With the holiday season high, there is festive cheer, family gatherings and also an undeniable increases in alcohol consumption that fills the air. Christmas and New Year's Eve celebrations to spring break and bachelor parties and sporting events that bring together huge crowds for celebrations mean that drinking becomes synonymous with partying. But behind the revelry lies a much darker behavior: high-intensity drinking.

Alcohol is the most widely used substance in the United States; it has been reported that 84% of adults aged 18 and older reported lifetime use. Moderate drinking is socially acceptable, but high-intensity drinking is an alarming trend. The behavior of consuming eight or more drinks over a few hours for women and 10 or more for men exceeds binge drinking and significantly increases risk for harm.

High-intensity drinking is far from being just a mere passing concern; it is instead a public health crisis. The burden is even greater as 29 million people in the United States suffer from alcohol use disorder. That has caused over 140,000 deaths annually while accounting for 200,000 hospitalizations and 7.4% of visits to emergency departments in the United States. However, only 7.6% of these affected get treated, thus forming a glaring gap in handling this concern.

What Is High-Intensity Drinking?

High-intensity drinking is a dangerous escalation from traditional binge drinking, characterized by consuming double or triple the standard binge amounts. While binge drinking involves four or more drinks for women and five or more for men, high-intensity drinkers often surpass these levels, leading to blood alcohol concentrations (BAC) exceeding 0.2%—a level that significantly impairs judgment and motor skills.

According to Dr. George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), high-intensity drinking is one of the factors that intensify the risks of injuries, overdose, and death. It is also very highly associated with the onset of AUD, since the chance of addiction increases with increased alcohol consumption per occasion.

Blackouts and Memory Loss Risks

One of the most troubling consequences of high-intensity drinking is alcohol-induced blackouts, periods of amnesia where individuals may appear functional but are incapable of forming memories. Blackouts occur when alcohol disrupts the hippocampus, the brain region responsible for memory formation.

Blackouts are often categorized into two types:

1. Fragmentary Blackouts: Characterized by spotty memory, where recalling certain details can trigger partial recollection.

2. En Bloc Blackouts: Significant amnesia for hours, wherein no memory is created at all, even if tried to be recalled.

Aside from memory loss, intense binge drinking is linked with poor decision-making, violence, injury, and conflicts in personal relationships.

Why Holidays and Special Events Are Hotbeds for Excessive Drinking

Holidays and celebrations create the perfect storm for high-intensity drinking. According to research, adults drink nearly double the amount of alcohol during holidays like Christmas and New Year's Eve than they do at any other time of the year. It is during these periods of social gathering, holiday stress, and seasonal sadness that people drink in excess.

For college students, experiences like spring break and 21st birthdays increase the danger. Some studies indicate that students, especially those who travel with buddies to spring break, indulge in more alcohol and make more serious decisions than any student who remains at home or goes with their family to other destinations. Sporting events are, too, notorious for promoting drunk consumption, especially among male customers. Alcohol consumption usually goes high during Super Bowl Sunday, thus leading to games day violence and arrests.

Consequences of Heavy Intensity Drinking

High-intensity drinking impacts not only physical health and mental well-being but also social relationships.

Acute Risks

- Alcohol poisoning

- Severe dehydration and electrolyte imbalances

- Hypoglycemia

- Risky sexual behavior

- Injuries and accidents

Chronic Risks

- Liver damage, alcoholic hepatitis, and cirrhosis

- Cardiovascular diseases such as arrhythmias and cardiomyopathy

- Neurological damage, including memory deficits and blackouts

- Progression to alcohol dependence or AUD

Psychological Impact

High-intensity drinking is strongly linked with increased risks of depression, anxiety, and suicidal ideation. Poor decision-making during episodes can lead to long-lasting consequences, including damaged academic, professional, or personal outcomes.

How to Address the Problem

Combating high-intensity drinking requires education, early intervention, and accessible treatment options. The NIAAA has defined high-intensity drinking to be distinct from binge drinking and has called for targeted approaches to decline prevalence and associated harms.

One promising treatment option is naltrexone, which a medication helps control alcohol cravings. Encouraging in preliminary evidence, more extensive clinical trials will be necessary to ascertain its efficacy more specifically in high-intensity drinkers.

As we head into the holiday season and other special occasions, it is important to heighten awareness of the dangers of high-intensity drinking. A good understanding of long-term consequences and seeking help when alcohol-related issues arise can be the difference between life and death. Celebrations should be about joy and connection, not about the gateway to harm.

If you or someone you know drinks at dangerous levels or have an alcohol use disorder, there is help available. Remember, for suspected cases of alcohol poisoning, dial 911. In this way, we can foster healthier relationships with alcohol and create safer environments for everyone.

Common metabolic conditions such as obesity and diabetes are increasingly becoming a serious public health concern in India. Their health implications extend beyond the conditions themselves, with obesity and diabetes associated with a range of chronic diseases and complications that can affect long-term health and wellbeing. As lifestyles become more sedentary and the prevalence of these conditions continues to rise, understanding their wider implications on women’s health is becoming increasingly important.

What many women may not realize is that this metabolic burden can carry a deeper, less visible consequence one that reaches into the domain of gynecological cancer.

One such concern is endometrial cancer. A form of uterine cancer, it develops in the lining of the uterus and is becoming an increasingly important health issue globally. Yet, many women remain unfamiliar with the disease, its risk factors, and the symptoms that require prompt medical attention.

The Metabolic Health Connection

Increasing evidence points to a link between metabolic syndrome and endometrial cancer, particularly through conditions such as obesity and diabetes. Excess body weight and metabolic disturbances can disrupt hormonal balance, such as by increasing estrogen production without a corresponding increase in progesterone. Over time, this hormonal imbalance may stimulate abnormal growth of the endometrial lining, increasing the likelihood of cancer development.

Diabetes, too, has been associated with an increased risk. As obesity and diabetes become more prevalent, recognizing these less-discussed consequences is an important part of strengthening women’s preventive health.

For women, maintaining a healthy weight, staying physically active, managing metabolic conditions effectively and paying attention to unusual symptoms can all form part of a broader approach to preventive health.

Watching Out For Unusual Symptoms

One of the most important characteristics of endometrial cancer is that it often presents with abnormal vaginal bleeding. Bleeding or spotting after menopause is one of the most significant warning signs and should never be ignored.

For women who have not reached menopause, heavier-than-normal periods, prolonged bleeding, or bleeding between periods should be discussed with a healthcare professional.

Why Awareness Matters

Improving awareness is important because there is currently no recommended routine screening test for endometrial cancer in asymptomatic women. As a result, recognizing symptoms and seeking timely medical advice are among the most effective ways to support earlier diagnosis.

At the same time, the conversation should not end with cancer awareness alone. As India continues to face a growing burden of obesity and diabetes, prioritizing metabolic health has become increasingly important for overall wellbeing.

Maintaining a healthy weight, staying physically active, eating a balanced diet, and effectively managing conditions such as diabetes can help reduce the risk of a range of serious health complications, including certain cancers. For women, understanding the connection between metabolic health and endometrial cancer can empower more informed decisions about prevention, symptom recognition, and long-term health. By addressing obesity and diabetes early and seeking medical advice when unusual symptoms arise, women can take meaningful steps towards protecting their health at every stage of life.

(By Dr. Shefali Sardana, Medical Oncologist, Apollo Hospitals, New Delhi)

Melanoma is often considered one of the more challenging cancers to treat, particularly when it has spread to distant organs. For early-stage disease, surgery remains an important treatment option. But once melanoma reaches stage IV, treatment becomes considerably more complex.

Understanding The Biology Of Advanced Melanoma

According to Dr. Mandeep Singh Malhotra, Cheif Mentor AOHC, cytotoxic chemotherapy has traditionally had a limited role in melanoma, while immunotherapy has changed the treatment landscape for many patients.

When melanoma is detected at an early stage and can be completely removed, surgery is generally considered the preferred treatment. Depending on the disease, this can involve removal of the primary tumour and assessment or treatment of regional lymph nodes.

But stage IV melanoma presents a very different challenge.

A Complex Case With Multiple Tumour Sites

Dr. Malhotra recalls the case of Sarah, who came to the team with multiple nodules in the scapular region. There were also lesions on both legs and a lesion in the pancreas. So there were multiple nodules. One in the right side of the leg, another in the left side of the leg. And there was a lesion in the pancreas.

Rather than relying on a standard treatment approach alone, the team first tried to understand the biology of the disease. As a standard protocol for this type of case, we first try to understand the disease biology. In Sarah’s case, the team used extensive testing, including chemosensitivity testing, transcriptomic analysis and next-generation sequencing.

Also read: Cancer Should Be Made Notifiable In India, Say Experts: Here’s Why

When Imaging Initially Suggests Progression

The results suggested sensitivity to certain drugs. When we analysed those reports, we were able to understand that cytotoxic drugs like temozolomide were effective. And checkpoint inhibitors like pembrolizumab, nivolumab were effective.

Based on these findings, the team developed a treatment protocol in which the main component was an immune checkpoint inhibitor along with low-dose temozolomide. Other agents, including lower doses of anti-VEGF, anti-FGF and CDK inhibitors, were also incorporated based on the analysis.

After around four weeks, the response became difficult to interpret on imaging. The PET scan suggested that all the lesions have had a pseudo progression.

Pseudo progression is a recognised phenomenon during immunotherapy. A tumour may appear larger initially because of immune-cell infiltration, even when the treatment is actually producing an anti-tumour response.

This is particularly relevant in melanoma treated with immune checkpoint inhibitors. However, doctors cannot simply assume that every apparent progression is pseudo-progression; true progression must also be considered and confirmed through Histopathology

Also read: French Court Links Flight Attendant’s Breast Cancer To Workplace Radiation; How Does Flying Increase Cancer Risk?

Histopathology Reveals A Dramatic Treatment Response

The team then proceeded with surgery, removing the nodules from the scapular region and both thighs. The specimens were sent for histopathological examination. And histopathology results were amazing. The tumours had gone necrotic.

The pathology showed extensive treatment-related changes, with inflammation and fibrosis around the nodules and only small areas containing viable melanoma cells.

Also read: _{Daraxonrasib: US FDA Approves Once-Daily Pill for Metastatic Pancreatic Cancer}

What Comes Next For The Patient?

For now, the plan is to continue the treatment for a few more cycles and then reassess the pancreatic lesion. The team is considering NanoKnife (irreversible electroporation) for the pancreatic lesion followed by Vaccines.

Certain cancer vaccines are being developed in certain labs in Germany and Europe and they are available for our patients in India on compassionate grounds. It's a very, very good response. And to achieve disease NED in stage four melanoma, I think we are really lucky and it's all due to the grace of God.

Why Individualised Treatment Matters In Stage IV Disease

The case also highlights an important point about advanced melanoma: treatment may need to be individualised according to the biology of the disease and the patient's response. At the same time, he stresses the need for hope. I hope that more people can benefit from this protocol and use this protocol to treat melanomas across the world.

For Sarah, the journey is still ongoing. The next step will be to reassess the pancreatic lesion and determine whether further local treatment can help achieve no evidence of disease (NED). A stage IV melanoma involving multiple sites, including the pancreas, reaching a point where NED may become a possibility is certainly an encouraging development. But it remains an individual clinical experience, rather than proof that the same protocol will work for every patient with metastatic melanoma.

By Dr. Mandeep Singh Malhotra, Director of Surgical Oncology at CK Birla Hospital and Chief Mentor at AOHC

People living with obesity and diabetes often feel healthy in their day-to-day life, but some of the most dangerous changes may be happening silently inside their bodies.

The liver is one of the first organs to be affected. In many cases, fat slowly accumulates in the liver without causing any pain, discomfort, or obvious symptoms. This is why fatty liver disease is often called a “silent condition.” By the time it is detected, it may already have progressed to an irreversible stage.

Excess body fat, particularly around the abdomen, disrupts how the body processes sugar and fats, placing continuous stress on the liver. Because of this silent progression, experts now strongly recommend that people living with obesity and type 2 diabetes should proactively check their liver health, even when they feel completely well.

Obesity is closely linked with liver damage through a series of metabolic changes that develop over time. When the body becomes resistant to insulin, fat begins to accumulate in liver cells, triggering inflammation and gradual injury.

If this continues unchecked, the condition can progress from simple fat accumulation to more serious stages, including metabolic dysfunction-associated steatohepatitis (MASH), where inflammation and liver cell damage become more significant.

Over time, this may lead to fibrosis (scarring of the liver), and in advanced cases, cirrhosis, which can severely affect liver function. Further, patients with fatty liver may directly present with liver cancer, which can occur in up to 20% of patients.

How Common Is Fatty Liver In People With Diabetes And Obesity?

In India, the burden of metabolic dysfunction-associated steatotic liver disease (MASLD) or fatty liver is rising and is now recognised as a common metabolic condition. Studies from the Indian subcontinent estimate that 1 in 3 people may have MASLD. Fatty liver is particularly common among individuals with metabolic risk factors.

It is seen in nearly 40–80% of people with type 2 diabetes and 30–90% of those with obesity, often without clear symptoms.iv Hospital-based trends also suggest increasing detection in younger age groups, reflecting changes in diet, reduced physical activity, and more sedentary lifestyles.

Also read: Post-Menopausal Women Face A Higher Risk Of Fatty Liver Disease: How Falling Estrogen Levels Impact Liver Health

What Liver Checks And Preventive Measures Should You Follow?

Preventive measures to be followed:

• If you live with excess weight/obesity and type 2 diabetes or PCOS (polycystic ovarian syndrome) or dyslipidemia, seek early consultation with a physician or hepatologist.

• Your doctor may request routine metabolic screening:

• Regular liver function tests as part of annual health check-ups

• Ultrasound screening for individuals with obesity or diabetes

• Monitoring blood sugar, cholesterol, and triglyceride levels

• Liver scarring scan (annually for patients with diabetes/obesity)

• Avoiding long-term neglect of “mild” or borderline test results

Also read: From Liver Inflammation to Cancer: When Hepatitis Becomes a Serious Warning Sign

With rising obesity rates in India, early liver screening should become a routine part of preventive healthcare. Even modest weight reduction, improved diet quality, and regular exercise (approximately 150 minutes per week of moderate-intensity exercise (example: brisk walking, gardening, swimming, cycling) or 75 minutes of vigorous exercise (example: weight training) can significantly reduce liver fat and inflammation within 3-6 months.

However, once the disease progresses to MASH or fibrosis, reversal becomes more difficult and may require long-term medical management. Early-stage fatty liver disease is reversible in many cases. In fact, medications can even reverse liver fibrosis (early scarring), but in only 25% of patients. Simple homemade food is sufficient to prevent these lifestyle diseases, and there is no need for “fancy online diets or supplements”.

Our forefathers lived longer by consuming homemade food and water without any supplements. Newly approved therapies such as semaglutide (GLP1 analogues) have been shown to resolve steatohepatitis and reduce liver fibrosis. These liver benefits do not appear to be explained solely by weight loss, suggesting a broader potential impact on liver health.

The absence of symptoms does not mean the absence of risk. Taking care of the liver early is not just about preventing disease; it is about protecting long-term health, energy, and quality of life.

By Dr. Anand V. Kulkarni, Senior Consultant Hepatologist & Director – Critical Care Hepatology, AIG Hospitals, Hyderabad