Valerie Schulz, MMSc, RD, LD/N, CDE

Alcohol Intake  On average, people in the United States consume from 6 to 10 percent of their total daily energy intake as alcohol  (Beer: 100 – 150 kcal /12 oz; 150/2000 kcal = 8%.  Wine: 100 – 120 kcal / 5 oz; 120/2000 kcal = 6%)  A third of U.S. college students drink alcohol in patterns of binge drinkers (What is criteria for binge drinking for women? Men?)

Alcohol in beverages  The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks, and when women consume 4 or more drinks, in about 2 hours. 1National Institute on Alcohol Abuse and Alcoholism  1.

Alcohol Action  Alcohols affect living things profoundly:  act as lipid solvents  Alcohols can easily penetrate a cell's outer lipid membrane  once inside, alcohol denatures cell protein structures and kills the cell  As an example of the action of alcohol: some alcohols kill microbial cells, they make useful disinfectants and antiseptics (rubbing alcohol, hand sanitizer)

Ethyl Alcohol (Ethanol = EtOH)  Alcoholic beverages = ethanol  somewhat less toxic than other alcohols  Sufficiently diluted and taken in small enough doses, its action in the brain produces euphoria  Used in this way, alcohol is a drug, and like many drugs, alcohol presents both benefits and hazards to the taker

How much is a drink?  Beer: _____ oz (4-5% alcohol)  Wine: ____ oz (12-14% alcohol)  Wine cooler (commercial): _____ oz  Hard liquor: _____ oz (80 proof)  What does proof mean? 80 proof = ______ % alcohol  A serving of alcohol is called a drink, and delivers ½ ounce of pure ethanol

So here’s a question:  How many ‘drinks’ is one can of Four Loko? 23.5 ounces, 12% alcohol by volume ○ One ‘drink’; it’s only one can ○ Two and ½ ‘drinks’; that’s a BIG can! ○ Three ‘drinks’: the volume is like 2 cans of beer, but the alcohol % is higher ○ Almost five ‘drinks’: the same alcohol % as wine, and since a ‘drink’ of wine is 5 oz, 23.5oz / 5 = 4.7 ‘drinks’

Definition of moderation  No more than: 1 drink a day for an average woman 2 drinks a day for an average man  These are 24 hour maximums (Why is moderation different between genders, even though a man and woman might weigh the same? The answer will be later in the chapter under the heading “Alcohol Arrives in the Liver”, and then under heading ‘Alcohol breakdown in the stomach’ ; also on slide 21)  (ie, no drinks all week and 7 on Saturday is NOT moderation; that’s ___________ drinking

Who should not drink?  People of any age who cannot restrict their drinking to moderate levels  Anyone younger than legal drinking age: (increased risk of drowning, car accidents)  Women who may become pregnant or who are pregnant or breastfeeding: alcohol may be especially hazardous during the first few weeks, before a woman knows she is pregnant  People who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination to remain safe.  People with medical conditions: HTN, liver disease

Moderate vs problem drinkers  Compare characteristics in chart C3-4 pg 98 – (titled: Behaviors typical of Moderate and Problem Drinkers  Harm from binge drinking: Fatal car crashes Alcohol related assaults, including sexual ○ (600,000 college students per year) 1,700 college students die from these injuries Unplanned pregnancies R. Hingson and co-authors: Magnitude of alcohol-related mortality and morbidity among US college students age 18-24: Changes from , Annual Review of Public Health 26, (2005),

Personal aside  Because we are not in the classroom, where I could verbally add some tidbits, I will have to do it by typing… A good friend, who has been ‘clean and sober’ for 28 years, has caused me to widen my eyes in surprise over her tales of drinking for days at a time, blacking out, going to work drunk, and about two months ago, telling me she drove home from work gripping the steering wheel tightly to keep the car pointed toward home because she wanted a drink so badly – after 28 years! She says, “I have alcohol- ism, not alcohol-wasim.” This same friend has an male AA friend who says (with a wry grin), “I know when I’ve been drinking, because I land in jail!”

Alcohol enters the body  Requires no digestion Tiny* alcohol molecules start diffusing right through the stomach walls and they reach the brain within a minute drinking on an empty stomach = quick intoxication  When stomach is full of food: molecules of alcohol less chance of touching the stomach walls and diffusing through alcohol reaches the brain more gradually Also, a full stomach delays alcohol's flow into the small intestine, allowing time for a stomach enzyme to destroy some of it in small intestine, alcohol is rapidly absorbed whether food is present or not * See next slide

Ethyl alcohol – small molecule About as big as 3 water molecules

Alcohol enters the body  increased urine output (because alcohol depresses the brain's production of anti- diuretic hormone)  Loss of body water leads to thirst (drink actual water between alcohol drinks, otherwise just get thirstier)  water lost due to hormone depression takes with it important minerals: magnesium potassium calcium zinc

Rate of drinking  drink slowly enough and the alcohol will be collected by the liver after absorption and processed without much effect on other parts of the body  more rapidly, however, some of the alcohol bypasses the liver and flows for a while through the rest of the body and the brain.

Alcohol’s effect on the brain- Figure C3- 2, after heading “A Lethal dose of Alcohol”, pg 99

Alcohol in the Brain  Inhibitory nerves are sedated, allowing excitatory nerves to take over, giving the impression that alcohol stimulates  (it’s really a depressant)  Table C3-5: Blood alcohol Levels and Brain Responses, pg 100: what blood alcohol level is consistent with death?

Alcohol metabolism (brief) ADH ALDH  CH 3 CH 2 OH →→ CH 3 CHO →→CH 3 COO ⁻ Ethanol acetaldehyde acetate  ADH = alcohol dehydrogenase (removes hydrogens)  ALDH = aldehyde dehydrogenase  Acetaldehyde: carcinogenic, short lived  (do not have to read this whole article, I put it here to corroborate the carcinogenicity of acetaldehyde)

Alcohol metabolism (brief)  During the breakdown of alcohol, also get free radicals, which attack Brain cell lipids, causing inflammation (also referred to as oxidative stress) Inflammation linked to diabetes, cancer, CVD  ADH converts about 80% of alcohol consumed; other enzymes will help if alcohol intake exceeds capacity of ADH

Alcohol around the body  If more alcohol arrives at liver than enzymes can handle, continues to circulate through brain, liver, other organs until enzymes available  Stomach wall produces ADH men make more ADH than … women; (so woman absorbs more EtOH from each drink) people dealing with alcoholism make less than those not struggling with the disease

Excretion in breath and urine  ~ 10% of alcohol in blood is excreted as is (as ethanol) through Lungs (breathalyzer directly proportional to alcohol in blood, so is accurate test of BAC) Kidneys (urine)  Rate of clearance: (good to know…) One drink per hour (1/2 oz of ethanol) Fasting even for one day can degrade body proteins, including ADH, and reduce the rate of alcohol metabolism Walking (muscles cannot metabolize alcohol) or coffee (only makes you alert & drunk) does not speed up rate of alcohol metabolism

Processing of alcohol  EtOH receives highest priority  Cannot be stored without first being converted to something safer  Acetaldehyde (first breakdown product) can bind to and disrupt enzyme and cell function

Progression of liver damage  Fatty liver acetate leads into fat synthesis Liver busy detoxifying alcohol, slower to package fats Fatty liver remains for > a day after single night of heavy drinking; reversible  Fibrosis If drinking continues, fibrous scar tissue invades liver Reversible with abstinence and good nutrition  Cirrhosis Liver cells harden and die – not reversible

Consequences of cirrhosis  Remember that all the nutrient rich blood from the GI tract flows into the portal hepatic vein, directly to the liver  Once the liver cells have hardened, it is much more difficult for them to receive the flow of this fluid  Backpressure occurs, forcing the fluid that used to go through the liver to pool in the abdomen: ascites  Ascites (def): The accumulation of fluid in the peritoneal cavity, causing abdominal swelling.

Ascites: Note the thin extremities (he is not fat all over) and the bulging belly button (fluid pressure). Imagine his effort to breathe when he lays down, with all that water weight pushing against his diaphragm.

Alcohol effects around the body  May suppress testosterone  Slows synthesis of immune system proteins  Synthesis of blood lipids speeds up, increasing triglycerides and HDL  Excess alcohol interferes with normal uric acid metabolism, causing gout-like symptoms

Hangover  Mild form drug withdrawal  Alcohol reduces water content of brain cells; swelling back to normal size with rehydration the next day sets up nerve pain (headache)  Same enzymes process both ethanol and methanol (produced in tiny amounts by cellular processes), but prefer ethanol Methanol’s first breakdown step is formaldehyde

Hangover  Both alcohols processed without delay until acetaldehyde monopolizes the second set of enzymes This leaves formaldehyde to wait, starts accumulating and the hangover begins ADH Methanol → formaldehyde  Time alone is the cure for a hangover.

Long term effects ○ Devastating to a fetus (we will cover in detail when get to chapter13) ○ Cirrhosis develops after 10 to 20 years of heavy drinking ○ Bladder, kidney, pancreas, and prostate damage ○ Bone deterioration and osteoporosis ○ Brain disease (attacks brain cells directly), CNS damage, strokes ○ Deterioration of testicles and adrenal glands ○ Diabetes (type 2) ○ Disease of heart muscles – (alcohol is toxic to muscle and raises blood pressure → alcoholic cardiomyopathy) ○ Feminization and sexual impotence in men ○ Impaired immune response

Long term effects ○ Impaired memory and balance ○ Increased risk of death from all causes (Incl cancer) ○ Malnutrition ○ Nonviral hepatitis ○ Severe psychological depression ○ Skin rashes and sores ○ Ulcers and inflammation of the stomach and intestines ○ More…

Alcohol’s effect on Nutrition  Alcohol does damage indirectly via malnutrition Not likely a person will eat enough food if they drink a lot Provides empty calories Disrupts tissue’s metabolism of nutrients Wernicke-Korsakoff syndrome – a thiamin deficiency (poor muscle coordination, impaired memory, nerve damage including paralysis of eye muscles) Pellagra, beriberi, scurvy, protein-energy malnutrition: all due to getting kcal from alcohol, not food

Alcohol in moderation  Alcohol in moderation may reduce risk of Heart attacks Strokes Dementia Diabetes Osteoporosis Lower mortality in adults >35 years old

Alcohol in moderation  1 to 2 drinks a day are credited with reducing the risk of death from heart disease in people over 60 years old who have an increased risk of heart disease.  A study showed an increased risk of death from all causes with more than 22 drinks per week (avg 3 drinks /d) and that men drinking more than 35 drinks a week (avg 5 drinks/d) had double the mortality from stroke compared with nondrinkers.

Alcohol in moderation  So there is a fine line between the reported health benefits of 1-2 drinks per day, and the poor health outcomes from 3-5 drinks per day…  Dealcoholized wine, purple grape juice and the grapes themselves contain phytochemicals (resveratrol) similar to those of wine but without the potential dangers of alcohol

Alcohol terms to know – pg 96 – From Table C3-1, after “Defining Drinking”  acetaldehyde  alcohol dehydrogenase  cirrhosis  fatty liver  fibrosis  Gout  methanol  Urethane  Wernicke-Korsakoff syndrome