Its Christmas time — the party season when you lose track of how much alcohol one downs. But such overindulgence during the festive period is surely going to leave most with more than just a bad hangover or a few embarrassing memories. The year-end binge drinking culture, typically found in Britain, is slowly catching up in India and rest of the world, says Dr Rajiv Jalan, professor of hepatology and head of the liver failure group at the University College London (UCL). When the party season gets into full swing, liver experts around the world gear up to handle the rising number of alcohol-related incidents, said Jalan.
Although the number of south Asians to get admitted in British hospitals is less than the number of white or Afro-Carribean people, the hepatologists come across the worst cases of alcohol-related liver disease in people who trace their origin to the Indian subcontinent. Indians, particularly at a young age, are vulnerable to alcoholic cirrhosis and other liver-related complications, he added.
Last year when Jalan, along with other British liver experts, tested the health of the livers of several daytime passers-by at mobile clinics in London and Birmingham, many of them were found to have livers damaged by alcohol consumption. In the sample only 18 per cent were of south Asian origin, but of them 41 per cent had pronounced liver problems. Seventy per cent of the sample was white, of whom only 19 per cent had critical liver problems.
Two months ago another study by Jalan and his colleagues at UCL, comprising more than 1,000 people, found that almost a third of routine drinkers had sustained liver damage enough to increase the risk of early death. The study was published in Hepatology. In this study too a substantial number of affected people were of south Asian descent. Both the studies corroborated what an earlier landmark paper in the journal Alcohol & Alcoholism had found: Indians are genetically predisposed to alcoholic cirrhosis.
That is why it is not surprising that 20 to 30 per cent of hospital admissions or medical consultations in India is somehow related to alcohol consumption. Nearly 50 per cent of liver-related problems is due to alcoholism and the latest trends show that a large number of the individuals affected are below 30, said Dr D.N. Guha Mazumder, head of the department of gastroenterology at Calcutta Medical Research Institute.
Treating cirrhosis or other critical liver diseases is extremely frustrating, said Dr K.N. Jalan, head of gastroenterology at Kothari Medical Centre (KMC). You need quite an aggressive therapy when there is fluid build-up in the abdomen, gastrointestinal bleeding or impaired brain function. The therapy is not only expensive (and not covered by medical insurance) but often turns out to be in vain when the patient dies.
According to him, the average age of death from alcoholic liver disease is steadily coming down. It used to be 60, now the average age is about 40. Recently a 35-year-old actor succumbed to alcoholic cirrhosis in the hospital, with multi-organ failure.
The UCL team may be in a position to extend some help in this regard. They have recently identified a telltale protein in blood to diagnose complicated cirrhosis at an early stage. The protein can act as an early indicator or biomarker — called Dasimar — to enable doctors identify which patients with cirrhosis are likely to develop multi-organ failure. To validate Dasimars function, 700 people across Britain are taking part in studies at specialist liver centres.
An increasing number of patients with alcoholic cirrhosis, concedes Sujit Choudhury, a gastroenterologist at the Advanced Medicare & Research Institute (Salt Lake), Calcutta, are below 30. Until recently alcoholic liver disease was not so common in eastern India. He asserted that most of them are middle-class professionals who have no idea of the damage theyre doing to themselves through social drinking that most think is perfectly harmless. He, too, has evidence that the phenomenon of binge drinking during the festive season or year-end parties and picnics is on the rise.
But Vivek Benegal, associate professor at the National Institute of Mental Health and Neuroscience, Bangalore, doesnt think that binge drinking is anything new in India. For most Indian drinkers the primary aim is to down at least five drinks and get intoxicated." His study — which was the key component of Indias Alcohol Atlas released last April — found that over half the nations drinkers are engaged in binge drinking, when one downs more than five drinks (220ml of spirits or 600ml of wine) in a single session. The liver is capable of processing just 10ml of alcohol in an hour.
However, there is no denying that drinking alcohol is becoming more acceptable in society. There are over 62 million alcohol drinkers in India and the age of initiation has come down to 13.5 years in 2006, from 19 in 1986, said Union health minister Anbumani Ramadoss at an international health ministers conference recently.
The early initiation raises the chance of getting cirrhosis at a younger age, said Rajiv Jalan. According to him, social drinking has made things worse because people dont count how much they drink at home or small gatherings. Social drinking lulls us into a false sense of security. For a long time liver failure goes undiagnosed.
To pick up early signs of a drinking problem and its effect on the liver the UCL recently introduced a machine called Fibroscan. Its non-invasive, painless and risk free to the patient, working on the principle that sound waves travel more slowly through a soft, healthy liver than a hardened, damaged liver ravaged by alcohol, he says. The UCL recently tied up with KMC for a pilot study on Indian alcoholics using the same technology.