situations, perceiving light as brighter or sounds as louder than usual, or the drinker’s becoming extremely sad or angry for no apparent reason). All of these are the injuries caused by alcohol to brain cells, as alcohol cuts off the oxygen supply to brain cells, and lack of oxygen can kill thousands of brain cells each time you drink.So,let's put all in an easy way,prolonged and chronic usage of alcohol can cause death of brain cells and reduce our brain total mass. Other than that, long term effects also include increased tolerance and dependency on alcohol. Alcohol can also cause stomach and intestinal ulcers as the constant alcohol use irritates and degrades the lining of these organs.Blood pressure can also increase, as the heart compensates for the initially reduced blood pressure caused by alcohol, and ''blood sludging'', where red blood cells clump together causing small vessel to clot up, starve the tissues of oxygen and cause cell death (in brain), thus sometimes anemia can also occurs in those heavy drinker due to sedation of bone marrow (where red and white blood cells are made) which reduces the amount of red and white blood cells formed, and hence low resistance towards infections. In addition, alcohol will result in low amount of sperm productions because of decreased sex-hormone,testosterone secretion (increased of female sex hormone,estrogen and cause enlarged breast and decreased in body hair). This is because alcohol sedates our endocrine glands. Chronic usage can even cause infertility in both men and women. And most often, alcoholics may suffer from poor nutrition,as a result of lacking of vitamins (due to poor absorptions in small intestine).Also, as drinking alcohol rises the blood sugar level steeply, our pancreas produces high amount of insulin to lower it which causes fast drop of sugar level and can lead to hypoglycemia (chronic low blood sugar level), and gradually, the overworked pancreas may stop producing insulin and results in diabetes.One should know that alcohol actually contains higher caloric values compared to carbohydrate, 7 calories per gram, almost as high as fat (8 calories per gram), which explain why exessive alcohol always link to ''beer belly''. Alcohol has not nutritional values, except that it can provide energy, thus can cause obesity but in the same time, malnutrition due to lack to vitamins.


The treatments for alcoholics are not very advancing at this moment. There are medicines to take, but mostly it depends on the drinker himself/herself. Supports of family members, and group/individual counsellings are very important to help them in kicking out alcohol of their lives. And of course, drinkers must have strong will, determinations and perseverance to be able to success and thus mental supports and encouragement from family,friends or lover are very crucial.


Of course, small amount of alcohol can actually help in improving our health . This is because small amount of alcohol can increase our blood pressure (heart pumps faster), and improve blood circulation, and when our blood circulation is working well, it improves of health as well, just like when the road traffic is good, less problem occurs. And here are some interesting facts on alcohol and our body :

1) Why after drinking, we have red and blotchy skin, our eyes become redish as well, if we drink too much?
This is because after drinking, red blood cells clump together, blocking the vessels, and the increased pressure leads to bursting of vessels, and thus, red , blotchy skin and eyes noticed.
2)Is alcohol one of the factors lead to obesity?
Alcohol can cause obesity, as it contains 7 calories per gram, and has no other nutrional values.

3)Why is it we will blackout or feeling nausea and vomit after drinking too much?
Due to large amount of alcohol can cause serious damage to our body, it's actually one way of our body system to protect ourselves by vomitting out the alcohol which is in our stomach, and thus give more time for liver cells to detoxify. Blackout is actually due to large amount of brain cells are affected by alcohol as lack of oxygen, thus neurons in our brain stop working, and we just black out. It's also one way of our body system to protect ourselves from taking in more alcohol.

4)Men or women are affected more by alcohol?
The answer is women. As when we compared men and women of same height, weight and build, men tend to have more muscle cells and less fat cells than women and because muscle tissue has more water than fat tissue, alcohol dilutes more in muscle tissue. Therefore, given an equal amount of alcohol will be diluted more in men than women, and thus women will feel the effects of alcohol more than men , as the BAC is higher.In addition, women who drink during pregnancy risk the development of both mental and physical defects in their children. Effects on the child can include: growth deficiencies; poorly formed bones and organs, heart abnormalities, cleft palate, retarded intellect, delayed motor development, poor coordination, behavior problems, and learning disabilities.


Part I on alcoholism finished, Part II on obesity - to be continued...

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