Male (and Female Pattern) Baldness

Male pattern baldness is a hereditary condition in which fewer new hairs grow to replace those that shed. It is passed down from generation to generation in our genes. Male pattern baldness can be inherited from the father or the mother. The gene that causes male pattern baldness was identified in 2008, raising hopes that a cure may be found in the not too distant future. Drug companies are currently spending billions trying to discover a cure. Male-pattern baldness is the commonest type of hair loss. Its medical name is androgenic alopecia.
As well as affecting men, it can sometimes affect women (female-pattern baldness). It affects about one third of the population. It can start early, sometimes in the teens and early 20s. Pattern baldness only affects the scalp; it does not affect hair on other parts of the body.

Male pattern and female pattern baldness is caused by hair follicles becoming oversensitive to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone. The follicles react to DHT and eventually shrink. The hair becomes thinner and grows for a shorter length of time than normal. The balding process is gradual because different follicles are affected at different times.

Treatment for male pattern baldness

There is no cure for male pattern baldness however there are some treatments which can slow down its progression or stimulate hair growth. Examples include minoxidil, tretinoin and zinc (which I will discuss again in my blog).

A low dose of a drug called finasteride can prevent hair loss and cause re-growth in male pattern hair loss. It works by stopping the conversion of testosterone to dihydrotestosterone (DHT). The strength of finasteride used to treat male pattern baldness approximately 1.25mg which is not available in Ireland. Finasteride 5mg tablets are only available in Ireland and is licensed to treat benign prostatic hyperplasia (enlarged prostate) in men. The brand Propecia^® is available in many countries such as the UK and US. Propecia^® contains finasteride 1mg and is specifically licensed to treat male pattern baldness; however it is not available in Ireland. Therefore, consultants in Ireland prescribe finasteride 1.25mg as an unlicensed indication for male pattern hair loss and pharmacists split the 5mg tablet in quarters so the patient has the correct strength (1.25mg). There is a good success rate from finasteride with about 2 out of 3 men experiencing hair re-growth. One in three men experience no hair growth from finasteride however it does stop further hair loss. It can take up to 6 months to notice results from finasteride and up to 2 years for full hair growth. Side effects are rare at the low dose used for male pattern baldness but it can cause loss of libido (sex drive) in about 2 in 100 patients. It should not be used by women. Because finasteride is not licenced at a low dose in Ireland, a specialist will only prescribe the low dose version if he/she feels the benefits outweighs the risks.

Techniques such as hair transplantation, scalp flaps, and other procedures may be considered. Success rates vary, specialist advice is needed if surgery is considered and they are generally expensive.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

 This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar

The difference between a Chartered Physiotherapist and a physical or massage therapist

Since launching our chartered physiotherapy service last year, a question posed to Whelehan’s staff is, what is the difference between and physiotherapist and a “chartered physiotherapist”? There is a difference. Unlike other medical professionals such as doctors, nurses and pharmacists, up until recently there has been no protection in Irish law for the title of physiotherapist in Ireland. This meant that in essence, anyone such as a “massage therapist” or “sports therapist” has been able to assume the name of a “physiotherapist”.

There has been many therapists practicing in the Republic of Ireland in many different settings including sports and leisure using the term “physiotherapists”/ “physio”/”physical therapist” but who have not completed the required courses recognised by the only governing body in the Republic of Ireland called the Irish Society of Chartered Physiotherapists. Protect yourself by ensuring you always check that the person pertaining to be a physiotherapist is a Chartered Physiotherapist. A Chartered Physiotherapist will have the letters MISCP after their name. Recently, after many years of campaigning, the Physiotherapists Registration Board was established. This will require all physiotherapists working in Ireland to be registered and will ensure that only registered physiotherapists can use the title and treat patients.

Why confusion can sometimes arise?

The confusion arises because in many countries including the UK and the US, the titles “physiotherapist” and “physical therapist” are protected, and may be used only by therapists with the appropriate qualifications such as four-year full-time degrees. In Ireland, however, physical therapists or sports therapists generally do not have the same qualifications as a physiotherapist, and often gain their qualifications through part-time programmes. A simple way of checking if a physiotherapist is a Chartered Physiotherapist is by going to the ISCP website (www.iscp.ie); by clicking on the section, “Is your physiotherapist chartered?” and when you type in the name of your Physiotherapist, if he/she is a Chartered Physiotherapist, it will confirm this as well as their county of practice. 

 What are the differences?

A Chartered Physiotherapist, physiotherapists must have completed a three- or four-year university degree programme. This training includes three core areas of muscular skeletal, neurology and cardiorespiratory. By choosing a Chartered Physiotherapist, you are choosing a professional who has scientific approach to the assessment, diagnosis and treatment of your complaint. Chartered Physiotherapists are recognised and covered by VHI, Laya Healthcare, AVIVA and other health insurance schemes

A physical therapist, on the other hand, can complete a course on a part-time basis, from 15 months to a three- year term, so the levels of experience and qualifications do differ. Moreover, training for a physical therapist typically only focuses on muscular-skeletal areas and does not take into account other body functions and processes. While the work undertaken by a physical therapist may be legitimate, the ISCP argues that it is essential that the patient should understand exactly what experience and training the person treating them has obtained. Thanks to physiotherapist Sinead Brogan from FlexPhysio Physiotherapy clinic at Whelehans for info for this article

 

 

 

Whelehans physiotherapy service with our Chartered Physiotherapist Sinead Brogan runs on Wednesdays, Fridays and Saturdays. We offer reduced physiotherapy rates for over 60’s and affiliated sport clubs. Book a physiotherapy appointment by calling Sinead at 083 1722171.

 

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

This article is shortened. More detailed info sheets is available in Whelehans

Heavy Sweating and its management (medically known as hyperhidrosis)

Hyperhidrosis is where a person suffers from excessive sweating. Excessive sweating is not considered a serious health problem, but can be a source of embarrassment and anxiety and can affect confidence. 

Types

Hyperhidrosis can sometimes only affect specific area of the body, generally the armpits, face, hands or feet. If hyperhidrosis affects the whole body, it is referred to as generalised hyperhidrosis. Generalised hyperhidrosis may be due underlying medical condition like overactive thyroid gland or a side effect of medication such as an anti-depressant. In the case of hyperhidrosis that affects the armpits primarily, there is usually no obvious cause. This is referred to as primary hyperhidrosis.

Treatment

Lifestyle changes

Certain changes to daily routine can improve symptoms including: Specialised antiperspirant sprays (rather than deodorants); Soaps may irritate the affected skin. If so, use a bland soap substitute such as an emollient (moisturiser) ointment or cream (eg) Aqueous Cream, Emulsifying ointment; Get to know triggers that make your sweating worse. Common examples include spicy foods and alcohol; Tight, restrictive clothing and man-made fibres like nylon or lycra make sweating worse so should be avoided; Black or white clothing mask signs of sweating better than other colours; Armpit shields can be used to absorb excessive sweat; Thick and soft socks made of natural fibres can absorb moisture better (eg) Cotton.Avoid socks made from man-made fibres and change socks regularly (more than once daily if required); Wear shoes made from natural material like leather or canvas rather than man-made material; Aternate pairs of shoes daily to allow them to dry fully; Avoid wearing trainers or boots as they tend to be less breathable than normal shoes; Use absorbent foot powder twice daily if sweating of the feet is an issue.

Aluminium chloride antiperspirants

Strong aluminium chloride antiperspirants work by plugging or blocking sweat glands. Aluminium chloride antiperspirant needs to be applied at night just before bed (as sweat glands are less active at night). Wash the aluminium chloride off the next morning. Mild skin irritation, itching and tingling in the areas where applied are the most common side effects of aluminium chloride. Brands available in pharmacies include Anhydrol Forte^® and Driclor^®. When it comes to using aluminium chloride antiperspirants, less is more; they are less effective if too much is used at each application. It should be used once every one to three weeks for best effect. It can take a few weeks initially to build up its effect.

Iontophoresis

Iontophoresis is only done under a specialist and works best for hands and feet. Hands and feet are placed in water and weak electric current passes through the water; the electric current has the effect of helping block the sweat glands. Iontophoresis is not painful but the electric current can cause a slightly uncomfortable sensation and skin irritation. Each treatment of iontophoresis takes about 20 to 40 minutes and person normally gets two to four treatments each week. Improvement occurs after about two weeks and it should be continued for a month after improvement is seen. 80 to 90% of people notice improvement in symptoms due to iontophoresis.

Botulinum toxin

Botulinum toxin (botox for short) blocks signals from the brain to sweat glands thus reducing sweating. Botox injections work particularly well for armpit sweating. It is not recommended for sweating of the palms and face due to the risk that botox may block nearby small muscles. Costs of this treatment depend on the part of the body being treated. Treatment needs to be repeated every 4 to six months. Botox is only effective for between two and twelve months so treatment must continually be repeated.

Anti-cholinergic drugs

Anticholinergic drugs include prescription drugs such as oxybutynin hydrochloride and glycopyrronium bromide. They only control generalised hyperhidrosis. Their success is variable so they are not used very often. Side effects can include drowsiness, dry mouth, dry eyes, blurred vision and constipation.

Surgery

Surgical options are available if the above options fail. They include Video-assisted thoracic sympathectomy (VATS), Shelley's procedure (removing sweat glands), Retrodermal curettage, Laser sweat ablation (LSA) and Body jet liposuction. Contact Whelehans for more details on surgical options.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar

Benzodiazepines (commonly known as "tranquillisers"

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Benzodiazepines are also referred to as tranquillisers and are drugs mainly prescribed for anxiety and insomnia. They are occasionally prescribed for epilepsy, as muscle relaxants, and as a detox from alcohol. They should only be prescribed short term as they can have serious side effects, withdrawal symptoms and addiction problems if overused. They should only be used short-term for the likes of anxiety until the effects of longer term treatment options (eg. counselling, antidepressants, mood stabiliser medication) start working. Benzodiazepines have been prescribed in Ireland for over 50 years and there has been a long history of overprescribing. When they first came out, the likes of “valium” were seen as wonder drugs, their potential problems and side effects were not realised initially and “mother’s little helpers” were overprescribed by family doctors. Only in the last few years have efforts been made to reduce over and inappropriate prescribing.

How they work?

Benzodiazepines work by slowing the communication between neurons giving a calming effect to many functions of the brain. Benzodiazepines main effect is to reduce anxiety and agitation, while it does this quickly (within half an hour); this effect is short lived (a few hours only). Side effects can include drowsiness and slowing of mental and bodily movements.

Benzodiazepines may cause confusion, slurred speech, coordination problems, impairment of judgement and memory loss in some people, especially at higher doses. Paradoxically they can cause mood swings in some people (perhaps this is more when the dose wears off).  With long term use, tolerance can occur; this involves needing higher doses to produce the same effects. Dependence can also occur with longer term use (more than a week); symptoms can include feeling a constant need for the drug with the feeling of not being able to function right without it and developing withdrawal symptoms if the drug is stopped. Withdrawal symptoms can be debilitating and can include nausea, vomiting, sweats, low mood, and paranoia and panic attacks.

 Benzodiazepines combined with alcohol or other medication (even some common over the counter medicines such as pain-killers and anti-histamines) can cause loss of consciousness and respiratory failure. Side effects are rare if doses are kept low and courses are short (ideally 4 weeks maximum).

Types of benzodiazepine

Examples of benzodiazepine include include alprazolam (Xanax^®), clonazepam (Rivotril^®), lorazepam (Ativan^®), diazepam (Valium^®, Anxicalm^®), and chlordiazepoxide (Librium^®). Some benzodiazepines have a very sedative effect so are only used as sleeping tablets; these include triazolam (Halcion^®), nitrazepam (Mogadon^®), temazepam (Nortem) and flurazepam (Dalmane). They should only be used short term as sedatives due to the reasons like tolerance, dependence and withdrawal symptoms described earlier.  

Use in the elderly

In older people, benzodiazepines are associated with more severe side effects including marked sedation and psychomotor impairment (slowdown of mental and physical activity), higher risk of fractures (especially hip fractures) and driving accidents, and a quicker development of tolerance, dependence and withdrawal symptoms (when compared to younger patients). Their use in the elderly should be avoided but if they are used they should be used with caution.

This article is shortened for this Health Blog.. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

Kidney-Transplant patients- What Over-the-Counter (OTC) medication can you take?

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Organ Donor Awareness Week is this week (March 29^th to April 5^th). Give the gift of life by getting an organ donor card from the Irish Kidney Association on LoCall 1890 543639 or logon to www.ika.ie. While I specifically deal with kidney transplants this week, much of the advice I give is true for any type of transplant (eg) Heart, lung, liver. Kidney failure has many causes including diabetes, high blood pressure and injury. Kidney failure causes a build-up of waste products and fluids leading to tiredness and fatigue, oedema (swelling), nausea and poor appetite and even death if a suitable donor is not found.

Medication to avoid

When you have a kidney transplant, medication called immunosuppressants are prescribed to prevent the body rejecting the new kidney. Some medications interfere with the immunosuppressive medications. Antibiotics to avoid include clarithromycin (Klacid^®), erythromycin and azithromycin (Zithromax^®). Other drugs to avoid include the antifungal fluconazole (Diflucan^®) and the heart rhythm drug diltiazem (Dilzem^®).

AVOID grapefruit or grapefruit juice when prescribed immunosuppressants like Neoral^®, Prograf^® or Rapamune^®; grapefruit changes the metabolism of these medications. Avoid antacids such as Rennies^®, Maalox^® or Gaviscon^® within 2 hours of taking your medications as they may reduce absorption of many anti-rejection drugs.

Herbal preparations and supplements

Herbs can cause serious interactions with kidney transplant drugs and can also affect the kidneys. *Some herbs reduce the effectiveness of transplant rejection medication. *Herbs may not be pure because of unregulated manufacture procedures. There have been reports of herbs containing bacteria, pesticides and metals including lead and mercury. *Some herbs are toxic effects to the liver, kidneys, and heart, especially when taken with other medication including changes in blood pressure, blood sugar and potassium levels leading to risk of bleeding and transplant rejection. *Dosages can vary from pill to pill, manufacturer to manufacturer or from what is stated on the label. To be safe, transplant patients should avoid herbal preparations.

What Over the Counter Medication is safe?

Headache, Fever, and Body Aches

Paracetamol eases mild pain and fever and is safe for kidney transplant patients (but use in caution if you had a liver transplant). Non-steroidal anti-inflammatory drugs (NSAIDs) must be avoided as they can harm the kidneys and interact with some immunosuppressants. Ibuprofen (Nurofen^®) is a common NSAID sold over the counter. Aspirin is a relation of NSAIDs so should also be avoided unless prescribed for medical reasons (eg) low dose aspirin to prevent clots

Sneezing, Itching and Runny Nose
Antihistamines can be safely used by transplant patients. Loratadine (Clarityn^®) and cetirizine (Zirtek^®) are recommended as they cause less drowsiness than other anti-histamines. Chlorpheniramine (Piriton^®) is also safe to use but is best used at bedtime as it causes more drowsiness. Avoid combination (multi-symptom) cold, sinus, and flu products (Benilyn Day & Night^®, Benylin 4Flu^®, Nurofen Cold and Flu^®). Treat each symptom individually to avoid accidentally taking a drug that can cause kidney problems.

Sore Throat

Most throat lozenges (eg. Strepsils^®) are safe to use and there are sugar free versions for diabetics.

Nasal and Sinus Congestion

Nasal sprays such as xylometazoline (Otrivine^® and Sudofed^®) are safest for congestion problems. Do not use longer than three days as longer use can make congestion worse. Salt sprays (eg. Sterimer^®) as nasal washes (eg. Neilmed Sinus Wash^®) can ease sinus systems by moistening sinuses and acting as a natural anti-inflammatory and are safe to use long term.  Oral decongestants, such as pseudoephedrine (contained in the likes of Sudafed^® tablets and many cold and flu remedies) should be used with care for transplant patients as they raise blood pressure which can put pressure on kidneys.

Chesty Cough

Guaifenesin (Robitussin^®, Viscolex^® or Exputex^®) is safe for transplant patients suffering from chest congestion.

Dry Cough

The cough suppressant dextromethorphan (Benilyn^® Dry Cough) is safe to use. Vicks VapoRub^® can help relieve a cough for a time. If diabetic, use a sugar free version such as Robitussin^® Dry Cough Mixture.

Diarrhoea

Loperamide (Imodium^®) can be used for short-term relief of diarrhoea. Do not use for longer than 48 hours. If diarrhoea is heavy, bloody, or lasts more than 48 hours, get checked by a doctor.

Constipation

Products safe to use for transplant patients include fibre supplements (Fybogel^®); stimulants such as bisacodyl (Dulcolax^®) or senna (Senokot^®) and osmotic laxatives such as lactulose (Duphalac^®). Do not use stimulant laxatives such as bisacodyl or senna long term as they cause lazy bowel which can worsen constipation. If constipation last longer than 48 hours you should see your doctor.

Indigestion and heartburn

Mild stomach upset can be eased with some over the counter remedies such as antacids (eg) Rennies^®; famotidine (Pepcid AC^®) and pantoprazole (Pantup Relief^®). Avoid antacids at the same time as immunosuppressants such as mycophenolate (Cellcept^®), tacrolimus (Prograf^®) or sirolimus (Rapamune^®) as they reduce absorption of these drugs. Take OTC remedies such as antacids at least one hour before or two hours after the immunosuppressant

Gas

Simethicone (Imogas^®) is recommended for gas which is a common cause of bloating.

Dry Eyes and Eye Irritation

Artificial tears eye drops should be first choice for the symptoms of dry eyes and eye irritation. They replicate the role of natural tears. Examples include Tears Naturale^® and Artelac Drops^®.

Nausea and Vomiting
Domperidone (Motilium^®, Domerid^®) can be used to treat and prevent symptoms of nausea and vomiting but only be use short term. See your doctor if nausea and vomiting lasts more than 24 hours as it can be caused by your prescription medication.

Skin Irritation, Insect Bites and Poison Ivy

Topical corticosteroids, such as hydrocortisone 1% cream (Cortisol 1% Cream), is safe to use for skin irritation, insect bites, and skin rashes. Use of corticosteroids should be short term (no longer than 7 days) as they can thin and mark the skin if used long term.

Disclaimer: Consult with your healthcare professional before making any changes recommended.

This article is shortened for my health blog. More detailed information and leaflets is available in Whelehans

How to deal with Alcohol Addiction

I will only touch on the treatment of alcohol addiction for the health blog. It is a long and hard process and a person must want to give up alcohol to be successful. Call into Whelehans Pharmacy for more detailed information or check www.whelehans.ie. All information is free and is confidential. Treatment depends on the amount of alcohol a person is drinking. Treatment options include detoxification, medication and counselling. Abstinence is the best and most successful approach to beat alcohol addiction.

Detoxification

In mild cases, detox can be done at home without the use of medication because withdrawal symptoms should be mild. If consumption of alcohol is high (over 20 units a day) or withdrawal symptoms were previously experienced, detox at home with medication to help ease withdrawal symptoms may be possible. A short course of a tranquiliser called chlordiazepoxide (Librium^®) is usually prescribed in this case (for about 5 days). If dependency is severe, detox at a hospital or clinic may be required as withdrawal symptoms will be severe.  

Withdrawal symptoms

Withdrawal symptoms are worst for the first 48 hours. They gradually start to improve as the body begins to get used to being without alcohol. This usually takes 3-7 days from the time of the last drink. Sleep will be disturbed. Sleep patterns often start to return to normal within a month. During detox, it is important to drink plenty of fluids (about three litres a day). Avoid drinking large amounts of drinks containing caffeine like tea and coffee as caffeine exacerbates sleep problems and cause feelings of anxiety. Stick with water, squash or fruit juice to re-hydrate. Try to eat regular meals even if not feeling hungry. Normal appetite will return gradually. Withdrawal from alcohol is an important first step; further treatment and support will be needed as it is a long term struggle to stay dry.

 Medication

The three most common drugs used to treat alcohol addiction are acamprosate, disulfiram and naltrexone.

 Acamprosate

Acamprosate (brand name Campral^®) is used to help prevent a relapse in people who have successfully given up alcohol and works by helping reduce craving. Acamprosate works by blocking a chemical in the brain called gamma-amino-butyric acid (GABA). GABA helps cause a craving for alcohol. Acamprosate is usually started as soon as withdrawal from alcohol begins and can be prescribed for up to six months. I will discuss the other drugs used to treat alcohol addiction and other counseling options next week.

Disulfiram

Disulfiram (brand name Antabuse^®) is a drug that may be tried if trying to achieve abstinence if relapse is a possibility. Disulfiram works by causing unpleasant physical reactions if alcohol is consumed thus acting as a deterrent. These can include nausea, chest pain, vomiting, flushed skin and dizziness. Unpleasant reactions can occur if the person comes into contact with alcohol for a week after finishing taking disulfiram, so it's important to avoid alcohol for a week after stopping disulfiram.

Naltrexone

Naltrexone works by reducing the enjoyment someone gets from alcohol thus reducing drinking or helping someone give it up completely. It works by blocking the opioid receptors in the body, stopping the effects of alcohol. It's usually used in combination with other medicine or counselling. Naltrexone should only be prescribed by a specialist in alcohol dependence.

Counselling

Self-help groups

Alcoholics Anonymous (AA) is a great support to many fighting alcohol dependence. The core belief behind AA is that alcoholic dependence is a long-term condition and total abstinence is the only solution. AA has a 12-step programme designed to help overcome addiction. It includes the following steps •Admitting a powerlessness over alcohol and that a normal fulfilled life with alcohol is impossible. •Realising that you cannot fight the addiction without support. •Examining past errors with the help of a sponsor (an AA member who has been through it before). •Making amends for errors made. •Living a new more fulfilled life without alcohol and improving behaviour. •Helping others who are going through the same addiction problems

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) uses a problem-solving approach to alcohol dependence.  CBTs approach to alcohol dependence is to identify and deal with unhelpful and unrealistic thoughts and beliefs that contribute to continual drinking such as: •"I can't relax without alcohol." • “all my friends drink” • “I can’t enjoy a social occasion without alcohol” •"Just drinking one pint can’t hurt."

The idea of CBT is to change these unhelpful thoughts and perceptions to: •"I can have a good time without alcohol" • “I don’t need the hassle of feeling miserable with hangovers” • “I will join new clubs and societies that don’t involve alcohol to make new friends that I can meet without having to drink”  •"I know I can't stop drinking once I start." Other types of therapy include Extended Brief Intervention and Family Therapy

Community Alcohol and Drug Service (CADS)

The HSE Community Alcohol and Drug Service offer counselling and treatment services for adults suffering from addiction to alcohol, drugs and gambling. CADS have centres in Mullingar, Athlone and Longford. CADS provides counselling and treatment to help people get over their addiction and offer support and counselling to family members. All services are totally confidential. You can refer yourself to the service directly. If you have a loved one or someone you know that could avail of this service you can contact CADS to discuss your options. All referrals must be made with the consent of the person being referred. You can contact their Mullingar centre at 04493 41630.

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

This article is shortened for this health blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie

 

Alcohol Health Problems

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Alcohol is safe if drank in moderation. Alcohol releases endorphins in the brain which is why it makes us feel good (and why it is so addictive); it also affects the area of the brain that causes inhibition which is why it makes us talk more and feel more relaxed.

Tonic or poison?
Alcohol can be described as both a tonic and a poison. The difference between “tonic and poison” lies in the dose. Moderate levels of alcohol can be beneficial for the heart and circulatory system, and may protect against diabetes and gallstones. However excessive alcohol intake can cause many health problems and premature death. While alcohol is an enjoyable social lubricant, we must also remember that alcohol is drug. The drug in alcohol is “ethanol” which affects the brain, heart, stomach, liver and gallbladder. It affects many other common functions including inflammation, coagulation (blood’s ability to clot), cholesterol and insulin levels. It also alters mood, concentration, and coordination. These affects lead to serious health problems if used in excess. As alcohol is a drug, it also interacts dangerously with many medicines, including paracetamol and other painkillers, antidepressants, epilepsy drugs and sedatives. Alcohol is very addictive and your tendency to become addicted is also thought to be hereditary (ie) those with a family history of alcohol problems are more at risk.

How do you know if you’re drinking too much alcohol?

You could be drinking excessively if: You feel you need to cut down on drinking. You feel guilty or ashamed about your drinking. Other people are critical of how much you drink. Sometimes have memory loss of drinking sessions. You need a drink first thing in the morning to settle nerves or ease a hangover. Drink at least a few drinks every day. Regularly go binge drinking. Not doing as expected due to drinking (eg) missing an appointment or work due to being drunk or hungover.

Long-term effects of alcohol abuse

Abuse of alcohol can cause 63 different diseases to our body; I will just discuss the more common ones.

Anaemia

Excess drinking reduces the number of red blood cells which carry alcohol around the body and can cause red blood cells to become extremely low. This is called anaemia and can cause many symptoms like fatigue, lightheadedness and shortness of breath.

Cancer
Many studies show that continual heavy drinking increases cancer risk. One of the reasons for increased cancer risk is that the body converts alcohol into acetaldehyde, a known carcinogen. Areas where alcohol is known to increase cancer risk include the mouth, throat, larynx (voice box), oesophagus, liver, breast, and colorectal region. Cancer risk rises even further in heavy drinkers who also smoke.

Cardiovascular disease

Heavy drinking, especially binge drinking makes platelets more likely to stick together to cause blood clots increasing risk of heart attack and stroke. Excessive drinking can also cause cardiomyopathy, a potentially fatal condition where the heart muscle weakens and can eventually fail. Excessive alcohol can cause heart rhythm problems such as atrial and ventricular fibrillation both of which lead to the heart not pumping properly and can lead to clots and death.

Cirrhosis

Alcohol can cause damage to liver cells if overused over a prolonged period of time. Heavy drinkers can develop cirrhosis, a sometimes lethal condition where the liver is so heavily scarred that it cannot function properly.

Dementia

As a person ages, the brains shrinks at an average of approximately 2% per decade. However heavy drinking accelerates the shrinkage of key areas in the brain leading to memory loss and other symptoms of dementia. Heavy drinking can also lead to mild but potentially debilitating problems including a person’s ability to plan, make judgments, solve problems and perform complex tasks.

Depression
Heavy drinking is often associated with depression. It has often been debated which comes first, the drinking or the depression. One theory is that depressed people use alcohol to ease emotional pain. But many studies are showing that is more likely the other way around (ie) it is heavy drinking that leads to depression more than the other way round.
Seizures
Heavy drinking can cause epilepsy and can trigger seizures even in those that do not have epilepsy. Alcohol can also interfere with the effect of epilepsy medications used to prevent convulsions.

Gout
Gout is an inflammatory condition that is more common in men and often affects the big toe. An acute attack of gout is very painful. Gout is caused by uric acid crystals forming in the joints. Although gout is often hereditary, alcohol and other dietary factors often play a role. Alcohol aggravates existing cases of gout.

High blood pressure
Alcohol disrupts the sympathetic nervous system which has a role in controlling the constriction and dilation of blood vessels in response to stress, temperature and exertion. Heavy drinking, especially binge drinking can cause blood pressure to rise. High blood pressure can lead to many other health problems, including heart disease, stroke and kidney problems.

Infectious disease

Heavy drinking suppresses the immune systems which can lead to infections. Studies show that heavy drinking increases the risk of tuberculosis, pneumonia, HIV/AIDS, and other sexually transmitted diseases.

Nerve damage

Heavy drinking can cause a form of nerve damage called alcoholic neuropathy leading to problems such as painful pins-and-needles and numbness in the extremities (eg. fingers, toes) as well problems like muscle weakness, incontinence, constipation and erectile dysfunction. Alcoholic neuropathy arises for two reasons, alcohol is toxic to nerve cells and because nutritional deficiencies (especially vitamin B1 deficiency) thus inhibiting nerve function.

 Oesophagus and stomach

Alcohol has a direct effect on the oesophagus relaxing the lower oesophageal sphincter (valve leading to the stomach) which means “acidic” stomach contents are more likely to come up leading to oseophagitis which can cause symptoms like heartburn in the chest area. Alcohol can also delay gastric emptying which can also lead to heartburn and indigestion.

Effect on nutrition

Excess alcohol consumption reduces the level of many important nutrients. This includes thiamine (vitamin B1) deficiency which can cause nerve damage (described above). Serious vitamin B1 deficiency is common in chronic alcoholics and can lead to a serious condition called Wernicke-korsakoff which is a serious acute condition characterised by confusion, vision changes, lack of coordination and impaired memory. Many people recovering from excessive alcohol consumption require thiamine supplement. Alcohol can also cause vitamin B12 deficiency (leading to symptoms like fatigue) and reduced calcium absorption (leading to brittle bones especially in women).

 Pancreatitis

As well as causing stomach irritation (gastritis), alcohol can inflame the pancreas. Chronic pancreatitis can restrict digestion, causing severe abdominal pain and persistent diarrhoea. Unfortunately this damage is sometimes irreversible. Chronic pancreatitis can be caused by gallstones, but up to 60% of cases are due to excessive alcohol consumption.

I will discuss options to help beat alcohol addiction in the coming weeks in my Health Blog

This article is shortened for this health blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie