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synergy · 1
Alcohol and fructose are both metabolized mainly in the liver, and both push the liver to turn surplus material into fat: metabolizing alcohol generates a flood of NADH, and fructose is broken down rapidly in the liver, using up ATP. Taken together, their push toward fatty liver may add up.
depletes · 3
Long-term drinking drains folate in several ways: it blocks absorption in the gut, increases loss through the kidneys and disrupts one-carbon metabolism in the liver. Alcohol combined with low folate raises homocysteine and throws DNA methylation off, which is thought to speed up alcoholic liver damage. Drinking in pregnancy is especially dangerous, and low folate adds to the risk of neural-tube defects.
Long-term drinking makes the gut absorb thiamin (vitamin B1) poorly and depletes the body's stores, while its need for thiamin does not fall. The most serious result is Wernicke encephalopathy, with abnormal eye movements, unsteady walking and confusion, which can progress to Korsakoff syndrome. A long-term drinker with these symptoms needs emergency care right away; hospitals usually give B1 before giving glucose to such patients, so as not to set off an acute attack.
People who drink heavily over the long term often eat too little and absorb poorly, so they tend to run short of protein and energy, and their absorption of vitamin B1, B12 and folate falls; alcohol also damages muscle directly (alcoholic myopathy), speeding up muscle loss.
regulates · 5
Alcohol raises uric acid in two ways: the lactate produced while metabolizing alcohol competes with uric acid for the kidney's excretion route, so less uric acid is cleared, and beer itself carries a fair amount of purines. In Choi 2004's cohort of men, beer had the strongest association with gout, spirits came next, and moderate wine showed no association (an observational study).
Long-term drinking increases a liver enzyme called CYP2E1. The reactive oxygen species it produces keep damaging the liver, and it converts more acetaminophen (a common fever and pain reliever) into a toxic metabolite. There are case reports of acute liver failure in heavy long-term drinkers who took this drug at ordinary doses.
←After birth and breastfeeding
The alcohol level in breast milk is essentially the same as in the mother's blood, peaks 30 to 60 minutes after a drink, and falls only as the liver clears alcohol from the blood; newborns break alcohol down at about half the adult rate. Not drinking is safest; after a single drink, wait at least 2 hours before breastfeeding.
Alcohol and hepatitis B damage the same organ. Among hepatitis B carriers, the more they drink, the higher their liver cancer risk. This comes from observational studies (an association that cannot by itself show cause), but the direction is consistent and the mechanism is plausible.
Alcohol is one of the reversible causes of high blood pressure: the more you drink, the higher your blood pressure tends to be, and cutting back or stopping brings it down somewhat within weeks. It is one of the few blood pressure measures that shows results quickly.
contrast · 2
Carbohydrate and alcohol both supply energy, but neither is strictly an essential nutrient: the body can make its own glucose through gluconeogenesis, and alcohol provides nothing but calories, with no requirement at all. Among the macronutrients, what the body truly cannot make are the 9 essential amino acids and 2 essential fatty acids.
Milk thistle is often treated as permission to keep drinking, yet in alcoholic liver disease it had no significant effect on death or complications; what changes the outcome is drinking less or not at all, which lightens the liver's load of breaking down alcohol.