Alcohol is a major part of our society and culture. It’s among the most commonly used recreational substances in the world, especially in the United States. Drinking and even binge drinking is often treated as a right of passage for young adults. It may also be seen as a culturally accepted form of self-medication in dealing with stress. However, despite its legal status, it can be a dangerous drug when it’s used excessively. Binge drinking can lead to immediate health threats, substance use problems, and alcohol poisoning.
Heavy drinking for long periods of time can have a serious impact on your health, leading to chronic diseases. Alcohol can damage your liver and lead to other serious diseases like cancer. While alcohol’s effects on your liver are well-known, its effects on your heart may be less understood. Alcohol can damage the heart over time, leading to a condition called alcoholic cardiomyopathy. You may also experience issues like heart palpitations when quitting drinking. What is the relationship between alcohol and coronary heart disease? How does alcohol affect your heart? Can it be good for heart health? How is alcoholic cardiomyopathy treated? Learn more about alcohol’s effects on the body and heart health.
How Does Alcohol Affect the Body?
What we know as alcohol or drinking alcohol is actually a specific type of alcohol called ethanol. Ethanol is a naturally occurring chemical and the only chemical in the alcohol class that humans are able to consume safely. It’s thought that humans developed the ability to consume ethanol so that they could eat fruit and vegetables that fell to the forest floor. It’s interesting to note that other animals, like elephants, that didn’t need to eat fallen fruit have a proportionally much lower alcohol tolerance. Humans have been purposefully fermenting and distilling alcohol for centuries, and it’s a deep part of many cultures around the world today. While humans can drink alcohol, it still has significant effects on the body.
When you drink, alcohol enters your stomach and intestines, where it’s absorbed into your bloodstream. Once it’s in your blood, your liver will go to work filtering it out. Unlike other things that you eat and drink, like water, fats, sugars, and proteins, your body can’t use or store alcohol. For that reason, your body will prioritize getting rid of it. In many ways, it’s treated as poison. However, your liver can only process around one standard drink per hour, depending on your sex and weight. Any alcohol beyond this makes it past your liver as it’s distributed throughout your body. It’s pumped through the body by your heart, and it comes in direct contact with your heart, brain, and nearly every other part of your body except your bones and fat before it’s broken down and removed.
The way and the degree alcohol affects different parts of your body depends on many variables. It’s not fully understood how each part of your body is affected by alcohol, but chronic alcohol misuse has been linked to serious diseases like heart disease, liver disease, and various cancers. Alcohol may damage parts of your body for various reasons, including the contact of toxic chemicals when alcohol is broken down.
Many of alcohol’s acute effects that you may be familiar with are caused by its effects on your brain. When alcohol is delivered to the brain, it can interact with a chemical called gamma-aminobutyric acid (GABA). It acts as a depressant, influencing GABA to have increased effectiveness as it slows down your nervous system. This causes its pleasurable relaxing and anxiety-releasing effects and its intoxicating side-effects. However, chronic misuse can have effects on your body that you don’t realize until they cause serious problems like liver and heart issues.
Is Alcohol Good for Your Heart?
If you have your finger on the pulse of popular science, you may be familiar with the claim that alcohol can have positive effects on the heart. The claim is usually applied to wine, and it states that the daily consumption of alcohol can actually improve heart health. There have been several studies that have investigated alcohol’s positive effects on heart health. As with many things in popular science, it’s easy to lose the details when you read exciting headlines like “alcohol is good for heart health.”
However, it is true that studies have shown some positive effects of alcohol on the heart. A 2017 study of 1,937,360 adults in their 30s or older examined heart health among people that did and didn’t drink alcohol. Complete abstinence from alcohol was associated with a higher risk of 12 heart problems, including angina, heart failure, cardiac arrest, and ischaemic stroke. Still, other heart issues may not be improved or prevented by the use of alcohol, like bleeding in the brain and specific types of mild stroke.
The study also noted that alcohol has several different effects on the heart and the rest of the body. They said, “…any positive aspects of drinking must be weighed against serious physiological effects…” Among these serious effects, they mention the potential for anatomical damage to the heart itself. In other words, while alcohol may have some effect on the body to prevent certain causes for heart attack or stroke, it can also directly damage the heart.
Doctors may respond to studies like this by encouraging moderation. The heart-healthy effects of alcohol require very little alcohol. Moderate drinking may include one drink per day for women and up to two for men. Still, drinking can be dangerous if you have other health issues, especially liver problems or a substance use disorder. Plus, the 2017 study shows that alcohol consumption may not be a good idea for people with certain types of heart disease. The study concluded by saying, “suggesting a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary.”
How Alcohol Can Damage the Heart
Alcohol can be toxic in excessive amounts. While moderate drinking may not be enough to significantly damage the heart, long-term exposure to heavy drinking can damage the heart over time. Alcohol can damage the heart in several ways, including the following:
- Acetaldehyde. Acetaldehyde is a toxic chemical that is produced as your body breaks down alcohol. As it accumulates in your heart, it can damage the organ. The toxin can be removed after several hours, but consistent heavy drinking can start to damage the heart in significant ways.
- Inflammation. Inflammation occurs all over the body for various reasons. It’s generally a way to protect a damaged or irritated area from further damage, but chronic inflammation can lead to significant damage.
- Heart chamber dilation. Alcohol can disrupt the dilation of the four chambers of your heart. Normally they enlarge and deflate in conjunction with one another, but alcohol can make them dilate unevenly. This can lead to issues like arrhythmia, which is when the heart beats irregularly. Arrhythmia can lead to heart disease.
- Impaired contraction. The valve that’s involved in pumping blood may be impaired by excessive alcohol use and less efficient.
- Increase in calcium. Alcohol can cause calcium to build up in heart cells which can cause problems.
Alcohol Use Disorders and Heart Health
An alcohol use disorder is officially diagnosed in the DSM-5 and may involve any one of a list of 11 major symptoms. It’s split into three categories based on severity. Mild alcohol use disorders involve two or three symptoms, moderate disorders involve four or five, and severe disorders involve six or more. Substance use disorders that involve alcohol can increase your risk of experiencing long-term health consequences, like heart disease. Plus, once you’ve become addicted, it’s difficult to quit drinking, even if you know you’re doing damage to your health and other areas of your life.
One of the hallmarks of addiction is the continued, compulsive use of a drug despite consequences. It’s possible for you to experience liver and heart problems caused by alcoholism and still feel unable to cut back or quit drinking. However, alcohol use disorders can be treated, and they often have to be addressed to treat serious issues like heart disease, especially if you are seeking alcoholic cardiomyopathy recovery.
It’s important to be able to identify alcohol use disorders as early as possible in their progression. Here are the signs of alcohol use problems in the DSM-5:
- Dangerous alcohol use. You use alcohol in a way that puts you or someone else in danger. Common examples of this are drunk driving or drinking to the point of alcohol poisoning.
- Relationship issues caused by drinking. Alcoholism can cause social problems. If alcohol is threatening your personal and professional relationships, it’s a sign of substance use issues.
- Neglect of your responsibilities. If you are neglecting important responsibilities like your job, your children, or your education in order to use, you may be experiencing a substance use disorder.
- Withdrawal symptoms. Alcohol can cause uncomfortable and even dangerous withdrawal symptoms when you miss a drink, cut back, or stop drinking. Symptoms like tremors, anxiety, and insomnia, are common signs.
- Tolerance. Another biological sign of alcoholism is tolerance. If you need to drink more and more to achieve the same effects, your body is adapting to heavy drinking, and you may be becoming dependent.
- Drinking more and more. As tolerance grows, you will feel the need to drink heavier amounts and more often to avoid uncomfortable side effects.
- Trying and failing to quit. Many people with alcohol use issues try to stop drinking or cut back more than once. But cravings and compulsions to use will send you back to drinking.
- Using more of your time drinking. As addiction progresses, you’ll spend more of your time drinking and recovering from drinking. You may drink at odd times like the morning during work.
- Physical or mental problems caused by drinking. Drinking can lead to both physical issues and mental health problems. Using despite these issues is a red flag for alcoholism.
- Giving up hobbies and activities to drink. Alcoholism may cause you to give up things you once enjoyed to facilitate more drinking and to maintain your addiction.
- Cravings. Cravings and compulsions to drink are overwhelming and difficult to control.
What is Alcoholic Cardiomyopathy?
Alcoholic cardiomyopathy is a condition that’s characterized by a weakening of the heart muscle that’s caused by excessive alcohol misuse. Over time, alcohol can thin and weaken the heart muscle so that it becomes less efficient in pumping blood throughout the body. As alcoholic cardiomyopathy worsens, it can cause serious issues like heart failure. The disease typically occurs after a long period of heavy alcohol use. Because it usually takes several years of alcoholism, it’s most common among people aged 35 to 50. It’s more common in men, and men tend to have a higher risk of alcohol use problems, but it can happen in women as well.
If you’ve used alcohol excessively for a long period of time and you’re seeking treatment and recovery. You should ask your doctor about your heart and the potential for alcoholic cardiomyopathy. Years of alcoholism can take their toll on several aspects of your physical health. When you are admitted into an addiction treatment program, you’ll go through an intake process that involves a medical assessment.
How is Alcoholic Cardiomyopathy Diagnosed?
Since heart health is such a common concern in the United States, many doctors are experienced in diagnosing and treating heart problems. If you’re concerned about your heart, whether or not you’ve experienced the symptoms of heart failure, your doctor can run tests to see if there’s a problem. The process may start with a physical examination. Some of the routine tests in a doctor’s office can reveal a heart problem. Your doctor may look at your blood pressure, pulse and listen to your heart and lungs. If your doctor finds an abnormal blood pressure or resting heart rate, it may point to a problem. Abnormal sounds in your heart or lungs or an irregular heartbeat could also indicate a problem.
These tests can all be performed by your family doctor, but if they believe it’s necessary or if you request it, you may be referred to a cardiologist for more comprehensive testing. A cardiologist may perform a chest x-ray, CT scan, or echocardiogram to take a look at the physical structure of your heart and to look for abnormalities or damage. Echocardiograms can also show blood clots and leaky heart valves. An electrocardiogram (EKG) can test the electrical signals that cause your heart to pump, which can be disrupted by alcoholic cardiomyopathy. Other physical things your doctor may look for in an exam include:
- An enlarged heart
- Murmurs or valve damage
- Sounds of heart congestion
- Swelling in your neck veins
- Ankles, legs, and feet swelling
Lab tests aren’t usually useful in diagnosing alcoholic cardiomyopathy, but they can help to check the overall damage or dysfunction of your heart. It can also help them test other organs like your liver for damage.
What are the Symptoms of Alcoholic Cardiomyopathy?
One of the most troubling aspects of alcoholic cardiomyopathy is that it can happen without warning. Most people don’t experience any symptoms until it starts to cause heart failure. When you do start to experience symptoms, they may be consistent with the symptoms of typical heart problems. Alcohol and heart disease symptoms include:
- Fatigue, easily tiring out
- Sudden, unintentional weight gain
- Loss of appetite
- Irregular heart rate
- Shortness of breath, even with minor tasks
- Persistent coughing
- Heart palpitations
- Leg and ankle swelling
- Abdominal swelling
- Protruding neck veins
- Dizziness or fainting
- Difficulty concentrating
- Muscle weakness
If you notice any of these symptoms, it could be a sign that something is wrong with your heart and that it’s not functioning properly. You should seek medical attention as soon as possible. However, if you’ve been drinking heavily for many years, you should speak to a doctor or cardiologist about your heart health, even if you don’t feel any of these symptoms.
How is Alcoholic Cardiomyopathy Treated?
The first step in treating alcoholic cardiomyopathy is to stop drinking. Continuing to use or misuse alcohol can cause your condition to worsen and frustrate any attempts to repair the damage to your heart. Addiction treatment is a multidisciplinary process that’s used to treat the physical, psychological, and behavioral aspects of substance abuse. When you stop drinking, some of the long-term effects may begin to reverse. Your liver has a remarkable ability to repair and heal. Liver damage may begin to reverse immediately, repairing dramatically within a few weeks.
Your heart may be less efficient when it comes to repairing, but quitting alcohol misuse can help it to heal. However, there are other things your doctor may recommend to help your heart recover from alcoholic cardiomyopathy. Like other forms of heart disease, some lifestyle changes may allow your heart to recover from excessive alcohol use. Your doctor may recommend a low-salt diet and other heart-healthy dietary changes.
You may also be prescribed medications for specific conditions that can be dangerous for your heart. Diuretics can help remove excess water and salt from your heart that’s caused by fluid retention. If you have hypertension, your doctor may prescribe beta-blockers or ACE inhibitors to lower your blood pressure. Alcoholic cardiomyopathy recovery time will depend on the extent of damage.
If your heart is already damaged too severely to recover without specific intervention, you may be given a pacemaker or defibrillator to help your heart function effectively. Severe heart damage may require a transplant.
Quitting Alcohol Use With Heart Problems
Alcohol can cause some heart issues that can get worse with chronic alcohol abuse. But that’s not the only way alcohol can affect your heart. Alcohol withdrawal makes alcohol the most dangerous substance to quit cold turkey. If you drink excessively and you’ve been diagnosed with a heart issue that is caused by alcoholism or some other source, it’s important to address your alcohol use disorder as soon as possible. However, quitting cold turkey is ill-advised. As a depressant, alcohol is in a class of psychoactive substances that can be dangerous and even life-threatening during alcohol withdrawal. Depressants work to slow down central nervous system activity. When you drink excessively for a long time, you’ll become chemically dependent on alcohol.
Dependence occurs when your brain adapts to the consistent presence of an active chemical by adjusting your natural brain chemistry. Your brain may respond to alcohol by decreasing your natural inhibitory chemicals and increasing excitatory chemicals. You can tell when this is happening when your alcohol tolerance grows. If you’ve been a heavy drinker for a long time, it’s likely that you can drink more now without feeling the effects than you were when you first started drinking. In fact, tolerance is often thought of as a mark of being able to drink more without consequences. However, being able to “hold your liquor” when drinking a lot is a sign of alcohol use problems.
As you develop a chemical dependence on alcohol, the changes in your brain chemistry happen over time. When you stop drinking abruptly, your brain and body will be thrown out of balance suddenly. The symptoms of alcohol withdrawal are often characterized by overstimulation. The sudden loss of an inhibitory chemical will cause things like restlessness, insomnia, and anxiety. You may also feel shaky, jittery, and generally uncomfortable. Your mind may race and make it difficult to focus.
Your brain also controls the unconscious functions of your body, like your heart rate. Alcohol and alcohol withdrawal can affect your nervous system in a way that causes change to some of these functions. This can include symptoms like:
- Increase heart rate
- Increased blood pressure
- Heart palpitations
- Chest pains
- Changes in breathing
In some cases, alcohol withdrawal can be life-threatening, causing strokes and heart attacks in otherwise healthy people. If you’ve used alcohol for a long time and developed alcoholic cardiomyopathy, your risks during withdrawal may be even higher. You may also be at risk for seizures that can cause injuries and spikes in your heart rate.
Another factor that could increase your risk of serious or fatal side effects is something called kindling. Kindling is a neurological phenomenon that refers to changes in the brain that occur during a period of depressant withdrawal. These changes can make each subsequent round of withdrawal more dangerous. In other words, if you’ve ever gone through depressant withdrawal before, going through it again may be more dangerous. People that have been drinking long enough to develop cardiomyopathy may have gone through several attempts at sobriety. The more times you’ve experienced withdrawal, the more likely you are to encounter dangerous symptoms.
How Can You Quit Alcohol Safely
Before you stop drinking cold turkey, speak to a doctor about quitting safely. A doctor can help determine whether or not you’re at risk for severe withdrawal symptoms. When you seek treatment for an alcohol use problem, a medical exam may be part of a typical assessment. However, if you’ve been drinking for a long time, make a point to ask about your heart health and how withdrawal might affect your heart.
Tapering at Home
If your dependence on alcohol is mild to moderate, your doctor may tell you it’s safe to go through withdrawal at home. They may prescribe medications to help you through the withdrawal symptoms. If you haven’t developed a severe substance use disorder, your doctor may prescribe a benzodiazepine to help you taper off of alcohol safely over several days. Tapering involves taking smaller and smaller doses of a drug to allow your body time to adjust back to your normal chemical balance. Benzodiazepines work in the brain in a way that’s very similar to alcohol, so they can curb or prevent alcohol withdrawal symptoms. Long-acting benzodiazepines are typically used to treat alcohol withdrawal syndrome.
Medical detox is a high level of care in the continuum of care in addiction treatment. Detox involves 24-hour medically managed care for people that are likely to go through severe withdrawal symptoms. Detox provides a standard of medical care and monitoring that you can’t get at home, even on a tapering schedule from your doctor. If you’re going into withdrawal after a long period of dependence, detox may be necessary to ensure your safety. But if you’re going into withdrawal with heart conditions like cardiomyopathy, the care you receive in detox may be essential in preventing deadly complications.
Detox may also involve the use of benzodiazepine medications to help taper you off of alcohol. However, it may also involve other medications to help control or prevent uncomfortable symptoms. Medical monitoring is one of the most essential parts of addressing dependence with potential complications. If you have a heart condition, medical staff can keep a close eye on your heart as you go through the withdrawal and detox phase of treatment to maintain your safety.
Detox may also involve clinical care and therapies to help address some of the potential underlying issues in addiction treatment. Once you get through the alcohol withdrawal and detox, you may need to move on to other levels of care in addiction treatment to help maintain your sobriety.