Medical The worst disease ever in human history

[hamster143]

A rather sobering reminder that population numbers were virtually flat until say 1500 a.d. at which time sufficient numbers were living plenty long enough to suffer the ravages of addictive illness. BTW I have seen several die under the age of 30 to cardiomyopathy and cirrhosis, but recognize that most of these illnesses have their largest impact in middle age.

During most of the human history, alcohol addiction was not a significant health issue for a simple reason. It can't develop without access to cheap concentrated alcohol. During middle ages, distillation techniques were primitive and uncommon. Most modern distilled beverages (whiskey, cognac, vodka) date in their present forms no further than 1700. Since they were distilled manually in small batches from lower-concentration alcohol (for example, whiskey is made by distilling beer), they were expensive and mostly used for medicinal purposes. Commonfolk typically could only afford to drink homebrewn beer, usually no stronger than 4%, and, in the Mediterranean, diluted wine.

The real breakthrough came in the 1800's, when industrial mass production methods of cheap spirits were developed.

 

[denverdoc]

Interesting points re the history of distillation, and of course, the fact that either beer or wine requires a diversion of foodstuff, has limited access among lower classes--that and taxes which have been around for EtOH since 1690, and my guess is much sooner. Nevertheless history dating back to B.C. suggests that habitual intemperance was a social problem for at least some of the people and it can be fairly assumed that health effects were known. Certainly some intruiging evidence points to the decline of the Roman Empire as a result of ever more spirited drinking, though the real culprit may have been the lead which was used as a preservative.

Nevertheless your point re distillation and the production of copius quantities of cheap gin is well taken. But it is incorrect to assume that beer and wine are less potentially injurious than distilled spirits.

Given it is a pro responsible use site, I thought this was a fair source for some of the info.

http://www2.potsdam.edu/hansondj/controversies/1114796842.html

 

[hamster143]

But it is incorrect to assume that beer and wine are less potentially injurious than distilled spirits.

They are less potentially injurious (beer in particular) because you need large amounts to achieve comparable levels of intoxication. Your source puts beer consumption in medieval Bavaria at 300 liters/capita/year. That's 800 ml/day or just under 2 drinks (assuming 4% alcohol content). You need to drink nothing but beer all day, every day before cirrhosis and gastrointestinal cancers can become significant threats.

 

[denverdoc]

They are less potentially injurious (beer in particular) because you need large amounts to achieve comparable levels of intoxication. Your source puts beer consumption in medieval Bavaria at 300 liters/capita/year. That's 800 ml/day or just under 2 drinks (assuming 4% alcohol content). You need to drink nothing but beer all day, every day before cirrhosis and gastrointestinal cancers can become significant threats.

I'm not sure where you are getting the info for your conclusion--the threshold for increased risk of cirrhosis in men varies between 40 and 120 gm/day. If we take the middle value of 80 gm/day--this is roughly 7 standard beers per day. It doesn't seem to matter from what type of beverage.

There were some recent studies that drinking a large proportion of wine vs other types of beverages might mitigate the risk, but these findings are now in doubt.

For women, the risk of cirrhosis increases significantly with an average daily intake as little as 20 gms/day--or two beers per day.

I am not arguing that I think cirrhosis has been a major killer throughout the ages. What I am arguing is that beer or wine are less damaging. Alcoholics can easily put away a six pick of beer in a couple of hours. This is hardly drinking nothing but beer all day. Try to put aside the notion of the cirrhotic as the skid row bum. I used to work for a liver transplant team and they come in all sizes and flavors, but the vast majority were "functional alcoholics" meaning they were able to hold down jobs,marriages, etc for at least the vast majority of their drinking careers. Some even confined EtOH consumption to weekends and an occasional binge.

 

[hamster143]

the threshold for increased risk of cirrhosis in men varies between 40 and 120 gm/day. If we take the middle value of 80 gm/day--this is roughly 7 standard beers per day. It doesn't seem to matter from what type of beverage.

80 gm/day at 4% is two liters of beer. That's roughly the amount of fluids an average person consumes in one day.

I'm curious, is there data on relative risks of binge drinking vs. spreading the alcohol consumption? With most chemicals, consuming a lot at once is much more dangerous than spreading the same amount over some time. 20 cups of espresso over 2 hours will put you in the ER, 20 cups of espresso over 2 weeks keep you alert throughout your work day. 5 gray of whole-body radiation in one day will kill you, 5 gray over six months might increase the risk of cancer. It seems logical that hitting the liver with 7 standard drinks at once (a glass of vodka) would make more damage than the same amount spread over a day.

 

[denverdoc]

There are some data, most of it somewhat conflictual on this issue--say comparing cirrhosis rates in scandanavia vs those in the mediterranean. Actually higher in the wine drinking countries vs the vodka guzzlers. But they drink more.

Some new evidence points at daily consumption and drinking on an empty stomach as risk factors--the latter is speculated for the reason you cite--liver is deluged by rapid gastric emptying. The former is speculated to be because the liver has less of a chance to "heal". So the notion is if you give the liver a few days break to process the fat and repair cellular damage, the injurious effects are lessened and don't accumulate. Bottom line is the disease just doesn't seem to follow any clear cut rules at this point.