Bottoms up? | by Lisa Marshall

Posted on Wed, Feb 4, 2015

Colorado’s top ranking in booze-related deaths brings imbibing into question

“Am I drinking too much?” According to a new report from the Centers for Disease Control and Prevention, it’s a question many Coloradans should be asking. Colorado – known as one of the fittest states in the nation – ranked third for alcohol-related mortality, behind only New Mexico and Alaska.

“Alcohol is basically a poison, and your liver is designed to filter out poison,”

Red wine bottle neck with corkWith 14.2 percent of all deaths related either to the long-term impacts of over-imbibing (liver disease, heart disease, breast cancer, etc.) or the acute effects of drunkenness (violence, motor-vehicle crashes, etc.), Colorado exceeds the national average of 10 percent, according to the study, published in June in Preventing Chronic Disease. For those who often end their day with a drink or two, how much is too much might surprise them.

The report defines “excessive drinking” as eight drinks or more during the course of a week for women (who metabolize alcohol more slowly) or 15 for men. “Binge drinking” is defined as four or more drinks on one occasion for women, or five or more for men. At least three in 10 adults regularly exceed those limits, and not all of them are “alcohol-dependent or alcoholics,” the CDC says.

“It’s shocking to see the public health impact of excessive drinking,” says lead author Dr. Robert Brewer, noting that 88,000 people die prematurely each year from the habit.

For some people, moderate alcohol use (one per day for women; two for men) can have health benefits, says J. Mimi Castelo, a board-certified clinical neuropsychologist with the Colorado Neurological Institute. The trouble is, many people don’t know what “moderate” means, she says. “There is a sweet spot, and once you exceed it, you start to see adverse health consequences.”

The first organ to take a hit is the liver, which, after just one drink begins to produce extra enzymes to break down alcohol before it reaches other organs. “Alcohol is basically a poison, and your liver is designed to filter out poison,” says Dennis Ballinger, a certified addictions counselor with Arapahoe/Douglas Mental Health Network. In moderation, the liver can keep up. But even slight excess can damage liver cells, promote inflammation, and prompt fat to build up, potentially leading to fever, nausea, appetite loss, and abdominal pain, according to the National Institute on Alcohol Abuse and Alcoholism. Keep drinking excessively, and the liver can become scarred and unable to perform critical functions, like helping the body absorb nutrients.

Once the alcohol hits the brain, it inhibits production of the energizing brain chemical glutamate, mimics the sedative neurotransmitter GABA, and prompts a surge in feel-good dopamine. That’s why you feel calm and happy. But in excess, those drinks can impair sleep and fuel mental health issues even when you’re not drinking. “Even a couple of drinks per night can influence neurotransmitters and potentially lead to anxiety and depression,” says Ballinger. In the long run, the brain cells shrink, and areas that control executive function and visual-spatial memory atrophy. For instance, Castelo says, people who chronically misuse alcohol might have difficulty remembering recent events, or get lost while driving.

Meanwhile, overdrinking (even binging on one occasion) can dull the body’s immune system by decreasing the function of white blood cells and bacteria-fighting cytokines and cause the heart to beat irregularly.

Red wine glassSo, how much is too much? That depends on the person, says Ballinger. For instance, a woman with no genetic predisposition to alcoholism, who isn’t on any other medication (which can enhance alcohol’s negative effects), and started drinking later in life (rather than as a teenager when the brain is still developing and ripe for addiction), may be able to have nine drinks spread throughout the week and be just fine. For someone who has been drinking since the teen years and has alcoholic relatives, complete abstinence might be a better bet.

The key is to take a hard look at how important alcohol has become in your life, says Ballinger. Is your work, school, or relationship being affected? Do you have to drink more to get the same effect? Do you continue to drink even if there have been negative consequences? If you’ve ever asked yourself if you’re drinking too much, you probably are, Ballinger says.

Here’s how to cut back:

Watch your portions

According to the CDC, “one drink” is: 12 oz. of 5 percent beer; 8 oz. of 7 percent malt liquor; 5 oz. of 12 percent wine. Keep size and potency in mind: A 22-ounce microbrew is not “one drink.”

Drink mindfully

If you like to have a glass of wine after work, make it a “one and done,” says Castelo. Cork the bottle and put it away.

Set a quota

Determine how many drinks you can have in a week and plan accordingly. If you know you’re going to a weekend party, don’t drink during the week.

Find a new routine

“If after work you typically have a drink and sit in front of the TV, don’t sit down in front of the TV,” says Ballinger. Take a walk or a bike ride instead. If you drink to wind down, try hot tea, a bath or a yoga class.

Am I drinking too much?Get to the root cause

Make an honest assessment of why you drink: If it’s to self-medicate for trauma, depression, or grief, backing off on consumption might not be enough. Seek counseling.

For more tips: Log on to http://rethinkingdrinking.niaaa.nih.gov

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