Alcohol and Vitamin, Mineral and Protein Deficiency

Alcohol and Nutrition

Main nutrition-related alcohol effects:

1. Weight gain. 1 gram of alcohol contains 7 Calories, so excessive (but less likely moderate) alcohol consumption along with regular diet can result in weight gain.
2. Weight loss. Chronic alcoholics who do not eat enough may suffer from severe weight loss.
3. Nutrient deficiencies. Chronic alcoholism associated with poor diet can result in mineral and vitamin deficiencies.
4. Impaired metabolism. Long-term excessive drinking can result in a severe liver damage (liver cirrhosis), which can affect the production of proteins in the liver.

Excessive drinking in combination with a poor diet may lead to various nutrient deficiencies and metabolic changes.

Vitamin A deficiency

Vitamin A deficiency with night blindness, dry, thick skin and brittle nails may develop in chronic alcoholics who do not eat enough or, in those with advanced liver cirrhosis (due to impaired conversion of the inactive forms of vitamin A into the active one), or in advanced chronic pancreatitis (due to impaired vitamin A absorption) ^[1,2].

Treatment with vitamin A supplements needs to be careful, because even usual doses may be toxic for the alcoholic’s liver ^[2].

Vitamin B1 (Thiamin) Deficiency

Vitamin B1 (thiamin) deficiency in chronic alcoholics may be due to poor diet and impaired vitamin absorption. 

Wernicke encephalopathy is a possibly reversible emergency brain disorder that may suddenly develop due to vitamin B1 deficiency lasting for as little as one month, with the following symptoms even in a sober state: apathy, double vision (due to paralysis of the eye muscles), newly appearing wide-based and short-stepped gait or hallucinations ^[3,4,5]. Treatment with vitamin B1 (thiamin) supplements, balanced diet and alcohol abstinence often results in complete recovery within few hours ^[5,6].

Thiamin deficiency lasting for several years may result in Korsakoff psychosis or Korsakoff syndrome with apathy, usually irreversible loss of short-term memory, inability to learn new things, making up stories (confabulation) or hallucinations ^[3,4,7]. Treatment of Korsakoff psychosis with vitamin B1 supplements rarely results in complete recovery ^[5,6].

Other symptoms of vitamin B1 deficiency may be due to nerve damage (peripheral neuropathy) and may include numbness and tingling in hands and feet or “burning feet syndrome” due to peripheral neuropathy, or rapid heart beat, difficulty breathing and leg swelling due to congestive heart failure ^[8].

Vitamin B3 (Niacin) Deficiency

Vitamin B3 (niacin) deficiency can cause pellagra with dermatitis, dementia and diarrhea ^[13] or alcoholic pellagra encephalopathy with hallucinations, insomnia, tremor, impaired coordination, incontinence, and seizures ^[14-p.395].

Folate (Vitamin B9) and Vitamin B12 Deficiency

Folate deficiency, probably caused by low folate intake ^[9] or vitamin B12 deficiency caused by impaired absorption ^[10], may result in megaloblastic anemia, brownish or pale-yellow discoloration of skin, swollen tongue, fatigue, tingling in the hands and feet and psychosis ^[10,11].

Vitamin B12 deficiency and pernicious anemia can occur due to H. pylori infection of the stomach, which is common in heavy drinkers, and which can affect the production of the intrinsic factor required for vitamin B 12 absorption; one of the symptoms is a smooth, bright red tongue (glossitis) ^[46].

Treatment is with oral folate supplements or vitamin B12 injections ^[12].

Chronic alcoholics are also at increased risk of developing the deficiency of vitamins B2 (riboflavin) ^[45], B6 (piridoxine) ^[44] and B7 (biotin) ^[37].

Vitamin C Deficiency

Vitamin C deficiency is common in chronic alcoholics because alcohol impairs vitamin C absorption and stimulates its excretion in the urine ^[15,16]. Vitamin C deficiency may slow down the healing processes in the body, but overt scurvy in alcoholics is rare ^[16]. Oral vitamin C in chronic alcoholics may be poorly absorbed, so intravenous vitamin C injections for several months may be needed ^[16].

Vitamin D Deficiency

Vitamin D deficiency in chronic alcoholics, especially in those with alcoholic hepatitis or advanced liver cirrhosis, may be due to impaired conversion of inactive forms of vitamin D into the active one in the liver ^[17]. Vitamin D deficiency may result in hypocalcemia, which may contribute to the development of osteoporosis ^[18].

Magnesium Deficiency

Magnesium deficiency in alcoholics may be caused by poor diet or magnesium loss due to increased excretion in the urine or due to diarrhea ^[19]. Low blood magnesium levels (hypomagnesemia) may also occur during alcohol withdrawal ^[20]. Symptoms include weakness and, in severe cases, numbness, muscle cramps, seizures, irregular hear rhythm ^[21].

Potassium Deficiency

Potassium deficiency in chronic alcoholics may be caused by increased excretion in the urine due to hypomagnesemia, potassium loses due to diarrhea and vomiting ^[22,23] id=”potassium” and probably due to poor diet ^[24]. Hypokalemia may also occur during alcohol withdrawal ^[20], especially in delirium tremens ^[25]. Symptoms of hypokalemia include weakness and muscle cramps. Potassium and calcium deficiency in combination may contribute to high blood pressure ^[26].

Iron Deficiency Anemia or Iron Overload

Iron deficiency may develop in alcoholics with frequent gastrointestinal bleeding ^[28]. Iron deficiency may cause microcytic anemia with paleness and weakness ^[29]. Polyphenols in red wine inhibit iron absorption but do not likely affect the iron balance in the body ^[30].

Other alcohol-related types of anemia include macrocytic anemia due to direct alcohol toxicity, sideroblastic anemia due to impairment of iron incorporation into the red blood cells, megaloblastic anemia due to folate or vitamin B12 deficiency and hemolytic anemia (with jaundice) due to alcoholic liver disease ^[28]. All mentioned types of alcohol-induced anemia are reversible with alcohol abstinence, proper nutrition and medication ^[28].

In alcoholics, iron overload–the accumulation of iron in the liver–, probably due to increased iron absorption, is more common than iron deficiency ^[31,32,33]. Consumption of more than two drinks per day significantly increases the risk of iron overload ^[31]. Iron overload may promote development of liver cirrhosis and cancer ^[28,32]. Excessive alcohol consumption may worsen symptoms of hereditary hemochromatosis ^[35].

Other Mineral Deficiencies

Low blood phosphate level (hypophosphatemia) may occur due to poor diet, excessive phosphate excretion in the urine or alcohol withdrawal ^[24].

A “beer drinkers’ hyponatremia” due to low sodium intake was documented in five persons drinking at least 5 liters (11 pints) of beer per day without any other food ^[24].

Alcohol may cause zinc deficiency by stimulating zinc excretion in the urine ^[27].

Protein Deficiency

Alcohol-related protein deficiency can be caused by poor diet, impaired protein digestion and absorption, decreased protein synthesis (in liver cirrhosis) and increased protein breakdown ^[2]. This may result in impaired immunity (since antibodies are proteins) and therefore increased susceptibility for infections, and muscle wasting ^[2].

Chronic alcohol consumption may cause fat and protein malabsorption even in the absence of liver cirrhosis or pancreatitis. Reduced levels of blood proteins albumins (hypoalbuminemia) may lead to escape of fluid from the circulation and its accumulation in the abdominal cavity (ascites) ^[2,36].

In alcohol-related liver disease, decreased production of coagulation factors (which are proteins) may result in increased risk of bleeding ^[47].

Hypoglycemia

Low blood glucose level or hypoglycemia may develop within 6-36 hours after a binge drinking in chronic alcoholics who do not eat regularly, because their liver glycogen stores–from which glucose is released–are low and because alcohol may inhibit the synthesis of new glucose (gluconeogenesis) in the liver ^[3,18].

Reactive hypoglycemia may occur after drinking alcohol along with carbohydrates (liqueurs, alcohol with carbohydrate mixers, such as cola, or alcohol with carbohydrate snacks) ^[38,39]. Chronic heavy drinkers, especially those with liver cirrhosis, often have increased blood glucose levels or hyperglycemia due to insulin resistance ^[18].

Alcoholic Ketoacidosis

A chronic alcoholic–but less likely an inexperienced drinker–who drinks heavily for few days and does not eat, may develop ketoacidosis – the accumulation of acidic ketones in the blood ^[40].

A person who drinks only alcoholic beverages and does not eat, may not consume any carbohydrates, so his or her body starts to break down glycogen in the liver to provide glucose, but glycogen stores suffice for only about 1 day. Additionally, alcohol inhibits the synthesis of new glucose in the body, which may, in combination, lead to low blood glucose levels (hypoglycemia).

When glucose stores are not available, triglycerides from the body fat stores start to break down into fatty acids, which become the main source of energy. But the human body cannot use a large amount of fatty acids at once, so some of them are converted into ketone bodies (acetoacetate, beta-hydroxybutyrate), which accumulate in the blood and make it acidic (from here the term ketoacidosis) ^[40].

Symptoms of alcoholic ketoacidosis may include rapid, deep breathing, fruity odor, nausea, repeated vomiting, fatigue, and stomach pain within three days after stopping binge drinking ^[41]. Diagnosis can be made from high urine ketone levels ^[42].

Treatment in the hospital includes intravenous infusion of glucose ^[43].