The Real Deal on

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STANFORDMedical School

• The Real Deal on
• Alcohol

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Ethanol is the active ingredient in alcohol

• Fermentation yeast metabolize sugar (from fruit
  or grain) to form ethanol and carbon dioxide
• Chemistry alcohols are organic compounds in
  which a carbon is attached to a hydroxyl (OH)
• Ethanol is the active ingredient in alcoholic
  beverages, which also contain water,
  preservatives,
• and flavoring ingredients.
• Fermentation usually ends when alcohol content
  reaches a potency of 14 to 15.
• Distillation of alcohol increases its potency.

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Alcohol Concentration in Various Beverages

• Alcohol content (percent alcohol by volume) is
  different in various beverages and brands.
• Beer the darker the beer the higher the
  alcohol content, and the bitter the beer the
  higher the
• alcohol content
• Wine red wines have more alcohol than white
  wines (exception is Chardonnay), and the sweeter
  the
• wine the lower the alcohol content
• Liquor the darker the liquor the higher the
  alcohol content, the sweeter the liquor the lower
  the
• alcohol content
• With the exception of grain alcohol, clear
  liquors have about 40 alcohol.

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What is Blood Alcohol Content (BAC)?

• Blood Alcohol Content is the percent of alcohol
  present in the blood.
• The most accurate way to determine BAC is to
  measure it from a sample of blood.
• Breathalyzers are a reliable estimate of BAC.
  They measure BAC by determining
• the amount of alcohol in alveolar (deep lung)
  air.

• To calculate your BAC using a chart you must
• determine the amount of alcohol you consumed
• in terms of standard drinks.
• Standard Drink is 0.5 oz. of alcohol.
• No. Standard Drinks Serving size (oz.) X Percent
  Alcohol
• 
  0.5 oz. (size of standard drink)
• A person's actual BAC is dependent on many
  complex
• factors, including their physical condition,
  what they
• have recently ingested (food, water,
  medications and
• other drugs).

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• It is illegal for adults to operate a motor
  vehicle with a BAC of 0.08 or greater.
• It is illegal for minors to operate a motor
  vehicle with a BAC of 0.01 or greater.

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• A man who has two standard drinks (within 40
  minutes) and weighs 120
• pounds has a BAC of about 0.06.
• A woman who has two standard drinks (within 40
  minutes) and weighs 120
• pounds has a BAC of about 0.08.

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Overview

• Pathway of Alcohol in The Body
• Alcohol Metabolism
• Health Drawbacks and Benefits
• Effects of Alcohol on Gastro-Intestinal Tract
• Effects of Alcohol on the Heart
• Effects of Alcohol on the Liver
• Effects of Alcohol on the Brain
• Effects of Alcohol on the Endocrine System
• Effects of Alcohol on the Kidney
• Statistics on Drinking
• Contact Information on Alcohol Drinking Abuse

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Health Drawbacks Benefits of Drinking Alcohol
Short Term Drawbacks Headache Nausea Vomiting
Upset Stomach Diarrhea Extreme thirst
Irritability Diuresis
Short Term Benefits Helps you release
stress Helps you release tension Helps you sleep
Long Term Benefits (only in small
amounts) Reduced risk of coronary artery
disease Reduced risk of ischemic stroke Possible
protection against gallstones Possible protection
against Type 2 diabetes
Long Term Drawbacks Altered brain function which
can lead to memory loss and even dementia Liver
damage which can manifest as Alcoholic
hepatitis Fatty liver Cirrhosis Altered
circulatory function and heart damage which can
manifest as Cardiac arrhythmias High blood
pressure Heart disease
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Pathway Of Alcohol In The Body
mouth
Esophagus
Stomach/ Intestines
bloodstream
Liver
Brain
Heart/ Other organs
Kidneys
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Normal Gastrointestinal System Physiology
mucosa
Mouth
Esophagus
Parietal cells
Short gastric pits lined with mucus cells
These are the components of the
gastro- Intestinal system
This is the normal appearance of the gastric
fundal mucosa

• The Gastrointestinal Tract Is a Tube That Is
  Specialized along Its Length for the Sequential
  Processing of Food
• Assimilation of Dietary Food Substances Requires
  Digestion As Well As Absorption
• Digestion Requires Enzymes Secreted in the Mouth,
  Stomach, Pancreas, and Small Intestine
• In Addition to Its Function in Nutrition, the
  Gastrointestinal Tract Plays Important Roles in
  Excretion,
• fluid and Electrolyte Balance, and Immunity
  (http//www3.us.elsevierhealth.com)

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Consumption of Alcohol Can Lead to Serious
Disorders of the Gastrointestinal Tract

• Alcohol consumption can promote the occurrence of
  heartburn
• Alcohol consumption increases the risk of
  esophageal cancer and other cancers
• Heavy alcohol consumption or binging can result
  in acute gastritis or bleeding of the mucosal
  lining in the stomach
• Alcohol consumption is associated with peptic
  ulcer disease in the stomach and small intestine
• Alcohol inhibits the muscles of the
  gastrointestinal tract leading to diarrhea
• Alcohol inhibits the absorption of nutrients
• Alcohol increases the transport and absorption of
  toxins across the intestinal wall which may
  predispose the liver and other organs to further
  damage
• (http//www.niaaa.nih.gov/publications/)

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Healthy Stomach
Damage Stomach
This is acute gastritis. There are many causes
of acute gastritis alcoholism, drugs, infection
This is the normal appearance of the stomach
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Pathway Of Alcohol In The Body
mouth
Esophagus
Stomach/ Intestines
bloodstream
Liver
Brain
Heart/ Other organs
Kidneys
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Normal Liver Physiology
Central Vein
Portal triad
The liver is the largest of the abdominal organs
lying just below the diaphragm
This is a microscopic section of normal liver.
The liver is divided into lobules which consist
of portal triads and a central vein
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Makes and stores metabolites and stores essential
vitamins and minerals
Metabolizes drugs, such as alcohol
Regulates level of glucose in the blood
Removes harmful sub- stances from blood
Regulates level of cholesterol in the body
www.livercancer.com/ liver
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Alcohol Metabolism Metabolism is the body's
process of converting ingested substances to
other compounds
Cytosol
Mitochondria
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Alcohol Consumption Can Lead to Altered Liver
Function and Liver Damage

• Most alcoholic liver damage is attributed to
  alcohol metabolism
• Liver injury can be the direct result of the
  toxic metabolic by-products of metabolism or the
  result of inflammation induced by these products
• Liver damage can manifest as
• Alcoholic hepatitisacute inflammation of the
  liver due to
• binging
• Fatty liverliver cells become filled with fat
  vacuoles due to
• abnormal lipid metabolism
• Cirrhosisliver becomes scarred and permanently
  damage due
• fibrosis (repair process that is abnormal)

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Bands of Fibrous Connective Tissue form due
to continuous intake of alcohol
Fibrous Bands
Lipid (fat) accumulates in hepatocytes (liver
cells) in vacuoles
Inflammation and fatty deposits due to binge
drinking
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Pathway Of Alcohol In The Body
mouth
Esophagus
Stomach/ Intestines
bloodstream
Liver
Brain
Heart/ Other organs
Kidneys
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Normal Heart Circulatory System Physiology
Four chamber view of the heart
External view of heart
Location of heart within the body

• The heart is a muscular pump that is located just
  to the left of the breastbone
• Its main function is to pump oxygenated blood
  into the arteries and deliver it to all tissues
  and organs in your body
• (www.jomed.com/.../heart_structure/ html/b.html )

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Alcohol Consumption Can Lead to Altered
Circulatory Function and Heart Damage

• Alcohol intake can lead to heart muscle disorders
  (cardiomyopathy) which interfere with heart
  function
• Alcohol intake can lead to heartbeat rhythm
  abnormalities (arrhythmias) which can cause the
  heart to stop working
• Alcohol intake can result in high blood pressure
  which damages other organs and increases the risk
  of stroke
• (http//www.niaaa.nih.gov/publications/)

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Pathway Of Alcohol In The Body
mouth
Esophagus
Stomach/ Intestines
bloodstream
Liver
Brain
Heart/ Other organs
Kidneys
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Cell Biology Alcohol is a drug that binds
receptors on cell
membranes
alcohol (ethanol)
Binding of the drug to the receptor causes
changes within the cell
receptor
GABAA Receptors NMDA Receptors
Structural changes Functional changes
cell
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Alcohol Affects the Brain

• Alcohol Acts On
• Mammilary bodies
• (involved in memory)
• Dorsal Medial Nucleus of the
• Thalamus (emotion)
• Cerebral Cortex
• (motor, sensory, cognition)

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alcohol
Alcohol Facilitates the Action of GABA at GABAA
Receptors
receptor

• GABA is the major inhibitory
• neurotransmitter in the brain.
• GABA binds to the GABAA
• receptor and causes Cl- to flow
• into cells and make then more
• negative on the inside.
• This inhibits the activity of brain
• neurons.
• Alcohol increases the effects
• of this major inhibitory
• neurotransmitter in the brain
• it decreases the activity of neurons.

barbiturates
GABA
alcohol
benzodiazepines
Alcohol and other drugs can bind to GABAA
Receptors and cause severe respiratory depression
(slow or stop breathing).
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alcohol
Alcohol Inhibits Activation of NMDA Receptors by
Glutamate
receptor

• Glutamate is the major excitatory
• neurotransmitter in the brain.
• Glutamate binds to the NMDA Receptor.
• And causes positive ions like Na and
• Ca2 to flow into the cells and make them
• more positive on the inside.
• This activates brain neurons.
• Alcohol decreases the effect of
• this major excitatory neurotransmitter
• in the brainit decreases the activity of
• neurons.

Alcohol and other drugs (i.e. ketamine) can bind
to NMDA Receptors and cause severe respiratory
depression (slow or stop breathing).
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Immediate Effect of Alcohol on the Brain

• Sedation
• Impaired Judgment
• Slurred Speech
• Loss of Coordination (ataxia)
• Loss of Consciousness
• Coma (at high doses)

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The Positive and Negative Effects of Short Term
and Long Term Alcohol Consumption on the Brain
Short Term Benefits Helps you release
stress Helps you release tension Helps you sleep
Short Term Negative Effect Headache Nausea Irrita
bility
Long Term Negative Effect Altered brain
function Potential memory loss Potential Dementia
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Pathway Of Alcohol In The Body
mouth
Esophagus
Stomach/ Intestines
bloodstream
Liver
Brain
Heart/ Other organs
Kidneys
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Hormone Problems are Associated with Alcohol Use

• Decreased testosterone levels
• Enlarged breasts (gynecomastia)

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Alcohol Decreases Testosterone Level

• Alcohol inhibits synthesis
• and release of hypothalamic
• releasing hormones.
• Alcohol causes liver damage.
• The liver makes the hormone
• IGF-1. Rats treated with alcohol
• have lower levels of IGF-1.
• Alcohol blocks the ability of
• IGF-1 to induce the release of
• LH in rats.
• Alcohol may directly inhibit
• release of LH from the pituitary
• and testosterone from the
• testes.

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Pathway Of Alcohol In The Body
mouth
Esophagus
Stomach/ Intestines
bloodstream
Liver
Brain
Heart/ Other organs
Kidneys
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Acute and Chronic Alcohol Consumption can
Compromise Kidney Function-- Especially if
Liver Disease is Also Present

• Function of the Kidney
• Regulates amount and
• composition of nutrients
• in the blood (i.e. glucose).
• Regulates amount and
• composition of key ions/
• electrolytes in the blood
• (i.e. Na, Cl-, K, H,
• Ca2, Mg2, PO4-,etc.).
• Regulates Blood Volume/
• Blood Pressure by adjusting
• the amount of Na and water
• in the blood.
• Role in excretion of waste
• (i.e. urea).

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The Kidneys Produce Hormones and Respond to
Hormones

• Kidneys make erythropoietin
• acts on bone marrow to
• increase production of
• RBCs.
• Kidneys make calcitrol active
• form of vitamin D. Vit D acts
• on intestine and helps with
• Ca2 absorption.
• Kidneys make renin stimulates
• production of other hormones
• that help regulate blood pressure.

Cross-Section of a Normal Adult Kidney
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Alcohol Can Impair the Kidneys Ability to
Regulate the Volume and Composition of Fluid and
Ions/Electrolytes in the Body

• Alcohol Stimulates the
• Hypothalamic-Pituitary-Adrenal Axis
• Alcohol stimulates the release
• of adrenocorticotropic hormone
• (ACTH) from the pituitary.
• ACTH ? Increased Aldosterone
• production from the adrenal gland
• ?Increased Na reabsorption?Increased
• Fluid Retention? High Blood Pressure

(alcohol stimulates ACTH release)
(produces aldosterone)
Hypothalamic-Pituitary-Adrenal Axis
Nephron functional unit of the kidney
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• Chronic Alcohol Use
• Low concentrations of key
• ions/electrolytes.
• Severe alterations of bodys
• acid/base balance.
• Disruption of hormonal control.
• In case of liver disease, can have
• impaired Na and Fluid Regulation.
• High Blood Pressure
• Possible Kidney Failure

Normal Kidney
Patients with Renal Failure who undergo
dialysis for years may develop multiple cysts in
their kidneys.
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Statistics on Drinking
Monitoring the Future Study (MTF) Trends in
Prevalence of Alcohol Use Teenagers 2000-2002
12th Graders
8th Graders
10th Graders
http//www.nida.nih.gov/infofax/HSYouthtrends.html

• For the 2002 MTF, more than 43,000 students in
  394 schools nationwide were surveyed
• about lifetime, past year, past month, and
  daily use of drugs, including alcohol.
• The latest data are online at http//www.drugabuse
  .gov.
• Very few youth drink on a daily basis.
• The percentage of youth reporting alcohol
  consumption within their lifetime, past year
• and last 30-days has been steadily declining.

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Contact Information

• Adolescent Counseling Services/Adolescence
• Substance Abuse Program
• http//www.acs-teens.org
• 650-424-0852 or 650-424-9853 (Fax)
• 4000 Middlefield Road Rm FH, Palo Alto, CA 94303
• Al-Anon Alateen Mid-Peninsula Information
• 650-592-7935
• 751 Alameda De Las Pulgas
• Blmnt, CA 94002
• Al-Anon/Alateen Serv de Informacion Hispana
• 2470 Pulgas Avenue
• Palo Alto, CA 94303
• Alcoholics Anonymous
• 650-342-2615
• 450 Peninsula Avenue
• SMto, CA 94401

Presentation Lecturers Antonio Alvarez galvi96_at_sta
nford.edu 650-497-5745 Aileen Green, Ph.D. Real
Deal Program Coordinator aileen.green_at_stanford.edu
650-497-6938
Alcohol Workshop Team Antonio Alvarez Odmara-Barre
tto Chang Aileen Green ChaRandle Jordan Delene
Richburg Frain Rivera
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References for Images
Wine picture on title slide http//www.buonissimo.
org/enoteca/ Fermentation picture http//www.mr-
damon.com/.../2sp/projects/ images/fermentation.jp
g Metabolic pathway on slide two http//www.scid
iv.bcc.ctc.edu/.../Respiration/ Alcohol
concentration in various beverages http//www.alco
hol.vt.edu/Students/alcoholEffects/estimatingBAC/i
ndex.htm Blood Alcohol Content Charts for Men
and Women http//www.alcohol.vt.edu/Students/alcoh
olEffects/estimatingBAC/BACCharts.htm Receptor
Neurotransmitter Schematics http//www.niaaa.nih.
gov/gallery/gallery.htm Side view of head and
brain http//www.bbc.co.uk/schools/
parents/ Gynecomastia Picture www.keepkidshealthy
.com/ .../gynecomastia.html Hypothalamus-Pituita
ry-Gonadal Axis http//www.psych.colorado.edu/spe
ncer/ PSYC4092/HPGaxispage.html
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References for Images
Kidney in the human body http//www.thaiclinic.com
/ renalfail.html Cross-section of Normal Adult
Kidney http//medlib.med.utah.edu/WebPath/RENAHTML
/RENAL116.html Hypothalamic-Pituitary-Adrenal
Axis http//www.niaaa.nih.gov/gallery/endocrine/hp
a.htm Nephron Diagram http//users.rcn.com/.../Bi
ologyPages/ K/Kidney.html Renal
Failure http//medlib.med.utah.edu/WebPath/TUTORIA
L/ RENCYST/RCYST025.html Statistics on
Drinking http//www.nida.nih.gov/infofax/HSYouthtr
ends.html