More than 10 million people in Germany between the ages of 18 and 69 have harmful high alcohol consumption, with the majority of alcohol intake in the form of beer and a small amount in the form of wine, sparkling wine and spirits. Due to the high energy content of alcohol – 7.1 calories in one gram – a large proportion of energy requirements are met by alcoholic beverages when consumed regularly. Thus, for example, 160 grams of alcohol – in 2 liters of wine – can contain 70% of the energy requirement, which in most cases neglects the intake of foods containing essential vital substances such as proteins, iron, calcium and potassium. Alcohol (ethanol; ethanol) is converted to acetaldehyde by alcohol dehydrogenase (ADH), which is immediately further metabolized to acetate by aldehyde dehydrogenases (ALDH). Acetate can then be used to synthesize fatty acids. This is one reason why frequent alcohol consumption can lead to obesity. Apart from this, the degradation product acetaldehyde causes severe metabolic disorders in high concentrations. On the one hand, it leads to a dysfunction of the cell membranes as well as the mitochondria, which serve the cells as power plants, and on the other hand to a change in proteins, which themselves damage the liver cells in this state. Absorbed fats accumulate more in the body due to disturbances in lipid metabolism, and the lipids that are not metabolized are stored. Furthermore, metabolic impairments lead to changes in the vital substance balance (micronutrients) and to disturbances in the conversion of certain vitamins – vitamins B1, B2, B6, folic acid, A, D and E – into their metabolically active form. Alcoholic beverages are usually devoid or low in important nutrients and vital substances and thus represent empty energy sources for the body. Alcohol abuse leads to changes in the body that result in reduced absorption of vital substances (micronutrients) on the one hand and increased accumulation of ingested fats on the other. To the lack of vital substances (micronutrients) also contributes an insufficient food intake, absorption as well as transport difficulties of fats as well as vitamins, minerals and trace elements and an increased excretion. Absorption of high amounts of energy by alcohol – vital substance deficiency.
| Vital substances (micronutrients) | Deficiency symptoms |
| Vitamin D |
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| B group vitamins such as vitamin B2, B3, B6, folic acid. |
Increased risk of
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| Vitamin A |
Increased risk of |
| Vitamin E |
|
| Calcium |
|
| Potassium |
|
| Iron |
|
| Protein |
|
Next to smoking, alcohol is the most important factor for severe health impairment and for the development of chronic diseases. The following are the most important diseases or complications (alcohol withdrawal delirium, most common complications marked with * ) that may be contributed to by alcohol dependence:
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).
- Malformations of the child
- Fetal Alcohol Spectrum Disorder (FASD); the full-blown syndrome is called Fetal Alcohol Syndrome (FAS); prevalence (disease frequency): 0.2-8.2 per 1,000 births – due to alcohol abuse during pregnancyNote: Early diagnosis and adequate support of affected children based on the S3 guideline “Early diagnosis of Fetal Alcohol Spectrum Disorder (FASD)” can positively influence the prognosis.
Respiratory system (J00-J99)
- Laryngitis (inflammation of the larynx)
- Pharyngitis (pharyngitis)
- Pneumonia (pneumonia)
Blood, blood-forming organs – immune system (D50-D90).
- Anemia (anemia) due to folic acid deficiency.
- Immunodeficiency (immune deficiency)
- Leukocytopenia – decreased number of white blood cells.
- Thrombocytopenia – decreased number of platelets.
- Zieve syndrome – metabolic disorder characterized by a triad of: Hyperlipoproteinemia (also hyperlipidemia; fat metabolism disorder), hemolytic anemia (anemia due to destruction of red blood cells) and alcohol toxic liver damage with jaundice (jaundice).
Endocrine, nutritional and metabolic diseases (E00-E90).
- Obesity (obesity).
- Adrenopause – decline in adrenal (originating from the adrenal cortex) DHEA(S) production in adults.
- Andropause (menopause in men)
- Hyperlipidemia/dyslipidemia (lipid metabolism disorders).
- Hypertriglyceridemia (excessive triglyceride levels in the blood).
- Malnutrition
- Hyperhomocysteinemia
- Hyperuricemia (increase in the level of uric acid in the blood).
- Hypoglycemia (hypoglycemia) or hypoglycemic shock* .
- Latent metabolic acidosis (hyperacidity).
- Malnutrition
- Metabolic syndrome – clinical name for the symptom combination of obesity (overweight), hypertension (high blood pressure), elevated fasting glucose (fasting blood sugar) and fasting insulin serum levels (insulin resistance) and dyslipidemia (elevated VLDL triglycerides, lowered HDL cholesterol). Furthermore, a coagulation disorder (increased tendency to clotting), with an increased risk of thromboembolism is also often detectable
- Micronutrient deficiency:
- Vitamin A (retinol)
- Thiamine (vitamin B1)
- Riboflavin (vitamin B2)
- Niacin (vitamin B3) → pellagra (first noticeable symptoms: Hyperpigmentation and diarrhea); the disease is characterized by the 4 Ds (dermatitis/inflammatory reaction of the skin, diarrhea, dementia, death/death).
- Pantothenic acid (vitamin B5)
- Pyridoxine (vitamin B6)
- Folic acid
- Vitamin E (tocopherols)
- Vitamin C (ascorbic acid)
- Vitamin D (calciferols)
- Biotin
- Calcium*
- Potassium*
- Magnesium*
- Phosphorus
- Selenium
- Zinc
- Pancreatic insufficiency (weakness of the pancreas).
- Somatopause (growth hormone deficiency)
- Wernicke encephalopathy (synonyms: Wernicke-Korsakow syndrome; Engl.: Wernicke’s encephalopathy) – degenerative encephaloneuropathic disease of the brain in adulthood; clinical picture: brain-organic psychosyndrome (HOPS) with memory loss, psychosis, confusion, apathy as well as gait and stance unsteadiness (cerebellar ataxia) and eye movement disorders/eye muscle paralysis (horizontal nystagmus, anisocoria, diplopia)); vitamin B1 deficiency (thiamine deficiency).
Factors affecting health status leading to health care utilization (Z00-Z99).
- Burnout syndrome
Skin and subcutaneous tissue (L00-L99)
- Skin aging
- Nail psoriasis (nail psoriasis)
- Pityriasis simplex capitis (dandruff of the head)
- Psoriasis (psoriasis)
- Rosacea (copper rose) – chronic inflammatory, non-contagious skin disease that manifests itself on the face; typical are papules (nodules) and pustules (pustules) and telangiectasia (dilation of small, superficial skin vessels).
Cardiovascular system (I00-I99).
- Apoplexy (stroke)
- Atherosclerosis (arteriosclerosis, hardening of the arteries)
- Heart failure (cardiac insufficiency)
- Cardiac arrhythmias*
- Extrasystoles (heart stumbles; extra heartbeats), but especially paroxysmal tachycardia.
- Supraventricular arrhythmias (6 drinks (70 g alcohol) daily: 2-fold risk).
- Atrial fibrillation (VHF)
- Hypertension (high blood pressure)
- Hypotension (low blood pressure)
- Cardiomyopathy (heart muscle disease)
- Coronary artery disease (CAD; diseases of the coronary arteries).
Infectious and parasitic diseases (A00-B99).
- Diarrhea (diarrhea)
- Legionellosis (Legionnaires’ disease)
Liver, gallbladder, and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).
- Acute pancreatitis (inflammation of the pancreas).
- Chronic pancreatitis
- Diabetes mellitus (diabetes)
- Hepatitis B (liver inflammation)
- Hepatitis C
- Liver failure coma*
- Liver cirrhosis – connective tissue remodeling of liver tissue with subsequent loss of function.
- Steatosis hepatis (fatty liver)
Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).
- Acute gastritis (inflammation of the gastric mucosa).
- Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon or rectum.
- Dysbiosis (imbalance of the intestinal flora).
- Enteritis (inflammation of the small intestine)
- Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
- Gingivitis (inflammation of the gums)
- Dental caries
- Colon adenoma (colon polyps)
- Mallory-Weiss syndrome – clustered longitudinal (elongated) tears of the mucosa (mucous membrane) and submucosa (submucosal connective tissue) of the esophagus occurring in alcoholics, which may be associated with potentially life-threatening hemorrhage of the external esophagus and/or the entrance to the stomach (gastrointestinal hemorrhage/GIB) as a complication
- Pulpitis (inflammation of the dental nerve).
- Ulcus duodeni (duodenal ulcer)
- Ulcus ventriculi (gastric ulcer)
Musculoskeletal system and connective tissue (M00-M99)
- Dupuytren’s contracture – progressive formation of a contracture of one or more finger flexors.
- Fractures (fractures of bones) due to hazardous behavior.
- Gout (arthritis urica/uric acid-related joint inflammation or tophic gout)/hyperuricemia (elevation of uric acid levels in the blood).
- Osteonecrosis of the femoral head – demise of bone tissue on the thigh.
- Myopathy (muscle weakness)
- Osteopenia – reduction in bone density.
- Osteoporosis (bone loss)
- Rhabdomyolysis (dissolution striated muscle fibers)* with renal failure.
Neoplasms – tumor diseases (C00-D48)
- Malignant tumors of the oropharynx (oral pharynx), larynx (larynx), and esophagus (esophagus); dose-response relationship.
- Bronchial carcinoma (lung cancer).
- Cholangiocellular carcinoma (CCC, cholangiocarcinoma, bile duct carcinoma, bile duct cancer).
- Gallbladder carcinoma (gallbladder cancer)
- Hepatocellular carcinoma (HCC; primary hepatocellular carcinoma; liver cancer); dose-response relationship.
- Colon carcinoma (colon cancer); dose-response relationship.
- Gastric carcinoma (stomach cancer)
- Mammary carcinoma (breast cancer) of women; dose-response relationship.
- Pancreatic carcinoma (pancreatic cancer).
- Squamous cell carcinoma of the skin
- Rectal carcinoma (rectal cancer); dose-response relationship.
Ears – mastoid process (H60-H95).
- Dysacusis (hearing disorder)
- Meniere’s disease (disease of the inner ear, usually affecting only one ear).
Psyche – nervous system (F00-F99; G00-G99)
- Alcohol withdrawal delirium (psychosis due to withdrawal); usually develops 6-8 hours after cessation of drinking and is greatest in severity in the first 48 hours after cessation of drinking [marked with * the most common acute complications occurring 1-2 days after cessation of alcohol intake].
- Alcoholic jealousy mania
- Anxiety disorders
- Auditory Perceptual Disorders (AVSD) – due to alcohol consumption during pregnancy.
- Attention deficit hyperactivity disorder (ADHD) – due to alcohol consumption in pregnancy.
- Cluster headache
- Dementia – people with high alcohol consumption (men > 60 g/day; women 40 g/day) are more than 3 times more likely than others to develop dementia; onset often at a younger age
- Depression
- Diabetic polyneuropathy – chronic disorders of the peripheral nerves or parts of nerves in diabetes mellitus. These lead mainly to sensory disturbances in the affected areas of the body.
- Epilepsy (seizures)* .
- Erectile dysfunction (ED; erectile dysfunction).
- Hallucinations
- Insomnia (sleep disturbances)
- Korsakoff syndrome (amnesic psychosyndrome) – a form of amnesia (memory disorder) first described in alcoholics.
- Libido disorders of the woman / man
- Marchiafava-Bignami syndrome (synonym: corpus callosum atrophy) – rare neuropsychiatric disorder whose cause has not yet been conclusively determined; occurs mainly as a result of chronic alcoholism associated with malnutrition.
- Migraine
- Alzheimer’s disease
- Obstructive sleep apnea syndrome – pauses in breathing during sleep caused by obstruction of the airway.
- Personality disorders
- Polyneuropathy (nerve damage)
- Pontine myelinolysis – damage to the central nervous system due to rapid compensation of hyponatremia (sodium deficiency).
- Post-traumatic stress disorder (PTSD) [due to traumatization of mental illness].
- Psychosis
- Restless Legs Syndrome (RLS)
- Somatoform disorders
- Transient ischemic attack (TIA) – sudden onset neurologic disorder that resolves within 24 hours, making it the only distinction from apoplexy (stroke)
Pregnancy, childbirth and puerperium (O00-O99).
- Spontaneous abortion (miscarriage).
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)
- Emesis (vomiting)
- Urinary incontinence (involuntary, involuntary leakage of urine).
- Icterus (jaundice)
- Cachexia (emaciation; severe emaciation).
- Multi-organ failure* (MODS, Multi organ dysfunction syndrome; MOF: Multi organ failure) – simultaneous or sequential failure or severe functional impairment of various vital organ systems of the body.
- Nausea (nausea)
- Pyrosis (heartburn)
- Rhonchopathy (snoring)
- Sinus tachycardia (accelerated heart rate; stimulus formation disorder).
- Social behavior disorders: Aggression (due tochanges in brain prefrontal cortex functioning under alcohol; even at low alcohol dose, a significant positive relationship was found between dorsomedial and dorsolateral prefrontal cortex activity and alcohol-induced aggression).
- Suicidality (suicide risk).
- Tremor (shaking) of the hands
- Underweight
- Vertigo (dizziness)
Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).
- Amenorrhea – no menstrual bleeding until the age of 15 (primary amenorrhea) or no menstrual bleeding for more than three months (secondary amenorrhea).
- Infertility – inability to carry a pregnancy to viability of the child.
- Nephrolithiasis (kidney stones).
- Testicular atrophy – reduction in the size of the testicles due to tissue atrophy.
- Urolithiasis (urinary stones)
Injuries, poisonings, and other consequences of external causes (S00-T98).
- Food allergy (immunologic reaction)
- Injuries: Falls, violent altercations, traffic accidents as a car or bicycle driver.
Further
- Sense of guilt and shame
- Social problems, especially in the partnership and at work.
