Alcohol

1. Alcohol

2. 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

3. 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

4. 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

6. 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

7. Production of Alcohol Anaerobic condition CO2 Glucose Ethanol Fermentation of yeast Maltose Amylase CHO

8. 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

9. 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

10. 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

11. Alcohol Absorption • Easily moves through the cell membrane (damaging it)→ gastritis • Alcohol is found wherever water is found in the body

12. 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

13. Metabolism of Moderate Alcohol Intake alcohol dehydrogenase Alcohol Acetaldehyde CO2 + H2O small amount excreted through lungs, urine, & sweat

14. Alcohol in the Body • Ethanol • 7 calories/gram • Denaturing agent • Drug – depresses/sedates CNS

15. 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

16. 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)

17. Fig. 7.1

20. 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

21. Women and Alcohol • Women develop alcohol-related ailments such as cirrhosis more quickly than men with the same drinking habits

22. 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

23. 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

25. Consumed in moderation Decrease risk for cardiovascular disease Socialization Benefits of Alcohol

26. 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

27. One Drink = • 12-ounce beer • 5-ounce glass of wine • 1 ounce of alcohol

28. 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

29. 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

30. Effect of Alcohol in the Body • Heart • Sedates muscle • Slows rate • Lungs • Exhaled in small amounts • Smell on breath

31. 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

32. Effects of Alcohol

33. Hangovers • Dehydration • Antidiuretic hormone depressed • Increased urine output • Brain cells dehydrate • Rehydration → severe headache

34. 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

35. Cure for Hangover • TIME • Fluids for rehydration

36. Limited Metabolic Enzymes Increase Risk • Normally metabolize ½ oz/hour • Fewer enzymes: • Women • Native Americans • Asians • Poor nutritional status (enzymes are proteins)

37. Some People Are at Greater Risk

38. Increased Enzymes • Previous drinking experience (develop tolerance) • MEOS increases

39. Alcoholic Hepatitis • Inflammation of the liver • Scar tissue • Reversible with • Abstinence • Good nutrition

40. 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

41. 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

42. 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

43. 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

44. Other Problems Related to Alcohol Abuse • Drinking in the workplace • Operating motor vehicles and equipment • Sexually transmitted diseases • Unplanned pregnancy • Children of alcoholics

45. 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

46. 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

47. 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

48. 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

49. Alcohol and Students • Academic problems (25% of students) • Vandalism (11% participate) • Police involvement (5% contact with police/campus security) • 110,000 arrests

50. 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