Hormones Resource
Center
Alcohol
and Hormones
article syndicated from NIAAA
Alcohol
and Hormones
Hormones are chemical messengers
that control and coordinate the functions of all tissues
and organs. Each hormone is secreted from a particular
gland and distributed throughout the body to act on
tissues at different sites. Two areas of the brain,
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 respond 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 body function: production, utilization,
and
storage of energy; reproduction; maintenance of the
internal environment (e.g., blood pressure and bone
mass); and growth and development. This Alcohol
Alert describes how, by interfering with hormone
actions, alcohol can alter blood sugar levels and exacerbate
or cause diabetes (1-4); impair reproductive functions
(5,6); and interfere with calcium metabolism and bone
structure, increasing the risk of osteoporosis (7).
Conversely, hormones also may affect alcohol consumption
by influencing alcohol-seeking behavior.
Alcohol Impairs Regulation of
Blood Sugar Levels
The sugar glucose is the main energy
source for all tissues. Glucose is derived from three
sources: from food; from synthesis (manufacture) in
the body; and from the breakdown of glycogen, a form
of glucose that the body stores in the liver. Hormones
help to maintain a constant concentration of glucose
in the blood. This is especially important for the
brain because it cannot make or store glucose but depends
on glucose supplied by the blood. Even brief periods
of low glucose levels (hypoglycemia) can cause brain
damage.
Two hormones
that are secreted by the pancreas and that regulate
blood glucose levels
are insulin and glucagon. Insulin lowers the glucose
concentration in the blood; glucagon raises it. Because
prevention of hypoglycemia is vital for the body, several
hormones from the adrenal glands and pituitary back
up glucagon function.
Alcohol consumption
interferes with all three glucose sources and with
the actions
of the regulatory hormones. Chronic heavy drinkers often have insufficient
dietary intake of glucose (8). Without eating, glycogen stores are exhausted
in a few hours (1). In addition, the body's glucose production is inhibited
while alcohol is being metabolized (2). The combination of these effects can
cause severe hypoglycemia 6 to 36 hours after a binge- drinking episode (1).
Even in well-nourished
people, alcohol can disturb blood sugar levels. Acute
alcohol
consumption, especially in combination with sugar,
augments insulin secretion and causes temporary hypoglycemia
(9). In addition, studies in healthy subjects (10)
and insulin-dependent diabetics (3) have shown that
acute alcohol consumption can impair the hormonal response
to hypoglycemia.
Chronic heavy
drinking, in contrast, 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 70 percent of patients with alcoholic liver disease
are glucose intolerant or are frankly diabetic (1).
In animals, chronic alcohol administration also increases
secretion of glucagon and other hormones that raise
blood g lucose levels (13).
Alcohol consumption
can be especially harmful in people with a predisposition
to hypoglycemia, such as patients who are being treated
for diabetes (3,4). Alcohol can interfere with the
management of diabetes in different ways. Acute as
well as chronic alcohol consumption can alter the effectiveness
of hypoglycemic medications (14,15). Treatment of diabetes
by tight control of blood glucose levels is difficult
in alcoholics, and both hypoglycemic and hyperglycemic
episodes are common (4). In a Japanese study, alcoholics
with diabetes had a significantly lower survival rate
than other alcoholics (16).
Alcohol Impairs Reproductive Functions
The human reproductive system is
regulated by many hormones. The most important are
androgens (e.g., testosterone) and estrogens (e.g.,
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
development
and thus fertility, and various aspects of male sexual
behavior. In women, hormones promote the development
of secondary sexual characteristics, such as breast
development and distribution of body hair; 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 study of normal healthy men who received
alcohol for 4 weeks, testosterone levels declined after
only 5 days and continued to fall throughout the study
period (17). Prolonged testosterone deficiency may
contribute to a "femininization" of male sexual characteristics,
for example breast enlargement (18).
In addition,
animal studies have shown that acute alcohol administration
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
(19). Alcohol also may interfere with normal sperm
structure and movement by inhibiting the metabolism
of vitamin A (20), which is essential for sperm development.
In premenopausal
women, chronic heavy drinking can contribute to a
multitude of reproductive
disorders. These include cessation of menstruation,
irregular menstrual cycles, menstrual cycles without
ovulation, early menopause, and increased risk of spontaneous
abortions (6,21,22). These dysfunctions can be caused
by alcohol's interfering directly with the hormonal
regulation of the reproductive system or indirectly
through other disorders associated with alcohol abuse,
such as liver disease, pancreatic disease, malnutrition,
or fetal abnormalities (6).
Although most
of these reproductive problems were found in alcoholic
women, some also were
observed in women classified as social drinkers, who
drank about three drinks per day during a 3-week study
(23). A significant number of these women had abnormal
menstrual cycles and a delay or lack of ovulation.
Alcohol also
affects reproductive hormones in postmenopausal women.
After menopause,
estradiol levels decline 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 risk for cardiovascular
disease and osteoporosis in po stmenopausal women (24).
Alcohol can increase the conversion of testosterone
into estradiol (25). Accordingly, postmenopausal women
who drank (24,26) were found to have higher estradiol
levels than abstaining women. Studies have shown that
in postmenopausal women, three to six drinks per week
may reduce the risk of cardiovascular disease (27)
without significantly impairing bone quality (24) or
increasing the risk of alcoholic liver disease (28)
or breast cancer (29).
Alcohol Impairs Calcium Metabolism
and Bone Structure
Calcium exists in two forms in the
body. The main reservoirs are the bones and teeth,
where the calcium content determines the strength and
the stiffness of the bones. 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 diet, how much
is absorbed into the body, and how much is excreted.
Calcium absorption, excretion, and distribution between
bones and body fluids are regulated by several hormones,
namely parathyroid hormone (PTH); vitamin D-derived
hormones; and calcitonin, which is made by specific
cells in the thyroid.
Alcohol can
interfere with calcium and bone metabolism in several
ways. Acute
alcohol consumption 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
also have shown that alcohol is directly toxic to
bone-forming
cells and inhibits their activity (32-34). In addition,
chronic heavy drinking can adversely affect bone metabolism
indirectly, for example by 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 alcohol, also affect bone metabolism
(7).
Calcium deficiency
can lead to bone diseases, such as osteoporosis.
Osteoporosis
is characterized by a substantial loss of bone mass
and, consequently, increased risk of fractures. It
affects 4 million to 6 million mainly older Americans,
especially women after menopause. In alcoholics, the
risk of osteoporosis is increased (35). Because many
falls are related to alcohol use (36), adverse alcohol
effects on bone metabolism pose a serious health problem.
Studies with
abstinent alcoholics have found that alcohol-induced
changes in bone metabolism,
including toxic effects on bone-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 different hormonal pathways may
in turn influence alcohol-seeking behavior. For example,
in animals, alcohol-seeking behavior appears to be
regulated in part through a system called 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 under investigation.
Alcohol and Hormones--A Commentary
by
NIAAA Director Enoch Gordis, M.D.
Alcohol's
wide-ranging effects on the hormone system present many
practical clinical
concerns. For example, managing diabetes, particularly
with the current emphasis on stringent control of blood
sugar, is complicated by alcohol's interference with
blood sugar levels. In the emergency room, stupor in
patients with alcohol on their breath often is not
caused by alcohol intoxication, but by the hypoglycemia
(low blood sugar) that is a complication of heavy drinking.
Failure to treat the hypoglycemia could have life-threatening
consequences. Heavy drinking has a major effect 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 blood estrogen levels coupled with their increased
risk of falling due to drinking. However, it is possible
that moderate alcohol use may help protect postmenopausal
women against osteoporosis by raising blood estrogen
levels. Scientists are working to discover for which
population this may be true and at what drinking levels.
Finally, research 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 by which alcohol-seeking
behavior can be controlled.
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ACKNOWLEDGMENT: The National Institute on Alcohol Abuse and Alcoholism wishes
to acknowledge the valuable contributions of Judith Fradkin, M.D., Chief, Endocrinology
and Metabolic Diseases Program Branch, National Institute of Diabetes and Digestive
and Kidney Diseases, to the development of this Alcohol Alert.
article
syndicated from National
Institute on Alcohol Abuse and Alcoholism:
http://www.niaaa.nih.gov/publications/aa26.htm
National Institute on Alcohol Abuse and Alcoholism No. 26 PH 352, October 1994
