Alcohol

Alcohol
 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

 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
 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
 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 micro-
organism that is responsible for alcohol
production
 Production of Alcohol

Anaerobic condition CO2

Glucose Ethanol
Fermentation of yeast

Maltose

Amylase

CHO
Production of Beer
 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
 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

 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

 Easily moves through the cell

membrane (damaging it)→ gastritis
 Alcohol is found wherever water is
found in the body
Alcohol (Ethanol)
Metabolism
 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

 Ethanol
 7 calories/gram
 Denaturing agent
 Drug – depresses/sedates CNS
Alcohol and Drugs

 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
 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
 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

 Women develop
alcohol-related
ailments such as
cirrhosis more
quickly than men
with the same
drinking habits
Drinking in America
 ~50% of adults
 ~17% of 12-17 year-
olds
 Highest prevalence in
18-25 year-olds
 >35% of adults with
alcohol problems
develop symptoms by
age 19
Binge Drinking

 >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

 Consumed in moderation
 Decrease risk for cardiovascular
disease
 Socialization
Moderate Alcohol Use

 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
 Alcohol Abuse

 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

 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
 Heart
– Sedates muscle
– Slows rate
 Lungs
– Exhaled in small amounts
– Smell on breath
Effect of Alcohol on the
Body
 Brain
– Depresses and sedates brain
 Order brain affected:
– Inhibitory nerves
– Judgement/reasoning
– Speech/vision
– Voluntary muscle control
– Respiration/heart activity
Effects of Alcohol
Hangovers

 Dehydration
– Antidiuretic hormone depressed
– Increased urine output
– Brain cells dehydrate
– Rehydration → severe headache
Hangovers

 Formaldehyde
– Metabolism → methanol
– Liver metabolizes methanol →
formaldehyde → C02, H20
 Same enzymes metabolize alcohol
– Ethanol → acetaldehyde → C02, H20
 Acealdehyde processed
 Formaldehyde builds up → hangover
symptoms
Cure for Hangover

 TIME
 Fluids for
rehydration
Limited Metabolic
Enzymes Increase Risk
 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

 Previous drinking experience (develop

tolerance)
 MEOS increases
Alcoholic Hepatitis

 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

 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
 Typical deficiencies include the fat-
soluble 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
 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
 Drinking in the workplace
 Operating motor vehicles and
equipment
 Sexually transmitted diseases
 Unplanned pregnancy
 Children of alcoholics
Alcohol-Related Health
Care Costs
 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 alcohol-
related 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
 In comparison to moderate and non-
drinkers, 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
 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

 >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

 Academic problems (25% of students)

 Vandalism (11% participate)
 Police involvement (5% contact with
police/campus security)
 110,000 arrests
Fetal Alcohol Syndrome

 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

 Leading preventable birth defect

 3.3 per 10,000 births
 Mental retardation
 Poor growth
 Physical deformities
Brain Damage

 Subtle cognitive dysfunction and motor

nerve deficit
 Shrinks the brain
 Reduces oxygen and nutrients to the
brain
 Alcohol is a powerful depressant
Advice

 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
 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
 Ethnic
Depression

 Goes with alcohol abuse

 Alcohol only alleviates depression in
the short run
 No longer concerned about their
health/behavior
Diagnosis

 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
 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 eye-
opener)
Do You Have a Problem
with Alcohol?
 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?
 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?
 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

 If yes to any, consult your family physician

or a certified counselor for help
Alcoholism: 4 symptoms

 Craving
 Loss of control
 Physical dependence
 Tolerance

 ~7% of Americans meet criteria

 >50% of adults have alcoholic family
member – active or recovering
Treatment

 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?