Alcohol and Nutrients Overview

Alcohol and Nutrients

• Alcohol is a general term for organic chemicals with a –OH group, with common properties. Ethanol is the most commonly consumed type. This course will use "alcohol" to refer specifically to ethanol.
• Alcohol is absorbed 100% in the small intestines (80%) and stomach (20%).
• Alcohol is mostly metabolized in the liver.
• Alcohol spreads throughout the body, impacting the brain and other tissues, until metabolized.
• Alcohol acts as a toxin, sedative, and CNS depressant, in addition to being a psychoactive drug, and a source of energy.

Introduction

• Alcohol is a broad term.
• It's commonly consumed in the form of ethanol.
• An alcoholic has an overwhelming desire for alcohol beyond their ability to control it. This is regardless of common sense.

Upper GIT/Food Intake

• Alcoholics/Binge drinkers: Reduced gastric motility (movement) and emptying, nausea, and loss of appetite lead to decreased food intake.
• Short-term appetite stimulation occurs, peaking within one hour.
• Increased energy intake through alcohol may create a positive energy balance.

Upper GIT

• Acute alcohol ingestion inflames the stomach.
• This may cause hidden bleeding and iron loss.
• Alcohol can cause upper gastrointestinal bleeding due to damage to the esophageal lining.

Pancreas

• Alcoholism is a major cause of recurring pancreatitis (inflammation of the pancreas).
• Pancreatic insufficiency results from pancreatitis.
• Pancreatic lipase decreases, leading to steatorrhea (undigested fat in feces) and weight loss.
• Absorption and utilization of fat-soluble vitamins are reduced.

Small Intestines

• Alcohol (0.5-3%) in small intestines reduces amino acid and glucose absorption.
• Thiamin, Vitamin B12, and folate absorption are also reduced for chronic alcoholics.

Liver

• The liver is the largest organ in the body, responsible for numerous roles.
• Alcohol breakdown occurs primarily in the liver, accounting for 80% in the process.
• Alcohol-related liver diseases account for a significant amount of liver problems in Western countries.

Liver: Suggested Mechanisms

• Steatosis (fatty liver) is the first step that leads to alcoholic hepatitis to ultimately lead to cirrhosis.
• Oxidative stress from alcohol breakdown causes cell inflammation and scarring.
• Toxins from the gastrointestinal tract are transported to the liver leading to inflammation and scarring.

Alcohol Metabolism

• Alcohol can be metabolized by the Alcohol dehydrogenase pathway (ADH) and the Microsomal ethanol oxidizing system (MEOS).
• A byproduct of alcohol metabolism is acetaldehyde and the liver further breaks this down into acetic acid.

Steatosis

• Steatosis, or fatty liver, occurs briefly after moderate drinking and is usually reversible.
• Acetaldehyde is converted into acetic acid, leading to fatty acid synthesis and triglyceride accumulation in the liver.

Alcoholic Hepatitis

• Alcoholic hepatitis is inflammation of the liver cells (hepatocytes).
• Cytokines induce cell death.
• Genetic predisposition influences susceptibility.

Liver Cirrhosis

• Inflammation (swelling) and hardening (scarring) of liver cells occur in cirrhosis.
• Liver architecture is lost.
• Acetaldehyde stimulates collagen deposition, leading to scarring.
• Symptoms include jaundice, enlarged liver, pain and can lead to liver failure.

Effect of Alcohol on Nutrients

• Alcohol-related changes in the liver affect nutrient utilization.
• Most significant effects result from heavy alcohol consumption.
• Small amounts of acetaldehyde can cause nausea, headache, palpitation, and decreased blood pressure.

Magnesium

• Increased magnesium excretion in urine in alcoholics.
• Alcohol decreases the response to parathyroid hormone.
• A sudden decrease in blood pressure, and potentially cardiac arrest, could result.

Zinc

• Insufficient zinc intake in alcoholics.
• Reduced intestinal absorption and increased excretion occurs due to low albumin levels.
• Alcohol affects zinc excretion.
• This leads to taste and smell changes.
• Impaired cell-mediated immunity and wound healing occur.

Vitamin A

• Alcohol affects zinc, which partially impacts retinol (Vitamin A) metabolism.
• Alcohol, and zinc deficiency impacts vitamin A metabolism.
• Zinc deficiency affects retinol-binding protein synthesis and the conversion of retinol to retinal.

Thiamin

• Thiamin deficiency is common among alcoholics due to insufficient intake, decreased absorption and increased calorie-to-thiamin ratios.
• Significant cognitive issues and Wernicke-Korsakoff syndrome occur.
• Psychosis, altered consciousness, and ataxia (muscular coordination problems) particularly in the eyes.
• Severe, or untreated cases, may result in permanent amnesia and ataxia.

Folate

• Folate deficiency is prevalent among alcoholics due to poor diet, malabsorption, and increased urinary loss.
• Oxidative catabolism caused by acetaldehyde contributes to the folate loss.
• Deficiency results in anemia and problems with cell division.

Pyridoxine

• Pyridoxine deficiency is common among chronic alcoholics.
• Related to the suppression of pyridoxal phosphatase and the displacement of pyridoxal-5-phosphate (active vitamin form) from its protein binder.
• Excretion of pyridoxine increases due to alcohol-related issues.
• Symptoms include anemia, withdrawal symptoms, and convulsions.

Nutrition Therapy of Chronic Alcoholics

• Treat with intravenous and oral fluids, high protein, minerals, and vitamins.
• Specific supplements to address deficiencies in B vitamins, along with nutritional counselling, is recommended.

Prevailing Conditions

• Danger of significant protein deficiency.
• Deficiencies of other minerals.
• Deficiencies of B vitamins in these individuals.

Nutrient Depletion

• Depletion depends on length of alcohol consumption, and the amount of food consumed during and between drinking periods.

Treatment

• Includes intravenous and oral fluids, along with a high protein, mineral and vitamin mix.
• High Vitamin B6 (pyridoxine, 100mg/day) and 50mg thiamin (for neurological issues and ataxia).
• Regular consultation with a dietician/nutritionist is crucial.