Dear Doctor: We have a dear friend who is 46 and has alcoholism. His liver is failing, but he blames that and all of his symptoms (fatigue, burning lungs, severe stomach pain, sinus problems, confusion) on factors besides his drinking. What are the long-term effects of abusing alcohol?

Dear Reader: Alcoholism is a disorder in which an individual has lost the ability to regulate their drinking, even though the habit is clearly causing harm. A diagnosis of an alcohol use disorder means someone has met at least two of a series of criteria within a one-year period. These behaviors, which have been laid out by the American Psychiatric Association, include a need to keep drinking despite clear evidence of self-harm; increasing tolerance to the effects of alcohol; physical symptoms when alcohol is withheld; an inability to limit the amount one drinks; losing large chunks of time to planning, seeking, consuming and recovering from drinking; and withdrawal from the activities of daily life. The more criteria that are met, the more severe the problem.

Risk factors for an alcohol abuse disorder range from stress, trauma, peer pressure, ease of access, depression and other emotional issues, to genetic factors, the age at which someone starts drinking and family history. And as your letter attests, the drinker is rarely the only one harmed by an alcohol use disorder. The effects are far-reaching and can interfere with a person’s family, social, work and spiritual lives.

Regarding the variety of physical symptoms your friend has experienced, it’s not possible to know the cause without a physical exam and diagnostic tests. However, many of them do correspond to symptoms that accompany alcohol abuse. As anyone who has ever had a drink too many knows, the short-term effects of alcohol use can include slurred speech, impaired coordination, impaired judgment, changes to mood, diarrhea, vomiting, headache, dehydration and memory lapses.

Long-term alcohol abuse adversely affects virtually every part of the body. Chronic heavy drinking can weaken the heart muscles, contribute to high blood pressure, cause irregular heartbeat and raise the risk of stroke. It can also lead to serious and persistent changes to the structures and functioning of the brain. Although heavy drinking is most associated with liver damage, including the irreversible destruction and scarring of liver tissue known as cirrhosis, it also causes a range of digestive problems. These include ulcers in the stomach or esophagus, inflammation of the pancreas and inflammation of the stomach lining.

Because alcohol interferes with the release of glucose from the liver, low blood sugar becomes a risk. This makes heavy drinking particularly dangerous for anyone with diabetes. A number of studies have linked long-term alcohol abuse to increased risk of certain cancers, including liver, colon, throat, mouth, larynx and rectum. Even moderate drinking has been linked to an increase in the risk of breast cancer.

Unfortunately, the denial that you describe is also often part of alcohol use disorder. If you decide to talk to your friend about his drinking, you’ll find guidance and support from a number of well-regarded organizations, including the National Institute of Alcohol Abuse and Alcoholism (NIAAA), and Alcoholics Anonymous.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My wife wants me to quit eating black licorice because she heard it’s bad for you. I think it’s just that she can’t stand the taste of it herself. I told her I was writing this email, and she said I have to include that I’m 42 and on blood pressure meds.

Dear Reader: Your wife is remembering a warning about black licorice issued by the Food and Drug Administration in 2017, just a few weeks before Halloween. Considering that Americans now spend upward of $2.7 billion (yes, with a B; and yes, we’re kind of shocked) per year on Halloween candy, the FDA’s timing seems spot on. According to the warning, “If you’re 40 or older, eating 2 ounces of black licorice a day for at least two weeks could land you in the hospital with an irregular heart rhythm or arrhythmia.”

To understand why, we need to talk about Glycyrrhiza glabra, the plant used to give licorice candy its distinctive flavor. Commonly referred to as licorice root, Glycyrrhiza glabra is a member of the pea and bean family, and is native to certain areas of Europe, the Middle East and western Asia. Its fleshy roots contain a compound called glycyrrhizin, which is 50 times sweeter than sugar.

Licorice root has medicinal properties, and it is a centuries-old treatment for a variety of ailments, including heartburn, stomach upset, ulcers, sore throat and bronchitis. However, one of the side effects of consuming glycyrrhizin is a potentially dangerous drop in the levels of potassium in the body. This means eating too much licorice can lead to a range of symptoms including high blood pressure, leg swelling, exhaustion, lethargy, cramping, abnormal heart rhythms and even congestive heart failure. Research shows that when you stop eating black licorice, potassium levels will usually return to normal on their own.

If you’re wondering why your wife wanted you to share your age and health status in your email, it’s because according to the FDA, people over the age of 40 who also have a history of hypertension or heart disease should be particularly careful not to eat too much licorice. Eating as little as 2 ounces -- that’s four small pieces -- of licorice every day for two weeks is enough to land someone in the hospital. Scientists at the National Institutes of Health, who take an even dimmer view of the candy, state that even 1 ounce of licorice per day consumed over the course of several weeks may be “potentially unsafe.” To avoid problems, black licorice lovers of any age should never eat large amounts of the candy at one time.

It’s also important to note that glycyrrhizin, the flavoring compound in licorice root, has the potential to interact with some medications, herbs and dietary supplements. For instance, the NIH warns that black licorice blunts the effects of the blood thinner warfarin, and it interferes with certain blood pressure drugs, steroid drugs and diuretics. If black licorice is a constant in your diet and you regularly take any medications or supplements, it would be wise to check with your doctor or pharmacist for any potentially adverse interactions.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My mom is 93, and her doctor says she needs a pacemaker to control a heart arrhythmia. How does a pacemaker work? Is the operation dangerous for someone her age?

Dear Reader: A pacemaker is a small medical device that uses electrical pulses to keep the heart beating at a steady rhythm. It may be needed to stimulate a faster heart rate in cases where the patient’s heart has begun to beat too slowly, or to correct potentially dangerous rhythm problems.

The device consists of two parts -- a battery-operated pulse generator, which contains a small computer chip, and between one and three fine wires, known as leads, which are tipped with electrodes. The generator, which is about the size of a matchbox or smaller, is surgically implanted beneath the skin of the chest, often near the collarbone. The leads are threaded through a vein that leads to the heart, and the electrodes are placed within those chambers of the heart that require outside stimulus. The specifics of the number of leads in a person’s pacemaker, as well as electrode placement, depend on the specific condition the pacemaker is treating.

Once the device has been implanted, the electrodes, which are sensors, read the electrical signals from the heart. They then transmit this data to the computer chip within the generator. Whenever an abnormal heart rate, or arrhythmia, is detected, the computer in the pacemaker instructs the generator to send corrective electrical impulses to the heart muscle. Adjustments can be made with a specialized computer called a programmer, which communicates with the pacemaker.

Pacemaker technology has benefited greatly from the tech revolution, and it continues to evolve. The earliest devices, which date back to the 1960s, were about the size of a hockey puck. Several years ago, a tiny pacemaker that’s smaller than a AAA battery won FDA approval. This device, which has no leads because it is placed directly in the chamber of the heart, is limited to certain patients with specific types of heart pacing needs.

The procedure to implant a pacemaker is performed in a cardiac catheterization lab, usually under small amounts of sedation in combination with local anesthesia. It’s considered to be a minimally invasive surgery, and it typically takes from one to two hours. Potential risks of the surgery include bleeding, infection, swelling or bruising, damage to the blood vessel used to guide the leads, or an adverse reaction to anesthesia used during the surgery. Patients either go home to recover the same day, or they spend one night in the hospital for observation. In the month following pacemaker surgery, patients must be careful to avoid vigorous exercise and heavy lifting.

About 400,000 pacemakers are implanted in the United States each year, half of them in people over age 75. And while surgery carries risks for people of any age, the complication rates of pacemaker implantation are low, including among patients who are in their 80s and 90s. Your mother’s own medical history is an important factor as well. We recommend that you speak with her cardiologist about the risks of the surgery versus the risks of going without it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)