1. CHAPTER 8 ALCOHOL

2. LEARNING OUTCOMES Describes the sources of alcohol and the calories it provides Define standard serving sizes of alcoholic beverages and the term moderate drinking Summarize how alcoholic beverages are produced Outline the process of alcohol absorption, transport and metabolism 2

3. LEARNING OUTCOMES Define binge drinking and explain how it increases the risk of alcohol poisoning Explain how alcohol consumption affects blood alcohol concentration Describe guidelines for using alcohol safely Discuss potential benefits of using alcohol Summarize the risks of alcohol consumption 3

4. LEARNING OUTCOMES Describe the effects of chronic alcohol use on the body and nutritional status List the signs of alcohol dependency and abuse Outline the methods used to diagnose alcohol abuse List the strategies and resources available for the treatment of alcoholism 4

5. ALCOHOL CAN BE MADE FROM MANY SOURCES 5

6. SOURCES OF ALCOHOL Contains 7 kcal/gm Beer, wine, distilled spirits, liqueurs, cordials and hard cider Vary in alcohol and caloric content Standard drink provides 15 g of alcohol 12 oz beer, 10 oz wine cooler, 5 oz wine or 1.5 oz of hard liquor Moderate intake 1 drink a day for women 1-2 drinks a day for men 6

7. HOW THOSE CALORIES ADD UP… 5 oz wine 120 5 oz champagne 95 Wine cooler 210 Guiness 210 Lite beer 140 1 shot hard liquor 50 1 shot Bailey’s 160 Rum and coke 180 Martini 220 Margarita (restaurant) 540 Pina colada (restaurant) 650 4 pints of beer = 4 x 180 = 720 kcal 1 bottle of wine = 5-6 glasses x 120 =650 kcal 7

8. PRODUCTION OF ALCOHOLIC BEVERAGES Fermentation Must get carbohydrate to monosaccharide form Keep sugar + yeast + water at room temp Yeast uses sugar for energy to make more yeast Oxygen depletes and yeast ferments sugar to ETOH and carbon dioxide If a starch must be malted: grains sprouts and makes enzymes that break sugars to simple sugars Distillation Separating the alcohol out of the product Boil off alcohol, save vapors and condense to make hard alcohol 8

9. WE DRINK ETHANOL 9

10. ALCOHOL ABSORPTION AND METABOLISM Alcohol is absorbed throughout the GI tract by simple diffusion Metabolism Low to moderate intakes Alcohol dehydrogenase pathway ETOH Acetaldehydate Acetyl- CoA 10

11. ALCOHOL ABSORPTION AND METABOLISM Moderate to excessive intakes Microsomal ethanol oxidizing system (MEOS) Liver treats alcohol as foreign substance Similar to ADH pathway but requires energy Pathway becomes more efficient with increasing alcohol intake- allows “tolerance” Same pathway used to metabolize drugs, but alcohol metabolism takes precedence Catalase pathway Plays minor role 11

12. ALCOHOL ABSORPTION AND METABOLISM 12

13. ALCOHOL METABOLISM Factors affecting alcohol metabolism Ethnicity, gender and age Alcoholic content, amount consumed, individual’s usual intake Rate of alcohol metabolism Average ½ drink an hour Blood alcohol levels rise Intoxication and alcohol poisoning Binge Drinking (4+ drinks females, 5+ for males in single sitting) 13

14. HOW MUCH IS TOO MUCH? 14

15. ESTIMATED ALCOHOL CONCENTRATION BY NUMBER OF DRINKS FOR AVERAGE 130# FEMALE 15 AC Level1 drink2 drinks3 drinks4 drinks Peak.038.077.116.144 After 1 hr.023.062.101.139 After 2 hrs.008.047.086.124 After 3 hrs.032.071.109 After 4 hrs.017.056.094 After 5 hrs.002.041.079 After 6 hrs.026.064 Peak usually 30-90 min after drinking

16. ESTIMATED ALCOHOL CONCENTRATION BY NUMBER OF DRINKS FOR AVERAGE 175# MALE 16 AC Level 1 drink2 drinks 3 drinks 4 drinks 5 drinks Peak.023.047.071.094.118 After 1 hr.008.032.056.079.103 After 2 hrs.017.041.064.088 After 3 hrs.002.026.049.073 After 4 hrs.011.019.053 After 5 hrs.004.043 After 6 hrs.028 Peak usually 30-90 min after drinking

17. ALCOHOL CONSUMPTION IN NORTH AMERICAN 62% adults consume alcohol 70% of college students who drink, at least 45% engage in binge drinking 4% of US population is alcohol dependent 9% of young adults are alcohol dependent By age 14/15 almost half have consumed alcohol 17

18. HEALTH EFFECTS Guidelines for Using Alcohol Safely Drink in moderation Should not be consumed by some individuals Should not be consumed during some activities 18

19. HEALTH EFFECTS Potential Benefits Appetite stimulant Cardiovascular benefits 19

20. RISKS OF EXCESSIVE ALCOHOL INTAKE A hangover describes the sum of unpleasant physiological effects following heavy consumption of alcohol. Headaches, dry mouth, and lethargy: Ethanol increases urine production (dehydration) which leads to decreased fluids in brain Nausea: Alcohol's irritates the stomach lining Fatigue, weakness, mood disturbances and decreased attention and concentration: three enzymes of the Citric Acid Cycle are inhibited leads to low blood sugar and prevents gluconeogenesis Acetaldehyde (ethanal) is between 10 and 30 times more toxic than alcohol itself 20

21. RISKS OF EXCESSIVE ALCOHOL INTAKE TRUE OR FALSE: some drinks are more likely to cause hangovers? TRUE OR FALSE: Drinking coffee or taking cold showers will help bring your blood alcohol content down TRUE OR FALSE: eating and drinking water will help bring your blood alcohol content down TRUE OR FALSE: some people are more or less prone to hangovers, even if age, gender, and size are equal 21

22. RISKS OF EXCESSIVE ALCOHOL INTAKE Alcohol affects many organs and systems Brain, heart damage, high blood pressure Cancers: oral cavity, esophagus, trachea, larynx and throat Cirrhosis of the liver 22

23. HEALTH EFFECTS OF EXCESSIVE ETOH 23

24. CIRRHOSIS 24

25. ALCOHOL POSIONING 25

26. BEER BELLY The average adult drinker gets around 10 percent of his/her total daily calories from an alcoholic beverage When you drink alcohol, the liver burns alcohol instead of fat Gender, age, smoking, genetics Treatment options 26

27. EFFECTS OF ALCOHOL ABUSE ON NUTRITIONAL STATUS Water soluble vitamin deficiency common (why?) Thiamin Wernicke-Korsakoff Syndrome Niacin B-12 and B6 Folate Fat soluble vitamins A, D, E and K 27

28. EFFECTS OF ALCOHOL ABUSE ON NUTRITIONAL STATUS Minerals Calcium, magnesium, zinc and iron Protein-energy malnutrition 28

29. ALCOHOL CONSUMPTION DURING PREGNANCY AND BREASTFEEDING Most severe damage occurs in the first 12-16 weeks of pregnancy Fetal alcohol syndrome Fetal alcohol effects Breastfeeding Alcohol does pass through breast milk 29

30. FAS 30

31. ALCOHOL ABUSE AND ALCOHOLISM Alcohol Abuse Alcohol Dependency (Alcoholism) Genetic influences Effect of gender Age of onset of drinking Ethnicity Mental health 31

32. HOW DRUGS WORK 32

33. DIAGNOSIS AND TREATMENT OF ALCOHOLISM Determining whether a problem exists 75% of people with alcohol problems do not seek treatment Recovery from alcoholism Medications Alcoholics Anonymous (AA) 33