EPHE 155 - Lecture 9 (Alcohol)

NUTRITION DEFICIT: WERNICKE-KORSAKOFF?

Wernicke-Korsakoff syndrome (Wet Brain) a cluster of symptoms involving nerve damage arising from a deficiency of the vitamin thiamin in alcoholism. Characterized by mental confusion, disorientation, memory loss, jerky eye movements, and staggering gait. • Severe Alcohol Abuse • Inadequate food intake (alcoholics don't typically care about diet. ) • Impaired nutrient absorption • Deficiency of Thiamine (B1) occurs Physical symptoms: • Paralysis of eye muscles, poor muscle coordination, impaired memory, damaged nerves • Might respond to thiamine supplements

Binge drinking?

• 4+___ drinks in a row (women) • _5+__ drinks in a row (men)

THE HANGOVER?

• A mild form of drug withdrawal • Contributors to hangovers: • Dehydration -> Increased urine output • GastricAcid->Abdominal discomfort • Acetaldehyde -> Headache • Impeded blood glucose maintenance to Fatigue. Body works to maintain blood glucose, and body stops maintenance. Not as urgent as getting poison out of system. Have higher level of fatigue, because body is not regulating.

ALCOHOL ARRI VES IN THE BRAIN?

• Alcohol arrives in the brain within one minute • Initially sedates the inhibitory nerves, allowing excitatory nerves to take over • This is temporary; eventually it sedates al lnerves • The brain is very sensitive to alcohol in any amount • Brain tissue shrinks, creating brain damage • Irreversible with sustained heavy drinking for more than a few years

Alcoholics and hypertension?

• Alcohol increases glucose concentrations which increase fluid retention, increasing blood pressure • More of an acute problem as 3+ drinks will have a noticeable effect on BP • For Alcoholics? Will give chronically high blood pressure. The heart tries to compensate for that = heart disease. Tries to play with cardiac output, changes physiology in the heart.

THE FATTENING POWER OF ALCOHOL?

• Alcohol promotes central abdominal fat storage • "Beer belly" • Increases risk for heart disease. Because of how it affects bp. • Promotes fattening of the chest (especially beer) • Especially in men at a high risk for gynecomastia • Hops in beer have a potent phytoestrogen called 8-PN (hopein). Result:

ALCOHOL AND BLOOD GLUCOSE?

• Alcohol steals the the liver's attention from regulating blood glucose. Go way up then way down. • Hyperglycemia then hypoglycemia • Increased insulin resistance • How does this affect alcoholics quitting drinking? Body is physically dependent on it. A lot of their carbs are coming from it. • Can be very dangerous if mismanaged. Why? • Answer: Drastic drops in blood glucose => hypoglycemia. A large portion of their carbohydrates comes from alcohol

ALCOHOL AFFEC TS BODY FUNC TIONS?

• Amino acid metabolism is altered by alcohol • Weakens the body's defences against infection • Acts as a diuretic, increasing urine output • Alcohol adds to the body's acid burden • Affects reproductive health 1) Infertility or spontaneous abortion in women 2) Suppressed male reproductive hormone (testosterone) Reduce testosterone production, why gets who are drinking end up with large chests, not muscle.

HOW RESPONSIBLE IS ALCOHOL FOR OVERALL HEALTH?

• At least 200 conditions have alcohol as a causative factor • Accounts for 5.1% of global health burden • Increases susceptibility to infectious diseases (TB, HIV/AIDS)

"Alcoholism"?

• Brings about irrational and dangerous behaviours • Health effects include depression, severe malnutrition, physical illness, and more • Dependency on Alcohol

ALCOHOL'S EFFECTS ON NUTRITION?

• Causes disturbances in nutrition; provides empty Calories • Intestinal cells fail to absorb some vitamins • Liver cells lose efficiency in activating vitamin D • Reduced capacity to process and use vitamin A • Kidneys excrete nutrients/minerals. Kidneys secrete folate in massive amounts when drinking. IS empty calories, not a lot of vitamins or nutrients in alcohol that benefit us. Damaging ability to absorb.

Why is folate so important?

• Critical in development - responsible for cell division and DNA repair. - huge in neural development. • Low folate drastically affects neural development - may be a contributor to Fetal Alcohol Syndrome • Low folate levels in pregnant women can lead to spina bifida. Big ball of the spinal cord outside. Need surgical procedure. • Deficiencies are linked to cervical and colon cancer

THIAMINE?

• Critical in glucose metabolism (TCA cycle) • Required for proper nerve, heart and muscle function • High alcohol intake causes thiamine deficiencies in three ways: 1) Increased need for/usage of thiamine to metabolize alcohol in liver 2) Reduces absorption of dietary thiamine in the gut 3) Dietary influencer (most heavy drinkers possess poor diets reducing dietary thiamine)

"Moderation"?

• Difficulties with defining due to individual alcohol tolerance - usually consume the Calories of alcohol in addition to their normal food intake, so the alcohol contributes to their daily Calorie totals. • Health authority definition set as daily MAXIMUMs

"NUTRITIONAL VALUE"?

• Fats-9kcal/g • Carbs-4kcal/g • Protein-4kcal/g • Alcohol - 7kcal/g Can we survive solely on alcohol? No bc no nutrients. Majority of carbs is alcohol. Maybe some dark dark beers for short time.

ALCOHOL AND LIVER HEALTH?

• Fatty liver: 1st stage of liver deterioration • Liver fibrosis: 2nd stage of liver deterioration • Cirrhosis: 3rd stage (irreversible) Left to right: normal liver, fatty liver, and cirrhosis. Once you get third stage - need transplant but can't get on list because will just destroy liver again.

FOLATE?

• Folate levels are significantly affected by alcohol • Expelled from all the body's sites, increasing blood folate • Kidneys falsely think folate is present in excess and begin to excrete folate • What about supplements!? Can't help you now. Intestines become so damaged from alcohol that they do not absorb folate. • Folate levels reduce even with alcohol consumption below the binge threshold. • Research shows there is a 5% reduction in folate levels with as few as two drinks

WHAT IS ALCOHOL?

• Names end in -ol (We commonly refer to ethanol as alcohol) - poison that will kill brain cells. • Act as lipid solvents • Once alcohol enters the cell, protein is denatured and the cell dies • Ethanol: The form of alcohol in beverages

ALCOHOL AND HEART DISEASE?

• One to two standard alcoholic drinks a day are linked with reducing risk of death from heart disease in people over 60 years old who have an increased risk of heart disease • Believed to be due to its actions as: - A moderate blood thinner - Positive effects on HDL - Damage mitigation for LDL - Antioxidants (notably in red wine) - Also an antiangiogenic - prevents cancer for vascularization. Not as affective as drugs but still not bad.

ALCOHOL'S LONG-TERM EFFECTS?

• Pregnancy - All alcohol consumed by the mother is consumed by the fetus - Pregnant women should NOT drink ANY amount of alcohol (FAS) • Effects on the heart - Heart disease (In small amounts ca reduce risk of heart disease but in high amounts really bad) • Effects on the brain - Dementia, damage neural connections. • Cancers - Breast, mouth, throat, esophagus, rectum, lungs - Anything alcohol touches will be affected. Breasts - body doesn't like hormonal imbalances.

THE HEALTH EFFECTS OF WINE?

• The science is mixed •Wine in small amounts may be beneficial to health (see previous slide) • Consider alternatives to "alcoholized" wine • Dealcoholized wine, purple grape juice, and grapes themselves contain phytochemicals similar to those of wine but without the potential dangers of alcohol • Resveratrol in red wine possesses anti-cancerous properties

alcohol dehydrogenase?

- (ADH) an enzyme system that breaks down alcohol. -The antidiuretic hormone listed below is also abbreviated ADH.

MEOS?

- (microsomal ethanol oxidizing system) a system of enzymes in the liver that oxidize not only alcohol but also several classes of drugs.

ALCOHOL METABOLISM?

- 20% of ethanol is absorbed in the stomach • 80% small intestine (100% for females) - Males have extra alcohol dehydrogenase in the stomach. Females don't, males have 20% in stomach. Females get 100% hit of alcohol in the small intestine. • Liver breaks down ethanol for energy • Liver can handle 0.5 oz. of alcohol per hour (0.6 oz. or 17 g of pure alcohol in 1 drink)

Cognitive effects of alcohol?

- Reds, yellows and oranges are high functioning for glucose uptake. Blue is no function, everything inhibited. Shuts off things at rapid pace.

WERNICKE-KORSAKOFF SYNDROME?

- See in alcoholic man is much less tissue, permanent damage.

FIGURE C3-3: ALCOHOL'S EFFECTS ON THE BRAIN

- AA metabolism affected by alcohol. - Makes you susceptible for infection. - Adds to bodies acid burden too.

Chart of alcohol and the risk of coronary heart disease.

- ALCOHOL and risk of coronary artery disease 1/2 drinks will reduce risk for cardiovascular disease - But as soon as you hit 5 drinks a day see an increase rapidly. The more you drink they faster is gets worse.

Summary?

- Alcohol is a poison that can be calorie rich - Impacts nutrient and mineral levels in the body and impairs absorptions - Despite harmful traits of alcohol in minute levels are not too bad Alcohol can influence the diet.

Formaldehyde?

- Another contributor to the hangover is formaldehyde, the same chemical that laboratories use to preserve dead animals. - Formaldehyde comes from methanol, an alcohol produced constantly by normal chemical processes in all the cells. - Normally, a set of liver enzymes converts this methanol to formaldehyde, and then a second set immediately converts the formaldehyde to carbon dioxide and water, harmless waste products that can be excreted. - But these same two sets of liver enzymes are the ones that process ethanol to its own intermediate (also highly toxic) waste product, acetaldehyde, and then to carbon dioxide and water. -The enzymes prefer ethanol 20 times over methanol. Both alcohols are metabolized without delay until the excess acetaldehyde monopolizes the second set of enzymes, leaving formaldehyde to wait for later detoxification. At that point, formaldehyde starts accumulating and the hangover begins.

Europeans are the heaviest drinkers and Americans and Russians suffer more from the effects. What may be a reason for this?

- Genetics is a part of it - Difference in diet - Within the culture, go through 3-4 drinks a day, body can adjust. More consistent part of lifestyle. - Not like NA culture in which its binge drinking, more of a toll on the body, body trying to catch up Europeans consuming less on a daily basis.

congeners

- In the alcoholic beverages industry, congeners are substances, other than the desired type of alcohol, ethanol, produced during fermentation. - cause some of the unpleasant symptoms of a hangover

Graph showing relative harm for all big drugs?

- Look at the relative harm for all big drugs. Note that alcohol is at the top, the most harmful drug. Partially due to the harm to others, ex drinking and driving.

WHAT IS A "DRINK"?

- a dose of any alcoholic beverage that delivers 15 mL of pure ethanol. - • % of alcohol is stated as proof • Proof: equals twice the % of alcohol - for example, 100 proof liquor is 50 percent alcohol. - Can cut down on calories by switching to hard bar. - Beer is very high in calories, can create beer bellies.

CAGE questions?

- a set of four questions often used internationally for initial screening for alcoholism. - The questions relate to C, Cutting down; A, Annoyance by criticism; G, Guilty feeling; and E, Eye-openers.

acetaldehyde?

- a substance to which ethanol is metabolized on its way to becoming harmless waste products that can be excreted.

cirrhosis?

- advanced liver disease, often associated with alcoholism, in which liver cells have died, hardened, turned an orange colour, and permanently lost their function.

Fatty liver?

- an early stage of liver deterioration seen in several diseases, including kwashiorkor and alcoholic liver disease, in which fat accumulates in the liver cells.

euphoria?

- an inflated sense of well-being and pleasure brought on by a moderate dose of alcohol and some other drugs.

fibrosis?

- n intermediate stage of alcoholic liver deterioration. Liver cells lose their function and assume the characteristics of connective tissue cells (fibres).

Alcohol consumption and mortality risk?

All cause mortality - Bottom is 8 drinks - Diff affect for whole body compared to heart - Cardiovascular system a bit more is better - But in terms of whole body want to keep around 7 a week.

ALCOHOL ARRI VES IN THE LI VER?

•The liver processes most of the body's alcohol • Two main liver enzymes break down alcohol • Alcohol dehydrogenase (ADH): Amount of ADH enzymes depends on amount of alcoholism. • MEOS (increased activity with chronic consumption via smooth ER) • Amount of ADH enzymes available depends on 1) Alcoholism - higher tolerance more ADH enzymes 2) Gender - females are affected more. 3) Presence of food - more food, will handle alcohol.