28 ms·
A lesser known mechanism for alcohol tolerance
- atourgates 5y agoI just want to point out the amazing amount of alcohol you'd have to ingest in a short time to get to the 1% BAC referenced in this article. Obviously there are lots of variables based on your size and individual physiology, but on average, each drink raises your BAC somewhere around .02%. So, even without accounting for an enlarged liver that processed alcohol more quickly, that driver with a 1% BAC in South Africa must have had around 50 drinks in quick succession, then gotten behind the wheel. Even if you were drinking liquor, that's basically downing two bottles of whisky in under an hour. Plenty to kill the average person, but apparently not enough to keep this driver from getting behind the wheel. Wild.
- MaximumYComb 5y agoAbout 10 years ago I called an ambulance for a friend at a party. Everyone had said just to get a taxi for him, so I did. When the taxi arrived I realised I couldn't put him in it and called an ambulance instead. He had seizures on the way to the hosptial, and was blood tested at 0.7% BAC. He woke up 12 hours later and was still 0.2% BAC (which is really drunk).
- vorpalhex 5y agoGood on you for recognizing it as an emergency and responding appropriately.
- silexia 5y agoI had a similar situation in a college dorm at age 18. My friend didn't want to get in trouble so just tried to babysit me. I had severe alcohol poisoning and was sick for days. I am still good friends with that guy, but have realized I need to say no to him quite a bit.
- taternuts 5y agoHonestly if you are in America, he _might_ have done you a favor as the emergency ride to the hospital costs about 5k (not great for college students), let alone the medical bill. It's always better safe than sorry though.
- markdown 5y agoThat's insane. Does the St. John Ambulance Brigade not operate in the US? T hey provide free services in many countries and have for decades. Perhaps the third world needs to send an aid mission to the US. https://www.stjohninternational.org/ https://www.stjohninternational.org/
- nkozyra 5y agoThe logistics of that got me thinking if there was perhaps instrumentation errors that led to that BAC number. It seems implausible, and not data-centric enough to hang your hat on in a blog post like this.
- throwaway0a5e 5y agoDepending on the incentive situation instrumentation errors may be the norm and not the exception. The NJ state police got in trouble for that in the past few years. If the calibration error isn't linear and someone shows up blowing a high number you could get a medically insane number on the screen.
- cromulent 5y agoSome of these are interesting: https://en.wikipedia.org/wiki/Blood_alcohol_content#Highest_levels https://en.wikipedia.org/wiki/Blood_alcohol_content#Highest_... I think anyone who has played with a personal breath test device knows that you can get false readings quite easily, but blood tests are something else altogether.
- RandallBrown 5y agoI have a police officer friend and even his breathalyzer gives pretty dramatically different readings.
- aerostable_slug 5y agoThe unspoken secret to DUI defense: pay $10k for an expert witness to show up and demand access to the breathalyzer's source code and pertinent documentation. The vendor will refuse and the case will be thrown out. Nobody wants to talk about the (in)accuracy of breathalyzers.
- throwaway0a5e 5y ago>Nobody wants to talk about the (in)accuracy of breathalyzers. That's because like every other bit of tech used to convict people it's designed to err on the side of convicting people not being accurate. If you want a laugh look up the sensors they use in the alcohol ankle bracelets. Then look up the OEM specs, calibration requirements, usage environment requirements and accuracy claims by the vendors and try and reconcile the two (several research papers have been written about this). The whole industry is lousy.
- outworlder 5y ago> The vendor will refuse and the case will be thrown out. I'm skeptical that a case would be thrown out that easily. I have seen expert witnesses getting chewed by the prosecution on minor details. So what if the source is unavailable. It can be argued that the device is tested and regularly calibrated, and that any inaccuracies found will be minor - and certainly not enough to exonerate the defendant. Yeah maybe there might be some inaccuracy - but then the defendant failed the standardized field sobriety tests. And the cop is saying that they were visibly drunk. Now what?
- rvense 5y agoI have just under ten years of AA (and sobriety) under my belt, so I have heard a lot of war stories. I can't remember ever hearing anyone claim more than about 0.65% BAC. 1% sounds more than a little extreme.
- MivLives 5y agoMost normal people pass out at around .2, so the fact this person could turn a car key is crazy.
- pengaru 5y agoIf you're pounding shots in a drinking game or just hitting the Economy-sized bottle of Bacardi rum directly, it's fairly easy to create a situation where you've gotten behind the wheel buzzed and it all catches up to once you're in motion.
- ksdale 5y agoYou'd have to literally take those shots and go out to your car in the next few minutes to get surprised like that, which... I guess people would do, but it's not that easy. Pounding shots catches up with you very quickly.
- pengaru 5y agoI've definitely had experiences where I managed to queue up a profound amount of alcohol intoxication, becoming realized abruptly after enough time had passed to switch bars on foot. In one specific instance, I promptly became incapacitated before even receiving my first drink at the new bar, falling off a bar stool and vomiting on the floor, unable to stand again, let alone walk. The bar-tender was convinced I was overdosing on some hard drug apparently and kicked us all out for being junkies, because I went from walking in perfectly normal and ordering a drink, to this complete disaster on the floor, in the time it took her to prepare our drinks... It must have been a 10-20 minute delay spent between bars on foot that time. The first bar specialized in stiff sweet cocktails, where they mask stupidly high alcohol content with sugary syrup. IIRC it was called Sugar Lounge (in SF). And I have very low tolerance not being much of a drinker, if you've got tolerance I imagine you can push that time-to-incapacitated delay out quite a bit.
- dexwiz 5y agoYou have never seen an alcoholic chug liquor like its water I take it? Long term alcoholics, talking decades+ here not youthful overindulgence, become incredibly tolerant and can consume huge amounts in ways that would make a normal person wretch. These are people who have altered their body chemistry enough that withdrawal is deadly.
- thebean11 5y agoTwo bottles in an hour though? I was under the impression that the most hardcore alcoholics consumed that much in a day.
- zepolen 5y agoI've seen an alcoholic down half a bottle of whiskey for breakfast. Literally.
- jessriedel 5y agoMy understanding is that serious alcoholics are drunks for days at a time. They go to bed with enough alcohol in their system to be drunk when they wake up, and they keep drinking throughout the day. Having zero alcohol in their system can be life threatening. That means they can build up to whatever BAC slowly.
- MisterBastahrd 5y agoIn the mid 90s, I worked for a grocery store doing full time, overnight stock to partially pay for college. One of my co-workers for a period of time, whose name I now forget, was a barely-functional alcoholic. He would show up to work on time most days, and work through his shift. At lunchtime he would disappear for a period of time and he would come back smelling like Listerine. Because that was his lunch. A bottle of Listerine. During the holidays they shifted some of us to a morning shift to continue to put items on shelves to match the holiday demand, and I saw him walk in on his day off, grab a fifth of bourbon and a fifth of vodka in the cheap plastic bottles, walk out, and walk back in about an hour later because he had consumed both bottles in his truck in the parking lot. He wanted a couple more to bring back to his apartment. And as bad as his drinking was, the reason he had sole custody of his daughter is because his ex-girlfriend was a full blown drug addict and he was good at hiding his drinking from CPS.
- MivLives 5y agoI was always told that you eliminate roughly one drink per hour from your system. So it is possible that they did that feat over a longer time span. Staying up all night drinking then hopping in the car seems much more reasonable (at least for how to achieve that BAC, and not as a decision you should make in life).
- mcguire 5y agoEliminating alcohol from your system reduces your BAC. One drink plus one hour ought to give you (fairly close to) a 0% BAC.
- retrac 5y agoIt's truly incredible. 0.15% is quite drunk for a typical person and most can't stand at 0.2%. At > 0.3% people often require hospitalization. At 1% it's probably over the LD50 for an alcohol-naive person! Though it seems estimates for that value are rather fuzzy.
- throwaway0a5e 5y ago>It's truly incredible. 0.15% is quite drunk for a typical person and most can't stand at 0.2%. At > 0.3% people often require hospitalization Unless you're using insanely puritanical definitions for "quite drunk" and "can't stand" this doesn't check out. One drink is ~0.02 and there's no shortage of college kids will kill 10+ in an hour with no effect other than becoming drunk and a headache the next day.
- bandyaboot 5y agoBinge drinking college students aren't "typical [people]"
- morsch 5y agoCollege kids who routinely have 10+ drinks in an hour probably aren't what the GP had in mind when referring to typical persons. Obviously words like typical on the one hand and puritanical on the other hand are sort of subjective. The NIH, probably on the more puritanical side, considers more than 4-5 drinks on one occasion (not per hour!) as binge drinking[1], or more precisely any drinking that raises BAC beyond 0.08%. As for typical, some random internet page[2] claims that on average, male college students have 9 drinks per week (not per hour!). [1] https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/college-drinking https://www.niaaa.nih.gov/publications/brochures-and-fact-sh... [2] https://www.scramsystems.com/blog/2014/02/infographic-much-college-students-drink/ https://www.scramsystems.com/blog/2014/02/infographic-much-c...
- retrac 5y agoI'm going by my own experiences. And I don't think I'm puritanical at all, but I am something of a lightweight with alcohol admittedly. I am male and I am a half-recovered alcoholic, for context. Around 0.05 I'm tipsy to the point of it being obvious. Feeling good, effusive. And if I'm smart I'll stop drinking around here. At 0.10 I'm flushed, joyous or melancholic, coordination is affected, I might slosh my drink on the table, and I'm going on and maybe making a bit of a fool of myself. I tend to want to go to bed shortly after. I won't have a bad hangover if I eat a good meal but yes, that's quite drunk in my opinion. And at like 0.15+, I get very sedated. I tend to pass out and while it's not a stupor I am hard to rouse. Above that is just passed out black-out drunk and I've only done that a few times thankfully, but I have, so I know that most of a bottle of 750 ml of 80 proof on an empty stomach is enough to potentially hospitalize me, and certainly leave me passed out in a puddle of vomit. These numbers being for when I am alcohol naive. Not having drunk in months. If I have been drinking regularly you could easily double or triple the numbers. Most people do not have alcohol tolerance though, which is why I assumed an alcohol-naive drinker.
- erikstarck 5y agoAndre the Giant level of consumption.
- spicybright 5y agoMaybe even 2 Andres. 1% is insane.
- bandyaboot 5y agoPart of it likely has to do with the fact that alcoholics' livers are often dysfunctional, so the .02% average wouldn't necessarily apply to the types of people who can reach 1% BAC.
- foolfoolz 5y ago0.02% BAC per drink is wildly underestimated. many people will reach the driving limit of .08 after 2 drinks there’s a chart on this dmv page that shows you have to be 240lbs to get .02 per drink https://www.dmv.ca.gov/portal/handbook/california-driver-handbook/alcohol-and-drugs/ https://www.dmv.ca.gov/portal/handbook/california-driver-han...
- giantg2 5y agoConsidering the rate of obesity, .02 per drink might be more common than one would think. That said, people should calculate it for themselves than use rules of thumb. I'm not convinced of the values in that table. I think they are being very conservative. My calculations using a BAC formula are different. For example, the .02 per drink seems to work for men weighing 215lbs.
- vkou 5y agoDo note: There's a lot of beer these days that's >5% alcohol, so a single beer often has more than one drink.
- giantg2 5y agoYeah. Standard drinks are 1.5oz 80 proof, 12 oz 5% beer, or 5oz 12% wine.
- brewdad 5y agoI go by a "rule of 60". A pint of 7% beer (very common with IPAs) would worth 7*16 = 112 points or almost 2 "drinks".
- arthurcolle 5y agoHow drunk were you when you came up with this? Clever
- 0des 5y ago
- tdrdt 5y agoThe list on Wikipedia is crazy: https://en.m.wikipedia.org/wiki/Blood_alcohol_content https://en.m.wikipedia.org/wiki/Blood_alcohol_content (Highest levels)
- _notreallyme_ 5y agoHe didn't start at 0% BAC, otherwise he would likely be experiencing delirium tremens. Alcoholics tend to maintain a high BAC all the time, enough so that even after sleeping they still have enough alcohol in their blood to avoid delirium tremens. So he probably drank much less than two hard liquor bottles.
- batty_alex 5y agoIsn't this just a really complicated way of saying that Alcohol is a potassium diuretic and your body is adapting to something flushing your potassium all the time? Not sure if it's lesser-known, though. When doing beer judging, we're told to load-up on foods with lots of fat and potassium to increase our tolerance (senses start working differently after you're toasted, can make judging tough)
- tsol 5y agoNo these are potassium channels in the brain the article is referring to, not the absorption of dietary potassium
- AnimalMuppet 5y agoDon't wine testers spit it out, so that their judgment remains unimpaired?
- IvanaSays 5y agoMeanwhile...there is an argument somewhere about the stomach being the 2nd brain. I don't know how you can reasonably taste without swallowing wine (while understanding it's a far more reasonable way to go for the pros).
- poooogles 5y agoYes. Often you'll do 3 - 5 tastings a week, sometimes even two in a day so spitting really helps keep the alcohol intake down. The thing that really gets you is palette exhaustion though. Taste 40 ripe Cali cabs and they all start tasting the same after a point...
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- rzzzt 5y ago(If someone wants to search for the term, also try "palate fatigue")
- deleted 5y ago[deleted]
- giantg2 5y ago"They can drink a lot of alcohol and still have a relatively low blood alcohol level." Any sources for this? My understanding is that an enlarged liver does not process more alcohol because the enlargement is typically fatty deposits, cirrhosis, and inflammation. I did find an article that says alcoholic livers can produce a different set of enzymes to metabolize the alcohol. But it says it produces a different buzz, bit nothing about faster processing.
- the-dude 5y agoI could drink 1L of wine @ 12% in ~1 hour and about 2.5 hours later feel safe to drive. Not only did I feel safe to drive, I had to take a breathalyzer once and passed ( although it did have to 'think' a while ). I did have dinner in the meantime.
- oaktrout 5y agoIt's well known that alcoholics are for the most part better metabolizers of alcohol (see https://www.sciencedirect.com/science/article/pii/S166526811932143X#sec0090 https://www.sciencedirect.com/science/article/pii/S166526811... Current concepts in alcohol metabolism, Caballeria), but its not at all related to liver enlargement. My understanding is that an enlarged liver is a symptom of alcoholic liver disease, not a physiologic adaptation to better metabolize alcohol. The current consensus is that most of the increased metabolism of alcohol comes from enzyme upregulation in the liver. The authors misunderstanding of physiology makes me doubt any further conclusions he makes.
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- JoeAltmaier 5y agoHow about: folks who are drunk, just think they have a high tolerance and are functional.
- shakezula 5y agoThere are objective and measurable differences between tolerances that this post points out, though.
- JoeAltmaier 5y agoHm, I thought I looked for them and didn't find them. Reading again, yup nothing there. Just some generalities.
- lloydgrossman 5y agoI guess everything is a generality if you believe hard enough.
- JoeAltmaier 5y agoThat's an ungenerous remark, and un-called for. If there are measures in the article, then please post them. Otherwise lighten up, and cease the ad-hominem attacks.
- drewbitt 5y agoYes, but also no. Through practice alone you do get better at activities while drunk, like walking or driving, but I can assure you that what two drinks did to me when I never drank vs what they do now is entirely different. My rationality stays the same now. Note that the high alcohol content will catch up to you later (you’re still dehydrated), but in the moment alcoholics are an entirely different breed a couple drinks in. If you ever hang out with people who drink regularly and those who don’t, you’ll quickly see the difference.
- IvanaSays 5y agoI don't know, man. I have a friend who drinks so much it's ludicrous, and is perfectly present and functional. he is a sailor, and I have avoided situations where I see he is getting plastered (because he can get plastered, too!) and the only competent sailor on board. But he is highly functioning when drunk, I can attest to that!
- tombert 5y agoFor some reason (presumably because I'm tall or because I have too much body fat (thanks Taco Bell!)), I have an extremely high tolerance to alcohol, despite the fact that I almost never drink. It can take upwards of 600ml of whisky for me to really "feel unsafe to drive" [1], which is part of the reason I don't really drink to begin with...If I don't have much fun with it, and it's not healthy for me, I don't really see the point in partaking. [1] Don't worry, I've never tested this theory, I don't even own a car.
- dpratt71 5y agoFyi, "Alcohol distributes into water spaces, not fat" https://sites.duke.edu/apep/module-1-gender-matters/content/content-where-does-alcohol-go-in-the-body/ https://sites.duke.edu/apep/module-1-gender-matters/content/...
- leodriesch 5y ago“See, it’s all just water weight!”
- hackingforfun 5y agoIt sounds like BK channels interact with NMDA receptors, which are glutamate receptors. Glutamate is an excitatory neurotransmitter. My understanding is that inhibiting glutamate is partly what makes alcohol relaxing (the other is it's interaction with GABA). Bodies have an amazing way of keeping themselves in equilibrium and when someone is introducing alcohol into their system on a regular basis, I figured that the body regulates this by increasing levels of glutamate (although maybe also via downregulating GABA receptors), so that the person stays awake even with higher doses of alcohol. I do think that this can lead to someone having a higher "tolerance". I also think that's what contributes to what some people call hangxiety, i.e. there's still extra glutamate floating around that wouldn't otherwise be there. However, an enlarged liver helping someone process alcohol better sounds bizarre to me. I thought a liver being able to process alcohol faster was due to increased enzymes since the body again is trying to balance itself and is dealing with what is being introduced by upping certain enzymes, whereas in a non-drinker, those enzymes wouldn't be at elevated levels.
- oaktrout 5y ago"However, an enlarged liver helping someone process alcohol better sounds bizarre to me. I thought a liver being able to process alcohol faster was due to increased enzymes since the body again is trying to balance itself and is dealing with what is being introduced by upping certain enzymes, whereas in a non-drinker, those enzymes wouldn't be at elevated levels." You are correct, in fact an enlarged liver could be a sign that you are less able to metabolize alcohol. "To this effect, the adaptative increase in alcohol metabolism observed in chronic alcoholics disappears in patients with advanced liver disease." [1] Liver enlargement is a sign of liver disease. I guess that's the sort of mistake you will encounter when reading posts regarding biochemistry / medicine on hacker news. [1] Current concepts in alcohol metabolism https://www.sciencedirect.com/science/article/pii/S166526811932143X#sec0090 https://www.sciencedirect.com/science/article/pii/S166526811...:
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- oaktrout 5y agoThe author seems confused about how BK channels relate to tolerance, here he notes that decreased BK channels lead to increased tolerance: "Exposure to alcohol upregulates microRNA (mir-9), which in turn modifies BK mRNA, selectively destabilizing certain types of BK mRNA." Then later he seems to be stating that decreased BK channels would lead to decreased tolerance: "The consequence of this would then be that the development of alcohol tolerance could be slowed or halted by preventing the modification of BK channels, like by using RNAi to degrade certain types of BK mRNA." Perhaps he meant "by using RNAi to degrade mir-9". Ignoring the above issues, it seems very hand wavy to say "let's just get this RNA interfering drug into your brain and target this specific BK RNA".
- 100ideas 5y agoThe author referenced a paper from 2009 about the microRNAs and BK subunits: "Post-transcriptional regulation of BK channel splice variant stability by miR-9 underlies neuroadaptation to alcohol" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714263/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714263/ "Tolerance represents a critical component of addiction. The large conductance calcium-and voltage-activated potassium channel (BK) is a well-established alcohol target, and an important element in behavioral and molecular alcohol tolerance. We tested whether microRNA, a newly-discovered class of gene expression regulators, plays a role in the development of tolerance. We show that in adult mammalian brain alcohol upregulates microRNA (miR-9) and mediates post-transcriptional reorganization in BK mRNA splice variants by miR-9-dependent destabilization of BK mRNAs containing 3’UTRs with a miR-9 Recognition Element (MRE). Different splice variants encode BK isoforms with different alcohol sensitivities. Computational modeling indicates that this miR-9 dependent mechanism contributes to alcohol tolerance. Moreover, this mechanism can be extended to regulation of additional miR-9 targets relevant to alcohol abuse. Our results describe a novel mechanism of multiplex regulation of stability of alternatively spliced mRNA by miRNA in drug adaptation and neuronal plasticity."
- peter_retief 5y agoI definitely fall into the latter category, that is I have very little tolerence for alchohol. There are people I have known who can drink huge amounts and still be functional, these people drink steadily and regularly. I gave up completely about two years ago and I strongly recommend this. I was never a big drinker but stopping has had a dramatic effect on my weight and health. It is not that difficult to stop and has dramatic benefits.
- kerblang 5y agoMy understanding was that increased alcohol intake raises hormone levels, especially cortisol, which raises blood pressure/breathing/etc and keeps you from dying. Also note the jitters experienced as the alcohol is metabolized and things swing out of balance in the opposite direction. So it would just be a matter of training your adrenals to recognize and react quickly to the incoming booze, which for some people is almost like a violent allergic reaction to a bee sting, causing them to drink heavily in order to calm down. I don't really have any research to back this part up though.
- 123pie123 5y agoNot sure which I fall into - maybe both but I very rarely get a hangover (yes this does encourage/ allow school night drinking - inc now) I have to drink either red wine or over 8 (uk - 568ml) pints of 5%abv lager to start to get fraction of a hangover the next day (starting at a slight thick head level) incedently for me, eating stuff with sugar and alchol = major acid reflux this took ages to figure out why sometime I was throwing up in the middle of the night (no other symtoms) another thing that is fairly obivious to me now is how proportional the effect is of the amount of food eaten before drinking and the speed of which you get drunk. This can be used to great effect for big drinking days (eg stag do) I could easily drink all day comsuming > 15 (uk - 568ml, 5% abv) pints if I keep a level of food in my stomache
- tk75x 5y agoI am guessing you are less than 30 years old? give it 5-10 years and it'll be much more painful after a heavy night of drinking. sugar and alcohol are both metabolized by the liver, and large amounts of both/either will make you feel poorly. age and frequent use of alcohol and junk food will just wear your body out sooner. the feeling of being drunk is most noticeable when your blood alcohol content is rising, aka when you drink quickly on an empty stomach. but you can have a nice buzz going all day with proper planning and eating beforehand. I realize after typing this out it sounds a bit preachy, but take it as a caution from someone who felt invincible in their 20s
- 123pie123 5y agonope - well over 50 because I understand how my body works with alcohol, I can now manage my alcohol better (with food/ sugar) I can drink very much more now forgot to mention - I ALWAYS have one month off drinking (typ January) and Oktoberfest is the best place in the world - make sure you dress up properly though
- fouc 5y agoI have noticed that with some intentional concentration, I can summon a higher degree of sobriety/functionality than I might ordinarily have when under the influence. I always assumed much of that was from the adrenal glands though.
- beebeepka 5y agoJust drink a lot of water. Try to have a glass of water for every hard drink or a beer. Makes quite a difference
- IvanaSays 5y agoI was reading the article to learn what I can do to increase my alcohol tolerance. I was never much of a drinker, but at some point it started dropping really radically - to where I now have a massive hangover if I have a large glass of wine in a restaurant (a restaurant pour vs. my own) - even over an hour, with water and food, etc. I do sometimes wish I could have two glasses, or try more wine when on a trip, or have a digestif in a great restaurant...but but nope, it's out entirely. Asked my doctor, she said, coldly: "uhm, why drink if it makes you feel bad?"