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What If “Alcoholism” Has Nothing To Do With Alcohol?

Posted Nov 11 2011 10:01pm

Posted on | November 10, 2011 |

My father’s closest friend was “Uncle Phil”. They attended Fordham University together, partied together, graduated together. Both were smart, accomplished, Catholic, enjoyed alcohol and were married with large families. Their lives diverged somewhere in the late 50′s or early 60′s when alcohol took over Uncle Phil’s life, his job, his family and his future. My father at first responded with compassion, but eventually took a hard line because the softer approach just didn’t work.

Uncle Phil looked like Paul Newman, but was much gentler. He had the best smile I’d ever seen. In one of those happy surprises that occur in life from time to time, he managed, with the help of a terrific wife and great kids, to stop drinking. What a blessing. My parents’ friendship with he and his wife lasted until their deaths. They – all four – lived into their late 70′s and 80′s.

After Uncle Phil stopped drinking, he and his wife would come over from New York to New Jersey for dinner with my parents 3 or 4 times a year. I noticed that each time, before they came, my mother would load up on juices and soda. I asked her about that and she said “Uncle Phil gets very thirsty.” That stuck in my mind.

When I was down in North Carolina in residency, I became interested in genitourinary physiology and fluid and electrolyte balance. In 1980 I published a book for Cambridge University Press on the neuroendocrinology of the genitourinary system. In writing that book, I uncovered a number of widely held beliefs within the medical community whose citations, when traced back, were bogus – generally the opinion of an “expert” at the time with no research basis. (The most notable example was the claim that “90% of all impotence is psychologic’ which I debunked – leading to a stint with erectile dysfunction, Bob Dole and Viagra – another story for another time.)

With the book published and feedback loops still actively on my mind, I observed over the next several years quite a few family and friends who were recovering alcoholics like Uncle Phil. In every case, I noticed that they were “very thirsty” also. It could be juice, soda, seltzer or coffee – but whatever it was, they consumed tons of the stuff. In fact, I met several recovering alcoholics who had to flat out quit coffee because they said if they drank a cup, they’d drink 20 cups and get heart palpitations.

Over the past year I’ve mentioned to several family members my theory – that maybe alcoholism has nothing to do with the alcohol.  What if these people instead have a genetically derived water and electrolyte imbalance – a defective feedback loop that leaves them with no “shut-off” valve for fluid? What if it isn’t alcohol that they crave but liquid?

I discussed this theory on the phone today with one of my brothers, and he said, “You have too much time on your hands.” Which is true. So with that time I searched to see if anyone had looked into this possibility. I found quite a few citations that detailed the effect of alcohol on fluids and electrolytes, as well as kidney and liver function. But I couldn’t find any articles that prospectively looked at the fluid and electrolyte physiology of a cohort of individuals to see if one could predict who would become an “alcoholic”. The presumption seems to be that alcohol is the cause and water and electrolyte imbalance the effect. But couldn’t the opposite be true?

So here are my biases: Alcohol research is sloppy and lazy (much as was “impotence” research in the 50′s, 60′s, and 70′s). Alcoholics in recovery drink copious amounts of fluid. Researchers presume this is a function of alcohol induced pathophysiology. It could be the opposite – the fluid imbalance could enable over-ingestion of disabling alcoholic beverages. If that was the case, early identification could lead to a cure – or at least spare the Uncle Phil’s of the world a heaping dose of misery.

Help me out – can some smart researcher tell me they’ve already covered this ground and I’m all wet?

For Health Commentary, I’m Mike Magee

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