I recently treated a middle-aged man who was discharged from the hospital after he had a stroke. He also had hypertension and kidney failure, and I wondered about the underlying cause that could explain these problems. After questioning him further, I found that the unifying explanation was that he had been a heavy drinker for three decades.
Americans have been drinking more during this pandemic. According to Nielsen market data, alcohol sales outside of bars and restaurants have increased 24 percent since mid-March compared to last year.
This should be no surprise since stress and isolation are known risks for drinking excessively. (The CDC defines drinking excessively as a pattern of drinking that raises a person’s blood alcohol to .08 g/dl (grams per deciliter) or above. Generally speaking, this can happen when a man consumes five or more drinks or a woman consumes four or more drinks in 2 hours.)
The irony is that increased alcohol intake leads to impaired immunity, which may increase the risk of more severe Covid-19 infection and mortality. Although alcohol temporarily blunts the brain’s stress response, anxiety, insomnia and stress can actually worsen when it wears off.
Observational studies have shown that moderate alcohol intake is associated with cardiac benefit, but there is a thin line between benefit and harm. Moderate drinking is defined as up to one drink per day for women and up to two drinks per day for men. A standard drink is 12 ounces of beer, 5 ounces of wine or 1½ ounces of liquor. There are some people, though, who should not have any alcohol: those under 21, any woman who is pregnant or planning to become pregnant, anyone planning to drive or do something that requires mental alertness, anyone taking particular medications that should not be combined with alcohol, those with certain medical disorders, and anyone who is recovering from alcoholism or who cannot control the amount they drink.
In the moment of drinking, whether it is for pleasure or escape, a person is unlikely to appreciate its short-term and long-term risks.
Short-term health risks are most commonly due to binge drinking. These include motor vehicle crashes and other injuries, blackouts, drowning, homicide, suicide, sexual assault, domestic abuse, risky sexual behavior, and miscarriage and stillbirth in pregnant women.
The long-term effects of alcohol excess can harm almost every organ of the body. These include high blood pressure, heart disease, stroke, liver disease, pancreatitis, stomach ulcers; cancers of the breast, mouth, throat, esophagus, liver or colon; memory problems including dementia; and mental health disorders such as anxiety and depression. In addition, alcohol excess can result in family problems, divorce and unemployment.
My patient revealed that his systolic blood pressure at the time of his stroke was 238. (Normal systolic BP should be around 120.) Years of drinking heavily led to extremely high blood pressure, which culminated in him having a stroke. Untreated chronic hypertension explains why he also developed kidney failure. A few weeks after his initial visit with me, he had to undergo emergency dialysis.
Surprisingly, my patient’s liver tests were normal, and he had no evidence of alcoholic cirrhosis. The explanation is that during the years he was drinking alcohol excessively, he had the habit of drinking at least two cups of coffee per day. Recent studies have demonstrated coffee’s protective effect on the liver. Compared to those who don’t drink coffee, drinking just one cup of coffee per day has been shown to lower the risk of alcoholic liver disease by more than 50 percent, and drinking four cups per day to lower the risk by more than 80 percent. Interestingly, only drip coffee has been associated with this beneficial effect. Decaf coffee may be helpful, too, as noted by its effect to lower liver enzymes, but this has not been as well studied.
According to the CDC, excessive alcohol use in the U.S. leads to more than 90,000 deaths per year. Among adults ages 20 to 64, alcohol excess is responsible for one in 10 deaths.
My patient had a wake-up call after his stroke, and he has not had another drink. He typifies many with an alcohol-use disorder who quit drinking only after something catastrophic happens. Although he is destined to be on chronic dialysis, he is thankful to be alive.