Three-time Mr. Olympia Frank Zane likes to have a glass of wine with his dinner every night. He cites the ability of wine to improve digestion. When Arnold Schwarzenegger was in his bodybuilding prime, I watched him add a few jiggers of rum to his protein drink. “It speeds the absorption of protein into the body,” he explained. Chet Yorton, the man who defeated Arnold in the ’66 Mr. Universe, favored malt liquor when he wasn’t pumping iron yet suffered few apparent ill effects. Yorton felt his superior nutritional program protected him against the well-known ravages of alcohol.
Americans don’t ask why when it comes to drinking. They chug the equivalent of 500 million gallons of spirits yearly, or about 2 1/2 gallons per person. Beer is the most popular form of booze; armchair athletes down 5.7 billion gallons a year. Wine is a distant second with 500 million gallons. Of the 160 million Americans legally old enough to drink, 112 million imbibe regularly, while 48 million are teetotalers. Another 12 million have serious alcohol-related problems, and 6 million are outright alcoholics.
Society pays a price for all that drinking—more than $136 billion every year. Statistics show that alcohol is a factor in 45 to 68 percent of spouse-abuse cases, 49 percent of child abuse, 50 percent of rapes, 83 percent of fire fatalities, 60 percent of murders, 55 percent of suicides, 69 percent of drownings and 75 percent of job-related accidents. Alcohol plays a role in about half of the 51,000 traffic fatalities and 750,000 injuries each year.
The problems with booze start early: In 1985, 100,000 children between 10 and 11 years old reported getting drunk at least once a week. It’s the number-one drug of abuse for teenagers. Dr. Charles Hennekens, of Harvard Medical School, notes: “Right now, the public needs to know that after cigarettes, alcohol is the second most avoidable cause of death in the United States.”
Much publicity centers on a few therapeutic effects of alcohol. Some studies reveal that it increases high-density lipoprotein, or HDL, the form of cholesterol thought to protect against cardiovascular disease. Alcohol’s relaxing properties may aid socialization. As Kinky Friedman notoriously put it, ”Beauty is in the eye of the beerholder.” No statistics show how many seductions have occurred under the influence, but alcohol-induced rape numbers tell a grim story.
Alcohol is a double-edged sword when it comes to bodybuilding and health. Opponents of drug testing make a valid point when they mention the hypocrisy of testing for anabolic steroids while ignoring the far more dangerous—but legal—drug alcohol. Let’s take a closer look to explain why.
Alcohol is a general term designating a group of organic—that is, carbon-rich—compounds. The type we drink, ethyl alcohol, contains two carbon atoms with a hydroxyl group attached to one of the carbons, meaning that alcohol is freely soluble in water and fat. It also means that alcohol rapidly circulates to all tissues after it gets into the body.
When you drink alcohol without food, the stomach swiftly absorbs 20 percent of it, and it doesn’t need to be digested. The other 80 percent enters the blood through the upper intestine. The body metabolizes 95 percent of alcohol before excreting it, 85 percent of that occurring in the liver and the other 15 percent in the stomach. The unabsorbed 5 percent passes out of the body through the lungs and urine. That’s the alcohol detected by law enforcement agents who use Breathalyzer tests.
Alcohol itself is actually a waste product of yeast metabolism—the breakdown of sugars and starches by yeasts in the fermentation process. Beer is made out of fermenting barley and hops. Wine is the product of fruit fermentation. Hard liquor starts with starch or plant fermentation, after which the fermented product is distilled to concentrate the alcohol. Our bodies also make about seven grams of alcohol each day as a result of sugar fermentation by intestinal bacteria.
The liver can metabolize alcohol at the rate of about a quarter ounce per hour, although that varies from person to person. The alcohol in two four-ounce glasses of wine circulates for three to five hours before being completely broken down. Of course, the more you drink, the longer it takes you to break down the alcohol. Food in the stomach, particularly protein and fat, slows the absorption of alcohol. Diluted drinks, such as wine or beer, are absorbed more slowly than hard liquor; carbonation, such as in champagne, speeds absorption, which makes you feel drunk more quickly.
The amount of alcohol in beverages varies. Beer averages 4 to 5 percent alcohol; wine, 12 to 14 percent; hard liquor, 40 to 45 percent. The alcohol content of liquor is expressed as proof, or double the percentage content. An 80-proof bottle of gin is 40 percent alcohol. To get 13 grams of alcohol, you’d drink one 12-ounce bottle of beer, one 4-ounce glass of wine or one 1.5-ounce shot glass of liquor.
The liver breaks down alcohol in three stages. Alcohol dehydrogenase, a liver enzyme, converts alcohol to acetaldehyde. That’s the “rate-limiting” step because it occurs at a certain speed and limits the rate of alcohol removal from the body. In the next stage the liver converts the extremely toxic acetaldehyde to acetic acid or acetate, which is then broken down into carbon dioxide and water.
An important point here is that the first step of alcohol breakdown produces not only acetaldehyde but also a lot of hydrogen, which in excess causes problems in the liver. To get rid of the surplus hydrogen, the liver shunts it into several different pathways. One involves converting noncarbohydrate substances, such as protein and fat, into glucose—vital for maintaining proper blood sugar. If your body is already carbohydrate-depleted, drinking large amounts of alcohol can cause hypoglycemia, or low blood sugar. Its toxic by-products put metabolizing alcohol first in line in the liver over such processes as glucose production and fat metabolism.
The microsomal ethanol-oxidizing system, or MEOS, is one of the systems the liver uses to break down alcohol and other drugs. Large doses of alcohol prime the system, the net effect being that certain drugs are excreted more rapidly. The MEOS also activates the carcinogens from cigarettes and barbecued meat, making them more potent than usual.
Alcohol, in fact, interacts with more than 50 of the most frequently prescribed drugs. For example, the sedative action of sleeping pills and tranquilizers is magnified when taken with alcohol. Other adverse drug interactions involve alcohol combined with anticonvulsants and anticoagulants. When combined with alcohol, aspirin causes stomach bleeding. If you take aspirin before drinking—as is sometimes advised to avoid hangovers—you’ll actually get drunker because aspirin speeds entry of alcohol into the body by inhibiting a stomach enzyme that breaks it down. Ulcer medications, such as Tagamet, do the same thing. Acetaminophen, a pain relieving aspirin alternative, is positively toxic to the liver in the presence of alcohol.
Effects on the Body
Many believe that alcohol is a stimulant because it lowers inhibitions, but it’s actually a sedative-depressant. At one time it was used as an anesthetic. In movie westerns you often see the hero slug a shot of whiskey while having a bullet yanked out of his body.
Alcohol first affects the part of the brain that controls social behavior, the frontal lobe. It “loosens the brakes,” leading to less inhibition and a looser tongue. As the drinking continues, so does the brain-depressant action. Most states consider you legally drunk when one part of every thousand parts of blood is composed of pure alcohol, expressed as 0.1 percent blood alcohol concentration. A 150-pound man who metabolizes one drink in 90 minutes would have to drink five beers or five ounces of whiskey within two hours to reach a blood alcohol count of 0.1 percent. At that point your speech is slurred and you get clumsy.
What’s happening is that the alcohol is depressing the motor areas of your brain, causing you to lose muscle control and balance. You’re seven times more likely to be in a fatal car accident with that much alcohol in your blood.
If you have five drinks or more in a short time, your blood alcohol climbs to 0.2 percent. At that point the effect of the booze is spreading to the middle part of your brain. You begin to stagger and want to lie down and sleep. Your emotions are also out of control, and you may suddenly laugh or cry for no apparent reason. As the blood alcohol climbs to 0.3 percent, you fall into a stupor and become increasingly confused. You’ll pass out at 0.4 percent blood alcohol and may need to go to a hospital. If you progress to 0.5 percent blood alcohol, forget the hospital—your next stop is the morgue. At that point alcohol has anesthetized your lower brain, which controls breathing. You die of respiratory failure. Game over; you’re now a statistic.
Luckily, few people reach that fatal point. As every half ounce of alcohol increases the blood alcohol by about 0.025 percent—depending on body composition and food intake—you’d need to drink 20 martinis, 40 bottles of beer or five bottles of wine within an hour to reach the dead zone. Most people either vomit or pass out before then.
Alcohol disrupts performance by interfering with brain coordination and expectations. According to neuroscientist Donald Woodward, Ph.D., at the University of Texas Health Science Center in Dallas, your brain manufactures a signal of what it expects to sense. For example, when you walk, you normally don’t think about the movement of your feet; it’s an automatic process. If your foot hits something, however, you instantly become conscious of your feet, as if a window has suddenly opened in your brain to make you aware of your feet. After drinking alcohol, your brain loses its ability to control those “windows.” You get locked into a single line of attention. If you’re doing only a single task, no problem. If something comes up that calls for a quick switch of attention, though, you’re sunk. That may be the cause of alcohol-related auto accidents—you can’t control the car because it requires you to coordinate several things quickly.
Even if you survive your booze trip, you face that bane of drinkers, the wrath of the grapes: the hangover. You know the feeling. Your head pounds; you feel nausea, dry mouth, dizziness, diarrhea and are just plain out of it. Several theories explain the cause of hangovers. One points to substances in alcoholic drinks called congeners, which are chemical by-products of the fermentation and distillation process. Beer, red wine, Scotch and cognac contain the most congeners; vodka the fewest. Another says that alcohol depletes body chemicals called prostaglandins, and its proponents believe that using the food supplement evening of primrose oil helps offset the hangover by providing the raw material the body needs to synthesize prostaglandins.
A University of Michigan study found that college students who took 5,000 milligrams of vitamin C before a drinking spree cleared alcohol from their bodies faster. An experimental drug known as Ro15-4513 keeps you from getting drunk in the first place by blocking alcohol’s sedative action in the brain. Some believe that fructose helps the liver metabolize alcohol faster. It does, but only when you inject it. A combination of the amino acid L-cysteine, vitamin C and vitamin B1 prevents the toxic effects of acetallaldehyde in animals.
The only thing that really cures a hangover is tincture of time. For some relief in the meantime, physicians recommend aspirin for the headache and antacids for the sour stomach. Drinking plenty of fluids—but not booze—helps restore body fluids depleted by alcohol. A United States Navy study found it takes an average of 36 hours for your body to recover from the effects of drunkenness. During a hangover your driving ability is still impaired by as much as 20 percent.
Heavy drinkers have more to fear than a hangover if they curtail booze suddenly. In those hapless souls a full withdrawal syndrome—extreme nausea, irritability, weakness, sweating and vomiting—sets in 12 to 48 hours after their last drink. A worst-case scenario involves the DTs, or delirium tremens, characterized by increased blood pressure, heart rate and body temperature, plus confusion and auditory and visual hallucinations. At that point the alcoholic “sees things,” such as animals entering the room. The body shakes violently, often leading to seizures. It’s no joke: Mortality rate may go as high as 20 percent.
The two organs most affected by alcohol are the liver and brain. Alcohol is toxic to neurons, or brain cells, and even moderate amounts may cause memory loss. The brain of a heavy drinker ages prematurely. Research has found actual brain atrophy, or shrinkage, after chronic heavy alcohol consumption. A recent study confirmed the brain-shrinking effects of even moderate alcohol intake, leading researchers to suggest that no amount of alcohol is protective for the brain.1 Other evidence points to a regeneration of brain functions if alcohol is eliminated.
Drinking booze regularly cuts both blood flow and oxygen to the brain and can cause the phenomenon known as alcoholic blackout. People seem to function as usual but are unaware of their surroundings and don’t remember anything that happened before they “woke up.”
Heavy boozers may progress to an alcoholic dementia similar to Alzheimer’s disease, producing shrinkage of the brain visible in X-rays. Studies from Finland, Hawaii and Massachusetts all point to increased incidence of strokes in drinkers, causing still more brain damage. People who drink excessively may suffer a deficiency of thiamine, or vitamin B1, leading to the Wernicke-Korsakoff syndrome. The Wernicke part features the uncoordinated, stumbling movement caused by alcoholic nerve damage. Korsakoff’s part is a psychosis; you can’t remember recent events. To fill in memory gaps, an alcoholic often makes up elaborate scenarios, a process called confabulation.
While light intake of alcohol is often suggested as a means of preventing brain disease, a recent study suggests otherwise.2 The researchers examined light-to-moderate alcohol consumption in 35 healthy older adults. Those who drank alcohol more frequently had increased amounts of two proteins in the brain. The first, S100B, is thought to be a marker of increased blood-brain barrier permeability, which would permit toxic substances to enter the brain. The other elevated protein was beta amyloid, which in excess is thought to be a primary cause of Alzheimer’s disease. Some studies implicate aluminum absorption in Alzheimer’s. While there is as yet no definitive evidence for that, beer is high in natural silicic acid, which blocks aluminum uptake.
A Punch to the Liver
The liver is where the action is as far as alcohol is concerned. When alcohol enters the liver, it drops everything to handle the booze. Protein builds up, and the liver, absorbing 10 times its weight in water, swells. Instead of metabolizing fat, the liver diverts its function to breaking down alcohol. Fat builds up, producing the first stage of liver disease. That can occur after only one weekend of heavy drinking. The next step is alcoholic hepatitis, an inflammation of the liver.
Liver functions can return to normal if you stop drinking. An estimated 10 to 20 percent of heavy drinkers, meanwhile, proceed to the final step of liver failure, cirrhosis. Cirrhosis—which causes 75 percent of alcoholic deaths and kills about 11,000 people a year and is America’s seventh leading cause of death—is a term describing the transformation of liver tissue into scar tissue. Some recent evidence shows that soy lecithin may help prevent the final stage of alcoholic liver disease, but the lecithin used in the relevant study was far more concentrated than anything now sold commercially.
Why some people develop cirrhosis and others don’t remains a mystery. Genetic and nutritional factors may play a role. One thing is now certain, however: Alcohol directly damages the liver. Past theories held that cirrhosis evolved out of long-term malnutrition because alcoholics almost always suffered numerous nutritional deficiencies. Although malnutrition frequently compounds the problem, the fact is that alcohol directly diminishes the stores or interferes with absorption of the following nutrients: thiamine, riboflavin, niacin, pyridoxine, folic acid, calcium, iron, zinc, magnesium, selenium, B12 and vitamins C, A and D.
Some people believe that because beer is made from yeast, it contains generous amounts of vitamins. A 12-ounce can of beer does contain the recommended daily allowance of the B-complex vitamin niacin, 1.1 grams of protein and 10 percent of the RDA for riboflavin, but an ounce of bread contains more nutrients. When total calorie intake from alcohol exceeds 30 percent of the diet, however, significant decreases in protein, fat and all other nutrients occur. Chronic alcohol use impairs the stomach’s ability to transfer food into the intestine. It directly damages the intestinal lining, leading to malabsorption of nutrients and milk sugar, causing lactose intolerance. Heavy drinkers often develop an aversion to high-protein foods, most likely because of their weak livers.
An analysis of Chicago skid row alcoholics showed that their usual diet consisted of jelly doughnuts washed down with booze. Liver damage may interfere with storing and processing nutrients, while the vomiting and diarrhea common in alcoholics causes them to lose the few nutrients they manage to take in. The intense vomiting experienced during alcoholic binges can cause small tears in the esophagus called Mallory-Weiss tears, which are considered precursors of esophageal cancer. Much of the vomiting stems from alcohol’s caustic impact on the stomach lining. Large amounts of booze cause gastritis, an inflammation of the stomach. Heavy drinkers also show a 75 percent higher incidence of inflammation of pancreas, a.k.a. pancreatitis, and stomach ulcers.
That’s a lot of negative alcohol information to digest. For some positives, see “Wine: A Healthful Exception” on the opposite page.
Next month I’ll explore whether alcohol is really good for the heart, how it affects women differently from men and its effects on muscle.
1 Paul, C.A., et al. (2008). Association of alcohol consumption with brain volume in the Framingham study. Neurology. 65:1363-1367.
2 Keary, T.A., et al. (2008). Light to moderate alcohol consumption is associated with S100B and amyloid beta levels in healthy older adults. Exp Aging Res. 34:101-113. IM