UNIT 5: Alcohol and Nutrition

THEME 1: Introduction and Physiology

Rolfes SR, Pinna K & Whitney E. 2015. Understanding Normal and Clinical Nutrition.
10th ed. USA: Wadsworth.

Sizer F & Whitney E. 2011. Nutrition Concepts and Controversies. 12th ed. USA:
Wadsworth: 95.

1. INTRODUCTION

Alcohol refers to a class of organic compounds containing hydroxyl (OH) groups.

The chemist’s name for alcohol (as we know it in beverages form) is ethyl alcohol.
Ethanol is less toxic than other alcohols. Alcohol can act as a drug and alters brain
function – alcohol offers benefits and poses hazards (Rolfes et al., 2015:220)

The term “moderation” is important when describing alcohol use. How many drinks
constitute moderate use, and how much is a drink? One drink = any alcoholic
beverage that delivers 15ml of pure ethanol:

 150ml wine (depending on alcohol content, dry wines generally contain more
alcohol than sweet wines)
 360ml regular beer
 45ml distilled liquor

An accepted definition of “moderate drinking” is two drinks per day for men, and
one drink per day for women. This is a maximum per day, and not an average
amount. You cannot abstain during the week, and on Saturday have your whole
week’s allowance at once!
3. ALCOHOL IN THE GASTROINTESTINAL TRACT (Rolfes et al., 2015:222)

 Unlike food, alcohol needs no digestion and some is quickly absorbed across
the walls of an empty stomach - this is why a person can feel the effects of
alcohol within a short period of time, as it reaches the brain in a few minutes
 Most of the alcohol will still be absorbed in the small intestine
 When the stomach contains food, alcohol will be absorbed slower
 The stomach begins to break down alcohol with its enzyme, alcohol
dehydrogenase
 Women produce less of this enzyme than men; consequently more alcohol
reaches the intestine for absorption into the bloodstream, and is one of the
reasons why women have a smaller allowance for alcohol
 Alcohol gets absorbed and metabolized before most nutrients (it receives
priority treatment)
 This ensures a speedy disposal and reflects two facts: alcohol cannot be
stored in the body, and it is potentially toxic

4. ALCOHOL ARRIVES IN THE LIVER (Rolfes et al., 2015:222)

 After absorption, the liver cells are the first to receive alcohol-laden blood
 Liver cells also produce alcohol dehydrogenase to oxidise alcohol (more than
in the stomach)
 The liver clears some of the alcohol out of the blood before it moves on
 The liver can process 15ml of ethanol (1 drink) per hour – depending on body
size, previous drinking experience, food intake and general health
 The maximum rate of alcohol breakdown is set by the amount of alcohol
dehydrogenase available

The amount of alcohol dehydrogenase depends on:

 The individual’s genes, and

 how recently they have eaten – fasting for a day forces the body to degrade
its proteins, including the alcohol-processing enzymes, and this can slow the
rate of alcohol metabolism by half which enhances the effect of alcohol!
 Don’t drink when you have been fasting or on an empty stomach, and only
consume 1 drink per hour (2 per day for men, one per day for women)
 -
In addition to the dehydrogenase enzymes, the liver possess another alcohol-
metabolising enzyme system called the MEOS (microsomal ethanol-oxidising
system)
Focus On Why do people tolerate alcohol better with
- With repeat exposures, alcohol stimulates the synthesis of enzymes in the MEOS
repeat exposure?
- This results in a more efficient metabolism of alcohol and tolerance to its effects
(Rolfes et al., 2015:223)

5. ALCOHOL ARRIVES IN THE BRAIN (Rolfes et al., 2015:224)

 Judgement and reasoning centres are most sensitive to alcohol – alcohol

sedates the frontal lobe where the centre of all conscious activity is
 Speech and vision centres in the midbrain are affected next – these centres
become sedated
 Voluntary muscle control is then affected – the cells in the cerebellum
responsible for coordination of voluntary muscles are affected including
speech, eye-coordination and limb movements
 Respiration and heart actions are the last to be affected – finally, the
conscious brain is completely subdued and the person passes out (this is
lucky, because if the person continues drinking, the deep brain centres which
control breathing and heartbeat can be anesthetized causing death)

Focus On! Why do you urinate more when

you drink?
- Alcohol suppresses the production of anti-diuretic hormone (ADH)
- This hormone has an action of retaining water in the body (working on the
kidneys): with less ADH, more water is lost in the urine
- TIP: drink a non-alcoholic drink in-between alcoholic drinks to prevent
dehydration (Rolfes et al., 2012:223)

6. THE HANGOVER

The hangover sufferer may be dizzy, anxious, depressed and irritable. Symptoms
may continue for an entire day (Insel et al., 2016:132).
6.1 Causes of a hangover

 Alcohol causes dehydration which leads to headache

and dry mouth/thirst
 Alcohol directly irritates the stomach and intestines
and causes increased stomach acid production - this
contributes to stomach pain, diarrhoea, nausea and
vomiting
 The sweating, vomiting and diarrhoea can lead to
further loss of fluids and electrolytes
 Alcohol can lead to lower glucose production in the liver, thereby leading to
low blood glucose, causing light-headedness and fatigue
 Alcohol disrupts sleep patterns, contributing to fatigue
 Alcohol triggers an inflammatory response from your immune system. Your
immune system may trigger certain agents that commonly produce physical
symptoms, such as an inability to concentrate, memory problems, decreased
appetite and loss of interest in usual activities

6.2 Treating a hangover

 Few treatments have undergone rigorous, scientific investigation – TIME is

the best treatment
 Eating bland foods containing complex carbohydrates, such as toast or
crackers, can combat low blood glucose and nausea
 Sleep can ease fatigue
 Non-alcoholic beverages can alleviate dehydration
 Certain medications can relieve some symptoms, such as antacid which may
relieve nausea
 The best treatment is prevention!

7. ALCOHOL AND LONGTERM HEALTH EFFECTS (Sizer & Whitney,

2017:109):

A couple of drinks set in motion many destructive processes in the body. The next
day’s abstinence can reverse them only if the doses taken are moderate, the time
between them is ample, and nutrition is adequate. If not, repeated onslaughts of
alcohol take a toll on the body.

7.1 EFFECTS IN PREGNANCY

 When a pregnant woman drinks during pregnancy, her foetus takes the same
drink within minutes and is defenceless against the effects
  This can lead to problems such as Foetal Alcohol Syndrome (FAS) in the baby
(a pattern of irreversible mental and physical defects that can develop in a
foetus in association with high levels of alcohol consumption during
pregnancy)

7.2 EFFECTS ON HEART AND BRAIN

 Alcohol is directly toxic to skeletal and cardiac muscle, causing weakness and
deterioration
 Chronic alcohol use raise blood pressure which can contribute to heart
disease
 Alcohol attacks brain cells directly and heavy drinking can result in dementia
 Acetaldehyde and associated free radicals adversely affects brain tissues

7.3 CANCER

 Daily ethanol exposure is seen as cancer-causing

 In smokers, alcohol greatly increase the risk of developing lung cancer
 In women it especially increases breast cancer risk; in men, it increases
cancer risk at many sites
 If cancer is established, alcohol speeds up its development

8. ALCOHOL AND NUTRITION (Sizer & Whitney, 2017:109):

Alcohol causes disturbances in nutrition. Its kilojoules are all “optional”, and often
overlooked by drinkers. Alcohol also causes direct negative effects on nutrients that
the body needs to function.

8.1 ALCOHOL AND MALNUTRITION

Alcohol is rich in energy, but provides no nutrients – the more people drink, the less
likely it is that they will consume enough food to obtain adequate nutrients (macro-
and micronutrients). Chronic alcohol intake also interferes with the body’s
metabolism of nutrients.

8.1.1 Alcohol’s effect on vitamins

 Alcohol disrupts stomach cells causing an over secretion of acid and

histamine – this causes inflammation of the intestinal cells which reduces the
ability to absorb vitamins such as vitamins B1, folate, B12 etc.
 Liver cells lose efficiency in activating vitamin D
 Cells of the eye’s retina, which normally process vitamin A, must process
ethanol instead – liver cells also lose capacity to process and use vitamin A
 The kidneys excrete needed minerals such as magnesium, calcium,
potassium and zinc

8.1.2 The fattening power of alcohol

 Metabolic interactions occur between fat and alcohol in the body – presented
with both fat and alcohol, the body will store fat and rather work on ridding
itself of the toxic alcohol by using it preferentially for energy
 Thus, alcohol promotes fat storage, especially in the central abdominal areas
 Ethanol yields 29 kilojoules per gram itself, and drink mixers/sweet wines,
etc., often contain a lot of added kilojoules/energy such as sugars
a

O
Alcoholic Drink-Equivalents of Select
n Beverages
e

Drink-
Drink Description Equivalents

Beer, beer coolers, and malt beverages

12 fl oz at 4.2% alcoholc 0.8

12 fl oz at 5% alcohol (reference beverage) 1

16 fl oz at 5% alcohol 1.3

12 fl oz at 7% alcohol 1.4

12 fl oz at 9% alcohol 1.8

Wine

5 fl oz at 12% alcohol (reference beverage) 1

9 fl oz at 12% alcohol 1.8

5 fl oz at 15% alcohol 1.3

5 fl oz at 17% alcohol 1.4

Distilled spirits

1.5 fl oz 80 proof distilled spirits (40% alcohol) 1

(reference beverage)

Mixed drink with more than 1.5 fl oz 80 proof distilled > 1d

spirits (40% alcohol)
alcoholic drink-equivalent is defined as containing 14 grams (0.6 fl oz) of pure alcohol.
The following are reference beverages that are one alcoholic drink-equivalent: 12 fluid
ounces of regular beer (5% alcohol), 5 fluid ounces of wine (12% alcohol), or 1.5 fluid
ounces of 80 proof distilled spirits (40% alcohol). Drink-equivalents are not intended to
serve as a standard drink definition for regulatory purposes.
b
To calculate drink-equivalents, multiply the volume in ounces by the alcohol content in
percent and divide by 0.6 ounces of alcohol per drink-equivalent. For example: 16 fl oz
beer at 5% alcohol: (16 fl oz)(0.05)/0.6 fl oz = 1.3 drink-equivalents.
c
Light beer represents a substantial proportion of alcoholic beverages consumed in the
United States. Light beer is approximately 4.2% alcohol or 0.8 alcoholic drink-
equivalents in 12 fluid ounces.
d
Depending on factors, such as the type of spirits and the recipe, one mixed drink can
contain a variable number of drink-equivalents.
2015 Dietary Guidelines for Americans [online]

Remember: 1 oz (ounce) = 30ml

9. RECOMMENDATIONS

The Dietary Guidelines for Americans (DGA) 2015

 If alcohol is consumed, it must be consumed in

moderation – up to two drinks per day for men, and one
drink per day for women
 Alcoholic beverages should not be consumed by the
following people:
 Those who cannot restrict their alcohol intake
 Women of childbearing age who may become pregnant
 Pregnant and lactating women
 Children and adolescents
 Individuals taking medications which can interact with alcohol
 Individuals with certain medical conditions
 Alcoholic beverages should be avoided by individuals engaging in activities
that require skill, attention or coordination, such as driving or operating
machinery

12. Blood Alcohol Contents Charts (BAC charts)

1 kg = 2.2 pounds

Blood alcohol content is usually expressed as a percentage of alcohol (generally in the

sense of ethanol) in the blood. For instance, a BAC of 0.10 means that 0.10% (one tenth
of one percent) of a person's blood, by volume (usually, but in some countries by mass),
is alcohol.

In South Africa the legal limit for driving is 0.05

This may be revised to 0.03 in the near future