How long will it take for alcohol to kill you? 🍻🥃🍷🍹🥂

Let’s start with the obvious statistics then get right onto it. Every year it is estimated that alcohol contributes to the deaths of over 3 million people with men being more affected than women. Whilst some of this death is instantaneous such as with car accidents resulting from drunk driving, most of it is as a result of the slow buildup of health problems associated with alcohol. Most of these health problems will present signs overtime that should be taken as a wakeup call by those who are consistent and heavy drinkers.

Welcome to Ndlalane health newsletters, my name is Sakhile, and I’ll be here with you as we learn about alcohol together. Let’s begin. 😊

The timeline of alcohol-related fatality can easily be misinterpreted because each individual is unique, and they have their own pattern of alcohol consumption, their own alcohol concentration preferences and their unique differences which can speak to their specific health outcomes and genetic risks.  In any case let’s do our best to at-least understand how it work.

So, what happens when one takes an alcoholic drink?  First let’s find out what an alcoholic drink contains. The brewing process is different for every drink but primarily they all contain the following key components:

1. Ethanol (Ethyl Alcohol):  - This is the primary psychoactive ingredient in alcoholic beverages. Ethanol is produced through the fermentation of sugars by yeast. The concentration of ethanol can vary widely depending on the type of alcohol, typically ranging from 4-6% in beers to 40% or higher in distilled spirits.

2. Water: - Water makes up the bulk of most alcoholic drinks, typically around 85-95% by volume. The water content helps dilute the ethanol and provides the base for the beverage.

3. Carbohydrates: - Alcoholic drinks may contain various carbohydrates, such as sugars and starches, depending on the ingredients and manufacturing process. These carbohydrates can contribute to the flavor, body, and mouthfeel of the beverage.

4. Acids: - Alcoholic drinks can contain organic acids like acetic acid, citric acid, and malic acid. These acids help balance the sweetness and contribute to the overall flavor profile.

5. Congeners: - Congeners are minor chemical byproducts produced during fermentation and distillation. Examples include fusel alcohols, esters, and aldehydes. Congeners can affect the taste, aroma, and perceived harshness of alcoholic beverages.

6. Flavor compounds: - Alcoholic drinks may contain a variety of flavor compounds, such as hop compounds in beer, grape compounds in wine, and botanical compounds in spirits. These compounds contribute to the unique flavor profiles of different alcoholic beverages.

The specific composition as I mentioned earlier of any drink can vary significantly depending on the type of alcohol, the raw materials used, and the production methods employed, but generally that’s what you will expect in the alcohol.

Now that you understand that, let us proceed. When an alcoholic beverage is sipped or held in the mouth, a small portion of the ethanol content can be directly absorbed directly into the bloodstream through the oral mucosa (inside the mouth). This is known as buccal absorption. The rate and extent of buccal absorption depend on the concentration of the alcohol. A highly concentrated drink (e.g., in hard liquors) will facilitate faster buccal absorption compared to lower concentrations (e.g., in beer or wine).

In some instances, the vapor or smell of alcohol can also lead to a minor degree of absorption through the nasal and respiratory passages. This process is known as olfactory or intranasal absorption, and it occurs when the volatile alcohol molecules in the beverage's aroma are inhaled and come into contact with the highly vascularized nasal and upper respiratory mucosa.

Then as the alcoholic beverage travels down the esophagus, a small portion of it can also be absorbed through the mucous membranes lining the esophageal walls. This is known as sublingual and esophageal absorption.

Bulk of the absorption however will primarily occurs in the stomach (10 -20%) and the small intestine (80-90%). The small intestine has a large surface area, and this is also where most of the food we eat is absorbed into the blood a well.

Once the alcohol reaches the bloodstream it’s quantity is then referred to as blood alcohol concentration (BAC). Speaking of BAC, this is affected or rather influenced by the differences in body water content, for example women generally have a lower percentage of body water compared to men, which affects the distribution and dilution of alcohol. Some of you may have their eyebrows raised at this moment, saying, “but DocSakhie wait, we thought women have higher water content.” The answer is no, they don’t because women typically have, less muscle mass, less bone density, a higher percentage of body fat (particularly subcutaneous fat) and a smaller average body size. On average, women have a body volume of around 45-50 liters, while men have a body volume of around 55-60 liters. However, this can vary greatly depending on individual factors such as age, fitness level, and body composition.

Alright then, before we get derailed again, we are talking about BAC, women tend to have lower levels of the enzyme alcohol dehydrogenase (ADH), which is responsible for metabolizing alcohol.

The legal BAC limit for women is the same as for men, but women tend to reach higher BAC levels than men for the same amount of alcohol consumption because of the water content reasons we eluded above.

In most countries, the legal BAC limit for drivers is between 0.04% to 0.08%, depending on the specific jurisdiction, this simple means that if the concentration of the blood alcohol goes beyond that, then the person is intoxicated.

I hope you are still with me since we started getting off topic a bit. So, we just drank the alcoholic beverage and it’s absorbed into our blood at this point. Specific absorption rates can vary based on individual factors, such as genetics, sex, body composition, and the presence of food in the gastrointestinal tract.

When alcohol enters the bloodstream, it wreaks havoc like reckless individuals in a supermarket, looting. It metaphorically knocks over shelves, flickers the lights, and creates a mess by spilling contents everywhere. It's like a destructive force that assaults the body's defenses and causes chaos, much like a belligerent person assaulting store employees and leaving a trail of destruction in their wake.

Let’s look at it scientifically for the purpose of this exercise. Once in the blood, the alcohol is distributed to various tissues and cells throughout the body, including the Central Nervous System (Brain and spine) it can have a range of effects on those tissues and cells. For example;

Cell membrane permeability is increased, and it allows for easier passage of substances in and out of cells. This can disrupt the normal functioning of cells and lead to various cellular-level effects.

Enzyme activity is either activated or inhibited on the various enzyme's activities within cells, affecting cellular metabolism and signaling pathways. For example, alcohol can inhibit the activity of enzymes involved in energy production, leading to decreased cellular energy levels.

Oxidative stress: Alcohol metabolism can lead to the production of reactive oxygen species (ROS), causing oxidative stress and damage to cellular components, such as proteins, lipids, and DNA. Chronic alcohol exposure can result in increased oxidative stress and inflammation within cells.

Calcium signaling: Alcohol can disrupt the normal regulation of calcium ion (Ca2+) levels within cells, affecting various calcium-dependent cellular processes. This can lead to changes in cellular signaling, neurotransmitter release, and muscle function.

Gene expression: Alcohol can alter the expression of certain genes, leading to changes in the production of proteins and cellular functions. These changes in gene expression can contribute to the development of alcohol-related health problems, such as liver disease and neurological disorders.

Cell death: Exposure to high levels of alcohol can directly cause cell death (apoptosis or necrosis) in various tissues, such as the liver, brain, and heart. Cell death can impair the normal functioning of these tissues and contribute to the development of alcohol-related diseases.

The specific effects of alcohol on tissues and cells can vary depending on the tissue type, alcohol concentration, and duration of exposure.

I hope the science wasn’t too much and I pray you are still following through the metaphorical process, and I didn’t loose you in the jargon. In recap once more, we have drunk the alcohol and it’s absorbed in the blood, and it’s distributed in the cells and tissues all around the body and it’s causing all manners of mischiefs.

Let’s continue, the body cells and the tissues with the help of the liver start to immediately breakdown the ethanol in an attempt to get rid of this alcohol in the blood. One of the first by products of the ethanol breakdown is a compound called acetaldehyde, which is a highly reactive and toxic compound that can cause various adverse effects, such as flushing, nausea, and headaches. We normal refer to these effects as being hung over or in my language, “uphethwe yi babalazi”

The body quickly converts this toxic substance called acetaldehyde into another one called acetate which is less toxic and can be used by the body for energy production or excreted through urination and sweat. This is the product that gives the drinker the impression that they are not hungry because the body can utilize it for energy. Many alcohol dependent people suffer from malnutrition, and this is one of the contributing factors.

Let’s imagine someone’s first encounters with alcohol in their teen years and continues to drink, occasionally on weekends, holidays and at any other chance they get. At first the body does not have many challenges in detoxifying the BAC but with every war, there are casualties. Our bodies are an amazing machine, and they know how to compensate and replace many of the cells that might or are dying in the war against alcohol detoxification. It is just unfortunate that; some cells are too unique and specific that, they are irreplaceable, especially in our delicate organs like the brain, liver and pancreas. The body being an amazing design that it is, it will always try to compensate for the loss by asking other cells to please try and help do the job of their fellow deceased member, but here is the kick; the owner of the body, which is you, will drink again and start another war. This will go on for years, you can only imagine what is happening at cellular level.

Let’s also imagine an older person, mid to late twenties or even early 30’s or 40’s when they first encounter alcohol. Their body cells aren’t as fresh, young and aggressive at fighting, like how that of the younger person would, but nonetheless they will fight to the death too to protect you. The replacement rate of the war casualties(cells) however is a bit slower, so they take longer to recover from the war (detoxification) and in some instances before they even recover there is another war which the owner of the body starts.

For many people, the manifestation of symptoms is the beginning of the end if they do not stop drinking, the early signs that indicate a cry for help are usually, yellowing or browning of the eyes, thinning of the face, in IsiZulu we call it “phuza-face” (Drinker’s face) and centripetal obesity also known as “umkhaba we beer” (drinker’s belly)

Other signs and symptoms include,

· Heavy drinking: Consuming five or more drinks in a short period for men, and four or more for women at least once a week

· Tolerance for alcohol: The person may need to drink more alcohol to achieve the desired effect

· Drinking to deal with negative emotions or stress which the alcohol has introduced into their life.

· Inability to cut down on alcohol intake

· Drinking until intoxicated at least once a week

· Blackouts

· Preoccupation with alcohol

· Inability to control the amount of alcohol consumed in one sitting

Back to the science, remember we said, when the alcohol gets into the bloodstream, it is transported to all the parts of the body, and it wreaks havoc on the cells and the byproduct created while trying to fight it off are toxic and harmful?  This is what happens over time.  

• There is an increased cortisol production, a hormone that promotes belly fat storage.

• There is an interferes with the body's ability to regulate blood sugar levels, leading to insulin resistance and weight gain. If unlucky type 2 diabetes will start too.

• There can be increase in appetite at first which lead to poor food choices, resulting in consuming more calories and unhealthy foods. Then over time as the cells that sense if someone is hungry are destroyed, there is a reduction in appetite which will lead to poor eating patterns and subsequently malnutrition.

• There is a disruption in gut health, altering the microbiome and leading to changes in how the body processes and stores fat.

The worst thing that can happen however to any person is the lose of ability of their liver to self heal and regenerate. The hepatotoxicity that is brought about by the toxic substances we mentioned earlier, coupled with the overwhelming amount of blood alcohol concentration will undoubtedly cause harm to the liver and when that happens, the gene Z kids would normally say “RIP” because dysfunction of the liver always result in a global catastrophe.

The process of death is slow and painful, for the liver and this is what happens to it.

• Hepatotoxicity: Alcohol is toxic to liver cells, causing damage and inflammation. Liver inflammation is called hepatitis. When it’s inflamed it will scar and then cause other problems like fibrosis and cirrhosis.

• Fatty liver disease: Alcohol can lead to fat accumulation in liver cells, causing fatty liver disease.

• Oxidative stress: the liver's antioxidant balance is disrupted, and oxidative stress starts, and cell damage begins

• Nutritional deficiencies: because there is interference with nutrient absorption, the liver is starved of vital nutrients and its ability to self generate is impacted.

• Gut-liver axis disruption: the gut microbiome is altered, and that leads to changes in the gut-liver axis that can harm liver health.

Liver damage is mostly silent because of the many compensatory mechanisms that it can employ, and symptoms may not appear until advanced stages which can manifest as.

• Acute liver failure (ALF)

• Chronic liver failure (CLF)

• End-stage liver disease (ESLD)

We are drawing closer to concluding and answering the master question but before we get to the question, we can look at the effects on the brain then wrap up. We have been at it for a while now, im sure you are also tired of reading. One last bit of patience. Thank you.

Alcohol can degenerate the brain in several ways which are quite similar to how the damage is done to the rest of the body except that, we need brain cells more than we need the other aspects of our body first.

• The first is neuroinflammation as we have discussed above about the toxic substances that lead to damage and cell death.

• The second is also quite obvious, which is oxidative stress because alcohol disrupts the brain's antioxidant balance, causing oxidative stress and cell damage.

The interesting and unique habit of alcohol in the brain is neurotransmitter imbalance: this is what causes you to feel drunk and drowsy because the the levels and function of neurotransmitters, such as GABA, glutamate, and dopamine are altered. Neurotransmitters are the little messenger boys that makes sure that, information is moved around the whole brain and body at speeds above that of light. Some move too quick in areas that are not meant to continuously experience that type of speed i.e. dopamine and caused over excitement, some move too slow and cause motor impairment and slur speech or even depression i.e. GABA. So alcohol puts the wrong messengers at the wrong places and there is confusion everywhere in there.

Due to repeated drinking and cell death, the brain will start to shrink especially at the level of the hippocampus and cerebellum. The hippocampus is responsible for memory, learning and emotions. It also deals with distinguishing between real life and fiction amongst a lot of other functions. The cerebellum on the other hand is also responsible for balance and movement, learning and memory and cognitive function. I don’t want to preach to a choir about what happens to a person when these parts of the brain are affected.

Another important region that gets affected the most is the white matter of the brain. Degradation of this area will lead to communication disruptions between brain regions. Everyone is doing their own thing and what they want in your brain, one part says let’s stop drinking while the other says let’s go get wasted again tonight because the euphoria feels amazing, it makes us forget about our problems.

This level of damage is called neuroplasticity disruption which means that there is an impairment to the brain's ability to adapt and change, leading to cognitive decline.

Lastly as an exercise for you, alcohol leads to gut-brain axis disruption, which is similar as well to how it happens to the liver, there will be vitamin deficiencies particularly thiamine (Vitamin B1), which will lead to Wernicke-Korsakoff syndrome. (Your assignment; find out what this syndrome is and email the answer back to me by responding to this email or to [email protected] )

The list of problems that alcohol can cause to the brain are too long to mention all here but people who have reached their end stage will manifest with

• Alcohol-related dementia

• Wernicke-Korsakoff syndrome

• Alcohol-related brain damage

• Cognitive decline

• Memory impairment

• Mood disorders

To some degree some of the damage can be stopped from progressing, depending on the extent and duration of alcohol consumption. It’s always better to stop drinking than to continue.

In conclusion, let’s answer the golden question. How long will it take for alcohol to kill you? The answer is, the minute you start drinking alcohol you are already in an active war with an enemy you cannot defeat, therefore alcohol starts to kill you the first time you consume it. 

Other factors like your health status, concentration of your alcohol choice, your nutritional status, your healthy habits, and your genetic predisposition will contribute to how long the war will last.

Thank you for reading up to this far and I hope to see you in our next installment.

Cheers bye for now, don’t forget to invite your friends to subscribe to our newsletter emails by  clicking here and follow out WhatsApp page by clicking here .