Alcohol
Alcohol
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Chemically known as ethanol
Has played many roles throughout history
Considered a food, because it contributes
energy to the diet (7 kcals/gram)
Not considered a nutrient, because is not
needed
Social stimulant: removes inhibitions
Has been a thirst quencher where water is
unsafe, and an analgesic to treat aches and
pains
History of Alcohol
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Beer recipes found on Babylonian clay
tablets 6000 years old
Probably known as early as the Stone Age,
10,000 years ago
Probably first wine was produced by
accident, fermentation caused by wild yeast
Beer had to wait until establishment of
agriculture
Alcohol as Alternative to
Water
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Alcoholic beverages provided a safe
alternative to contaminated drinking water
Early alcoholic beverages had relatively low
alcohol content, focused more on taste,
thirst quenching
In the Old and New Testament, drinking
water seldom mentioned; wine and beer is
All ages, even children, drank wine and ale
Production of Alcoholic
Beverages
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Fermentation: the breakdown of
carbohydrates without the use of oxygen
Alcohol, carbon dioxide, and various acids
are byproducts
High carbohydrate foods especially
encourage the growth of yeast, the microorganism that is responsible for alcohol
production
Production of Alcohol
Anaerobic condition
Ethanol
Glucose
Fermentation of yeast
Maltose
Amylase
CHO
CO2
Production of Beer
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CHO must be simple sugar, such as maltose
or glucose in order for the yeast to use it as
food
If the CHO is a starch, such as that found in
cereal grains (barley) it must be broken
down to simpler forms, or malted
Beer is made from malted cereal grains,
such as barley, flavored with hops and
brewed by slow fermentation
Resulting CO2 is used to carbonate the beer
Production of Distilled
Spirits
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Distilled spirits such as whiskey, vodka,
or gin are made by distilling the
alcohol after fermentation
Distilling separates the alcohol from
water and the alcohol is recovered
Vodka and gin are unaged
Whiskey, rum and brandies are aged
Alcohol Absorption
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Depends on rate of stomach emptying
Absorbed readily by simple diffusion
(no digestion needed)
Higher proof → faster absorption
Wine is faster absorbed than liquor
which is faster than beer
Food slows absorption from the
stomach
Alcohol Absorption
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Easily moves through the cell
membrane (damaging it)→ gastritis
Alcohol is found wherever water is
found in the body
Alcohol (Ethanol)
Metabolism
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Depends on gender, race, size, food,
physical condition, alcohol content
Metabolism depends on alcohol
dehydrogenase (ADH)
Alcoholics and women have less ADH
Majority of the ethanol is metabolized
by the liver
Metabolism of Moderate
Alcohol Intake
alcohol dehydrogenase
Alcohol
Acetaldehyde
CO2 + H2O
small amount
excreted through lungs,
urine, & sweat
Alcohol in the Body
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Ethanol
7 calories/gram
Denaturing agent
Drug – depresses/sedates CNS
Alcohol and Drugs
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Alcohol cannot be stored and has
priority in metabolism
If taken with sedatives, alcohol and
sedatives compete for the same
metabolic pathways
Liver cannot metabolize the sedatives
fast enough → coma or death
Alcohol (Ethanol)
Metabolism
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Social drinker who weighs 150 pounds with
normal liver function metabolizes about 5-7
grams of alcohol her hour, about half a beer
of ¼ of another drink
When intake of alcohol exceeds liver’s ability
to metabolize it, builds up in the
bloodstream
Small percentage excreted in urine, sweat,
expired air (levels in expired air correspond
with blood alcohol content → Breathalyzer
test)
Fig. 7.1
Women and Alcohol
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Women absorb and metabolize alcohol
differently than men
Have less activity of ADH; metabolize only
10% of alcohol in stomach lining vs 30%
by men
Have less body water in which to dilute the
alcohol than men do
When men and women of equal size drink
equal amounts of liquor, more alcohol
reaches the bloodstream in women
Women and Alcohol
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Women develop
alcohol-related
ailments such as
cirrhosis more
quickly than men
with the same
drinking habits
Drinking in America
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~50% of adults
~17% of 12-17 yearolds
Highest prevalence in
18-25 year-olds
>35% of adults with
alcohol problems
develop symptoms by
age 19
Binge Drinking
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>5 drinks in a few hours
20% of all Americans binge drink
38% of 18-25 year-olds report
bingeing
48% of 21 year olds
12% of 12-17 year-olds
Benefits of Alcohol
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Consumed in moderation
Decrease risk for cardiovascular
disease
Socialization
Moderate Alcohol Use
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Men – 1 or 2 drinks daily
Women – 1 drink daily
Difference due to
– Body size/blood volume
– Differences in body composition and
water content
– Differences in metabolism
One Drink =
12-ounce beer
 5-ounce glass of wine
 1 ounce of alcohol
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Alcohol Abuse
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Contributes to the leading causes of
death
Combined with tobacco, increases the
risk for esophageal and oral cancer
Risk for heart disease, heart
arrhythmia, HTN, stroke, osteoporosis,
brain damage, colorectal cancer,
breast cancer, nutritional deficiencies,
fetal damage, obesity, cancer
Health Effects of Alcohol
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Pancreas – inflammation (pancreatitis)
Small intestine – rapid absorption
with/without food
Liver – major site of metabolism
– 80% via ADH
– 10% MEOS (microsomal ethanol oxidizing
system)
– 10% excreted
Effect of Alcohol in the
Body
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Heart
– Sedates muscle
– Slows rate
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Lungs
– Exhaled in small amounts
– Smell on breath
Effect of Alcohol on the
Body
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Brain
– Depresses and sedates brain
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Order brain affected:
– Inhibitory nerves
– Judgement/reasoning
– Speech/vision
– Voluntary muscle control
– Respiration/heart activity
Effects of Alcohol
Hangovers
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Dehydration
– Antidiuretic hormone depressed
– Increased urine output
– Brain cells dehydrate
– Rehydration → severe headache
Hangovers
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Formaldehyde
– Metabolism → methanol
– Liver metabolizes methanol →
formaldehyde → C02, H20
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Same enzymes metabolize alcohol
– Ethanol → acetaldehyde → C02, H20
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Acealdehyde processed
Formaldehyde builds up → hangover
symptoms
Cure for Hangover
TIME
 Fluids for
rehydration
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Limited Metabolic
Enzymes Increase Risk
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Normally metabolize ½ oz/hour
Fewer enzymes:
– Women
– Native Americans
– Asians
– Poor nutritional status (enzymes are
proteins)
Some People Are at
Greater Risk
Increased Enzymes
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Previous drinking experience (develop
tolerance)
MEOS increases
Alcoholic Hepatitis
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Inflammation of the liver
Scar tissue
Reversible with
– Abstinence
– Good nutrition
Cirrhosis
Fatty infiltration of the liver
 Response to the increased synthesis of
fat
 Enlarged fat cells choke off nutrient
and O2 supply to liver cells
 Engorged fat cells burst and die
 Scar tissue
Cirrhosis
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15-20% of alcoholics after >10 years
of alcohol abuse
2 million people in the U.S.
50% chance of death within 4 years
Advance stages are not reversible
Second leading cause of the need for
liver transplant
Malnutrition in
Alcoholism
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Typical deficiencies include the fatsoluble vitamins (A, D, E and K) and
water soluble vitamins (thiamin,
niacin, B-6, folate, B-12 and C)
Mineral deficiencies: calcium,
phosphorus, potassium, magnesium,
zinc and iron
Malnutrition in
Alcoholism
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Arise due to poor nutritional intakes and fat
malabsorption and increased urinary losses
May also be at risk for toxicities of A and
iron
Malnutrition makes the liver more vulnerable
to toxic substances (deficiency of C and
folate)
Most important treatment: abstention from
alcohol
Other Problems Related
to Alcohol Abuse
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Drinking in the workplace
Operating motor vehicles and
equipment
Sexually transmitted diseases
Unplanned pregnancy
Children of alcoholics
Alcohol-Related Health
Care Costs
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Twenty-five to forty percent of all patients in
U.S. general hospital beds (not in maternity
or intensive care) are being treated for
complications of alcohol-related problems. 1
Annual health care expenditures for alcoholrelated problems amount to $22.5 billion.
The total cost of alcohol problems is $175.9
billion a year (compared to $114.2 billion for
other drug problems and $137 billion for
smoking).2
http://www.marininstitute.org/alcohol_policy/health_care_costs.htm
Alcohol-Related Health
Care Costs
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In comparison to moderate and nondrinkers, individuals with a history of heavy
drinking have higher health care costs. 3
Untreated alcohol problems waste an
estimated $184.6 billion dollars per year in
health care, business and criminal justice
costs, and cause more than 100,000 deaths.
4
http://www.marininstitute.org/alcohol_policy/health_care_costs.htm
Consequences of Alcohol
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Alcohol-related car crashes are the number
one killer of teens. Alcohol use is also
associated with homicides, suicides, and
drownings-the next three leading causes of
death among youth. 7
Alcohol is the drug most frequently used by
12 to 17 year-olds-and the one that causes
the most negative health consequences.
More than 4 million adolescents under the
legal drinking age consume alcohol in any
given month. 8
http://www.marininstitute.org/alcohol_policy/health_care_costs.htm
Alcohol and Students
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>1400 die from unintentional injuries
>600,000 assaults by drinking
students
>70,000 victims of sexual assault/date
rape
400,000 unprotected sex
– 100,000 too drunk to remember
Alcohol and Students
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Academic problems (25% of students)
Vandalism (11% participate)
Police involvement (5% contact with
police/campus security)
110,000 arrests
Fetal Alcohol Syndrome
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Alcohol reaches the fetus
Deprive brain of oxygen and nutrients
~4 drinks a day or binge drinking while
pregnant
First trimester drinking greatest danger
(women are unaware they are pregnant)
Abstinence from alcohol is the best advice
Fetal Alcohol Syndrome
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Leading preventable birth defect
3.3 per 10,000 births
Mental retardation
Poor growth
Physical deformities
Brain Damage
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Subtle cognitive dysfunction and motor
nerve deficit
Shrinks the brain
Reduces oxygen and nutrients to the
brain
Alcohol is a powerful depressant
Advice
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U.S. surgeon general’s office, the
National Academy of Science, and the
USDA/DHHS do not recommend
drinking
Drink in moderation
Avoid drinking and driving
Avoid drinking while pregnant
Alcohol Dependency
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Genetic links
Risk is increased fourfold in children of
alcoholics
Can be addictive and dangerous for some
Warn these children by the age of 10
Low threshold may be genetic
– requires greater amounts of alcohol to produce
same effects
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Ethnic
Depression
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Goes with alcohol abuse
Alcohol only alleviates depression in
the short run
No longer concerned about their
health/behavior
Diagnosis
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Physiological dependence on alcohol
Tolerance to the effects of alcohol
Evidence of alcohol-associated
illnesses (memory loss, liver disease,
etc.)
Continued drinking in defiance of
medical and social contradictions
Depression and blackouts
Flushed face/reddened skin
CAGE Screening
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C: Have you every felt you ought to cut
down on drinking?
A: Have people annoyed you by
criticizing your drinking?
G: Have you ever felt bad or guilty
about your drinking?
E: Have you ever had a drink first thing
in the morning to steady your nerves or
to get rid of a hangover? (As an eyeopener)
Do You Have a Problem
with Alcohol?
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Have you had memory lapses or blackouts
due to drinking?
Do you continue to drink although you have
health problems caused by alcohol?
Do you get withdrawal symptoms such as
headaches, chills, shakes and a strong
craving for alcohol, and drink more to get
rid of those symptoms?
Do You Have a Problem
with Alcohol?
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Do you take part in high-risk
behaviors, such as having unsafe dex
in a non-monogamous relationship or
driving a boat or car when under the
influence of alcohol?
Has drinking caused trouble at home,
at work, or in relationships with
others?
Do You Have a Problem
with Alcohol?
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Do you have to drink alcohol for any of the
following reasons?
– To get through the day or unwind at the end of
the day
– To cope with stressful life events
– To escape from ongoing problems
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If yes to any, consult your family physician
or a certified counselor for help
Alcoholism: 4 symptoms
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Craving
Loss of control
Physical dependence
Tolerance
~7% of Americans meet criteria
>50% of adults have alcoholic family
member – active or recovering
Treatment
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Guidance from a physician
Counseling
Total abstinence
AA 12 step program
Treatment program
Medication (blocks craving or cause
physical reaction when drinking)
Alcohol Poisoning
Warning Signs
 Semiconsciousness or unconsciousness
 Slow respiration (8 or fewer per
minute or lapse of greater than 8
seconds)
 Cold, clammy, pale, or even bluish skin
 Strong odor of alcohol
 Others?