The effects of alcohol that no one talks about. Episode 73

Monika Rachtan
Hi Monika Rachtan, I would like to welcome you to another episode of Po Pierwsze Pacjent. A few days ago, mysterious tubes appeared on grocery shop shelves in Poland. But interestingly not with mousse, but with alcohol. Do Poles drink too much? This is what I am going to talk about with my guest today, and that is Karolina Pyziak Kowalska, MD in Medicine. Good morning, and a warm welcome to you, doctor.

Karolina Pyziak Kowalska
Good morning, and a warm welcome.

Monika Rachtan
Your doctor specialises in infectious diseases, but I know that topics related to the liver are also of great interest to you. So today we are going to talk a little about the liver, but above all about the effects of drinking. Doctor, is it really the case that, more and more often, patients come to see their doctor and find out that the ailments they are suffering from are directly related to alcohol consumption?

Karolina Pyziak Kowalska
Oh yes, definitely. At the moment there is a huge increase in the number of patients who come in because they are abusing alcohol and it doesn't come out sometimes straight away that the patient comes in, stands in the doorway and says And I have an alcohol problem. It just comes out in the course of the interview or in the tests that get transferred because there is something going on with the liver. That is, most often liver enzymes are elevated. Whether steatohepatic disease appears on ultrasound. And these are the kind of first elements that prompt the patient to come to the doctor and see what's going on with them.

Monika Rachtan
But in general it's like, after all we all know, the liver doesn't hurt, so it's difficult to identify these symptoms at all in my opinion, because if we don't do tests and liver tests, if we don't have any imaging tests done, how can we know that there's something going on with that liver?

Karolina Pyziak Kowalska
Sometimes patients do what are known as follow-up examinations, that is, once or twice a year they just go for a check-up. This is especially the case for such a group of young people between the ages of 20 and 30. These are often people who just like to check what's going on there and then, if they have any abnormalities in their examinations, they come to the surgery straight away. And here I would say that the preponderance of men, because men are very successful in trying to get to the bottom of what's going on there?

Monika Rachtan
And not to die by accident.

Karolina Pyziak Kowalska
Exactly and, as it were, in the course of the conversation it just turns out that, as it were, these test results are linked somewhat to alcohol consumption.

Monika Rachtan
But it's your doctor, because it's a bit difficult for me to grasp it in my head. So these individuals come in. It turns out that the liver enzymes are elevated and these people don't identify it, they don't relate it. It is only the doctor who tells them. Dear Mr Mark, having five beers a week is too much. And it is because of this that you have these symptoms. These people don't correlate it. I'm sorry.

Karolina Pyziak Kowalska
That's the problem: beer is sometimes associated with a drink that is a kind of after-dinner drink, sometimes it's such a nice way to spend an evening, and it's not treated as alcohol at all. This is very common in conversation. It's only when I ask around that it comes out that there's a lot of this beer, and that's during the week. On the other hand, when a patient asks if you drink alcohol, the answer is often no. Or just like everyone else. And later on, when we start getting into the details, it turns out that we ask whether beer, wine, vodka. So the patient just says yes, vodka. So it's a party thing, but mostly. Well, sometimes beer with friends, and how often is it beer with friends? And then it turns out it's beer with friends. Well, it's every night, or not just one, but sometimes 3, and sometimes on weekends even 5 or 6, and that's when he does large quantities.

Monika Rachtan
And when you saw this information on the internet that you can buy vodka in a tube in Poland, what did you think?

Karolina Pyziak Kowalska
I thought it was a very unethical way of approaching the sale of alcohol, because we have at the moment a lowering of the age of children, who start at 13 or 14, their first initiation with alcohol and these tubes are de facto like fruit mousses, oatmeal, which are available to buy. So at that point it's such a first element that the identification of this product as an alcoholic product is absolutely not associated with that. And in addition, anyone who goes somewhere to school, to work, to the office, can put such a tube in a bag, drink it somewhere and squash it. Even, no one will identify the fact that this person is drinking alcohol, just some such, let's say tasty snack.

Monika Rachtan
We, fortunately, were already recording on the day that Prime Minister Tusk told us that these products would be withdrawn from shop shelves. The company, on the other hand, has also apologised for its behaviour, but absolutely this apology does not justify its behaviour and it has withdrawn the product from production. On the other hand, it is very worrying that such situations occur. A great storm on the internet, a great uproar. If it wasn't for the Internet users, would it have been possible to solve this problem so quickly? I'm very curious to know whether something like this could have been adopted in our country at all. We probably consume a record number of monkeys in Poland compared to the entire European Union. Is the availability of these alcoholic products a problem? If Poles took all these vodkas, monkeys and other cans off the shelves, would we drink less?

Karolina Pyziak Kowalska
I think this is one of the solutions that should be thought through, so that this alcohol is available at specific, let us say, times or in specific places. Because if, for example, alcohol is widely available at petrol stations, where drivers mainly fill up their tanks and take this alcohol with them later on a journey somewhere, well, there is also the question of when this consumption takes place. Well, and then they are going to drive that car back somewhere. And if you look at the statistics, the number of accidents involving drunk drivers or various elements of drunken robbery or brawls is also a significant element. So the moment we would restrict the possibility of availability of alcohol, and especially, for example, buying alcohol after 10 p.m., which is often such a method in various countries around the world, as if to restrict the sale of alcohol, that it is simply not available in places outside of clubs, outside of some places of entertainment, and it simply cannot be sold.

Monika Rachtan
And in Poland, the rule is that people come back from a party, go to a petrol station and buy two more beers to drink at home. And then it turns out that maybe the party wasn't so bad after all, but after having consumed a lot of alcohol at home, it's still a very large amount.

Karolina Pyziak Kowalska
Definitely yes. And this alcohol, which is promoted de facto, because in Poland, as it seems, there is no obligatory price for the lowest alcohol, so companies often compete, especially in the summer, during some football performances. This is done to promote the sale of alcohol by just adding more cans of beer to the sale within the price for this four or six-pack. So it is also such an absurdity that this alcohol is becoming more and more available, we can buy more of it, and for the same price de facto.

Monika Rachtan
I recently heard such a commercial on the radio, where one actor was singing that for 99 zloty and a can for you or something like that. And it's also appalling that in Poland, public figures who work as actors, journalists, singers, take up advertising for alcohol. That, in my opinion, should be forbidden as well, but I think it's not even necessary to forbid anyone to do that. The question is where is the ethics of these people, that they are promoting poison?

Karolina Pyziak Kowalska
Yes, because it is using an authority figure who is some kind of idol for certain groups. To soften the message related to alcohol and to having fun. So that's plenty too, by the way. I am now looking at the work of young people, who sing a lot of songs that also nicely summarise excessive alcohol consumption and at the same time show ways out of alcohol or a life without alcohol. There are well-known artists such as Faust, Gibbs and Kukon, who promote a lot of their songs, in which there is an element of both consumption and prevention.

Monika Rachtan
Yes, but also a professional driver, very popular in our country, at one time promoted. I'm not convinced that he is still promoting alcohol. And here we are saying that with this kind of thing we should probably, well, balance these attitudes, put the bad ones in the bin and promote the good ones, so that there is as little of it as possible. I think it is precisely such authorities that reach young people, our society, which in a short while will be deciding who will govern us, sit on important posts, and treat us, among other things. And it is very important that this young society learns that alcohol is not, and should not be, an everyday occurrence.

Karolina Pyziak Kowalska
And, above all, the awareness that this harmful drinking affects further lives and the lives of not only those people who just get into a car under the influence of alcohol, but also the lives of others. In addition to this, what we see in hospital statistics is frightening, that such acute alcohol poisoning is a group of patients who end up in hospitals, a lot of patients who end up in psychiatry for various disorders, such depressive moods, suicide attempts, these are also patients who have just been admitted because there was alcohol in the background, so there is a lot of this. And also when you look at the fact that later on, the consequence of pregnant women drinking alcohol is that children are born with disorders. Here I am thinking of FAS. It's a question of the fact that we have these cases more and more, and more and more specialities are also kind of affected. When it comes to medicine, the fact that we have patients with different types of drinking and the impact of this harmful drinking and the impact on their health.

Monika Rachtan
And in your opinion, if a patient is found to have alcohol to blame for their health problems, should that patient be treated at their own expense?

Karolina Pyziak Kowalska
I mean, I think that here we should remember that alcohol is de facto a narcotic substance and it is a bit treated in the context of a person who has a problem and who has a disorder. So I think that these people should also be helped, that therapeutic ways should be found and that a harm reduction programme should be run to make them aware of how alcohol affects their lives and how this can be changed. I always say that harmful drinking is a kind of abnormal relationship between a person and alcohol. And that's what shows all these factors that are so additional and affecting. So that's sort of the element that it's sort of a consequence of not being able to deal with that alcohol, sort of that intoxication, so I wouldn't punish people for that by sort of paying. But I think it would be a good idea to set up some kind of foundation or fund to make it work nicely.

Monika Rachtan
Well, not so long ago, we heard in the media about a driver who had his licence revoked three times because he was driving under the influence of alcohol and who killed his pregnant fiancée, having just driven under the influence of alcohol once again. So we can see that these consequences are not only for the person who consumes alcohol, but, as you said, they are for society as a whole, and they may not seem so obvious, because here, well, this girl is dead, this child is dead, but also the family is left with a huge trauma.

Karolina Pyziak Kowalska
As much as possible. There are many such traumas, because it is a matter of the fact that often the perpetrator is under the influence of alcohol and performs an act that he or she is not even aware of, nor does he or she render assistance at the scene. In addition, sometimes people under the influence of alcohol are additionally the victims of an accident, because they enter undesirable places somewhere and simply do not see that they are walking in the middle of an unlit road, they may even step in front of a car somewhere, it will drive properly, that such things also happen. And then there's also the issue of all these brawls that we see and aggression and robbery. And it's amazing how, for example, in countries in the Middle East or North Africa, where you don't drink that alcohol, it's definitely quieter, it's calmer, there are no brawls and it's really beautiful. It's a different way of spending time and you often see whole groups of men sitting together, talking. It creates a completely different culture of being and a way of sort of interacting. And in our country, alcohol often results in such a pushy, aggressive approach, various brawls, and this can sometimes be very unpleasant for the perception, for others, that they feel threatened in such an environment.

Monika Rachtan
In Poland, in large and small towns, it is often the case that people under the influence of alcohol stand outside a grocery shop in the evening, for example, and others who are not under the influence of that alcohol. They are simply afraid to walk down the street, because they do not know what to expect from such people. Because these people, as the doctor mentioned, are often insane and not in control of what they are doing. Then they don't even remember their actions.

Karolina Pyziak Kowalska
This is exactly what sometimes happens when young people need another alcoholic beverage or to have a good time. They also start extorting money from people passing by. Also staggering. Also creating certain dangers, often accosting other people. This becomes such a highly unpleasant and uncomfortable situation. Often requiring a call to security or the municipal police. So it can be so unpleasant for everyone.

Monika Rachtan
Harmful drinking can be seen in laboratory results. What parameters need to be checked to find out if there is already something wrong in our body?

Karolina Pyziak Kowalska
In general, the most important element is to check, first of all, liver function parameters, i.e. here we can check liver enzymes: ALT, ASTP, PGA, and sometimes, if there are already such specific symptoms associated with, for example, swelling of the legs, swelling of the abdomen, well, we also check the level of albumin in the body to see what is going on there. Well, and sometimes someone comes in already with skin coating or sclerosis and then it means that they have elevated bilirubin often. So this is also a parameter that we assess. So here these parameters are a little bit to check. In addition, certain features, as if increasing the symptoms of alcohol abuse, cirrhosis, cause, for example, the number of blood platelets to begin to fall in the normal morphology. This will also be one of the symptoms, as it were, of a breakdown in liver function.

Monika Rachtan
Who can help such a patient? Do we at this point have to go to a hepatologist? Can a primary care physician also be a pillar of treatment in such patients?

Karolina Pyziak Kowalska
I think that the basic element here is the level of knowledge and checking, at least at the beginning of these tests. So, you can go to your family doctor or the nearest internist, and when there are already such large disorders, which require some kind of repair or referral for more specialised tests, then to a hepatologist.

Monika Rachtan
And are these tests that are carried out as part of the outpatient clinic. Are these tests reimbursed?

Karolina Pyziak Kowalska
Yes, as much as possible. These basic tests, just such an assessment of liver enzyme function or even tests related to like additional elements that can affect the liver. Such as viral co-infections, hepatitis B or hepatitis C. We can check all of this in the framework of primary health care.

Monika Rachtan
And are these changes in the liver that occur as a result of excessive alcohol consumption reversible?

Karolina Pyziak Kowalska
Up to a certain point, yes. If we are talking about these first stages of liver damage, then by all means. However, if there is already remodelling in the liver, so-called fibrosis, i.e. under the influence of inflammation, the next stage is, as it were, fibrosis. If this fibrosis takes place and we already have such a scale, we assess it on such a fibroscan scale. This is a scale that assesses the degree of fibrosis from one to four. And this fourth degree, which is F4, already means cirrhosis. Well, then, as it were, those elements that fibrosise, well, that won't change. Then only those cells that are somewhere in between this fibrotic element will perform their normal function.

Monika Rachtan
But is it possible to live and function normally with such, say, a 40% functioning liver?

Karolina Pyziak Kowalska
You can. Just remember that up to a certain time, that is, at that point, if there is even a simple infection, or if there is a need to take some medication, or if other illnesses appear, then it decompensates more quickly. Whether it's just this abuse of alcohol or even the overuse of medication that can cause it all to start exploding much, much faster and as if this destruction happens much more rapidly.

Monika Rachtan
What does this destruction consist of? What symptoms then appear in the patient?

Karolina Pyziak Kowalska
Because we already call it a kind of moment of decompensation of liver function. This means that ascites, oedema or oesophageal varices appear, which can cause bleeding, for example. One of the things that happens when patients first arrive at hospital wards or the ED is when they start bleeding, for example, from the upper gastrointestinal tract. Figuratively speaking, they spurt blood. And these are very difficult cases, because such a patient first of all has to make it to the unit that will take care of them and also be properly supplied there. So these are the moments when patients sometimes find out for the first time at this stage that they have a diseased liver.

Monika Rachtan
Are people who are diagnosed and are still at a stage where, as your doctor said, they don't have these critical symptoms. Is it easy for them to quit alcohol? Are there any cells that, for example, help them introduce this harm reduction?

Karolina Pyziak Kowalska
This is where it makes sense to seek the care of a specialist, because it's like quitting alcohol on your own. Sometimes it happens that patients are able to implement this, but let's remember that it's a dependency on a physical level, but a mental level. So it often happens to me, for example, that I have to deal with patients who have been in the centres for some time and they come back later to their family home, somewhere to the environment where they drank the alcohol, and the whole element of the therapy stops working because, as it were, the company, the environment doesn't change. Well, then you get back into the same shoes again and the same thing happens again, which is excessive alcohol consumption again. So here it's very important for the person to work on changing their life completely, to change sometimes even the places where they used to visit. So it's like a lot of work on oneself, in the form of not reaching for the alcohol, simply saying no in this environment or not attending these meetings. And sometimes this can happen through a kind of internal analysis of the person who takes certain steps, and sometimes you need the cooperation of a therapist or even a psychiatrist to help you get out of this psychological dependence.

Monika Rachtan
And what connection does liver cancer have with cirrhosis, with alcohol consumption?

Karolina Pyziak Kowalska
As it were, liver cancer is a consequence of cirrhosis very often of what happens with the destruction of liver function. And then what happens is that these cells become inefficient and that's where the neoplastic process forms and this neoplastic process, progressing, well unfortunately it often has very disastrous consequences because it's already very often very difficult to treat and the patient is at the stage where one has alcohol dependency and two has neoplasia, they're very devastated, so these are very difficult people, often to manage. These cases happen to us very often in the practice.

Monika Rachtan
And what is the most interesting patient-related story? Maybe most interesting is a difficult word, but what story? What story comes to mind for your doctor when we are just talking about patients who come in and who show their test results. And it turns out to be that it's the alcohol and liver problem.

Karolina Pyziak Kowalska
That was probably the case for me. There are two such cases. One involves a man and one involves a woman. One element. As far as the female patient is concerned, the patient came to me and said Actually you say doctor, I think I have a problem with alcohol. And it probably wasn't, because the patient forgot that it was Christmas and the family called her 3 4 days later, when the patient woke up and took those calls and saw that she had numerous missed calls. The child was away on a student exchange and she was alone. A high-functioning woman working remotely because it was pandemic day. So in general, well, just as individuals often reach for a cup of coffee, she reached for a glass of alcohol. And then it got to the point where there were 3 or 4 bottles of alcohol, and at one point she lost count of how much she had drunk and just fell asleep. And it was so very tangible. The patient came out of it. Later coming, sort of going through the whole process of therapy of everything. She is a person who is back to living a full life and functioning without alcohol.

Karolina Pyziak Kowalska
Whereas the second example is of a man who came to see me and I asked him how much alcohol he consumed. And it was such a moment when the patient stopped answering me and I thought. I say yes, you didn't understand the question and I asked the question a second time. I ask But do you drink the alcohol at all? Because I'm looking at these test results as if everything points to yes. And the patient says yes I say but beer, wine? No, well vodka. And I say Well, but how much vodka is there in a week? And he looks at me like this and goes on without answering. And at this point he says I say but it's like weekly, daily, monthly. And he says no, well, every day it's a litre of vodka. And I say how long have you been drinking like this? Yes, about a year and a half, that's the norm. And at the weekends, you know what, I can't count. So to the cut-off. And at this point, I will say that for the first time in my life I really had that moment. Gosh, that these norms seem big to us. But here it was already a shock.

Monika Rachtan
And this patient came to the doctor for a specific reason, he had some kind of ailment, something was going on with him, or he just came. I wonder how a person who drinks a litre of vodka a day can get to the doctor at all, But sort of here.

Karolina Pyziak Kowalska
The person who persuaded the patient to have the tests done was his wife, who was very concerned about how the patient was functioning on a daily basis and persuaded him to have the tests done. These tests were very bad, so the patient was concerned and what was so bizarre, he wasn't concerned about these test results, that he kind of had hepatitis, he was only concerned about the fact that he had steatosis in this liver and that he also started to put on weight during this drinking, because also the drinking involved a lot of snacking, uncontrolled eating. And he sort of pointed out that he had just come to do something about it, to sort of tangibly lose weight here, and at the same time it turned out that he also had newly diagnosed diabetes, with all this?

Monika Rachtan
And what happened to this patient?

Karolina Pyziak Kowalska
The patient at the moment is a person. He was with me quite recently. He has not consumed alcohol for six months. On the other hand, he says he is incredibly drawn to sweets. So there's a bit of a problem setting him up diet-wise. And there is also a lot of psychiatric care to set him up with regard to his mood disorders. So as not to turn one addiction into another. Because I also always warn patients that there is a tendency for a patient to come out of one addiction and into another, either depending on medication, or an addiction to sweets, or another type of stimulant.

Monika Rachtan
This is how we usually associate liver disease with alcohol. On the other hand, this is also a bit of a stigma, because there are people who are ill, who have this organ, but they do not consume excessive amounts of alcohol. What are the most common liver diseases now? Those not caused by alcohol?

Karolina Pyziak Kowalska
Here after covida we generally see a very large, growing problem with autoimmune hepatitis. And these are those affecting the liver directly, as well as primary, sclerosing cholangitis, also these autoimmune diseases. When one's own cells wake up and start producing antibodies against one's own organs, that's the thing that we see a lot more of than she sort of said a couple of years ago when I started working. But also a huge number are patients with hepatitis B and C and hepatitis C is such a flagship example here that we know that more or less there are 150,000 to 200,000 people in the population who are infected with HCV, they just don't do the tests And these tests you can just go to your GP and ask them to even do the tests, because of course these hepatitis It doesn't always have to be the case. There are elevated liver enzymes, always detectable. It's a bit like a sine wave once they'll be up, once they'll be down, in other words once they're elevated, once they're not. And the question is when will the patient do the tests? And we call this virus the silent killer.

Karolina Pyziak Kowalska
That is to say, in general, the infection goes on for a very long time without any symptoms, but when the patient appears, it is often at the stage of compensated cirrhosis with complications such as with alcohol, among other things, because he did not know at all that he had the virus, which is at the moment. Just detected we have a therapy of two, three months and the patient will be healthy and is able to function normally.

Monika Rachtan
How can this virus be contracted?

Karolina Pyziak Kowalska
Mainly through blood. So it's all kinds of tattoo parlours, different cosmetic procedures, but also before that there was intravenous drug taking, when there were shared needles, syringes. So it's kind of a multitude of patients, but also sexual contacts. And here I mean mainly anal contact. These are the patients who are most often infected in this way, because it's all about blood contact.

Monika Rachtan
And not alcoholic steatosis of the liver. Is this also a problem in our country today.

Karolina Pyziak Kowalska
As much as possible non-alcoholic steatosis. Liver disease is quite a big problem and here we have this link very often. At the moment we are talking about a version of metabolic disorders that is associated with this steatohepatic disease, that is, any abnormality associated with the appearance of lipid disorders, carbohydrate disorders. Patients are often diagnosed with diabetes, but they know about it. I have the impression that our society looks at these diseases from the point of view that I have a little diabetes, I have a little hypertension, I take a little pill, a little dose, and it minimises the damage. And that damage sort of from these diseases is what causes liver disorders, disorders related to the accumulation of these excess fats in the liver. And this is very harmful. It also leads to inflammation and to cirrhosis and to tumours.

Monika Rachtan
Generally speaking, most of the diseases we are talking about are caused by factors that we ourselves supply to our bodies. And just as we have non-alcoholic steatohepatitis, it is very often a consequence of the fact that we simply do not eat properly. So is type two diabetes. Again, when it comes to cirrhosis of the liver, again we are supplying our body with this factor and again we are the de facto culprit of what happens in our body. Do you have the impression, Doctor, that we in Poland do not yet fully understand how our behaviour and our choices translate into what state of health we are in?

Karolina Pyziak Kowalska
I have the impression that what is needed here is really broad education, because our society moves very little. This is also, as it were, a consequence of the fact that when we consume excess calories and move little, we do not actually burn them, but store them. If we store, then there are specific examples of diseases related to this mechanism. So we have diabetes, we have fatty liver disease, we have obesity. And it is obesity among children. We are already one of the fastest-living societies in the world, so here we have already overtaken the United States at times, so this is already very worrying. And this health education and also the issue of educating children to, for example, attend P.E. classes or some sports activities, including educational ones, well, it is poor, and adults are not moving at all. Sometimes I have patients who usually come in and say well, I have this problem, I would like these drugs, the new ones. GLP1, right? And we reduce the problem, because once the drugs are switched on, of course these drugs also have a phenomenal reducing effect, because they reduce the appetite, they reduce the patient's weight.

Karolina Pyziak Kowalska
On the other hand, it's not as if it's a solution that you have to start changing your diet and movement too.

Monika Rachtan
I'll just add to those medications that you said, because this is a very interesting phenomenon. I started observing society and I started observing the people who take these drugs And I will tell you frankly that this absolutely does not even apply. It's different social groups and different professional groups. And what am I hearing? That if I start taking these drugs, I totally stop eating. I stop eating altogether, I just reach for one sweet roll a day and that's enough for me. And that wasn't the idea of this therapy at all. Because the idea was that the patient should first introduce healthy eating habits and get used to them for six months before receiving the medication, and reduce his body weight in order to prove to the doctor that he is a candidate for the medication we are talking about. Then the patient was supposed to have this treatment in order to reduce his body weight faster, easier, to motivate himself a little bit to do it, and then he was supposed to maintain these healthy eating habits, but he was also supposed to cultivate these healthy habits for the duration of the consumption of these drugs. And something terrible has happened, because people started taking these drugs, eating one sweet roll, then stopping, and the yo-yo effect is that these people are gaining twice as much weight.

Karolina Pyziak Kowalska
That we are going to have many victims here of uncontrolled treatment with these drugs, because younger and younger people are now taking them and treating them as a way of getting rid of excess weight without absolutely changing their diet. Because let us remember that there is very often a phenomenon here that is rarely mentioned, but is obesity related to malnutrition. This is called in medicine sarcopenic obesity. That is to say, in general, a person who has an excess of calories is not necessarily eating properly at all, because it is already sort of cumulative, because there seems to be a lot of it all, but there is a lack of protein in that diet. That protein is key, because also remember that as we get older we lose protein, so we need more of that protein to build muscle, to maintain overall fitness. So these drugs have one mechanism, when they also dehydrate the patient a lot, But we sort of need to build it all into the muscle tissue, to make it function, to provide us for the future later with sort of the fitness elements of the way we function. And here is the pitfall a little bit in all these elements, that the change, as the trainers say, the bowl is the basis, yes?

Karolina Pyziak Kowalska
So a change in diet, then just the question of sport, or at least I say it's sometimes very simple, because it's not some difficult performance, it's de facto 10,000 steps a day, which is an hour's walk? Yes? And roughly 150 minutes of exercise or 150 minutes of exercise per week. Yes? So those are the elements. If you divide it up into days, it doesn't come out to be particularly much.

Monika Rachtan
It's just that somehow you have to throw it into everyday life. And this is difficult for many people because of the way we live nowadays, we are in a hurry, we are under a lot of stress. And we are often in pain and consume large amounts of ibuprofen or paracetamol. These drugs in general. I have a feeling that after the COVID 19 pandemic this happened. I think everyone has one in their handbag nowadays. How it affects our functioning. On the functioning of our body, on our health, our liver. Is it possible to eat NSAIDs with impunity?

Karolina Pyziak Kowalska
These drugs are all metabolised mainly by either the kidneys or the liver, so one organ always gets a ricochet. My issue here is that during the course of an infection, a lot of people buy various preparations with different names, but the same composition. And this is the trap, that very often people end up with drug poisoning, because if they use it in excess, the daily dose of paracetamol is more or less 4 grams, and above that it is toxic, but these 4 grams are still spread over time, i.e. every 6 hours, so one gram each. That is two tablets of de facto paracetamol every 6 hours.

Karolina Pyziak Kowalska
We take 20 30 tablets a day, sometimes a drug of one group, for example paracetamol. But sometimes there can also be drugs from the group of non-steroidal anti-inflammatory drugs, i.e. ibuprofen for example. And here we have different forms of this drug and also these drugs are consumed in excess. The daily dose that should be consumed is 1200 milligrams, i.e. one tablet every 8 hours of these so-called max tablets, i.e. 400 milligrams each.

Monika Rachtan
Well, actually, here, as far as this intake is concerned, I have the impression that we do not know either, because the doctor has just said that if we take paracetamol and the fever does not go down, we should take a medicine from another group, i.e. Ibuprofen or pyralginum, for example. Whereas we are afraid, we don't know. It seems to us that if we took this paracetamol, then maybe it's better if I take paracetamol, because I've already taken it. So how do we manage this therapy here?

Karolina Pyziak Kowalska
Well, it is good sometimes to seek advice from the GP. Sometimes even when patients come in, whether with a fever or an infection, I just give them the dosage or write down the antipyretics. We use paracetamol in such and such a dose. We also write down the maximum daily dose for the period of tablets or maximum use of a given preparation, but if the fever does not go down, then we use a drug from another group and then we list the subsequent drugs and what dosage. And it is thanks to this that the patients also have protection against fever, while at the same time they will not cause themselves additional, health-related damage.

Monika Rachtan
Since we eat drugs to excess and drink to excess, is it permissible to take drugs? The very ones we are talking about are non-steroidal anti-inflammatory drugs and consuming alcohol. Is this safe?

Karolina Pyziak Kowalska
Everything is for people, it just all depends on the quantity. Of course, if someone has a headache and takes a tablet and has one drink, nothing will happen. On the other hand, if this happens repeatedly and there is damage to the liver, or if it is consumed to a greater extent, then there is a cumulative effect of the dose and this causes great damage to the liver, and it is toxic, because we have both alcoholic and drug-related damage.

Monika Rachtan
If you were to present, let's say to the decision-makers at the end of our conversation, some kind of action plan when it comes to reducing alcohol consumption in Poland. In your opinion, what measures should be introduced systemically to cut people's access to these alcoholic beverages a little?

Karolina Pyziak Kowalska
I believe that it should be first and foremost an education for young people as well, how specific alcohol consumption and the content of this alcohol in products such as beer, wine, vodka in large quantities translates into how much pure alcohol we drink.

Monika Rachtan
I don't think we know how to calculate that either.

Karolina Pyziak Kowalska
Because it is very, very important that, for example, it is estimated on average that Poles drink between 90 and 100 litres of beer, on average over the course of a year, a litre is about 200 such pints of beer. Someone will say maybe not much, because it will be so less than one beer a day. Yes, but if we count it among the population and some of the non-drinkers, it turns out that these other people make the norm, that it's from 4 to 8 in a day, so it's already a big pity. So here I would look first and foremost at preventing the sale of these large packs of alcohol and educating the public that the alcohol in beer is, first and foremost, alcohol that damages just as much, causes just these disorders related to the patient's life, because these are also drinks with a high glycaemic index, high calorie content, So all this also leads later to diabetes, to fatty liver. What is number one? The second is precisely the education of children and young people. First and foremost in terms of the fact that alcohol is harmful. And also all these undesirable events, even if it's in the media that someone under the influence of alcohol commits such and such an act.

Karolina Pyziak Kowalska
They also give food for thought and show the consequences of such actions. And, in addition, restricting the sale of alcohol after certain hours. I think this can have an impact on, for example, an already inability to drink. Yes, because this is often also such a very harmful element.

Monika Rachtan
But let us also not hide, when we talk about these solutions which could be introduced by the state, that for the state, for the state budget, these revenues related to the fact that Poles drink a lot are very lucrative, because several, a dozen or so billion zlotys come into the state budget from.

Karolina Pyziak Kowalska
Excise.

Monika Rachtan
Excise. So it's a bit of a vicious circle, isn't it.

Karolina Pyziak Kowalska
It's a vicious circle, as I juxtapose this later with hospital statistics. That is, if we look at it, we have, for example, 20,000 people with acute alcohol poisoning a year, who generate specific costs in hospital, often also demolishing wards or emergency rooms, because this also involves specific costs later on to repair various things. In addition, we have people who end up, as I say, with a K70 diagnosis, because this is the basket in which all people who have some kind of alcohol-related liver disorder are put. And here we have 25,000 people and it's already doing sort of a huge job. And if we look at the psychiatric wards, the so-called F10 diagnoses, which are related to harmful drinking, well, it turns out that in total, in outpatient clinics and in hospitals, there are 160 thousand patients in hospital centres alone and 120 thousand in such outpatient clinics. So when you look at the figures of almost 250 000 people directly related to alcohol consumption in various forms and who are referred to an outpatient clinic or a doctor for various reasons, we are talking about these registered cases.

Karolina Pyziak Kowalska
And how many people still don't end up there, but treat themselves somewhere at home? Whether by buying themselves some rehab drugs, or by going to these very fashionable therapies nowadays, to these expensive detox centres, where a lot of people go, and we get the aftermath of these patients, where the patients get drugs, they get a nice room, good food, peace and quiet, detoxification from alcohol, but this is not followed by any therapy. Only later they come to us, for example, because they have turned yellow, because something is going on, because they have severe itching of the skin. And such a patient comes into the surgery on a Saturday morning, has no test results and something needs to be done and is in a serious condition. I would say in terms of various disorders related to liver metabolism. We have no way of knowing how deep these disorders are and at the same time the patient doesn't want to go to hospital because everything is supposed to be done quietly, it's supposed to be sort of in a private practice setting.

Monika Rachtan
But there are actually people who make money from such a patient tragedy that they organise such private stays where.

Karolina Pyziak Kowalska
I would say that insanely a lot at the moment recently I have just been showing this phenomenon on Twitter, among other things. People don't believe that these things are there. And we are seeing the consequences of it in the office. Just that it's happening. And also we hear about the prices that are being charged for these kind of ten or seven day detoxification stays. These are in the order of 40-50 thousand that patients spend on so-called expensive detox holidays.

Monika Rachtan
But who organises such centres in the first place? I wonder Ms.

Karolina Pyziak Kowalska
You type in the internet.

Monika Rachtan
Are there doctors there or not?

Karolina Pyziak Kowalska
The problem is that the doctor is in such centres, prescribing specific medication for a particular patient. This is then supervised by staff who are, let's say, nurses, there are security guards, there are people connected with medicine, but there is often no person there who exercises such formal supervision, who is there 24 hours a day. Because the patient can't even, sometimes they can walk out of such a centre without having any card. I say, well, why don't we call the centre and ask what you've been taking? And no one knows, because the decision maker is not here.

Monika Rachtan
I've made the connection that I've seen one well-known person on breakfast TV talking about this kind of centre that she's just opened and I wonder what it's like there. So maybe if there's someone watching this programme who could publicise this issue, the doctor is probably very open to talking about it.

Karolina Pyziak Kowalska
The consequences of the kind of condition patients end up in are appalling. Here, too, we have a lot of things to do, and I also think that the decision-makers should look at how such centres function and what care they provide. Because among these, these centres, there are certainly some that are, as it were, well-constructed, but I think there are also some that prey on the ignorance of patients and, apart from receiving basic tranquillisers and vitamin drips, there is nothing else there.

Monika Rachtan
I don't think anyone doubts today that Poles drink too much and that they should reduce the amount of alcohol they consume. Is it a good thing to stop drinking at all? This is where you have to answer for yourself. But remember that any amount of alcohol is harmful and that by reaching for a pint of beer, a glass of vodka or a glass of wine, you are damaging your health. Today, my guest, but above all your guest, was Dr Karolina Pyziak Kowalska. Thank you very much to the doctor for our conversation.

Karolina Pyziak Kowalska
Thank you very much.

Monika Rachtan
And thank you for your attention. This was the After First Patient programme. My name is Monika Rachtan and I invite you to subscribe to my channel.