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Alcohol, Digestion, Energy BalanceNTR 300 – Fundamentals
Dr. Lorna Shepherd
Alcohol/Ethanol
Consumed by ~60% of Americans Provides 3% of total energy intake
7kcal/gm Is a narcotic
Reduces sensation, consciousness, central nervous system depressant
Sources Beer
5-11% Wine
5-14% Distilled spirits
>22% Liquors
Alcohol listed as “proof” which is double the alcohol content
A standard drink
15gm of alcohol 12oz beer 5oz wine 10oz wine cooler 1.5oz hard liquor
Moderate ETOH Consumption
One drink daily for female Two drinks daily for males Does not require digestion Absorbed by simple diffusion Easily crosses cell membranes
but does damage as it passes through
Metabolism of ETOH The cells of the GI tract
metabolize 10- 30% of the alcohol ingested
The remainder is metabolized by the liver
Not stored so takes priority in metabolization
alcohol –> acetaldehyde –>acetyl Co-A
Potential Benefit of ETOH
Moderate intake reduces risk of CVD Reduces LDL
High Alcohol intake
With high ETOH intake the liver uses an alternate path (microsomal ethanol oxidizing system) MEOS More efficient Requires energy Increases tolerance Decrease ability to metabolize drugs
Health Effects of Alcohol Increase blood pressure and
stroke Cirrhosis of liver Poor food intake Deficiency of B vitamins
Niacin needed for alcohol metabolism Thiamin absorption affected Increased excretion of B6 May impair absorption of B12
Excessive Intake of ETOH
Increased risk of Brain damage Oral and esophageal CA Breast CA Irritation of stomach lining Cirrhosis of liver Pancreatitis and pancreatic CA Impaired nutrient use Fetal alcohol syndrome
Fetal Alcohol Syndrome
1 in every 1000 First 12 – 16 weeks of fetal
development most critical Fetal alcohol effect
Short attention span Learning and behavioral difficulties hyperactivity
Actual Picture
Energy Metabolism
Substrates Converted to Acetyl CoA and enter to Kreb’s cycle to produce energy
Carbohydrates – 4kcal/gm Lipids – 9kcal/gm Proteins – 4kcal/gm Alcohol – 7 Kcal/gm
Metabolism
Ketone Bodies
Produced by liver and (kidney) The brain uses it during periods of
fasting when glucose is not available
Hormones involved in Energy Metabolism (Regulation)
Insulin Glucagon Thyroid
Energy Balance
Basal Metabolic Rate (BMR)
The minimum amount of energy needed when resting and fasting
Factors that affect BMR
Muscle mass Body surface area Gender body temperature Thyroid hormone Stages of growth Stimulants Sedatives
Methods of Calculating Energy Requirement
Predictive equations Harris-Benedict Simple method – 30-35kcal/kg
Harris Benedict Equation Male
66.5+(13.8xWt)+(5xHt)-(6.8xage) Females
655.1+(9.6xWt)+(1.9xHt)-(4.7xage) Activity factor
Sedentary – 1.0 Low – 1.1 Active - 1.26 Very active – 1.46
BMI Formula
Body Mass Index
Interpretation of BMI: Under weight <18.5 Healthy – 18.5 to 24.9 Over weight – 25 to 29.9 Obese - >30
Ideal Body Weight (IBW)Hamwi
Males First 5’ = 106# 6# for each additional inch
Females First 5’ = 100# 5# for each additional inch
Other: measurement of body fat
Skin fold thickness Bioelectric impedance Underwater weighing
Percentage Body Fat
Description Women Men Essential fat 10-13% 2-5% Athletes 14–20% 6-13%
Fitness 21–24% 14-17% Average 25–31% 18–24% Obese 32%+ 25%+
Health risk associated with obesity Increase risk for
Diabetes Hypertension Some types of Cancers
Colon, uterus, prostate CardioVascular Disease Joint disorders/arthritis Sleep apnea
Distribution of fat
Waist Circumference
Males 40 inches (102cm) or less
Females 35 inches (88cm) or less
Weight Reduction Interventions
Reduce caloric consumption Diet Behavior modification Surgery
Increase energy expenditure 3500kcal = 1 pound (#)
500kcal/day
Eating disorders
Anorexia nervosa Refusal to maintain weight at or
above normal Intense fear of gaining weight Disturbance in perception of body
image or denial of seriousness of low body weight
Amenorrhea
Anorexia symptoms Low body weight Lower body temperature Slower metabolic rate Anemia Rough scaly skin Loss of hair Low WBC count Lanugo
Bulimia Nervosa Recurrent binge eating episodes Inappropriate compensatory
behavior to prevent weight gain Purging – vomiting or abuse of
laxatives Undue influence of body weight or
shape on self-evaluation Symptom
Erosion of teeth enamel, GI problems