Alcohol Notes

Alcohol

Sources of Dietary Alcohol

• Volatile higher alcohols:
  • Produced by plants (flowers and fruits). They contribute to aroma.
• Low molecular weight alcohols:
  • Produced by microbes.
  • Act as defense mechanisms.
• Alcohols are generally toxic and need to be quickly metabolized.
• Ethanol:
  • Among the least toxic of the lower molecular weight alcohols.
  • It is a nutrient.

Sources of Alcohol

• Microbes in the gut produce small amounts (blood alcohol levels 0-0.008%).
• Disease (auto-brewery syndrome).
• Food (partially fermented fruit; ethanol concentrations range from 0.04 to 0.72%).
• Endogenous production (acetaldehyde metabolism).
• Diet (major - alcoholic beverages).

Per Capita Ethanol Consumption in the United States (1977-2018)

The graph shows the gallons of ethanol consumed per capita in the United States from 1977 to 2018, broken down by beverage type (beer, spirits, wine) and total consumption.

Moderate Alcohol Intake

• Moderate alcohol intake = up to one drink per day for women, up to two drinks per day for men.
• A drink is defined as the amount of a beverage that provides 0.6 fluid ounce of pure alcohol.
• Proof & ABV (alcohol by volume) are measurements of alcohol content.
  • ABV is the % pure alcohol in a beverage.
  • Proof is twice the ABV.

One Drink Equivalent

• 12 fl oz of regular beer (about 5% alcohol).
• 8-9 fl oz of malt liquor (about 7% alcohol).
• 5 fl oz of table wine (about 12% alcohol).
• 1. 5 fl oz shot of 80-proof spirits ("hard liquor" - whiskey, gin, rum, vodka, tequila, etc.) (about 40% alcohol).

Variations in Beer Alcohol Content

• 16 oz of Coors Light (4.2% ABV) = 0.67 oz of pure ethanol = 1.1 drink equivalents.
• 16 oz of Boneyard IPA (6.5% ABV) = 1.04 oz of pure ethanol = 1.7 drink equivalents.
• 16 oz of A Little Sumpin’ Sumpin’ Ale (7.5% ABV) = 1.2 oz of pure ethanol = 2.0 drink equivalents.

Alcohol Contains Calories

• Metabolism of ethanol produces 7 kcal/g
• Beverages also contain unfermented contents (malt, grapes, etc.), potentially added sugar
• Shot of hard alcohol (1.5 oz, 40% ABV) = 117 kcal
• 12-ounce:
  • White Claw (5%) = 100 kcal
  • Coors light (4.2%) = 100 kcal
  • Budweiser (5%) = 137 kcal
  • 2 Towns Blackberry Cider (6%) = 160 kcal
  • Boneyard IPA (6.5%) = 225 kcal
  • Little Sumpin’ Sumpin’ (7.5%) = 275 kcal
• Wine:
  • White = ~120 kcal
  • Red = ~140 kcal
• Margarita/pina colada = ~450-550 kcal

Booze Calories

• All those calories are empty calories!
  • Alcohol contains no essential nutrients (besides calories).
• To counter balance all those calories you drink, your body desires less calories from nutritious food
• Ethanol is converted to fat, which causes leptin secretion, which makes you feel satiated
• Set point theory – your body wants to sustain your body weight

Alcohol Metabolism

• Alcohol begins to be metabolized in the stomach.
• Most metabolism takes place in the liver.
• Alcohol is converted to Acetylaldehyde, then to Acetate, and finally to Acetyl-CoA, which enters the TCA Cycle to produce ATP and FAT.

Benefits of Moderate Consumption

• Stress and anxiety reduction
• Appetite improvement
• Lower rates of heart disease
• Complements foods
• Possible lower risks for diseases such as diabetes, heart disease, and liver disease
• Possible increase in bone mineral density

Moderate Drinking and the Heart vs Heavy Drinking and the Heart

• Moderate Drinking and the Heart:
  • Reduction of plaque deposits in arteries (atherosclerosis).
  • Protection against blood clot formation (protects against heart attack and stroke).
  • Promotion of blood clot dissolution (protects against heart attack and stroke).
• Heavy Drinking and the Heart:
  • Increased risk for heart muscle disease (cardiomyopathy).
  • Increased risk for disturbed heart rhythm (arrhythmia).
  • Increased risk for high blood pressure.
  • Increased risk for hemorrhagic stroke.
• Dose-dependent Effects of Alcohol on the Heart

Meta-Analysis of Alcohol Consumption and Mortality Risk

• Meta-analysis of over 1 million people found decreased risk of dying with moderate alcohol consumption compared to not drinking.

Relative Risk of Death by Number of Drinks Per Day

A graph is presented showing the relative risk of death from various causes (all causes, accidents and violence, cancer, cerebrovascular disease, coronary heart disease) as a function of the number of drinks per day. The graph indicates increased risk with higher consumption levels.

Global Burden of Disease 2018

• 2. 8 million people around the world
• “Our results show that the safest level of drinking is none.”
• Globally, alcohol is the leading cause of death among 18-49 year olds
• Accounts for about 10% of deaths
• Why the discrepancy?
  • Previous meta-analyses did not control for health among the zero drinks per day group and those who consumed some alcohol
  • Those who consumed zero could have been severely ill or very old
  • However, the GBD study included people who died of self harm as “healthy”
  • Meta-analyses were conducted in high-income countries
  • Less risk of dying from diseases more common in low-income countries (ex: tuberculosis, road injuries – the #1 and #2 causes of alcohol-related death)

Relative Risk graph for Females

A graph is presented showing the relative risk from Breast cancer, Ischaemic heart disease, Diabetes, and Tuberculosis based on number of standard drinks daily.

Relative Risk Graph for Males

A graph is presented showing the relative risk from Lip and oral cavity cancer, Ischaemic heart disease, Diabetes, and Tuberculosis based on number of standard drinks daily.

Concerns About Alcohol Intake

• Categorized as a Group 1 carcinogen by the World Health Organization
• Strong evidence that alcohol causes cancer at 7 sites in the body
• Estimated 6% of all cancers are alcohol related
• Estimated 15% of breast cancers
• Relatively high calorie content
• Increased risk of obesity
• Increased risk of communicable and non-communicable disease
• Increased risk of accidental injury
• Potential risk of adverse drug interactions

Alcohol-Induced Malnutrition

• Increased empty Calories from alcohol → decreased Calories from food
• Crave simple carbs and fatty foods
• Toxicity to stomach and intestines → decreased nutrient absorption (particularly B-vitamins)
• Liver toxicity → impaired utilization of nutrients, increased degradation of nutrients, decreased transport of nutrients

The Cycle of Alcohol-Induced Malnutrition

This slide illustrates how alcohol consumption leads to malnutrition through several pathways:

• Alcohol: Has direct toxicity and provides "empty calories."
• Stomach and Intestine: Alcohol leads to maldigestion and malabsorption of nutrients.
• Liver: Alcohol impairs nutrient utilization while increasing nutrient degradation.
• The overall consequences is malnutrition and functional impairment from alcohol.

Alcohol Consumption and Liver Disease

The slide references data on age-adjusted death rates from liver cirrhosis in the United States from 1910-96, and total per capita ethanol consumption in the United States from 1935-97, illustrating the link between alcohol consumption and liver disease.

Consequences of Liver Cirrhosis

• Jaundice, or a yellow tint of the whites of the eyes and the skin
• Edema, or swelling of the lower limbs
• A buildup of fluid in the abdomen, known as ascites
• Confusion
• Men develop breast tissue, testicles shrink
• Fever and shivering
• Extremely itchy skin
• Losing a significant amount of weight
• General weakness and wasting muscles
• Bleeding and bruising more easily
• Blood in vomit and stools