Women and alcohol: a gastric disadvantage.

Women and alcohol: A gastric disadvantage

It's no secret that men and women respond differently to alcohol. For instance, compared with a man of similar size who has imbibed the same amount, a woman winds up with more of the alcohol in her bloodstream. And women are much quicker to develop alcohol-related ailments, such as liver disease, than are men with the same drinking history. A team of U.S. and Italian researchers now suggests most of the difference traces to the stomach, where gender-related factors appear to influence the activity of alcohol-degrading enzymes.

"This is the first report of this type of enzyme in the human stomach," says coauthor Charles S. Lieber, who directs the Alcohol Research and Treatment Center at the Veterans Affairs Medical Center in New York City. Until now, he says, scientists viewed the liver not only as the major site of alcohol breakdown but also as the place where that breakdown begins. But his team's research, involving 20 male and 23 female volunteers in Trieste, Italy, shows that the same family of alcohol-dehydrogenase enzymes that initiate alcohol breakdown in the liver actually get their first shot at ingested alcohol in the stomach. The group reports its findings in the Jan. 11 NEW ENGLAND JOURNAL OF MEDICINE.

This makes alcohol alcohol the only known example of a drug whose "first pass" metabolism is initiated at the stomach wall, Lieber says. Animal data obtained by the same team suggest this pharmacologic phenomenon can remove as much as 20 or 30 percent of the alcohol ingested. But in humans, only men break down such a large proportion of their alcohol in the stomach, the new study indicates. For reasons yet unexplained, among the 31 volunteers who routinely consumed less than 2-1/2 ounces of alcohol weekly, stomach enzymes broke down less than one-fourth as much alcohol in women as in men. The extent of alcohol degradation in the stomach proved even lower among the 12 alcoholics in the study, with the six alcoholic women showing virtually none at all and the six alcoholic men showing only about half as much as nonalcoholic men.

Lieber notes that studies of males reported by his team in the February 1989 GASTROENTEROLOGY indicate that some drugs -- including cimetidine, widely presribed to control gastric ulcers -- can inhibit the stomach's first-pass metabolism of alcohol.

"We usually recommend that people drink moderately," Lieber says. But his group's findings suggest clinicians need to redefine moderate alcohol consumption, because "what's moderate for a man is not moderate for a woman" -- or for patients taking certain prescription drugs.

This is "very exciting work," comments liver specialist Steven Schenker of the University of Texas Medical School in San Antonio. Not only might it explain why women suffer so much more from alcohol than do men, he says, but it also "opens up a new area of research" -- the role of the stomach, including the drug interactions that occur thee, in a person's susceptibility to inebriation and alcohol-related disease.