Nightingale College Chapter 7 Measures to Control Weight Gain and Obesity Discussion Discuss ways to lose weight that are safe and healthy. Include the 3 a

Nightingale College Chapter 7 Measures to Control Weight Gain and Obesity Discussion Discuss ways to lose weight that are safe and healthy. Include the 3 areas of life that need to be adjusted for successful, long term weight loss. – 300 words / Attached PDF for cited resources from the book.

2. Is gastric bypass surgery a healthy weight-loss measure for obese adolescents?

Imagine you have an obese child and doctors are recommending surgery. What factors would you consider in deciding whether or not your child should have the surgery?

Do you think rates of gastric surgery among adolescents are likely to increase or decrease in the future? Explain your answer. – no word limit

3. What strategies have taken place to address the overweight and obesity population in the United States especially in children?

After reading about these strategies, discuss ways to address the childhood obesity problem in your own community. – no word limit

Attached PDF for sited resources from the book. CHAPTER 7. ALCOHOL
263
Introduction
Ka wai hoʻomalule kino
The liquid that causes limpness to the body
Image by Allison Calabrese / CC BY 4.0
Learning Objectives
By the end of this chapter, you will be able to:
265
• Describe the process of alcohol metabolism
• Describe the health benefits and health risks associated with alcohol consumption
Alcohol is both a beverage providing some sustenance and a drug. For thousands of years, alcohol has been consumed in
a medicinal, celebratory, and ritualistic manner. It is drunk in just about every country and often in excessive amounts.
Alcohol can be made from a variety of different starch foods through the processes called fermentation. Fermentation of
a starchy food such as barley or wheat can produce ethanol and CO2 which makes up what is commonly known as beer.
The Native Hawaiians distilled a mash of fermented ti roots in iron try-pots pre-colonization in the 1700s. This form of
alcohol was called “Okolehao”. This alcoholic beverage more commonly known today as “moonshine”, is still made locally
in the islands today.1
Alcohol is a psychoactive drug. A psychoactive drug is any substance that crosses the blood-brain barrier primarily
affecting the functioning of the brain, be it altering mood, thinking, memory, motor control, or behavior. Alcohols in
chemistry refer to a group of similar organic compounds, but in beverages the only alcohol consumed is ethanol.
The Behavioral Risk Factor Surveillance System survey reported that more than half of the adult US population drank
alcohol in the past thirty days.2 Of the total population who drank alcohol, approximately 5 percent drank heavily, while
15 percent binge drank. Binge drinking (as defined by the National Institute on Alcohol Abuse and Alcoholism) is when
men consume five or more drinks, and when women consume four or more drinks, in two hours or less.3
Alcohol in excess is detrimental to health; however since its beginnings it has been suspected and promoted as a benefit
to the body and mind when consumed in moderation. In the United States, the Dietary Guidelines define moderate
alcohol intake as no more than one drink per day for women and no more than two drinks per day for men.4 Although
drunkenness has pervaded many cultures, drinking in moderation has long been a mantra of multiple cultures with access
to alcohol.
More than 90 percent of ingested alcohol is metabolized in the liver. The remaining amount stays in the blood and is
eventually excreted through the breath (which is how Breathalyzers work), urine, saliva, and sweat. The blood alcohol
concentration (BAC) is measured in milligrams percent, comparing units of alcohol to units of blood. BAC is a
measurement used legally to assess intoxication and the impairment and ability to perform certain activities, as in driving
a car. As a general rule, the liver can metabolize one standard drink (defined as 12 ounces of beer, 5 ounces of wine,
or 1 ½ ounces of hard liquor) per hour. Drinking more than this, or more quickly, will cause BAC to rise to potentially
unsafe levels. Table 10.1 “Mental and Physical Effects of Different BAC Levels” summarizes the mental and physical effects
associated with different BAC levels.
Table 7.1 Mental and Physical Effects of Different BAC Levels
Introduction | 266
BAC
Percent
Typical Effects
0.02
Some loss of judgment, altered mood, relaxation, increased body warmth
0.05
Exaggerated behavior, impaired judgment, may have some loss of muscle control (focusing eyes), usually good feeling,
lowered alertness, release of inhibition
0.08
Poor muscle coordination (balance, speech, vision, reaction time), difficulty detecting danger, and impaired judgment,
self-control, reasoning, and memory
0.10
Clear deterioration of muscle control and reaction time, slurred speech, poor coordination, slowed thinking
0.15
Far less muscle control than normal, major loss of balance, vomiting
In addition to the one drink per hour guideline, the rate at which an individual’s BAC rises is affected by the following
factors:
• Sex (A woman’s BAC will rise more quickly than a man’s.)
• Weight (BAC will rise more slowly for heavier people.)
• Genetics
• Length of time as a heavy drinker
• Type of alcohol consumed
• Amount of alcohol consumed
• Consumption rate
• Consumption before or after a meal (food in the stomach slows absorption)
• Mixture (carbonated mixers speed absorption)
• Medications may increase the bioavailability of alcohol
Introduction by University of Hawai‘i at Mānoa Food Science and Human Nutrition Program is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International License, except where otherwise noted.
Notes
1.
Will Hoover. Will New ‘Okolehao be your cup of Ti?. Honolulu Advertiser.com http://the.honoluluadvertiser.com/article/2003/Jun/
01/ln/ln05a.html. Published June 1, 2003. Accessed November 10, 2017.
2.
Alcohol and Public Health. Centers for Disease Control and Prevention. http://www.cdc.gov/alcohol/. Updated March 5, 2012.
Accessed October 1, 2017.
3.
Alcohol and Public Health. Centers for Disease Control and Prevention. http://www.cdc.gov/alcohol/. Updated March 5, 2012.
Accessed October 1, 2017.
4.
Alcoholic Beverages.US Department of Agriculture and US Department of Health and Human Services.http://www.health.gov/
DIETARYGUIDELINES/dga2005/document/html/chapter9.htm. Published 2005. Accessed October 5, 2017.
267 | Introduction
Alcohol Metabolism
Image by Serge Esteve on unsplash.com / CC0
Giving the liver enough time to fully metabolize the ingested alcohol is the only effective way to avoid alcohol toxicity.
Drinking coffee or taking a shower will not help. The legal limit for intoxication is a BAC of 0.08. Taking into account the
rate at which the liver metabolizes alcohol after drinking stops, and the alcohol excretion rate, it takes at least five hours
for a legally intoxicated person to achieve sobriety.
Figure 7.1 Alcohol Metabolism Summary
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Image by Allison Calabrese / CC BY 4.0
Ethanol Consumption
Distilled spirits have exceptionally few nutrients, but beer and wine do provide some nutrients, vitamins, minerals, and
beneficial plant chemicals along with calories. A typical beer is 150 kilocalories, a glass of wine contains approximately 80
kilocalories, and an ounce of hard liquor (without mixer) is around 65 kilocalories.
As a person starts drinking alcohol, up to 5% of the ingested ethanol is directly absorbed and metabolized by some of cells
of the gastrointestinal tract (the mouth, tongue, esophagus and stomach). Up to 100% of the remaining ethanol travels in
circulation. This is one reason why blood tests are more accurate in measuring alcohol levels.
The lungs and kidneys will excrete about 2% to 10% of this circulatory ethanol. The more you drink the more quick trips
to the restroom. The human body dehydrates as a result of these frequent trips to the restroom. This dehydration affects
every single cell in your body, including your brain cells. This is the cause of the so-called “morning hangover”. Do not take
Tylenol (acetaminophen). Alcohol metabolism activates an enzyme that transforms acetaminophen into a toxic metabolite
that causes liver inflammation and damage. Liver damage may not be irreversible. Instead, drink water with electrolytes
or sport drinks to rehydrate the body’s cells.
Alcohol is a volatile (flammable) organic substance and can be converted to a gas. The lungs exhale alcohol as a gas. The
more alcohol consumed, the stronger the smell of alcohol in a person’s breathe. Breathalyzer tests measure the exhaled
alcohol levels in the lungs to determine the state of inebriation.
The liver metabolizes up to 85% – 98% of the circulatory ethanol. The liver uses two metabolic processes to get rid of this
circulatory ethanol as quickly and safely as possible.
269 | Alcohol Metabolism
1. Alcohol dehydrogenase system
2. Microsomal ethanol oxidizing system (MEOS)
Alcohol Dehydrogenase System
About 80 to 90% of the total hepatic ethanol uptake is processed via the alcohol dehydrogenase system.The degradation
of ethanol begins in the liver. The enzyme that catalyzes this reaction is called alcohol dehydrogenase. The products
from this reaction are acetaldehyde, NADH (a reduced coenzyme that carries electrons from one reaction to another)
and H+ ion. Acetaldehyde is very toxic to the liver and the body’s cells. The moment acetaldehyde is produced; it must
be degraded to protect the liver cells. The enzyme that will carry this type of degradation reaction is acetaldehyde
dehydrogenase (ALDH). Acetaldehyde dehydrogenase converts acetaldehyde into acetate, a non-toxic molecule.
Microsomal Ethanol Oxidizing System (MEOS)
In a moderate drinker, about 10 to 20% of the total liver ethanol uptake is processed via the microsomal ethanol oxidizing
system (MEOS). During periods of heavy drinking, the MEOS system will metabolize most of the excess ethanol ingested.
Heavy drinking stimulates the human body to include the MEOS system enzymes to clear ethanol faster from the body.
The MEOS system is also located in the liver. Similar to the Alcohol dehydrogenase system, acetaldehyde dehydrogenase
will immediately convert acetaldehyde into acetate, a non-toxic molecule. Other products from this reaction are NADH
and H+ ion.
Fate of Acetate
The acetate produced (from the alcohol dehydrogenase system and microsomal ethanol oxidizing system) is either
released into circulation or retained inside the liver cells. In the liver cells, acetate is converted to acetyl CoA where it is
used to produce other molecules like CO2 or used in the synthesis of fatty acids and cholesterol.
Alcohol Metabolism by University of Hawai‘i at Mānoa Food Science and Human Nutrition Program is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International License, except where otherwise noted.
Alcohol Metabolism | 270
Health Consequences of Alcohol Abuse
Alcoholic drinks in excess contribute to weight gain by substantially increasing caloric intake. However, alcohol displays
its two-faced character again in its effects on body weight, making many scientific studies contradictory. Multiple studies
show high intakes of hard liquor are linked to weight gain, although this may be the result of the regular consumption
of hard liquor with sugary soft drinks, juices, and other mixers. On the other hand drinking beer and, even more so, red
wine, is not consistently linked to weight gain and in some studies actually decreases weight gain. The contradictory
results of scientific studies that have examined the association of alcohol intake with body weight are partly due to
the fact that alcohol contributes calories to the diet. When alcohol is drunk in excess, it reduces the secretion of
pancreatic juice and damages the lining of the gastrointestinal system, impairing nutrient digestion and absorption.
The impaired digestion and absorption of nutrients in alcoholics contributes to their characteristic “skinniness” and
multiple associated micronutrient deficiencies. The most common macronutrient deficiency among alcoholics is water,
as it is excreted in excess. Commonly associated micronutrient deficiencies include thiamine, pyridoxine, folate, vitamin
A, magnesium, calcium, and zinc. Furthermore, alcoholics typically replace calories from alcohol with those of nutritious
foods, sometimes getting 50 percent or more of their daily caloric intake from alcoholic beverages.
Effects of Alcohol Abuse on the Brain
A small amount (up to 10%) of the liver acetaldehyde may accumulate inside the liver cells. As more alcohol is ingested,
this stimulates the production of acetaldehyde by both the alcohol dehydrogenase and MEOS systems. As the levels of
acetaldehyde increase inside the liver cells with heavy consumption of alcohol, some of the acetaldehyde diffuse into
the blood circulation. In circulation, high levels of acetaldehyde cause nausea and vomiting. Vomiting causes more body
dehydration and loss of electrolytes. If the dehydration becomes severe enough, this can impair brain function and a
person may lose consciousness.
Alcohol can adversely affect nearly every area of the brain. When BAC rises, the central nervous system is depressed.
Alcohol disrupts the way nerve cells communicate with each other by interfering with receptors on certain cells. The
immediate impact of alcohol on the brain can be seen in the awkwardly displayed symptoms of confusion, blurred vision,
slurred speech, and other signs of intoxication. These symptoms will go away once drinking stops, but abusive alcohol
consumption over time can lead to long-lasting damage to the brain and nervous system. This is because alcohol and its
metabolic byproducts kill brain cells.
Effects of Excessive Alcohol on the Liver
Alcohol stimulates the release of epinephrine from the kidneys. Epinephrine binds to receptors in the liver cells to
stimulate the release of glucagon from the pancreas. Glucagon and epinephrine stimulate glycogenolysis in the liver cells.
Epinephrine also stimulates the breakdown of triglycerides and glycerol into free fatty acids in adipose tissue and are
released into the bloodstream and travel to the liver.
A portion of these triglycerides are stored in the liver cells; while, the remainder of these triglycerides are converted to
very low density lipoprotein (VLDL). The increased accumulation of both stored triglycerides and VLDL particles inside
271
the liver cells causes a condition called fatty liver or hepatic steatosis. This can impair normal liver function. The more
alcohol consumed, the more lipids produced and stored inside the liver cells. These effects are cumulative over time.
According to the CDC, 14,406 Americans died from alcohol-related liver diseases in 2007. Although not every alcoholic
or heavy drinker will die from liver problems, the liver is one of the body’s main filtering organs and is severely stressed
by alcohol abuse. The term Alcoholic Liver Disease (ALD) is used to describe liver problems linked to excessive alcohol
intake. ALD can be progressive, with individuals first suffering from a fatty liver and going on to develop cirrhosis. It is
also possible to have different forms of ALD at the same time.
Figure 7.2 Liver Cirrhosis
Cirrosi Micronodular by Amanda Alvarez / CC BY SY 4.0
Excessive alcohol consumption causes the destruction of liver cells. In an attempt to repair itself, the liver initiates an
inflammatory and reparation process causing scar tissue to form. In the liver’s attempt to replace the dead cells, surviving
liver cells multiply. The result is clusters of newly formed liver cells, also called regenerative nodules, within the scar
tissue. This state is called cirrhosis of the liver.
The three most common forms of ALD are:
• Fatty liver. A rather benign disorder that develops after excessive alcohol consumption; however it can progress to
more fatal diseases. Fatty liver is reversible if alcohol use is brought under control.
• Alcoholic hepatitis. The symptoms of this alcohol-induced liver inflammation are a swollen liver, abdominal pain,
nausea, fever, jaundice, and vomiting. Although linked to alcohol use, even people who drink moderately can
sometimes develop this condition, and not all alcohol abusers do. If a person stops drinking alcohol, the liver
damage can be reversed. But if they continue, cirrhosis may develop and death can result.
• Cirrhosis. This serious and sometimes fatal form of ALD develops when liver cells die and form scar tissue, which
blocks blood flow and causes wastes and toxins to build up in the system. Strictly speaking, cirrhosis cannot be
cured. It can, however, be stopped with medical treatment and complications can be managed if the individual stops
Health Consequences of Alcohol Abuse | 272
drinking, and many do survive. Not all cases of cirrhosis are strictly due to alcoholism, and not all alcoholics develop
the disease. Symptoms of cirrhosis include the buildup of abdominal fluid (ascites), abdominal pain, fever, thirst,
confusion, and fatigue.
Figure 7.3 The Progression of ALD
Stages of Liver Damage by National Digestive Diseases Information Clearinghouse / Public Domain
As the liver cells release VLDL particles into circulation, this increases the levels of VLDL particles in blood. As VLDL
particles continue to accumulate in blood, this cause a condition called hyperlipidemia. In their journey through
circulation, VLDL particles are eventually degraded to low density lipoproteins (LDL) particles. LDL particles are also
known as “bad cholesterol”. Higher levels of LDL particles in circulation lead to the build-up of cholesterol deposition
plaques inside the walls of the blood vessels (known as atherosclerosis). These plaques can impair or stop blood flow to
the cells. If an artery is blocked, the cells cannot make enough energy and eventually stop working. If the artery remains
blocked for more than a few minutes, the cells may die. When a cardiac artery is blocked, this causes a heart attack
(acute myocardial infarction). Depending on the length and severity of the blockage, damage to the cardiac cells may be
permanent and irreversible. Once the heart structure and function is compromised, the more susceptible a patient would
be to suffer a second heart attack.
Health Consequences of Alcohol Abuse by University of Hawai‘i at Mānoa Food Science and Human Nutrition Program is licensed under a Creative
Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.
273 | Health Consequences of Alcohol Abuse
Health Benefits of Moderate Alcohol Intake
In contrast to excessive alcohol intake, moderate alcohol intake has been shown to provide health benefits. The data
is most convincing for preventing heart disease in middle-aged and older people. A review of twenty-nine studies
concluded that moderate alcohol intake reduces the risk of coronary heart disease by about 30 percent in comparison to
those who do not consume alcohol.1
Several other studies demonstrate that moderate alcohol consumption reduces the incidences of stroke and heart
attack, and also death caused by cardiovascular and heart disease. The drop in risk for these adverse events ranges
between percent. Moreover, there is some scientific evidence that moderate alcohol intake reduces the risk for metabolic
syndrome, Type 2 diabetes, and gallstones. In addition to providing some health benefits, moderate alcohol intake also
serves as a digestive aid, a source of comfort and relaxation, and inducing social interactions, thereby benefiting all
aspects of the health triangle. It has not been clearly demonstrated that moderate alcohol consumption benefits younger
populations, and the risks of any alcohol consumption do not outweigh the benefits for pregnant women, those who are
taking medications that interact with alcohol, and those who are unable to drink in moderation.
The Reality
Alcohol is a diuretic that results in dehydration. It suppresses the release of antidiuretic hormone and less water is
reabsorbed and more is excreted. Drinking alcohol in excess can lead to a “hangover,” of which the majority of symptoms
are the direct result of dehydration.
Health Benefits of Moderate Alcohol Intake by University of Hawai‘i at Mānoa Food Science and Human Nutrition Program is licensed under a Creative
Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.
Notes
1.
Ronksley PE, et al. Association of Alcohol Consumption with Selected Cardiovascular Disease Outcomes: A Systematic Review and
Meta-Analysis. BMJ. 2011; 342, d671. http://www.bmj.com/content/342/bmj.d671. Accessed October 5, 2017.
274
CHAPTER 8. ENERGY
275

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