Alcoholics and Malnutrition

File photo. Credit: NDTV Food In the United States and Canada, where food is plentiful and fortification of foods with vitamins and minerals is common, overt nutrient deficiencies are rare—except among alcoholics. The results of their poor diet interact with the results of alcohol’s toxicity—which include diarrhea, malabsorption, liver malfunction, bleeding, bone marrow changes, and hormonal changes—to worsen malnutrition. In general, the more a person drinks, the worse the malnutrition.

Poor Diet

A nationally representative study found that as alcohol quantity increased, diet quality worsened, but as alcohol frequency increased, diet quality improved. Diet quality was poorest among the highest-quantity, lowest-frequency drinkers and best among the lowest-quantity, highest-frequency drinkers.

Disordered eating is common among heavy drinkers, especially among alcoholic women. Factors responsible for the poor diet of alcoholics are much easier to identify than to correct. Economic factors include poverty, lack of cooking facilities, and homelessness. Anxiety, depression, loneliness, and isolation are all characteristic of alcoholism, and all contribute to loss of appetite. So can physical pain. Lack of interest in food is common.

There may be an aversion to many specific foods or to eating in general, especially after the experience of diarrhea, painful indigestion, or difficulty swallowing.

Heavy drinkers who get about half their calories from alcohol cannot eat enough to obtain adequate vitamins and minerals. Severely malnourished alcoholics often have multiple deficiencies.

Vitamin Deficiencies

Inadequate intake, poor absorption, increased vitamin destruction in the body, and urinary losses all contribute to vitamin deficiencies in the alcoholic. Alcohol also interferes with the conversion of vitamin precursors to active forms.

Folate, thiamin, and vitamin A are most often affected by alcoholism. Folate deficiency contributes to malabsorption, anemia, and nerve damage—all of which worsen malnutrition.

Vitamin A deficiency also creates a vicious cycle by damaging the gastrointestinal lining and by impairing immunity, leaving the victim susceptible to infections.

Thiamin deficiency contributes to classic diseases of alcoholism: the brain damage of Wernicke-Korsakoff syndrome, polyneuropathy (nerve inflammation), and cardiomyopathy (heart inflammation). Alcoholics can have overt scurvy from vitamin C deficiency. Vitamin B₆ and vitamin B₁₂ deficiencies are less common.

Alcohol metabolism interferes with the normal metabolism of vitamins and other nutrients. For example, metabolism of ethanol uses up the dehydrogenase enzyme that is also used for metabolism of retinol. Retinol (vitamin A) uses that enzyme for its conversion to other active forms of vitamin A, and the disruption of its metabolism is probably one way in which alcohol increases cancer risk. The same disruption may produce fetal brith defects when pregnant women drink.

Alcohol-induced fat malabsorption and metabolic abnormalities contribute to the depletion of fat-soluble vitamins A, D, E, and K. Blood-clotting factors drop with depleted vitamin K, increasing risk of bleeding and anemia. Vitamin E deficiency is not generally recognized as a complication of alcoholism, but its depletion due to fat malabsorption is possible. Optimal vitamin E status is necessary to quench free radicals generated during alcohol metabolism.

Mineral Deficiencies

Alcoholics are commonly deficient in minerals such as calcium, magnesium, iron, and zinc. Alcohol itself does not seem to affect their absorption; rather, fluid losses and an inadequate diet are the primary culprits. Magnesium deficiency causes “shakes” similar to that seen in alcohol withdrawal.

Chronic diarrhea and loss of epithelial tissue (caused by skin rashes or sloughing off of the digestive lining) may seriously deplete zinc, a mineral needed for immune function. In cases of bleeding, especially gastrointestinal blood loss, iron levels fall.

Not all minerals are lower in heavy drinkers than in nondrinkers. If there is no bleeding, a heavy drinker’s iron levels tend to be higher than normal in the blood and liver, potentially contributing to harmful oxidation. Copper and nickel levels also may be elevated in advancing disease, but the reason and the effects are unclear.

Macronutrients

Animal experiments can demonstrate a number of ways that alcohol alters digestion and metabolism of carbohydrate, fat, and protein, but the relevancne to humans at usual levels of intake is not certain.

Alcohol interferes with amino acid absorption, but its overall effect on protein balance appears minimal. It inhibits gluconeogenesis and lowers blood glucose levels, probably contributing to hangovers and, at the most extreme, causing acute, potentially lethal hypoglycemia if a person who drinks heavily neglects to eat.

Alcohol’s most dramatic effect is on fats —alcohol causes fatty liver. On the one hand, excess alcohol has the undesirable effect of raising blood triglyceride levels, often significantly. Hyperlipidemia (high blood fats) is common among heavy drinkers.

Abstinence and a balanced diet can usually return blood lipids to normal. On the other hand, moderate alcohol use increases protective high-density lipoproteins (HDL, or “good cholesterol”), an important factor in alcohol’s relationship to the reduced risk for coronary artery disease.

Body Weight

Although alcoholic beverages provide minimal nutrient value, they do provide calories; although contains 7 kilocalories per gram. Does alcohol consumption contribute to obesity? It appears likely.

In an analysis of data collected from more than 37,000 people, researchers found that overweight drinkers consumed more drinks than leaner drinkers on the days that they drank. Men and women who infrequently consume the greatest quantity of alcohol weigh more than those who frequently drink small amounts. Because smoking and drinking interact to influence body weight, the researchers looked only at current drinkers who had never smoked.

Drinking patterns are important. Alcohol consumption consists of two components: (1) the amount consumed on drinking days (quantity) and (2) how often drinking days occur (frequency).

Although previous studies of the relationship between drinking alcohol and body weight have been inconsistent, these studies looked at average consumption. A given average volume, however, can result from widely varying drinking patterns.

An average volume of 2 drinks per day, for example, may result from consuming 2 drinks every day, 4 drinks every other day, 14 drinks on one day per week, or 30 drinks on two days per month. Body weight is more sensitive to drinking patterns than average volume.

Dietary changes may be helpful in treating liver disease, but abstinence from alcohol is essential. Reducing dietary fats somewhat reduces fat accumulation in the liver. Consuming adequate micronutrients and a healthful balance of macronutrients probably speeds recuperation from liver diseases in their earlier stages. In late-stage liver diseases, dietary restrictions, often of proteins, may slow disease progression or improve symptoms.