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Ethyl alcohol (ethanol), abbreviated to alcohol in everyday language, has beenknown from time immemorial and has been used for the effect it has on thepsychological state. Even small amounts depress the sense of anxiety and induce asense of well-being and sociability. It is also valuable as an aid to sleeping if onlysmall amounts are taken; larger amounts lead to disturbed sleep. In debilitatedpersons it often enhances the appetite as well as being a useful source of energy.
Among its drawbacks are its induction of poor judgement and poor performanceof skills requiring fine muscular movements and a loss of awareness of thesechanges. Of all the drugs of addiction in the western world, alcohol is by far themost abused.
Alcohol is rapidly absorbed into the blood from the stomach and the small intestine, requiring no digestion. It is metabolized mainly (over 90 per cent) by the liver and the products of this metabolism can then beused by the body generally. It yields about 7 kcal/g, thus giving more energy per gram than does carbohydrate or protein (4 kcal/g) but less than fat (9 kcal/g). As an energy supplier alcohol has a drawback because it causesconsiderable dilatation of the blood vessels of theskin, thereby allowing some of the energy it providesto be lost as heat. Because the extra blood flowingthrough the dilated vessels of the skin makes thesubject feel warm, dangerous rapid cooling of thebody outdoors may not be noticed.
Alcohol cannot be stored by the body and is only trivially excreted in the breath and urine(about 5 per cent of the intake). It is metabolizedat a rate of about 50–200 mg of alcohol/kg bodyweight/hour, the rate being more or less constantin any individual. An average 70 kg person containing about 21 g (about 27 ml) ofalcohol, it would therefore take about three hours to clear the body of all alcohol. Most people drinking four pints ofbeer or one bottle of table wine (700 ml) during an evening would still havealcohol in the blood next morning.
The sugar fructose has been used to treat patients in alcoholic coma because it increases the rate of metabolism of the alcohol but it can induce a dangerous rise inacidity of the blood (lactic acid acidosis).
Disulfiram (Antabuse: Dumex)
This substance is sometimes used to help alcoholics avoid alcohol. When alcoholis metabolized, the substance acetaldehyde is produced and it is normally brokendown to harmless products as fast as it is formed. When disulfiram is given theenzyme which normally breaks down the acetaldehyde is inhibited and theaccumulation of the intact acetaldehyde in the tissues rapidly causes severe nausea,headache, giddiness and sometimes vomiting. Most people who have taken anadequate dose of disulfiram and then also alcohol seldom repeat their mistake. Aregular adequate dose of disulfiram thereby greatly assists the alcoholic in resistingdrinking alcohol.
Effect of alcohol on nutrition
Alcohol can affect nutrition in several ways. Excessive spending on alcohol mayleave insufficient money for an adequate diet, which is therefore likely to bepoor in protein, vitamins, iron and calcium. The main vitamin deficiency is offolate, which sometimes leads to a macrocytic anaemia. There may also be agastritis, especially with higher concentrations of alcohol, resulting in loss ofappetite and perhaps poor digestion and absorption if the upper small intestineis also damaged. If there is gastric bleeding the body iron stores will be furtherdiminished, though some chronic alcoholics retain excess iron, which damagesthe liver and the pancreas. The damage to the pancreas may lead to furtherexcess iron absorption. Iron supplements should therefore not be given tochronic alcoholics without evaluation of their need for the metal. If a normaldiet is eaten plus much alcohol, the extra energy intake will lead to obesity withits several disadvantages. Spirits (whisky, gin, brandy, rum) supply only energybut some beers may provide useful amounts of the vitamin B complex, thoughthere are better and cheaper sources of these.
Nutritional deficiency in chronic alcoholics is seen only in those whose alcoholism is severe and who are in the lower economic groups. In the more well-to-do segments of the population, alcoholism tends to produce not nutritionaldeficiency but overweight.
refrain from alcohol for at least sixmonths.
brought about by the alcoholism butthat is often not so. The liver can beseverely damaged by excess alcohol intake even when the general diet is good, so that eating well is no certainprotection from the damage that excess alcohol can do to the liver and also tothe pancreas. After a bout of hepatitis it is advisable to refrain from alcohol forat least six months after the liver has recovered its normal functions and eventhen the intake should be kept low.
The defects that arise from vitamin B group deficiency in alcoholism affect the peripheral nerves, muscles of the arms and legs, muscles that move the eyes, memoryand other higher mental functions. The arms and legs are characteristically thinand weak. There is often also sensory impairment and numbness. In very severecases complete paralysis of these muscles may occur in a few days, with recoverytaking many months. The eyes may show involuntary rapid movements either fromside to side or up and down and in some cases the eyes cannot be moved to focuson near objects. The mental disturbances may include agitation, hallucinations,poor memory for new information and sometimes old information, loss of timeperception, apathy, loss of adequate speech and delirium tremens. Ability to walkis poor and balance can sometimes be kept only if the feet are widely spaced. Theabnormalities are treated with high supplements of the vitamins of the B group;recovery is variable.
both the systolic and diastolic pressures (hypertension). This beneficial effect is usually seen within one month. It is notnecessary for there to be a fall in body weight, but if such a fall occurs because of the reduction in alcohol intake then thelowering of the high blood pressure will be even greater, reducing still further therisk of coronary heart disease and stroke. This fall in blood pressure is reversed ifthe alcohol intake is increased to the original level.
intake of alcohol on a daily basisgives some protection against coronary heart disease. It is doubtful,however, whether people who do notdrink regularly should be encouraged to do so because of the damage that they may do by becoming more than very moderatedrinkers. It is often very difficult for some people to resist increasing their alcoholintake once they embark on a regular daily dosage.
There seems to be a causal relationship between alcohol drinking and cancer of the mouth, pharynx, larynx, oesophagus and liver. Smoking makes this worse. Theeffect seems to occur with beer and wine as well as with the distilled spirits.
The effects of alcohol during pregnancy and lactation are described in The energy supplied by some common alcoholic drinks is given in Table 10.
Table 10 Energy supplied by common alcoholic drinks

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