I consider myself a one-a-day drinker with the occasional night where I over indulge and I wake up saying, “that was not worth it, I’m too old for this!” I think we have all been there. Some of us drink a glass of red wine every night for our “health” drinking is social; it’s something that many people do on a regular basis. Have you ever really thought about what alcohol is doing to the body? I’m not a person who is going to 100% abstain from ever having a drink so I set out on a quest to understand what alcohol is doing in my body and find some ways to offset the negative effects. If you have one or more drinks per day, ever binge drink, drink too much or know someone who drinks to much… I hope this research will be helpful!
Reminder: This is not an article on alcoholism, this is not an article on how to improve your health so you can drink more, this is not an article in support of drinking, this is a research based piece and for informational use only.
It all starts in the gut! (Doesn’t everything?)
You take that first sip; the alcohol travels through your esophagus into your stomach where it meets your gastric juices. Did you know if your drink is carbonated the effects of the alcohol will be felt quicker? The pressure in your stomach from the carbonation forces the alcohol into the blood stream faster! Did you also know if there is food in there when you have a drink, the effects will be slowed as the alcohol will stay in your stomach longer and be released into the blood slower. Your portal vein connecting your gut to your liver transports alcohol to the liver. The liver is the king of alcohol metabolism. As the alcohol enters the liver it will enter a very complex pathway involving two enzymes called alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). ADH breaks down the alcohol into safer products (this is part of phase II detoxification, see here to read my blog on detoxification) like acetate, water and CO2 where it can be excreted out of the body. But imagine what happens when you drink too fast, and too much for your body without food in your stomach. Your livers capacity is exceeded it cannot metabolize or breakdown what’s coming in and your blood alcohol levels rise because the alcohol escapes from the gut and small intestine without being processed by the liver!
This rising level has many effects…if it’s within safe limits say one drink for women or two drinks for men it can be a relaxing, possibly even providing some cardiovascular benefits. Why does drinking relax your body? Once in the blood stream the alcohol travels many different places one being the central nervous system where it interferes with neurotransmitter signals, specifically GABA. When your body produces more GABA it slows down your brain cells. (S) (Xanax and Valium also increase GABA production). This may be one of its beneficial qualities; moderate drinking provides relaxation that can improve blood pressure a known risk for CVD. Might it even have long-term benefits of reducing stress? The reservatrol in red-wine has been touted as a positive effect, there has even been some research on its effects of increasing HDL, but mind you that is from drinking in moderation! When you keep drinking past this moderate level, you now enter the phase of slurred speech and impaired balance. Vomiting may occur because your liver is overwhelmed and your body knows it needs to get rid of this toxin. You have your gut to thank for this! The lining is extremely irritated by all this alcohol and its sending signals to your brain that it should get rid of some of it! You wake up, you curse yourself drink some water and take a few Advil and go on with your day. Fast forward 10, 20 year and this has been going on regularly. Sound familiar?
So what have I been doing to my body?
Your body is designed to cope with moderate levels of toxins. And remember alcohol is a toxin; the body see’s it as poison and produces the enzyme alcohol dehydrogenase (ADA) to help your body rid itself of it. When the alcohol comes into contact with this enzyme it steals a hydrogen atom off the ethanol (alcohol) molecule and turns it into a less toxic acetylaldehye (but still toxic). Your body then sends in acetaldehyde dehydrogenase to finish the job and break down the acetaldehyde into acetic acid (an ingredient in vinegar) and rid your body of it. So really it’s a fight between how much you drink and how fast the enzymes can work. On average one ounce of alcohol can be metabolized every 60-90 minutes. As you can imagine EVERYONE is going to be different. We have male versus female (females make less ADA), age (We make less ADA as we age), how much you ate, whether you take aspirin, your nationality (Asians make less ADA), and your genes (people with impaired detox genes in the CYP genome are affected more!)! Putting that all aside for now lets look at some of the things happening in your body once you’ve moved past moderate drinking.
-Alcohol affects the way your neurons get triggered by glutamate. Alcohol gets into the glutamate receptors and hurts their ability to send off their normal messages. This is what impairs your speech, coordination and judgment.
-Alcohol increases the amount of Dopamine (a catecholamine) that creates a feeling of pleasure when someone takes a drink. One interesting note here, when reviewing your DNA results from 23andMe (see here on how to analyze your test) there is a particular gene mutation COMT 4680 which degrades dopamine. I happen to be homozygous (meaning both genes are different from the norm) my dopamine breaks down slower than normal. People with this gene SNP are more prone to searching for a dopamine fix because they have a high accumulation of dopamine and the brains starts to ignore it and needs a bigger and better fix to get that pleasure feeling. This can be dangerous as drinking is increasing the dopamine even more.
-Alcohol interferes with NMDA or N-methyl-D-aspartic acid that is a receptor that helps the brain make memories. Ever forget the whole night when drinking heavily? This may be why.
-Do you have a glass of wine to help you sleep? Yep it might help you get to sleep because of the relax response we talked about before but as you sleep your brain try’s to take back control and it screws up your crucial REM sleep (S), plus you are dehydrated which affects sleep too.
To get rid of toxins from the body the liver needs water. Alcohol is a diuretic and therefore there will not be sufficient amounts in your body. The liver will start diverting water from other organs including the brain that may cause the pounding headache you experience.
When intoxicated, hypoglycemia (low blood sugar)can occur. An accumulation of the coenzyme NADPH that is involved in the citric acid cycle can cause pyruvate to convert to lactate instead of Oxaloacetate (OAA). Pyruvate and OAA are both intermediates for gluconeogenesis, so if both are reduced gluconeogensis cannot occur. Hypoglycemia can occur if glycogen stores are depleted in liver. This will be worse in people who have not eaten before drinking.
Alcohol depletes key nutrients, it also affects the gut and impedes their absorption.
-Folic acid –tetrahydrafolate receives 1-carbon units from numerous amino acids that are depleted when drinking (impairs methylation).
-Pyridoxine (B6) depleted – acetaldehyde messes with the enzymes needed to activate B6, it also makes it less available in food. B6 or P5P is used in many important pathways in your body.
-Thiamine (B1) is depleted – alcohol decreases the absorption in the GI tract and impairs utilization of thiamine in cells, this can contribute to neurological problems.
-Alcohol is hydrophilic and lipophilic and may harm nearly every organ.
-Alcohol increases the NADH:NAD+ ratio and can lead to increased androstenedione conversion to testosterone in the liver, may cause hyperandrogenism and loss of female characheteristics in females who drink heavily.
-Alcohol inhibits Vitamin A synthesis. It provides competition for the alcohol dehydrogenase enzyme we discussed above (blocks oxidation of Vit A by inhibiting ADH).
-This destruction of Vitamin A increases P450 enzyme activity that stimulates hydrolysis and indirectly reduces Vit A in the liver by increasing the mobilization of Vit A to peripheral tissues.
-Amino acids are lower in people who drink, this affects neurotransmitter synthesis, serotonin and dopamine levels are impacted because of low tryptophan and tyrosine. It also affects coenzyme formation and the body’s ability to handle ammonia load in the body.
-The citric acid cycle is impaired because of higher NADH, the liver than has impaired function to oxidize the acetate to CO2 to be expelled. Acetate therefore escapes from the liver into the blood; acetaldehyde can also escape the liver (the more toxic form) and can bind with proteins and nucleic acids and disrupt DNA function.
-Acetaldehyde can also bind and inactivate glutathione causing oxidative stress increasing reactive oxygen species (ROS).
-Our gene CYP2E1 is induced when alcohol intake is high, repeated induction is responsible for alcohol intolerance. This can also increase metabolism of barbiturates, anesthetics, and acetaminophen all by increasing clearance and formation of toxic intermediates (S)
-Alcohol creates a choline imbalance and interference with lecithin synthesis needed for VLDL synthesis (cholesterol) it inhibits 3 enzymes needed for lecithin synthesis.
-Increases serum estradiol levels.
-Alcohol creates deficiencies in most water-soluble vitamins especially Vit C and B3.
-Decreases bone density and increased osteoporosis-defect in hydroxylation step of Vit D product by P450 enzymes in liver.
-Decreased Vit K storage/utilization (also needed for Vitamin D synthesis).
-Depleted minerals from increased urinary loss and decreased ingestion: Zinc, Calcium, Magnesium.
-Alcohol irritates your digestive system. It damages the stomach lining and can cause gastritis (or inflammation of the stomach lining). Initially alcohol increases the production of stomach acid that can damage the lining. This can lead to gastritis that in turn leads to heartburn. Alcohol also relaxes the esophageal sphincter making it easier for stomach contents to escape into the esophagus.
Steps you can take to be healthier if you choose to drink:
-Eat protein, drink a protein shake or protein heavy meal before indulging so your body has amino acids to use, and buffers the effects of the alcohol.
-Keep your stomach full of food when drinking: A full stomach slows down the rate at which alcohol is absorbed into the blood. Absorption from the stomach is much slower than absorption from the intestines. This prevents accumulation in the blood. The decreased rate of gastric emptying gives your liver more time to break down the alcohol before it enters your blood (called first pass hepatic metabolism). As the alcohol moves to your liver more slowly, your liver enzymes don’t become overwhelmed. Food stimulates blood flow to the liver and the production of liver enzymes that also help break down alcohol (ADA and CYP450). Enough food can substantially decrease the amount of alcohol that reaches your blood. A meal basically lessens the damage from alcohol. The best meal is something that stimulates your liver and delays gastric emptying. That means protein, fiber and vegetables and a high volume of food.
-Drink a lot of water, especially when drinking alcohol. You’ve been told to do this (glass for glass) but now that you see the science of what is happening in your body I hope you will make a concerted effort to drink more water!
-Make sure your body has sufficient vitamin C. Consider keeping something like Emergen-C on hand to take after indulging. It also contains a good dose of B vitamins that can become depleted.
Most people could use more B vitamins, especially if you drink. Find a good B-complex to take (one that contains folate not folic acid) my favorite here. (Search for Metabolic Maintenance B-Complex Phosphorylated)
-Avoid Tylenol (acetaminophen) with regular alcohol consumption. Alcohol interferes with the gene that regulates the way your body processes acetaminophen, it interferes with the enzymes needed to process it and can damage the liver further. If you take Tylenol regularly (Tylenol PM also) you should not be drinking regularly.
-Monitor your yearly blood tests and watch for liver enzymes and other markers that are out of range. Read here for traditional and specialty tests that can be looked at when assessing risk.
Keep your liver healthy – it is doing a lot of work!
Besides detoxing chemicals like alcohol it does the following:
-Stores glycogen (a form of sugar for energy)
-Helps regulate blood sugar levels
-Production and storage of proteins and substances that aid in protein metabolism
-Production of bile acids to help with the digestion of fats
-Production of blood proteins and substances important to the production of RBC’s
-Regulation of a number of hormones
-Helps to neutralize free radicals with antioxidants
-Stores many vitamins like iron, copper, B12, vitamins A, D E and K
Do you see how stressing the liver with too much alcohol can have a negative affect on all the functions in the body mentioned above? The image of toxins “building-up” in the liver is actually false its just that the liver becomes less effective and toxins entering the liver to be processed do not get acted upon in the most efficient way so they are left to float around in the body or are stored in adipose tissue causing destruction. This is what being toxic means. Love your liver by sticking to a moderate amount of alcohol and when you do over-indulge, follow the rules to lessen the impact the binge will have on your liver health!