Alcohol and Nutrients PDF

ALCOHOL AND NUTRIENTS 1 Introduction  Alcohol is general term for a collection of organic chemicals with –OH group, having common properties  E.g. ethanol, methanol, isopropanol, etc  Most commonly consumed is ethanol  In this course, alcohol = ethanol...

ALCOHOL AND NUTRIENTS 1 Introduction  Alcohol is general term for a collection of organic chemicals with –OH group, having common properties  E.g. ethanol, methanol, isopropanol, etc  Most commonly consumed is ethanol  In this course, alcohol = ethanol 2  Toxin SEDATIVE E CNS DEPRESSANT N E R G Alcohol Y Psychoactive Nutrient drug 3  Introduction  100% absorption rate  20% in stomach, 80% in small intestines  Mostly metabolized in the liver  Spreads throughout the body, affecting the brain and other tissues, until all have been metabolized An alcoholic is someone with a distinct physical desire to consume alcohol beyond their capacity to control it, regardless of all rules of common sense 4 5 Alcohol and health benefits 1 drink = 12 g ethanol Binge drinking, alcoholics Light to Moderate drinking 6 Alcohol and body systems 7 Upper GIT/food intake  Alcoholics/Binge drinkers: Decreased gastric Loss of Decreased Nausea motility and appetite food intake emptying  Short-term appetite stimulation  Maximum of 1 hour  Additive energy intake may contribute to positive energy balance 8 Upper GIT  Acute ingestion inflames stomach  Hidden bleeding and loss of iron  Upper GIT bleeding due to laceration of the mucosal layer of oesophagus 9 Pancreas  Alcoholism is leading cause of recurrent pancreatitis (pancreatic inflammation)  Results in pancreatic insufficiency  Decrease in pancreatic lipase  Steatorrhea (undigested fat in feces)  Weight loss  Reduction in absorption and utilization of fat- soluble vitamins 10 Small intestines  Experimentally, exposure of small intestinal mucosa to ethanol (0.5-3%) inhibits absorption of amino acids and glucose  Intestinal absorption of thiamin, vitamin B12, and folate is reduced in chronic alcoholic subjects 11 Liver  Largest organ in the body with numerous roles  Main centre for alcohol breakdown (80%)  Alcohol-related liver diseases account for more than a third of liver problems in Western countries 12 Liver: Suggested Mechanisms  Steatosis (fatty liver) Alcoholic hepatitis Cirrhosis  Oxidative stress that results from continuous alcohol breakdown  Inflammation of cells and scarring  Toxins from GIT: damage to intestines by alcohol may lead to increased level of toxins from bacteria in the GIT  Transported to liver  Inflammation and scarring 13 Alcohol metabolism ALCOHOL Alcohol Microsomal dehydrogenase ethanol pathway oxidizing system (ADH) (MEOS) Acetaldehyde 14 Steatosis  Occurs after a short time of moderate drinking, reversible Aldehyde dehydrogenase NADH Acetaldehyde Acetic acid CO2 + H2O ↑NADH/NAD Fatty acid Triglyceride + ratio synthesis accumulation 15 Alcoholic hepatitis Liver cirrhosis  Inflammation (swelling),  Inflammation of cellular hardening hepatocytes (scars), loss of liver architecture  Cytokines induce cell  Acetaldehyde stimulates death collagen deposition  Genetic disposition plays  Symptoms include a role jaundice, liver enlargement, pain  Can lead to liver failure 16 Effect of alcohol on nutrients 18  Altered hepatic metabolism due to alcohol affects the utilization of nutrients  Most proven effects are related to excessive intakes  Small amounts of acetaldehyde can cause nausea, headache, palpitation, decrease in BP in humans 19 Magnesium  Increased excretion in urine among alcoholics  Decreases response to the parathyroid hormone  Sudden decrease in BP, cardiac arrest Severe alcoholics: 1.29 ± 0.27 mgEq/L Controls: 1.91 ± 0.20 mgEq/L 20 Zinc  Inadequate intake  Decreased intestinal absorption and increased excretion due to low levels of albumin  Alcoholic excretion: 884 ± 139 µg/day  Normal excretion: 457 ± 120 µg/day   Effects:  Altered taste and smell  Altered cell-mediated immunity  Impaired wound healing 21 Vitamin A  Mainly due to  Effect on zinc  Retinol and ethanol having similar pathways partially  Zinc deficiency affects:  Synthesis of retinol-binding protein  Conversion of retinol to retinal 22 Thiamin  Deficiency is common among alcoholics  Inadequate intake  Decreased absorption  Increased calorie:thiamin ratio  Effects:  Significant defects in judgment and concentration  Wernicke-Korsakoff syndrome - emergency condition ○ Psychosis, altered consciousness ○ Ataxia (failure of muscular coordination), esp. eyes  Severe forms or insufficiently treated ones can result in permanent amnesia and ataxia 23 Folate  May be the most common vitamin deficiency among alcoholics  Due to:  Poor diet  Malabsorption  Increased urinary loss due to reduced renal re- absorption  Oxidative catabolism caused by acetaldehyde  Effect: anaemia, poor cell division regulation 24 Pyridoxine  Deficiency symptoms occur among chronic alcoholics  Due to:  Suppression of the function of pyridoxal phosphatase  Acetaldehyde displaces pyridoxal-5-phosphate, active form of vitamin from its protein binder  Results in increased excretion in urine  Effect:  Anaemia, withdrawal, convulsions 25 Nutrition therapy of chronic alcoholics 26  Prevailing conditions to note:  Danger of protein deficiency  Deficiencies of some minerals  Deficiencies of B-vitamins Nutrient Not drinking Drinking Energy (kcal/day) 2800 850 Protein (g/day) 105 35 Thiamin (mg/day) 1.6 0.5 Riboflavin (mg/day) 2 0.2 Nicotinic acid (mg/day) 17 6  Depletion depends on  Length of drinking  Amount of food eaten during drinking periods  Amount of food eaten when not drinking 27  Treatment usually includes intravenous and oral fluids, high protein, mineral, vitamin mix therapy  E.g. as much as 100 mg B6 per day to reduce withdrawal symptoms, 50 mg thiamin for neurological disorders and ataxia  Regular consultation for dietary advice is useful 28