LOST 11.08: Popular Beverage Choices

Skills to Develop

• Explain the impacts of excessive alcohol intake (both acutely and chronically) on health.
• Discuss the scientific evidence about caffeine and human health.

In this last section we will discuss three beverage types in particular: alcohol, caffeinated drinks, and sports drinks. We will examine the effects of these beverages upon fluid levels and nutrition within the body so that you will be better able to make wise decisions about your beverage choices.

Alcohol

Alcohol is both a beverage providing some sustenance and a drug. For thousands of years, alcohol has been consumed in a medicinal, celebratory, and ritualistic manner. It is drunk in just about every country and often in excessive amounts. Alcohol is a psychoactive drug. A psychoactive drug is any substance that crosses the blood-brain barrier primarily affecting the functioning of the brain, be it altering mood, thinking, memory, motor control, or behavior. Alcohols in chemistry refer to a group of similar organic compounds, but in beverages the only alcohol consumed is ethanol.

The Behavioral Risk Factor Surveillance System survey reported that more than half of the adult US population drank alcohol in the past thirty days.Centers for Disease Control and Prevention. “Alcohol and Public Health.” Last updated March 5, 2012. http://www.cdc.gov/alcohol/. Of the total population who drank alcohol, approximately 5 percent drank heavily, while 15 percent binge drank. Binge drinking (as defined by the National Institute on Alcohol Abuse and Alcoholism) is when men consume five or more drinks, and when women consume four or more drinks, in two hours or less.Centers for Disease Control and Prevention. “Alcohol and Public Health.” Last updated March 5, 2012. http://www.cdc.gov/alcohol/. Alcohol in excess is detrimental to health; however since its beginnings it has been suspected and promoted as a benefit to the body and mind when consumed in moderation. In the United States, the Dietary Guidelines define moderate alcohol intake as no more than one drink per day for women and no more than two drinks per day for men.US Department of Agriculture and US Department of Health and Human Services. “Alcoholic Beverages.” In Dietary Guidelines for Americans 2005. (Washington D. C.: US Department of Health and Human Services and US Department of Agriculture, 2005). http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm. Although drunkenness has pervaded many cultures, drinking in moderation has long been a mantra of multiple cultures with access to alcohol.

More than 90 percent of ingested alcohol is metabolized in the liver. The remaining amount stays in the blood and is eventually excreted through the breath (which is how Breathalyzers work), urine, saliva, and sweat. The blood alcohol concentration (BAC) is measured in milligrams percent, comparing units of alcohol to units of blood. BAC is a measurement used legally to assess intoxication and the impairment and ability to perform certain activities, as in driving a car. As a general rule, the liver can metabolize one standard drink (defined as 12 ounces of beer, 5 ounces of wine, or 1 ½ ounces of hard liquor) per hour. Drinking more than this, or more quickly, will cause BAC to rise to potentially unsafe levels. Table 7.8.1 summarizes the mental and physical effects associated with different BAC levels.

Table 7.8.1: Mental and Physical Effects of Different BAC Levels

BAC Percent	Typical Effects
0.02	Some loss of judgment, altered mood, relaxation, increased body warmth
0.05	Exaggerated behavior, impaired judgment, may have some loss of muscle control (focusing eyes), usually good feeling, lowered alertness, release of inhibition
0.08	Poor muscle coordination (balance, speech, vision, reaction time), difficulty detecting danger, and impaired judgment, self-control, reasoning, and memory
0.10	Clear deterioration of muscle control and reaction time, slurred speech, poor coordination, slowed thinking
0.15	Far less muscle control than normal, major loss of balance, vomiting

In addition to the one drink per hour guideline, the rate at which an individual’s BAC rises is affected by the following factors:

• Sex (A woman’s BAC will rise more quickly than a man’s.)
• Weight (BAC will rise more slowly for heavier people.)
• Genetics
• Length of time as a heavy drinker
• Type of alcohol consumed
• Amount of alcohol consumed
• Consumption rate
• Consumption before or after a meal (food in the stomach slows absorption)
• Mixture (carbonated mixers speed absorption)
• Medications may increase the bioavailability of alcohol.

Figure 7.8.1: In moderation, alcohol promotes some aspects of health. However, caution is necessary because excessive alcohol intake can have detrimental effects on health.

Giving the liver enough time to fully metabolize the ingested alcohol is the only effective way to avoid alcohol toxicity. Drinking coffee or taking a shower will not help. The legal limit for intoxication in many states is a BAC of 0.08. Taking into account the rate at which the liver metabolizes alcohol after drinking stops, and the alcohol excretion rate, it takes at least five hours for a legally intoxicated person to achieve sobriety.

Health Benefits of Moderate Alcohol Intake

In contrast to excessive alcohol intake, moderate alcohol intake has been shown to provide health benefits. The data is most convincing for preventing heart disease in middle-aged and older people. A review of twenty-nine studies concluded that moderate alcohol intake reduces the risk of coronary heart disease by about 30 percent in comparison to those who do not consume alcohol.Ronksley, P. E. et al. “Association of Alcohol Consumption with Selected Cardiovascular Disease Outcomes: A Systematic Review and Meta-Analysis.” BMJ 342, no. d671 (2011). doi: 10.1136/bmj.d671. Several other studies demonstrate that moderate alcohol consumption reduces the incidences of stroke and heart attack, and also death caused by cardiovascular and heart disease. The drop in risk for these adverse events ranges between percent. Moreover, there is some scientific evidence that moderate alcohol intake reduces the risk for metabolic syndrome, Type 2 diabetes, and gallstones. In addition to providing some health benefits, moderate alcohol intake has long served as a digestive aid and a source of comfort and relaxation, and it induces social interaction, thereby benefiting all aspects of the health triangle. It has not been clearly demonstrated that moderate alcohol consumption benefits younger populations, and the risks of any alcohol consumption do not outweigh the benefits for pregnant women, those who are taking medications that interact with alcohol, and those who are unable to drink in moderation.

Health Consequences of Alcohol Abuse

Distilled spirits have exceptionally few nutrients, but beer and wine do provide some nutrients, vitamins, minerals, and beneficial plant chemicals along with calories. A typical beer is 150 kilocalories, a glass of wine contains approximately 80 kilocalories, and an ounce of hard liquor (without mixer) is around 65 kilocalories. Alcoholic drinks in excess contribute to weight gain by substantially increasing caloric intake. However, alcohol displays its two-faced character again in its effects on body weight, making many scientific studies contradictory. Multiple studies show high intakes of hard liquor are linked to weight gain, although this may be the result of the regular consumption of hard liquor with sugary soft drinks, juices, and other mixers. On the other hand drinking beer and, even more so, red wine, is not consistently linked to weight gain and in some studies actually decreases weight gain. The contradictory results of scientific studies that have examined the association of alcohol intake with body weight are partly due to the fact that alcohol contributes calories to the diet, but when drunk in excess reduces the secretion of pancreatic juice and damages the lining of the gastrointestinal system, impairing nutrient digestion and absorption. The impaired digestion and absorption of nutrients in alcoholics contributes to their characteristic “skinniness” and multiple associated micronutrient deficiencies. The most common macronutrient deficiency among alcoholics is water, as it is excreted in excess. Commonly associated micronutrient deficiencies include thiamine, pyridoxine, folate, vitamin A, magnesium, calcium, and zinc. Furthermore, alcoholics typically replace calories from alcohol with those of nutritious foods, sometimes getting 50 percent or more of their daily caloric intake from alcoholic beverages.

Effects of Alcohol Abuse on the Brain

Alcohol can adversely affect nearly every area of the brain. When BAC rises, the central nervous system is depressed. Alcohol disrupts the way nerve cells communicate with each other by interfering with receptors on certain cells. The immediate impact of alcohol on the brain can be seen in the awkwardly displayed symptoms of confusion, blurred vision, slurred speech, and other signs of intoxication. These symptoms will go away once drinking stops, but abusive alcohol consumption over time can lead to long-lasting damage to the brain and nervous system. This is because alcohol and its metabolic byproducts kill brain cells. Excessive alcohol intake has the following effects on specific areas of the brain:

1. Medulla. This area controls automatic functions, such as heart rate. When alcohol first limits its functioning, people feel sleepy. With greater BAC levels, unconsciousness, comas, and death can result.
2. Cerebellum. This is where conscious movement is coordinated. With too much alcohol, balance and motor skills are impaired.
3. Cerebral cortex. Senses and thoughts are processed here, and this is where action is initiated. When BAC levels increase, the ability to think, exercise good judgment, and feel pain decrease.
4. Hypothalamus and pituitary gland. Alcohol increases sexual desire but decreases sexual performance. It also prompts signals which increase urine production.
5. Limbic system. When alcohol affects this area, individuals may become very emotional and lose memory function.

Effects of Alcohol Abuse on the Liver

According to the CDC, 14,406 Americans died from alcohol-related liver diseases in 2007. Although not every alcoholic or heavy drinker will die from liver problems, the liver is one of the body’s main filtering organs and is severely stressed by alcohol abuse. The term Alcoholic Liver Disease (ALD) is used to describe liver problems linked to excessive alcohol intake. ALD can be progressive, with individuals first suffering from a fatty liver and going on to develop cirrhosis. It is also possible to have different forms of ALD at the same time.

Figure 7.8.2: Liver Cirrhosis. Excessive alcohol consumption causes the destruction of liver cells. In an attempt to repair itself, the liver initiates an inflammatory and reparation process causing scar tissue to form. In the liver’s attempt to replace the dead cells, surviving liver cells multiply. The result is clusters of newly formed liver cells, also called regenerative nodules, within the scar tissue. This state is called cirrhosis of the liver. See a full animation of this medical topic. Image used with permission from BruceBlaus (via Wikipedia).

The three most common forms of ALD are:

• Fatty liver. A rather benign disorder that develops after excessive alcohol consumption; however it can progress to more fatal diseases. Fatty liver is reversible if alcohol use is brought under control.
• Alcoholic hepatitis. The symptoms of this alcohol-induced liver inflammation are a swollen liver, abdominal pain, nausea, fever, jaundice, and vomiting. Although linked to alcohol use, even people who drink moderately can sometimes develop this condition, and not all alcohol abusers do. If a person stops drinking alcohol, the liver damage can be reversed. But if they continue, cirrhosis may develop and death can result.
• Cirrhosis. This serious and sometimes fatal form of ALD develops when liver cells die and form scar tissue, which blocks blood flow and causes wastes and toxins to build up in the system. Strictly speaking, cirrhosis cannot be cured. It can, however, be stopped with medical treatment and complications can be managed if the individual stops drinking, and many do survive. Not all cases of cirrhosis are strictly due to alcoholism, and not all alcoholics develop the disease. Symptoms of cirrhosis include the buildup of abdominal fluid (ascites), abdominal pain, fever, thirst, confusion, and fatigue.

The Reality

Alcohol is a diuretic that results in dehydration. It suppresses the release of antidiuretic hormone and less water is reabsorbed and more is excreted. Drinking alcohol in excess can lead to a “hangover,” of which the majority of symptoms are the direct result of dehydration.

Caffeine

Caffeine is a chemical called xanthine found in the seeds, leaves, and fruit of many plants, where it acts as a natural pesticide. It is the most widely consumed psychoactive substance and is such an important part of many people’s lives that they might not even think of it as a drug. Up to 90 percent of adults around the world use it on a daily basis. According to both the FDA and the American Medical Association the moderate use of caffeine is “generally recognized as safe.” It is considered a legal psychoactive drug and, for the most part, is completely unregulated.

Typical Doses and Dietary Sources

What is a “moderate intake” of caffeine? Caffeine intakes are described in the following manner:

• Low–moderate intake. 130–300 milligrams per day
• Moderate intake. 200–300 milligrams per day
• High intake. 400 or more milligrams per day

The average caffeine consumption for American adults is considered moderate at 280 milligrams per day, although it is not uncommon for people to consume up to 600 milligrams per day. This works out to almost 4 ½ cups of coffee per day. The bitter taste of caffeine is palatable for many and coffee is the most readily available source of it, accounting for 70 percent of daily caffeine consumption. The second readily available source of caffeine is soft drinks, delivering 16 percent of daily caffeine. (In this case, the bitter caffeine taste is usually masked by a large amount of added sugar.) Tea is the third common source of caffeine, at 12 percent.

Just how much caffeine is there in a cup of coffee? It varies. The caffeine content of an average cup of coffee can range from 102 to 200 milligrams, and the range for tea is 40 to 120 milligrams. Table 7.8.2 provides useful information on the levels of caffeine found in common beverages. When estimating your total caffeine consumption remember its not only in beverages, but also some foods and medicine.

Table 7.8.2: Caffeine Content in Various Beverages and Foods

Beverage/Food	Milligrams
Starbuck’s Grande Coffee (16 oz.)	380
Plain brewed coffee (8 oz.)	102–200
Espresso (1 oz.)	30–90
Plain, decaffeinated coffee (8 oz.)	3–12
Tea, brewed (8 oz.)	40–120
Green tea (8 oz.)	25–40
Coca-Cola Classic (12 oz.)	35
Dr. Pepper (12 oz.)	44
Jolt Cola (12 oz.)	72
Mountain Dew (12 oz.)	54
Mountain Dew, MDX (12 oz.)	71
Pepsi-Cola (12 oz.)	38
Red Bull (8.5 oz.)	80
Full Throttle (16 oz.)	144
Monster Energy (16 oz.)	160
Spike Shooter (8.4 oz.)	300

Source: MedicineNet.com. “Caffeine.” Accessed October 2, 2011. http://www.medicinenet.com/caffeine/article.htm.

Health Benefits

The most renowned effects of caffeine on the body are increased alertness and delay of fatigue and sleep. How does caffeine stimulate the brain? Watch Note 7.55 "Video 7.7" to see a graphic account of a brain on caffeine. Caffeine is chemically similar to a chemical in our brains (adenosine). Caffeine interacts with adenosine’s specific protein receptor. It blocks the actions of the adenosine, and affects the levels of signaling molecules in the brain, leading to an increase in energy metabolism. At the molecular level, caffeine stimulates the brain, increasing alertness and causing a delay of fatigue and sleep. At high doses caffeine stimulates the motor cortex of the brain and interferes with the sleep-wake cycle, causing side effects such as shakiness, anxiety, and insomnia. People’s sensitivity to the adverse effects of caffeine varies and some people develop side effects at much lower doses. The many effects caffeine has on the brain do not diminish with habitual drinking of caffeinated beverages.

Video 7.7: A Brain on Caffeine. Watch this graphic account of the brain on caffeine (click to see video).

Tools for Change

Consuming caffeine in the evening and in the middle of the night will help keep you awake to study for an exam, but it will not enhance your performance on the next day’s test if you do not get enough sleep. Drink caffeinated beverages in moderation at any time of the day or evening to increase alertness (if you are not sensitive to caffeine’s adverse effects), but get the recommended amount of sleep.

It is important to note that caffeine has some effects on health that are either promoted or masked by the other beneficial chemicals found in coffee and tea. This means that when assessing the benefits and consequences of your caffeine intake, you must take into account how much caffeine in your diet comes from coffee and tea versus how much you obtain from soft drinks.

The coffee industry is a billion-dollar industry. Coffee is one of the most widely distributed beverages in the world.

© Shutterstock

There is a good amount of scientific evidence supporting that higher consumption of caffeine, mostly in the form of coffee, substantially reduces the risk for developing Type 2 diabetes and Parkinson’s disease. There is a lesser amount of evidence suggesting increased coffee consumption lowers the risk of heart attacks in both men and women, and strokes in women. In smaller population studies, decaffeinated coffee sometimes performs as well as caffeinated coffee, bringing up the hypothesis that there are beneficial chemicals in coffee other than caffeine that play larger roles in the health benefits of coffee. A review of fifteen epidemiological studies in The Journal of the American Medical Association proposes that habitual coffee consumption reduces the risk of Type 2 diabetes.van Dam, R. M., PhD and F. B. Hu, M.D., PhD “Coffee Consumption and Risk of Type 2 Diabetes: A Systematic Review.” JAMA 294, no. 1 (2005): 97–104. doi: 10.1001/jama.294.1.97. The risk reduction was 35 percent for those who consumed greater than 6–7 cups of coffee per day and was 28 percent for those who consumed 4–5 cups daily. These groups were compared with people who consumed less than 2 cups of coffer per day. Parkinson’s disease is an illness of the central nervous system causing many disorders of movement. Research scientists in Hawaii found an inverse relationship between caffeine intake and the incidence of Parkinson’s disease. In fact, men who did not consume coffee had a five times more likely chance of Parkinson’s disease than men who consumed more than 3 cups of coffee daily.Ross, G. W. et al. “Association of Coffee and Caffeine Intake with the Risk of Parkinson’s Disease.” JAMA 283, no. 20 (2000): 2674–79. doi: 10.1001/jama.283.20.2674. In this study other caffeine sources, such as soft drinks and tea, were also associated with a reduced risk of Parkinson’s disease. A review of several studies, published in the Journal of Alzheimer’s Disease, has reaffirmed that caffeine intake may reduce the risk of Parkinson’s disease in both men and women.Costa, J. et al. “Caffeine Exposure and the Risk of Parkinson’s Disease: A Systematic Review and Meta-Analysis of Observational Studies.” J Alzheimers Dis 20 (2010). Supplement 1: S221–38. http://www.ncbi.nlm.nih.gov/pubmed/20182023. This review also took into consideration caffeine obtained from dietary sources other than caffeine, though the data on these is not as extensive or as strong as for coffee. There is also some scientific evidence that drinking coffee is linked to a much lower risk for dementia and Alzheimer’s disease.Patil, H., C. J. Lavie, J. H. O’Keefe. “Cuppa Joe: Friend or Foe? Effects of Chronic Coffee Consumption on Cardiovascular and Brain Health.” Missouri Medical 108, no. 6 (November–December 2011): 431–8. http://www.ncbi.nlm.nih.gov/pubmed/22338737.

Health Consequences

The acute adverse health effects of caffeine ingestion are anxiety, shakiness, and sleep deprivation. On a more chronic basis, some scientific reports suggest that higher caffeine intake is linked to negative effects on heart health and increased cardiovascular disease; although at this point most data suggests caffeine does not significantly increase either. A comprehensive review published in the American Journal of Clinical Nutrition reports that caffeine induces a modest increase in blood pressure lasting less than three hours in people with hypertension, but there is no evidence that habitual coffee consumption increases blood pressure long-term or increases the risk for cardiovascular disease.Mesas, A. E. et al. “The Effect of Coffee on Blood Pressure and Cardiovascular Disease in Hypertensive Individuals: A Systematic Review and Meta-Analysis.” Am J Clin Nutr 94, no. 4 (2011): 1113–26. http://www.ncbi.nlm.nih.gov/pubmed/21880846. There is no good evidence that chronic caffeine exposure increases blood pressure chronically in people without hypertension.

Some have hypothesized that caffeine elevates calcium excretion and therefore could potentially harm bones. The scientific consensus at this time is that caffeine minimally affects calcium levels and intake is not associated with any increased risk for osteoporosis or the incidence of fractures in most women. Although the effect of caffeine on calcium excretion is small, postmenopausal women with risk factors for osteoporosis may want to make sure their dietary caffeine intake is low or moderate and not excessive.

The Caffeine Myth

A diuretic refers to any substance that elevates the normal urine output above that of drinking water. Caffeinated beverages are commonly believed to be dehydrating due to their diuretic effect, but results from scientific studies do not support that caffeinated beverages increase urine output more so than water. This does not mean that consuming caffeinated beverages does not affect urine output, but rather that it does not increase urine output more than water does. Thus, caffeinated beverages are considered a source of hydration similar to water.

Sports Drinks

Scientific studies under certain circumstances show that consuming sports drinks (instead of plain water) during high-intensity exercise lasting longer than one hour significantly enhances endurance, and some evidence indicates it additionally enhances performance. There is no consistent evidence that drinking sports drinks instead of plain water enhances endurance or performance in individuals exercising less than one hour and at low to moderate intensities. A well-concocted sports drink contains sugar, water, and sodium in the correct proportions so that hydration is optimized. The sugar is helpful in maintaining blood-glucose levels needed to fuel muscles, the water keeps an athlete hydrated, and the sodium enhances fluid absorption and replaces some of that lost in sweat. The American College of Sports Medicine states that the goal of drinking fluids during exercise is to prevent dehydration, which compromises performance and endurance.

The primary source of water loss during intense physical activity is sweat. Perspiration rates are variable and dependent on many factors including body composition, humidity, temperature, and type of exercise. The hydration goal for obtaining optimal endurance and performance is to replace what is lost, not to over-hydrate. A person’s sweating rate can be approximated by measuring weight before and after exercise—the difference in weight will be the amount of water weight you lost.

The primary electrolyte lost in sweat is sodium. One liter of sweat can contain between 1,000–2,000 milligrams of sodium. Potassium, magnesium, and calcium are also lost, but in much lower amounts. If you are exercising at high intensity for greater than ninety minutes, it is important to replace sodium as well as water. This can be partly accomplished by consuming a sports drink. The highest content of sodium in commercial sports drinks is approximately 450 milligrams per liter and thus will not replace all lost sodium unless a person drinks several liters. This is NOT recommended, as water intoxication not only compromises performance, but may also be deadly. The sodium in sports drinks enhances fluid absorption so that rehydration is more efficiently accomplished. If you are not exercising for more than ninety minutes at a high intensity, dietary intake of sodium and other electrolytes should be sufficient for replacing lost electrolytes.

Who Needs Sports Drinks?

Children and adult athletes exercising for more than one hour at high-intensity (tennis, rowing, rugby, soccer, etc.) may benefit endurance-wise and possibly performance-wise from consuming a sports drink rather than water. However, consuming sports drinks provides no benefit over water to endurance, performance, or exercise recovery for those exercising less than an hour. In fact, as with all other sugary drinks containing few to no nutrients, they are only another source of calories. Drinking sports drinks when you are doing no exercise at all is not recommended.

Sports Drink Alternatives

Instead of a sports drink, you can replenish lost fluids and obtain energy and electrolytes during exercise by drinking plain water and eating a sports bar or snack that contains carbohydrates, protein, and electrolytes. Postexercise, low-fat milk has been scientifically shown to be just as effective as a sports drink as a rehydration beverage and it is more nutrient-dense, containing carbohydrates, protein, and electrolytes, in addition to other vitamins.

The Bottom Line

Sports drinks consumed in excess by athletes or used by non-athletes simply are another source of added sugars, and thus extra calories, in the diet and provide no performance, exercise recovery or health benefit.

Key Takeaways

• Alcohol in excess is detrimental to health; in moderation, however, it is promoted as a benefit to the body and mind. The US Dietary Guidelines define moderate alcohol intake as no more than one drink per day for women and no more than two drinks per day for men.
• Moderate intake of alcohol has been shown in multiple scientific studies to provide health benefits, including reducing the risks of heart disease, cardiovascular disease, metabolic syndrome, Type 2 diabetes, and gallstones.
• The most renowned effects of caffeine on the body are increased alertness and delay of fatigue and sleep. At high doses, caffeine stimulates the motor cortex of the brain and interferes with the sleep-wake cycle, causing side effects such as shakiness, anxiety, and insomnia.
• There is a good amount of scientific evidence supporting that higher consumption of caffeine, mostly in the form of coffee, substantially reduces the risk for developing Type 2 diabetes and Parkinson’s disease. There is a lesser amount of evidence suggesting increased coffee consumption lowers the risk of heart attacks in both men and women and strokes in women. According to both the FDA and the American Medical Association, the moderate use of caffeine is “generally recognized as safe.”
• For most physically active individuals, water is the best hydration source. For endurance athletes, there is increased need of glucose as well as fluid. The body needs healthy foods and beverages, not supplements, to regain electrolytes lost through sweat.

Discussion Starters

1. Late nights seem to be part of college life, and with many students working while going to school, early mornings can be part of the equation, too. How much do you and most people you know sleep? How much caffeine do you use? Have you ever suffered from the ill effects of caffeine?
2. How big a problem is the over-consumption of energy drinks at your school? What might be some of the ramifications to learning?