Doc here. An alcoholic in DTs could spend a week in the hospital. I've seen an alcoholic who lied to her surgeon, said she had a couple of glasses of wine a night. Right. Couple of bottles. Her liver couldn't handle the anesthetic. She died, but only after 2 weeks in the ICU and her 8 year old and 10 year old daughters asked her dad why. He only brought them so they would remember. He couldn't wait for her to die.
So, the long-term effect of a bender is to upregulate production of alcohol dehydrogenase in your liver, which allows you drink more before you're drunk, but also allows you to pickle your liver faster. That takes a long time to recover from. That and the physical dependency. And the obesity. See, the liver saves you from killing yourself by turning that EtOH into fatty acids. And, since you probably ate a fair bit too, you'll get a lot of fat there. If you don't eat, you end up with Vitamin B12 deficiency. Even well-to-do, upstanding drinkers with the self control to not eat while drinking may end up with numbness in their extremities due to that.
Now, as for the short-term recovery from a bender: you need to hydrate before you go to sleep and then probably during the night. If you wake up in the middle of the night with heartburn, it may well be from the temporary gastroparesis induced by the alcohol. Drink some water and stay upright for awhile. Some advil will probably help. Then work out the next morning and, then have some coffee. Then eat. Preferably some yogurt to replace the gut bacteria you poisoned the night before. Then accept that you'll be cranky for the rest of the day. You're neurons generally aren't happy when the neighbors die.
But 36 hours after, when you wake up the day after the day after, you should be fine. Minus the alcohol dehydrogenase, fat, dead brain cells, and extra 1/2 lb of fat.
Doctor of Pharmacy here. You haven't actually addressed what he said. None of that indicates that one heavy night of drinking takes a week to recover from (how? mentally? physically? emotionally? enzymatically?). Where's the PubMed or Medline citation?
DTs occur in patients undergoing life threatening alcohol withdrawal. These people have often been drinking upwards of a twelve-pack of beer a day for years.
Almost all alcoholics lie about their drinking. This is expected in both ambulatory and critical care. Implying that this patient's alcoholism killed her because her liver couldn't handle the anesthetic is disingenuous at best. If you're talking about a patient who was admitted with DTs, she should not have even been administered an anesthetic. If it was something else entirely, from the limited information you've provided I have to find fault with the anesthetist. The Glasgow Coma Scale is your friend, and it (and other scales of conscious) must be constantly used.
A single bender is not going to upregulate liver enzymes, just like a single dose of medication won't. It takes weeks or months of consistent exposure to make that happen. Again, this has nothing to do with the original, uncited claim that a single night of drinking takes a week to recover from.
And finally, do not recommend to your heavy drinking patients that they should take ibuprofen. NSAIDs, by virtue of their nonspecific effect on cycloxygenase, decrease the protective prostaglandins that are produced in the stomach to maintain the mucosal lining. Taking Advil after a night of heavy drinking is only going to make it more likely that the patient throws up blood the next day and needs to go to the hospital. NSAIDs have absolutely no positive effect on acid reflux - they will only make it worse. If a patient has heartburn, give them the obvious recommendation: take an antacid. Heartburn is not the same kind of discomfort as hitting your thumb with a hammer.
Coffee before food will make this heartburn worse due to the acidity. Again, a single serving of yogurt isn't going to have an appreciable effect on your gut flora. You need to be eating it regularly for a few weeks before the bacteria can overcome your natural defenses and the other flora to colonize.
This is all misinformation you've provided, and it's not even relevant to what you're replying to.
First, thanks for replying. Perhaps I was to casual in my initial reply. I think we're in agreement that alcohol is a bad idea. I was assuming I was addressing a 20-40 year old entrepreneur, and my impression of these guys, on the forum and those I've met in person, is that they're generally healthy and interested in staying that way, they go to parties now and again, and once in a blue moon wake up with a nasty headache. My goal was to first address that there are generally long term effects and short term effects, and leave it as exercise to the reader to see that there's not much in the 1-week range.
With regards to your specific concerns:
> DTs vs anesthesia
These were intended as two separate examples. I could have made that more clear. I absolutely agree, anesthesia is a very bad idea for someone in DTs. The larger point being, alcohol is a bad idea.
> A single bender is not going to upregulate liver enzymes
I argue a single bender will upregulate liver enzymes. Not a lot, but a little. A single workout will build muscle and improve your physical fitness. Not a lot, but a little. The larger point no doubt being one you're in favor of: alcohol is a bad idea.
> do not recommend to your heavy drinking patients that they should take ibuprofen
I would not recommend a heavy-drinking patient take ibuprofen. That said, alcoholics in the hospital vomiting blood are classically associated with esophageal varices due to a cirrhotic liver, which bleed spontaneously and then they vomit. They are not coming in for gastric ulcers, which generally require days to weeks of NSAIDs, and are more classically associated with aspirin, which irreversibly acetylates the COX enzymes, whereas ibuprofen binds reversibly. The larger point being, alcohol is a bad idea.
> Coffee before food will make this heartburn worse due to the acidity.
I didn't recommend coffee as an antidote to heartburn. I recommended some water and staying upright. The coffee recommendation was for the next morning. The caffeine will activate cAMP, causing some dilation of cerebral blood vessels, getting more profusion to the noggin, helping overcome the headache. The larger point being, alcohol is a bad idea.
> a single serving of yogurt isn't going to have an appreciable effect on your gut flora
Are you arguing against yogurt?
Let me take the opportunity to suggest that I don't advocate drinking as a solution to problems. Quite the opposite. But keep it coming. Glad you came across my comment. Look forward to seeing you around.
I'm glad we can keep it civil. I've been reading HN for a while but don't post often and only recently created an account. Medications are the domain of knowledge, so I try to contribute about that when I can. For better or worse, I don't know much about startups, erlang, emacs, or what have you, so I don't post in those sorts of discussions.
What I was initially looking for was something to back up the claim "it takes a week to recover from a night of serious drinking.". Niels is arguing that this could be true for alcoholics with DT. While I wont argue that, I don't think the original statement was referring to alcoholics, but rather anyone who goes out for a night of serious drinking. I haven't seen any proof for the original statement.
I'm not a doctor in any way, shape or form, but I would still like to argue the running point in Niels' second post, alcohol is a bad idea.. Overconsumption, yes, but that's true for almost anything. I don't think smaller amounts is a bad idea -- on the contrary. I recently heard a statement that the UK recommended limit (21 units per week) was just made up, and studies have shown that you're more likely to live longer if you drink around 40-50 units per week (somewhere after that number, the life expectancy starts dropping and goes below the life expectancy for people not drinking). I'm afraid I can't remember where I heard/saw it though, so I'll have to leave a [citation needed] for myself for the time being.
There some thinking that this whole finding about a glass of red wine a day being associated with longer survival is probably due to profile of people who drink like that: they have a moderately active social life and have not-to-much stress in their lives. Which is probably far better for you than any amount of alcohol.
Are active, stress-free people more likely to have a drink with dinner, or is a drink with dinner helping to relieve stress?
I quite enjoy having a drink after work, especially if it's been a lot of pressure during the day. It helps me relax, disconnect from the work situation. A couple of beers and non-work-related chat will take my mind off any stressful work I've been doing, which could otherwise carry on in my mind throughout the night.
Mixing alcohol with advil to relieve an upset stomach sounds like a dubious idea. Why not just vape a little weed, which would not only work better, but also doesn't come with the risk of dying. Plus using weed may help reduce the brain damage caused by drinking.[1]
wait,B-12 deficiency can cause numbness in my extremities?
and I thought it was the ascending aortic dissection that traveled all the way to the right iliac branch whereupon the false lumen completely blocked any indication of a pulse for a period of at least 8 hours (in the ER, while the attending followed the wrong path on his ddx).
11 hours of surgery followed.
but seriously.. I'm sure it's the beta-blocker they have me on as a result (reducing contraction velocity).
(and I've all but stopped drinking since the surgery.)
Alcohol is highly associated with mental illness. For example, alcoholism is associated with an 800% increase in psychotic disorders in males. It also is associated with a 5 - 20x increased likelihood of suicide:
The causality runs both directions here. For example, the adverse childhood experience study shows that having an abusive childhood makes one dramatically more susceptible to drug abuse and mental illness:
However, drug abuse also greatly increases the risk of depression and other mental illnesses. There are probably several different mechanisms here. For example, alcohol causes inflammation. Inflammation seems to be one of the things that causes depression:
Also, once one has an alcohol dependency then one is going to suffer depression whenever one isn't drinking. It's the same thing with any drug. E.g. you can smoke weed one or two times per week, or you can smoke weed 30+ times per week, but if you smoke weed say 5 times per week then you'll just be depressed all the time except for right after you smoke. (Because depression is a symptom of withdrawal, and you're essentially permanently in withdrawal.)
There are certainly strong correlations between substance abuse and other mental illnesses. However, you have to dig deeper: is the patient an alcoholic because of a preexisting mental illness? Is the alcoholism just the first outward sign that was noticed by others?
There is also a strong correlation among mental illnesses: once you get one (any one), you are statistically more likely to get one or more of the others within your lifetime. It doesn't help that they are often overlapping, though (e.g. bipolar disorder type 2 - bipolar depression). From the American Psychiatric Association Practice Guidelines: "in a study of patients in psychiatric treatment in the United States, 84% of major depressive disorder patients had at least one co-occurring condition: 61% had a co-occurring Axis I condition, 30% a co-occurring Axis II condition, and 58% a co-occurring Axis III condition (978). Anxiety disorders were the most common co-occurring disorder in the prior 12 months" (http://www.psychiatryonline.com/content.aspx?aID=655908)
As a slightly different example, 80-90% of schizophrenic patients smoke. This is because the stimulating effect of nicotine tends to improve their negative symptoms by increasing dopamine levels in certain parts of the brain (for about 15 minutes or so... then they need another one).
As far as alcohol causing depression: alcohol /is/ a depressant. It binds to GABA receptors (among other receptors) and increases sedation, decreases mental activity, etc. (GABA is the primary inhibitory neurotransmitter of the brain).
Inflammation as a cause of depression is not really significant right now. Look at our classes of antidepressants: tricyclics (which work in depression by inhibiting the reuptake of serotonin and norepinephrine), selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, dopamine reuptake inhibitors (bupropion is mostly what I'm going for here, though sertraline also has some dopaminergic activity), serotonin receptor agonists (e.g. trazodone), and alpha-2 antagonists (mirtazapine - it indirectly increases serotonin and norepinephrine levels by blocking autoinhibition of alpha-2 receptors in the brain). None of these have noteworthy effects on inflammation, and all of them are effective in a modest population of patients (unfortunately only about 1/3 of patients achieve remission on their first drug trial, regardless of which one). Inflammation isn't really a significant theory of depression right now, although I'm not saying it doesn't exist. Mental illnesses are unbelievably complex and medical science is only beginning to catch up with our needs.
"None of these have noteworthy effects on inflammation, and all of them are effective in a modest population of patients"
The fact that taking drugs that mess with your neurotransmitter levels can sometimes alleviate depression doesn't prove, and isn't even particularly strong evidence for, the idea that depression is caused by some sort of neurotransmitter imbalance. Wearing perfume can also alleviate depression in some people, but it would be ridiculous to claim that depression is caused by a lack of Chanel No. 5.
History time. Antidepressant pharmacotherapy was actually discovered in the 1950s when reserpine, then used as an antihypertensive, was noted to cause depression. Reserpine acts by blocking the transmission of neurotransmitters 5HT, NE, and DA. Given that over twenty drugs, all with different actions on different neurotransmitters, have shown efficacy in depressed patients over the last 60 years, I think it would be rather shortsighted to dismiss the significant body of literature dedicated to the role of neurotransmitters in depression.
There are certainly many theories, and depression is a complicated disease. It is primarily modified by neurotransmitters, however. That much should be clear. Beta adrenergic receptor sensitivity and downregulation are also involved - but to what extent? Hypersecretion of cortisol (or lack of cortisol suppression) is also a factor - but to what extent? Even thyroid hormones are implicated.
Like I said, I'm not saying there is no inflammatory problem in depression - I said that we have no antidepressants based on this idea (and as far as I know, there are none in the pipeline in at least Phase II trials). Do I think inflammation is involved? Yes, I do. Do I think it's directly going to lead to more treatments for depression? No, I don't.
"Given that over twenty drugs, all with different actions on different neurotransmitters, have shown efficacy in depressed patients over the last 60 years, I think it would be rather shortsighted to dismiss the significant body of literature dedicated to the role of neurotransmitters in depression."
Virtually every form of sensory stimulation has been shown to ease depression, from aromatherapy to acupuncture to exercise. What makes you think that neurotransmitters are the root cause of the problem? To me the fact that no matter how you mess with the neurotransmitters it eases depression shows that this is a function of sensory novelty, as opposed to some neurotransmitter imbalance being the root cause.
"There are certainly many theories, and depression is a complicated disease."
By "a week to recover" I don't mean that you're totally dysfunctional for a week, but that you're still not at 100% 3-7 days after a night of heavy drinking. If you're trying to perform at the highest levels, you notice it.
While that might conceivably be true, it still sounds an extraordinary claim. If you'd said 1-3 days it would be plausible, if you say 3-7 days it goes against most people's experiences so it's only natural you get asked evidence/citations.
[citation needed]