Literature Review on Alcohol Consumption and the Changes It Can Do on Hormones
National Institute on Booze Abuse and Alcoholism No. 26 PH 352 October 1994
Alcohol and Hormones
Hormones are chemic messengers that control and coordinate the functions of all tissues and organs. Each hormone is secreted from a item gland and distributed throughout the torso to act on tissues at unlike sites. Two areas of the encephalon, the hypothalamus and the pituitary, release hormones, as do glands in other parts of the body, such as the thyroid, adrenal glands, gonads, pancreas, and parathyroid. For hormones to function properly, their amount and the timing of their release must be finely coordinated, and the target tissues must be able to reply to them accurately. Alcohol can impair the functions of the hormone-releasing glands and of the target tissues, thereby causing serious medical consequences.
Hormones control four major areas of torso part: production, utilization, and storage of energy; reproduction; maintenance of the internal environs (e.g., blood pressure and bone mass); and growth and development. This Alcohol Alert describes how, past interfering with hormone deportment, alcohol can alter blood sugar levels and exacerbate or cause diabetes (1-4); impair reproductive functions (5,6); and interfere with calcium metabolism and os structure, increasing the risk of osteoporosis (7). Conversely, hormones besides may affect booze consumption past influencing alcohol-seeking behavior.
Alcohol Impairs Regulation of Blood Sugar Levels
The saccharide glucose is the primary energy source for all tissues. Glucose is derived from 3 sources: from nutrient; from synthesis (manufacture) in the body; and from the breakup of glycogen, a form of glucose that the trunk stores in the liver. Hormones assistance to maintain a constant concentration of glucose in the blood. This is especially important for the brain because it cannot make or shop glucose but depends on glucose supplied past the blood. Fifty-fifty brief periods of low glucose levels (hypoglycemia) can cause brain damage.
Ii hormones that are secreted by the pancreas and that regulate blood glucose levels are insulin and glucagon. Insulin lowers the glucose concentration in the claret; glucagon raises it. Because prevention of hypoglycemia is vital for the body, several hormones from the adrenal glands and pituitary support glucagon office.
Alcohol consumption interferes with all 3 glucose sources and with the deportment
of the regulatory hormones. Chronic heavy drinkers often have bereft dietary intake of glucose (8). Without eating, glycogen stores are exhausted in a few hours (1). In improver, the body'south glucose production is inhibited while alcohol is being metabolized (ii). The combination of these effects can cause severe hypoglycemia 6 to 36 hours subsequently a binge- drinking episode (1).
Even in well-nourished people, alcohol can disturb blood sugar levels. Acute booze consumption, especially in combination with sugar, augments insulin secretion and causes temporary hypoglycemia (ix). In add-on, studies in salubrious subjects (10) and insulin-dependent diabetics (three) have shown that acute alcohol consumption can impair the hormonal response to hypoglycemia.
Chronic heavy drinking, in dissimilarity, has been associated with excessive blood glucose levels (hyperglycemia). Chronic alcohol abuse can reduce the body's responsiveness to insulin and cause glucose intolerance in both healthy individuals (11) and alcoholics with liver cirrhosis (12). In fact, 45 to seventy percentage of patients with alcoholic liver illness are glucose intolerant or are frankly diabetic (1). In animals, chronic alcohol administration also increases secretion of glucagon and other hormones that enhance blood m lucose levels (thirteen).
Booze consumption can be especially harmful in people with a predisposition to hypoglycemia, such as patients who are existence treated for diabetes (iii,4). Alcohol can interfere with the management of diabetes in different ways. Acute too as chronic booze consumption can alter the effectiveness of hypoglycemic medications (14,15). Treatment of diabetes by tight control of claret glucose levels is difficult in alcoholics, and both hypoglycemic and hyperglycemic episodes are common (iv). In a Japanese study, alcoholics with diabetes had a significantly lower survival charge per unit than other alcoholics (16).
Alcohol Impairs Reproductive Functions
The man reproductive system is regulated by many hormones. The most important are androgens (e.g., testosterone) and estrogens (e.chiliad., estradiol). They are synthesized mainly by the testes and the ovaries and affect reproductive functions in various target tissues. Other reproductive hormones are synthesized in the hypothalamus and pituitary. Although men and women produce many of the same hormones, their relative concentrations and their functions vary.
In men, reproductive hormones are responsible for sexual maturation, sperm evolution and thus fertility, and diverse aspects of male person sexual behavior. In women, hormones promote the development of secondary sexual characteristics, such equally chest development and distribution of trunk pilus; regulate the menstrual cycle; and are necessary to maintain pregnancy. Chronic heavy drinking can interfere with all these functions. Its most severe consequences in both men and women include inadequate functioning of the testes and ovaries, resulting in hormonal deficiencies, sexual dysfunction, and infertility (5,6).
Alcohol is directly toxic to the testes, causing reduced testosterone levels in men. In a written report of normal healthy men who received booze for 4 weeks, testosterone levels declined after only v days and continued to fall throughout the study catamenia (17). Prolonged testosterone deficiency may contribute to a "femininization" of male sexual characteristics, for instance breast enlargement (18).
In addition, fauna studies have shown that acute booze assistants affects the release of hormones from the hypothalamus and pituitary (5). Even without a detectable reduction of testosterone levels, changes in these hormones can contribute to the impairment of male sexual and reproductive functions (nineteen). Booze also may interfere with normal sperm structure and motion by inhibiting the metabolism of vitamin A (20), which is essential for sperm development.
In premenopausal women, chronic heavy drinking tin contribute to a multitude of reproductive disorders. These include cessation of menstruation, irregular menstrual cycles, menstrual cycles without ovulation, early on menopause, and increased risk of spontaneous abortions (6,21,22). These dysfunctions tin be caused past alcohol's interfering directly with the hormonal regulation of the reproductive arrangement or indirectly through other disorders associated with alcohol abuse, such as liver disease, pancreatic disease, malnutrition, or fetal abnormalities (vi).
Although most of these reproductive bug were found in alcoholic women, some besides were observed in women classified as social drinkers, who drank about three drinks per solar day during a three-week study (23). A pregnant number of these women had abnormal menstrual cycles and a delay or lack of ovulation.
Alcohol likewise affects reproductive hormones in postmenopausal women. After menopause, estradiol levels reject drastically because the hormone is no longer synthesized in the ovaries, and only small amounts are derived from the conversion of testosterone in other tissues. This estradiol deficiency has been associated with an increased take chances for cardiovascular affliction and osteoporosis in po stmenopausal women (24). Booze can increase the conversion of testosterone into estradiol (25). Appropriately, postmenopausal women who drank (24,26) were constitute to take higher estradiol levels than abstaining women. Studies take shown that in postmenopausal women, 3 to six drinks per week may reduce the take chances of cardiovascular disease (27) without significantly impairing bone quality (24) or increasing the chance of alcoholic liver affliction (28) or breast cancer (29).
Alcohol Impairs Calcium Metabolism and Bone Structure
Calcium exists in two forms in the body. The chief reservoirs are the bones and teeth, where the calcium content determines the strength and the stiffness of the basic. The rest of the body's calcium is dissolved in the body fluids. Calcium is important for many body functions, including communication between and within cells. The overall calcium levels depend on how much calcium is in the nutrition, how much is absorbed into the torso, and how much is excreted. Calcium assimilation, excretion, and distribution betwixt bones and body fluids are regulated by several hormones, namely parathyroid hormone (PTH); vitamin D-derived hormones; and calcitonin, which is made past specific cells in the thyroid.
Alcohol can interfere with calcium and bone metabolism in several ways. Acute alcohol consumption tin can lead to a transient PTH deficiency and increased urinary calcium excretion, resulting in loss of calcium from the body (30). Chronic heavy drinking can disturb vitamin D metabolism, resulting in inadequate absorption of dietary calcium (31).
Studies in alcoholics besides accept shown that alcohol is straight toxic to bone-forming cells and inhibits their action (32-34). In addition, chronic heavy drinking can adversely affect bone metabolism indirectly, for example past contributing to nutritional deficiencies of calcium or vitamin D (7). Liver disease and altered levels of reproductive hormones, both of which can be caused by booze, as well affect bone metabolism (7).
Calcium deficiency can lead to bone diseases, such every bit osteoporosis. Osteoporosis is characterized by a substantial loss of os mass and, consequently, increased adventure of fractures. It affects four million to 6 one thousand thousand mainly older Americans, particularly women after menopause. In alcoholics, the take chances of osteoporosis is increased (35). Considering many falls are related to alcohol use (36), adverse alcohol effects on bone metabolism pose a serious wellness problem.
Studies with abstinent alcoholics have found that alcohol-induced changes in bone metabolism, including toxic effects on os-forming cells, are at least partially reversible after cessation of drinking (32,33,37,38).
Hormones May Influence Alcohol-Seeking Behavior
The effects of alcohol on dissimilar hormonal pathways may in plow influence booze-
seeking behavior. For instance, in animals, alcohol-seeking behavior appears to be regulated in part through a organisation chosen the renin-angiotensin system, which controls blood pressure and salt concentrations in the blood. In rats, activation of this system through alcohol consumption caused the animals to reduce their alcohol intake (39). The mechanism and relevance of this effect are currently nether investigation.
Alcohol and Hormones--A Commentary by
NIAAA Manager Enoch Gordis, Grand.D.
Alcohol's broad-ranging effects on the hormone system present many applied clinical concerns. For instance, managing diabetes, particularly with the current accent on stringent control of claret sugar, is complicated by alcohol'southward interference with blood sugar levels. In the emergency room, stupor in patients with alcohol on their jiff often is not caused by booze intoxication, but past the hypoglycemia (depression blood sugar) that is a complication of heavy drinking. Failure to treat the hypoglycemia could have life-threatening consequences. Heavy drinking has a major consequence on the reproductive system, affecting libido, fertility, and pregnancy. Heavy drinking also places postmenopausal women at risk for fractures from falls due to their increased risk for osteoporosis from alcohol's effect on claret estrogen levels coupled with their increased risk of falling due to drinking. However, it is possible that moderate booze utilize may help protect postmenopausal women against osteoporosis past raising blood estrogen levels. Scientists are working to observe for which population this may be truthful and at what drinking levels. Finally, enquiry on how alcohol's interactions with hormones may contribute to the pathological drive to consume alcohol is just beginning and may provide valuable insight into the mechanisms past which booze-seeking behavior tin can be controlled.
References
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(xv) Angelini, P.; Vendemiale, G.; & Altomare, E. Booze and diabetes mellitus. Alcologia 4(2):109-111, 1992. (16) Yokoyama, A.; Matsushita, S.; Ishii, H.; Takagi, T.; Maruyama, Thousand.; & Tsuchiya, Yard. Impact of diabetes mellitus on the prognosis of alcoholics. Alcohol and Alcoholism 29(2)181-186, 1994. (17) Gordon, One thousand.C.; Altman, 1000.; Southren, A.L.; Rubin, Eastward.; & Lieber, C.S. The effects of alcohol (ethanol) administration on sex activity hormone metabolism in normal men. New England Periodical of Medicine 295:793-797, 1976. (18) Bannister, P., & Lowosky, M.S. Ethanol and hypogonadism. Alcohol and Alcoholism 22(3):213-217, 1987. (xix) Bartke, A. Chronic disturbances of the hypothalamic-pituitary-testicular axis: Effects on sexual behavior and fertility. In: Zakhari, South., ed. Alcohol and the Endocrine Organization. National Institute on Alcohol Abuse and Alcoholism Research Monograph No. 23. NIH Pub. No. 93-3533. Bethesda, Doc: National Institutes of Health, 1993, pp. 69-87. (20) Leo, M.A., & Lieber, C.S. Hepatic vitamin A depletion in alcoholic liver injury. New England Journal of Medicine 307(10):597-601, 1982. (21) Booze and abortion. New Zealand Medical Journal 92:353, 1980. (22) Kline, J.; Levin, B.; Stein, Z.; Susser, Chiliad.; & Warburton, D. Epidemiologic detection of low dose effects on the developing fetus. Environmental Health Perspectives 42:119-126, 1981. (23) Mendelson, J.H., & Mello, N.Grand. Chronic alcohol effects on inductive pituitary and ovarian hormones in healthy women. Periodical of Pharmacological and Experimental Therapy 245:407-412, 1988. (24) Gavaler, J.S., & Van Thiel, D.H. The clan between moderate alcoholic beverage consumption and serum estradiol and testosterone levels in normal postmenopausal women: Relationship to the literature. Alcoholism: Clinical and Experimental Research 16(1):87-92, 1992. (25) Gordon, G.G.; Southren, A.L.; Vittek, J.; & Lieber, C.South. Effect of booze ingestion on hepatic aromatase activity and plasma steroid hormones in the rat. Metabolism 28(ane):20-24, 1979. (26) Gavaler, J.South., & Van Thiel, D.H. Hormonal condition of postmenopausal women with booze-induced cirrhosis: Further findings and a review of the literature. Hepatology xvi(2):312-319, 1992. (27) Stampfer, 1000.J.; Colditz, G.A.; Willett, W.C.; Speizer, F.Due east.; & Hennekens, C.H. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. New England Journal of Medicine 319:267-273, 1988. (28) Gavaler, J.Due south.; Kelly, R.H.; Wight, C.; Sanghvi, A.; Cauley, J.; Belle, Southward.; & Brandt, Yard. Does moderate alcoholic potable consumption affect liver role/injury tests in postmenopausal women? Alcoholism: Clinical and Experimental Research 12(2):337, 1988. (29) Willett, West.C.; Stampfer, M.J.; Colditz, 1000.A.; Rosner, B.A.; Hennekens, C.H.; & Speizer, F.E. Moderate booze consumption and the risk of breast cancer. New England Periodical of Medicine 316:1174-1180, 1987. (thirty) Laitinen, Thousand.; Lamberg-Allardt, C.; Tunninen, R.; Karonen, S.Fifty.; Tahetla, R.; Ylikahri, R.; & Valimaki, One thousand. Transient hypoparathyroidism during acute alcohol intoxication. New England Journal of Medicine 324(eleven):721-727, 1991. (31) Bjorneboe, A.-E.A.; Bjorneboe, A.; Johnsen, J.; Skylv, Due north.; Oftebro, H.; Gautvik,K.Thou.; Hoiseth, A.; Morland, J.; & Drevon, C.A. Calcium status and calcium-regulating hormones in alcoholics. Alcoholism: Clinical and Experimental Research 12(2):229-232, 1988. (32) Jaouhari, J.; Schiele, F.; Pirollet, P.; Lecomte, E.; Paille, F.; & Artur, Y. Concentration and hydroxyapatite binding capacity of plasma osteocalcin in chronic alcoholic men: Effect of a three-calendar week withdrawal therapy. Bone and Mineral 21(3):171-178, 1993. (33) Pepersack, T.; Fuss, M.; Otero, J.; Bergmann, P.; Valsamis, J.; & Corvilain, J. Longitudinal written report of bone metabolism after ethanol withdrawal in alcoholic patients. Journal of Bone and Mineral Research 7(iv):383-387, 1992. (34) Bikle, D.D.; Stesin, A.; Halloran, B.; Steibach, 50.; & Recker, R. Alcohol-induced os disease: Human relationship to age and parathyroid hormone levels. Alcoholism: Clinical and Experimental Enquiry 17(3)690-695, 1993. (35) Rico, H. Alcohol and bone disease. Booze and Alcoholism 25(4):345-352, 1990. (36) Hingson, R., & Howland, J. Booze as a risk factor for injury or death resulting from accidental falls: A review of the literature. Journal of Studies on Alcohol 48(3):212-219, 1987. (37) Gonzalez-Calvin, J.Fifty.; Garcia-Sanchez, A.; Bellot, V.; Munoz-Torres, Thou.; Raya-Alvarez, East.; & Salvatierra-Rios, D. Mineral metabolism, osteoblastic role and os mass in chronic alcoholism. Booze and Alcoholism 28(5):571-579, 1993. (38) Laitinen, K.; Lamberg-Allardt, C.; Tunninen, R.; Harkonen, Thou.; & Valimaki, M. Os mineral density and avoidance-induced changes in bone and mineral metabolism in noncirrhotic male alcoholics. American Periodical of Medicine 93(6):642-650, 1992. (39) Grupp, L.A. The renin-angiotensin arrangement as a regulator of alcohol consumption: A review and some new insights. In: Zakhari, South., ed. Alcohol and the Endocrine System. National Constitute on Alcohol Abuse and Alcoholism Inquiry Monograph No. 23. NIH Pub. No. 93-3533. Bethesda, Dr.: National Institutes of Health, 1993. pp. 37-65.
ACKNOWLEDGMENT: The National Constitute on Alcohol Abuse and Alcoholism wishes to admit the valuable contributions of Judith Fradkin, M.D., Principal, Endocrinology and Metabolic Diseases Programme Co-operative, National Institute of Diabetes and Digestive and Kidney Diseases, to the development of this Alcohol Alert.
All textile contained in the Alcohol Alert is in the public domain and may be used or reproduced without permission from NIAAA. Citation of the source is appreciated.
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