OUTSIDE LINKS   Walden ETHANOL METABOLISM an interview with Cabeza Wapner Ethanol, or grain alcohol, is a fascinating substance that is the source of much mirth as well as tragedy in our society. Noted scholar and raconteur Cabeza Wapner consented to tell us what he has learned about liquor in his lifetime. Our conversation was helped along with a Third Rail or two. Cabeza Wapner: Ethanol is, of course, a very potent beverage. Taken into the alimentary canal, a bolus of alcohol is still technically outside the body. It is not located inside the body until it traverses the lumen of the gastrointestinal (GI) tract. Just because you swallow something, it doesn't mean it's inside your body . . . As a side note, we were going to talk about the cremasteric reflex. This goes over the ilioinguinal/genetofemeral reflex arc. This is basically achieved by scratching the upper inner thigh of a man--the testical on the ipsilateral side should rise. Now kangaroos, indigenous to areas such as Australia and zoos all over the world, have very developed cremasteric reflexes and can actually control the tension of their testicles at will. This is to their advantage, because when the urge to mate is strong they will fight, and they have a special hook on the back of their foot with which they try to rip each other's testicles off. LANDLUBBER So if you tried to kick a kangaroo in the nads, he'd just pull them up. He'd pull up his nads, they'd be safe like NORAD. But getting back to the subject here. Alcohol, as you know, has no fat, no cholesterol. It's the perfect food! It's the perfect food, other than causing several other problems. Alcohol is readily absorbed through the lumen of the GI tract because of its small size and polarity. It is almost immediately absorbed in the stomach. How long should it take your face to turn red after you drink alcohol? We'll talk about that, peripheral vasodilation, in a little bit. Alcohol enters the bloodstream rather quickly, within a few minutes. As a side note, when you cook with alcohol a lot of the alcohol stays in the food, even in a flambe'. It doesn't all burn off, that's a bunch of crap. Now as we said, the alcohol enters the bloodstream, and once it enters the bloodstream it very readily crosses the blood/brain barrier. This is why it has almost immediate effects on your brain. The capillaries throughout the body, the fenestrated . . . . . . and defenestrated . . . . . . and unfenestrated capillaries. The blood/brain barrier contains what are called "tight junctions," because they don't let many substances through. This protects the brain from poisoning and damage and such by substances that should not normally be there. Alcohol crosses this barrier readily which causes problems, as we shall see, my friend. Alcohol affects most of the brain. It affects the cerebellum and the thalamus. The thalamus, of course, is in charge of temperature control--the anterior thalamus is for cooling and the posterior is for heating. Now the anterior thalamus is affected and this causes peripheral vasodilation, which causes a blush or red face. It makes you feel warm, even though you're trying to give off excess heat and are not really warm. But a lot of people say, "Hey, we'll drink some of this stuff to stay warm in winter," but actually you're losing heat which is not what you want. It also affects your cerebellum, which affects your coordination. Coming back to alcohol itself, it is fat-free and has no cholesterol. It raises your level of high-density lipoprotein (HDL), which is a good thing. It reduces your level of scavenger low-density lipoprotein (LDL) receptors, which is also good, because these can form foam cells, a precursor to atherosclerotic plaques and lesions. Of course, this is all in moderation. It's hard to define "moderation." They have "CAGE" questions for checking for alcoholism: C-- Have you tried to Cut down on your drinking? A-- Do you get Annoyed when people ask you about your drinking? G-- Do you feel Guilt about your drinking? E-- Do you have an Eye-opener? Now the CAGE questions as we like to ask them are somewhat different. For example, rather than G for Guilt we ask "Do you drink a Gallon or more of alcohol a day?" If you answer "yes" to three out of the four, there's a 74% specificity, and approximately the same sensitivity, that you are an alcoholic. If you answer all four, it is a 95% specificity and sensitivity that you are indeed an alcoholic. Now, of course, HDL is your high-density lipoprotein--that's good. Your VLDLs (very-low-density lipoproteins) and chilomicrons are actually triisoglicerides, the chilomicrons are exogenous, your VLDLs are endogenous. The LDLs are really bad, they're a high source of cholesterol, and that's bad. Of course the HDLs also have a good bit of cholesterol. Conincidentally, the group of people that has the highest HDL activity level is lumberjacks. They seem to be the most fit of any people on earth. Even Olympic atheletes do not equal their level of HDL. Incredible. Of course, any medical people . . . Henry David Thoreau . . . "Simplify, simplify, simplify." Did you see the Bob Villa where Henry David Thoreau came on? They visited Walden, and Bob Villa complained about the lack of facilities (not enough closet space), and Henry David Thoreau just about slapped him in the face. Anyway, you should try to drink one glass of wine or one ounce of alcohol a day. How much alcohol is naturally occurring in your body? That's a very interesting question! I think approximately three millimoles of alcohol are produced in your system each day by fermentation, by the bacteria in your body. There are three systems that remove alcohol from your body. There is of course the MEOS, the microsomal ethanol oxidizing system. That can be induced--in other words, an increased demand will cause an increased level of activity in these enzymes such that they're either more readily produced, or their catabolism is decreased so that you have higher levels in your system. That's why some people who drink regularly can drink more than others--they have induced that system. Now you also have the acid aldehyde/alcohol dehydrogenase system for detoxification of alcohol. As alcohol is metabolized, you produce acid aldehyde as an intermediate, and catlyase is used to break that down. Chinese people and people of Asian descent often lack catylase. If you lack catylase, or "DHEA," acid aldehyde will build up, which can also cause blushing. The MEOS system will only do so much, and will have a harder time of detoxification. That's why some Asian people can't drink as much as non-Asians, because the acid aldehyde builds up. An interesting side note here is that acetominophen-- Tylenol. Tylenol. The detoxification for it is similar to that for alcogol, it uses a lot of the same enzymes. So if you take Tylenol while drinking, ibuprofen too, it can cause liver and kidney damage. What about taking narcotics with alcohol, as I am wont to do? Well, there's interesting side-effects. Of course the receptors used to clear diazepam, commonly called Valium, from the body are the same as for semetidime, so if you take an acid-blocker with it . . . they can have synergistic effects. To be considered synergistic, it must be an effect four times greater than if given by itself. Like you feel four times drunker. Yes. I also guess it does much more damage to your organs? Probably so. It would remain in your system longer and cause more damage. Now we can talk about DHEA. It is the third enzyme system. That's what normally removes the natural alcohol from your body, the alcohol that bacteria make. The last important note is about ethyl glycol. Ethyl glycol is a common component of antifreeze. It's very sweet-tasting and a lot of animals like to drink it. And it kills them! It kills them, it does. Actually, ethyl glycol doesn't kill them, one of its metabolates does. If you drink methanol (wood alcohol) or you drink ethyl glycol, and you make it to the emergency room, one of the first things that the doctors will do is pump you full of ethanol. As ethyl glycol and methanol are metabolized in the body they produce toxic intermediates. The toxic intermediate of methanol collects in the vitreous humor and the aqueous humor. Like in your eyes. That's why you can go blind from methanol poisoning. By using the ethanol as a competative inhibitor, at almost lethal levels of ethanol, it competes for the receptor sites with ethyl glycol and methanol, which keeps them from being taken up, so they can be passed via the kidneys to the urine unmetabolized, thus causing no damage to your body. That's one interesting side side note there. Chris Zagrodny: They send it in as line jumpers. Pardon? They send it in as line jumpers, basically. What do you mean? To block the ethyl intermediates from getting to your eye. Whatever Zagrodny says, I concur pretty much, if it's right. Alcohol is also avery potent inhibitor of ADH, anti-diuretic hormone, also called vasopresine. This inhibition of ADH causes you to urinate more than you should. Hence Socrates's famous statement that "You don't buy beer, you rent it." Yeah, exactly. Socrates was a wise man. This causes the osmolality of your cerebrospinal fluid (CSF) to increase to the point where it irritates your system and causes a hangover. So you should drink a lot of water when drinking ethanol. It indirectly decreases the pH of the CSF. It's a very roundabout way, having to do with carbon dioxide and carbonic acid. Right And it gets really deep into the system of maintaining acidosis or, actually, to prevent respiratory acidosis. The system blows off excess carbon dioxide, and that reacts with carbonic acid, and that brings more protons out. Well, protons don't move readily across the blood/brain barrier to the CSF, so by decreasing the amount of CO2 in your bloodstream you can upset the buffer system. CO2 moves across the membrane, which in cooperation with dehydration will increase the hydrogen concentration and cause your chemoreceptors to be firing more rapidly. And it causes you pain. Are you familiar with congeners? What? What is that. It is other kinds of alcohol besides ethyl alcohol that are formed during the alcohol-making process. They are present in very small amounts, and are somehow related to hangovers. I've heard that hangovers are due in large part to the impurities in alcohol, but I've also heard that's a bunch of crap. Of course, it's well-known that an element in red wine causes headaches. Those allergy things. Allergens? . . . Histamines! Red wine contains histamines. Histamines are released in the late stages of a Type 1 hypersensitivity allergic reaction. Mass cells degranulate and release histamines. The histamines cause a cascade effect. Remember vasodialation? Your brain doesn't feel pain, but when the blood vessels supplying blood to the brain vasodialate, the nerve endings supplying them perceive this increased diamater as a pain. That's also one of the reasons why you get throbbing headaches--the diameter will increase and decrease as blood pressure varies with the heartbeat. Mic check. Fatty liver. Check check microphone check. We're going to talk about fatty liver for a second. Everyone gets fatty liver after drinking. That's because it increases glycogen stores. Oh, we didn't even talk about Wernicke-Korsakoff syndrome, did we? First fatty liver. So what happens is you get increased glycogen stores, fatty liver. You can get an appreciable increase in liver size. One of the problems with fatty liver, and seen with alcoholics in general, is that they require nicotanamine adenide dinucleotide (NAD) as a coenzyme for one of the steps of alcohol metabolism. They often run out of NAD, and that's bad. This is one of the reasons why alcoholics are much more sensitive to barbiturates, because once the NAD is gone they can't metabolize barbiturates. If an alcoholic is taking drugs like that, they are much more sensitive to them than someone off the street who could metabolize them and remove them from their system much more quickly. Like Chris Zagrodny. Like Chris Zagrodny, an avid barbiturate abuser. Now once you've run out of NAD you can't remove the glycogen stores, the fatty liver, and over time this can be a precursor to cirrhosis or cancer of the liver. Although the liver has tremendous capacity to regenerate itself. That's one good thing, I guess. Sensory input and computations in different parts of the brain are, unfortunately (or maybe fortunately for you, whatever your case may be) modified. Reality is curved and warped. Hence Thoreau's famous statement that "She'll be pretty enough by the end of the night." That's right. That may also be why he said, as he saw the tail of the woodchuck sliding through the brush, "At that moment I had an overwhealming urge to seize and devour him raw." Two-thirds of homeless people are schizophrenic. Of course, if a female consumes alcohol while she's pregnant you get what you call the Fetal Alcohol Syndrome, which includes mid-line brain defects or anomolies, also anaencephaly, which means they have no brain. Oh, Wernicke-Korsakoff syndrome! This is one thing that's bad. You see, thiamin is very necessary in your body. It's a precursor to many things, together with folate. Lack of thiamin and folate can cause what's called megablastoanemia. In other words, your red blood cells remain large--they normally lose their nuclei after being formed, thus taking the familiar bi-concave discoid shape. Folate is also required in other areas of the body for normal neurological activity, and for normal homeostasis of the nervous system. If you do not have thiamin then you get this anemia, also called pernicious anemia. Normally this manifests itself in vegetarians. They'll show up at the doctor's because they're feeling weak, or whatever. Big deal, we'll take care of that. The problem is, if someone has a folate deficiency. Folate stays stored in the body for over a year, so you have plenty stored up. You don't have to go to the store that often to buy more folate. But if you don't have folate, it causes neurological damage. That's one of the reasons why they don't fortify foods with thiamin--it would mask the pernicious anemia, allowing the red blood cells to regenerate in lieu of folate, but you would still get the neurological damage because would have a folate deficiency. Well, you see, to pick up Vitamin B-12 you need what's called "intrinsic factor," which is produced in the stomach and the proximal small colon. People who have gastritis or degradation, removal, or just abnormal functioning of the stomach mucosa, will not have instrinsic factor, and they cannot pick this up. Now, alcoholics who have a very poor dietary intake (although their caloric intake may be fine) get what's called Wernicke-Korsakoff syndrome, a neurological syndrome associated with alcoholism because of decreased not only thiamin but folate levels. They get what's called "wet beri-beri," which is three-fold: they get chronic diarrhea, they get skin problems, and they get fatty liver. That's the whole triad there, associated with wet beri-beri. Let me ask you, why is it that women are affected more readily by alcohol than men? I'm glad you asked that, Michael. This is a very basic premise of getting laid. Is it because they have more fat than men? No, women just have fewer enzymes, lower constituted enzyme levels, because their body weights are lower. And so that, if you take a glass of water for instance, that's half full, and a glass that's full, assuming that the glasses are the same, and if you add a drop of dye to each one, the amount of dye is the same in each-- I thought that even taking into account body weight that they were more affected by alcohol. Like I said, it's because they have fewer enzymes to metabolize it. I think it's because they have more fat. I don't think so. All right. They do have more fat. They do, because of their breasts. Anyway, let's see what else . . . hmm . . . What's a really good episode of "The People's Court" that you remember right off? Right off the top of my head . . . on the original "People's Court," I remember that there was this really, sort of . . . what's the word I'm looking for . . . not pristine . . . purnish? I dunno, this woman who had this bright purple jacket on, she was just very snotty, and did not respect Judge Wapner. His Honor, Judge Joseph A. Wapner (retired). She had no respect for the court system in general. She was losing the case, and as Judge Wapner was explaining his decision, she just got mad, and she says, "I'm leaving." She says, "You know, my business, my building is much nicer than this one." And she turned around and walked out. Judge Wapner got very mad and started pounding his gavel, and said, "I'm going to assess you fines." And he fined her two thousand dollars because of this, in addition to the regular fine. A few minutes later, what's-his-name-- Rusty. No . . . Doug Llewellyn. He says, "Unfortunately, because Judge Wapner is retired, he cannot assess fines." And they had to take them back. I just remembered that eposide, where THAT . . . FUCKING . . . BITCH . . . disrespected Judge Wapner. If I had been there, I would've taken her out. She'd of been gone, Ghandi, Mahatma Ghandi. A side note here: Bob Flanagan-- --supermasochist-- --supermasochist, may he rest in peace, he enjoyed red wine enemas given by his mistress. The red wine would be very readily absorbed across the intestinal mucosa, and would cause an almost instantaneous and very intense intoxication. A very interesting practice. Also, I guess it stings quite a bit, too. [Walks outside] Alcohol, or any other noxious stimulant, when repeatedly exposed to the body--hey, Chris, let me drive! No. When repeatedly exposed to the body, can cause what's called-- You been drinking! You have been drinking, Zagrodny. Zagrodny . . . No, I haven't! Gimme the keys. He's been drinking. Zagrodny . . . "Officer, I want to use this as evidence against Mr. Zagrodny. He will not listen to us . . . " Walk a straight line. Yeah, out here, right now. We're going to test your cerebellar . . . now, anyway, what you get is called metaplasia . . . we'll stop here. Gimme the keys! [Takes keys] No! That is my parents' car! Chris, it's OK. But walk the line first. I'll give you the keys, I promise. Walk. What happens is the pseudocilliated columnar epithelium is transformed into a stratified squamous epithelium. [Returns keys to Zagrodny] "He walked the line, officer, I swear." You're drunk, Chris. So the pseudocilliated columnar epithelium is transformed into a squamous epithelium. I had one beer two hours ago! And that, of course, is a protective role, but this actually happens bodywide, and that's one of the reasons why alcoholics become infertile. The pseudostratified squamous epithelium lining the urogenital tract is also transformed into stratified squamous epithelium, and this . . . [Zagrodny, now driving, rolls down his window] You know, when police are looking for drunk drivers, they look for an open window. The driver rolls down the window thinking the cold air will revive him. Anyway, that's another very interesting side to alcoholics. Alcoholics! also have lower esophageal sphincters (LESs) that are poorly controlled. This is under the control of cranial nerve 10, the vegas nerve. They often get regurgitation of stomach contents up into their throat, and thus often aspirate, or take into the trachea, contents that are acidic, and these contents can eat away at their lungs and cause lots of problems. This guy, he decided to pay for your drinks for the night? Yeah, it was too tempting. In exchange for sex? In exchange for the fact that he thought it was pretty cool that I was drinking shots of warm vodka . . . Was this other man healthy, wealthy, or wise? . . . and as far as I know, we didn't have sex. Very good. Earlier in the evening, I asked Zagrodny what kind of woman he preferred. And he says, "Unconscious." All errors in this interview are due to mistakes in transcription.