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Re: [IP] alcohol and BG (long)

I received this from another IP member who has had some difficulty posting to 
the list. If you have an understanding of biochemistry, this will be easily 
understood. It does explain in more detail what happens with detoxification 
process by the liver. 
In short, it takes a lot of energy for this process, using up large amounts 
of glucose and greatly increasing the risk for severe low BG.  (I have edited 
nothing.)  Please direct any questions to Rick.


Subj:   Alcohol and BG info (for Insulin Pumpers)   
Date:   5/22/03 7:08:40 PM Eastern Daylight Time    
 From: <A HREF="mailto:email @ redacted">email @ redacted</A>

Hi Barbara,

Here is the mechanism with which alcohol causes a STRONG initial drop in 
BG, only to have a rise much later. Please post this to IP for me.  Feel free 
to blame me for the content by adding my name and email address ;)

SUMMARY OF FACTS: Your liver first consumes large amounts of blood 
glucose to convert the alcohol into fatty acids (dropping BG), and then, 
much later, tries to burn up the fats (creating glycogen) or distribute 
them back into the body (for energy storage).

Alcohol (7 Kcal/gram) is much more caloric than protein and carbs (4 
Kcal/gram). Calories from alcohol behave like calories from fat (i.e., 
they tend to raise your BG 6-12 hours later --- but YMMV!) However, 
alcohol initially causes a large DROP in BG which doesn't occur with any 
"normal" food.

MY OPINIONS: For me, more than ONE drink is difficult to handle. Thus I 
we always either (a) drink a sweet drink with high residual sugar to 
counteract the upcoming DROP; or (b) drink with additional carbs (e.g., 
pretzels). The alcohol conversion process takes substantial time, with 
the greatest danger of low BG typically near 3 hours (YMMV!). So, you 
probably need to keep those carbs coming for the entire period. (DON'T 
go to bed too early, which can lead to insulin shock in your sleep.) 
After 3-4 hours, if your pump offers features to handle this, set up 
your dosage to handle the upcoming high BG from the later "fat-like" effect.


Alcohol gets into your bloodstream very quickly, because the molecules 
are so small. It is not 'digested' in the normal sense of being 
processed by stomach and intestinal enzymes. Your LIVER responds by 
treating it as a harmful chemical, converting it into acetaldehyde. In 
the human body, this enzyme 'alcohol dehydrogenase' is produced in the 
liver, with only negligible amounts produced elsewhere. So all of this 
processing happens in liver cells.

Next, 'acetaldehyde dehydrogenase' removes protons from acetaldehyde in 
a complicated process, producing acetyl-CoA plus H+ ions. (BTW, H+ ions 
= acid). These H+ ions are picked up by NAD+, producing NADH.
Unlike normal human glycolysis, however, this pathway consumes NAD+ and 
substantial energy, and DOESN'T get either of these back from the 
electron transport chain later.

So your liver cells need more ATP (energy), and the cells consumes 
glucose from the bloodstream. However, NAD+ has been diminished. A lack 
of NAD+ disrupts the creation of cellular energy from glucose by 
suppressing the citric acid cycle ("Krebs cycle"), which needs 6 NAD+ 
molecules to process the 2 Acetyl-S CoA molecules which glycolysis and 
pyruvate oxidation produce.

In human cells, the balance between NAD+ and NADH, and the production of 
ATP, depend on successful completion of the citric acid cycle and the 
electron transport chain (ETC). Pyruvate and acetyl-CoA build up in the 
liver cells.  The cells respond by converting some of the excess 
acetyl-CoA into fats, a process which also consumes energy. (So they 
consume even more BG, which still doesn't get into the ETC to create NAD+).

Many hours later the liver has converted all of the alcohol into 
acetyl-CoA and fats. It ceases using large amounts of NAD+ and ATP to do 
this. NAD+ becomes more available, and the correct balances are restored 
(the citric acid cycle starts consuming Acetyl-S CoA, and the electron 
transport chain starts producing more ATP and NAD+).

As the fatty acids build up, the liver attempts to distribute the fats 
(triglycerides) to the bloodstream. This is why alcohol calories behave 
like fat calories AFTER the conversion. But the conversion process (from 
alcohol into fatty acids) is very energy-intensive, with no payback 
until much later. BG drops during this processing, for multiple reasons 
indicated above.

BTW, in heavy drinkers, the load of triglycerides created in liver cells
can't be distributed into the bloodstream (because the blood is already 
stuffed with the stuff), and begins to clog up the liver cells and blood 
vessels. "Fatty Liver" impairs functionality of the cells by reducing 
their ability to interact with blood (O2/CO2 exchange, obtaining 
nutrients, releasing products). This is the initial damage which 
ultimately leads to cirrhosis.


I feel that we should all be extra careful to keep our consumption 
quantities safe. But we all 'enjoy' a big circulatory system risk factor 
already ("D"), and multiple large-scale studies showing an enormous 
advantage with light drinking in these same health risk areas (stroke, 
arteriosclerosis, heart attack, etc.). My personal feeling is that 1 
drink per day appears to be a VERY healthy practice, and I try to almost 
never miss it. (At the same time, I almost never have more than one.)

Sincerely, Rick
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