Alcohol impairs and inhibits proper breakdown and digestion of
nutrients. Even if nutrients are digested and absorbed, alcohol prevents
full utilization by altering food transport, storage, and excretion.
Nutrition is a process that serves two purposes: to provide energy
and to maintain body structure and function. Food supplies energy and
provides the building blocks needed to replace worn or damaged cells and
the nutritional components needed for body function. Alcoholics often
eat poorly, limiting their supply of essential nutrients and affecting
both energy supply and structure maintenance. Furthermore, alcohol
interferes with the nutritional process by affecting digestion, storage,
utilization, and excretion of nutrients.
Impairment of Nutrient Digestion and Utilization
Once ingested, food must be digested (broken down into small
components) so it is available for energy and maintenance of body
structure and function. Digestion begins in the mouth and continues in
the stomach and intestines, with help from the pancreas. The nutrients
from digested food are absorbed from the intestines into the blood and
carried to the liver. The liver prepares nutrients either for immediate
use or for storage and future use.
Alcohol inhibits the breakdown of nutrients into usable molecules by
decreasing secretion of digestive enzymes from the pancreas. Alcohol
impairs nutrient absorption by damaging the cells lining the stomach and
intestines and disabling transport of some nutrients into the blood. In
addition, nutritional deficiencies themselves may lead to further
absorption problems. For example, folate deficiency alters the cells
lining the small intestine, which in turn impairs absorption of water
and nutrients including glucose, sodium, and additional folate.
Even if nutrients are digested and absorbed, alcohol can prevent them
from being fully utilized by altering their transport, storage, and
excretion. Decreased liver stores of vitamins such as vitamin A, and
increased excretion of nutrients such as fat, indicate impaired
utilization of nutrients by alcoholics.
Alcohol and Energy Supply
The three basic nutritional components found in food--carbohydrates,
proteins, and fats--are used as energy after being converted to simpler
products. Some alcoholics ingest as much as 50 percent of their total
daily calories from alcohol, often neglecting important foods.
Even when food intake is adequate, alcohol can impair the mechanisms
by which the body controls blood glucose levels, resulting in either
increased or decreased blood glucose (glucose is the body's principal
sugar). In non-diabetic alcoholics, increased blood sugar, or
hyperglycemia--caused by impaired insulin secretion--is usually
temporary and without consequence. Decreased blood sugar, or
hypoglycemia, can cause serious injury even if this condition is short
lived. Hypoglycemia can occur when a fasting or malnourished person
consumes alcohol. When there is no food to supply energy, stored sugar
is depleted, and the products of alcohol metabolism inhibit the
formation of glucose from other compounds such as amino acids. As a
result, alcohol causes the brain and other body tissue to be deprived of
glucose needed for energy and function.
Although alcohol is an energy source, how the body processes and uses
the energy from alcohol is more complex than can be explained by a
simple calorie conversion value. For example, alcohol provides an
average of 20 percent of the calories in the diet of the upper third of
drinking Americans, and we might expect many drinkers who consume such
amounts to be obese. Instead, national data indicate that, despite
higher caloric intake, drinkers are no more obese than nondrinkers.
Also, when alcohol is substituted for carbohydrates, calorie for
calorie, subjects tend to lose weight, indicating that they derive less
energy from alcohol than from food.
The mechanisms accounting for the apparent inefficiency in converting
alcohol to energy are complex and incompletely understood, but several
mechanisms have been proposed. For example, chronic drinking triggers an
inefficient system of alcohol metabolism, the microsomal
ethanol-oxidizing system (MEOS). Much of the energy from MEOS-driven
alcohol metabolism is lost as heat rather than used to supply the body
with energy.
Alcohol and the Maintenance of Cell Structure and Function
Structure
Because cells are made mostly of protein, an adequate protein diet is
important for maintaining cell structure, especially if cells are being
damaged. Research indicates that alcohol affects protein nutrition by
causing impaired digestion of proteins to amino acids, impaired
processing of amino acids by the small intestine and liver, impaired
synthesis of proteins from amino acids, and impaired protein secretion
by the liver.
Function
Nutrients are essential for proper body function; proteins, vitamins,
and minerals provide the tools that the body needs to perform properly.
Alcohol can disrupt body function by causing nutrient deficiencies and
by usurping the machinery needed to metabolize nutrients.
Vitamins
Vitamins are essential to maintaining growth and normal metabolism
because they regulate many physiological processes. Chronic heavy
drinking is associated with deficiencies in many vitamins because of
decreased food ingestion and, in some cases, impaired absorption,
metabolism, and utilization. For example, alcohol inhibits fat
absorption and thereby impairs absorption of the vitamins A, E, and D
that are normally absorbed along with dietary fats. Vitamin A deficiency
can be associated with night blindness, and vitamin D deficiency is
associated with softening of the bones.
Vitamins A, C, D, E, K, and the B vitamins, also deficient in some
alcoholics, are all involved in wound healing and cell maintenance. In
particular, because vitamin K is necessary for blood clotting,
deficiencies of that vitamin can cause delayed clotting and result in
excess bleeding. Deficiencies of other vitamins involved in brain
function can cause severe neurological damage.
Minerals
Deficiencies of minerals such as calcium, magnesium, iron, and zinc
are common in alcoholics, although alcohol itself does not seem to
affect the absorption of these minerals. Rather, deficiencies seem to
occur secondary to other alcohol-related problems: decreased calcium
absorption due to fat mal-absorption; magnesium deficiency due to
decreased intake, increased urinary excretion, vomiting, and diarrhea;
iron deficiency related to gastrointestinal bleeding; and zinc
mal-absorption or losses related to other nutrient deficiencies. Mineral
deficiencies can cause a variety of medical consequences from
calcium-related bone disease to zinc-related night blindness and skin
lesions.
Nutritional Status of Alcoholics
Techniques for assessing nutritional status include taking body
measurements such as weight, height, mass, and skin fold thickness to
estimate fat reserves, and performing blood analysis to provide
measurements of circulating proteins, vitamins, and minerals. These
techniques tend to be imprecise, and for many nutrients, there is no
clear "cut-off" point that would allow an accurate definition
of deficiency. As such, assessing the nutritional status of alcoholics
is hindered by the limitations of the techniques. Dietary status may
provide inferential information about the risk of developing nutritional
deficiencies. Dietary status is assessed by taking patients' dietary
histories and evaluating the amount and types of food they are eating.
A threshold dose above which alcohol begins to have detrimental
effects on nutrition is difficult to determine. In general, moderate
drinkers (two drinks or less per day) seem to be at little risk for
nutritional deficiencies. Various medical disorders begin to appear at
greater levels.
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