A blog about science, medicine, media and the ramblings of Irish hack....

Thursday, December 29, 2011

Getting wasted 101 - some amazing alcohol anecdotes and fantastic facts

 This post is all about alcohol, how it affects us and some interesting facts you may not have heard. I've tried to hyperlink any references in the main text where required. It's written for an Irish audience but is applicable throughout the western world. For those of you who have been so supportive regarding my previous post on the Kate Fitzgerald / Irish Times fiasco, thank you so much for your support during this difficult time. Kate is no longer with us but many of your comments touched me deeply, and indeed I think Kate's family too. Merry X-mas, Dave

The festive season is upon us, and for the Irish in particular that means copious consumption of various alcoholic beverage, or as we call it "business as usual". It is also the season of "Drink aware" adverts which try to be helpful by reminding us of such useful things as our consumption levels and drink driving limits, in terms of the 'Standard drink'.

Scrooge-like as it seems, this bugs me - not because the sentiment isn't appreciated, nor because I have some subconscious urge to play Dionysus but rather due to the fact that the standard drink is largely a myth; a misconception based on the idea that biology can be standardized when in fact personal variations matter hugely. So in the X-mas spirit, allow me to present "Getting wasted 101" and come delve haphazardly into psychopharmacology with me.If that sounds eerily reminiscent of that time some mischief maker slipped you a tab of LSD instead of an after dinner mint, worry not, this is entirely educational.

Like, Gee Scoob! This after dinner mint is making me feel CRAZY!

Getting drunk in the first place
Whether your chosen poison is beer, wine, spirits or abnormally high concentrations of mouth wash, the culprit for inebriation is always alcohol - specifically the ethanol in that alcohol. As you consume it, it affects various neurotransmitter systems in the brain, the chemical messengers of the central nervous system. Alcohol inhibits some of these systems, slowing the messages down from some chemical messengers. Oddly, it also enhances the messages from other neurotransmitters like serotonin. This is important as serotonin is a really bloody weird chemical in our brains that regulates everything from our sex drive to our moods, explaining some of the euphoric effects of intoxication. The net effect is one of depressing the central nervous system, which results in delayed reactions, stupor and in all likelihood, bad dance moves.

Bad dance moves. Not to be confused with vaguely rhymatic drunken stumbling

 On a side note, it's worth talking about drunken sexual adventures and misadventures - this is a beautiful example of the duality of alcohol on our nervous system. Those of you who studied or performed MacBeth (or 'the Scottish play' to our more superstitious thespian friends) might remember the Porter's speech;

Marry, sir, nose-painting, sleep, and urine. 
Lechery, sir, it provokes, and unprovokes;
it provokes the desire, but it takes away the performance: 
therefore, much drink  may be said to be an equivocator with lechery:
it makes him, and it mars him; 
it sets him on, and it takes him off; 
it persuades him,  and disheartens him; 
makes him stand to, and not stand to; 
in conclusion, equivocates him
in a sleep, and, giving him the lie, leaves him.

The porter is playing here on the equivocal nature of booze - provoking desire but removing performance, or in a slightly more musical hall-esque style, standing to..and not standing to! Wink, wink!  Hey, you come here for the science bit but don't say I don't give you culture and textual studies in the mix.

But how true is this ? We all know alchol impairs judgement and control, and everyone knows horror stories about that. But what IS surprising is that alcohol actually suppresses testosterone production in men - this reduces sex drive and performance. As testosterone is pretty damn important for maintaining an erection, drinking does indeed produce the infamous "whiskey dick", the inability in healthy men to sustain an erection. Even if the man can overcome (no pun intended..) this annoyance, it tends to lead to an anorgasmic state - in other words, the ability to perform but not the ability to climax. In short, alcohol suppresses male sexual desire and decreases performance.

What of the fairer sex ? Strange as it may seem, alcohol increases testosterone production in females, and increases sex drive. While men under the influence are less aroused, women drunk are actually MORE prone to arousal. As alcohol impairs judgement and inhibition, this also means a corresponding rise in questionable sexual (mis)adventures, regardless of gender.

Getting sober - Liver to the rescue!
Spare a thought for your liver; it's the bodily superhero that breaks down poisons and excess chemicals into forms you can excrete. Ethanol is broken down or metabolised in a pretty complex process, but essentially this process has the following four stages
  1. Ethanol is broken down to acetaldehyde. Acetaldehyde is highly unstable, and doesn't live that long. This is a good thing, as it reacts with bodily tissue otherwise as a form of free radical production and can be carcinogenic or cancer causing. In fact, it's the presence of acetaldehyde which can be damage the neural cells of developing fetus, a big reason why pregnant women are advised not to drink, unless they're actively hoping for brain damaged offspring. Acetaldehyde is likely responsible for some aspects of hang overs, and in high enough levels can damage liver and kidneys, so the body breaks this down quick as it can.
  2. Acetaldehye is broken down into acetic acid. Oddly, this stage explains why Asians get drunk quicker than Caucasians but more on that later
  3. Acetic acid to acetyl-CoA
  4. Acetyl-CoA is then processed by the critic acid cycle to become our normal waste products of carbon dioxide (which we exhale) and water, which we sweat or urine, explaining another mystery of alcohol consumption.
So to be sober, all the alcohol you consume has to be metabolised, which is does mainly in the liver through the cycle above. Actually in reality, some alcohol is also processed by the gastrointestinal (GI) tract but the bulk of alcohol handling is taken on by the liver. You might be wondering why we evolved such a convoluted process for dealing with alcohol, and the answer to that is that our body naturally creates alcohol when food stuffs ferment in your stomach and gut, roughly 3g a day which we deal with by the exact same process.

Measuring intoxication
There are many supposed ways to measure intoxication - American TV seems to indicate that the ability to say the Alphabet backwards or walk a straight line implies sobriety -this is unfortunate for me, as both are things I find practically impossible even when utterly sober. In fact, I know Professors who find the alphabet hard work in the forward direction but I digress; the real test is blood alcohol content (BAC). This is essentially a measure of how much alcohol you've absorbed into your blood stream -  the kind that the liver hasn't started dealing with yet, and is having the time of its life fiddling around with your nervous system, brain function, and resistance to stealing traffic cones while your liver deals with the backlog.

He also walks the line

BAC can be expressed a few different ways, the most straight forward of which is is a a percentage of your entire blood stream. So, for example a BAC of 0.01 means 0.01%, or one hundredth of one percent of your blood contains alcohol. A BAC of 0.1 means a tenth of a percent of your blood contain alcohol etc. The following chart is stolen from Wikipedia (thanks Jimmy Wales, your cheque is in the mail!) to give an example of what happens to your body at various BAC levels

I quite like the term "General lack of behavior" - I think this would be a good synonym for 'death'

So straight off the bat it's clear that having a blood alcohol percentage of 0.5% is likely going to result in a rather severe case of death, so try to avoid that one.

What factors influence intoxication and metabolistic rate ?
This is the important part for many of us - how long does it take alcohol to metabolise, and how drunk will it make us ? According to the (industry sponsored) drinkware.ie your liver can process roughly a standard drink an hour. What exactly a standard drink is becomes a pertinent question, but we'll tackle that under a different heading. But does the claim hold ?

Eh.. sometimes. But not really. Alcohol is extremely idiosyncratic - it affects different people in very different ways, and even the same person will show different responses to the same drinking patterns depending on a wide variety of factors. Let's look at some of these intoxication / metabolism factors now.

  • Body Weight - The greater your body weight, the more water it contains. This is significant, as greater amounts of body water greatly reduce the absorbion of alcohol. Imagine adding a cup of cordial to a 1 litre bottle of water, then imagine adding that same quantity to a 2 litre bottle of water - same idea. A person with a lower body mass will get drunk quicker than a person with a greater one.
  • Gender - Women have smaller body masses, ergo less water content and it follows that alcohol could be expected to hit them harder. Indeed, this is the case - it might be a double whammy for women, as they have less of the alcohol metabolising enzyme ADH in their stomach, meaning a less efficient alcohol clean up system (metabolism) and a lower threshold for intoxication.
  • Food consumption prior to boozing responsible drinking - The rate at which alcohol is absorbed is a big factor in the inebriation caclulation; about 20% of the alcohol is absorbed in the stomach and the remainder in the GI tract, and the liver can only handle a certain amount at a time - this means the more gradual the introduction of alcohol, the quicker the liver can process it. As you'd expect, more food means a more huge difference in intoxication and metabolistic rate.
  • Drinking velocity - Following on from the last point, the more gradual the introduction of the alcohol, the more efficient the metabolistic process. Shotgunning a beer will make you drunker than casually drinking the same beer. It is also a waster of good beer, and only considered acceptable at parties where the beer, and company, is of a sufficiently low level.
  • Genetics - Remember when I said Asians get drunk easier than Caucasians ? This is become most Caucasians have two enzymes for processing alcohol, whereas 50% of Asian men do not. This means they will get drunk quicker, and take longer to sober up. Genetic factors also influence the amount of ADH in your stomach, your mass, build and - at the risk of sounding obvious - your gender. Genetics then play a huge role in ease of intoxication and metabolistic rate.

These are just some of the factors influencing intoxication and recovery rate, some of which we can influence, some of which we cannot. So how much ethanol can the liver deal with at a time ? This is also hugely variable, and depends on liver size, ADH levels, and a host of other factors.

A whiskey chaser or three is going to have VERY different effects on these two...

What the hell is a standard drink ?
Errr... good question. And this is my bone of contention with the very concept of 'standard drink' - there isn't one. Have a look at the what the clear cut graphic says from the Irish campaign.

Despite the trendy graphic, all booze is NOT created equal
Ignoring the dubious comparison, are these all the same ? Well, that's easy to test; A litre is a volume of 10cm x 10cm x 10 cm which yields 10^-6 m^3 or 0.000001 m^3. To a good approximation the density of all the above alcohols is close to water, so it can be shown that 1 litre of any alcohol is roughly a kilogram. Now we're ready to play the numbers game.
  • Beers can vary hugely in their alcohol content. If you're drinking an awful American larger (but why would you do such a thing?) you're looking at as low as 3.5% whereas if you're proudly skulling Belgian brews it's more like 7.5%. This would be between 9.94g and 21.3g alcohol - a pretty big difference. Taking a rough average of 4.5%, that's still 12.78 g. And where exactly can one acquire EXACTLY 284ml of beer anyway ? Glasses and bottles tend to be about 300ml, raising the alcohol content somewhat of a typical beer to 13.5 g. For a pint, that's about 25.56 g.
  • Wines also vary hugely. From 12% to 22.5% for a fortied wine. So for a 100ml 'small' glass, that's an alcohol mass of 12g to perhaps 22.5g for a port. If the average wine has an alcohol content of 14% that's 14g. But typically, wine is sold in snipes of about 185ml, which would be about 25.9 g alcohol.
  • Spirits vary too, but typically they're at the 40% mark. This translates as about 14.2g of alcohol in shot or spirit mix. 
 So this indicates a little bit of a disconnect with reality - the 'standard' drink is little more than an advertising fabrication - a convenient fiction that tend to downplay the actual alcohol content of the drinks. With the exception of spirits, the measures counted are not typical pub measures, and are in fact understatements of the amount of alcohol typically consumed.

Oh GOD! All I've known is a LIE! How long until I'm sober ?!
Take it easy Sparky. There is no sure way of knowing - the common thread of these random alcohol facts has been that biology and circumstances make all episodes of drinking different. That said, there has been some studies done on the rates of metabolism but be very careful drawing any averages from these, as the range is simply too great for it to be meaningful. In 1977 Wilkinson et al did a study on fasting volunteers to see how quickly booze left their system. Better still, the researchers got these starving men to rapidly down varying number of drinks - so basically, speed drinking on an empty stomach. A graph from their result is shown here

Speed drinking on an empty stomach - it's ok, it's for SCIENCE! Tell that to the cops...

Annoyingly, I cannot get full access to the original paper and every country has a differing definition of 'standard drink' (see?! SEE?! Standard my ass!) but assuming the drink refers to American standard drinks, that's 13.7 g of alcohol per drink. So in essence, Wilkinson and his co-workers got volunteers to shotgun between 13.7 g of alcohol and 54.8 g of alcohol with no food whatsoever, and this is the result obtained. Obviously with lower consumption rate and some food the curves would be much smaller. Amazingly enough, Even shotgunning 27.4g of alcohol kept the men just under the legal limit, but it would take at least 4 hours until the men who shotgunned double this could start their engines without being arrested. Remember, this is NOT a sure fire indication! The only way of knowing is to have your BAC measured. So if in doubt, don't drive.

So is there anything that can speed up alcohol metabolism ? Curiously, yes, there is one thing. Fructose, the sugar found in some fruits. The effect is very complicated but has been measured and verified. Still, this doesn't mean that wolfing down a rake of dates or corn syrup will cure you instantly of drunken-ness. In a nutshell, your liver is not a huge fan of fructose and this might cause its own issues.

Gargling corn syrup is not an approved path to sobriety!

What to take home from all this
So we've now learnt a few things about alcohol for this X-mas season. Let's do a speed re-cap of all the pertinent points

  • If you're a white guy in a multi-cultural drinking competition, try to pick an Asian opponent - odds are good he only has half the enzymes for digesting it as you do.
  • Don't drink and drive - you'll likely spill most of it and it's expensive
  • Really, don't drink and drive - hang on 'til it wears off
  • Women get friskier with drink, men less frisky and more dysfunctional - catch 22.
  • You can make starving people shotgun drinks in the name of science.
  • Your liver is pretty important so don't mess it up.
  • Fructose can speed up alcohol metabolism but don't bank on it. Fructis, on the other hand, is a shampoo. Neither are great for your liver.
  • Alcohol is idiosyncratic. People are different. Thus, standard drink is an oxymoron.
  • The porter in MacBeth is a device for continuing the theme of equivocation that runs through out the play. He also knows a thing or two about the effects booze on sexual performance.
  • "I wasn't drunk, I was on a serotonin buzz" is not entirely a valid excuse.
  • Stolen glassware can serve as a make-shift X-mas gift.
 Be safe, have fun, but don't do anything (too) silly. Alcohol is great, but be around friends, don't take undue risks and always respect the power of booze. In the right amounts, it's a wonderful addition to a eve (or afternoon, or lunch, or morning..) in or out, but to excess, like all things, it's a killer.

Remember also also that alcohol is the number one and perhaps only date rape drug - please see my first ever post for details if you're curious or surprised. Protect yourself, be aware and if you are consensually doing something crazy, use protection. Remember to that if you find drink is controlling you rather than you controlling it you may need help - please don't suffer in silence, have a peek at this site.

Happy New Year folks!

As usual, if I've made any mistakes, fire them to my twitter - @drg1985 or just use the comment form!


  1. Bro, one thing, 284ml, isn't it half a pint, including a small head on the beer. So a traditional half-pint glass would be pretty easy to find in most bars in Ireland. It's a standard serve in our country where a woman wielding a pint tumbler would be, in olden times (or by your aul lad) considered uncouth, and definitely un-ladylike.

    Also, you didn't take in to account the incredible ability of some females to smash a bottle of vodka at age 16 and be fine, but amazingly lose that ability as they approach middle age, and stagger helplessly around at your cousins wedding, "dancing" to Abba after 4 Vodka tonics. It's a bloody mystery to me.

  2. Damn it Dempsey, you're right. 284 ml is indeed a half pint, and some people still order them. More common now seems to be to go for bottles though, at a standard 300ml for the metric and imperial markets :)

  3. "pregnant women are advised not to drink, unless they're actively hoping for brain damaged offspring"

    Bit inaccurate, no? From reading I've done it seems like there's a lack of detailed evidence on the topic, though we obviously know lots is bad - hence why US health authorities say "no drinking at all, ladies!" despite the lack of evidence to support harmful effects for *every* level of alcohol consumption at *every* stage of pregnancy.

    "While the safest approach may be to avoid any alcohol intake during pregnancy, it remains the case that there is no evidence of harm from low
    levels of alcohol consumption, defined as no more than one or two units of alcohol once
    or twice a week"


  4. I'm afraid QoB it isn't at all inaccurate - Acetaldehyde destroys the formation of the neural crest. The only debate is over at what stage this damage occurs, which is why mosy physicians advocate a cautious approach.

    In any case, FAS has occured from (Self reported) low level drinking. Not a risk I'd happily take, though low level drinking probably isn't a huge risk


    For more academic discussion -


  5. David "the critic acid cycle" a missprint I assume "citric" ?

  6. Fructose is not as good as we know. I read it here - http://articles.mercola.com/sites/articles/archive/2010/01/02/highfructose-corn-syrup-alters-human-metabolism.aspx. It is not only bad to our liver but it contributes to obesity, insulin resistance, heart diseases and more.

  7. Fructose is bad alright..but don't trust Mercola's articles in general. He is a known quack... and Liam, yes you're correct :D


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