From the Guidelines
Alcohol breakdown in the body primarily occurs through metabolic processes in the liver, where it is converted into acetaldehyde and then acetate before being broken down into carbon dioxide and water for elimination, as supported by the most recent and highest quality study 1.
Process of Alcohol Breakdown
When alcohol is consumed, it's first absorbed through the stomach and small intestine into the bloodstream. In the liver, an enzyme called alcohol dehydrogenase (ADH) converts alcohol into acetaldehyde, a toxic substance. Acetaldehyde is then quickly converted to acetate by another enzyme called aldehyde dehydrogenase (ALDH), and finally broken down into carbon dioxide and water for elimination.
Management of Alcohol Breakdown
The liver can process approximately one standard drink per hour. When consumption exceeds this rate, alcohol accumulates in the blood and tissues, leading to intoxication. The body manages alcohol through multiple systems: the liver handles most metabolism, while small amounts are eliminated unchanged through breath, urine, and sweat. Factors affecting alcohol metabolism include genetics, gender, body weight, liver health, and food consumption.
Treatment and Support
Some individuals have genetic variations in ADH or ALDH enzymes that affect their ability to process alcohol efficiently. Medications like disulfiram (Antabuse) can be used to treat alcohol use disorder by blocking ALDH, causing unpleasant symptoms if alcohol is consumed, as recommended by 1. For those experiencing alcohol poisoning, supportive care including IV fluids, oxygen, and careful monitoring is essential, as there is no medication that can speed up alcohol elimination from the body.
- Key factors in managing alcohol breakdown include:
- Understanding the metabolic process in the liver
- Recognizing the role of genetics, gender, body weight, liver health, and food consumption in alcohol metabolism
- Utilizing medications like disulfiram for treating alcohol use disorder
- Providing supportive care for alcohol poisoning
- Pharmacological treatment must be considered for promoting the maintenance of alcohol consumption targets (abstinence or reduced consumption) in dependent patients, as stated in 1.
From the Research
Alcohol Breakdown Process
- Alcohol is eliminated from the body by various metabolic mechanisms, involving enzymes such as aldehyde dehydrogenase (ALDH), alcohol dehydrogenase (ADH), cytochrome P450 (CYP2E1), and catalase 2
- The main metabolic pathway for ethanol involves the enzymes ADH and ALDH, with seven different ADHs and three different ALDHs that metabolize ethanol identified 3
- Variations in the genes for these enzymes have been found to influence alcohol consumption, alcohol-related tissue damage, and alcohol dependence 2, 3
Management of Alcohol Breakdown
- The consequences of alcohol metabolism include oxygen deficits, interaction between alcohol metabolism byproducts and other cell components, and formation of highly reactive oxygen-containing molecules 2
- Alcohol breakdown in the liver generates toxic products such as acetaldehyde and highly reactive oxygen-containing molecules, which can interfere with the normal metabolism of other nutrients and contribute to liver cell damage 4
- Nutritional approaches can help prevent or ameliorate alcoholic liver disease, such as a complete balanced diet and administration of antioxidants 4
Factors Influencing Alcohol Breakdown
- Genetic variants of ADH and ALDH enzymes can affect the rate of ethanol breakdown and acetaldehyde accumulation in the body, influencing drinking behaviors and risk for alcoholism 3
- Malnutrition is common among alcoholics, either due to inadequate nutrient intake or impaired nutrient absorption and utilization, which can contribute to liver disease and other serious alcohol-related disorders 4