Chapter 11: Water and the Major Minerals

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Recap of last lecture

• Alcohol
• Effects of different blood alcohol levels
• Alcohol Absorption/metabolism LADH/MEOS
• Converted to fat
• Benefits/abuse
• Effects of Alcohol on organs

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22 Outline for today

• Alcohol contd
• Caffeine
• Next time, Nutritional/health value of diet
  sodas, Risks of artificial sweeteners,
  Hi-energy drinks

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Answers to questions

• Alcohol drug interactions
• Effects on brain
• Symptoms of cirrhosis

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Drug interactions with alcohol

• http//www.niaaa.nih.gov/publications/aa27.htm

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Pain killer interactions with alcohol

• Acetaminophen/TYLENOL, TEMPRA
• Interactions
• Food For rapid relief, take on an
• empty stomach because food may slow the
• bodys absorption of acetaminophen.
• Alcohol Avoid or limit the use of alcohol
• because chronic alcohol use can increase your
• risk of liver damage or stomach bleeding. If you
• consume three or more alcoholic drinks per day
• talk to your doctor or pharmacist before taking
• these medications.

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• NSAIDs reduce pain, fever, and inflammation.
• E. g. aspirin/BAYER, ECOTRIN
• ibuprofen/MOTRIN, ADVIL
• naproxen/ANAPROX, ALEVE, NAPROSYN
• ketoprofen/ORUDIS
• nabumetone/RELAFEN
• Interactions
• Food Because these medications can irritate the
• stomach, it is best to take them with food or
  milk.
• Alcohol Avoid or limit the use of alcohol
• because chronic alcohol use can increase your
• risk of liver damage or stomach bleeding. If you
• consume three or more alcoholic drinks per day
• talk to your doctor or pharmacist before taking
• these medications. Buffered aspirin or enteric
• coated aspirin may be preferable to regular
• aspirin to decrease stomach bleeding.

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NARCOTIC ANALGESICS

• TYLENOL 2,3, 4
• morphine/ROXANOL, MS CONTIN
• oxycodone combined with acetaminophen/PERCOCET,
  ROXICET
• meperidine/DEMEROL
• hydrocodone with acetaminophen/VICODIN, LORCET
• Interaction
• Alcohol Avoid alcohol because it increases the
• sedative effects of the medications. Use caution
• when motor skills are required, including
• operating machinery and driving.

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• Narcotic pain relievers. These drugs are
  prescribed for moderate to severe pain. They
  include the opiates morphine, codeine,
  propoxyphene (Darvon), and meperidine (Demerol).
  The combination of opiates and alcohol enhances
  the sedative effect of both substances,
  increasing the risk of death from overdose (28).
  A single dose of alcohol can increase the
  availability of propoxyphene (29), potentially
  increasing its sedative side effects.
• Chronic alcohol ingestion activates enzymes that
  transform acetaminophen (Tylenol and others) into
  chemicals that can cause liver damage, even when
  acetaminophen is used in standard therapeutic
  amounts (32,33). These effects may occur with as
  little as 2.6 grams of acetaminophen in persons
  consuming widely varying amounts of alcohol (34).

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Drug Interactions with Herbal Products

• Ginkgo biloba Aspirin, warfarin (Coumadin),
  ticlopidine (Ticlid), clopidogrel
  (Plavix), dipyridamole (Persantine)
• St. John's wort Antidepressants
• Ephedra Caffeine, decongestants,
  stimulants
• Ginseng Warfarin
• Kava Sedatives, sleeping pills,
  antipsychotics, alcohol

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Effects of alcohol on the brain

• Results of autopsy show that patients with a
  history of chronic alcohol abuse have smaller,
  and more shrunken brains than nonalcoholic adults
  of the same age and gender.
• The findings of brain imaging techniques, such as
  CT scans  consistently show an association
  between heavy drinking and physical brain damage,
  even in the absence of chronic liver disease or
  dementia.
• The detection of structural brain damage is
  complemented by results of functional imaging
  techniques, such as positron emission tomography
  (PET) and single photon emission computed
  tomography (SPECT).

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• Brain shrinking is especially extensive in the
  cortex of the frontal lobe - the location of
  higher cognitive faculties.
• The vulnerability to this frontal lobe shrinkage
  increases with age.  After 40 some of the changes
  my be irreversible
• Shrinkage also occurs in deeper brain regions,
  including brain structures associated with
  memory, as well as in the cerebellum, which helps
  regulate coordination and balance..
• Limited research suggests that women may be more
  susceptible than men to alcohol-related brain
  shrinkage

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• Young people who binge drink could be risking
  serious damage to their brains now and increasing
  memory loss later in adulthood, according to new
  research. Adolescents may be even more vulnerable
  to brain damage from excessive drinking than
  older drinkers.Researchers at Duke University,
  studied frequent binge exposure to alcohol in
  rats to compare the effects of binge drinking on
  younger and older rats. The animals were given
  doses of alcohol which were comparable to
  multiple instances of binge drinking in humans.

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• Young people who drink can have a significant
  reduction in learning and memory, and teen
  alcohol users are most susceptible to damaging
  two key brain areas that are undergoing dramatic
  changes in adolescence
• The hippocampus handles many types of memory and
  learning and suffers from the worst
  alcohol-related brain damage in teens. Those who
  had been drinking more and for longer had
  significantly smaller hippocampi (10 percent).
• The prefrontal area (behind the forehead)
  undergoes the most change during adolescence.
  Researchers found that adolescent drinking could
  cause severe changes in this area and others,
  which play an important role in forming adult
  personality and behavior and is often called the
  CEO of the brain.

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Early alcoholic drinking may produce the
following specific medical conditions

• Loss of control of eye muscles
• Hypoglycemia
• Gastritis
• Increased susceptibility to infections
• Cardiac arrhythmia
• Anemia
• Constant flushing of facial edema
• Peripheral
• neuritis
• Pancreatitis
• Increase in blood alcohol level
• Withdrawal signs
• Fatty liver
• Increase in blood pressure

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Chronic alcohol drinking produces even more
severe conditions, some of which may be
irreversible, such as

• Liver damage
• Korsokoff Syndrome (vitamin B deficiency)
• (A memory disorder caused by excessive drinking
  or thiamin deficiency)
• Brain damage
• Cardiomyopathy
• Cancer of the tongue, mouth, or pharynx,
  hypopharynx, esophagus, and liver

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Wernicke-Korsakoff Syndrome

• This disease, notably frequent among chronic
  alcoholics, is due to a deficiency of vitamin B1
  or thiamine.  The poor diet of alcoholics who are
  suffering from this syndrome leads to lesions and
  increased microhemorrhages in the mammillary
  bodies, thalamus and brainstem. This syndrome can
  also be associated with diseases of the GI tract
  when there is inadequate thiamine absorption. 
• Neurologic symptoms include confusion, memory
  loss, impaired movements and peripheral
  neuropathy.  Immediate administration of thiamine
  is usually successful in treating the symptoms,
  but sometimes permanent memory loss occurs.

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WHAT ARE THE SYMPTOMS OF CIRRHOSIS? Early
symptoms include the following

• Fatigue and loss of energy.
• Loss of appetite and nausea.
• Spider angiomas may develop on the skin these
  are pinhead-sized red spots from which tiny blood
  vessels radiate.

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Patients in later stages may develop the
following symptoms

• Jaundice. This is a yellowish cast to the skin
  and eyes, which occurs because the liver cannot
  process bilirubin for elimination from the body.
• The palms of the hands may be reddish and
  blotchy, a condition known as palmar erythema.
• Loss of body hair.
• Abnormalities in hormone-affected organs. In men
  with alcoholic cirrhosis, the testicles may
  atrophy and their breasts may become swollen,
  sometimes painfully.
• Ascites. A swollen belly is a sign of ascites,
  the most common major complication of cirrhosis,
  which occurs when fluid accumulates in the
  abdomen. Fever, abdominal pain, and tenderness
  when the belly is pressed indicate that the fluid
  is infected, but infection can occur without any
  symptoms.
• Fluid-build up and swelling (edema) in legs.

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Effects of alcohol on Water-Soluble Vitamins

• Thiamin deficiency
• Polyneuropathy
• Wernicke-Kersakoff syndrome (severe neurological
  problems such as impaired movement and memory
  loss)
• Niacin deficiency
• Alcohol uses large amounts of NAD and NADP during
  its metabolism
• Vitamin B-6 deficiency
• Deficient intake and possibly increase breakdown
• Leads to decrease in RBC and anemia

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More Effects

• Vitamin B-12
• Alcohol interferes with absorption
• Folate deficiency
• Inadequate intake
• Reduced absorption due to mucosal damage
• Much is excreted
• Cells, villi decrease in number
• Vitamin C
• Decreased intake and/or altered liver metabolism
• Scurvy

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Effects on Vitamin A

• Vitamin A
• Deficient intake
• Inability of the liver to produce carrier protein
• Low stores, regardless of intake
• Increased degradation of vitamin A
• Reduced enzymes to digest fat, reduces vitamin A
  absorption
• Impaired conversion of beta-carotene to retinoids

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Effects on Vitamin D

• Inadequate intake
• Reduced enzymes to digest fat, thus reduces
  vitamin D absorption
• Decreased activation of vitamin D with liver
  damage
• May cause bone cell dysfunction, reduces bone
  formation
• Compromises calcium and phosphorus metabolism

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Other Fat Soluble Vitamins

• Vitamin K
• Decreased absorption
• Damages intestinal bacteria
• Vitamin E
• Reduced pancreatic enzymes

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Effects on Minerals

• Magnesium deficiency
• Increased magnesium loss via the urine
• Tetanysharp contraction of muscles
• Impaired CNS
• Hallucinations
• Zinc deficiency
• Decreased absorption and increased excretion
• Change in taste and smell, anorexia, trouble
  seeing at night, impaired wound healing
• Iron deficiency and toxicity
• Injuries in the GI tract increased uptake

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Fetal Alcohol Syndrome

• Avoidable
• Alcohol reaches the fetus
• Deprives brain of oxygen and nutrients
• 4 drinks a day or binge drinking while pregnant
• Abstinence from alcohol is the best advice

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Table 8.4
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Gender effects

• Women absorb and metabolize alcohol differently
  than men. In general, women have less body water
  than men of similar body weight, so that women
  achieve higher concentrations of alcohol in the
  blood after drinking equivalent amounts of
  alcohol
• Views of the brain obtained by magnetic resonance
  imaging (MRI) suggest that women may be more
  vulnerable than men to alcohol-induced brain
  damage.
• A survey of female college students found a
  significant relationship between the amount of
  alcohol the women reported drinking each week and
  their experiences of sexual victimization

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• First, soon after consumption, alcohol rapidly
  spreads throughout the water in a drinkers body,
  and mens bodies have a greater percentage of
  water by volume.
• Women also have lower levels of activity in the
  alcohol-metabolizing enzyme, alcohol
  dehydrogenase, in the stomach. This means that
  more alcohol is metabolized in the stomachs of
  men before being absorbed into the bloodstream
  than in the stomachs of women. The end result is
  that more alcohol passes directly into the
  bloodstream of women.
• Finally, as a womans hormone levels vary during
  the course of her menstrual cycle, her blood
  alcohol concentration can vary dramatically with
  the same amount of alcohol intake.

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• In addition, women appear to eliminate alcohol
  from the blood faster than men. This finding may
  be explained by women's higher liver volume per
  unit lean body mass
• Research suggests that women are more vulnerable
  than men to alcohol-related organ damage, trauma,
  and legal and interpersonal difficulties.
• Compared with men, women develop alcohol-induced
  liver disease over a shorter period of time and
  after consuming less alcohol. In addition, women
  are more likely than men to develop alcoholic
  hepatitis and to die from cirrhosis. Animal
  research suggests that women's increased risk for
  liver damage may be linked to physiological
  effects of the female reproductive hormone
  estrogen.

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• Men and women who consume one or two alcoholic
  drinks per day have a lower death rate from
  coronary heart disease (e.g., heart attacks) than
  do heavier drinkers and abstainers
• Many studies report that moderate to heavy
  alcohol consumption increases the risk for breast
  cancer, although one recent study found no
  increased breast cancer risk associated with
  consumption of up to one drink per day, the
  maximum drinking level reported by most women

33

• The relative contribution of genetic factors to
  women's risk for alcoholism has been debated. A
  survey of 2,163 female twins revealed greater
  similarity between identical twins compared with
  fraternal twins on measures of alcohol
  consumption. Similar studies including more than
  12,000 twin pairs from the general population
  have confirmed that among both male and female
  twin pairs, identical twins are more likely than
  fraternal twins to have similar rates of alcohol
  dependence, alcohol abuse, and heavy alcohol
  consumption.

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Alcohol Dependency/Abuse

• Genetic factors
• Children of alcoholics are 4x more likely to
  become alcoholics
• A low threshold to alcohol
• Ethnic role
• Depression

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Diagnosis

• Physiological dependence
• Tolerance to the effect of alcohol
• Evidence of alcohol-associated illnesses
• Continued drinking in defiance of medical and
  social advice
• Depression and blackouts

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Binge Drinking

• Especially in college students
• 4 or more drinks in a row
• Acute alcohol intoxication
• Signs of alcohol poisoning
• semiconsciousness or unconsciousness
• slow respiration (8
  seconds between breath)
• cold, clammy, pale, or bluish skin
• strong odor of alcohol

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Binge Drinking - definitions

• 5 drinks in a row for men and 4 drinks in a row
  for women
• an extended bout of drinking (at least 2 days)
  in which the person neglects other activities in
  order to drink.

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Binge Drinking

• Call it a "binge" or call it something else over
  one hour or over ten, five drinks on one occasion
  is not a healthy amount of alcohol for anyone to
  consume. Five drinks on one occasion will make
  almost anyone "legally" drunk, and will make most
  people quite drunk. At least five non-drinking
  hours after the last drink would have had to pass
  before the person would be sober.

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Binge Drinking

• If someone has a big meal before drinking, it
  takes longer for the alcohol to reach the
  bloodstream. However, when you are talking about
  four or five drinks, no meal is going to keep the
  person from becoming drunk. Bingeing boils down
  to intent number of drinks in a row. If someone
  intends to become drunk, and drinks four or five
  drinks (depending on gender,) its high-risk
  drinking no matter what you call it.

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• if a person is taking any one of a large number
  of medications both over-the-counter and
  prescription medications he or she may become
  drunk with very little alcohol. In addition,
  drinking alcohol while taking medications can be
  extremely dangerous.
• Acetaminophen (Tylenol,) barbiturates,
  benzodiazepines, and prescription pain medication
  are among the most dangerous, but many others can
  cause trouble, as well.

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• A threshold dose above which alcohol begins to
  have detrimental effects on nutrition is
  difficult to determine.
• In general, moderate drinkers (two drinks or less
  per day) seem to be at little risk for
  nutritional deficiencies.
• Various medical disorders begin to appear at
  greater levels.
• Research indicates that the majority of even the
  heaviest drinkers have few detectable nutritional
  deficiencies

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Be warned!

• 24.5 of those who start drinking at age 17 or
  younger develop alcohol dependence. (2)
• 10 of those who start drinking at age 21 or
  older develop alcohol dependence. (2)

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CAFFEINE

• Caffeine is a naturally occurring substance found
  in the
• leaves, seeds, or fruits of more than 60 plant
  species, including
• coffee and cocoa beans, kola nuts, and tea
  leaves.
• Caffeine belongs to a group of stimulants called
  xanthines.
• Caffeine is exreted in urine as methylxanthine
  and methyluric acid as a product of metabolizing
  caffeine.

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Caffeine properties

• Its highest concentration in our system occurs
  within thirty
• to sixty minutes, and its effects usually last
  for four to six hours.
• Caffeine is a mild stimulant to the central
  nervous system.
• and a diuretic
• Caffeine is mildly addictive
• signs of withdrawal from a caffeine addiction
• Sleepiness
• feeling overtired (from not having had any
  caffeine to energize you)
• a terrible headache (when you abruptly stop
  having caffeine regularly)
• Caffeine often improves symptoms for persons with
  headaches or migraines.

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Caffeine Contents
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Caffeine Content of Foods and Drugs
Coffee, instant 8 ounces 95 General
Foods International Coffee, 8 ounces 90
Cafe Vienna Coffee, decaffeinated 8 ounces
5
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• Celestial Seasonings Iced
• Lemon Ginseng Tea 16-ounce bottle 100
• Bigelow Raspberry
• Royale Tea 8 ounces 83
• Tea, leaf or bag 8 ounces 50
• Snapple Iced Tea,
• all varieties 16-ounce bottle 48
• Lipton Natural Brew
• Iced Tea Mix, unsweetened 8 ounces 25-45
• Lipton Tea 8 ounces 35-40
• Tea, green 8 ounces 30
• Tea, instant 8 ounces 15

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• Celestial Seasonings
• Herbal Tea, all varieties 8 ounces 0

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• Four out of five Americans have some caffeine on
  any given day, the average amount being about 200
  milligrams a day (approximately equivalent to
  what's found in two 8-ounce cups of coffee, three
  to four 12-ounce cans of caffeinated soda, or
  four 8-ounce cups of tea).

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• Caffeine is well absorbed from by the stomach and
  intestine, and peak blood levels occur about 45 -
  60 minutes after ingestion. Once in the blood
  stream, caffeine causes a number of responses in
  the body. Caffeine is well known for it's effects
  on the brain, but there are a number of other
  physiologic effects that occur.
• Blood pressure, pulse rate, and stomach acid
  production are increased, fat stores are broken
  down, and fatty acids are released into the blood
  stream. These effects can last from a few hours
  to as long as 12, but within 4 days of regular
  use, the body develops tolerance to many of the
  effects of caffeine. For example, although
  caffeine increases blood pressure and pulse in a
  first time user, a regular user will not
  experience any significant change.

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How much is too much caffeine? It depends on the
person -- oftentimes, you'll know when you've had
more than enough if it makes you feel

• anxiousexcitablerestlessdizzyirritableunable
  to concentrategastrointestinal (GI)
  achesheadaches that don't seem to go
  awaytrouble with sleeping

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HOW MUCH CAFFEINE IS "SAFE?"

• Most experts agree that 300 mg. of caffeine
  (about the amount contained in 3 cups of coffee)
  is a moderate intake.
• At this time, there is NO evidence that caffeine
  intake is associated with heart disease,
  hypertension, osteoporosis or high cholesterol.

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WILL CAFFEINE HELP ME STUDY?

• Caffeine may help you stay awake and be alert to
  study, but it will not improve your performance
  on an exam the next day if you have not gotten
  enough rest or are exhausted from an all-nighter.

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HOW CAN I GET ENERGY?

• Instead of reaching for another Coke, try these
  non-caffeinated strategies to maintain good
  energy levels
• Get a good night's sleep. If you are tired during
  the day, take a short nap.
• Take a brisk, 10-minute walk.
• Eat regular, healthful meals. Use the food guide
  pyramid to build your meals. Fatty foods and
  alcohol can make you feel "draggy."
• Try not to skip or delay meals. Avoid eating very
  large meals - digesting a large meal can make you
  want a nap.

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Note

• Herbal supplements for weight loss often contain
  high levels of caffeine and/or quarana or ephedra
  (ma huang) - other nervous system stimulants.

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HOW CAN I QUIT OR REDUCE MY CAFFEINE CONSUMPTION?

• Cut back gradually. Eliminate a cup or glassful a
  day rather than going "cold turkey."
• Keep a log to see how much caffeine you consume.
  Remember to count medications and supplements.
  Experiment with your intake to see how you feel
  both physically and psychologically
• Limit your intake to 200-300 mg of caffeine per
  day.
• Substitute herbal tea, hot or cider or decaf
  coffee for caffeinated drinks.
• Be active or be still - run, walk, bike ride,
  swim, do yoga or meditate.
• Eat regular meals
• Stop smoking - caffeine and cigarettes often go
  together.
• Ask others in your house or office to decrease
  their caffeine with you. There is strength in
  numbers.
• Remember that coffee does NOT help you to sober
  up after drinking alcohol.

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Some common brands of medications that contain
caffeine are

• Caffedrine Caplets
• Enerjets
• NoDoz Maximum Strength Caplets
• Vivarin

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Caffeine is one of the best-researched substances
in the food supply. The overwhelming scientific
evidence suggests that, in moderation, it has no
adverse health effects.

• A recent review undertaken by Health Canada has
  considered the numerous studies dealing with
  caffeine and its potential health effects. It has
  re-confirmed that for the average adult, moderate
  daily caffeine intake at dose levels of 400-450
  mg/day is not associated with any adverse
  effects. Data has shown, however, that women of
  childbearing age and children may be at greater
  risk from caffeine.

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• Numerous studies have examined the effects of
  caffeine intake on fertility and pregnancy. Most
  studies found that moderate caffeine intake does
  not affect fertility or increase the chance of
  having a miscarriage or a baby with birth defects

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• While little harm can be directly associated with
  coffee or other caffeinated beverages, coffee
  drinkers do tend to do things that contribute to
  health risks. Surveys suggest that they are more
  likely to smoke cigarettes, exercise too little,
  and eat fatty meats. Tea drinkers, in comparison,
  tend to exercise more and eat more fresh fruit.
• For women, there is no association between
  caffeine intake and fibrocystic breast disease,
  benign tumors, breast tenderness, or breast
  cancer--or cancer of any type. Also, caffeine is
  not an important risk factor for osteoporosis in
  women who drink at least one glass of milk per
  day. But when caffeinated beverages replace milk,
  low calcium intakes may interfere with bone
  health.

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• A woman who wants to start a family should be
  aware that consuming over 300 milligrams of
  caffeine a day might increase the time it takes
  to get pregnant, as well as the risk of
  miscarriage or a low-birth-weight baby. The US
  Food and Drug Administration recommends that
  pregnant women avoid caffeine-containing foods
  and drugs or consume them only sparingly, because
  caffeine crosses the placenta and is a stimulant
  to the unborn baby. It is also transferred into
  breast milk, so women who breastfeed should avoid
  caffeine.

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Caffeine is also used by triathletes and other
athletes as a performance aid.

• Caffeine does not appear to benefit short term,
  high intensity exercise (eg. sprinting)
• Caffeine can enhance performance in endurance
  sports.
• Caffeine mobilizes fat stores and encourages
  working muscles to use fat as a fuel. This delays
  the depletion of muscle glycogen and allows for a
  prolongation of exercise. The critical time
  period in glycogen sparing appears to occur
  during the first 15 minutes of exercise, where
  caffeine has been shown to decrease glycogen
  utilization by as much as 50.