Alcohol: The Positives and Negatives

Transcription

1 Nutrition Scoreboard 1 Alcohol is produced from carbohydrates. 2 You can protect your body from the harmful effects of consuming excessive amounts of alcohol by eating a nutritious diet. 3 Alcohol abuse plays a major role in injuries and deaths in the United States. TRUE FALSE Answers on next page Alcohol: The Positives and Negatives

2 [ KEY CONCEPTS AND FACTS ] Alcohol is both a food and a drug and can have positive or negative effects on health. Alcohol is produced from carbohydrates. Alcohol abuse is harmful to the body and is associated with a high proportion of fermentation The process by which carbohydrates are converted to ethanol by the action of the enzymes in yeast. acts of violence and accidents. Both genetic and environmental factors are associated with the development of alcoholism. Alcohol Facts Answers to Nutrition Scoreboard 1 Alcohol (actually ethanol) is produced by the fermentation of carbohydrates in grains, fruits, and other foods. 2 High intakes of alcohol are harmful to the body, regardless of the quality of the diet. 3 The statistics on alcohol abuse, injury, and death are startling. Alcohol abuse is a major personal, social, and public health problem in the United States. Alcohol is both a food and a drug. It s a food because alcohol is made from carbohydrates and the body uses it as an energy source. Alcohol is a drug because it modifies various body functions. The type of alcohol people consume in beverages is ethanol. (We refer to ethanol by the broader term alcohol in this unit.) Alcohol is produced from carbohydrates in grains, fruits, and other foods by the process of fermentation. Wines, brews made from grains, and other alcohol-containing beverages are a traditional part of the food supply of many cultural groups. In high doses, however, alcohol is harmful to the body and can cause a wide variety of nutritional, social, and physical health problems. The Positive Whether alcohol has harmful effects on health depends on how much is consumed. The consumption of moderate amounts of alcohol by healthy adults who are not pregnant appears to cause no harm. 1 In fact, moderate alcohol consumption is associated with a significant level of protection against heart disease. 2 A moderate level of alcohol consumption is considered to be one standard-sized drink per day for women and two drinks for men (Illustration 14.1). Alcohol increases the body s production of high-density lipoprotein cholesterol (HDL). 3 HDL is known as the good cholesterol because it helps eliminate cholesterol from the body, and that reduces plaque build-up in arteries. All types of alcohol-containing beverages reduce the risk of heart disease. But is there something special about red wine that reduces the risk of heart disease more than other alcohol-containing beverages do? The answer may be yes for women. 4 Red wine includes pigments that make grapes deep red, blue, or purple. A number of these pigments act as antioxidants and may decrease the tendency of blood to clot (which may happen during a heart attack) and may decrease the ability of LDL cholesterol to stick to plaque in the arteries. Purple grape juice contains these antioxidants, too, and may also help prevent heart disease. 5 People don t have to consume alcohol to reduce their risk of heart disease. Diets low in saturated fat, liberal intakes of vegetables and fruits, ample physical activity, and not smoking also reduce the risk of heart disease. 6 TRUE FALSE

3 The Negative LIGHT BEER MALT BEVERAGE 12 oz Heavy drinking, often defined as the consumption of five or more drinks per day, poses a number of threats to the health of individual drinkers and often to other people 80-PROOF LIQUOR as well. Although health can be damaged by 11/2 oz. the regular consumption of high amounts of WINE COOLER alcohol, the ill effects of alcohol are most obvious in people with alcoholism. Habitually high alcohol intakes and alcoholism increase the risk of developing high WINE blood pressure, stroke, and cirrhosis of the 5 oz. liver; throat, stomach, and bladder cancer; central nervous system disorders; and vitamin and mineral deficiency diseases. Alcohol abuse is associated with a high proportion of deaths from homicide, drowning, fires, traffic accidents, and suicide (Illustration Illustration ). It is also involved in a large proportion of rapes and assaults. Alcohol poisoning from the consumption of a large amount of alcohol in a short period of time can cause death and does to a number of college students each year. 7 Drinking during pregnancy may harm the fetus. Women who binge drink or drink regularly during pregnancy are at risk of delivering an infant with signs of fetal alcohol syndrome (Illustration 14.3). 8 Children with fetal alcohol syndrome experience long-term growth and mental retardation. The severity of the condition depends on how much alcohol was consumed during pregnancy and whether excessive intake occurred early or late in pregnancy. 9 Although small amounts of alcohol do not appear to be hazardous, it is recommended that women who are, or may become, pregnant not drink. 10 Spouse abuse Traffic fatalities Homicides Manslaughter charges Drownings Child abuse Rapes Assaults Suicides 0% 10% 20% 30% 40% 50% 60% Percent of cases associated with alcohol use 70% 80% y k e s i BEER Standard serving sizes of alcohol-containing beverages. Serving sizes shown contain 13 to 16 grams of alcohol. alcoholism An illness characterized by a dependence on alcohol and by a level of alcohol intake that interferes with health, family and social relations, and job performance. Illustration 14.2 Violence and injuries associated with alcohol. Source: National Institute on Alcohol Abuse and Alcoholism, 2001.

4 David H. Wells/CORBIS Illustration 14.3 Children with fetal alcohol syndrome experience growth and mental retardation, in addition to specific facial characteristics. Alcohol-containing beverages must show a warning statement on labels. Illustration 14.4 Caloric value of common alcohol-containing beverages. LIGHT BEER 95 calories BEER 150 calories MALT BEVERAGE 180 calories Alcohol Intake and Diet Quality Alcohol provides 7 calories per gram, making alcohol-containing beverages rather high in caloric content (Illustration 14.4). Because many alcohol-containing beverages provide calories and few or no nutrients, they are considered emptycalorie foods. On average, alcohol accounts for 3 to 9% of the caloric intake of U.S. adults who drink. The average goes up to around 50% among heavy drinkers. 11 Although beer, wine, and mixed drinks are known to contain alcohol and to provide calories, there exists some confusion about whether calories from alcohol contribute to weight gain. This issue is addressed in the Reality Check. As caloric consumption from alcohol-containing beverages increases, the quality of the diet generally decreases. Diets of heavy drinkers frequently provide too little thiamin, vitamins A and C, calcium, and iron. 13 Deficiencies of nutrients, as well as direct, toxic effects of high levels of alcohol ingestion, produce most of the physical health problems associated with alcoholism. The lack of thiamin, for example, impairs the brain s utilization of glucose. When people with alcoholism initially withdraw from alcohol, the thiamin deficiency may result in delirium tremens, a condition called the DTs by people who staff detoxification centers. People with delirium tremens experience convulsions and hallucinations and are severely confused. Thiamin injections are a key component of treatment for delirium tremens. 14 Because alcohol in excess is directly toxic to body tissues, consuming an adequate diet won t protect heavy drinkers from all of the harmful effects of alcohol. 15 How the Body Handles Alcohol Jonathan Nourok/PhotoEdit Alcohol is easily and rapidly absorbed in the stomach and small intestine. Within minutes after it is consumed, alcohol enters the circulatory system and is on its way to the liver, brain, and other tissues throughout the body. Alcohol remains in blood and body tissues until it is broken down and used for energy or is converted into fat and stored. The process of converting alcohol into a source of WINE energy takes several hours or more to complete, 5 oz. depending on the amount of alcohol consumed. 110 calories Because of the lag time between alcohol intake and utilization, blood levels of alcohol build up as drinking continues (Table 14.1). The intoxicating effects of alcohol correspond to blood alcohol levels. After a drink or two, WINE COOLER blood levels of alcohol reach approximately 0.03% in people who weigh about 150 pounds. 170 calories Blood alcohol levels of 0.03% correspond to mild intoxication. At this level, people lose some control over muscle movement and have slowed reac- 80-PROOF LIQUOR 11/2 oz. 105 calories tion times and impaired thought processes. A (without mix) person s ability to drive or operate equipment in a safe manner is decreased at this level of blood

5 Pedro: I started drinking a beer at night over the summer, and my weight never changed. REALITY CHECK Do alcohol calories count? Perhaps you ve heard the popular scientific opinion that alcohol intake does not increase the risk of obesity. Is that the same as the not-so-popular opinion of scientists? Do your thoughts side with Pedro or Erik? Answers on next page alcohol content (Illustration 14.5). Blood alcohol levels of around 0.06% are associated with an increased involvement in traffic accidents. The legal limit for intoxication according to most states highway safety ordinances is 0.08 to 0.1% beyond the point where driving is impaired. When blood alcohol content increases to 0.13%, speech becomes slurred, double vision occurs, reflexes are dulled, and body movements become unsteady. 16 If blood alcohol level continues to increase, drowsiness occurs and people may lose consciousness. Levels of blood alcohol above 0.6% can cause death, especially in individuals who have not developed a tolerance for alcohol. Over 150 medications, including sleeping pills, antidepressants, and painkillers, interact harmfully with alcohol. 17 Combining three or more drinks per day with aspirin or nonaspirin pain relievers (acetaminophen, ibuprofen) may cause stomach ulcers or liver damage. 18 A given amount of alcohol intake among women produces higher blood levels of alcohol than for men of the same body weight. Pound for pound, women s bodies contain less water than men s bodies, so blood alcohol levels in women increase TABLE 14.1 ALCOHOL DOSES AND BLOOD LEVELS. NUMBER OF DRINKS* PERCENT BLOOD ALCOHOL BY BODY WEIGHT 100 LB 120 LB 150 LB 180 LB 200 LB *Taken within an hour or so; each drink equal to 1 2 ounce pure ethanol. Source: Sizer F, Whitney EN. Nutrition: current concepts and controversies, eighth edition. Belmont, CA: Wadsworth; 2000, p Erik: The six-pack around my abdomen is really a six-pack. Illustration 14.5 The legal limit for intoxication in most states highway safety ordinances is 0.08 to 0.1% beyond the point where driving is impaired.

6 Pedro Illustration 14.6 The younger a person is when drinking begins, the higher the probability that a drinking problem will develop. ANSWERS TO REALITY CHECK Do alcohol calories count? Maybe you ve never seen an obese person with alcoholism, so you re tempted to think alcohol calories don t count. Chronic alcohol abuse is associated with weight loss and muscle wasting, even though the calorie intake of heavy drinkers is high. The effect appears to be due to an inhibition of fat tissue accumulation. The calories do count for light and moderate drinkers, however. 12 faster than in men. 19 Consequently, women may experience the intoxicating effects of alcohol on lower amounts of alcohol than men. Acute Alcohol Poisoning Very high blood levels of alcohol can be extremely dangerous. Such levels can be reached by drinking large amounts of alcohol (usually in the form of liquor such as rum or gin) in a short time. People who have overdosed on alcohol become unconscious; their pulse is rapid, their blood pressure is low, and their pupils remain dilated. 20 They require emergency medical care. How to Drink Safely if You Drink] Many of the problems related to alcohol intake can be prevented by not drinking, or drinking responsibly. That means: Not drinking if you are or could become pregnant Not drinking on an empty stomach (which can make you intoxicated surprisingly fast) Slowly sipping rather than gulping drinks Limiting alcohol to an amount that doesn t make you lose control over your mind and body Never driving a car or boat, hunting, or operating heavy equipment while under the influence of alcohol. What Causes Alcoholism? One in 13 adults in the United States abuse alcohol or has alcoholism. 21 Alcoholism tends to run in families, so there is a genetic component to the disease. Its development is also influenced by environmental factors. In general, the younger individuals are when they begin to drink, the greater likelihood that they will develop a drinking problem at some point in life. Individuals who begin drinking before the age of 15, for example, are four times more likely to become alcohol dependent than are people who do not drink before age 21 (Illustration 14.6). Close association with friends or peers who drink, high levels of stress, and availability of alcohol may also increase the risk of alcoholism. 22 Television ads depicting youthoriented parties, fun, and beer may increase underage drinking. 23 Erik

7 Nutrition UP CLOSE Effects of Alcohol Intake FOCAL POINT: Estimating blood alcohol levels and side effects. Scenario: Ligia and Mark attend a wedding reception. Prior to the meal, they both drink a glass of champagne to toast the bride. Fiften minutes later, they drink another glass to toast the groom. Ligia weighs 150 pounds and Mark, 180. Questions: Using the information in Table 14.1 and the information on How the Body Handles Alcohol (p. 14 4), answer the following questions: A. After two glasses of champagne, what would be Ligia s estimated blood alcohol level? % blood alcohol. What would be Mark s? % blood alcohol B. List three side effects of these blood alcohol levels: 1) 2) 3) FEEDBACK (answers to these questions) can be found at the end of Unit 14. Alcohol Use Among Adolescents Alcohol use among adolescents is increasing, and the age when teens begin drinking is going down. Underage drinking accounts for 20% of all the alcohol consumed in the United States. The average age when teens begin drinking is now 14 years. These trends are particularly disturbing because they may lead to higher rates of alcoholism and alcohol-related problems in the near future. 24 Reduction in alcohol intake by adolescents is a major public health initiative of the Year 2010 Health Objectives for the Nation. 25 Much remains to be learned about the prevention of alcohol abuse and alcoholism. Until then treatment programs, such as Alcoholics Anonymous and educational programs that stress safe drinking, will be relied upon to lessen the impact of alcohol abuse on personal and public health. Key Terms alcoholism, page 14-3 fermentation, page 14-2 www links The National Institute on Alcohol Abuse and Alcoholism offers this site for exploration of alcohol and health issues, quick facts, college drinking prevention programs, current research projects, and answers to common questions on alcohol abuse. Search alcohol and get the latest information on alcoholism, treatment programs, taking control, pros and cons of alcohol use, and an alcohol quiz. Information about services for alcoholism available from Alcoholics Anonymous World Service is available at this address. Al-Anon/Alateen alcohol treatment services can be found at this address. This site offers peer-reviewed information on topics including alcoholism, cirrhosis, alcohol and health, alcohol use in pregnancy, alcohol and heart disease, and alcohol use and aggression. Search the word alcohol and be greeted by a large selection of topics related to alcohol: women and alcohol, fetal alcohol syndrome, Alcoholics Anonymous, and alcohol and youth.

8 Notes 1. Alcoholism: getting the facts. National Institute on Alcohol Abuse and Alcoholism. accessed 6/ Di Castelnuovo A et al. Meta-analysis of wine and beer consumption in relation to vascular risk. Circulation 2002;105: Silva ERDE et al. Alcohol consumption raises HDL cholesterol levels by increasing the transport rate of apolipoproteins A-I and A-II. Circulation 2000;102: Di Castelnuovo A et al. Alcohol and coronary heart disease (letter). N Engl J Med 2003;348: Freedman J et al. Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Clin Invest Reports, June Goldberg IJ. To drink or not to drink? N Engl J Med 2003;348: Alcohol Alert. National Institute on Alcohol Abuse and Alcoholism. accessed 6/ Spohr H-L, Willms J, Steinhausen H-C, Prenatal alcohol exposure and long-term developmental consequences, Lancet 1993;241:907 10; and Mattson SN, et al., Heavy prenatal alcohol exposure with or without physical features of fetal alcohol syndrome leads to IQ deficits. J Pediatrics 1997;131: Nutrition UP CLOSE Effects of Alcohol Intake Feedback for Unit 14 A.Ligia s estimated % blood alcohol 0.05%. Mark s estimated % blood alcohol 0.04%. B. Three side effects of these blood alcohol levels: 1. Loss of some control over muscle movements 2. Slowed reaction time 3. Impaired thought processes 9. Committee on Substance Abuse and Committee on Children with Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics 2000;106: Knupfer G, Abstaining for fetal health: the fiction that even light drinking is dangerous, British J Addiction 1991;86: ; and Alcohol Alert, NIAAA ( 11. Wannamethee SG and Shaper AG, Alcohol, body weight, and weight gain in middle-aged men, Am J Clin Nutr 2003;77:1312 7; and Kesse E et al., Do eating habits differ according to alcohol consumption? Am J Clin Nutr 2001;74: Levine JA, et al. Energy expenditure in chronic alcohol abuse. Euro J Clin Invest 2000;30: Kesse et al., Do eating habits differ? and Levine JA, et al. Energy expenditure in chronic alcohol abuse. Euro J Clin Invest 2000;30: Lieber CS. The influence of alcohol on nutritional status. Nutr Rev 1988;46: Klatsky AL. Diet, alcohol, and health: a story of connections, confounders, and cofactors. Am J Clin Nutr 2001;74: Charness ME, Simon RP, Greenberg DA. Ethanol and the nervous system. N Engl J Med 1989;321: Alcohol and your health: the pros and cons. accessed 6/ FAQs on alcohol abuse and alcoholism. National Institution on Alcohol Abuse and Alcoholism. accessed 6/ Alcohol Alert, NIAAA ( 20. Charness et al., Ethanol and the nervous system. 21. FAQs on alcohol abuse, NIAAA ( Grant BR, Dawson DA. Age of onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse 1998;9: Alcohol consumption and expenditures for underage drinking and adult excessive drinking. Alcoholism & Drug Abuse Weekly 2003;15(9): Steinberg B and Vranica S. Brewers are urged to tone down party. Wall Street Journal, 6/23/03, p. B Alcohol consumption and expenditures. 25. Healthy People 2010 Objectives for the Nation. web/health.gov/healthy/people, 2001 Jan.