Health - A glass or two can’t hurt, can it?

[Lunar Loops]

This from The Times (UK):

A glass or two can’t hurt, can it?
Judith Heath had only a couple of drinks every night after a tough day – but it nearly cost her life when her liver failed. Graeme Whitcroft reports

Like most social drinkers, Judith Heath, 57, enjoyed a couple of glasses of wine at the end of the day. In fact, wine with her evening meal was a daily event. “I saw nothing wrong with it,” says Heath, a former practice manager for a doctor’s surgery in Birmingham. “After a hard day’s work my husband John and I would nearly always open a bottle of wine before we sat down to dinner.

“Most nights we would polish off the bottle between us and at the weekend we might have some with our lunch, especially during the summer if we were at a barbecue or having friends round. As far as we were concerned, we drank no more or less than most of our friends. In fact, we considered wine our hobby and prided ourselves on our knowledge of it, often driving to France to stock up.”

It may have seemed normal, but it nearly cost Heath her life. In July 2004, after 20 years of daily drinking, acute liver failure as a result of alcoholic cirrhosis was diagnosed and she spent the following two years in a slow and painful recovery. She hasn’t been able to touch alcohol since and, because her liver struggles to process fatty foods, she has to watch everything she eats.

Her drinking pattern was one that would be recognised by millions of couples up and down the country. While national attention has focused on the problems of teenage binge drinking, there is an equally pernicious problem in Middle England. This was demonstrated in a report published in October by the North West Public Health Observatory, part of the Centre for Public Health, indicating that more than a quarter of adults in the most prosperous parts of the country are drinking at “hazardous” levels. And, according to NHS figures released this week, cases of liver cirrhosis have doubled in the past decade.

For people like Heath, alcohol has moved from being a treat enjoyed on high days and holidays to a daily ritual: a G&T to unwind when you get home from work, a shared bottle of wine at dinner, and maybe a bit more at weekends. But such daily indulgence can add up. Heath calculates that she was clocking up five units of wine a day in the week and about ten units a day at the weekend – about 45 units a week (approximately four-and-a-half bottles), three times the recommended limit for women. But she didn’t notice a problem.

“It was a very traumatic time”

In fact, alcohol became a necessary emotional crutch in her life when, in April 2002, her workload increased and she began to feel the pressure. “It all got too much, so much so that I was given a three-month sick note by the doctor in April 2003. At the same time John had been made redundant and we knew that my job was our only source of income. It was a very traumatic time. I didn’t hit the bottle, but I did drink slightly more than I had done.”
With hindsight, Heath realises that there were some telltale signs that she was becoming ill. But like so many social drinkers, she simply failed to recognise them. “I wasn’t suffering from hangovers or blackouts,” she says. “I didn’t wake up craving a drink. How could I have a problem with alcohol? But from Christmas 2003 onwards I wasn’t well. From always having had a healthy appetite, my interest in food began to wane. I was also having trouble sleeping. I suffered from swollen ankles in the morning, which I now know is a sign of liver failure, and then I suddenly found out that I had put on a stone (6.4kg), shooting up from 8st to 9st.
“I was vomiting horrible yellow bile every morning. I thought it was nerves because of stress at work, but it was a symptom of liver failure. My eyes were yellow and bloodshot and by summer 2004 people were commenting on how poorly I looked.” In July that year, Heath was feeling so ill that she went to see her GP.
“He took one look at me, asked me how much I drank a week, and when I told him he immediately rang to get me a hospital bed. I was taken to the City hospital. I was filling up with fluid and my stomach was huge. A blood test revealed my blood wasn’t clotting which indicated some form of liver damage and one look told the doctors that I was jaundiced.

“They didn’t know if I would live or die”

“I tested positive for auto-immune hepatitis but they couldn’t do an ultrasound because there was too much fluid for them to see anything and they didn’t want to carry out a liver biopsy because I was too ill. In the end they had to bypass my liver because it was so inflamed and they gave me drugs and nutrients through a drip. The verdict was that I had alcoholic liver disease. Luckily, I was so ill I didn’t care, but now I am mortified by that diagnosis.”

“The consultant told my husband that they didn’t know if I would live or die. I look back now and cringe that I took my body to such a point, but the frightening thing was that until I became really ill I’d had no real warning signs, not even any hangovers to indicate the damage I was doing.”
A liver transplant was considered, but Heath’s liver did start to recover. She was in hospital for a month and lived off a glucose drip, plus six daily multivitamin drinks, also taking vitamin D and diuretics. She was discharged in August and was put on a strict diet: no salt, no sugar, no fat. Because she was so full of fluid she weighed 10st. But by the end of August, she had gone to the other extreme and weighed just 6st. “All my muscle mass had gone. My arms were like sticks and I looked dreadful. I was permanently exhausted. But gradually I began to feel better and my weight increased. I stayed on the diuretics until April 2005 and the diet until January 2006.

“I still go back once a year to the hospital for ultrasound. I can now eat and digest some fat, but I still have to careful. Fortunately, John shoots game, which has no fat, so I eat a lot of rabbit, woodpigeon and pheasant. I don’t drink wine at all and can’t say that I miss it. I can’t even bear the smell of it because it brings back bad memories. I drink nonalcoholic wine and nonalcoholic martinis instead, although I had to be reassured there was no alcohol in them. They are a bit bland, but you adapt to the taste.
“My story is a warning to others. It is not a question of whether you can hold your drink, or even whether you are addicted to it. It is what alcohol is doing to your body that you have to be worried about.”

Judith’s story is featured in Diet Doctors on Five, December 12, 8pm

Drinking by numbers
25% the proportion of adults drinking at ‘hazardous levels’ in the most prosperous parts of the country
20% the proportion of adults drinking enough to put their health at significant risk
5% the proportion of adults drinking enough to make alcohol-related disease inevitable
22 the number of units a week that can pose a danger for men
15 the number of units a week that can pose a danger for women
A large glass of wine, 250ml at 12% alcohol, is 3 units; a pint of weak beer is 2 units. The medically recommended maximum number of units of alcohol a week is 14 for women and 21 for men

Source: Centre for Public Health; Times database

What is alcoholic cirrhosis? Cirrhosis is the term used to describe irreversible scarring of the liver. It occurs during the late stages of various liver disorders, which may be caused by excessive alcohol consumption.
Cirrhosis may not cause any symptoms, but when symptoms occur they might include jaundice (yellowing of the skin and whites of the eyes), poor appetite, weight loss and nausea.
Cirrhosis causes 3,000 deaths each year in the UK. In rich countries, it is the third most common cause of death of people aged between 45 and 65.

[bcubed]

Wow. Amazing how much disparity there is: someone gets liver failure from comparatively small amounts, where others consume much more with impunity. It makes me wonder if resistance to alcoholic damage is hereditary.

Incidentally, the most recent objective data on milk thistle as a liver protectant is "inconclusive": is this accurate?

[Nature Boy]

She had an unusually weak liver. Though I feel sorry for her, how is this exactly newsworthy? Cirrhosis may cause 3,000 deaths a year in the UK but what percentage of those deaths came from drinking only that small an amount? Not many methinks.

[kareena]

As bcubed and Nature Boy have noted she appears to have an unusually weak liver. SWIM's friends with an addiction councelor: two of his patients were women in their 60s. One had drank 2 glasses of wine a day for 40 years whilst the other had drank a fifth of whisky daily for a similar time period. The former's liver is a mess whilst the heavy drinker has very decent liver function.