Alcohol PDF

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Alcohol Learning Objectives -

Describe the term alcohol Describe the absorption and metabolism of alcohol Define a unit of alcohol Describe trends in alcohol intake in the UK population Discuss the problems related to excessive alcohol consumption

What is alcohol? -

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Common term for ethanol o Ethanol is produced when glucose is fermented by yeast o Alcohol content of a drink is controlled by:  The amount of yeast  Length of fermentation o Fruit is used to make wine and cider o Cereals [barley, rye] form the basis of beer and spirits Alcohol is a legalised drug Nutritional value = 7kcal per gram

Absorption -

Some can be absorbed from stomach – called first pass metabolism Small amounts are metabolised by alcohol dehydrogenase [ADH] o Women produce less of this enzyme Once absorbed it spreads rapidly into water body space – diluting the alcohol Small amounts pass unchanged into urine Smaller amounts are excreted in breath Absorption and metabolism can be delayed if taken slowly throughout the course of a meal

Absorption of 1 unit of alcohol -

65kg man – increase in blood alcohol level within first hour by 15mg/100ml 55kg woman – increase in blood alcohol level within first hour by 20mg/100ml Healthy person – alcohol cleared from blood by liver at a constant rate of 15mg/100ml blood per hour Women are less tolerant of alcohol than men o Have lower % of total body water [less dilution of alcohol when it spreads into body fluid] and higher fat stores o Have less alcohol dehydrogenase o On average are smaller and have smaller livers

Metabolism -

Liver is the principle site of alcohol metabolism Principle route is via ADH – converts ethanol  acetaldehyde [toxic] and NADPH o Acetaldehyde is rapidly removed by conversion to acetyl coA [krebs cycle]

o ADH is the rate limiting step in alcohol metabolism  It will always clear at a constant rate – you cannot speed it up

Unit of alcohol -

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One unit = 10ml / 8g of pure alcohol o 25ml whisky [ABV 40%] o 175ml [half a glass] of red wine [ABV 12%] o 1/3 pint of beer [ABV 5-6%] It takes the body 1 hour to remove the alcohol in one unit

Calculation [ABV x volume [ml]] / 1000 = units of alcohol

Alcohol by Volume [ABV] = alcohol content expressed as % of the whole drink - Alcoholic content in similar types of drinks can vary - One pint of strong lager/one large glass of wine can contain more than 3 units

Alcohol in: -

35ml vodka [37.5% ABV] = [37.5 x 25] / 1000 = 1.31 250ml Malibu and pineapple [5% ABV] = 1.25 25ml sherry [15% ABV] = 0.375 568ml Stella [4.8% ABV] = 2.73

Measures and glass sizes -

Spirits – 25ml measures [one unit] o Many pubs now serve 35ml and 50ml measures Large wine glass – 250ml [1/3 bottle] Smaller wine glass – 175ml [can be 125ml]

Alcohol Guidelines Regular drinking -

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Do not regularly drink more than 14 units per week to keep health risks at a low level o If you do drink 14 units, spread it out evenly over 3 or more days o 14 units = 6 pints of beer, 6 glasses of wine, 6 double shots 1 or 2 heavy drinking session increases risk of death from long term illness, and accident/injury The risk of developing a range of illnesses [mouth/throat/breast cancer; heart disease and stroke; liver disease; damage to brain and nervous system] increases with any amount you drink on a regular basis If you wish to cut down the amount you’re drinking – a good way to help achieve this is to have several drink-free days each week

Single drinking episodes -

To keep short term health risks from a single drinking occasion at a low level: o Limit total amount of alcohol drunk on one occasion

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Drink more slowly Stick to single measures Drink with food Alternate with water Avoid risky places and activities Ensure you get home safely

Pregnancy -

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Safest approach is not to drink at all Drinking can lead to long term harm to baby o More alcohol drunk = greater the risk o Risks when drinking above 1-2 units/day include:  Low birth weight  Preterm birth  Being small for gestational age 19% women don’t drink alcohol ever and 40% who do drink normally stop during pregnancy The risk of harm to the baby is low if the woman has only drunk small amounts before she knew she was pregnant o Stop drinking as soon as you find out you are pregnant

Legal limits -

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Drivers in UK o 80mg per 100ml/blood o 35mg per 100ml/breath o 107mg per 100ml/urine It is lower in most other European countries [usually 50mg per 100ml/blood] Functions affected by alcohol when driving: o Brain takes longer to receive messages from eye o Processing information becomes more difficult o Instructions to muscles are delayed  slower reaction times o Blurred and double vision o More likely to take dangerous risks

Statistics [England 2017] -

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57% reported drinking alcohol in the past week 15% drank more than 8/6 units on heaviest drinking day 4% 11-15yrs drank alcohol once a week 5% 11-15yrs drank alcohol once a fortnight 67% 11-15yrs never drank / don’t drink now 91% of current drinkers said their family was aware they drank 2016/17 – 1.1 million alcohol related admissions to hospital 2016/17 – 6813 deaths caused by alcohol o More than 1/10 deaths of people in 40s is from liver disease [mostly alcohol related] Alcohol related harm costs society £21 billion

Dehydration -

One of the main causes of hangover symptoms [e.g. headache] o Because alcohol acts as a diuretic so you urinate more Drink plenty of fluids to rehydrate o Try fruit juice or a smoothie to get a vitamin boost

Obesity -

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Empty calories – no nutritional value o 4 pints of strong lager = 715 calories = cheeseburger and fries Alcohol reduces the amount of fat the body burns for energy Alcohol stimulates your appetite, leading to increased intake of food after drinking  weight gain o It may also weaken the resolve to not over-indulge Alcohol isn’t stored – body gets rid of it as quickly as possible – taking priority over absorbing nutrients [therefore may show higher nutrient deficiencies] and burning fat

Calories -

35ml gin & tonic = 128 35ml dark rum & coke = 141 175ml white wine = 130 175ml red wine

Binge drinking -

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Drinking over the double daily unit guidelines in one session o Men  over 8 units o Women  over 6 units Major factor in accidents, violence and antisocial behaviour Binge drinking is most common among 16-24 yr olds [haven’t discovered ‘limits’ yet] and especially men

Effects -

Balance and coordination Stops breathing Choke on vomit Affects mood and memory

Crime -

Alcohol is a factor in: o 30% sexual offences o 33% burglaries o 50% street crimes

Effects on behaviour -

1-2 units – little effect 3-4 units – feeling of relaxation and mild sedation

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5-6 units – loss of physical/mental coordination, judgement & memory affected 7-8 units – speech slurring; difficulty walking and standing 15-20 units – most people pass out

Impact on nutrition of chronic alcohol abuse -

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Loss of appetite o Poor nutrition [don’t feel like cooking a meal] o Low vitamin C Digestion and absorption impaired o Lower absorption of fat-soluble vitamins [esp K] Depleted zinc levels o Reduced alcohol metabolism o Reduced wound healing and immune function Inflammation of GIT and stomach lining o Vomiting, diarrhoea  electrolyte imbalance o Blood loss  possible iron depletion Liver damage – impaired function o Elevated LDL – increased risk of CHD o Unstable blood sugar levels o Protein synthesis and tissue repair declines Pancreatic inflammation o Reduced production of insulin – loss of control of blood sugar levels Alcohol – diuretic effect o Loss of water-soluble nutrients – esp B complex vits o Folate loss – megoblastic anaemia o Thiamine deficiency - Wernicke-Korsakov syndrome  Required for metabolism of alcohol  Neuropathy affecting hands and feet  Psychological disturbances  Loss of memory  Psychosis

Effect of excessive alcohol consumption -

Depressive or euphoric effects on mental health Rise in blood alcohol levels deteriorates motor and intellectual performance Rise in blood alcohol level leads to low BP, low body temp, drowsiness Death usually results from respiratory depression or the inhalation of vomit

Foetal alcohol syndrome -

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Due to chronic alcohol abuse during pregnancy Leads to: o Intrauterine growth retardation o Facial abnormalities o Cognitive impairment Non reversible condition...