AlcoholAlcohol

AlcoholAlcohol

Chemically known as ethanolChemically known as ethanol Has played many roles throughout Has played many roles throughout

historyhistory Considered a food, because it contributes Considered a food, because it contributes

energy to the diet (7 kcals/gram)energy to the diet (7 kcals/gram) Not considered a nutrient, because is not Not considered a nutrient, because is not

neededneeded Social stimulant: removes inhibitionsSocial stimulant: removes inhibitions Has been a thirst quencher where water Has been a thirst quencher where water

is unsafe, and an analgesic to treat aches is unsafe, and an analgesic to treat aches and painsand pains

History of AlcoholHistory of Alcohol

Beer recipes found on Babylonian clay Beer recipes found on Babylonian clay tablets 6000 years oldtablets 6000 years old

Probably known as early as the Stone Probably known as early as the Stone Age, 10,000 years agoAge, 10,000 years ago

Probably first wine was produced by Probably first wine was produced by accident, fermentation caused by wild accident, fermentation caused by wild yeastyeast

Beer had to wait until establishment of Beer had to wait until establishment of agricultureagriculture

Alcohol as Alternative Alcohol as Alternative to Waterto Water Alcoholic beverages provided a safe Alcoholic beverages provided a safe

alternative to contaminated drinking wateralternative to contaminated drinking water Early alcoholic beverages had relatively low Early alcoholic beverages had relatively low

alcohol content, focused more on taste, alcohol content, focused more on taste, thirst quenchingthirst quenching

In the Old and New Testament, drinking In the Old and New Testament, drinking water seldom mentioned; wine and beer iswater seldom mentioned; wine and beer is

All ages, even children, drank wine and aleAll ages, even children, drank wine and ale

Production of Alcoholic Production of Alcoholic BeveragesBeverages Fermentation: the breakdown of Fermentation: the breakdown of

carbohydrates without the use of carbohydrates without the use of oxygenoxygen

Alcohol, carbon dioxide, and various Alcohol, carbon dioxide, and various acids are byproductsacids are byproducts

High carbohydrate foods especially High carbohydrate foods especially encourage the growth of yeast, the encourage the growth of yeast, the micro-organism that is responsible for micro-organism that is responsible for alcohol productionalcohol production

Production of AlcoholProduction of Alcohol

Anaerobic conditionAnaerobic condition COCO22

Glucose Glucose EthanolEthanol Fermentation of yeastFermentation of yeast

Maltose Maltose

AmylaseAmylase

CHO CHO

Production of BeerProduction of Beer

CHO must be simple sugar, such as CHO must be simple sugar, such as maltose or glucose in order for the yeast maltose or glucose in order for the yeast to use it as foodto use it as food

If the CHO is a starch, such as that found If the CHO is a starch, such as that found in cereal grains (barley) it must be in cereal grains (barley) it must be broken down to simpler forms, or maltedbroken down to simpler forms, or malted

Beer is made from malted cereal grains, Beer is made from malted cereal grains, such as barley, flavored with hops and such as barley, flavored with hops and brewed by slow fermentationbrewed by slow fermentation

Resulting CO2 is used to carbonate the Resulting CO2 is used to carbonate the beerbeer

Production of Distilled Production of Distilled SpiritsSpirits Distilled spirits such as whiskey, Distilled spirits such as whiskey,

vodka, or gin are made by distilling vodka, or gin are made by distilling the alcohol after fermentationthe alcohol after fermentation

Distilling separates the alcohol from Distilling separates the alcohol from water and the alcohol is recoveredwater and the alcohol is recovered

Vodka and gin are unagedVodka and gin are unaged Whiskey, rum and brandies are agedWhiskey, rum and brandies are aged

Alcohol AbsorptionAlcohol Absorption

Depends on rate of stomach Depends on rate of stomach emptyingemptying

Absorbed readily by simple Absorbed readily by simple diffusion (no digestion needed)diffusion (no digestion needed)

Higher proof Higher proof → → faster absorptionfaster absorption Wine is faster absorbed than liquor Wine is faster absorbed than liquor

which is faster than beerwhich is faster than beer Food slows absorption from the Food slows absorption from the

stomachstomach

Alcohol AbsorptionAlcohol Absorption

Easily moves through the cell Easily moves through the cell membrane (damaging it)membrane (damaging it)→ gastritis→ gastritis

Alcohol is found wherever water is Alcohol is found wherever water is found in the bodyfound in the body

Alcohol (Ethanol) Alcohol (Ethanol) MetabolismMetabolism Depends on gender, race, size, Depends on gender, race, size,

food, physical condition, alcohol food, physical condition, alcohol contentcontent

Metabolism depends on alcohol Metabolism depends on alcohol dehydrogenase (ADH)dehydrogenase (ADH)

Alcoholics and women have less Alcoholics and women have less ADHADH

Majority of the ethanol is Majority of the ethanol is metabolized by the livermetabolized by the liver

Metabolism of Metabolism of Moderate Alcohol Moderate Alcohol IntakeIntake

alcohol dehydrogenase

Alcohol Acetaldehyde CO2 + H2O

small amount

excreted through lungs,

urine, & sweat

Alcohol in the BodyAlcohol in the Body

EthanolEthanol 7 calories/gram 7 calories/gram Denaturing agentDenaturing agent Drug – depresses/sedates CNSDrug – depresses/sedates CNS

Alcohol and DrugsAlcohol and Drugs

Alcohol cannot be stored and has Alcohol cannot be stored and has priority in metabolismpriority in metabolism

If taken with sedatives, alcohol If taken with sedatives, alcohol and sedatives compete for the and sedatives compete for the same metabolic pathwayssame metabolic pathways

Liver cannot metabolize the Liver cannot metabolize the sedatives fast enough sedatives fast enough → coma or → coma or deathdeath

Alcohol (Ethanol) Alcohol (Ethanol) MetabolismMetabolism Social drinker who weighs 150 pounds Social drinker who weighs 150 pounds

with normal liver function metabolizes with normal liver function metabolizes about 5-7 grams of alcohol her hour, about 5-7 grams of alcohol her hour, about half a beer of ¼ of another drinkabout half a beer of ¼ of another drink

When intake of alcohol exceeds liver’s When intake of alcohol exceeds liver’s ability to metabolize it, builds up in the ability to metabolize it, builds up in the bloodstreambloodstream

Small percentage excreted in urine, Small percentage excreted in urine, sweat, expired air (levels in expired air sweat, expired air (levels in expired air correspond with blood alcohol content correspond with blood alcohol content → → Breathalyzer test)Breathalyzer test)

Fig. 7.1Fig. 7.1

Women and AlcoholWomen and Alcohol

Women absorb and metabolize Women absorb and metabolize alcohol differently than menalcohol differently than men

Have less activity of ADH; metabolize Have less activity of ADH; metabolize only 10% of alcohol in stomach lining only 10% of alcohol in stomach lining vs 30% by menvs 30% by men

Have less body water in which to Have less body water in which to dilute the alcohol than men do dilute the alcohol than men do

When men and women of equal size When men and women of equal size drink equal amounts of liquor, more drink equal amounts of liquor, more alcohol reaches the bloodstream in alcohol reaches the bloodstream in womenwomen

Women and AlcoholWomen and Alcohol

Women develop Women develop alcohol-related alcohol-related ailments such ailments such as cirrhosis as cirrhosis more quickly more quickly than men with than men with the same the same drinking habitsdrinking habits

Drinking in AmericaDrinking in America

~50% of adults~50% of adults ~17% of 12-17 ~17% of 12-17

year-oldsyear-olds Highest prevalence Highest prevalence

in 18-25 year-oldsin 18-25 year-olds >35% of adults with >35% of adults with

alcohol problems alcohol problems develop symptoms develop symptoms by age 19by age 19

Binge DrinkingBinge Drinking

>5 drinks in a few hours>5 drinks in a few hours 20% of all Americans binge drink20% of all Americans binge drink 38% of 18-25 year-olds report 38% of 18-25 year-olds report

bingeingbingeing 48% of 21 year olds48% of 21 year olds 12% of 12-17 year-olds12% of 12-17 year-olds

Benefits of AlcoholBenefits of Alcohol

Consumed in moderationConsumed in moderation Decrease risk for cardiovascular Decrease risk for cardiovascular

diseasedisease SocializationSocialization

Moderate Alcohol UseModerate Alcohol Use

Men – 1 or 2 drinks dailyMen – 1 or 2 drinks daily Women – 1 drink dailyWomen – 1 drink daily Difference due to Difference due to

– Body size/blood volumeBody size/blood volume– Differences in body composition and Differences in body composition and

water contentwater content– Differences in metabolismDifferences in metabolism

One Drink =One Drink =

12-ounce beer12-ounce beer 5-ounce glass of wine5-ounce glass of wine 1 ounce of alcohol1 ounce of alcohol

Alcohol AbuseAlcohol Abuse

Contributes to the leading causes of Contributes to the leading causes of deathdeath

Combined with tobacco, increases the Combined with tobacco, increases the risk for esophageal and oral cancerrisk for esophageal and oral cancer

Risk for heart disease, heart Risk for heart disease, heart arrhythmia, HTN, stroke, osteoporosis, arrhythmia, HTN, stroke, osteoporosis, brain damage, colorectal cancer, brain damage, colorectal cancer, breast cancer, nutritional deficiencies, breast cancer, nutritional deficiencies, fetal damage, obesity, cancerfetal damage, obesity, cancer

Health Effects of Health Effects of AlcoholAlcohol Pancreas – inflammation Pancreas – inflammation

(pancreatitis)(pancreatitis) Small intestine – rapid absorption Small intestine – rapid absorption

with/without foodwith/without food Liver – major site of metabolismLiver – major site of metabolism

– 80% via ADH80% via ADH– 10% MEOS (microsomal ethanol 10% MEOS (microsomal ethanol

oxidizing system)oxidizing system)– 10% excreted10% excreted

Effect of Alcohol in the Effect of Alcohol in the BodyBody HeartHeart

– Sedates muscleSedates muscle– Slows rateSlows rate

LungsLungs– Exhaled in small amountsExhaled in small amounts– Smell on breathSmell on breath

Effect of Alcohol on the Effect of Alcohol on the BodyBody BrainBrain

– Depresses and sedates brainDepresses and sedates brain Order brain affected: Order brain affected:

– Inhibitory nervesInhibitory nerves– Judgement/reasoningJudgement/reasoning– Speech/visionSpeech/vision– Voluntary muscle controlVoluntary muscle control– Respiration/heart activityRespiration/heart activity

Effects of AlcoholEffects of Alcohol

HangoversHangovers

DehydrationDehydration– Antidiuretic hormone depressedAntidiuretic hormone depressed– Increased urine outputIncreased urine output– Brain cells dehydrateBrain cells dehydrate– Rehydration Rehydration → severe headache→ severe headache

HangoversHangovers

FormaldehydeFormaldehyde– Metabolism Metabolism → methanol→ methanol– Liver metabolizes methanol → Liver metabolizes methanol →

formaldehyde → C02, H20formaldehyde → C02, H20 Same enzymes metabolize alcoholSame enzymes metabolize alcohol

– Ethanol → acetaldehyde → C02, H20Ethanol → acetaldehyde → C02, H20 Acealdehyde processedAcealdehyde processed Formaldehyde builds up → Formaldehyde builds up →

hangover symptomshangover symptoms

Cure for HangoverCure for Hangover

TIMETIME Fluids for Fluids for

rehydrationrehydration

Limited Metabolic Limited Metabolic Enzymes Increase RiskEnzymes Increase Risk Normally metabolize ½ oz/hourNormally metabolize ½ oz/hour Fewer enzymes:Fewer enzymes:

– WomenWomen– Native AmericansNative Americans– AsiansAsians– Poor nutritional status (enzymes are Poor nutritional status (enzymes are

proteins)proteins)

Some People Are at Some People Are at Greater RiskGreater Risk

Increased EnzymesIncreased Enzymes

Previous drinking experience Previous drinking experience (develop tolerance)(develop tolerance)

MEOS increasesMEOS increases

Alcoholic HepatitisAlcoholic Hepatitis

Inflammation of the liverInflammation of the liver Scar tissueScar tissue Reversible with Reversible with

– AbstinenceAbstinence– Good nutritionGood nutrition

CirrhosisCirrhosis

Fatty infiltration of the liverFatty infiltration of the liver Response to the increased Response to the increased

synthesis of fat synthesis of fat Enlarged fat cells choke off Enlarged fat cells choke off

nutrient and Onutrient and O22 supply to liver supply to liver cellscells

Engorged fat cells burst and dieEngorged fat cells burst and die Scar tissueScar tissue

CirrhosisCirrhosis

15-20% of alcoholics after >10 15-20% of alcoholics after >10 years of alcohol abuseyears of alcohol abuse

2 million people in the U.S.2 million people in the U.S. 50% chance of death within 4 50% chance of death within 4

yearsyears Advance stages are not reversibleAdvance stages are not reversible Second leading cause of the need Second leading cause of the need

for liver transplantfor liver transplant

Malnutrition in Malnutrition in AlcoholismAlcoholism Typical deficiencies include the Typical deficiencies include the

fat-soluble vitamins (A, D, E and fat-soluble vitamins (A, D, E and K) and water soluble vitamins K) and water soluble vitamins (thiamin, niacin, B-6, folate, B-12 (thiamin, niacin, B-6, folate, B-12 and C)and C)

Mineral deficiencies: calcium, Mineral deficiencies: calcium, phosphorus, potassium, phosphorus, potassium, magnesium, zinc and ironmagnesium, zinc and iron

Malnutrition in Malnutrition in AlcoholismAlcoholism Arise due to poor nutritional intakes Arise due to poor nutritional intakes

and fat malabsorption and increased and fat malabsorption and increased urinary lossesurinary losses

May also be at risk for toxicities of A May also be at risk for toxicities of A and ironand iron

Malnutrition makes the liver more Malnutrition makes the liver more vulnerable to toxic substances vulnerable to toxic substances (deficiency of C and folate)(deficiency of C and folate)

Most important treatment: abstention Most important treatment: abstention from alcoholfrom alcohol

Other Problems Other Problems Related to Alcohol Related to Alcohol AbuseAbuse Drinking in the workplaceDrinking in the workplace Operating motor vehicles and Operating motor vehicles and

equipmentequipment Sexually transmitted diseasesSexually transmitted diseases Unplanned pregnancyUnplanned pregnancy Children of alcoholicsChildren of alcoholics

Alcohol-Related Health Alcohol-Related Health Care CostsCare Costs Twenty-five to forty percent of all Twenty-five to forty percent of all

patients in U.S. general hospital beds patients in U.S. general hospital beds (not in maternity or intensive care) are (not in maternity or intensive care) are being treated for complications of being treated for complications of alcohol-related problems. alcohol-related problems. 11

Annual health care expenditures for Annual health care expenditures for alcohol-related problems amount to alcohol-related problems amount to $22.5 billion. The total cost of alcohol $22.5 billion. The total cost of alcohol problems is $175.9 billion a year problems is $175.9 billion a year (compared to $114.2 billion for other (compared to $114.2 billion for other drug problems and $137 billion for drug problems and $137 billion for smoking).smoking).22 http://www.marininstitute.org/alcohol_policy/health_care_costs.htm

Alcohol-Related Health Alcohol-Related Health Care CostsCare Costs In comparison to moderate and non-In comparison to moderate and non-

drinkers, individuals with a history of drinkers, individuals with a history of heavy drinking have higher health care heavy drinking have higher health care costs. costs. 33

Untreated alcohol problems waste an Untreated alcohol problems waste an estimated $184.6 billion dollars per estimated $184.6 billion dollars per year in health care, business and year in health care, business and criminal justice costs, and cause more criminal justice costs, and cause more than 100,000 deaths. than 100,000 deaths. 44

http://www.marininstitute.org/alcohol_policy/health_care_costs.htm

Consequences of Consequences of AlcoholAlcohol Alcohol-related car crashes are the Alcohol-related car crashes are the

number one killer of teens. Alcohol use is number one killer of teens. Alcohol use is also associated with homicides, suicides, also associated with homicides, suicides, and drownings-the next three leading and drownings-the next three leading causes of death among youth. causes of death among youth. 77

Alcohol is the drug most frequently used Alcohol is the drug most frequently used by 12 to 17 year-olds-and the one that by 12 to 17 year-olds-and the one that causes the most negative health causes the most negative health consequences. More than 4 million consequences. More than 4 million adolescents under the legal drinking age adolescents under the legal drinking age consume alcohol in any given month. consume alcohol in any given month. 88

http://www.marininstitute.org/alcohol_policy/health_care_costs.htm

Alcohol and StudentsAlcohol and Students

>1400 die from unintentional >1400 die from unintentional injuriesinjuries

>600,000 assaults by drinking >600,000 assaults by drinking studentsstudents

>70,000 victims of sexual >70,000 victims of sexual assault/date rapeassault/date rape

400,000 unprotected sex400,000 unprotected sex– 100,000 too drunk to remember100,000 too drunk to remember

Alcohol and StudentsAlcohol and Students

Academic problems (25% of Academic problems (25% of students)students)

Vandalism (11% participate)Vandalism (11% participate) Police involvement (5% contact Police involvement (5% contact

with police/campus security)with police/campus security) 110,000 arrests110,000 arrests

Fetal Alcohol Fetal Alcohol SyndromeSyndrome Alcohol reaches the fetusAlcohol reaches the fetus Deprive brain of oxygen and nutrientsDeprive brain of oxygen and nutrients ~4 drinks a day or binge drinking while ~4 drinks a day or binge drinking while

pregnantpregnant First trimester drinking greatest danger First trimester drinking greatest danger

(women are unaware they are (women are unaware they are pregnant)pregnant)

Abstinence from alcohol is the best Abstinence from alcohol is the best adviceadvice

Fetal Alcohol Fetal Alcohol SyndromeSyndrome Leading preventable birth defectLeading preventable birth defect 3.3 per 10,000 births3.3 per 10,000 births Mental retardationMental retardation Poor growthPoor growth Physical deformitiesPhysical deformities

Brain DamageBrain Damage

Subtle cognitive dysfunction and Subtle cognitive dysfunction and motor nerve deficitmotor nerve deficit

Shrinks the brainShrinks the brain Reduces oxygen and nutrients to Reduces oxygen and nutrients to

the brainthe brain Alcohol is a powerful depressantAlcohol is a powerful depressant

AdviceAdvice

U.S. surgeon general’s office, the U.S. surgeon general’s office, the National Academy of Science, and National Academy of Science, and the USDA/DHHS do not the USDA/DHHS do not recommend drinkingrecommend drinking

Drink in moderationDrink in moderation Avoid drinking and drivingAvoid drinking and driving Avoid drinking while pregnantAvoid drinking while pregnant

Alcohol DependencyAlcohol Dependency Genetic linksGenetic links Risk is increased fourfold in children of Risk is increased fourfold in children of

alcoholics alcoholics Can be addictive and dangerous for someCan be addictive and dangerous for some Warn these children by the age of 10Warn these children by the age of 10 Low threshold may be geneticLow threshold may be genetic

– requires greater amounts of alcohol to requires greater amounts of alcohol to produce same effectsproduce same effects

EthnicEthnic

DepressionDepression

Goes with alcohol abuseGoes with alcohol abuse Alcohol only alleviates depression Alcohol only alleviates depression

in the short runin the short run No longer concerned about their No longer concerned about their

health/behaviorhealth/behavior

DiagnosisDiagnosis

Physiological dependence on alcoholPhysiological dependence on alcohol Tolerance to the effects of alcoholTolerance to the effects of alcohol Evidence of alcohol-associated illnesses Evidence of alcohol-associated illnesses

(memory loss, liver disease, etc.)(memory loss, liver disease, etc.) Continued drinking in defiance of Continued drinking in defiance of

medical and social contradictionsmedical and social contradictions Depression and blackoutsDepression and blackouts Flushed face/reddened skinFlushed face/reddened skin

CAGE ScreeningCAGE Screening CC: Have you every felt you ought to : Have you every felt you ought to

cutcut down on drinking? down on drinking? AA: Have people : Have people annoyedannoyed you by you by

criticizing your drinking?criticizing your drinking? GG: Have you ever felt bad or : Have you ever felt bad or guiltyguilty

about your drinking?about your drinking? EE: Have you ever had a drink first : Have you ever had a drink first

thing in the morning to steady your thing in the morning to steady your nerves or to get rid of a hangover? nerves or to get rid of a hangover? (As an (As an eye-openereye-opener))

Do You Have a Do You Have a Problem with Alcohol?Problem with Alcohol? Have you had memory lapses or Have you had memory lapses or

blackouts due to drinking?blackouts due to drinking? Do you continue to drink although you Do you continue to drink although you

have health problems caused by have health problems caused by alcohol?alcohol?

Do you get withdrawal symptoms such Do you get withdrawal symptoms such as headaches, chills, shakes and a as headaches, chills, shakes and a strong craving for alcohol, and drink strong craving for alcohol, and drink more to get rid of those symptoms?more to get rid of those symptoms?

Do You Have a Do You Have a Problem with Alcohol?Problem with Alcohol? Do you take part in high-risk Do you take part in high-risk

behaviors, such as having unsafe behaviors, such as having unsafe dex in a non-monogamous dex in a non-monogamous relationship or driving a boat or car relationship or driving a boat or car when under the influence of alcohol?when under the influence of alcohol?

Has drinking caused trouble at Has drinking caused trouble at home, at work, or in relationships home, at work, or in relationships with others?with others?

Do You Have a Do You Have a Problem with Alcohol?Problem with Alcohol? Do you have to drink alcohol for any of Do you have to drink alcohol for any of

the following reasons?the following reasons?– To get through the day or unwind at the To get through the day or unwind at the

end of the dayend of the day– To cope with stressful life eventsTo cope with stressful life events– To escape from ongoing problemsTo escape from ongoing problems

If yes to any, consult your family If yes to any, consult your family physician or a certified counselor for physician or a certified counselor for helphelp

Alcoholism: 4 Alcoholism: 4 symptomssymptoms CravingCraving Loss of controlLoss of control Physical dependencePhysical dependence ToleranceTolerance

~7% of Americans meet criteria~7% of Americans meet criteria >50% of adults have alcoholic family >50% of adults have alcoholic family

member – active or recoveringmember – active or recovering

TreatmentTreatment

Guidance from a physicianGuidance from a physician CounselingCounseling Total abstinenceTotal abstinence AA 12 step programAA 12 step program Treatment programTreatment program Medication (blocks craving or cause Medication (blocks craving or cause

physical reaction when drinking)physical reaction when drinking)

Alcohol PoisoningAlcohol Poisoning

Warning SignsWarning Signs Semiconsciousness or unconsciousnessSemiconsciousness or unconsciousness Slow respiration (8 or fewer per minute Slow respiration (8 or fewer per minute

or lapse of greater than 8 seconds)or lapse of greater than 8 seconds) Cold, clammy, pale, or even bluish skinCold, clammy, pale, or even bluish skin Strong odor of alcoholStrong odor of alcohol Others?Others?