House Call, MD

by Leah Frankel, MS, RD

It’s Friday afternoon and after a long week of work you head to the bar for happy hour and order a margarita, but did you ever stop to think about what’s really in that drink? Drinks can be filled with hidden calories, sugar and sometimes even fat. So does that mean you should cut out drinking all together? Not necessarily. With a little help you should be able to navigate your way through a bar menu and enjoy your drink as a cocktail connoisseur!

Before we understand the nutrition in our drinks it’s important to understand what constitutes a “drink”:

• 0.5 ounce of pure alcohol

• 12 oz of beer (5% w/v)

• 5 oz wine

• 1.5 oz whiskey, rum, vodka etc. (80-proof)

So when you’re out enjoying $1 pint night, after 3 pints (16 oz x 3 = 48 oz) you’ve actually had 4 drinks. Remember that moderate drinking is defined as one drink a day for women and two drinks a day for men, and no you can’t “save” up all your drinks for one night.  We appreciate your creative, “outside the box” thinking, however.

To better understand where the calories in your drink come from, it is essential to have some basic knowledge of where calories come from in general. In our diet there are three macronutrients that provide calories: carbohydrates, protein and fat. Both carbohydrates and protein provide 4 calories (kcal) per gram(g) (of carbohydrate or protein), but fat provides 9 calories per gram of fat. For instance if your cookie contained 10 grams of carbohydrates, 2 grams of protein and 5 grams of fat it would have a total of 93 calories.

Breaking that down:  (10 g carb x 4 kcal/g carb4) + (2 g protein x 4 kcal/g protein) + (5 g fat x 9 kcal/g fat)

Pure alcohol has 7 kcal per gram, which means it provides more calories per gram than protein or carbohydrates but less than fat.  However, most drinks, luckily, aren’t 100% alcohol (which would be 200 proof).

We know that alcohol has more calories that protein or carbs, but that’s not the only reason a few drinks can add up to a lot of calories. Mixers, whether it’s soda, juice, margarita mix or flavored liqueur, can add excess calories to a drink. It’s not uncommon to find martinis that look and sound more like desserts, consisting of creamy liqueurs and sugar-rimmed glasses. Many of these mixed drinks are also being supersized and can have up to 1,000 calories!

To play devil’s advocate, even though drinking can add inches to our waistline there are some benefits associated with moderate drinking. Moderate drinking (1 drink for women or 2 for men per day) has been linked with a reduced risk of heart disease and heart attacks in the elderly, if they are at increased risk for developing heart disease. Wine contains potassium which may help lower blood pressure, as well as flavonoids and resveratrol. Flavonoids have an antioxidant property which can help prevent blood clots and the formation of plaques in your arties. Resveratrol is found in grape skins and seeds and has been shown to increase HDL (“good”) cholesterol and prevent blood clots. Alcohol has been shown to improve appetite in the elderly or other populations with a poor appetite (enter drunk muchies).

Now to the magic numbers you’ve been waiting for…

Calories in common drinks (Note: Calories vary slightly depending on brand):

• 12 oz regular beer: 150 kcal

• 12 oz light beer: 100 kcal

• 5 oz wine: 100 kcal

• 12 oz wine cooler: 180 kcal

• 1.5 oz 80 proof spirit (not including mixers): 100 kcal

• 1.5 oz cordial or liqueur (not including mixers): 160 kcal

• 8 oz Margarita: 336 kcal

• 9 oz Pina Colada: 460 kcal

• 6 oz Long Island Ice Tea: 350 kcal

Is it possible to enjoy a drink and watch your waistline?  Of course it is!

Healthy Drinking Tips:

• Alternate your alcoholic drink with water or a low calorie non-alcoholic drink

• Use low calorie or diet mixers whenever possible

• Plan your alcohol consumption into your daily calorie intake like you would with food

• Stay away from “sweet” drinks, the added flavored liqueurs are primarily sugar

• Dilute your drink with club soda or sparkling water

by Joshua Goldman, MD/MBA 2010

It’s 9am and you’re cuddling your fire truck-esk alarm as you wake up to realize that you’re already an hour late for work.  You sit up and immediately notice the pounding sensation in your head, reminding you of your alcoholic escapades from the night before.  It’s official, you’re hungover.  The question is “What do you do now?”  We’re here to offer a few suggestions to help mitigate hangovers with some preventive steps before and during drinking, and some hangover-relieving tricks for the morning after.

House Call, MD’s Hypothetical Hangover Remedy:

In simplified terms, this is our best (scientifically supported) guess at what can get you back on track:

1. A carbohydrate-rich breakfast with eggs on the side (but remember to keep it bland)

2. Electrolyte-enhanced fluids…lots of them

3. A multivitamin (make sure it has Vit B6, B12, riboflavin, and selenium)

4. Vitamin C – Consume any way you’d like (OJ or oranges will kill two birds with one stone)

5. Aspirin – One dose in the AM is probably all you need

6. Rest - Try an afternoon nap…you look like you need it.

References:
1. Johnston CJ, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood cell glutathione in healthy adults. Am J Clin Nutr 58:103-5, 1993
2. Kera Y, Ohbora Y, Komura S (1989). “Buthionine sulfoximine inhibition of glutathione biosynthesis enhances hepatic lipid peroxidation in rats during acute ethanol intoxication”. Alcohol Alcohol. 24 (6): 519–24.

Anyone who drinks alcohol has woken up the morning after a big night out feeling like death (if you have no idea what we are referring to we recommend you see the recent hit The Hangover).  Yes, this is the hangover you masterfully crafted during your night out on the town.  We’re here to help you understand what causes you to feel so bad and recommend some tips to get you back to 100% as quickly as possible.

Apparently proving the underlying physiologic cause of a hangover is not at the top of the NIH’s To Do List.  As such, the verdict is still out as to the exact mechanism of a hangover but scientists believe it is a combination of four effects in your body:

1. Vasopressin Inhibition: Your Ticket to Dehydration
One of alcohol’s effects on the brain is to decrease the amount of vasopressin it produces.  Vasopressin, also known as anti-diuretic hormone (ADH), is produced in the pituitary gland and, when released into your bloodstream, prevents your body from excreting water in your urine.  When under the influence of alcohol, you body’s vasopressin level decreases and you lose more water in your urine (yes, this is why you pee so much when you’re drinking).  The effect is so strong that for every pint of beer you drink, you can lose up to 4 pints of water.  This is why you will undoubtedly be dehydrated the next morning. The vasopressin-induced hangover effects are from dehydration and include:

• Dry Mouth – Your body’s signal that you are dehydrated

• Headache – Less water in your body means less water in your brain.  As your brain shrinks from dehydration, it pulls on the membranes surrounding it causing pain.  Enter the headache.

• Fatigue & Nausea – When water is lost in the urine, sodium, potassium, and magnesium go with it. Loss of these vital electrolytes can cause feelings of nausea and fatigue

2. Congeners of Alcohol: Inevitable Toxins
Congeners are alcohol derivatives that form as byproducts of the fermentation process utilized in alcohol production.  Congeners of alcohol are toxic and cause a number of damaging effects on the body leading to typical hangover symptoms.  These congerners are found in higher concentrations in darker alcohols such as red wine, whiskey, bourbon, and brandy.  One study found that when subjects drank and equivalent amount of bourbon and vodka, 33% of bourbon drinkers reported hangover symptoms while only 3% of vodka drinkers reported such symptoms.

3. Acetaldehyde: Toxins that Keep on Giving

The breakdown process of alcohol is quite complex.  What you need to know is that acetaldehyde, one of the products formed in a step in the process, wreaks havoc on your body.  Your body requires another chemical, glutathione, to breakdown acetaldehyde and clear it from your body.  The problem is that when you drink a LOT of alcohol, you run out of glutathione and are stuck with the toxic acetaldehyde in your system while your liver makes more glutathione.  Women have fewer of the necessary enzymes and less glutathione than men, making their hangovers longer and more painful.  The miserable effects of acetaldehyde include headache, nausea, and vomiting.

4. Glutamine Rebound: The Sleep Buster
Another one of alcohol’s effects on the brain is to suppress a chemical stimulant in your brain called glutamine.  When you stop consuming alcohol, your brain counters the suppressive effects of alcohol by secreting more glutamine that normal.  The increased level of glutamine stimulating your brain prevents you from sleeping as deeply as you normally would and leads to fatigue the next day.  If your glutamine rebound is especially strong, you may experience tremors, anxiety, and restlessness from glutamine’s stimulant effects.

Now you know why hangovers are so miserable, and knowing is half the battle.  Stay tuned for an upcoming article about hangover cures: myths, miracles, and proven remedies.