The Real Deal on Alcohol

1. STANFORDMedical School The Real Deal on Alcohol

2. Ethanol is the active ingredient in alcohol • Fermentation: yeast metabolize sugar (from fruit or grain) to form ethanol and carbon dioxide • Chemistry: alcohols are organic compounds in which a carbon is attached to a hydroxyl (OH) • Ethanol is the active ingredient in alcoholic beverages, which also contain water, preservatives, • and flavoring ingredients. • Fermentation usually ends when alcohol content reaches a potency of 14% to 15%. • Distillation of alcohol increases its potency.

3. Alcohol Concentration in Various Beverages • Alcohol content (percent alcohol by volume) is different in various beverages and brands. • Beer: the darker the beer the higher the alcohol content, and the bitter the beer the higher the • alcohol content • Wine: redwines have morealcohol than whitewines (exception is Chardonnay), and the sweeter the • wine the lower the alcohol content • Liquor: the darker the liquor the higher the alcohol content, the sweeter the liquor the lower the • alcohol content • With the exception of grain alcohol, clear liquors have about 40% alcohol.

4. What is Blood Alcohol Content (BAC)? • Blood Alcohol Content is the percent of alcohol present in the blood. • The most accurate way to determine BAC is to measure it from a sample of blood. • Breathalyzers are a reliable estimate of BAC. They measure BAC by determining • the amount of alcohol in alveolar (deep lung) air. • To calculate your BAC using a chart you must • determine the amount of alcohol you consumed • in terms of standard drinks. • Standard Drink is 0.5 oz. of alcohol. • No. Standard Drinks= Serving size (oz.) X Percent Alcohol • 0.5 oz. (size of standard drink) • A person's actual BAC is dependent on many complex • factors, including their physical condition, what they • have recently ingested (food, water, medications and • other drugs).

5. It is illegal for adults to operate a motor vehicle with a BAC of 0.08% or greater. • It is illegal for minors to operate a motor vehicle with a BAC of 0.01% or greater.

6. A man who has two standard drinks (within 40 minutes) and weighs 120 • pounds has a BAC of about 0.06%. • A woman who has two standard drinks (within 40 minutes) and weighs 120 • pounds has a BAC of about 0.08%.

7. Overview • Pathway of Alcohol in The Body • Alcohol Metabolism • Health Drawbacks and Benefits • Effects of Alcohol on Gastro-Intestinal Tract • Effects of Alcohol on the Heart • Effects of Alcohol on the Liver • Effects of Alcohol on the Brain • Effects of Alcohol on the Endocrine System • Effects of Alcohol on the Kidney • Statistics on Drinking • Contact Information on Alcohol Drinking & Abuse

8. Health Drawbacks & Benefits of Drinking Alcohol Short Term Drawbacks: Headache Nausea Vomiting Upset Stomach Diarrhea Extreme thirst Irritability Diuresis Short Term Benefits: Helps you release stress Helps you release tension Helps you sleep Long Term Benefits (only in small amounts): Reduced risk of coronary artery disease Reduced risk of ischemic stroke Possible protection against gallstones Possible protection against Type 2 diabetes Long Term Drawbacks: Altered brain function which can lead to memory loss and even dementia Liver damage which can manifest as Alcoholic hepatitis Fatty liver Cirrhosis Altered circulatory function and heart damage which can manifest as Cardiac arrhythmias High blood pressure Heart disease

9. Pathway Of Alcohol In The Body mouth Esophagus Stomach/ Intestines bloodstream Liver Brain Heart/ Other organs Kidneys

10. Normal Gastrointestinal System Physiology mucosa Mouth Esophagus Parietal cells Short gastric pits lined with mucus cells These are the components of the gastro- Intestinal system This is the normal appearance of the gastric fundal mucosa • The Gastrointestinal Tract Is a Tube That Is Specialized along Its Length for the Sequential Processing of Food • Assimilation of Dietary Food Substances Requires Digestion As Well As Absorption • Digestion Requires Enzymes Secreted in the Mouth, Stomach, Pancreas, and Small Intestine • In Addition to Its Function in Nutrition, the Gastrointestinal Tract Plays Important Roles in Excretion, • fluid and Electrolyte Balance, and Immunity (http://www3.us.elsevierhealth.com)

11. Consumption of Alcohol Can Lead to Serious Disorders of the Gastrointestinal Tract • Alcohol consumption can promote the occurrence of heartburn • Alcohol consumption increases the risk of esophageal cancer and other cancers • Heavy alcohol consumption or binging can result in acute gastritis or bleeding of the mucosal lining in the stomach • Alcohol consumption is associated with peptic ulcer disease in the stomach and small intestine • Alcohol inhibits the muscles of the gastrointestinal tract leading to diarrhea • Alcohol inhibits the absorption of nutrients • Alcohol increases the transport and absorption of toxins across the intestinal wall which may predispose the liver and other organs to further damage (http://www.niaaa.nih.gov/publications/)

12. Healthy Stomach Damage Stomach This is acute gastritis. There are many causes of acute gastritis: alcoholism, drugs, infection This is the normal appearance of the stomach

13. Pathway Of Alcohol In The Body mouth Esophagus Stomach/ Intestines bloodstream Liver Brain Heart/ Other organs Kidneys

14. Normal Liver Physiology Central Vein Portal triad The liver is the largest of the abdominal organs lying just below the diaphragm This is a microscopic section of normal liver. The liver is divided into lobules which consist of portal triads and a central vein

15. Makes and stores metabolites and stores essential vitamins and minerals Metabolizes drugs, such as alcohol Regulates level of glucose in the blood Removes harmful sub- stances from blood Regulates level of cholesterol in the body www.livercancer.com/ liver

16. Alcohol Metabolism Metabolism is the body's process of converting ingested substances to other compounds Cytosol Mitochondria

17. Alcohol Consumption Can Lead to Altered Liver Function and Liver Damage • Most alcoholic liver damage is attributed to alcohol metabolism • Liver injury can be the direct result of the toxic metabolic by-products of metabolism or the result of inflammation induced by these products • Liver damage can manifest as Alcoholic hepatitis—acute inflammation of the liver due to binging Fatty liver—liver cells become filled with fat vacuoles due to abnormal lipid metabolism Cirrhosis—liver becomes scarred and permanently damage due fibrosis (repair process that is abnormal)

18. Bands of Fibrous Connective Tissue form due to continuous intake of alcohol Fibrous Bands Lipid (fat) accumulates in hepatocytes (liver cells) in vacuoles Inflammation and fatty deposits due to binge drinking

19. Pathway Of Alcohol In The Body mouth Esophagus Stomach/ Intestines bloodstream Liver Brain Heart/ Other organs Kidneys

20. Normal Heart & Circulatory System Physiology Four chamber view of the heart External view of heart Location of heart within the body • The heart is a muscular pump that is located just to the left of the breastbone • Its main function is to pump oxygenated blood into the arteries and deliver it to all tissues and organs in your body • (www.jomed.com/.../heart_structure/ html/b.html)

21. Alcohol Consumption Can Lead to Altered Circulatory Function and Heart Damage • Alcohol intake can lead to heart muscle disorders (cardiomyopathy) which interfere with heart function • Alcohol intake can lead to heartbeat rhythm abnormalities (arrhythmias) which can cause the heart to stop working • Alcohol intake can result in high blood pressure which damages other organs and increases the risk of stroke (http://www.niaaa.nih.gov/publications/)

22. Pathway Of Alcohol In The Body mouth Esophagus Stomach/ Intestines bloodstream Liver Brain Heart/ Other organs Kidneys

23. Cell Biology: Alcohol is a drug that binds receptors on cell membranes alcohol (ethanol) Binding of the drug to the receptor causes changes within the cell receptor GABAA Receptors NMDA Receptors Structural changes Functional changes cell

24. Alcohol Affects the Brain • Alcohol Acts On : • Mammilary bodies • (involved in memory) • Dorsal Medial Nucleus of the • Thalamus (emotion) • Cerebral Cortex • (motor, sensory, cognition)

25. alcohol Alcohol Facilitates the Action of GABA at GABAA Receptors receptor • GABA is the major inhibitory • neurotransmitter in the brain. • GABA binds to the GABAA • receptor and causes Cl- to flow • into cells and make then more • negative on the inside. • This inhibits the activity of brain • neurons. • Alcohol increases the effects • of this major inhibitory • neurotransmitter in the brain— • it decreases the activity of neurons. barbiturates GABA alcohol benzodiazepines Alcohol and other drugs can bind to GABAA Receptors and cause severe respiratory depression (slow or stop breathing).

26. alcohol Alcohol Inhibits Activation of NMDA Receptors by Glutamate receptor • Glutamate is the major excitatory • neurotransmitter in the brain. • Glutamate binds to the NMDA Receptor. • And causes positive ions like Na+ and • Ca2+ to flow into the cells and make them • more positive on the inside. • This activates brain neurons. • Alcohol decreases the effect of • this major excitatory neurotransmitter • in the brain—it decreases the activity of • neurons. Alcohol and other drugs (i.e. ketamine) can bind to NMDA Receptors and cause severe respiratory depression (slow or stop breathing).

27. Immediate Effect of Alcohol on the Brain • Sedation • Impaired Judgment • Slurred Speech • Loss of Coordination (ataxia) • Loss of Consciousness • Coma (at high doses)

28. The Positive and Negative Effects of Short Term and Long Term Alcohol Consumption on the Brain Short Term Benefits: Helps you release stress Helps you release tension Helps you sleep Short Term Negative Effect: Headache Nausea Irritability Long Term Negative Effect: Altered brain function Potential memory loss Potential Dementia

29. Pathway Of Alcohol In The Body mouth Esophagus Stomach/ Intestines bloodstream Liver Brain Heart/ Other organs Kidneys

30. Decreased testosterone levels Enlarged breasts (gynecomastia) Hormone Problems are Associated with Alcohol Use

31. Alcohol Decreases Testosterone Level • Alcohol inhibits synthesis • and release of hypothalamic • releasing hormones. • Alcohol causes liver damage. • The liver makes the hormone • IGF-1. Rats treated with alcohol • have lower levels of IGF-1. • Alcohol blocks the ability of • IGF-1 to induce the release of • LH in rats. • Alcohol may directly inhibit • release of LH from the pituitary • and testosterone from the • testes.

32. Pathway Of Alcohol In The Body mouth Esophagus Stomach/ Intestines bloodstream Liver Brain Heart/ Other organs Kidneys

33. Acute and Chronic Alcohol Consumption can Compromise Kidney Function-- Especially if Liver Disease is Also Present • Function of the Kidney • Regulates amount and • composition of nutrients • in the blood (i.e. glucose). • Regulates amount and • composition of key ions/ • electrolytes in the blood • (i.e. Na+, Cl-, K+, H+, • Ca2+, Mg2+, PO4-,etc.). • Regulates Blood Volume/ • Blood Pressure by adjusting • the amount of Na+ and water • in the blood. • Role in excretion of waste • (i.e. urea).

34. The Kidneys Produce Hormones and Respond to Hormones • Kidneys make erythropoietin: • acts on bone marrow to • increase production of • RBCs. • Kidneys make calcitrol: active • form of vitamin D. Vit D acts • on intestine and helps with • Ca2+ absorption. • Kidneys make renin: stimulates • production of other hormones • that help regulate blood pressure. Cross-Section of a Normal Adult Kidney

35. Alcohol Can Impair the Kidney’s Ability to Regulate the Volume and Composition of Fluid and Ions/Electrolytes in the Body • Alcohol Stimulates the • Hypothalamic-Pituitary-Adrenal Axis • Alcohol stimulates the release • of adrenocorticotropic hormone • (ACTH) from the pituitary. • ACTH  Increased Aldosterone • production from the adrenal gland • Increased Na+ reabsorptionIncreased • Fluid Retention High Blood Pressure (alcohol stimulates ACTH release) (produces aldosterone) Hypothalamic-Pituitary-Adrenal Axis Nephron: functional unit of the kidney

36. Chronic Alcohol Use • Low concentrations of key • ions/electrolytes. • Severe alterations of body’s • acid/base balance. • Disruption of hormonal control. • In case of liver disease, can have • impaired Na+ and Fluid Regulation. • High Blood Pressure • Possible Kidney Failure Normal Kidney Patients with Renal Failure who undergo dialysis for years may develop multiple cysts in their kidneys.

37. Statistics on Drinking Monitoring the Future Study (MTF): Trends in Prevalence of Alcohol Use Teenagers 2000-2002 12th Graders 8th Graders 10th Graders http://www.nida.nih.gov/infofax/HSYouthtrends.html • For the 2002 MTF, more than 43,000 students in 394 schools nationwide were surveyed • about lifetime, past year, past month, and daily use of drugs, including alcohol. • The latest data are online at http://www.drugabuse.gov. • Very few youth drink on a daily basis. • The percentage of youth reporting alcohol consumption within their lifetime, past year • and last 30-days has been steadily declining.

38. Contact Information Presentation Lecturers Antonio Alvarez galvi96@stanford.edu 650-497-5745 Aileen Green, Ph.D. Real Deal Program Coordinator aileen.green@stanford.edu 650-497-6938 Adolescent Counseling Services/Adolescence Substance Abuse Program http://www.acs-teens.org 650-424-0852 or 650-424-9853 (Fax) 4000 Middlefield Road Rm FH, Palo Alto, CA 94303 Al-Anon & Alateen Mid-Peninsula Information 650-592-7935 751 Alameda De Las Pulgas Blmnt, CA 94002 Al-Anon/Alateen Serv de Informacion Hispana 2470 Pulgas Avenue Palo Alto, CA 94303 Alcoholics Anonymous 650-342-2615 450 Peninsula Avenue SMto, CA 94401 Alcohol Drug Treatment Referral-Adult & Adolescents 1-800-454-8966 Insights Of Youth And Family Assistance 650-692-9300 1860 El Camino Real Burl, CA 94010 Alcohol Workshop Team Antonio Alvarez Odmara-Barretto Chang Aileen Green ChaRandle Jordan Delene Richburg Frain Rivera

39. References for Images Wine picture on title slide http://www.buonissimo.org/enoteca/ Fermentation picture http://www.mr-damon.com/.../2sp/projects/ images/fermentation.jpg Metabolic pathway on slide two http://www.scidiv.bcc.ctc.edu/.../Respiration/ Alcohol concentration in various beverages http://www.alcohol.vt.edu/Students/alcoholEffects/estimatingBAC/index.htm Blood Alcohol Content Charts for Men and Women http://www.alcohol.vt.edu/Students/alcoholEffects/estimatingBAC/BACCharts.htm Receptor Neurotransmitter Schematics http://www.niaaa.nih.gov/gallery/gallery.htm Side view of head and brain http://www.bbc.co.uk/schools/ parents/ Gynecomastia Picture www.keepkidshealthy.com/ .../gynecomastia.html Hypothalamus-Pituitary-Gonadal Axis http://www.psych.colorado.edu/~spencer/ PSYC4092/HPGaxispage.html

40. References for Images Kidney in the human body http://www.thaiclinic.com/ renalfail.html Cross-section of Normal Adult Kidney http://medlib.med.utah.edu/WebPath/RENAHTML/RENAL116.html Hypothalamic-Pituitary-Adrenal Axis http://www.niaaa.nih.gov/gallery/endocrine/hpa.htm Nephron Diagram http://users.rcn.com/.../BiologyPages/ K/Kidney.html Renal Failure http://medlib.med.utah.edu/WebPath/TUTORIAL/ RENCYST/RCYST025.html Statistics on Drinking http://www.nida.nih.gov/infofax/HSYouthtrends.html