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Chapter 9
Impact of Fluids
and Beverages on
Nutritional Health
Ask Yourself
True or False?
1. “Soft” water is healthier than hard water.
2. Bottled water sold in the U.S. is always
cleaner and safer than most tap water.
3. Caffeine can cross the placenta and enter
the fetus.
4. Even moderate caffeine users can suffer
from withdrawal symptoms if they stop using
caffeine cold turkey.
5. Soft drinks sweetened with sugar contribute
to empty calorie intake.
Ask Yourself
Energy drinks are regulated and therefore
always safe to consume.
7. Enhanced waters provide an important
source of nutrients.
8. A 12-ounce beer, a 5-ounce glass of wine,
and a 1-ounce shot of tequila all contain the
same amount of alcohol.
9. Reflexes are not impaired if your blood
alcohol concentration is below the legal
limits of intoxication.
10. Drinking alcohol may be associated with an
increased risk of breast cancer.
• Adults consume and excrete about 1 ½
to 3 quarts of water a day.
• Most of the water we consume comes
from juice, milk, soft drinks, and other
beverages including tap water.
• Foods add considerable water to the
• Adults are advised to consume 1-1.5
mL of water from all sources for each
calorie expended.
Water input (Total = 1,450–2,800 mL)a
Water created by
(200–300 mL)
(700–1,000 mL)
Water output (Total = 1,450–2,800 mL)b
(150 mL)
(550–1,500 mL)
(350 mL)
(450–900 mL)
(500–1,400 mL)
• The makeup of water differs based on:
 Where it comes from.
 How it is processed.
• Variations can have significant health
implications :
 One of the most basic distinctions, hard
versus soft water, is based on the
concentrations of three minerals:
1. Calcium
2. Magnesium
3. Sodium
• Hard water:
Water with a high
concentration of
minerals such as
calcium and
 From a health
standpoint, hard
water seems to be
the better
• Soft water:
Water containing a
high sodium
 The excess sodium
adds more of the
mineral to our already
sodium-laden diets.
 It dissolves potentially
toxic substances such
as lead from pipes.
Keeping Water Safe
• Water taken from the earth contains different
levels of bacteria, microorganisms, and heavy
metals such as lead.
• Environmental Protection Agency (EPA):
arm of the government responsible for
monitoring municipal water supplies.
• Some potential health threats are:
 A parasite called Cryptosporidium.
 The level of lead that comes out of your faucet
(EPA has little control over this).
 Lead-containing plumbing was banned in
Bottled Water
• Not necessarily any purer
or more healthful than tap
• About 25%-40% of bottled
water comes from the same
municipal water supplies.
• Bottled water may not
contain adequate amounts
of fluoride.
• Increased the use of
nonrenewable resources.
• Cost may be 250-10,000
times higher than tap
Best Choices for Juice
• Select a 100%
fruit/vegetable juice.
• Read labels; not all juices
are uniformly beneficial.
• Avoid “juice drink,” “fruitflavored drink,” or “juice
blend” because these
contain little real juice
and have added sugars.
• Select juices that have
the most color.
Juices with Benefits
• Cranberry juice protects against urinary
tract infections and may protect against
heart disease and cancer.
• Citrus juices are rich in flavonoids that
help protect against cancer.
• Tomato juice and tomato products are
rich in lycopene which may protect
against prostate cancer and
cardiovascular disease.
• Also applies to non
animal beverages such
as soy milk
• Nutritional content
varies per animal
• Nutrient dense
• Intake has been
associated with weight
• Milk consumption has
Caffeinated Beverages
• Caffeine is one of a group of chemicals
called xanthines.
• In the U.S. most caffeine is consumed
in coffee but teas, carbonated soft
drinks, and energy drinks also
• Reports have linked caffeine to more
than 100 diseases but scientists have
never confirmed the evidence with the
exception of jitteriness.
Caffeinated Beverages
• Daily caffeine consumption can be habit
• Caffeine dependence syndrome includes three
out of these four symptoms upon withdrawal:
headache and fatigue; caffeine consumption
despite knowledge that it may be causing harm;
repeated unsuccessful attempts to cut back; and
tolerance to caffeine.
• People with some medical conditions should
consume caffeine in moderation or avoid it.
 Pregnant women advised to limit to <150
Caffeinated Beverages
• For a healthy person,
drinking 1-2 cups of
coffee, tea, or cola a
day does not pose any
• People who are
sensitive to caffeine and
experience headaches,
nervousness, and
insomnia should avoid it
or cut back.
• If you decide to quit, do
it gradually.
Caffeinated Beverages
• Contains antioxidants which have been
found to reduce inflammation.
• Potential health benefits for coffee
drinkers include:
 Lower risk of type 2 diabetes.
 Reduced risk of cardiovascular disease and
 Reduced risk of alcohol-related cirrhosis and liver
• May increase blood pressure.
Caffeinated Beverages
• Tea leaves are rich in
phytochemicals, antioxidants
and caffeine.
• Health benefits for tea
drinkers include:
 Decreased risk of
cardiovascular disease.
 Decreased risk of cancer.
 Protects against
neurodegenerative diseases.
• Health benefits appear to be
Caffeinated Beverages
• Contains minerals:
potassium, magnesium,
phosphorus, and
• Contains fats and
• Contains antioxidants,
phytochemicals, and
• May positively influence
cardiovascular health.
Caffeinated Beverages
Soft Drinks
• Standard serving
size (increasing)
 1950s = 6.5 oz
 1960s = 12 oz
 1990s = 20 oz
 2000+ = 32 oz &
64 oz
Caffeinated Beverages
Soft Drinks
• Called soda, pop, soda pop, coke, or fizzy
drinks, all are carbonated soft drinks.
• Includes soft drinks sweetened with highfructose corn syrup.
 Contributes to empty-calorie intake in the
U.S. population and its replacement of
nutrient-dense foods.
• Includes soft drinks sweetened with artificial
Caffeinated Beverages
Soft Drinks
• Nutrition and health issues related to soft
drink consumption:
 Increased energy consumption.
 Increased weight.
 Lower consumption of other nutrients.
 Lower intake of milk, fruit, and fruit juices.
 Increased risk of medical problems such as:
type 2 diabetes, osteoporosis, dental caries,
increased blood pressure.
• No indisputable positive health benefits have
been associated with soft drink consumption.
Functional Beverages
Energy Drinks
• Nonalcoholic
beverages enhanced
with purported energyenhancing ingredients.
• Primary ingredients
are sugar and caffeine.
• Energy drinks tend not
to live up to most of
the claims made.
Functional Beverages
Energy Drinks
• Nutrition and health concerns:
 Not regulated by FDA.
 Caffeine level unsuitable for children or caffeinesensitive individuals.
 Mixing energy drinks with alcohol can cause heart
 Should not be used before or during exercise.
 Counter productive for fluid replacement.
 Combo of stimulant ingredients can be unsafe.
 Sudden cessation can cause withdrawal
• Should be used with caution.
Functional Beverages
Sports Drinks
• Formulated to replace
fluids and electrolytes
(minerals) lost through
sweat and provide energy
for muscles.
• What should you look for?
 6% carbohydrate (glucose,
sucrose, and fructose)
 Sodium
 No carbonation
 No caffeine
Functional Beverages
Enhanced Waters
• Most are no
healthier than
other beverages
containing sugar.
• The only
ingredient in
“vitamin waters”
that your body
might use is sugar.
Functional Beverages
• Water with fiber?
 The fiber is maltodextrins and no research
shows it works like fiber from fiber-rich foods
• Antioxidant supplemented water?
 No research has ever shown antioxidant
supplements prevent disease.
• Why is it invigorating or energizing?
 Same amount of caffeine as a cup of coffee…
• Therapeutic substances like herbs added to
 Only if in therapeutic doses and that is
probably NOT the case
Functional Beverages
Enhanced Waters
• Water-soluble vitamins taken in excess
will flush out of the body with water.
• Fat-soluble vitamins will not be
absorbed without the presence of fat.
• Some of the ingredients may not have
proven health benefits.
• A vitamin/mineral supplement is a
better choice.
• Alcohol is not a nutrient and is best
described as an organic chemical.
• The most commonly ingested form is
Ethanol (EtOH).
• Alcohol is a sedative and central
nervous system depressant.
• Alcohol supplies 7 calories/gram.
• Alcohol is not an essential nutrient, nor
is it stored in the body.
Alcohol Absorption and Metabolism
• Alcohol absorption involves the stomach and
the small intestine.
 Alcohol absorbed in the small intestine
passes through the portal vein to the liver.
• Alcohol dehydrogenase:
 A liver enzyme that facilitates conversion of
alcohol into acetaldehyde and water.
 Acetaldehyde: a substance to which
drinking alcohol (ethanol) is metabolized.
• Alcohol that has yet to be metabolized flows
through the bloodstream and affects the brain
and other tissues.
Alcohol absorption
Very small
amounts of alcohol
are absorbed in
the mouth and
Upper small
The upper portion
of the small intestine
is the primary site
of alcohol
Some alcohol
absorption takes
place here.
Alcohol Absorption and Metabolism
• The liver can metabolize a limited amount of
alcohol per hour, no matter how much is
• Alcohol metabolism rate is dependent on the
amount of alcohol dehydrogenase formed.
• Until all alcohol has been metabolized, it
circulates through the bloodstream, affecting
the brain and other tissues.
• It takes about one hour to metabolize a
standard drink.
Influencing Absorption & Metabolism:
• Food
 Presence of food in the stomach slows
 Dietary fat delays emptying time of the stomach.
• Gender
 Men and women absorb and metabolize alcohol
 Women will absorb 30% more alcohol into the
 Women are more susceptible to alcoholic liver
disease, heart muscle damage, and brain
• Ethnicity
 Native Americans have higher rates of liver
damage due to alcohol consumption.
• Women have a lower
capacity to metabolize
alcohol because of:
 Body composition – have
less water in their bodies.
 Enzymes – lower activity of
alcohol dehydrogenase in
the stomach.
 Causes a larger
proportion of ingested
alcohol to reach the
Alcohol and Its Effects
• Alcohol is distributed through the body
and affects the central nervous system
even in small concentrations.
 Even small amounts can slow reactions.
 Higher blood alcohol content (BAC) leads to
increased loss of mental and physical
 Large amounts of alcohol over a short
period of time can lead to loss of
consciousness or even death.
Alcohol and Its Effects
• Alcohol and Medications:
Use of prescription or over-the-counter
medications can increase the effects of
 Chronic, heavy drinking appears to activate an
enzyme that may be responsible for changing
the over-the-counter pain reliever
acetaminophen and many others into
chemicals that can produce liver damage,
even when taken in recommended doses.
• Alcohol and Sex Hormones:
Alcohol alters the sex hormones in men
and women.
Alcohol and Its Effects
• Alcohol and Urine Output:
Alcohol blocks antidiuretic hormone (ADH),
leading to water loss and eventual dehydration.
• Alcohol and Hangovers:
A group of ailments including headache, nausea,
vomiting, sensitivity to light and sound, dry
mouth, and irritability.
• Alcohol and Blood Alcohol Level (BAL):
BAL indicates the amount of alcohol in the
 BAL is affected by amount and speed at which
alcohol is consumed.
Alcohol and Driving
• Never drink and drive.
 Even one drink can impair your response time.
 In most states, the legal limit for driving is
0.08 and for those under 21 there is zero
 If this limit is exceeded, the driver could
receive a DUI (driving under the influence) or
DWI (driving while intoxicated), which is a
felony in some states.
Alcohol and Tolerance
• Continued exposure to alcohol causes
increased tolerance.
 Tolerance
Decrease of effectiveness of drug after a
period of prolonged or heavy use.
 Metabolic tolerance
Increased efficiency of removing high levels of
alcohol from the blood due to long-term
exposure, leading to more drinking and
possible addiction.
 Functional tolerance:
Actual change in sensitivity to a drug resulting
in hallucinations and convulsions when alcohol
is removed.
Alcohol and Tolerance
• Alcohol abuse (problem drinker)
A person who experiences psychological,
social, family, employment, or school
problems because of alcohol. Problem drinkers
often binge drink and turn to alcohol when
facing problems or making decisions.
• Alcohol dependency (alcoholism):
A dependency on alcohol marked by
compulsive, uncontrollable drinking with
negative effects on physical health, family
relationships, and social health.
Impact of Alcohol on Nutrition
• If you are in good health and otherwise
well nourished, the occasional
consumption of alcohol will probably
have little effect on your nutritional
 Alcohol and mixers can contribute
additional calories which can cause
unwanted weight gain.
Impact of Alcohol on Nutrition
• Excessive intake of alcohol on a regular basis will
compromise your nutritional status.
 Protein deficiency can develop:
 Depression of protein synthesis in the cells.
 Substituting alcohol for food, resulting in poor
 Stomach cells become inflamed and vulnerable to
ulcer formation.
 Intestinal cells fail to absorb vitamins.
 Liver cells lose efficiency in activating vitamin D,
and the production and excretion of bile are altered.
 Lowered red blood cell formation due to
acetaldehyde interfering with metabolism.
Health Benefits of Alcohol
• Drinking moderate amounts appears to be
healthy for people who do not have problems
with alcohol abuse or dependency.
• People who consume one to two drinks daily
have lower mortality rates than nondrinkers.
• Like any other drug, there is a beneficial dose
and a level (dose) that will cause harm.
• Most research indicates wine consumption to
be most beneficial; it appears that the benefits
are from the alcohol itself.
 The protective effect is the result of increased
levels of high-density lipoprotein (HDL)
 It also inhibits blood from forming clots,
reducing risk of death from heart attack.
Health Risks of Alcohol
• Moderate consumption is not risk free:
 Deaths reduced by moderate alcohol
consumption generally occur in people 45
years of age and older.
 Most deaths due to alcohol consumption occur
in people younger than 45 years of age.
 Among young adults, the risks far outweigh
the benefits.
Health Risks of Alcohol
• Alcohol affects judgment & slows reflexes, which
leads to:
• Increased accidents: falls, motor vehicle
• Increase in homicide and suicide.
• Drug Interactions: Drugs, like alcohol, are
metabolized in the liver.
• Drugs: substances that can modify one or more
of the body’s functions.
• Liver has limited processing capacity and drugs
and alcohol will compete with each other.
• Increased risk of medication side effects.
Other Risks of Alcohol
Night blindness
Breast cancer
Other cancers
Liver damage
 Alcoholic hepatitis
 Cirrhosis
• High blood pressure
and stroke
• Pancreatitis
• Gastrointestinal
• Brain damage
• Decreased sex
hormone production
• Anemia
• Emotional and social
Pros and Cons of Alcohol Consumption
• Compare your age/gender to the leading causes
of death for those of similar ages/gender.
 Leading causes of death for men under 40
years of age and women under 50 years of
age (premenopausal) are accidents and breast
cancer, respectively.
• In this case, risks of low to moderate
alcohol consumption outweigh the benefits.
 Leading cause of death for men over 40 years
of age and women over 50 years of age is
heart disease.
• In this case, the benefits of low to
moderate alcohol consumption outweigh
Alcohol Abuse
• Alcoholism is a dependency on alcohol
characterized by:
 Craving (a strong need to drink).
 Loss of control (being unable to stop drinking
despite a desire to do so).
 Physical dependence.
 Withdrawal symptoms.
 Tolerance (increased difficulty of becoming
Alcohol Abuse
• Use: ingestion of alcohol or other drugs
without experiencing any negative
• Misuse: a person experiences negative
consequences from his/her use of alcohol or
other drugs.
• Abuse: continued use of alcohol or other
drugs in spite of negative consequences.
• Dependency/Addiction: compulsive use of
alcohol or other drugs regardless of adverse or
negative consequences.
 Needs professional help.
Alcoholics Anonymous (AA)
• Well-known method to deal with alcohol
• Established in 1935.
• Through group meetings, selfproclaimed alcoholics come together for
counseling, guidance, and support with
the primary purpose of staying sober
and helping others to achieve sobriety.
• What is Binge Drinking?
 At least five drinks at one time for a man.
 At least four drinks at one time for a
• Short-Term Reactions Include:
 Vomiting, dizziness, impaired mental
capabilities, and hangover.
• Serious Problems Include:
 Risky sexual behavior.
 Alcohol-related injuries or even death.
What Is a Drink?
What Is a Drink?
According to the Dietary Guidelines for
Americans, “If you drink alcoholic beverages, do
so in moderation.”
Moderation is defined as the following:
• Men: No more than two drinks per day.
• Women: No more than one drink per day.
What Is a Drink?
Alcohol is alcohol is alcohol. It
does not matter if the beverage
of choice is beer, wine, wine
cooler, a cocktail, or a mixed drink.
• 12 oz of regular beer
• 5 ounces of wine
• 1 ½ ounces of 80-proof
distilled spirits
• 12 ounces of wine/malt
or spirit-based cooler
• 3 oz of sherry or port
• 9.75 oz of malt liquor
It’s really how much that counts.
People who should not drink alcoholic
• Children and adolescents.
• Individuals of any age who cannot restrict their
drinking to moderate levels.
• Women who may become pregnant or who are
pregnant. A safe alcohol intake has not been
established for women at any time during
pregnancy, including the first few weeks.
• Individuals who plan to drive, operate
machinery, or take part in other activities that
require attention, skill, or coordination. Most
people retain some alcohol in their blood up to 2
to 3 hours after a single drink.
• Individuals taking prescription or over-thecounter medications that can interact with
Fetal Alcohol Syndrome
What is Fetal Alcohol Syndrome (FAS)?
A pattern of birth defects found in the children of
mothers who drank alcohol during pregnancy.
• One of the primary sources of birth defects in the
• Most common source of preventable birth defects.
Defined by four criteria:
1. Maternal drinking during pregnancy.
2. Characteristic pattern of facial abnormalities.
3. Growth retardation.
4. Brain damage including intellectual difficulties or
behavioral problems.
Fetal Alcohol Syndrome
How Does Alcohol Get
Into the Baby’s Body?
•Alcohol passes from the
mother to the baby
through the placenta.
•The unborn baby’s
ability to metabolize
alcohol is slower than the
As a result, the baby’s
BAC is higher and alcohol
remains in the baby’s
blood longer than in the
How Much Alcohol
Causes FAS?
• No quantity of alcohol
use during pregnancy
is considered safe.
• An average of one
drink a day increases
• Especially hazardous
use includes:
 Binge drinking.
 Frequent heavy
Fetal Alcohol Syndrome
FAS is completely
Preventable if pregnant
women do not drink
• Typical traits of FAS…
 Small eyes with drooping
upper lids.
 Short upturned nose, flat
 Undeveloped groove in
center of upper lip.
 Mental retardation, impaired
learning …
 Memory problems, seizures
• Irreversible abnormalities of
the brain and other organs.
Fetal alcohol syndrome is completely
preventable if pregnant women do not consume
Everything a woman eats or drinks affects her
baby. No quantity of alcohol use during
pregnancy has been established as safe.