Alcohol consumption can potentially affect an individual, either directly or indirectly, across the lifecycle. Most low risk alcohol use guidelines recommend that women who are planning a pregnancy, currently pregnant or lactating avoid alcohol consumption as exposure to alcohol can affect infant brain development resulting in cognitive, developmental and behavioural problems (17). Dietitians can play a role in helping to safe guard the health of the unborn by advising women of childbearing age and those who are pregnant of the risks of development of fetal alcohol spectrum disorder as a result of exposure to alcohol.

 

Most low risk alcohol use guidelines recommend that children and youth avoid consumption of alcohol, although the specific age limit of legal alcohol use varies between jurisdictions. Alcohol use by youth poses many risks including self poisoning with alcohol, physical fighting, suicide and injury through accident (18-20). Dietitians should consider that adolescents may be using alcohol and include assessment of this lifestyle factor as part of the nutritional assessment.

 

Similarly, assessment of alcohol use, type, quantity and context of use is important in a comprehensive nutritional assessment of an adult. Whether seeking general nutritional counselling or information to support the self management of a chronic condition, adults of all ages can benefit from accurate information about health effects associated with the consumption of alcohol.

 

A hangover has been described as a collection of symptoms, occurring within 24 hours, that are associated with excessive alcohol consumption, with sufficient severity to disturb daily life activities (21). The nature and variety of symptoms that are reported varies by the individual and may include feelings of dizziness, anxiety, drowsiness, dry mouth, sweating, nausea and other gastrointestinal problems (22). Although traditionally hangover symptoms have been attributed to the effects of dehydration, it is challenging to separate the potential effects of dehydration, sleep deprivation and alcohol consumption, all of which may be co-occurring after excess alcohol consumption. To date researchers have been unable to identify the precise explanation for hangover symptoms. Although some newer hypotheses propose that hangover symptoms may be related to immune system activation and the release of cytokines (cerebral cytokines IL-1, IL-6 and tumour necrosis factor) (22), further research is required to fully understand this phenomenon.

 

Chronic and excessive alcohol intake is associated with acute and chronic pancreatitis. Although the precise mechanism resulting in tissue injury remains to be fully understood, it is thought that fatty acid ethyl esters in combination with alcohol stimulate Ca2+ release from intact cell, oxidative stress and subsequent changes at the cellular level to the pancreatic mitochondria, endoplasmic reticulum and lysosomes (23,24). Complex changes to the mitochondrial cell permeability as a result of exposure to cellular stress are thought to play a key role in subsequent cell damage and eventual death.

 

Alcohol beverages also contain many organic and inorganic non-alcohol components that may be implicated in this process; for example, beer contains more than 2,000 non-alcohol organic components and wine contains more than 1,000 identified components (25). Non-alcohol components in beer that form from the alcohol fermentation of glucose have been identified as a factor stimulating basal pancreatic enzyme production.

 

It should be noted that only approximately 10% of heavy alcohol consumers develop chronic pancreatitis so other environmental factors (such as exposure to tobacco smoke) and genetic factors must also have a role in pancreatic injury. Alcohol’s role in potentiating the effects of other risk factors (such as tobacco smoke, poor nutrition and inflammation) may also be a risk factor for the development of pancreatic cancer (26).

 

The consumption of alcohol increases the risk of fetal damage throughout pregnancy. Alcohol consumption during gestation results in damage to the developing fetal brain resulting in neuron loss that ultimately effects behaviour, learning and memory as well as defects across a range of cells resulting in central nervous system dysfunction, growth restriction, cardiac problems, the development of characteristic craniofacial features and other issues (17,27). While it is well known that alcohol permeates across fluid membranes in both mother and baby, identifying the precise ways that alcohol precipitates damage has been challenging because the effects of consumption can be influenced by a number of factors including:

• timing of alcohol exposure (trimester and stage in fetal development)
• type of exposure (regular consumption, binge)
• cell type or developmental system studied and its sensitivity to the effects of alcohol 
• maternal and fetal genetic factors (17).

Despite this complexity, several processes have been identified that help to explain the various ways that alcohol can cause fetal harm, including producing oxidative stress on cells, disrupting and damaging key developmental processes, interference with growth factor signalling and routine cell interactions, and altering the expression of genes and inducing cell death (17).

 

In most countries there are several regulatory dimensions that govern alcohol production, sales and marketing, which include:

• regulation and monitoring to ensure quality standards and the safety of alcohol production and importation
• regulation standards that govern alcohol labelling and define terms that may be used on labels, such as "low alcohol"
• national or regional age restrictions on who may purchase and/or be served alcohol
• regulations on alcohol advertising, sponsorship, product placement and sales promotion (5).

The Australia New Zealand Food Standards Code, standard 2.7.1 specifies the labelling requirements for alcohol containing foods and beverages. As well as describing standard drink labelling, the standards also define the approved use of the terms “low alcohol”, “non-intoxicating” and “non-alcoholic”.

 

The Canadian Food Inspection Agency, provinces and territories collaborate to ensure that labelling and safety standards that are prescribed in the Food and Drugs Act and the Consumer Packing and Labeling Act are met. These Acts specify labelling, standard container size and define standards for quality.

 

In the United Kingdom the Food Standards Agency monitors safety, labelling and law enforcement of the food supply, including alcohol beverages.  The European Union has undertaken a review of nutrition labelling and the European Parliament has approved proposed new Food Information for Consumers Regulations. These regulations will be phased in with mandatory nutrition labelling by 2016.

 

Binge Drinking: the description of binge drinking varies between countries, between research studies, surveys and its use is avoided in some cases because of a lack of consensus on a precise description. For example, the NHS defines binge drinking as the consumption of eight or more units of alcohol by a man or six or more units of alcohol by a woman in a single occasion (28), whereas a research study defines binge drinking as repeated excessive consumption of alcohol over a short period of time (29) and a clinical practice guideline defines binge drinking as alcohol consumption that raises blood alcohol concentrations to 0.08% (30). The Australian guidelines no longer use this term (31).

 

Blood Alcohol Concentration: or BAC refers to the amount of alcohol in milligrams (mg) present in 100 millilitres (mL) of blood. For example, 60 mg is 0.06 grams of alcohol in 100 mL blood or 0.06% (32). The blood alcohol concentration legal limit for driving varies between countries.

 

Hazardous Drinking: a pattern of drinking that increases an individual’s risk of physical or psychological harm (28).

 

Description: An international collection of alcohol guidelines.

 

Title: Australian Guidelines to Reduce Health Risks from Drinking Alcohol

Description: These National Health and Medical Research Council guidelines provide extensive background information on the process and evidence used to develop the current guidelines for alcohol use.

 

Title: NHMRC New Alcohol Guidelines: What Do They Really Mean?

Description: In this National Health and Medical Research Council podcast (8:15 minutes), Professor Jon Currie reviews Australia’s alcohol guidelines and risks of alcohol use.

 

Title:  Position Statement - Alcohol and Cancer Risk

Description: This position statement from Cancer Council Australia provides professionals with evidence on the link between alcohol and cancer and recommendations on alcohol use.

 

Description: This Canadian Centre on Substance Abuse document provides a summary of the evidence and guidelines for low risk drinking in Canada.

 

Nova E, Baccan GC, Veses A, Zapatera B, Marcos A. Potential health benefits of moderate alcohol consumption: current perspectives in research. Proc Nutr Soc. 2012 May;71(2):307-15. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/22391060

 

Grønbaek M. The positive and negative health effects of alcohol- and the public health implications. J Intern Med. 2009 Apr;265(4):407-20. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/19298457

 

Title: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Alcohol Consumption and Ethyl Carbamate. 

Description: This International Agency for Research on Cancer, World Health Organization publications provides professionals with information on the risks of alcohol on various cancers.

 

Title: Primary Care Addictions Toolkit. Dealing with Alcohol Problems

Description: This Centre for Addiction and Mental Health on-line tool kit includes a range of resources including frequently asked questions on screening for alcohol problems, brief advice for people at risk, alcohol problems in women, pregnancy, and older individuals.

 

Description: This booklet produced by the Ministry of Health New Zealand, provides health care providers with information on addressing alcohol use during and following pregnancy, as well as a resource list.

 

Title: Pregnancy and Alcohol Cessation Toolkit

Description: This Ako Aotearoa online set of four education modules is designed to support health care professionals to ask and assess alcohol use during pregnancy, provide advice on cessation and offer assistance or make a referral to addiction treatment services. It facilitates the Alcohol and Pregnancy Guide for Health Professionals.

 

Description: These 2011 NICE clinical practice guidelines provide guidance on diagnosis, assessment and management of alcohol use disorders.

 

Title: Alcohol-use Disorders: Diagnosis and Clinical Management of Alcohol-related Physical Complications

Description: These 2010 NICE clinical practice guidelines address the management of alcohol related liver disease, pancreatitis and Wernicke’s encephalopathy.

 

Title: Alcohol Identification and Brief Advice e-Learning

Description: This Public Health England e-learning website is based on World Health Organization validated tools, and includes six learning modules exploring the psychosocial aspects of alcohol use, harms, tools to identify problem alcohol use, patient and provider relationships. Case examples of brief advice are offered.

 

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