April is Alcohol Awareness Month, and we have simplified science on everything related—effects on the body, nutrition, and how an individual can still be on a quest with sound nutrition, making sense of how alcohol and calories mix. Patients often times have questions related to alcohol, its effects on medications, diet, and their health, so what better time to dive into this topic and share what the science has to say, to better arm pharmacists, and to help patients.

The National Council on Alcoholism and Drug Dependence named April National Alcohol Awareness Month back in 1987 as a way to decrease the stigma associated with alcoholism, and to provide education to prevent unnecessary health risks.1 There are some key terms, definitions, and implications that will prove helpful for pharmacists, and pharmacy students alike to know, so that they can better educate their patients on alcohol, its effects, and the implications of certain drinking patterns and behaviors, so let’s look at those first:
 
Excessive drinking is associated with a significant increase in acute health and safety risks, proportional to the amount of alcohol consumed. If this behavior becomes habitual, then over time it can lead to many other health complications. These include2-7:
  • Hypertension
  • Heart disease
  • Stroke
  • Liver disease
  • Digestive problems
  • Cancer of the breast, mouth, throat, esophagus, liver, and colon
  • Learning and memory problems, including dementia and poor school performance
  • Mental health problems, including depression and anxiety
  • Social problems, including decreased productivity, family problems, and unemployment
  • Dehydration
  • Malnutrition
  • Alcohol dependence and alcoholism
Abstaining from alcohol consumption is not the only solution to avoiding the above; responsible drinking in moderation, provided there are no contraindications, is a viable option to remain healthy, minimize health risks, and still partake in libations. Let’s define what 'a drink' is, and how the frequency of drinking can be categorized, and defined:
 
1.     'A drink' is defined as8:
  • 12 oz beer
  • 8oz malt liquor
  • 5oz wine
  • 1.5oz 80-proof spirits or liquor
2.     'Binge drinking' is defined as9:
  • Men: 5 or more drinks in a single session
  • Women: 4 or more drinks in a single session
3.     'Heavy drinking' is defined as9:
  • Men: 15 or more drinks per week
  • Women: 8 or more drinks per week
Again, the key is responsible drinking in moderation provided no contraindications exist. Now, let’s dive into nutrition, and how alcohol fits:


How to track alcohol into nutrition—calories, carbs, oh my!

A lot of times, patients can feel overwhelmed about how alcohol and calories mix, and being the most accessible healthcare providers, pharmacists have the ability to shed some light on the matter. In general, the formula for calories contributed by alcohol comes out to 7kCal/1 gram for alcohol (EtOH), but when looking at mixed drinks (say a margarita, for example), some alcoholic drinks do contain carbohydrates from sweeteners, so those ingredients also contribute to the calories in a beverage.

Looking at how alcohol is broken down by the body, it can get a bit technical, and going into that level of detail for patients really is not necessary,or advised. To simplify explaining this process, alcohol is technically broken down like fat by the body, but metabolized more like a carbohydrate. I know, I know—stay with me here!

It is conceptually similar by saying 'track fiber, starch, and sugar separately.' We don't differentiate each one separately, though we could, because ultimately, we categorize it all as a carbohydrate (allotting 4kCal/gram) due to how the body is using it.10
 

How to accurately track alcohol—back to math class!

One example pharmacists can use comes from a popular beer. This beverage, for 1 bottle, has listed on the nutrition label 95kCal, yet only labeled '2.6 gram of carbs.' Doing the math of 4kCal/gram of carbohydrate X 2.6 gram listed, that’s 10.4kcal, so where does the remaining 84.6kCal come from?

This is where labeling and 'consumer beware' comes into action: the nutrition label does not list EtOH, so the bottling companies get away with this misleading statement of perceived low carbohydrate/low calorie claim. Fear not, however—there is hope!

One good resource to get to the bottom of this mathematical mayhem is Calorieking.com. For the example, the website this beer listed with 11.9gram of alcohol.11
11.9grams x 7kCal/gram = 83.3kCal, which makes up the remaining difference! (Side note: there’s a trace amount of protein to completely count everything.)
 
Now, a pharmacist could take calories, and divide into fat (9kCAl/gram) or carbohydrate grams (4kCal/gram) or both—but, as you can imagine, this would seriously complicate things. The simple solution is to just take the total calories, and divide by 4 (carbohydrates) to yield 23.75gram. Logging only fat would yield 10.5gram; and a combo of each would yield 11.9gram of carbs and 5.25gram of fat. 


Sugar alcohols

Sugar alcohols can raise an individual’s blood sugar, albeit much lower than actual sugar, so they still need to be counted as carbs (~2kCal/gram), if tracking. Just because something doesn’t exert an insulin response does not mean it is free of calories. Too much of these sugar alcohols, found especially in sugar-free foods, can have a laxative effect or other gastrointestinal disturbances.
 

So there you have it, my pharmacy friends: a crash course in all things alcohol and nutrition! I hope this will serve you in answering questions you get from your patients in this area, and helps to spread awareness for April being Alcohol Awareness Month!
 
To learn more about alcohol, nutrition, and how we can have an impact as healthcare professionals, feel free to reach out to TheFitPharmacist Dr. Adam Martin, and contributor Kevin Brunacini! You can reach us on social media on Instagram, Kevin is @brunofnp and Adam is @thefitpharmacist , or visit our websites for more information and evidence-based resources related to health to empower your practice and your patients at http://thefitpharmacist.com – thank you for reading!
 
 
References 
  1. Wilcox, S. Alcohol awareness month. National Council on Alcoholism and Drug Dependence website. www.ncadd.org/about-ncadd/events-awards/alcohol-awareness-month. Updated December 26, 2017. Accessed April 23, 2018.
  2. Rehm J, Baliunas D, Borges GL, Graham K, Irving H, Kehoe T, et al. National Institutes of Health. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. NIH website. 2010;105(5):817-43. https://www.ncbi.nlm.nih.gov/pubmed/20331573. Accessed April 23, 2018. 
  3. International Agency for Research on Cancer. Personal Habits and Indoor Combustions: A Review of Human Carcinogens, Volume 100E 2012. IARC website. http://monographs.iarc.fr/ENG/Monographs/vol100E/index.php. Accessed April 23, 2018.
  4. Miller JW, Naimi TS, Brewer RD, Jones SE. National Institutes of Health. Binge drinking and associated health risk behaviors among high school students. Pediatrics. 2007;119(1):76-85. https://www.ncbi.nlm.nih.gov/pubmed/17200273. Accessed April 23, 2018.
  5. Castaneda R, Sussman N, Westreich L, Levy R, O’Malley M. A review of the effects of moderate alcohol intake on the treatment of anxiety and mood disorders. J Clin Psychiatry 1996;57(5):207–212. www.ncbi.nlm.nih.gov/pubmed/8626352?dopt=Abstract. Accessed April 23, 2018.
  6. Booth BM, Feng W. The impact of drinking and drinking consequences on short-term employment outcomes in at-risk drinkers in six southern states. J Behavioral Health Services and Research 2002;29(2):157–166. www.ncbi.nlm.nih.gov/pubmed/12032973?dopt=Abstract. Accessed April 23, 2018.
  7. Leonard KE, Rothbard JC. Alcohol and the marriage effect. J Stud Alcohol Suppl; 1999 Mar;13:139-46. www.ncbi.nlm.nih.gov/pubmed/10225498?dopt=Abstract. Accessed April 23, 2018.
  8. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition, Washington, DC; 2015.
  9. Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS. Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011. Prev Chronic Dis 2014;11:140329.
  10. Whitney, E., & Rolfes, S. R. (2016). Alcohol in the body. Understanding nutrition (14th ed., pp. 222-233). Stamford, CT: Cengage Learning.
  11. Calories in Michelob | Nutrition, Carbohydrate and Calorie Counter. CalorieKing. www.calorieking.com/foods/calories-in-michelob_b-YmlkPTYzNA.html. Accessed April 23, 2018.