Alcohol and Nutrition

Question 1

What are some things that can influence the impact alcohol has on health?

Answer 1

Dose of alcohol, potential interactions with nutrients, duration and pattern of consumption

Question 2

Where does absorption of alcohol take place?

Answer 2

The stomach (20%), small intestines (passive diffusion)

Question 3

Where is the site of primary alcohol metabolism?

Answer 3

The liver

Question 4

What does the liver do to alcohol?

Answer 4

Removes it from the blood through oxidation to prevent accumulation (limits cell death and organ damage)

Question 5

When does Blood Alcohol Concentration (BAC) peak?

Answer 5

About 30-60 mins after consumption

Question 6

What are some factors that can influence BAC?

Answer 6

Gender, race, chronic alcohol consumption, drinking pattern, medication, food consumption

Question 7

What are the physiological processes that influence BAC?

Answer 7

Absorption, distribution, metabolism, excretion

Question 8

Why does controlling rate of consumption limit BAC?

Answer 8

Gives the liver time to metabolise the alcohol

Question 9

What is the only way to remove alcohol from the blood?

Answer 9

Time

Question 10

How does food influence peak BAC?

Answer 10

Food reduces absorption and speeds up elimination, slows gastric emptying and may bind to alcohol

Question 11

How does feeding affect portal blood flow and how does this impact alcohol metabolism?

Answer 11

Increases portal blood flow which causes faster metabolism of alcohol

Question 12

What does a slower and prolonged absorption phase do?

Answer 12

Increases first pass metabolism, causing metabolising enzymes to not be fully saturated

Question 13

Why does alcohol lead to weight gain?

Answer 13

Consistent failure to compensate for energy ingested as alcohol, and alcohol tends to increase food intake when taken around meals

Question 14

What type of drinking is likely to result in weight gain?

Answer 14

Heavy and binge drinking

Question 15

What are some tips for calorie reduction?

Answer 15

Have one non-alcoholic drink in between each alcoholic drink, select light versions, always have food in your stomach before you drink, learn to sip, keep water available

Question 16

Why does alcohol lower food intake?

Answer 16

Replaces food, alters appetite

Question 17

How does alcohol impact metabolism and digestion?

Answer 17

Decreases secretion of pancreatic enzymes and bile, ethanol metabolism requires micronutrients

Question 18

How does alcohol affect nutrients?

Answer 18

Decreases liver stores of vitamins and increases secretion

Question 19

How does alcohol impact absorption?

Answer 19

Damages the cells lining the stomach and small intestine

Question 20

What is thiamine?

Answer 20

Water soluble essential nutrient phosphorylated in gut to active coenzyme form

Question 21

What is the active coenzyme form of thiamine involved in?

Answer 21

ATP production, normal nerve conduction and maintenance of neural membranes

Question 22

Why do thiamine levels decline due to chronic alcohol use?

Answer 22

Poor intake, decreased conversion to co-enzyme, reduced storage in fatty liver, inhibited intestinal absorption, increased metabolic demand

Question 23

What are the clinical signs of thiamine deficiency?

Answer 23

Dry beriberi, wet beriberi, Wernicke-Korsakoff syndrome

Question 24

What is dry beriberi?

Answer 24

Condition that affects the nervous system-polyneuropathy, weakness, numbness, paralysis, usually lower limbs

Question 25

What is wet beriberi?

Answer 25

Condition that affects the CV system=increased HR, SOB, high output cardiac failure

Question 26

Are the symptoms of thiamine deficiency common?

Answer 26

No-only seen in 16-20%of patients so often missed

Question 27

What are some other water soluble vitamins alcoholics are often deficient in?

Answer 27

Folate and B12 (megaloblastic anaemia due to impaired metabolism), Niacin

Question 28

Why does vitamin A deficiency occur in alcoholics?

Answer 28

The storage and synthesis of retinol binding protein is abnormal which reduces plasm retinol levels (causes night blindness)

Question 29

What can calcium deficiency cause and how does it arise?

Answer 29

Increased urinary excretion-leads to osteoporosis

Question 30

What are some signs of zinc deficiency?

Answer 30

Lesions around eyes, nose and mouth, impaired wound healing/liver regeneration/mental status/immune function

Question 31

How does nutritional support help malnourished patients?

Answer 31

Improves nutritional parameters, liver function, reduces length of hospitalisation and complications of liver disease, improves outcomes of hospitalisation/surgery/transplantation

Question 32

What type of drinking has the highest risk of CVD?

Answer 32

Heavy drinking

Question 33

What cancers is alcohol linked to?

Answer 33

Breast, bowel, liver, mouth/throat, oesophageal, stomach

Question 34

What are some mechanisms for alcohol leading to cancer?

Answer 34

Acetaldehyde is carcinogenic, it’s a solvent (makes it easier for carcinogens to enter cells), combined effect with oestrogen

Question 35

Why do deficiencies in essential nutrients increase the risk of cancer?

Answer 35

Makes tissues more susceptible to carcinogenesis

Question 36

How are tobacco and alcohol synergistic carcinogens?

Answer 36

Tobacco induces specific mutations in DNA that are less efficiently repaired in the presence of alcohol

Question 37

What three things regulate blood glucose?

Answer 37

The food we eat, the breakdown of glycogen stores and gluconeogenesis

Question 38

How much alcohol can cause low blood sugar on an empty stomach?

Answer 38

2 ounces

Question 39

What is the effect of chronic alcohol consumption on insulin’s effectiveness?

Answer 39

Decreases insulin’s effectiveness, resulting in hypoglycaemia

Question 40

What are the risks of drinking alcohol in the first trimester?

Answer 40

Risk of miscarriage, higher rate of premature birth

Question 41

How much alcohol induces a risk to a foetus?

Answer 41

Above 1-2 units a day

Question 42

What are some features of foetal alcohol disorders?

Answer 42

Abnormal appearance, stunting, low body weight and head size, poor co-ordination, low intelligence, behavioural problems, sight/hearing problems

Question 43

What are some features of Foetal Alcohol syndrome (FAS)?

Answer 43

Physical/mental/behavioural problems, learning difficulties, most severe form of disorder

Question 44

What effect can large volumes of alcohol have on a baby (>2units/day)?

Answer 44

Drowsiness, deep sleep, weakness, abnormal weight gain

Question 45

How do the livers of babies and new-borns differ from those of adults?

Answer 45

New-borns have immature liver so will be more affected, up until 3 months of age infants metabolise alcohol at 50% the rate of adults

Question 46

What are some considerations for a mother to have when drinking?

Answer 46

How much they weight (heavier people metabolise alcohol faster), the amount of alcohol, will they be eating (food decreases absorption rate of alcohol into bloodstream)