NMDM121 MEDICINAL FOOD SCIENCE Session 25 … · Alcoholic Beverages Nutritional Medicine...

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NMDM121

MEDICINAL FOOD SCIENCE

Session 25

Alcoholic Beverages

Nutritional Medicine Department


Session Summary

• Discuss the constituents of alcoholic beverages,

including key phytochemicals.

• Discuss the benefits and risks associated with the

consumption of alcoholic beverages.

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Alcohol: Introduction

• Alcohol is the oldest and most widely used

psychoactive drug and is legal in most countries.

• Alcohol is fermented from the sugar or other

carbohydrates found in grapes and other fruits,

vegetables, or grains.

• Ethyl alcohol (ethanol) is the main psychoactive

component in all alcoholic beverages.

• Beer made from grain is about 5% alcohol, wine made

from grapes and other fruits is about 12% alcohol, and

distilled liquor made from grains or wines is about 40%

alcohol.



• Alcohol is absorbed by the body at different rates

depending on weight, gender, age, and other factors.

• It is metabolised, mostly by the liver, and subsequently

excreted through urine, sweat, and breath.

• Ethyl alcohol - a substance that can cause drunkenness

and changes in consciousness, mood, and emotions.

• Alcohol is responsible for a considerable burden of

death, disease and injury in Australia.

(NHMRC 2009)



• Around 8% of Australians drink daily, and around 41%

drink weekly.

• The mean volume of alcohol consumed has remained

relatively stable since 1991, but there have been

important changes in the patterns of consumption.

• Preferences in beverage type have shifted towards

spirits and pre-mixed drinks, especially among younger

drinkers and there is an increased level of informality in

drinking styles, such as drinking directly from the

container.

(NHMRC 2009)


Alcohol: Standard Drink

• In Australia, a standard drink contains 10 grams of

alcohol.

• Examples of one standard drink include:

‒ 1 X 375 mL bottle of mid-strength beer (3.5% alcohol)

‒ 1 X 100 mL glass of wine (13.5% alcohol)

‒ 1 X 30 mL nip of spirits (40% alcohol)

http://www.ichangeforhealth.co.za/wp-content/uploads/types-of-alcohol.jpg


Alcohol: Metabolism

• Alcohol usually starts to affect the brain within about five

minutes of being swallowed. The blood alcohol concentration

(BAC) reaches its peak about 30–45 minutes after the

consumption of one standard drink (10g alcohol).

• Rapid consumption of multiple drinks results in a higher BAC

because the liver has a relatively fixed rate of metabolism

regardless of how many drinks are consumed.

• It generally takes about an hour for the body to clear one

standard drink, although this varies from person to person.

The rate of this metabolism depends on several factors

including genes, liver size, body mass and composition, and

alcohol tolerance.

(NHMRC, 2009)


Alcohol: Metabolism

Alcohol

Acetaldehyde

Acetate

Aldehyde Dehydrogenase

(B3 Dependent Enzyme)

Alcohol Dehydrogenase

(B3 Dependent Enzyme)


Alcohol: Biological Effects

• Alcohol is a source of energy providing 29 kJ per gram;

this can easily be converted to fat.

• Alcohol is a central nervous system depressant.

• Alcohol is a diuretic – it depresses production of

antidiuretic hormone (ADH), a hormone produced by the

pituitary gland that retains water – thus with less ADH,

more water is lost.

• The accumulation of hydrogen ions during alcohol

metabolism shifts the body’s acid-base balance towards

acid.

• Alcohol disrupts liver metabolic processes.


Liver Detoxification

• Detoxification or biotransformation

• Chemical changes of a xenobiotic, phytochemical or

endogenous compound that render it less toxic and/or

more readily excreted. (Groff & Gropper 2000)

• Phase I bioactivation

• Phase II conjugation


Phase I Liver Detoxification

• Introduce or expose a functional group on the parent

compound, making it more polar.

• May activate inert compounds (e.g. pro-drugs and pro-

carcinogens).

• Cytochrome P 450 enzymes initiate actions.

• Generates toxic reaction products: ammonia, hydrogen

peroxide, aldehydes.

(Groff & Gropper 2000)


Phase II Liver Detoxification

• Covalent linkage between parent compound functional

group and water-soluble moiety.

• Product generally inactive and excreted via bile or urine:

‒ Glucuronidation

‒ Sulfation

‒ Glutathionation

‒ Acetylation

‒ Peptide conjugation: taurine, glycine, glutamine

‒ Methylation

(Groff & Gropper 2000)


Liver Detoxification

www.balancedconcepts.net/liver_phases_detox_paths.pdf


http://www.balancedconcepts.net/liver_phases_detox_paths.pdf


Alcohol: Protective Compounds

In-vitro and animal studies suggests that the following

compounds may offer some protection against alcohol-induced

damage:

• Lipoic acid associated with gastric protection against alcohol

induced damage (Sehirli 2008).

• Fenugreek seeds prevented alcohol induced liver damage (Kaviarasan 2008).

• Grape seed extract decreased oxidation associated with high

alcohol intake (De Freitas 2004).

• Grapefruit seed extract (Brzozowski 2005) and naringenin (Seo

2003) suppresses PGE2 and increases gastric protection.

(Continued on next slide)


Alcohol: Protective Compounds

• Capsaicin prevented gastric ulceration stimulated by alcohol (Saeki 2000).

• Se and vitamin C (Ozdil 2004) and quercetin (Liu 2008)

decreased liver oxidative markers and gastric injury.

• Zn deficiency increases with alcohol intake; is a cofactor for

alcohol dehydrogenase; stimulates liver regeneration (Kang

2008).

• B3, (involved with alcohol dehydrogenase) reduces oxidation (Tampier 1999).

• Curcumin found to inhibit lipid peroxidation with high alcohol

consumption (Vanisree 2006).


Alcohol: Adverse Effects

Alcohol intoxication can be harmful for a variety of reasons, including:

• Impaired brain function resulting in poor judgment, reduced reaction

time, loss of balance and motor skills, or slurred speech.

• Dilation of blood vessels causing a feeling of warmth but resulting in

rapid loss of body heat.

• Increased risk of certain cancers, stroke, and liver diseases (e.g.,

cirrhosis), particularly when excessive amounts of alcohol are

consumed over extended periods of time.

• Damage to a developing foetus if consumed by pregnant women.

• Increased risk of motor-vehicle traffic crashes, violence, and other

injuries.

• Coma and death can occur if alcohol is consumed rapidly and in

large amounts.

(CDC, 2014)


Beer: Introduction

• The ingredients in beer are basically barley, hops, yeasts

and water.

• Hops contains:

‒ Polyphenols such as quercetin and kaempferol

‒ α-bitter acids such as humulone

‒ β-bitter acids such as lupulone

‒ 8-prenylnaringenin – a phyto-oestrogen

http://www.ctbeverage.com/beers.jpg


Beer: Nutrients

• Vitamin B6 found in higher amounts in beer compared

with wine and spirits; thought to be responsible for the

lack of effect on homocysteine with beer compared with

wine and spirits (van der Gaag 2000).

• Lager style beers contain less thiamin (vitamin B1) than

other beers – lager, 35.7 μg/L; ale, 88.3 μg/L;

stout/porters, 104.4 μg/L; wheat beers, 130.7 μg/L.

• Cider and wines contain less thiamin and riboflavin than

beer.(Hucker et al., 2011)


Beer: Nutrients

Lager per 100 mL Stout per 100 mL

Energy 153 kJ 226 kJ

Ethanol 4 g 5.7 g

Potassium 32 mg 62 mg

Riboflavin 0 mg 0.03 mg

Niacin 0.44 mg 0.91 mg

Vitamin B6 0.03 mg 0.05 mg

Folate 0 mcg 6 mcg

(NUTTAB, 2010)


Beer: Research

• In a study of 2,291 patients presenting for colonoscopy

screening (US population) there was a higher incidence

of significant neoplasia in those who consumed more

than eight drinks of spirits alcohol (26.3%; OR = 2.53;

95% CI = 1.10-4.28; p < 0.01) and those who drank

more than eight servings of beer per week (21.7%; OR =

2.43; 95% CI = 1.11-5.32; p= 0.02) compared to

abstainers (Anderson, 2005).


Beer: Research

• Beer intake is associated with higher incidence of gout,

compared with spirits and wine; beer contains purines,

which combined with ethanol increases lactic acid and

serum uric acid (Yamamoto 2005).

• Found to deplete vitamin C levels more than spirits and

wine (van der Gaag 2000).

• Linked to increased incidence of migraines (Leira 1996).

• Full strength beer found to have more antioxidants than

light strength or spirits (Ghiselli 2000).


Cider

http://www.recipes4us.co.uk/images/Fotolia_Cider.jpg


Cider: Introduction

• Cider is made by a “producer” rather than a “brewer”. They

may use a mixture of bittersweet and bittersharp cider apples

or sweet dessert apples, or a mixture of the two to make cider.

• Cider varies in alcohol content from 2% ABV (Alcohol by

Volume) to 8.5% ABV or more in traditional English ciders.

• Perry is the correct term for Pear Cider and can only be made

from specialised perry pears, which are high in natural

tannins.

http://www.barnesandadams.com/wp-content/uploads/2011/09

/perry-pears-rock-thorn-brandy.jpg


Cider: Constituents

• Conventional apple cider has been shown to have a

relatively high concentration of phenolics, flavonols, and

antioxidants, including quercetin.

• This is, in part, because apples themselves have a fairly

high concentration of phenolics.

• One analysis identified 16 phenolic compounds

including: hydrocaffeic acid, chlorogenic acid,

hydrocoumaric acid, procyanidins, vitamins B2 and B5,

and high amounts of quercetin.

(Madrera, Lobo, & Valles. 2006)


Cider: Research

• Another study involving Scrumpy Jack® cider showed an

increase in polyphenol metabolites such as phlorizin.

‒ Phlorizin is an inhibitor of cellular transporter SGLT1

responsible for the transport and uptake of glucose and

galactose.

‒ This study showed the potential for the blood glucose

lowering effects of apple cider, though further studies are

required.

‒ The relatively new popularity of alcoholic cider renders it

immature in the research field and a lot more is required to

determine the health benefits, if any.

(DuPont et. al., 2002)


Wine: Introduction

• Wine is made from fermented grape juice. The added

yeast ferments the sugar naturally present in grapes to

create alcohol.

• Wines can be grouped into six primary categories: white

wines, red wines, rosé wines, sparkling wines, dessert

wines and fortified wines.

• Most grapes have colourless juice so the red

pigmentation in red wine comes from the inclusion of

grape skins. Grape skins contain tannins and resveratrol

so red wine contains these additional phytochemicals.

• Wine may contain sulphur preservative 220.


Wine: Constituents

• Wine contains a large variety of phytochemicals including:

‒ Phenolic acids (from grape pulp)

‒ Stilbenes (from grape skins – so present in red wine)

‒ Flavonoids (such as anthocyanins and flavan-3-ols, e.g.

catechins) – present in red wine.

• Red wine contains more polyphenols than white wine (around

10 fold) because during the wine making process, red wine,

unlike white wine, is macerated for weeks with the skin. The

concentrations in red wine range from around 1.2 to 3.0 g/L.

• Wines that are aged in oak barrels can contain additional

phenolic compounds from the oak barrels.


Red Wine: Resveratrol

• Much of the research interest in red wine has focused on

the phytochemical, resveratrol.

• Resveratrol (3,5,4-trihydroxy-trans-stilbene) is a natural

polyphenolic compound that exists in Polygonum

cuspidatum (Japanese knotweed), grapes, peanuts and

berries.

• Polyphenols → Stilbenes – e.g. resveratrol,

phenostilbene (i.e. the Stilbenes are a sub-group within

the polyphenol group of phytochemicals).



• Despite the frequent media reporting of the benefits of

red wine due to resveratrol, good quality human trials on

resveratrol are currently lacking.

• The biological actions of resveratrol identified from in-

vitro and animal studies have focused on its potential

protective effect against cardiovascular disease,

ischemia–reperfusion injury and diabetes mellitus.

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In-vitro and animal studies suggest that resveratrol exerts its

protective effects through modulation of:

• Adipocyte/fibroblast biology

• Platelet activation

• Blood vessel function

• Oxidative stress

• Inflammation

• Serum glucose maintenance

• Cardiomyocyte biology

• Maintenance of cell structure

• Serum lipid activity

(Tang et al., 2014)



Beverage Total Resveratrol

mg/L

Resveratrol in 150

mL serve (mg)

White wines (Spanish) 0.05-1.8 0.01-0.27

Rose wines (Spanish) 0.43-3.52 0.06-0.53

Red wines (Spanish) 1.92-12.59 0.29-1.89

Red wines (Global) 1.98-7.13 0.30-1.07

Red grape juice (Spanish) 1.14-8.69 0.17-1.30

1 cup of red grapes provides 0.24-1.25 mg resveratrol.

(Higdon, 2007)


Spirits

• Highest content of ethanol; likely associated with hangover

intensity (Woo 2005).

• Congeners, the by-products of individual alcohol preparations,

increase the frequency and severity of a hangover.

Congeners are found primarily in brandy, wine, tequila,

whiskey and other dark liquors, whereas clear liquors such as

rum, vodka and gin tend to cause hangover less frequently

((Wiese et al., 2009).

• Significant increase in the risk of neoplastic colon cell growth

with increased consumption (Anderson 2005).

• Increased ethanol associated with spleen and thymus

oxidation via reduction of vitamin C and glutathione (Parthasarathy 2006).


Energy Drink + Alcohol

• The ingestion of Energy Drinks in combination with

alcohol has become increasingly popular, especially

amongst young people.

• One of the concerns associated with combined use is

that users may not feel the symptoms of alcohol

intoxication, thus increasing the potential for alcohol-

related injury (i.e. caffeine can mask the depressant

effect s of alcohol - a wide-awake drunk is more of a

hazard than a sleepy one).

• Caffeine has no effect on the metabolism of alcohol.


Alcohol: Health AdviceNHMRC, 2009. ‘Australian guidelines to reduce health

risks from drinking alcohol.’

Guideline 1 For healthy men and women, drinking no more than two

standard drinks on any day reduces the lifetime risk of harm

from alcohol-related disease or injury.

Guideline 2 For healthy men and women, drinking no more than four

standard drinks on a single occasion reduces the risk of

alcohol-related injury arising from that occasion.

Guideline 3 For children and young people under 18 years of age, not

drinking alcohol is the safest option.

Guideline 4 Maternal alcohol consumption can harm the developing foetus

or breastfeeding baby.

A) For women who are pregnant or planning a pregnancy, not

drinking is the safest option.

B) For women who are breastfeeding, not drinking is the safest

option.


Alcohol: Health AdviceGiven the constituents and biological actions of alcoholic beverages,

consider recommending reduced intake or avoidance for those

suffering from:

• Overweight, obesity

• Liver disease – e.g. fatty liver, hepatitis

• Gastro-oesophageal reflux disease; peptic ulcer; inflammatory

bowel disease

• Menopausal hot flushes and night sweats

• Inflammatory skin conditions such as acne rosacea, eczema,

psoriasis

• Gout

• Histamine intolerance; migraine; headaches

• Anxiety, depression, insomnia, mental health conditions

• Preconception, pregnancy and breastfeeding.


Alcohol: Health Advice

Based on the current evidence available:

• Light to moderate drinkers (1-2 standard drinks per

day), without medical complications, could continue

their current consumption.

• The evidence is not strong enough to advise

abstainers to start drinking – abstainers could

continue abstaining.

• The Mediterranean diet includes the consumption of

1-2 glasses of red wine per day with a meal.

• Further research is required to clarify health advice

regarding alcohol consumption.


Alcohol: Health Advice

According to the Cancer Council Australia (2014):

• There is convincing evidence that drinking alcohol

increases the risk of cancers of the bowel, breast, mouth,

throat, voice box, oesophagus and liver.

• Even drinking small amounts of alcohol increases your

cancer risk. The more you drink, the greater the risk. If you

choose to drink, limit your intake.

• The type of alcohol you drink doesn’t make any difference.

Beer, wine and spirits all increase your risk of cancer. Even

at low intake, alcohol contains a lot of energy (kilojoules or

calories) so it can easily contribute to weight gain. Being

overweight or obese also increases your cancer risk.


Session Summary

• Discuss the constituents of alcoholic beverages,

including key phytochemicals.

• Discuss the benefits and risks associated with the

consumption of alcoholic beverages.

http://cdn.builtlean.com/wp-content/uploads/2012/11/alcohol-weight-loss-1.jpg


References

Anderson, J.C., Alpern, Z., Sethi, G., Messina, C.R., Martin, C., Hubbard, P.M., Grimson,

R., Ells, P.F, & Shaw, R.D. (2005). Prevalence and risk of colorectal neoplasia in

consumers of alcohol in a screening population. American Journal of

Gastroenterology, 100(9), 2049-2055.

Brzozowski, T., Konturek, P.C., Drozdowicz, D., Konturek, S.J., Zayachivska, O., Pajdo,

R., Kwiecien, S., Pawlik, W.W., & Hahn, E.G. (2005). Grapefruit-seed extract

attenuates ethanol-and stress-induced gastric lesions via activation of prostaglandin,

nitric oxide and sensory nerve pathways. World Journal of Gastroenterology, 11(41),

6450-6458.

Cancer Council Australia. (2014). Reduce your risk: Limit alcohol. Retrieved December 7,

2014, from http://www.cancer.org.au/preventing-cancer/reduce-your-risk/limit-

alcohol.html

CDC. (2014). Alcohol and public health. Centre for Disease Control and Prevention.

Retrieved December 7, 2014, from http://www.cdc.gov/alcohol/faqs.htm

De Freitas, V., Da Silva Porto, P., Assunção, M., Cadete-Leite, A., Andrade, J.P., & Paula-

Barbosa, M.M. (2004). Flavonoids from grape seeds prevent increased alcohol-

induced neuronal lipofuscin formation. Alcohol and Alcoholism, 39(4), 303-311.

http://www.cancer.org.au/preventing-cancer/reduce-your-risk/limit-alcohol.html

http://www.cdc.gov/alcohol/faqs.htm


References

DuPont, S.M., Bennet, R.N., Mellon, F.A., & Williamson, G. (2002). Polyphenols from

alcoholic apple cider are absorbed, metabolized and excreted by humans. Journal of

Nutrition, 132, 172-175.

Ghiselli, A., Natella, F., Guidi, A., Montanari, L., Fantozzi, P., & Scaccini, C., (2000). Beer

increases plasma antioxidant capacity in humans. Journal of Nutritional Biochemistry,

11, 76−80.

Groff, J.L., & Gropper, S.S. (2000). Advanced nutrition and human metabolism (3rd ed.).

USA: Wadsworth/Thompson Learning.

Higdon, J. (2007). An evidence-based approach to dietary phytochemicals. New York:

Thieme.

Hucker, B., Wakeling, L., & Vriesekoop, F. (2011). The quantitative analysis of thiamin

and riboflavin and their respective vitamers in fermented alcoholic beverages. Journal

of Agriculture and Food Chemistry, 59(23), 12278-12285.

Kang, X., Song, Z., McClain, C.J., Kang, Y.J., & Zhou, Z. (2008). Zinc supplementation

enhances hepatic regeneration by preserving hepatocyte nuclear factor-4{alpha} in

mice subjected to long-term ethanol administration. American Journal of Pathology,

172, 916-925.


References

Kaviarasan, S., Sundarapandiyan, R., & Anuradha, C.V. (2008). Protective action of

fenugreek (Trigonella foenum graecum) seed polyphenols against alcohol-induced

protein and lipid damage in rat liver. Cell Biology and Toxicologoy, 24(5), 391-400

111-120. doi: 10.1007/s10565-007-9050.

Leira, R., & Rodríguez, R. (1996). Diet and migraine. Revista De Neurologia, 24(129),

534-538.

Liu, J.L., Du, J., Fan, L., Liu, X., Gu, L., & Ge. Y. (2008). Effects of quercetin on hyper-

proliferation of gastric mucosal cells in rats treated with chronic oral ethanol through

the reactive oxygen species-nitric oxide pathway. World Journal of Gastroenterology,

14(20, :3242-3248.

Madrera, R.R., Lobo, A.P., & Valles, B. S. (2006). Phenolic profile of Asturian (Spain)

natural cider. Journal of Agricultural and Food Chemistry, 54(1), 120–124.

NHMRC. (2009). Australian Guidelines to Reduce Health Risks from Drinking Alcohol.

National Health and Medical Research Centre. Retrieved December 7, 2014, from

www.nhmrc.gov.au

NUTTAB. (2010). Beer. Food Standards Australia New Zealand. Retrieved December 8,

2014, from

http://www.foodstandards.gov.au/science/monitoringnutrients/nutrientables/nuttab/Pa

ges/default.aspx

http://www.nhmrc.gov.au/

http://www.foodstandards.gov.au/science/monitoringnutrients/nutrientables/nuttab/Pages/default.aspx


References

Ozdil, S., Yanardag, R., Koyuturk, M., Bolkent, S., & Arbak, S. (2004). Protective effects

of ascorbic acid, dl-a-tocopherol acetate, and sodium selenate on ethanol-induced

gastric mucosal injury of rats. Biological Trace Element Research, 99(1-3), 173-190.

Parthasarathy, N.J., Kumar, R.S., Manikandan, S., & Devi, R.S. (2006). Methanol-

induced oxidative stress in rat lymphoid organs. Journal of Occupational Health,

48(1), 20-27.

Saeki, T., Ohno, T., Boku, K., Saigenji, K., Katori, M., & Majima, M. (2000). Mechanism of

prevention by capsaicin of ethanol-induced gastric mucosal injury--a study in the rat

using intravital microscopy. Alimentary Pharmacology and Therapeutics, 14(Suppl 1),

135-144.

Sehirli, O. Tatlıdedea, E., Yükselb, M., Erzikc, C., Çetineld, S., Yeğene, B.C., & Şenera,

G. (2008). Antioxidant effect of alpha-lipoic acid against ethanol-induced gastric

mucosal erosion in rats. Pharmacology, 81(2), 173-180.

Seo, H.J., Jeongb, K.S., Leec, M.K., Parkd, Y.B., Junga, U.J., Kima, H.J., & Choi, M.S.

(2003). Role of naringin supplement in regulation of lipid and ethanol metabolism in

rats. Life Sciences, 73(7), 933-946.


References

Tampier, L. Quintanilla, M. E. & Mardones, J. (1999). Effect of nicotinamide administration

on ethanol consumption and on liver and brain acetaldehyde oxidation rate, by UChB

rats. Addiction Biology, 4(2), 191-195.

Tang, P., NG, Y., Ho, S., Gyda, M., & Chan, S. (2014). Resveratrol and cardiovascular

health – Promising therapeutic or hopeless illusion? Pharmacological Research, 90,

88-115.

van der Gaag, M.S., van den Berg, R., van den Berg, H., Schaafsma, G., & Hendriks,

H.F. (2000). Moderate consumption of beer, red wine and spirits has counteracting

effects on plasma antioxidants in middle-aged men. European Journal of Clinical

Nutrition, 54(7), 586-591.

van der Gaag, M.S., Ubbink, J.B., Sillanaukee, P., Nikkari, S., & Hendriks, H.F. (2000).

Effect of consumption of red wine, spirits, and beer on serum homocysteine. Lancet.

355(9214), 1522.

Vanisree, A.J., & Sudha, N. (2006). Curcumin combats against cigarette smoke and

ethanol-induced lipid alterationsin rat lung and liver. Molecular and Cellular

Biochemistry, 288(1-2), 115-123

Wiese, J. Shlipak, M., & Browner, W. (2009). The alcohol hangover. Annals of Internal

Medicine, 132, 897-902.


References

Woo, Y.S., Yoon, S.J., Lee, H.K., Lee, C.U., Chae, J.H., Lee, C., & Kim, D.J. (2005).

Concentration changes of methanol in blood samples during an experimentally

induced alcohol hangover state. Addiction Biology, 10(4), 351-355.

Yamamoto, T., Moriwaki, Y., & Takahashi, S. (2005). Effect of ethanol on metabolism of

purine bases (hypoxanthine, xanthine, and uric acid). Clinica Chimica Acta, 356(1-2),

35-57.


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NMDM121 MEDICINAL FOOD SCIENCE Session 25 … · Alcoholic Beverages Nutritional Medicine...

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