Alcohol, Digestion, Energy BalanceNTR 300 – Fundamentals

Dr. Lorna Shepherd

Alcohol/Ethanol

Consumed by ~60% of Americans Provides 3% of total energy intake

7kcal/gm Is a narcotic

Reduces sensation, consciousness, central nervous system depressant

Sources Beer

5-11% Wine

5-14% Distilled spirits

>22% Liquors

Alcohol listed as “proof” which is double the alcohol content

A standard drink

15gm of alcohol 12oz beer 5oz wine 10oz wine cooler 1.5oz hard liquor

Moderate ETOH Consumption

One drink daily for female Two drinks daily for males Does not require digestion Absorbed by simple diffusion Easily crosses cell membranes

but does damage as it passes through

Metabolism of ETOH The cells of the GI tract

metabolize 10- 30% of the alcohol ingested

The remainder is metabolized by the liver

Not stored so takes priority in metabolization

alcohol –> acetaldehyde –>acetyl Co-A

Potential Benefit of ETOH

Moderate intake reduces risk of CVD Reduces LDL

High Alcohol intake

With high ETOH intake the liver uses an alternate path (microsomal ethanol oxidizing system) MEOS More efficient Requires energy Increases tolerance Decrease ability to metabolize drugs

Health Effects of Alcohol Increase blood pressure and

stroke Cirrhosis of liver Poor food intake Deficiency of B vitamins

Niacin needed for alcohol metabolism Thiamin absorption affected Increased excretion of B6 May impair absorption of B12

Excessive Intake of ETOH

Increased risk of Brain damage Oral and esophageal CA Breast CA Irritation of stomach lining Cirrhosis of liver Pancreatitis and pancreatic CA Impaired nutrient use Fetal alcohol syndrome

Fetal Alcohol Syndrome

1 in every 1000 First 12 – 16 weeks of fetal

development most critical Fetal alcohol effect

Short attention span Learning and behavioral difficulties hyperactivity

Actual Picture

Energy Metabolism

Substrates Converted to Acetyl CoA and enter to Kreb’s cycle to produce energy

Carbohydrates – 4kcal/gm Lipids – 9kcal/gm Proteins – 4kcal/gm Alcohol – 7 Kcal/gm

Metabolism

Ketone Bodies

Produced by liver and (kidney) The brain uses it during periods of

fasting when glucose is not available

Hormones involved in Energy Metabolism (Regulation)

Insulin Glucagon Thyroid

Energy Balance

Basal Metabolic Rate (BMR)

The minimum amount of energy needed when resting and fasting

Factors that affect BMR

Muscle mass Body surface area Gender body temperature Thyroid hormone Stages of growth Stimulants Sedatives

Methods of Calculating Energy Requirement

Predictive equations Harris-Benedict Simple method – 30-35kcal/kg

Harris Benedict Equation Male

66.5+(13.8xWt)+(5xHt)-(6.8xage) Females

655.1+(9.6xWt)+(1.9xHt)-(4.7xage) Activity factor

Sedentary – 1.0 Low – 1.1 Active - 1.26 Very active – 1.46

BMI Formula

Body Mass Index

Interpretation of BMI: Under weight <18.5 Healthy – 18.5 to 24.9 Over weight – 25 to 29.9 Obese - >30

Ideal Body Weight (IBW)Hamwi

Males First 5’ = 106# 6# for each additional inch

Females First 5’ = 100# 5# for each additional inch

Other: measurement of body fat

Skin fold thickness Bioelectric impedance Underwater weighing

Percentage Body Fat

Description Women Men Essential fat 10-13% 2-5% Athletes 14–20% 6-13%

Fitness 21–24% 14-17% Average 25–31% 18–24% Obese 32%+ 25%+

Health risk associated with obesity Increase risk for

Diabetes Hypertension Some types of Cancers

Colon, uterus, prostate CardioVascular Disease Joint disorders/arthritis Sleep apnea

Distribution of fat

Waist Circumference

Males 40 inches (102cm) or less

Females 35 inches (88cm) or less

Weight Reduction Interventions

Reduce caloric consumption Diet Behavior modification Surgery

Increase energy expenditure 3500kcal = 1 pound (#)

500kcal/day

Eating disorders

Anorexia nervosa Refusal to maintain weight at or

above normal Intense fear of gaining weight Disturbance in perception of body

image or denial of seriousness of low body weight

Amenorrhea

Anorexia symptoms Low body weight Lower body temperature Slower metabolic rate Anemia Rough scaly skin Loss of hair Low WBC count Lanugo

Bulimia Nervosa Recurrent binge eating episodes Inappropriate compensatory

behavior to prevent weight gain Purging – vomiting or abuse of

laxatives Undue influence of body weight or

shape on self-evaluation Symptom

Erosion of teeth enamel, GI problems