Re: Alcohol - What is the truth about it and PSC???

[Guest guest]

I did the same thing for 17 years with the

permission of my GI. He actually encouraged an occasional drink.

Joe

PSC & UC 1990; Liver Tx 2007

From:

[mailto: ] On Behalf Of archiebanker

Sent: Saturday, February 14, 2009

7:27 PM

To:

Subject: Alcohol -

What is the truth about it and PSC???

I have heard varying things about alcohol and PSC.

Some on this site have said the occasional

drink is not a concern. Others have said it should be avoided completely.

Personally

diagnosed 1.5 yrs ago, have no symptoms and on Urso. Have a drink once in a

while, don't

go binging or anything. Is this wrong?

[Guest guest]

I did the same thing for 17 years with the

permission of my GI. He actually encouraged an occasional drink.

Joe

PSC & UC 1990; Liver Tx 2007

From:

[mailto: ] On Behalf Of archiebanker

Sent: Saturday, February 14, 2009

7:27 PM

To:

Subject: Alcohol -

What is the truth about it and PSC???

I have heard varying things about alcohol and PSC.

Some on this site have said the occasional

drink is not a concern. Others have said it should be avoided completely.

Personally

diagnosed 1.5 yrs ago, have no symptoms and on Urso. Have a drink once in a

while, don't

go binging or anything. Is this wrong?

[Guest guest]

I did the same thing for 17 years with the

permission of my GI. He actually encouraged an occasional drink.

Joe

PSC & UC 1990; Liver Tx 2007

From:

[mailto: ] On Behalf Of archiebanker

Sent: Saturday, February 14, 2009

7:27 PM

To:

Subject: Alcohol -

What is the truth about it and PSC???

I have heard varying things about alcohol and PSC.

Some on this site have said the occasional

drink is not a concern. Others have said it should be avoided completely.

Personally

diagnosed 1.5 yrs ago, have no symptoms and on Urso. Have a drink once in a

while, don't

go binging or anything. Is this wrong?

[Guest guest]

My interventional radiologist said an occasional drink isn’t

going to do a darned thing – it’s autoimmune.

The social worker at the transplant center said it’s a shame,

because that’s probably true. But if I test positive for alcohol at all – I’m

out.

Nita

==================

I have heard varying things about alcohol and

PSC. Some on this site have said the occasional

drink is not a concern. Others have said it should be avoided completely.

[Guest guest]

There is some evidence that alcohol consumption in PSC patients

increases risk for cholangiocarcinoma:

Hepatology 31: 7-11 (2000)

Cholangiocarcinoma in patients with primary sclerosing cholangitis: a

multicenter case-control study.

Chalasani N, Baluyut A, Ismail A, Zaman A, Sood G, Ghalib R,

McCashland TM, Reddy KR, Zervos X, Anbari MA, Hoen H

Indiana University School of Medicine, Indianapolis, IN 46202, USA.

nchalasa@...

Patients with primary sclerosing cholangitis (PSC) have a

significantly increased risk of developing cholangiocarcinoma (CCA).

Risk factors for developing such a complication are not well defined.

We conducted a multicenter, case-control study to determine the risk

factors and possible predictors for CCA in patients with PSC. The

demographic, clinical, and laboratory features of 26 PSC patients

with CCA diagnosed over a 7-year period at eight academic centers

were compared with 87 patients with PSC but no CCA (controls). There

was no statistically significant difference in demographics, smoking,

signs or symptoms or complications of PSC, indices of disease

severity (Mayo Risk score or Child-Pugh score), frequency or duration

or complications of inflammatory bowel disease (IBD), frequency of

biliary surgery, or therapeutic endoscopy between the two groups.

Alcohol consumption was significantly associated with CCA in patients

with PSC (odds ratio: 2.95; 95% CI: 1.04-8.3). Serum carbohydrate

antigen 19-9 (CA 19-9) was significantly higher in patients with CCA

than those without (177 +/- 89 and 61 +/- 58 U/mL, respectively; P

=.002). A serum CA 19-9 level > 100 U/mL had 75% sensitivity and 80%

specificity in identifying PSC patients with CCA. In conclusion,

alcohol consumption was a risk factor for having CCA in PSC patients.

The indices of severity of liver disease were not associated with CCA

in patients with PSC. Serum CA 19-9 appeared to have good ability to

discriminate PSC patients with and without CCA. PMID: 10613720.

The full text of this article is available at:

http://www3.interscience.wiley.com/cgi-bin/fulltext/106596622/PDFSTART

But please also read the commentary that accompanied it:

Comment in: Hepatology. 2000 Jan;31(1):247-8.

http://www3.interscience.wiley.com/cgi-bin/fulltext/106596656/PDFSTART

The latter article concludes:

" Finally, should patients with PSC be allowed to use alcohol? Based

on the known effects of even small amounts of alcohol on portal

pressures, I advise patients with cirrhosis and portal hypertension

to abstain from alcohol use. All others I allow an occasional glass

of wine, stressing quality over quantity. "

I would further add that alcohol consumption is known to interfere

with vitamin A metabolism, and can make vitamin A and beta-carotene

toxic and carcinogenic:

Am. J. Clin. Nutr. 69: 1071-1085 (1999)

Alcohol, vitamin A, and beta-carotene: adverse interactions,

including hepatotoxicity and carcinogenicity.

Leo MA, Lieber CS

Section of Liver Disease and Nutrition, the Alcohol Research and

Treatment Center, Bronx VA Medical Center and Mount Sinai School of

Medicine, NY 10468, USA.

Isozymes of alcohol and other dehydrogenases convert ethanol and

retinol to their corresponding aldehydes in vitro. In addition, new

pathways of retinol metabolism have been described in hepatic

microsomes that involve, in part, cytochrome P450s, which can also

metabolize various drugs. In view of these overlapping metabolic

pathways, it is not surprising that multiple interactions between

retinol, ethanol, and other drugs occur. Accordingly, prolonged use

of alcohol, drugs, or both, results not only in decreased dietary

intake of retinoids and carotenoids, but also accelerates the

breakdown of retinol through cross-induction of degradative enzymes.

There is also competition between ethanol and retinoic acid

precursors. Depletion ensues, with associated hepatic and

extrahepatic pathology, including carcinogenesis and contribution to

fetal defects. Correction of deficiency through vitamin A

supplementation has been advocated. It is, however, complicated by

the intrinsic hepatotoxicity of retinol, which is potentiated by

concomitant alcohol consumption. By contrast, beta-carotene, a

precursor of vitamin A, was considered innocuous until recently, when

it was found to also interact with ethanol, which interferes with its

conversion to retinol. Furthermore, the combination of beta-carotene

with ethanol results in hepatotoxicity. Moreover, in smokers who also

consume alcohol, beta-carotene supplementation promotes pulmonary

cancer and, possibly, cardiovascular complications. Experimentally,

beta-carotene toxicity was exacerbated when administered as part of

beadlets. Thus ethanol, while promoting a deficiency of vitamin A

also enhances its toxicity as well as that of beta-carotene. This

narrowing of the therapeutic window for retinol and beta-carotene

must be taken into account when formulating treatments aimed at

correcting vitamin A deficiency, especially in drinking populations.

PMID: 10357725.

The full text of this article is available at:

http://www.ajcn.org/cgi/content/full/69/6/1071

Since PSC patients are often vitamin A deficient, alcohol consumption

could make this deficiency worse, and render their vitamin A

supplements potentially toxic and carcinogenic. I wonder whether the

reported increased risk of CCA associated with alcohol consumption in

PSC patients described by Chalasani (above) may have something to do

with this vitamin A/alcohol adverse interaction?

Dave

(father of (23); PSC 07/03; UC 08/03)

>

> I have heard varying things about alcohol and PSC. Some on this

site have said the occasional

> drink is not a concern. Others have said it should be avoided

completely. Personally

> diagnosed 1.5 yrs ago, have no symptoms and on Urso. Have a drink

once in a while, don't

> go binging or anything. Is this wrong?

>

[Guest guest]

There is some evidence that alcohol consumption in PSC patients

increases risk for cholangiocarcinoma:

Hepatology 31: 7-11 (2000)

Cholangiocarcinoma in patients with primary sclerosing cholangitis: a

multicenter case-control study.

Chalasani N, Baluyut A, Ismail A, Zaman A, Sood G, Ghalib R,

McCashland TM, Reddy KR, Zervos X, Anbari MA, Hoen H

Indiana University School of Medicine, Indianapolis, IN 46202, USA.

nchalasa@...

Patients with primary sclerosing cholangitis (PSC) have a

significantly increased risk of developing cholangiocarcinoma (CCA).

Risk factors for developing such a complication are not well defined.

We conducted a multicenter, case-control study to determine the risk

factors and possible predictors for CCA in patients with PSC. The

demographic, clinical, and laboratory features of 26 PSC patients

with CCA diagnosed over a 7-year period at eight academic centers

were compared with 87 patients with PSC but no CCA (controls). There

was no statistically significant difference in demographics, smoking,

signs or symptoms or complications of PSC, indices of disease

severity (Mayo Risk score or Child-Pugh score), frequency or duration

or complications of inflammatory bowel disease (IBD), frequency of

biliary surgery, or therapeutic endoscopy between the two groups.

Alcohol consumption was significantly associated with CCA in patients

with PSC (odds ratio: 2.95; 95% CI: 1.04-8.3). Serum carbohydrate

antigen 19-9 (CA 19-9) was significantly higher in patients with CCA

than those without (177 +/- 89 and 61 +/- 58 U/mL, respectively; P

=.002). A serum CA 19-9 level > 100 U/mL had 75% sensitivity and 80%

specificity in identifying PSC patients with CCA. In conclusion,

alcohol consumption was a risk factor for having CCA in PSC patients.

The indices of severity of liver disease were not associated with CCA

in patients with PSC. Serum CA 19-9 appeared to have good ability to

discriminate PSC patients with and without CCA. PMID: 10613720.

The full text of this article is available at:

http://www3.interscience.wiley.com/cgi-bin/fulltext/106596622/PDFSTART

But please also read the commentary that accompanied it:

Comment in: Hepatology. 2000 Jan;31(1):247-8.

http://www3.interscience.wiley.com/cgi-bin/fulltext/106596656/PDFSTART

The latter article concludes:

" Finally, should patients with PSC be allowed to use alcohol? Based

on the known effects of even small amounts of alcohol on portal

pressures, I advise patients with cirrhosis and portal hypertension

to abstain from alcohol use. All others I allow an occasional glass

of wine, stressing quality over quantity. "

I would further add that alcohol consumption is known to interfere

with vitamin A metabolism, and can make vitamin A and beta-carotene

toxic and carcinogenic:

Am. J. Clin. Nutr. 69: 1071-1085 (1999)

Alcohol, vitamin A, and beta-carotene: adverse interactions,

including hepatotoxicity and carcinogenicity.

Leo MA, Lieber CS

Section of Liver Disease and Nutrition, the Alcohol Research and

Treatment Center, Bronx VA Medical Center and Mount Sinai School of

Medicine, NY 10468, USA.

Isozymes of alcohol and other dehydrogenases convert ethanol and

retinol to their corresponding aldehydes in vitro. In addition, new

pathways of retinol metabolism have been described in hepatic

microsomes that involve, in part, cytochrome P450s, which can also

metabolize various drugs. In view of these overlapping metabolic

pathways, it is not surprising that multiple interactions between

retinol, ethanol, and other drugs occur. Accordingly, prolonged use

of alcohol, drugs, or both, results not only in decreased dietary

intake of retinoids and carotenoids, but also accelerates the

breakdown of retinol through cross-induction of degradative enzymes.

There is also competition between ethanol and retinoic acid

precursors. Depletion ensues, with associated hepatic and

extrahepatic pathology, including carcinogenesis and contribution to

fetal defects. Correction of deficiency through vitamin A

supplementation has been advocated. It is, however, complicated by

the intrinsic hepatotoxicity of retinol, which is potentiated by

concomitant alcohol consumption. By contrast, beta-carotene, a

precursor of vitamin A, was considered innocuous until recently, when

it was found to also interact with ethanol, which interferes with its

conversion to retinol. Furthermore, the combination of beta-carotene

with ethanol results in hepatotoxicity. Moreover, in smokers who also

consume alcohol, beta-carotene supplementation promotes pulmonary

cancer and, possibly, cardiovascular complications. Experimentally,

beta-carotene toxicity was exacerbated when administered as part of

beadlets. Thus ethanol, while promoting a deficiency of vitamin A

also enhances its toxicity as well as that of beta-carotene. This

narrowing of the therapeutic window for retinol and beta-carotene

must be taken into account when formulating treatments aimed at

correcting vitamin A deficiency, especially in drinking populations.

PMID: 10357725.

The full text of this article is available at:

http://www.ajcn.org/cgi/content/full/69/6/1071

Since PSC patients are often vitamin A deficient, alcohol consumption

could make this deficiency worse, and render their vitamin A

supplements potentially toxic and carcinogenic. I wonder whether the

reported increased risk of CCA associated with alcohol consumption in

PSC patients described by Chalasani (above) may have something to do

with this vitamin A/alcohol adverse interaction?

Dave

(father of (23); PSC 07/03; UC 08/03)

>

> I have heard varying things about alcohol and PSC. Some on this

site have said the occasional

> drink is not a concern. Others have said it should be avoided

completely. Personally

> diagnosed 1.5 yrs ago, have no symptoms and on Urso. Have a drink

once in a while, don't

> go binging or anything. Is this wrong?

>

[Guest guest]

's information was excellent! My doctor has told me pretty much

what was stated in the comments at the end of the first article. I do

not have cirrhosis or any signs of liver damage yet, and he said the

occasional glass of wine is ok. He also said to make it a good one.

He said the same for Tylenol.

ee

>

> I have heard varying things about alcohol and PSC. Some on this site

[Guest guest]

's information was excellent! My doctor has told me pretty much

what was stated in the comments at the end of the first article. I do

not have cirrhosis or any signs of liver damage yet, and he said the

occasional glass of wine is ok. He also said to make it a good one.

He said the same for Tylenol.

ee

>

> I have heard varying things about alcohol and PSC. Some on this site

[Guest guest]

Thanks everyone for all the great responses. Really appreciate it. I have read

once or twice on

this site people mentioning that they can't have a transplant if they have

alcohol. Is that ever

or is that when you are on a regiment before tx? I am pretty sure that my

occasional glass of

wine will become obsolete if and when I progress further (although with the

promising new

drugs coming out, i'm hoping and praying it never gets to that!).

Hope you and your families are all well.

-

[Guest guest]

Thanks everyone for all the great responses. Really appreciate it. I have read

once or twice on

this site people mentioning that they can't have a transplant if they have

alcohol. Is that ever

or is that when you are on a regiment before tx? I am pretty sure that my

occasional glass of

wine will become obsolete if and when I progress further (although with the

promising new

drugs coming out, i'm hoping and praying it never gets to that!).

Hope you and your families are all well.

-

[Guest guest]

Thanks everyone for all the great responses. Really appreciate it. I have read

once or twice on

this site people mentioning that they can't have a transplant if they have

alcohol. Is that ever

or is that when you are on a regiment before tx? I am pretty sure that my

occasional glass of

wine will become obsolete if and when I progress further (although with the

promising new

drugs coming out, i'm hoping and praying it never gets to that!).

Hope you and your families are all well.

-

[Guest guest]

I think it also depends on where you live/what type of care you're

under.

I'm English under the care of St ' Hospital in Leeds. I'm

currently on the liver transplant list, but even now the doctors have

said that alcohol intake is not forbidden. The only time you have to

sign a no alcohol pact is if you're on the list because of self

inflicted alcoholic liver disease.

>

> ,

>

>

>

> I think they mean, that once you are listed for a transplant, you

are to

> keep a very strict regiment and follow doctors orders.

>

>

>

> Before that, I don't think that an occasional glass of wine will

kill you.

> But. If your doctor tells you not to drink alcohol and you do it

anyway, and

> he finds out, it might be detrimental to your chances of getting

your

> transplant. Transplant teams only like people who follow their

doctor

> instructions. If you can't follow simple instructions like no

alcohol, what

> will happen when you need to take anti-rejection drugs etc? Since

organs are

> so scarce, transplant teams don't want to waste livers on people

who might

> destroy it because they don't follow instructions. The same is true

for

> people with drug addictions and even recreational drug use. There

was a bad

> example of this a while ago of someone who received medicinal

Marijuana in

> CA, and was not allowed a transplant in NV because of it (even

though it was

> prescribed by a doctor).

>

>

>

> Regards,

>

>

>

> CHaim

>

>

>

> _____

>

> From: [mailto:psc-

support ] On

> Behalf Of archiebanker

> Sent: Sunday, February 15, 2009 15:37

> To:

> Subject: Re: Alcohol - What is the truth about it and

PSC???

>

>

>

> Thanks everyone for all the great responses. Really appreciate it.

I have

> read once or twice on

> this site people mentioning that they can't have a transplant if

they have

> alcohol. Is that ever

> or is that when you are on a regiment before tx? I am pretty sure

that my

> occasional glass of

> wine will become obsolete if and when I progress further (although

with the

> promising new

> drugs coming out, i'm hoping and praying it never gets to that!).

>

> Hope you and your families are all well.

>

> -

>

[Guest guest]

I think it also depends on where you live/what type of care you're

under.

I'm English under the care of St ' Hospital in Leeds. I'm

currently on the liver transplant list, but even now the doctors have

said that alcohol intake is not forbidden. The only time you have to

sign a no alcohol pact is if you're on the list because of self

inflicted alcoholic liver disease.

>

> ,

>

>

>

> I think they mean, that once you are listed for a transplant, you

are to

> keep a very strict regiment and follow doctors orders.

>

>

>

> Before that, I don't think that an occasional glass of wine will

kill you.

> But. If your doctor tells you not to drink alcohol and you do it

anyway, and

> he finds out, it might be detrimental to your chances of getting

your

> transplant. Transplant teams only like people who follow their

doctor

> instructions. If you can't follow simple instructions like no

alcohol, what

> will happen when you need to take anti-rejection drugs etc? Since

organs are

> so scarce, transplant teams don't want to waste livers on people

who might

> destroy it because they don't follow instructions. The same is true

for

> people with drug addictions and even recreational drug use. There

was a bad

> example of this a while ago of someone who received medicinal

Marijuana in

> CA, and was not allowed a transplant in NV because of it (even

though it was

> prescribed by a doctor).

>

>

>

> Regards,

>

>

>

> CHaim

>

>

>

> _____

>

> From: [mailto:psc-

support ] On

> Behalf Of archiebanker

> Sent: Sunday, February 15, 2009 15:37

> To:

> Subject: Re: Alcohol - What is the truth about it and

PSC???

>

>

>

> Thanks everyone for all the great responses. Really appreciate it.

I have

> read once or twice on

> this site people mentioning that they can't have a transplant if

they have

> alcohol. Is that ever

> or is that when you are on a regiment before tx? I am pretty sure

that my

> occasional glass of

> wine will become obsolete if and when I progress further (although

with the

> promising new

> drugs coming out, i'm hoping and praying it never gets to that!).

>

> Hope you and your families are all well.

>

> -

>

[Guest guest]

Anita, Not so, I am listed for PSC never was a drinker, still had to

sign a contract with my transplant center no alcohol, smoking, illegal

drugs (never smoker or drug user either).

[Guest guest]

My hepatologist so far has not advised me to discontinue having

alcohol. However, that said, she has said to limit my intake. As I'm

not currently taking any meds that directly advise against alcohol

use, I do admit to still imbibing. But I'd say I've become a pretty

cheap date--one drink seems to have become my limit ...