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On Alcohol, Alcohol Use Disorders and Weight Gain

During my heavy drinking days, my best friend (who, given the choice, much prefers a Diet Coke over a glass of wine) asked me, “Why aren’t you overweight, given all the calories you’re consuming in those martinis?”

During the 7 years when I had an alcohol use disorder, I wasn’t overweight, although I often overate after a night of more than a few too many – the result of alcohol’s disinhibiting effects. That is, when under the influence, it’s not uncommon for people to let down their guard about what they eat, as “what-the-hell” thinking takes over. The end result is morning-after guilt and remorse – not only about having drunk too much but also about binge eating.

However, the whole issue of alcohol and weight gain is complex and depends on the person.

The Calorie Factor

There’s no question that alcoholic beverages are loaded with what nutritionists call “empty calories.”

At its face value of about 7 calories per gram, alcohol comes close to fat at approximately 9 calories per gram. (In my training as a registered dietitian, we were taught that alcohol “counts” as a fat in the diet of someone with diabetes.)

The other energy-containing nutrients that make up food – protein and carbohydrates – have 4 calories per gram, significantly fewer for the same unit of measure. So fat and alcohol (and foods and beverages with high levels of them) are considered more “calorically dense.” (Of course, alcoholic beverages often come bottled with lots of added sugar and sometimes fat, as in Irish cream.)

The National Institute on Alcoholism and Alcohol Abuse Offers an alcohol calorie calculator for various alcohol-containing beverages at its Rethinking Drinking link.

In my training as a registered dietitian, we were taught that alcohol “counts” as a fat in the diet of someone with diabetes.-Anne FletcherResearchers attempting to identify health behaviors that might be helpful for weight management in young adults showed how the combination of caloric, appetite-stimulating, and disinhibiting caloric factors of alcohol can add up in the results of a 2008 Journal of the American Dietetic Association study involving 43 college students.

One of their findings was that of the two-thirds who drank alcoholic beverages, they did so at least one to two nights a week, having a minimum of 5 to 6 drinks per night. While drinking, they often had pizza, fast food, chips, or sweets. Without taking food into account, drinking 5 beers (regular, not light) two nights a week for 40 weeks out of a year adds up to more than 60,000 calories, which could lead to at least a 10-15 pound weight gain if a person doesn’t compensate for the same amount of calories by eating less or being more physically active.

The Aperitif Factor poetically defines an aperitif as an alcoholic beverage “meant to spark the appetite without overwhelming the senses.” And, indeed, research findings suggest that drinking alcohol just before a meal is associated with increased food consumption. Is it because alcohol sparks the appetite? To date, no studies have shown a significant increase in self-reported hunger following an aperitif.

In a new study published in July 2015 in the prestigious journal, Obesity, researchers attempted to learn more about how alcohol affects the brain (and thereby may impact food intake) by intravenously administering alcohol to 35 women before eating a meal. On another study visit, the women were given a placebo saline injection in place of the alcohol.

Before eating, brain responses to food and non-food aromas were measured using brain imaging scans. (With the IV injection, they were able to bypass the digestive system and, thus study the direct effects of alcohol on the brain.) William J. A. Eiler II, PhD of the Indiana University School of Medicine and colleagues found that when the women received IV alcohol, they ate more food at lunch, on average, compared to when they were given the placebo.

They also found that alcohol exposure sensitized the brain’s response to food aromas. Dr. Eiler said, “The brain, absent contributions from the gut, can play a vital role in regulating food intake. Our study found that alcohol exposure can both increase the brain’s sensitivity to external food cues, like aromas, and result in greater food consumption.” He added that combining the “empty calories” in alcoholic beverages with the aperitif effect can lead to energy imbalance and possibly weight gain.

Despite media fanfare, it should be noted that this was a small study involving normal-weight women who did not report a history of drinking problems. (Certainly with advanced alcohol problems, loss of appetite can occur.) Moreover, one-third of them actually ate less after alcohol exposure when compared to the placebo exposure. And obviously, most people don’t consume alcoholic beverages via an IV route.

Why Aren’t All “Alcoholics” Overweight?

Returning to my friend’s question about why people with alcohol use disorders are not necessarily overweight, let’s consider a “fifth” (now about the same as a 750 milliliter bottle) of hard liquor such as gin, vodka, or whiskey – which I determined as the minimum daily intake (or its equivalent from such beverages as beer or wine) of more than 90 of the 222 participants in my book Sober for Good. That amount of hard liquor would provide about 1,650 calories a day. Add 1,500 calories from food to that, and you’ve got more than 3,000 calories, which should lead to weight gain in many people. (A typical sedentary man needs about 2,200-2,400 calories a day and a woman needs just 1,800-2,000.) So what’s going on?

I recalled from my nutritional biochemistry days that, somehow, when the body of a very heavy drinker metabolizes alcohol, some of those calories are “wasted.” To see if my recollection was correct, I turned to Susan Smith, Ph.D., Professor of Nutritional Sciences at the University of Wisconsin-Madison, who affirmed what I recalled. She said:

“When talking about ‘alcoholics’, not social drinkers, several things are going on. For starters, alcohol typically doesn’t promote an insulin response (although what you drink with it can, like the carbs in beer or the soft drink in the liquor.) This means that for very heavy drinkers, alcohol calories are less likely to be processed for cellular energy.”

Food for Thought

Dr. Smith also noted that in people with severe alcohol use disorders, the body can become less efficient at getting energy from food because alcohol reduces the function of mitochondria, the energy generators of cells. She said, “It’s a bit like adding sugar to a gas tank. The cell can’t extract the energy from food as efficiently, so more goes to waste. To make matters worse, as alcohol screws up the cell’s energy budget, the cells’ attempts to fix the situation causes a chemical called lactate to build up – and lactate is part of what makes a person feel awful when they’re hung over.”

…in people with severe alcohol use disorders, the body can become less efficient at getting energy from food because alcohol reduces the function of mitochondria, the energy generators of cells. Dr. Smith stated that before anyone starts thinking that heavy drinking is a great way to lose weight (I actually did have someone in my book, Thin for Life, try a “beer diet”) he or she should think again. She warned, “Apart from all the damage that alcohol causes to the liver, brain, and other organs, its disruption of energy metabolism creates toxic by-products called free radicals. Much like the fumes from your car engine, these by-products leak out of the mitochondria to damage DNA and proteins in the cells. Not only do these promote aging, they can also mutate the DNA and cause cancer.”

The bottom line is that alcohol calories count more in moderate non-daily imbibers than in daily heavy consumers. For the vast majority of people who drink alcohol socially and don’t have a problem with it, their alcohol calories can lead to weight gain and count toward excess body fat. So a good way for social drinkers to lose weight is to cut down on or cut out alcohol.

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