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Dr. Tim Says....



Being Careful with Alcohol

Glass of Red WineLast week’s column about being prepared for the cocktail or holiday party resulted in a lot of questions about alcohol and drinking. While we know that drinking can be beneficial, it can also cause many health issues. About 2 drinks a day on average for men and 1 per day for women has been shown to be favorable, but binge drinking can cause more health problems than balanced consumption.

The key is moderation. That may be a challenge and parties can be a place that tips the balance. When heading out for that party it helps to understand a little about what you are going to consume. For instance, there are a lot of things that affect alcohol absorption.  

The higher the concentration of alcohol in a given drink, the faster the absorption. That's good old fashioned physics at work, and the mechanisms of active absorption in the small intestine are no exception. About 20% is absorbed from the stomach and the other 80% in the small intestine.  So drinking a shot of 80 proof (this is 40% since by definition "proof" is twice the concentration of ethanol) would be absorbed faster than a glass of wine with 12% ethanol.  Maximum absorption is at the 20 - 25% range on an empty stomach.  So that 80 proof drink (40%) diluted 1:1 is about 20%, and having a stiff vodka and tonic with no food on board may be the prototype for maximum absorption (and getting drunk a lot faster).  

By making a "weak" gin and tonic the concentration goes down rapidly.  A good measure for spirits is to use at least 4 parts of mixer to 1 part of spirit.   

Once you get above 80 proof it may be that absorption is actually slower because higher concentrations of alcohol will delay stomach emptying.  Since the majority of ethanol is absorbed in the small intestine, higher concentrations might work.  This will certainly depend on a number of other factors, including what else might be in the stomach.  For instance, high fat meals will delay gastric emptying.  As such absorption is slowed.  

That said, it will still be absorbed and will actually be more of a problem if someone drinks a number of 100 proof shots along with a greasy appetizer.  The delay in emptying that could lead to a delay in absorption may cause to a false sense that "I'm not getting drunk" and lead to more consumption.  Eventually that can catch up and cause the "especially sloshed" state.  

One final consideration is that women have less total body water, so their blood alcohol concentration will be higher with fewer drinks consumed.  

Consider the following guidelines for drinking responsibly:

1.  Preload with some food.  Even though fat may delay gastric emptying more effectively it appears that any food in the stomach will help.  

2.  Drink dilute alcohol.  Lower proof spirits with a higher ratio of 4:1, mixer to spirit.  Wine is a good choice. Beer falls well into this category, being in the 5% range.

3.  Drink slowly.  Alternate that vodka and tonic with a tonic water or, better yet, sparkling water (remember that tonic water has the same number of calories as soda).  The hydration will help dilute the alcohol in your blood stream to some extent.  

4.  KEEP TRACK. There's all kinds of tricks, but the napkin count is a good one.  Take a cocktail napkin and put it in your pocket when you get each drink.  Know your limit and stop when you have the right number of napkins.  

You can have alcohol be part of your healthy life with just a bit of care.

Eat well, eat healthy, enjoy life! (And drink responsibly!)

Timothy S. Harlan, M.D.
Dr. Gourmet
December 13, 2010