eNutrition
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Nutrition for Nursing Students, independent study

Alcohol Use & Abuse

Alcohol use is discussed here in the context of “eating” disorders because there are some superficial similarities between alcohol abuse and eating disorders.
    Alcohol use can be considered to be eating because alcohol can used as an energy source, and because most alcoholic beverages also contain significant amounts of carbohydrates plus some vitamins and phytochemicals. The alcohol [ethanol] in beers and wines is the by-product from anaerobic digestion of carbohydrates by brewer's yeast. Humans have a liver enzyme that drives the conversion of ethanol back to pyruvate for use in the Citric acid (Krebs) Cycle to capture the energy in ATPs. Technically, any brewed beverage could have up to 14% alcohol, because ethanol is toxic to living organisms, including yeast; it becomes fatal to brewer's yeast at concentrations of 14% or more. Even fully brewed (12 to 14% alcohol) beverages [in the United States, beer is not fully-brewed because Prohibition was never fully repealed] contain residual carbohydrates that were not digested prior to the death of the yeast; while partially brewed beverages may contain substantial concentrations of carbohydrates. Logically this means that low alcohol beers contain much more carbs than do the higher alcohol beers, which explains why drinking 3.2 beer [3.2% alcohol] causes the development of “beer belly,” and I suspect that “Lite” beers will have the same effect. Remember that the highest risk over-weight adipose deposits for cardiovascular health are the abdominal [apple-shape] fats, a.k.a. beer belly.
    Alcohol abuse could be considered [but usually isn't] a form of eating disorder, because it is often accompanied by somewhat similar underlying psychological disorders. Alcohol abusers often present with compulsive drinking behaviors and the drinking behaviors tend to resemble binge disordered eating behaviors. Similar to the preference for high carbohydrate foods seen in binge eaters, alcohol abusers gravitate toward the higher alcohol concentrations in hard liquors. It has been suggested that alcohol abuse may be a risk factor for developing Alcoholism. Alcoholism is considered to be a treatable disease, and has underlying psychological and genetic factors which are better predicters of the disease than is alcohol abuse [in this version, alcohol abuse is a sign (not a symptom) of developing the disease, but many alcohol abusers never develop the disease]. There have been hypotheses that suggest that alcoholism is inherited, but the alternate hypotheses suggest that the drinking behaviors are learned by example from the alcoholic parent. I am inclined to believe that the less serious (but non-trivial) alcohol abuse behaviors are learned by example from the parent(s) who abuse alcohol at home. It is known that there is a genetic component to the extent to which the liver produces the enzymes necessary to convert the ethanol to pyruvate, but the correlation between this trait and alcoholism has not been demonstrated. Although alcoholism is considered to be a treatable disease, the treatments have relatively low effacacy [again a similarity to diagnosable eating disorders]. Some patients respond well to “the 12-step program” [they remain compliant for years after “graduating from the program”], but others seem not to respond to the treatment at all. Untreated (and patients not responding to treatment) frequently have cirrosis of the liver as the proximate cause of death, while non-alcoholism alcohol abusers are more likely to have congestive heart failure as the proximate cause of death.

Benefits?

Brewed alcohol-containing beverages do contain moderately high concentrations of known anti-oxidants and phytochemicals, and have similar claims [not proven] to health benefits. The distilled alcoholic beverages are not known to contain the anti-oxidants nor phytochemicals found in brewed beverages, and are known to contain toxic esters and other exotic chemicals not found [or in low concentrations] in brewed beverages. Hence, this discussion of the presumed benefits of alcohol-containing beverages is limited to the brewed beverages, beer and wine. Initially, the assignment of claimed benefits to alcohol-based beverages arose out of the highly publicized “French Paradox” [see the Lecture text for Vitamins, near the end of the discussion]. There is a increasing amount of research which supports these presumed benefits, but we have not confirmed the claims to the standards of scientific (or clinical) research.

    Guidance from the CDC (Centers for Disease Control, Atlanta, GA) suggests that to get the benefits, alcohol consumption must be moderate, which the CDC defines as a maximum of one or two drinks per day. “Maximum” means that you can not save up by avoiding alcohol during the week in order to have 14 drinks Friday and Saturday evening. Even if you drink zero drinks per day Sunday through Thursday, you still get only one or two drinks each day on Friday and Saturday! A “standard” drink is as follows:
      beer - 12 oz at 5% alcohol delivers 0.6 oz of ethanol
      wine - 5 oz at 12% alcohol delivers 0.6 oz of ethanol
The standard drink is sized to deliver the same dose rate, although there has been a trend in restaurants to “biggie-size” serving sizes, including brewed beverages. Note also that a shot (1 ½ oz) of 80 proof (40%) whiskey delivers 1.2 oz ethanol, so is two standard drinks compared to beer and wine; hard liquor however does not provide the anti-oxidant and phytochemical benefits of brewed beverages, and does provide a generous serving of oxidants. The benefits claimed for one or two standard drinks [brewed beverages only] include a reduced risk for the following conditions:
      1. coronary heart disease [heart attack]
      2. hypertension and stroke
      3. peripheral vascular disease [clots]
      4. type 2 diabetes
      5. bone and joint health [slight increase in bone density]
      6. non-alzheimer's dementia [increase in cerebral blood circulation]
      7. GI tract disease [reduction in some bacterial infections]
In addition beer and wine may provide dietary B vitamins; vitamin C is also present in these beverages, but it has been suggested that beer or wine is not a significant dietary source of vitamin C due to the low concentrations found in the beverages plus the dehydration effects of the alcohol.

Risks

The benefits of moderate alcohol consumption can be offset by the risks of excessive comsumption of these beverages. Since the CDC has defined “moderate consumption,” it should not be surprising that the CDC has also defined criteria for excessive consumption. The criteria for excess consumption are in the form of “one or more” from the list of three behaviors:
      1. more than three drinks in one day [note: three drinks is more than moderate, but less than excessive]
      2. a single "binge" episode, currently defined as five or more consecutive drinks for women, and six or more consecutive drinks for men
      3. consuming a standard drink in less than 20-30 minutes
It typically takes the liver about one hour to completely metabolize the alcohol in one standard drink to pyruvate, and if additional drinks are consumed before the first has been completely metabolized to pyruvate, the metabolic rate decreases. Clearly, if you take 20 to 30 minutes to drink a standard drink, and 60 minutes to metabolize the alcohol in it; you should wait 40 to 30 minutes between drinks to minimize the risks of alcohol consumption [theoretically including the risk of being stopped for DUI, but do not attempt to explain this to the police officer; he/she will not be amused].

Assumes:
sipping takes 20 min,
30 min between drinks,
and 1 hr to metabolize.
Wine or Beer consumption
Intake vs Metabolism
# drinks time to
finish drink
time to
metabolize 100%
1 20m 61m
2 1h 10m 2h 1m
3 2h 0m 3h 1m



    Prolonged [undefined] heavy [see definition of excessive] drinking has the opposite of the beneficial effects of moderate drinking; so re-read the benefits, but as the increased risk associated with excessive drinking. But, wait, there's more. If you drink excessively long enough you also get, at no additional cost:
      1. increased GI tract cancers
      2. fat deposits in liver, becoming cirrhosis [which can be fatal]
      3. loss of peripheral sensory neuron function
      4. increased abdominal and internal fat deposits (on organs), which can lead to congestive heart failure due to fat deposits within the pericardial membrane
      5. heavy drinkers tend to reduce intake of nutritious foods
      6. many drinkers increase smoking (if they are currently smokers), or resume smoking (if they are “reformed” smokers)…
    …and if you are worried about developing some fatal cancer, never fear; chronic ‘over-dosing’ on alcoholic beverages can shorten your life span sufficiently that you will not be alive when the fatal cancer should develop.

Abuse

Data collected about alcohol abusers have shown a clear pattern in the mis-use of alcohol. The initial psychological effect is perceived relaxation; the drinker vocalizes a feeling of relaxation after having a standard drink. This leads to “having a quick drink on the way home from work to relieve the stress of work,” and perhaps a drink at lunch to relax before returning to work. Many [but not all] people claim decreased anxiety in social settings; these people find it easier to approach members of the opposite sex (or which ever sex they would like to approach) with the intent to strike up a potential relationship. This is explained by pointing out that alcohol has been shown to reduce inhibitions (of any kind). The continued exposure to alcohol leads to tolerance, so a higher dose is required to get same perceived effect. A drink on the way home from work becomes two or three drinks, then among “serious” drinkers, it is considered rude to turn down a round offered by a friend [who may have become a “friend” as recently as during the previous drink, or the round you offered a stranger in order to establish a friendship]. At this point in the patient history of alcohol consumption, some personality types will develop a dependence on the alcohol. These patients will exhibit behaviors such as “needing” a drink or two before they can socialize or in order to relax, or they become obviously agitated (nervous) at a social event where drinks are not being served; their drinking has shifted from impulsive to compulsive. True psychological addiction [sub-clinical alcoholism] may occur in addictive personalities [it has been my observation of Human behavior that some people claim addiction to just about anything, and a portion of those people present with quasi-additive (non-diagnosed) behavior; members of this population exhibit what I refer to as addictive personality]. Some of these patients become “true” alcoholics (diagnosable Alcoholism). And to paraphrase from March of the Penquins (Warner Independent Pictures [Warner Bros] and National Geographic Feature Films, 2005 release of a Bonne Pioche - APC [France] film), many will not make it [will die from proximate causes secondary to alcohol abuse].



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revised: 19 May 2009