Excessive alcohol consumption is linked with hypertension —Professor Lasebikan

Professor Victor Lasebikan, FAAS, is a Professor of Psychiatry at the College of Medicine, University of Ibadan. He is also a Consultant Psychiatrist and Addiction Specialist at the University College Hospital, Ibadan. He speaks with SADE OGUNTOLA on alcohol use and its contributions to mental health conditions in Nigeria.

IN your studies on alcohol use, what were those things that you found scary, particularly in young generations?

Well, alcohol use, notably liquor and spirits, like any other substance use, is endemic among adolescents and young adults. Some people misquote some areas in modern literature that say alcohol is heart protective. They say a unit of liquor, half or a third of a bottle of beer, or a shot of spirit taken with food every day is protective for the heart in men. Less than half of this amount is to be taken with the meal by women. For older generations, the recommendation is an amount that is less than that for women. It is not mentioned that its heart-protective benefit is because these alcoholic drinks also contain what are called antioxidants. These antioxidants act as macrophages that engulf the fat and lipids in the blood vessels and the heart. By so doing, they protect the heart from a heart attack.

Are there alternatives for these antioxidants with heart-protective properties in alcoholic drinks?

Of course, these antioxidants are present in large quantities in other food items like fresh fruits, onions, avocados, and almonds. Therefore, we should not be carried away with “alcohol is good for the heart”. It’s not the alcohol; it’s the antioxidant there, which you can get from other non-alcoholic sources. There is the good, the bad, and the ugly of alcohol.

Even though the quantity of alcohol that is recommended is so small that it can be metabolised by anybody who takes it, a person whose brain is voluntarily prone to addiction can still become addicted if taking one shot every day. Some people become addicted to a single dose of a substance if their brain is so primed. So, it is better to take antioxidants through other routes than alcohol.

Unfortunately, some adolescents and young adults take as much as a whole bottle of brandy at once. That contains 30 units of alcohol. Alcohol is a poison on its own even though it has some health benefits. It is highly addictive. The consequences of alcohol use can be physical, social, and psychological.

Excessive alcohol consumption is directly linked with hypertension, stroke, and ischaemic heart disease. Ischaemic heart disease can occur when clots block the blood vessels that supply the heart, leading to a heart attack. Excessive alcohol use can pack all the bad cholesterol in the body at a point, such that over time it blocks blood supply. In addition, excessive alcohol can constrict blood vessels, and that can lead to hypertension.

Other physical consequences of excessive alcohol use include hepatitis of the liver, liver cirrhosis, and liver cancer. Also, alcohol, when consumed excessively, can cause cancer anywhere from the mouth to the oesophagus to the stomach itself. It can cause chronic pancreatitis and cancer of the pancreas. Unfortunately, chronic pancreatitis or cancer of the pancreas has no treatment. It is not symptomatic until one has about a month to live before it is diagnosed. Excessive alcohol mops up the immunoglobulins and can predispose an individual to serious infections because immunity will be lowered. When you see many who have been alcoholics for a long time, they are frail and highly susceptible to various infections.

Most road accidents in Nigeria have been linked with alcohol use. In fact, some studies show that alcohol use was linked to almost 80 per cent of accidents involving long-distance and commercial drivers. Likewise, violence, intimate partner violence, impairment in social and official functioning, and unemployment are also challenges associated with alcohol addiction.

Psychologically, alcohol, when used in excess, causes depression because it can depress the central nervous system. Some individuals may experience psychosis, mood problems, alcohol-induced cognitive impairment, and problems with memory and attention deficiency. When they drink to stupor, they can have epileptic seizures. Later in life, they could also develop dementia.

So how do you explain some that drink 10 bottles of beer and are not intoxicated, while with a bottle of beer, some are already drunk?

There is an enzyme in the body called aldehyde dehydrogenase. Men have a higher level of this enzyme than women, and that is why women are poor metabolisers of alcohol and get drunk faster. Also, the level of aldehyde dehydrogenase in men is variable, so different men tolerate alcohol differently.

Some people also develop tolerance to alcohol because they are chronic users. When they take increasingly higher doses, the system becomes habituated. However, being able to drink large amounts without getting intoxicated does not mean that harm is not occurring elsewhere in the body. A person who, over time, has clogged blood vessels and is about to have a heart attack may not be intoxicated when it happens. The same applies to alcohol-related cancers of the stomach and liver. In fact, intoxication is more common in young users. Becoming intoxicated simply means that the level of alcohol crossing the blood-brain barrier into the brain has increased.

There are different local alcoholic drinks – ‘Sepe’, ‘Burukutu’, ‘Ogogoro’, fresh palm wine and so on. Do these complications extend to them as well?

They do, but one of the problems we have with alcohol control policy in Nigeria is that the primary occupation of some cultures is local alcohol production. In these areas, they drink alcohol ad libitum. Do not forget that alcohol causes both immediate and long-term health problems. We do not follow up with these people over time to know what is happening to them in the long term. It is possible that some of those who drink alcohol also eat fish, take fresh fruits, or do not smoke. These are modifying factors that can reduce their risk of the consequences of habitual alcohol use.

Certainly, spirits like whisky have the highest concentration of alcohol, so they are the most dangerous. The same applies to drinking an equivalent quantity of local gin (Ogogoro), as both contain the same amount of alcohol. The alcohol content in wines is variable. Ideally, red wine does not have more than 7.5 per cent to 10 per cent alcohol content. Palm wine, when taken fresh, is sweet with very little or no alcohol. If you take fresh palm wine and become intoxicated, it means that either Ogogoro was added or the palm wine was allowed to ferment before it was collected. Burukutu is fermented sorghum, so it contains alcohol. ‘Sepe’ is a term our people coined; it refers to alcohol mixed with certain medicines, some of which are aphrodisiacs. But whether it is in a local drink or an imported wine or spirit, alcohol remains alcohol. The implication for the health of whoever is taking it is the same.

Which one is more dangerous, the spirits or the fermented palm wine?

It depends on the quantity you take. For instance, if you take a glass of brandy or a whole bottle of red wine or champagne once in a while, you will get high. That will cause acute intoxication. Accidents and injuries are the immediate effects of alcohol. The long-term effect occurs when you continue taking it like that every day.

What are, therefore, signs of alcohol dependence or addiction?

One, the person has a compulsion towards using it. Two, the person has a subjective awareness of impaired capacity to control its use. If the person doesn’t use it, he will have withdrawal symptoms. So, in order not to experience those withdrawal symptoms, he will need to take alcohol. Another point of alcohol addiction is tolerance. The person will require an increased dose of alcohol each time to achieve the effect that a lower dose produced in the past. Now, the person no longer has a repertoire for a good life. He has narrowed his repertoire. If you want to see him, he will say, “Meet me over a bottle of beer.” Such a person may also neglect other ways of finding pleasure or may relapse after abstinence. His New Year’s resolution could be that he wouldn’t take alcohol again. By March, he will be back at it, giving a flimsy excuse or reason for doing so. If someone has any three of those eight things, the person has dependence.

But some people see alcohol as an ideal solution to stress.

That is a negative coping strategy for stress. Everybody has periods when they are going through stress. I turned to writing a textbook at a time when I was under a lot of stress in my career. That is a positive coping strategy. Other forms of positive coping include religious engagement. I don’t blame people who go to churches or mosques. That is the person’s way of ventilating. But when under pressure of any sort, one should not use sexual engagement. It can lead to other problems, including diseases. Neither should one resort to substance use, because it can lead to addiction. During the COVID-19 period, when there was a lockdown, many people developed depression, and they ended up having substance use disorder and alcohol dependence. In fact, a fallout of COVID-19 was a higher rate of alcohol dependence all over the world. But it is not a good coping strategy for stress. Rather, one should turn to something positive.

A study said hypertension deaths from excessive alcohol use are increasing. What is the link, and why?

There is a direct link between the heart and the brain. People who have alcohol use disorder or severe alcohol use disorder are at a higher risk of hypertension-related deaths due to its detrimental effects on the cardiovascular system. Hypertension is a cause of stroke, myocardial infarction, or ischaemic heart disease. All these cardiovascular problems are high-risk factors for death. So, that is the link.

Of course, hypertension-related deaths from excessive alcohol use are recorded in many of our hospitals. If you go to the medical outpatient clinic of UCH Ibadan and take the history of people who have hypertension, heart failure, or serious heart diseases, you will see that about 80 per cent of them are serious alcohol users and smokers. So, people should avoid alcohol. Even if they are social drinkers, it must be mild.

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