Chapter 9

Alcohol: Another Form of Grape and Grain

IN THIS CHAPTER

Explaining how alcohol beverages are made

Getting to know the ABV of your choice drink

Discovering how your body digests alcohol

Evaluating alcohol’s health benefits and risks

Alcohol beverages are among mankind’s oldest home remedies and simple pleasures, so highly regarded that the ancient Greeks and Romans called wine a “gift from the gods,” and when the Gaels — early inhabitants of Scotland and Ireland — first produced whiskey, they named it uisge beatha (whis-key-ba), a combination of the words for “water” and “life.” Today, although you may share their appreciation for the product, you know that alcohol may have risks as well as benefits.

When microorganisms (yeasts) digest (ferment) the sugars in carbohydrate foods, they make two byproducts: a liquid and a gas. The gas is carbon dioxide. The liquid is ethyl alcohol, also known as ethanol, the intoxicating ingredient in alcohol beverages.

This biochemical process is not an esoteric one. In fact, it happens in your own kitchen every time you make yeast bread. Remember the faint, beerlike odor in the air while the dough is rising? That odor is from the alcohol the yeasts make as they chomp their way through the sugars in the flour. (Don’t worry; the alcohol evaporates when you bake the bread.) As the yeasts digest the sugars, they also produce carbon dioxide, which makes the bread rise.

In this chapter, I explain how alcohol beverages are made, discuss what ABV means, show you what happens to your body when you drink alcohol, and discuss the health benefits and risks of imbibing.

Creating Alcohol Beverages

Alcohol beverages are produced either through fermentation or through a combination of fermentation plus distillation. Beer, wine, and spirits professionals call these products “alcohol beverages” not “alcoholic beverages.” The first is accurately descriptive; the second is colorful but conjures up the image of tipsy bottles dancing on a shelf rather than respected members of the food and drink family.

Fermented alcohol products

Fermentation is a simple process in which yeasts or bacteria are added to carbohydrate “starter” foods such as corn, potatoes, rice, or wheat. The microorganisms digest the sugars in the food, leaving liquid (alcohol); the liquid is filtered to remove the solids, and water is usually added to dilute the alcohol, producing — voilà — an alcohol beverage.

Beer is made this way. So is wine. Kumiss, a fermented milk product, is slightly different because it’s made by adding yeasts and friendly bacteria called lactobacilli (lacto = milk) to mare’s milk. The microorganisms make alcohol, but it remains in the milk, creating a fizzy, fermented beverage.

Distilled alcohol products

The second way to make an alcohol beverage is through distillation.

As with fermentation, yeasts are added to starter foods to make alcohol from the sugars. But yeasts can’t thrive when the concentration of alcohol is higher than 20 percent, as occurs in most distilled products. To concentrate the alcohol and separate it from the rest of the ingredients in the fermented liquid, distillers pour the fermented liquid into a still, a large vat with a wide columnlike tube on top. The still is heated so that the alcohol, which boils at a lower temperature than everything else in the vat, turns to vapor, which rises through the column on top of the still, to be collected in containers where it condenses back into a liquid.

The condensed liquid, called neutral spirits, is the base for the alcohol beverages called spirits or distilled spirits: gin, rum, tequila, whiskey, and vodka. Brandy is a special product, a spirit distilled from wine. Fortified wines, such as Port and Sherry, are wines with brandy added.

The foods used to make beverage alcohol

Beverage alcohol can be made from virtually any carbohydrate food, most commonly cereal grains, fruit, honey, molasses, or potatoes. Table 9-1 shows which foods are used to produce the different kinds of alcohol beverages.

Table 9-1 Foods Used to Make Alcohol Beverages

Original Food	Alcohol Beverage Produced
Fruit and fruit juice
Agave plant	Tequila
Apples	Hard cider
Grapes and other fruits	Wine
Grain
Barley	Beer, various distilled spirits, kvass
Corn	Bourbon, corn whiskey, beer
Rice	Sake (a distilled product), rice wine
Rye	Whiskey
Wheat	Distilled spirits, beer
Others
Honey	Mead
Milk	Kumiss (koumiss), kefir
Potatoes	Vodka
Sugar cane	Rum

On its own, alcohol provides energy (7 calories per gram) but no nutrients, so distilled spirits, such as whiskey or plain unflavored vodka, serve up nothing but calories. Beer, wine, cider, and other fermented beverages contain some of the food from which they’re made, so they may deliver (very) small amounts of proteins, carbohydrates, vitamins, and minerals.

Checking How Much Alcohol Is in That Bottle

No alcohol beverage is 100 percent alcohol. It’s alcohol plus water, and — if it’s a wine or beer — some residue of the foods from which it was made.

The label term ABV or Alc/Vol (alcohol by volume) shows the amount of alcohol as a percentage of all the liquid in the container. For example, if your bottle or can holds 10 ounces of liquid and 1 ounce of that is alcohol, the product is 10 percent ABV — the alcohol content divided by the total amount of liquid multiplied by 100. Like this:

1 / 10 = 0.1 × 100 = 10 percent

Proof — an older term to describe alcohol content —is two times the ABV. For example, an alcohol beverage that is 10 percent alcohol by volume is 20 proof.

Right now, alcohol beverages, which are regulated by the Alcohol and Tobacco Trade and Tax Bureau (ATT) rather than the Food and Drug Administration (FDA), are the only food and drink products not required by law to carry a Nutrition Facts Label. However, in 2013, ATT announced that beer, wine, and spirits companies may voluntarily list serving size and nutrients per serving on their bottles. The result has been interesting.

Check your supermarket shelf, and you’ll see that “light” beers, whose selling point is that they have fewer calories than “regular” beers, generally list their nutrients, whereas regular beers generally don’t. For example, here is the exact language on two varieties of a popular beer brand:

Bud	Bud Light
5% Alc/Vol	4.2% Alc/Vol, per 12 fl. oz., average analysis: Calories: 110; Carbohydrates: 6.6 g; Protein: 0.9 g; Fat: 0.0 g

Bud Bottle Copy, 2015

In addition, in 2015, Diageo, the world’s largest producers of alcohol beverages, announced that it would put complete Nutrition Facts Labels on every one of its products. Others will likely follow.

Following Alcohol through Your Body

Other foods must be digested before being absorbed by your cells, but alcohol flows directly through your body’s membranes into your bloodstream, which carries it to nearly every tissue and organ. Here’s a road map to show you the route traveled by the alcohol in every drink you take:

• Starting at the mouth: Alcohol is an astringent; it coagulates proteins on the surface of the lining of your mouth to make it “pucker.” Some alcohol is absorbed through the lining of the mouth and throat, but most spills into your stomach, where an enzyme called gastric alcohol dehydrogenase (gADH) begins to metabolize (digest) it.

  How much alcohol dehydrogenase your body churns out is influenced by your ethnicity and your gender. For example, Asians, Native Americans, and Inuits appear to secrete less gastric alcohol dehydrogenase than do most Caucasians, and the average woman (regardless of her ethnicity) makes less gADH than does the average man. As a result, more unmetabolized alcohol flows from her stomach into her bloodstream, which is why the average woman is likely to feel the effects of alcohol more quickly than the average man does. For both men and women, a certain amount of unmetabolized alcohol flows through the stomach walls into the bloodstream and on to the small intestine.

• Stopping at the liver: Most of the alcohol you drink is absorbed through the duodenum (the first part of the small intestine), from which it flows through a large blood vessel (the portal vein) into the liver. There, ADH, an enzyme similar to gADH, metabolizes the alcohol, which is then converted to energy by a coenzyme called nicotinamide adenine dinucleotide (NAD). NAD is also used to convert the glucose derived from other carbohydrates (see Chapter 8) to energy, so while NAD is being used for alcohol, glucose conversion grinds to a halt.

  The normal, healthy liver can process about ½ ounce of pure alcohol (that’s 6 to 12 ounces of beer, 5 ounces of wine, or 1 ounce of spirits) in an hour. The rest flows on to your heart.

• Breathing in and out: Entering the heart, alcohol reduces the force with which the heart muscle contracts. You pump out slightly less blood for a few minutes, blood vessels all over your body relax, and your blood pressure goes down temporarily. The contractions soon return to normal, but the blood vessels may remain relaxed and blood pressure lower for as long as half an hour.

  At the same time, alcohol flows in blood from the heart through the pulmonary vein to the lungs. Now you breathe out a tiny bit of alcohol every time you exhale, and your breath smells of liquor. Then the newly oxygenated, still alcohol-laden blood flows back through the pulmonary artery to your heart, and up and out through the aorta (the major artery that carries blood out to your body).

  As it circulates in the blood, alcohol raises the level of high-density lipoproteins (HDLs), although not necessarily the specific good ones that carry cholesterol out of your body. (For more about lipoproteins, see Chapter 7.) Alcohol also makes blood less likely to clot, temporarily reducing the risk of heart attack and stroke.

• Rising to the surface: Alcohol makes blood vessels expand, so more warm blood flows up from the center of your body to the surface of the skin. You feel warmer for a while and, if your skin is fair, you may flush and turn pink. (Asians, who tend to make less alcohol dehydrogenase than do Caucasians, often experience a characteristic flushing when they drink even small amounts of alcohol.) At the same time, tiny amounts of alcohol ooze out through your pores, and your perspiration smells of alcohol.

• Hitting curves in the road: Alcohol is a depressant. When it reaches your brain, it slows the transmission of impulses between nerve cells that control your ability to think and move.

  Do you feel a sudden urge to urinate? That’s because alcohol reduces your brain’s production of antidiuretic hormones, chemicals that keep you from making too much urine. You may lose lots of liquid, plus vitamins and minerals. You also grow very thirsty, and your urine may smell faintly of alcohol.

• Ending the process: This cycle continues as long as you have alcohol circulating in your blood, or in other words, until your liver can manage to produce enough ADH to metabolize all the alcohol you’ve consumed. How long is that? Most people need an hour to metabolize the amount of alcohol (½ ounce) in one drink within an hour, but that’s an average. Some people may have alcohol circulating in their blood for up to three hours after only one drink. What’s one drink? See the next section.

Understanding How Alcohol Affects Your Health

Beverage alcohol offers both benefits and risks. The benefits are strongly linked to what is commonly called moderate drinking — no more than one drink a day for a woman, two drinks a day for a man.

Moderate amounts of alcohol not only reduce stress but also have beneficial effects on various parts of the human body. For example, as noted by the Mayo Clinic, moderate drinking may

• Reduce your risk of developing and/or dying from coronary artery disease (CAD), the form of heart disease due to narrowed or blocked blood vessels
• Reduce your risk of ischemic stroke — that is, stroke due to narrowed or blocked blood vessels in your brain
• Reduce your risk of developing diabetes

That’s the good news. Here’s the bad news: Although the evidence isn’t conclusive, some studies that applaud the effects of moderate drinking on heart health are less reassuring about the relationship between alcohol and cancer. For example, the National Cancer Institute says that people who smoke and drink are at higher risk for cancers of the mouth, throat (esophagus, pharynx, larynx), and liver. And American Cancer Society (ACS) statistics suggest a higher risk of breast cancer among women who have more than three drinks a week; some studies suggest this effect may apply only to older women using hormone replacement therapy.

A LOT AND A LITTLE VERSUS THE MIDDLE

When scientists talk about the relationship between alcohol and heart disease, the words J-curve often pop up. What’s a J-curve? A statistical graph in the shape of the letter J.

In terms of heart disease, the lower peak on the left of the J shows the risk among teetotalers, the high spike on the right shows the risk among those who drink too much, and the curve in the center shows the risk in the moderate middle. In other words, the J-curve says that people who drink moderately have a lower risk of heart disease than people who drink too much or not at all.

According to a recent report from the Alberta (Canada) Alcohol and Drug Abuse Commission, the J-curve may also describe the relationship between alcohol and stroke, alcohol and diabetes, alcohol and bone loss, and alcohol and longevity. The simple fact is that moderate drinkers appear to live longer, healthier lives than either teetotalers or alcohol abusers. Cheers!

The physical effects of excessive drinking

Alcohol abuse is a term generally taken to mean drinking so much that it interferes with your ability to have a normal, productive life. Excessive drinking, including binge drinking (see the sidebar “Binge drinking: A behavioral no-no,” later in this chapter), can also make you feel terrible the next day. The morning after is not fiction. A hangover is a miserable physical fact:

• You’re thirsty because you lost excess water through copious urination.
• Your stomach hurts and you’re queasy because even small amounts of alcohol irritate your stomach lining, causing it to secrete extra acid and lots of histamine, the same immune system chemical that makes the skin around a mosquito bite red and itchy.
• Your muscles ache and your head pounds because processing alcohol through your liver requires an enzyme — nicotinamide adenine dinucleotide (NAD) — normally used to convert lactic acid, a byproduct of muscle activity, to other chemicals that can be used for energy. The extra, unprocessed lactic acid piles up painfully in your muscles.

Alcoholism: An addiction disease

No one knows exactly why some people are able to have a drink once a day or once a month or once a year, enjoy it, and move on, while others become addicted to alcohol. In the past, alcoholism has been blamed on “bad genes,” lack of willpower, or even a nasty childhood.

As science continues to unravel the mysteries of body chemistry, it’s reasonable to expect that researchers will eventually come up with a rational scientific explanation for the differences between social drinkers and people who can’t safely use alcohol. It just hasn’t happened yet.

What is clear, however, is that alcoholics are people who find it difficult to control their drinking. This situation, if left untreated, may lead to life-threatening situations, such as acute alcohol poisoning that paralyzes body organs, including the heart and lungs, liver damage (cirrhosis), or malnutrition.

Alcoholics are often emaciated, with such visible symptoms of malnutrition as problem skin, broken nails, and dull hair. Less visible symptoms of vitamin and mineral deficiencies may hide underneath the surface because

• Alcohol depresses appetite.
• An alcoholic may substitute alcohol for food, getting calories but no nutrients.
• Even if the alcoholic eats a balanced, nutritious diet, the alcohol in his tissues can prevent the proper absorption of vitamins (notably the B vitamins), minerals, and other nutrients. Alcohol may also reduce the alcoholic’s ability to synthesize proteins.

This set of problems can’t be resolved simply by downing a multivitamin with the alcohol; it requires medical attention to understand and treat the primary cause — drinking too much, much too often.

BINGE DRINKING: A BEHAVIORAL NO-NO

Binge drinkers have been described as “once-in-a-while alcoholics.” They don’t drink every day, but when they do indulge, they go so far overboard that they sometimes fail to come back up. In simple terms, binge drinking is downing very large amounts of alcohol in a short time, not for a pleasant lift but to get drunk. As a result, binge drinkers may consume so much beer, wine, or spirits that the amount of alcohol in their blood rises to lethal levels that, in the worst case, may lead to death by alcohol poisoning.

Efforts to stamp out binge drinking, which often occurs on college campuses, may rely on guilt or shame to change behavior, but a 2008 study at the Kellogg School of Management at Northwestern University found that binge drinkers are already uncomfortable with their behavior. Attempting to make them more so doesn’t work. Instead, the researchers suggested couching anti-binge messages in simple, intelligent language focusing on how to avoid situations that lead to binge drinking rather than the nasty effects of the overindulgence.

As in other areas of modern life, money matters here, at least to grown-ups. In 2015, scientists at Boston University’s School of Public Health published a report in the journal Addiction, showing that a simple 1 percent increase in the tax on alcohol beverages lowered the proportion of adult binge drinkers by 1.4 percent. To prove the point, they noted that Tennessee, with the highest taxes on beer, has the lowest proportion of binge drinkers, while states with lower taxes — specifically Delaware, Montana, and Wisconsin — have the highest.

Who shouldn’t drink

No one should drink to excess. But some people shouldn’t drink at all, not even in moderation. They include

• People who plan to drive or do work that requires both attention and skill: Alcohol slows reaction time and makes your motor skills — operating a sewing machine or turning the wheel of a car — less precise, which make you more likely to end up with a needle through the hand or a head through the windshield.

• Women who are pregnant or who plan to become pregnant in the near future: Fetal alcohol syndrome (FAS) is a collection of birth defects including low birth weight, heart defects, cognitive delays, and facial deformities documented only in babies born to female alcoholics.

  No evidence links FAS to casual drinking — that is, one or two drinks during a pregnancy, or even one or two drinks a week. In fact, for years before FAS was identified and diagnosed, pregnant women were routinely advised to drink beer as a source of nutritious calories.

  However, it’s not clear yet whether there’s any completely safe level of alcohol during pregnancy. In 2005, the U.S. Surgeon General urged women who are pregnant or may become pregnant to abstain from alcohol. This advice remains in effect not only in the United States but also in other countries, including Australia, Canada, France, and New Zealand.

• People who take certain prescription drugs or over-the-counter medication: Alcohol makes some drugs stronger, increases some drugs’ side effects, and renders other drugs less effective. At the same time, some drugs make alcohol a more powerful sedative or slow down the elimination of alcohol from your body.

Table 9-2 shows some of the interactions known to occur between alcohol and some common prescription and over-the-counter drugs. This short list gives you an idea of some of the general interactions likely to occur between alcohol and drugs. But the list is far from complete. Today, by law, drugs that interact with alcohol usually carry a warning on the label, but if you’re taking any kind of medication — over-the-counter or prescription — and you’re not sure of the possibility of interactions, check with your doctor or pharmacist.

Table 9-2 Drug and Alcohol Interactions

Drug	Possible Interaction with Alcohol
Acetaminophen	Increased liver toxicity
Aspirin and other nonsteroidal inflammatory drugs (NSAIDs)	Increased stomach bleeding; irritation
Anti-arthritis drugs	Increased stomach bleeding; irritation
Antidepressants	Increased drowsiness/intoxication; high blood pressure
Antihypertension drugs	Very low blood pressure
Diabetes medications	Very low blood sugar
Diet pills	Excessive nervousness
Diuretics	Low blood pressure
Isoniazid (anti-tuberculosis drug)	Decreased drug effectiveness; higher risk of hepatitis
Sleeping pills	Increased sedation
Tranquilizers	Increased sedation

Alcohol and age

As you grow older, changes in the body’s ability to metabolize food may lower your tolerance for alcohol, increasing the risk of problems associated with excessive drinking.

On the other hand, moderate drinking remains a pleasant experience for people healthy enough to indulge. Like everyone else, senior citizens are likely to find a moderate amount of alcohol relaxing and — believe it or not — beneficial for the aging brain. For more on that subject, check out Chapter 24.

Advice from the Sages: Moderation

Good advice is always current.

Who could improve on this from the Romans — actually, one Roman writer named Terence (Publius Terentius Afer): “Moderation in all things.”

Or this, from the authors of Ecclesiastes (31:27): “Wine is as good as life to a man, if it be drunk moderately: what life is then to a man that is without wine? for it was made to make men glad.”

Intelligent. Sensible. Enjoy.