This article was downloaded by: [Wayne State University]

On: 25 November 2014, At: 23:45

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK

Journal of the American College of Nutrition

Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/uacn20

How much do alcohol calories count?

P M Suter
Published online: 04 Sep 2013.

To cite this article: P M Suter (1997) How much do alcohol calories count?, Journal of the American College of Nutrition,
16:2, 105-106, DOI: 10.1080/07315724.1997.10718659

To link to this article: http://dx.doi.org/10.1080/07315724.1997.10718659

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the Content) contained
in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the
Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and
are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and
should be independently verified with primary sources of information. Taylor and Francis shall not be liable for
any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever
or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of
the Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://
www.tandfonline.com/page/terms-and-conditions
 Editorial
How Much Do Alcohol Calories Count?
Do alcohol calories count [l]? In view of the pandemic of
overweight and obesity this becomes a central question for
many if not all moderate alcohol consumers (a moderate con-
sumption level is regarded to be in the range of 20 to 30 grams
alcohol per day). In this issue of The Journal of the American
College of Nutrition Cordain et al report that the supplemen-
tation of two glasses of wine during a period of 6 weeks does
Downloaded by [Wayne State University] at 23:45 25 November 2014
not affect body weight and/or energy metabolism. If the addi-
tion of two glasses of wine (corresponding to about 35 g of
alcohol) to the daily energy requirements seems to be free of an
effect on body weight this would indeed represent good news
for many weight concerned moderate alcohol consumers. These
results seem to be valid for the studied population, however, it
would be of major interest to know whether these results can be
generalized to all moderate alcohol consumers.
The epidemiologic studies of the last 30 years do not show
a consistent pattern between the association of alcohol con-
sumption and body weight. Several studies showed a positive
or negative relation, while others showed no relationship [2].
All the data are probably correct for the corresponding study
population but they can not be generalized to other populations
or single individuals!
The effects of alcohol on body weight are - as many other
alcohol effects - at least biphasic. Small quantities have no
effect, moderate amounts may lead to an increase in body
weight, whereas excessive amounts lead again to a decrease in
body weight. The relationship is best represented in the clas-
sical engravings from William Hogarth (1751) of the Beer
Street and Gin Lane. In the former the typical representatives
are overweight individuals with the characteristic beer belly.
These subjects are moderate to heavier regular alcohol consum-
ers, who usually add the alcohol to their food intake. However,
if the "members of the Beer Street" increase their alcohol
intake further they will find themselves sooner or later in the
Gin Lane. The typical phenotype is an underweight emaciated
person showing the signs of primary malnutrition. Excessive
amounts of alcohol are mainly metabolized in the microsomal
ethanol oxidizing system characterized by an increased alcohol
related thermogenesis and "energy wastage" as well as second-
ary malnutrition. Present evidence suggests that these engrav-
ings may - besides the social and moral aspects - represent the
extremes of the effects of alcohol on body weight.
Journal of the American College of Nutrition, Vol. 16, No.2, 105-106 (1997)
Published by the American College of Nutrition
105
Research about the effect of alcohol on body weight is
still very controversial and even with modem research tools
the phenomena of the Beer Street and Gin Lane have not yet
been completely elucidated. The controversy regarding the body
weight effects of alcohol is mainly caused by the heterogeneity of
the study populations regarding the quantity and frequency of
alcohol consumption, food composition, socioeconomic charac-
teristics, life style characteristics including patterns of physical
activity, gender, smoking, biochemical characteristicsof the major
metabolic pathways of alcohol degradation and unknown factors.
To study the effects of alcohol on body weight in epide-
miologic studies, the study population should be as homogeneous
as possible for as many factors as possible except for the amount
of alcohol consumed. Studies fulfilling these criteria are rare.
Tofler and Woodings [3] studied a homogeneous group of social
drinkers of similar age and identical socioeconomic background.
Beer was the principal source of alcohol and the consumption
level ranged from 0 to II L per day. The body weight of these
subjects increased continuously from the lowest to the highest
consumption levels. This study of a rather homogeneous group of
subjects - differing in alcohol intake over a rather wide range -
would strongly support the concept, that alcohol may be an im-
portant positive modifier of the body weight status and has to be
regarded as a risk factor for weight gain.
Metabolic studies regarding the alcohol effects on body
weight are also controversial. Much of the controversy can be
explained by methodological issues including the characteristics
of the study subjects especially regarding their usual alcohol
intake, the alcohol dose given, and methods of the evaluation of
energy metabolism and quantity as well quality of the concomit-
tant food intake during the experiments [4]. The isocaloric substi-
tution of large amounts of alcohol lead to weight loss, which is not
surprising. Further the addition of alcohol did not always result in
weight gain [5, 6]. Many theories and hypotheses have been
formulated to explain this controversy. Nevertheless the alcohol
consumption frequency and quantity as well as individual factors,
such as baseline fatness, food composition, etc. may be important
modulators of the effect of alcohol.
Daily clinical experience strongly supports the enhancement
of body weight changes as a function of changes in alcohol
intake. Further, clinical experience suggests that food compo-
sition (especially the amount of fat) may be a modulator of the
 Editorial
alcohol effects. Periods of increased alcohol consumption lead
to weight gain, alcohol abstinence leads to weight loss in
regular consumers; however, baseline fatness seems to be an
important modifier of the clinical response. One of the major
determinants of baseline fatness is the absolute body weight
and food composition. It seems that alcohol enhances weight
gain especially in subjects with a higher baseline fatness or
obese subjects and less in lean subjects [6, 7]. The constellation
described in the study by Cordain et al could be explained by
this, since their subjects were quite lean and the fat intake was
much lower than the average fat intake in the US population! In
a recent study we showed that acute dosing with alcohol
suppresses lipid oxidation thus leading to the development of a
positive fat balance, the prerequisite for body weight gain [8].
We suggested that this effect can be counterbalanced by the
reduction of fat intake in the ratio of at least 1:1 to the amount
Downloaded by [Wayne State University] at 23:45 25 November 2014
of alcohol consumed.
In contrast to other energy sources, alcohol can not be stored
in the body and is therefore metabolized continuously. There-
fore alcohol has an absolute preference in the intermediary me-
tabolism, this also to minimize potential toxic effects. This priority
position in metabolism takes place at the expense of changes in
other metabolic pathways including the suppression of lipid oxi-
dation. To a variable degree the energy in alcohol can be used for
ATP production [4]. The amounts of ATP derived from alcohol
calories depend on the pathway of ethanol metabolism (ADH
versus MEOS) and will displace other energy sources from being
utilized to a variable degree. This displacement of other energy
substrates will have indirect effects on body weight, since after
accounting for absolute body weight and composition as well as
physical activity, energy requirements remain pretty stable and
predictable. The interaction of alcohol with the different energy
substrates (especially fat) is, however, a function of the ratio of the
different substrates in the diet and the quantity of alcohol con-
sumed. The effects of alcohol on body weight and energy metab-
olism are indeed "a matter of balance," as stated in the title of a
recent report on this topic [9].
Acute ingestion of alcohol leads to well known phenomena
which may vary from one person to the other. The physiologic
and pathophysiologic responses (including body weight
changes) to chronic alcohol ingestion may also vary consider-
ably from one person to another. The increase in body weight
is in most subjects a slowly but steadily progressing process.
The subjects in Cordain's study (assuming that they did not
compensate for the additionally ingested alcohol energy) in-
gested an excess energy of about 10,000 kcal. This excess
energy would theoretically result in a weight gain of around 1
kg. However, body weight may vary considerably from day to
day. Therefore the question has to be raised whether the length
of 6 weeks in the study by Cordain et al was sufficiently long
to induce a measurable weight change at all.
Apparently the addition of two glasses of wine does not
affect energy metabolism in the population studied by Cordain et
al. The weight stability in this population does, however, not mean
106
that these subjects were resistant to the metabolic effects of alco-
hol; however, their behavior and their life style and other not
measured/not measurable factors seemed to be ideal regarding
their body weight dynamics, since they maintained a stable
weight For Cordain's study population, the alcohol calories did
apparently not count during the intervention period. However, a
stable body weight alone may not be enough. Alcohol has been
identified to enhance the abdominal deposition of fat, which would
be associated with a higher overall cardiovascular risk [10].
In view of the present evidence the question "whether
alcohol calories do count" is a very important question but
probably the incorrect question. The more appropriate question
would be "How much do alcohol calories count?". There may
be considerable variation of the effects of alcohol on body
weight from one person to another. What is moderate for one
consumer may be too much for another consumer is apparently
also applicable to the body weight effects of alcohol. In daily
life the careful balance between potentially negative and ben-
eficial effects of alcohol should be evaluated on an individual
basis only. The study by Cordain et al is an important step
towards well controlled interventional studies for the elucida-
tion of the question "How much do alcohol calories count?".
REFERENCES
I. Lieber C: Perspectives: do alcohol calories count? Am J Clin Nutr
54:976-982, 1991.
2. Macdonald I, Debry G, Westerterp K: Alcohol and overweight. In
Verschuren PM: "Health Issues Related to Alcohol Consumption."
Washington, DC ILSI Press, 264-279, 1993.
3. Tofler DB, Woodings TL: A 13-year follow-up of social drinkers.
Med J Aust 2:479-481, 1981.
4. Suter PM, Jequier E, Schutz Y: The effect of ethanol on energy
expenditure. Am J of Physiol 266:RI204-RI212, 1994.
5. Pirola RC, Lieber CS: The energy cost of the metabolism of drugs,
including ethanol. Pharmacology 7:185-196, 1972.
6. Crouse JR, Grundy SM: Effects of alcohol on plasma lipoproteins
and cholesterol and triglyceride metabolism in man. J Lipid Res
25:486-496, 1984.
7. Lands WE: Alcohol and energy intake. Am J Clin Nutr 62(Suppl.):
I 10 IS-ll06S, 1995.
8. Suter PM, Schutz Y, Jequier E: The effect of ethanol on fat storage
in healthy subjects. N Engl J Med 326:983-987, 1992.
9. Leibel RL, Dufour M, Hubbard VS, Lands WEM: Alcohol and
calories: a matter of balance. Alcohol 10:429-434, 1993.
10. Suter PM, Maire R, Vetter W: Is an increased waist:hip ratio the
cause of alcohol-induced hypertension. The AIR94 study. J Hy-
pertens 13:1857-1862, 1995.
Paolo M. Suter, MD, MS, FACN
Medical Policlinic
University Hospital
Zurich, Switzerland
Received January 1997.
VOL. 16, NO.2