Alcoholics Anonymous

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Nothing beats winding down from a long work day with a few cold ones. Or enjoying a glass of wine with friends. Or two. Or three. For most of us, alcohol is a relaxing and fun habit. For many, however, alcohol is an out of control problem which is unhealthier than you may realise.

The Australian Dietary Guidelines recommend no more than two standard drinks per day to reduce the risk of alcohol related disease and injury. For some, meeting these guidelines is a struggle as they fight the temptation to order ‘just one more round’. Considerable over-indulging on a regular basis leads to a variety of health issues including malnutrition and liver failure. Drunken hazy nights suddenly don’t seem so fun.

I know vodka is made from potato, and beer is made from barley and wheat, but this does not mean these beverages are suitable substitutes for food. One of the most pressing issues experienced by alcoholics is protein-energy malnutrition. Alcohol contains ‘empty calories’ which means it provides energy but no other nutrients. Hence, when meals are replaced with alcohol, the individual may achieve sufficient energy intake, but experience vastly insufficient nutrient intake. Protein is commonly the most problematic nutrient deficiency observed in alcoholics.

A shot of vodka, whiskey or rum has a protein content of a big fat zero grams, and a standard can of beer contains a mere 1.6 grams. A whopping 40 cans are required for a male to reach his Recommended Daily Intake for protein consuming beer alone. If you are drinking 40 cans a day, you have a lot more to worry about than just protein deficiency.

Since protein is not sufficient in the diet, the body seeks it from within. Protein is extracted from muscle and used for energy metabolism and DNA, enzyme and carrier protein synthesis. The usage of muscle proteins to fuel these vital functions is extremely unhealthy and not at all sustainable. In extreme cases, protein deficiency results in Kwashiorkor Syndrome which is characterised by swelling (oedema) of gut.

Since alcoholics often replace dinner with drinks, it is unsurprising that vitamins and minerals are largely lacking. Inadequate intake, however, is only one of obstacles alcoholics face concerning micronutrients.

It is widely known that alcohol is not a friend of the liver. Excessive consumption robs the liver of its ability to convert vitamins to their active form, decreasing their bioavailability and healthful effects.

Anti-diuretic hormone (ADH) helps control how quickly our bladder fills. It stimulates resorption of water from tubular fluid (precursor to urine) into the body, and by doing so, limits our urine stores and urge to visit the bathroom. Alcohol has an inhibiting effect on ADH, which is why when you consume alcohol, you might feel urination urges more strongly and more often. Hence, urination becomes more frequent with alcohol consumption, particularly if consumption is excessive. With this, comes increased water soluble vitamin excretion as they are dissolved in the urine.

Remember when we discussed protein-energy malnutrition and all the health issues associated with protein deficiency? Well, here’s another one. Thiamine is consumed in the diet (for example pork) as TPP (thiamine pyrophosphate) which needs to be converted to free thiamine (found in plant-based vegan food sources) before it can be absorbed by the body. Problem is, that the intestinal phosphates responsible for this conversion are reliant on a healthy protein supply. Effectively, protein deficiency contributes to a secondary deficiency of thiamine. Even if absorption is sufficient, for example if the alcoholic consumed a healthy amount of plant based thiamine (Unlikely!), the body still wouldn’t be able to use it. This is because, generally, the liver is so damaged that the active co-enzyme form cannot be synthesised. Moreover, the body demands more thiamine in times of excessive alcohol consumption as it is necessary to alcohol metabolism. This storm of issues surrounding thiamine is culminated in thiamine deficiency and Wernickle-Korsakoff disease. The alcoholic may experience symptoms that, ironically enough, resemble being drunk. For example, double vision, ataxia (uncontrolled movement) and impaired mental function. However, unlike being drunk, Wernickle-Korsakoff is not something you can just sleep off and wake up from with nothing but a raging hangover.

Vitamin B3 (niacin) is another nutrient used extensively in the metabolism of alcohol and as such is especially important to alcoholics. However, being a water-soluble vitamin, it suffers from excessive excretion. In the event of B3 deficiency, the body can synthesise a small amount from tryptophan. However, tryptophan is found in protein, and as you already know, protein is generally not abundant in alcoholics. Even in a healthy individual, endogenous synthesis is very unlikely to meet bodily demands, so there is no hope for alcoholics. Alcoholics may experience the ‘four D’s’ because of B3 deficiency and these are; dermatitis, diarrhoea, dementia and eventually, death!

Water soluble cobalamin (vitamin B12) is already complex for the body to absorb and alcohol most certainty does not help with this. For this reason, alcoholics are at increased risk of its deficiency, in which case, anaemia and neuropathy (tingling and pain) is experienced. B12 deficiency goes hand in hand with B9 (folate) deficiency as these two water soluble vitamins recycle each other. Hence, low B9 means low B12 and visa-versa.

Folate (B9) deficiency is a particularly problematic because it is responsible for maintaining the integrity of gut cells. When these cells aren’t acting as well as they should, absorption of all other nutrients is impaired. You can only imagine how big of a problem this would be. B9 deficiency also causes anaemia and DNA synthesis and repair issues.

Acetaldehyde is a chemical produced as a by-product of alcohol metabolism. It has somewhat toxic effects on the body is responsible for some of the symptoms experienced during a hangover. It also inhibits the activation of the water-soluble vitamin B6 (pyridoxine) contributing to the risk of its deficiency, as well as increased excretion. B6 deficiency involves oily dermatitis, convulsions, depression and confusion.

In alcoholics, the absorption of riboflavin (vitamin B2) is impaired because it requires a special protein (think protein-energy malnutrition) created by the liver (think liver damage) to enter our cells from the gut. Furthermore, it is used up to produce niacin from tryptophan in the case of niacin deficiency (see above). It also has a role in combating the oxidative stress (see anti-oxidant supplement section) that occurs as a result of alcohol metabolism. So, not only is B2 difficult to absorb by the alcoholic (even if the diet was adequate) but is also in incredibly high demand as it serves a variety of functions pertaining to alcoholism. Hence, deficiency often results. The deficient individual will experience scaly skin, anaemia, glossittis (tongue inflammation), angular stomatitis (cracked sides of mouth that never heal), fatigue and headaches.

Fat soluble vitamins includes A, D, E and K. By now, I’m sure you understand that the liver is under a lot of stress when alcohol is consumed. It prioritises the metabolism and detoxification of alcohol over other necessary bodily functions. Namely, the production of bile. Bile is substance produced in the liver and stored in the gall bladder. It is responsible for the emulsification and absorption of fat and therefore, the absorption of fat soluble vitamins as well.

One consequence of this is vitamin K deficiency, which decreases the bloods ability to clot in response to an ulcer or vessel breakage. Ulceration within an alcoholic stomach is common and the excessive bleeding means excessive loss of iron. This excessive iron loss can contribute to its deficiency, which results in anaemia, shortness of breath and a compromised immune system. Furthermore, iron is increasingly important in alcoholics as is used to neutralise the destructive pro-oxidants produced as by-products to alcohol metabolism.

Since fat soluble vitamins cannot be easily dissolved in the blood, they require a carrier-protein to be transported around the body. These carrier proteins are reliant on adequate protein status and a functional liver. Neither of which are strong suits of alcoholics. This leads to a variety of deficiencies and health issues.

Fat soluble vitamins are easily stored in the liver. Or at least they would be, if the liver wasn’t so badly damaged by alcohol. The liver is so busy processing alcohol, that it doesn’t have much energy for the storage. This lack of storage causes deficiencies. For example, vitamin A deficiency which results in night blindness.

Furthermore, most fat soluble vitamins need to be activated at the liver in order to do their job effectively. But once again, the alcoholic liver lets us down. The inability of the liver to activate vitamin D, increases the risk of osteoporosis. Active vitamin D (D3) acts to promote the deposition of calcium to bones, its deficiency results in less calcium deposition to bone and more free calcium. Of which, gets excessively excreted, causing calcium deficiency. In a nut shell, vitamin D3 deficiency snowballs to a calcium deficiency.

Another mineral affecting bone health is magnesium. Like water soluble vitamins, it experiences increased excretion in the presence of alcohol. Hence, its deficiency is likely in alcoholics. Magnesium assists the deposition of calcium to the bone, so its deficiency further contributes to osteoporosis. Some other results of magnesium deficiency include cardiac arrhythmia, muscle weakness and spasms.

Time for a reality check. Although a long list of problems concerning alcohol are listed in this article, it takes extreme alcohol consumption to even get close to achieving such an unhealthy state. In fact, some studies even suggest that red wine contains extremely healthful nutrients and we could all benefit from a glass occasionally! The body is designed to process alcohol, even a lot of it. I urge you to keep everything in perspective and enjoy in moderation. Cheers to that!

Renae Earle

Renae Earle is a Masters of Dietetics student at the University of Queensland. Having achieved her Bachelor of Exercise and Nutrition Science with distinction, she is motivated to complete her studies and become an accredited practicing dietitian.

Renae is passionate about evidence-based practice and debunking nutrition myths. She believes that in today’s fad celebrity diet culture, it is increasingly important to deliver the facts. She aims to help people achieve a sustainable and healthful lifestyle by combating the flurry of misinformation offered by tabloids and social media.

In order to achieve this goal, Renae has dedicated herself to the field of nutrition. She is well educated on a wide range of nutrition topics such as supplementation, chronic disease, restrictive diets and metabolism.

Renae has a keen interest in offering personalised nutrition plans that suit the specific needs of her future clients.

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