March 2011 Ides of March

The Doctor Is In

Gail Hacker MD
Gail Hacker, MD

March 2011

Beware the Ides of March!

health clinic graphic icon of stethoscopeMarch fifteenth marks the Ides of March, best known as the day Julius Caesar was killed, and now celebrated in some countries (and in U.S. college fraternities) by folks donning bed sheets, marching through the streets, and reveling at Toga Parties. What better time to review party drinks?

Did you know...?  Alcohol is one of the most commonly used and abused substances.Unfortunately tobacco ranks right up there---but not on our tobacco free campus! Because both of these substances are sold legally they are more available than others, such as marijuana, methamphetamine, cocaine, and heroin. Prescription drugs, illegally used by those other than the person they were prescribed for, or in dosages outside of the range of a written prescription, are becoming more of a problem as well.  In case you didn't already know this, this misappropriation of a controlled substance is a felony offense.

Beware the ides of march graphic of drinking personIs there a safe dose of alcohol? If you are a child (defined as younger than 18), are pregnant, have hepatitis B or C or any other liver disease, the answer is categorically no. Developing brains are very susceptible to any kind of toxin (poison) and, yes, alcohol is considered a poison in these settings. Alcohol is removed from your body by the liver, causing it to ramp up its workload. Not a good thing if your liver is damaged or stressed by infection or other causes. There have been studies that suggest that a small amount of alcohol daily (defined as 1 average sized beverage for women and 2 for men) may help protect a person from heart disease and stroke, but anything more than 3-4 drinks daily on a regular basis is associated with significant illness, including cirrhosis, bleeding into the brain and stomach, and pancreatitis, to name a few.  And it's pretty obvious how alcohol can affect the judgment and reaction time of someone who is driving under its influence.

Rx:  Coffee?  The age-old tale has it that coffee helps sober up a drunk. Not true. Caffeine simply makes your brain think it needs to stay awake.  In no way does caffeine counteract the effects of alcohol on a person's judgment or level of impairment. It simply allows you to stay awake longer and drink more, leading to a state of "wide-awake drunkenness." This can and does lead to increased risk taking such as driving while intoxicated as well as increased sexual behavior, both consensual and forced.

What's all the fuss about energy drinks and alcohol? After a number of college students were hospitalized in Washington with acute alcohol poisoning after drinking Four Loko, that state banned the sales of these ready-to-drink concoctions of alcohol and caffeine. Shortly thereafter the FDA banned the sales of Four Loko anywhere in the US. But college students, being smarter than the average bear, have made their own versions of this revolting drink by mixing energy drinks and hard liquor of their own choosing. 

So what's the problem with this?  Isn't it the same as drinking rum and coke or Irish coffee? Again, the answer is a big no. The concentration of caffeine in "energy" drinks is much higher than in soda, sometimes as high as 3 to 8 shots of espresso in an easy-to-gulp small bottle of liquid. The energy provided by these drinks is a direct result of this high caffeine punch, not the additional factors that are thrown into the mix. These are added because it allows the manufacturers of these drinks to bypass the federal guideline that limits the amount of caffeine that can be added to soft drinks. Caffeine is a drug. It is a stimulant that raises a drinker's heart rate, blood pressure, and state of arousal. In high doses it can cause heart rhythm abnormalities and has been associated with sudden death, particularly in athletes who use these to get pumped up for competition.

Faster and More Impaired (My Overdose Is Quicker Than Yours):  Blood alcohol levels rise more rapidly when liquor is combined with caffeine, so a person can reach a level of impairment more rapidly. Seen as an advantage by some, it is a major concern of physicians. Inexperienced drinkers and binge drinkers are much more likely to overdose and reach a point of toxicity because of this effect. It is not uncommon for a person to pass from "pleasantly intoxicated" to passed out drunk very rapidly with this combination. Some of the kids in Washington had blood alcohol levels well over 0.3%, a potentially lethal level. At this level people can stop breathing altogether and certainly cannot protect their lungs if they experience that other well-known phenomenon associated with too much alcohol—puking, praying to the porcelain god, and passing out. Breathing vomit into your lungs is not only disgusting, it can kill you.

woman in sunshineToga Party Take-Away:  Just some food for thought as we head towards Toga Party season (and that other holiday associated with drinking green beer) - All things in moderation.

Supporting you in good health,
Gail Hacker, MD