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Conquer Your Weight

Episode #84: Alcohol: The Macronutrient Your Body Doesn't Need



Show Notes

July 31, 2024

In this week's episode, you'll learn about alcohol. You'll learn about how your body processes alcohol for energy and how it can slow your weight loss goals. You'll get tips for how to reduce your alcohol intake.

We'd love to have you as a patient in our practice. To learn more and enroll, please visit www.sarahstombaughmd.com today!

Transcript

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode of the Conquer Your Weight podcast. Today we are talking about alcohol. This is a macronutrient interestingly, that we don't usually think about and a lot of people in my clinic feel that both alcohol and food are contributing to their weight. And the challenging thing about alcohol is that even if it doesn't feel like a problem in the sense that someone may not be having any trouble with the law, maybe they feel like they're only drinking a couple of drinks per week, but it's still just really not fully in line with their health goals, it can still be a problem for them if they feel like they're not fully in line with what they'd like to be doing or understanding the role that alcohol may be playing and contributing with their weight. So today we're going to talk a bit about that, talk about the role of alcohol, how our body metabolizes it, talk about the energy in alcohol, what are the calories of that? How does that play out in some real life examples of different beverages? And then if you are looking to change your alcohol, decrease your alcohol consumption, what are ways that you can practically do that? So let's go ahead and dive in. So alcohol is a macronutrient, as I stated a couple of minutes ago. So interestingly, we think about macronutrients like carbohydrates, fats and proteins, but interestingly, alcohol is a macronutrient as well. It's just one that your body doesn't need as the title of this episode implies. So our body, or not even implies, but just says, our body does not need alcohol. We know how to process it. Our body is capable of doing it, but it serves null role in our body. When we compare it to things like carbohydrates, fasts, and proteins, which do have a very important role in different aspects of our energy metabolism. Alcohol provides no mandatory role. So our body is capable of utilizing that energy. It's just not needed. So a lot of times when you hear people refer to alcohol as empty calories, this is what we're referring to. But I want to take a little bit of time and talk about alcohol specifically because I think a lot of time we think about what it's mixed with. We think about the other aspects of the drink. Someone who's having a rum and Coke, for example, they may say, okay, well instead of having a rum and Coke, if you have a vodka in soda water, then you're not getting calories from Coke and you're having a soda water or club soda instead. And while that is true, a lot of times mixers may have a pretty significant amount of added sugar, even alcohol in and of itself has calories and your body needs to utilize those. So it is empty calories. And what that means is that your body has no purpose for those. So when we think about the amount of calories and alcohol, there are seven calories in one gram of alcohol. When we compare that to our other macronutrients, there are four calories in a gram of carbohydrate. There are four calories in a gram of protein and there are nine calories in a gram of fat. But each of those things serve a very important role in different aspects of our health and metabolism. So alcohol contains seven calories per gram, and we don't need any of those calories. They don't serve any role in our body. However, our body, as I said, can process those, does process those and interestingly actually prioritizes the processing of them. So when there is alcohol in the body, the body sort of simply put, will halt metabolism of other things in order to prioritize metabolizing the alcohol. So our body is going to work through metabolizing alcohol. And when it's doing that, it prioritizes that over fat oxidation, meaning that our body is burning and utilizing and processing that alcohol and therefore is not also processing and burning fat for energy. So people say that it slows down, or if you hear that it slows down weight loss. One of the main reasons that this happens is because when there is alcohol active in the bloodstream, our body is going to prioritize the metabolism of that over metabolizing other macronutrients like especially fat, but also carbs and protein. So the alcohol aspect in and of itself has calories, and one of the hard things is that the nutrition labels of alcoholic beverages are not as in depth compared to the nutrition labels on any other food item or beverage that we have. So we want to spend a little bit of time talking about that and we'll talk through a couple of examples of a glass of red wine and a single 12 ounce beer just so that you can have an idea of what these look like, both in terms of how much alcohol is in it and then therefore how many calories are in them. Let's first talk through a glass of red wine. I will tell you I did all of these calculations in advance because they are not simple mental math. So if you're trying to follow my calculations, you may have to sit down and do it on paper. But if we were to take a look at a five ounce glass of red wine, if you look at a glass of red wine, on average there's going to be about 12 to 15% ABV or alcohol by volume. So if we take the average of that and we say 13.5% alcohol by volume, so if 13.5% of that total five ounce glass of red wine is alcohol, then we're looking at 19.8 grams of alcohol in that glass of red wine because there are seven calories per gram of alcohol, we can multiply that out and that gives us about 139 calories specifically coming from alcohol. There is also a little bit of sugar in red wine, but usually pretty minimal, usually less than one to five grams depending on the glass of red wine. So there may be a nominal amount of calories that is coming from sugar also in that, but primarily working at calories coming from the alcohol content there. So that 139 calories that you would find in an average glass of red wine, that is something that your body is going to prioritize burning energy and 139, it's not a huge amount of calories. So having a single glass of red wine may not be an issue, but the problem starts to become where it adds up when people feel like they're drinking more in a setting than they really intended to. Maybe they're drinking because someone put it in front of them, maybe they're drinking because they feel really compelled to. And so over time it adds up and just may not be in line with our health goals. Similarly, let's take a look at a 12 ounce can or bottle of Bud Light In that 12 ounce bottle, the alcohol by volume is 4.2%, so quite a bit less alcohol compared to the wine. And so that gives us about 14 grams of alcohol in that whole bottle. So if we take that 14 grams of alcohol, we multiply it by the seven calories per gram. That gives us 98 calories that are coming from the alcohol itself. Now in beer there are also carbohydrates. And so in that there's about 6.6 grams of carbohydrate in a 12 ounce bottle of Bud Light times four calories per gram gives us 26.4 calories coming from the carbohydrate. Now, I spent a lot of time going through these calculations and I was about to drive myself crazy because that adds up to 124 calories, which if you read the side of a Bud Light can or bottle, it says 110 calories and 110 and 124 are not the same thing. So I had to do a little bit of research to decide why does it say 110 if you're reading the grams of alcohol, if you're reading the grams of carbohydrate, all of those things actually add up to 124 calories. So there are actually FDA labeling guidelines that say it can be rounded to the nearest factor of 10, which is still wrong. So that'd be rounded to 120 instead of 110, but there are slight variations in the manufacturing process such that they're able to round it down to 110. But interestingly, the average bottle of 12 ounce spread light actually has 124 calories if you go by the calculations on the side of the label. So that is when we think about the alcohol coming from beer, alcohol coming from wine, those calories, as I said, are going to be prioritized over burning and processing anything else such that your body is utilizing those first. And that can be a problem because a lot of times people feel like even if, am I saying you should never drink again? Of course not. You can drink alcohol. You just have to decide what is the amount that's going to make the most sense for you. So a lot of my patients feel that at the end of the day or at a social event, maybe they're feeling compelled to drink a drink was set in front of them. Someone else is refilling their glass of wine even before it's at the bottom, and so it adds up really quickly. And when we're trying to lose weight, these are calories coming in that they're not providing satiety, they're not doing anything for you to help your body feel nourished. And that's where that empty calorie part comes in. So it does contribute to weight gain in that way. Another thing that happens, we talked about the mixers. A lot of times there may be other things that you're getting empty calories from soda or other mixers, for example, things especially in cocktail drinks. And then there's the impaired judgment that comes with alcohol. And so even if you haven't gotten fully intoxicated, you're capable of walking a straight line. You're capable of even driving, let's say a glass or two of wine can create a situation where if you're trying to stick to certain nutrition guidelines trying to make certain decisions for your health, all of the sudden the impaired judgment that comes from being just a little bit tipsy, that dessert or the food choice that wasn't on your plan starts to sound a lot better. Like, oh, what the heck? Why not? And so that impaired judgment makes it more challenging for us to stick to the food choices that we were planning on making. Otherwise, there are also indirect effects that alcohol can have in that when we have more alcohol or have any alcohol in our system, there's a change in neurotransmitters that regulate our hunger and satiety. So interestingly as we're drinking alcohol, there can be an increase in ghrelin that goes up. Ghrelin is our hunger hormone. It makes us feel that we're hungry and there is a decrease in leptin, which is our satiety hormone. And so we feel more hungry, less satiated. Our body is craving more food. I can only imagine that's because our body is telling us we need some food in order to support our health so that we're not going to get too intoxicated. We know that having more food can reduce the amount of intoxication that we feel, the amount of absorption of alcohol and the rate at which that happens. We absorb alcohol a lot more quickly on an empty stomach compared to if we have other food in our stomach slows down the absorption of the alcohol. But we see this increase in in this decrease in leptin, so we feel more hungry, we feel less satiety. So we're driven to eat more food when we have alcohol in our system. We also know that alcohol really has a major impact on our sleep. So a lot of people will sort of argue this and say, well, alcohol makes me tired and it does. Alcohol is a depressant. It makes our body feel more tired. But one of the things that happens is that it sort of knocks you out but does not contribute to restful sleep. So when we have alcohol in our system, there's decreased quality sleep that's happening. So we spend less time in REM sleep and our body is really just more restless while we're sleeping. So even if we're in bed for the same quantity of hours, the quality of sleep that we're getting is often quite a bit lower compared to if we had not had any alcohol in the system. And we do know a lot of times too, alcohol is used as a response to sort of self-medicating if we're feeling anxious, feeling stressed and worried about something, alcohol does actually make that feel better short term. But what happens is it can start contributing to this vicious cycle where our neurotransmitters can change over time and our body can start to both feel dependent on alcohol as well as having a baseline level of overall more depressed rather than being as keyed up. So whether I guess you feel like it's a problem for you or not, I think it's worth stopping to assess that. So there are certainly people for whom they meet the criteria for substance use or alcohol use disorder where they are having for women eight or more drinks in a week for men having 15 or more drinks in a week. So averaging more than one glass a day for women and more than one drink per day per men having episodes where there's binge drinking. So for women having more than four drinks in one setting, or for men having more than five drinks in one setting, and if you're finding consistently that you're having more alcohol use than this, it can really be contributing to other health issues in your life. And if you feel like you're really driven to alcohol, compelled to drink it, and you're wondering, oh gosh, maybe I do have a problem, that's something making sure to discuss with your own physician because you should be evaluated and seeking treatment for that. But if you are the person who's saying, no, I don't think I have a problem, but I am drinking more than I'd really like to because it's not in line with my health goals right now, I'd love to talk a little bit about how you can start to adjust that. So when we think about alcohol use, it's really important to make a plan and be cognizant and intentional about the amount that you are choosing to consume. I think of this just as the same way as I think of desserts, for example. It's not necessarily something that you have to eliminate from your diet, but it is something to just be really intentional and planful about. And so what is an amount of drinks per week that makes sense for you that you could enjoy, that you could be intentional about? And you can set that number. Maybe it's zero, maybe it's three, maybe it's five. Any of those numbers could be okay. The important thing is then deciding how that will play out as you're going into a social event. For example, deciding how many drinks that you want to have as you're going into a week of vacation, deciding how many drinks you'd like to have, maybe in the whole time, maybe deciding how many drinks you'd like to have on a certain occasion. Having those expectations in advance can be really important. And then allowing it to play out in a very intentional way than just sort of letting life sweep you up. You can decide that you are going to choose maybe non-alcoholic drinks instead. So there are some non-alcoholic wines, non-alcoholic beers, many different mocktails, so cocktails that have no alcohol in them or just plain out substituting something else that you enjoy just as much. So maybe that's water. Maybe that's sparkling water with lime like a club soda with lime. Maybe that is something like a kombucha, but deciding how are you going to handle these things in order to choose the amount of alcohol and then stick to that amount of alcohol. The other thing I will say is that if you are thirsty, make sure you are well hydrated. We know if you have a glass of alcohol in front of you and that's the only thing in front of you and you are simultaneously feeling thirsty, you are going to drink that. So make sure that if you're thirsty, you've got a glass of water, you've got a glass of wine so that you're not having to just drink that wine in order to work on your thirst, but you actually have the option to have the water in front of you. Maybe even making decisions about making sure that your hydration is adequately addressed before moving to any alcoholic beverages can be a way to stay healthy to reduce the risk of intoxication even. And so that can be a great way to reduce your alcohol use as well. Really interestingly, a lot of the new GLP-1 medications, so medications like Ozempic and others, medications that we're using in order to reduce weight to reduce food cravings, we're finding that same sort of craving center of the brain is being reduced. And so the urges and cravings that people get for food, they're finding that those are decreased, but people are really surprised to find how much their urges and cravings for alcohol are decreasing as well. And that has been one of the most wonderful things for me to see. Many of my patients who feel like they've really struggled with their relationship with alcohol, even if it hasn't been something that another, they'd never be diagnosed with an alcohol use disorder. They've never had any legal or other problems as a result of their alcohol use. Just feeling like they're really drinking more than they'd like to, and feeling like they're really called to alcohol as a result of stress or anxiety or other factors in their day and feeling like they're drinking really more than they'd really desire to be doing, especially in line with their health goals. The really cool thing is seeing as these patients are using some of the GLP-1 medications in order to support their weight loss goals, they're finding that their cravings for alcohol are way turned down. And so even patients who've come into my clinic and have said, I think I don't really want to be on medications, like to be able to try to get off of these. I do counsel everybody about the role of those medications for long-term use, but it's really interesting because there are patients for whom they're able to decrease and potentially even wean off of medications. It's really going to be dependent on the individual. But I share that to say the effect that they have had, not just in food, but in alcohol cravings, has been so significant that they've realized, wow, this is really helping me to support my overall health goals, both in terms of food and alcohol. And that's really pretty cool. And so if you're listening to this, you're thinking, gosh, I really could use support on that, whether it's medications, whether it's just some of the coaching aspect to be able to think about how you can start reducing some of your alcohol intake in order to support your weight loss goals. We would love to support you in that. You can become a patient at our clinic by visiting our website. It's www.sarahstambaughmd.com. It's S-A-R-A-H-S-T-O-M-B-A-U-G-H md.com. I am enrolling new patients right now. I would love to have you as a patient in our practice. Please reach out. Otherwise, we'll see you all next week. Bye-Bye.
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