Alcohol and Health: A Functional Medicine Perspective on Holiday Drinking

As the festive season approaches, it's common for people to partake in the merriment with a celebratory drink in hand. The association between holiday celebrations and alcohol consumption is deeply ingrained in many cultures. However, amidst the clinking glasses and toasts, it's imperative to consider the potential ramifications of such indulgence on one's health. In this article, we delve into the effects of holiday drinking on health, aiming to shed light on how festive libations may impact the body in ways that extend beyond the immediate merriment of the season.

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Alcohol's Impact on the Body

The biochemical breakdown of alcohol (ethanol) within the human body involves a multi-step enzymatic process predominantly taking place in the liver. First, an enzyme called alcohol dehydrogenase (ADH) catalyzes the metabolism of alcohol to acetaldehyde, a toxic intermediate and known carcinogen. Other enzymes, including cytochrome P450 2E1 (CYP2E1) and catalase, convert alcohol to acetaldehyde. However, CYP2E1 becomes active only after consuming large amounts of alcohol, and catalase metabolizes a small fraction of alcohol in the body. (3, 11) 

Acetaldehyde is then metabolized into a less active, relatively non-toxic substance called acetate by the enzyme aldehyde dehydrogenase (ALDH). Acetate can be broken down into water and carbon dioxide for elimination from the body. (3, 11)

The immediate effects of alcohol on the body ("intoxication") result from alcohol's impact on the brain and central nervous system (CNS). Ethanol acts as a CNS depressant by enhancing the inhibitory effects of the neurotransmitter gamma-aminobutyric acid (GABA). By binding to GABA receptors, alcohol increases GABAergic activity, leading to overall neural inhibition and promoting relaxation. Additionally, alcohol suppresses the excitatory neurotransmitter glutamate, further dampening neural activity and impairing cognitive function. The suppression of glutamate, essential for alertness and cognitive performance, contributes to the sedative effects of alcohol. Alcohol also influences the release of dopamine, a neurotransmitter associated with pleasure and reward. This leads to feelings of euphoria and relaxation, contributing to the subjective experience of intoxication. The combined impact on neurotransmitter balance results in impaired judgment, decreased coordination, and other characteristic signs of alcohol intoxication. (7, 11, 23) 

Drinking too much takes a significant toll on the body. Alcohol's toxic metabolic byproduct, acetaldehyde, damages cells and tissues in the body before it is broken down into acetate, and it is the reason why alcohol has been linked to increased risk for many health conditions. Excessive drinking can damage the heart, causing cardiomyopathy, arrhythmia, stroke, and high blood pressure. Heavy drinking is linked to liver disease, including alcoholic fatty liver disease, cirrhosis, alcoholic hepatitis, and hepatocellular carcinoma. Alcohol causes the pancreas to produce toxic substances that can lead to pancreatitis. Alcohol weakens the immune system, increasing the risk of illness and infection. Clear patterns have been made between alcohol consumption and cancer risk, even for those who have no more than one drink daily. Alcohol has been identified as a strong risk factor for head and neck, esophageal, liver, breast, and colorectal cancers. (4, 11) 

The Functional Medicine Approach to Alcohol Consumption

Functional medicine approaches health holistically, recognizing the interconnectedness of various bodily systems and emphasizing customized care. The functional medicine perspective on alcohol emphasizes the importance of personalized assessments to gauge how an individual's body metabolizes alcohol and how it may impact various physiological systems. Individual responses to alcohol vary widely based on genetic factors, overall health, and lifestyle. Functional medicine doctors consider these factors better to understand an individual's susceptibility to alcohol-related health issues and tailor interventions accordingly.

Furthermore, functional medicine takes into account the broader health context of an individual. Factors such as liver function, gut health, nutritional status, and overall lifestyle choices are examined to assess how they may influence and be influenced by alcohol consumption. This holistic approach allows functional medicine practitioners to work collaboratively with patients in developing personalized strategies for moderation, harm reduction, or abstinence, depending on individual needs and goals.

Genetic Factors in Alcohol Metabolism

Variations in the genes that encode ADH, ALDH, CYP2E1, and catalase influence alcohol consumption, alcohol-related tissue damage, and alcohol dependence. Genetic variations, or polymorphisms, can alter enzymatic function by slowing or increasing their activity. People with polymorphisms that lead to less efficient alcohol metabolism are at higher risk for increased serum concentrations of acetaldehyde and, therefore, alcohol-induced tissue damage after alcohol consumption. For example, individuals carrying at least one copy of the ADH1B*2 or ALDH2*2 allele experience altered alcohol metabolism that favors acetaldehyde accumulation and lower tolerance to alcohol than others without these genotypes. (2, 12) 

Research shows that genes are responsible for about 50% of the risk for alcohol use disorders. However, there is not one "alcohol addiction" gene. More than 566 genetic variants have been identified as influencing an individual's predisposition for alcohol misuse. The ADH1B and ALDH2 genes, along with other genes related to alcohol metabolism, appear to contribute most strongly to the risk of alcoholism.

Alcohol and Gut Health

The gastrointestinal tract is in contact with the highest amount of alcohol and alcohol-derived metabolites during alcohol consumption. Research shows that drinking alcohol is a risk factor for gastric, liver, and colorectal cancers. Evidence also suggests that alcohol use is associated with a higher risk of ulcerative colitis relapse and increased inflammatory bowel disease symptom severity.

Alcohol-associated bowel disease is a newer and less clearly understood concept that refers to a spectrum of intestinal dysfunction linked to excessive alcohol use. Alcohol, acetaldehyde, and acetate may promote alcohol-associated bowel disease by inducing changes in the gut microbiome, intestinal epithelium, and immune system. (19) 

Chronic and heavy alcohol consumption has been associated with alterations in the composition of the gut microbiome. Alcohol intake can reduce the overall diversity of the gut microbiome, as well as cause a decrease in beneficial bacteria and an increase in potentially harmful bacteria. These dysbiotic changes are associated with gastrointestinal inflammation, intestinal hyperpermeability, endotoxemia, and alcoholic liver disease. (13)

Functional Medicine Lab Tests Related to Alcohol Consumption 

Functional medicine utilizes specific laboratory tests to assess the impact of alcohol on health. These tests aim to provide a detailed understanding of how alcohol may affect various physiological systems, allowing for a personalized and targeted approach to health assessment.

Hepatic Function

The Hepatic Function Panel by Access Medical Laboratories measures various biomarkers of liver health, including liver enzymes AST and ALT. Elevations in AST and ALT indicate liver damage and inflammation. An AST:ALT ratio equal to or greater than 2:1 aids in distinguishing inflammation resulting from heavy alcohol consumption from alternative sources of liver inflammation.

Additionally, GGT by Access Medical Laboratories measures the gamma-glutamyl transferase (GGT) levels in the blood. GGT is a liver enzyme that can travel into the bloodstream when the liver is damaged. Heavy alcohol use is a common reason for elevated GGT. (14) 

Pancreatic Enzymes

Elevations in pancreatic enzymes amylase and lipase indicate pancreatic inflammation and help in diagnosing and assessing the severity of pancreatitis that can result from chronic alcohol use. The blood tests Amylase and Lipase by Access Medical Laboratories are examples of tests that can measure these enzymes.

Inflammation

C-reactive protein (CRP) is an acute-phase reactant protein that increases in response to inflammatory stimuli and persists in chronic inflammatory states. Measuring CRP with the blood test by Access Medical Laboratories can screen for and quantify the level of systemic inflammation that is often associated with alcohol-related health issues. 

Nutritional Deficiencies

Malnutrition is common in alcoholics. Alcohol intake is known to cause low levels of magnesium, selenium, zinc, thiamine, folate, and vitamins A, B12, C, D, E, and K. The NutrEval FMV by Genova Diagnostics is a comprehensive nutritional analysis that can screen for nutritional deficiencies and markers of oxidative stress and depleted antioxidant systems.

Complete Blood Count (CBC)

Alcohol has deleterious effects on blood cells, potentially leading to anemia and changes in white blood cell counts. A CBC w/ Diff, such as that offered through Access Medical Laboratories, measures various markers that provide information about the quantity and quality of red blood cells, white blood cells, and platelets to screen for anemias and immunodeficiencies secondary to alcohol consumption.

Comprehensive Stool Analysis

The GI-MAP + Zonulin by Diagnostic Solutions is a microbiome-focused comprehensive stool analysis. It detects microbial imbalances, gastrointestinal inflammation, immune dysfunction, and leaky gut to provide insights into the impact of alcohol on gut health.

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Managing Holiday Drinking

If you choose to drink during holiday festivities, managing alcohol consumption is crucial for maintaining both physical and mental well-being. Setting clear limits is an essential first step in responsible drinking. Establishing a predetermined number of drinks or a specific timeframe for drinking can help prevent excessive alcohol intake. It's necessary to be mindful of individual tolerance levels and to pace oneself throughout the festivities. The Centers for Disease Control and Prevention (CDC) defines moderate drinking as up to one drink per day for women and up to two drinks per day for men. This is based on standard drink sizes, typically containing about 14 grams of pure alcohol. Binge drinking is defined as consuming at least five drinks for men or at least four drinks for women during a single occasion. Binge drinking is never recommended, as it is associated with serious injuries and health problems. Alternating alcoholic beverages with water is one way to help control alcohol intake, and it also mitigates dehydration, a common side effect of alcohol consumption.

It's beneficial to plan ahead and communicate with others about personal limits. Having a support system that encourages responsible drinking/abstaining from alcohol and understands the importance of drinking in moderation can positively influence behavior. 

Alternatives to Alcoholic Beverages

Embracing non-alcoholic alternatives for holiday festivities promotes inclusivity and provides healthier drink options that everyone can enjoy. 

Infused water is a refreshing choice, combining fruits like berries, citrus slices, and herbs such as mint or basil. This hydrating option is both visually appealing and delicious. Sparkling water infused with fruit juices can mimic the effervescence of champagne without the alcohol content, catering to those who enjoy bubbly beverages. Hot and iced herbal teas can provide a comforting and aromatic experience similar to some alcoholic drinks. 

Create a "mocktail" station featuring alcohol-free versions of popular cocktails, using ingredients like ginger ale, cranberry juice, and fresh garnishes to add flair. Virgin versions of classic cocktails can be equally satisfying without the alcohol. 

Spiced Ginger Mocktail Recipe

Ingredients

• ½ cup ginger beer
• ¼ cup apple cider
• ½ tablespoon fresh lemon juice
• ½ tablespoon honey or maple syrup (adjust to taste)
• Ice cubes
• Cinnamon sticks and apple slices for garnish

Instructions

1. Combine ginger beer, apple cider, fresh lemon juice, and honey or maple syrup in a mixing glass or shaker.
2. Stir or shake the mixture well to thoroughly combine all ingredients.
3. Fill a glass with ice cubes.
4. Pour the spiced ginger mixture over the ice in the glass.
5. Garnish with a cinnamon stick and a few fresh apple slices.

Given the increased awareness surrounding the anti-alcohol movement, there is an increased number of non-alcoholic beverages on the market being sold as comparable alternatives to their alcoholic counterparts. Here is a list of notable companies that sell alternative non-alcoholic drinks and spirits:

• Athletic Brewing Company
• Fre Wines
• Kin Euphorics
• Curious Elixirs
• Seedlip
• Ritual Zero Proof

Recovery and Support Post-Holiday Season

When it comes to alcohol, the best way to support health is by abstaining from alcohol altogether. There is no evidence to suggest that any health benefits of alcohol outweigh the risks. However, if you find yourself overindulging, there are things you can do to support recovery from holiday drinking. 

Alcohol is a diuretic and depletes electrolytes as it is metabolized. In addition to ensuring you stay well-hydrated while you drink, it is equally important to drink plenty of water the day after drinking to replenish water lost during the celebrations. Supplementing with electrolytes will help the body retain water.

Give particular attention to liver health by eating foods rich in antioxidants, fiber, omega-3 fatty acids, and sulfur-containing amino acids. Short-term use of dietary and herbal supplements can neutralize free radicals generated during alcohol metabolism, replenish the body's natural stores of glutathione (a potent antioxidant), and reduce liver inflammation. It is always recommended to consult a healthcare professional before adding supplements to your routine, but common liver-supportive supplements include N-acetyl cysteine (NAC), vitamin C, milk thistle, and B vitamins.

Treatment options are available for those struggling with alcohol. Healthcare professionals, including general practitioners, addiction specialists, and mental health professionals, possess the expertise to conduct thorough assessments, provide personalized advice, and offer evidence-based treatment options. Resources are also available through the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

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Alcohol During the Holidays: Final Thoughts

While alcohol is often part of lively festivities, it is important to recognize the potentially detrimental effects holiday drinking can have on your health. Encouraging a balanced approach to holiday drinking involves promoting moderation, mindful choices, and an awareness of individual tolerances. Prioritizing overall health, embracing nutritional support, and seeking professional guidance can foster a holistic and sustainable approach to holiday celebrations.