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Alcohol and nutrition

By Betty Kovacs MS RD
The next time you reach for a cocktail before your meal, consider if it’s worth the weight that you could be gaining from it. Research has shown a 20% increase in calories consumed at a meal when alcohol was consumed before the meal. There was a total caloric increase of 33% when the calories from the alcohol were added. Along with the increase in weight, you can have an increased risk to your health because of where you gain the weight. A study of over 3,000 people showed that consuming elevated amounts of alcohol is associated with abdominal obesity in men. Many people joke about this being a “beer belly.” Unfortunately, a “beer belly” puts you at an increased risk for type 2 diabetes, elevated blood lipids, hypertension, and cardiovascular disease.
The late-night munchies are often associated with a night of drinking. Have you ever realized that any time that you drink alcohol you are hungrier or you end up eating more than usual? Studies have shown that in the short term, alcohol consumption stimulates food intake and can also increase feelings of hunger. Having your judgment impaired and stimulating your appetite is a recipe for failure if you are trying to follow a weight-control plan.
The form that alcohol comes in can also be part of the reason why you can gain weight from drinking. This applies to all liquids that contain calories. Research has shown that liquid calories are different than calories consumed from food when it comes to our weight. Imagine eating three to four oranges versus drinking an 8 oz glass of orange juice. The oranges take longer to consume because you need the time to chew, and you may also enjoy the taste and feel more than with drinking the juice, all of which can lead to feeling more satisfied with the food and more aware of the calories being consumed. Being aware of the calories can then lead you to cut back later on in the day, a practice known as leading to what is called dietary compensation. One study compared the effects of 450 kcal from jelly beans versus juice on total caloric intake. They found that people tended to cut back on calories during the day when they had jelly beans, but not when they drank the juice.
Here are some tips for calorie reduction when consuming alcohol:
Have one nonalcoholic drink in between each alcoholic drink.
Select light versions whenever possible. “Light” means fewer calories, but these products are not calorie- or alcohol-free, so you will still need to limit your intake.
Always have food in your stomach before you have a drink.
Keep water available to quench your thirst while you drink alcoholic beverages.
Learn to sip your drink to make it last longer.
How does alcohol affect your blood sugar?
The sugar in our blood, also known as blood glucose, is used for growth and energy. Blood glucose comes from the foods that we eat, the breakdown of the glucose stored in our muscles (glycogen), and it can also be made from other nutrients in the body. The primary hormones involved in maintaining a healthy blood glucose level are insulin and glucagon. Normally, when your blood sugar begins to drop, your body can respond by making more blood sugar or burning up stored sugar. And when your blood sugar begins to rise, additional insulin is secreted to bring your levels back to a healthy range.
Alcohol is considered a poison by your body, and all efforts are made to excrete it, including the cessation of maintaining healthy blood glucose levels. Studies have shown that alcohol interferes with all three sources of glucose and the hormones needed to maintain healthy blood glucose levels. The greatest impact is seen in those who drink heavily on a frequent basis. Heavy drinkers deplete their glycogen stores within a few hours when their diet does not provide a sufficient amount of carbohydrates. Over time, excessive alcohol consumption can decrease insulin’s effectiveness, resulting in high blood sugar levels. One study showed that 45%-70% of people with alcoholic liver disease had either glucose intolerance or diabetes.
Alcohol can also negatively impact blood sugar levels each time that it is consumed, regardless of the frequency of consumption. Research has shown that acute consumption increases insulin secretion, causing low blood sugar (hypoglycemia), and can also impair the hormonal response that would normally rectify the low blood sugar. Drinking as little as 2 ounces of alcohol on an empty stomach can lead to very low blood sugar levels. This makes alcohol an even bigger problem for anyone with diabetes. Along with the impact on blood sugar, studies have also shown that alcohol can impact the effectiveness of the hypoglycemic medications, so extreme caution needs to be taken when consuming alcohol by anyone with diabetes.
There is also an increased risk of problems when combining exercise and alcohol. It is not uncommon for people to go out for a drink after playing sports (for example, hockey, soccer, tennis) or to consume some alcoholic beverages while playing. Your blood sugar levels naturally drop during exercise, and your body is working on replacing your glycogen stores once you are finished. Consuming alcohol during this time will halt this process and can cause blood sugar levels to stay at an unhealthy level.
Alcohol can wreak havoc on a system that is in place for your health and well-being. Excessively low or high blood sugar levels have long-term consequences. If you choose to consume alcohol, here are some tips to help avoid this problem.
Never drink on an empty stomach.
Start with nonalcoholic beverages to satisfy your thirst and continue to have one available while you consume alcohol.
Limit the amount that you drink.
You can make a drink last longer and lower the impact that it will have on your blood sugars by having a wine spritzer.
If you have diabetes, speak with your physician about how alcohol will affect your medication(s).
Consume beverages without alcohol during and after exercise.
Does alcohol cause nutritional deficiencies?
When alcohol replaces foods in a person’s diet, the decreased intake of nutrients can cause primary malnutrition. Consuming too little of any of the essential nutrients (protein, carbohydrates, fats, vitamins, and/or minerals) can lead to deficiencies and health problems. Deficiencies can also occur because alcohol and its metabolism prevent the body from properly absorbing, digesting, and using the essential nutrients in your body. Unfortunately, deficiency signs only occur in when your body is extremely depleted so by the time you find out about the deficiency, you are already suffering the health consequences.
The following are common deficiencies brought on by alcohol consumption.
Vitamin B1 (thiamine)
Vitamin B1 is found in many foods, including cereal grains, beans, nuts, yeast, and meat. In the body, high concentrations are found in skeletal muscles and in the liver, brain, kidney, and heart. In the tissues, thiamine is required for the building and functioning of several enzymes. These enzymes are important for the breakdown of sugar molecules into other types of molecules, production of certain brain chemicals (for example, neurotransmitters), the production of several other essential molecules, and maintaining the body’s ability to defend against free radicals.
Alcohol rapidly reduces thiamine levels in people who chronically use it. An unbalanced diet and alcohol’s impact on absorption, storage, activation, and excretion of thiamine are thought to be the reasons this occurs. Beriberi is the disease caused by vitamin B1 (thiamine) deficiency. The two major types of beriberi are wet and dry beriberi. Wet beriberi affects the cardiovascular system, and dry beriberi affects the nervous system. Early symptoms of thiamine depletion include weakness, fatigue, and emotional disturbance. As this continues, the deficiency leads to beriberi with cardiac failure, neuropathy, or peripheral edema. Wernicke syndrome and Korsakoff syndrome are related disorders that often occur with dry beriberi. Wernicke’s syndrome, also known as Wernicke’s encephalopathy, is a neurological disease characterized by the clinical triad of confusion, the inability to coordinate voluntary movement (ataxia), and eye (ocular) abnormalities. Korsakoff’s syndrome is a mental disorder characterized by disproportionate memory loss in relation to other mental aspects. When these two disorders occur together, the term Wernicke-Korsakoff syndrome is used. Unfortunately, the symptoms are only seen in 16%-20% of patients. For this reason, it is missed in 75%-80% of cases and not detected until after death if an autopsy is done.
As long as alcohol consumption continues, it is difficult to know how much thiamine to give to correct the deficiency because the alcohol will continue to interfere with thiamine being properly absorbed and converted to its active form. The recommended dietary allowances (RDA) for thiamine are: men 14 years and older, 1.2 mg, and women over 18 years, 1.1 mg. In people who have or are at risk of thiamine deficiency, 50 milligrams of thiamine may be taken by mouth daily, and in severe cases, doses of 50-100 milligrams of thiamine may be injected into the vein three to four times daily. Consult with your physician if you’re at risk and in need of treatment for a deficiency in thiamine.
Folate
Folate is a B vitamin that has received a great deal of attention for its health benefits. Most notably is the risk of birth defects and cancer with an inadequate intake. Folate helps produce and maintain new cells. It is found in a wide variety of foods, including vegetables (spinach, asparagus, and Brussels sprouts are highest), nuts, beans, peas, fruits and fruit juices, meat (liver is highest), eggs, seafood, yeast, and dairy products.
Alcohol interferes with dietary folate intake, folate absorption, transport of folate to necessary tissues, and the storage and release of folate by the liver. Research has shown that even moderate alcohol consumption (8 fluid ounces of wine per day or 2.7 fluid ounces of vodka) over 2 weeks can significantly decrease serum folate concentration in healthy men. In the Nurses’ Health Study, women who consumed one alcoholic drink a day or more and had the highest levels of folate in their blood were 90% less likely to develop breast cancer than those who had the lowest levels of it.
The RDA for folate for men and women over 18 years old is 400 mcg. A well-balanced diet is typically enough to meet this. There are no clear guidelines for how much folate you need to take if you consume alcohol. One study suggested that 600 micrograms a day of folate could counteract the effect of moderate alcohol consumption on breast cancer risk. High levels can mask B12 deficiency. As long as you continue to consume alcohol, you can alter your levels regardless of how much you are taking.

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