BEER CLINIC :: Alcohol Part 1 – Your Brain on Beer

by Dr. Carol Westbrook on October 18, 2011

or… how to maximize consumption!!

Always in Control

Why is it that some people can drink pint after pint of beer without getting wasted, while someone else will fall over after one drink? Today we’re going to answer this question. We’ll discuss alcohol intoxication, and give you a few tips on how to handle more beer with less drunkenness.

First, let’s dispel a misconception. It’s NOT TRUE that some people tolerate a higher blood alcohol level than others. With few exceptions* everyone reaches the same level of intoxication at the same blood alcohol concentration (BAC). The chart gives the level of intoxication for a given BAC. You can see that most casual drinkers stay within the  0.01 – 0.1% range, while the first time drinker or serious binger might be well over 0.2% for a time, and you’ll rarely see anyone over 0.3%. The legal limit in most states is 0.08%, but you’d like to keep yours well below that for safety and optimal enjoyment. Here’s what you need to know:

Not so much.

Now, the highest BAC you can reach with a drink is related only to your weight. If you were to give all the alcohol in a pint of 5% ABV beer (0.8 ounces of alcohol) by rapid intravenous to an average 180 lb. man, he would reach a BAC, of about 0.05%, while  a 90 lb. woman would reach twice that,  0.1%. But have them each drink the two beers instead the BAC will be lower. How much lower is almost impossible to predict, since there is a tremendous variability from person to person.

Since everyone has the same level of intoxication to a given BAC, the difference in alcohol tolerance is not due to how much you consumed, but rather to how the body handles the alcohol. That’s because of two things: (1) how quickly it goes in and (2) how rapidly it goes out. Once you understand those factors you can use them to your advantage and improve your alcohol tolerance.

(1) HOW QUICKLY ALCOHOL GOES IN. About 70% of the alcohol you drink is absorbed  directly  in the stomach, the rest in intestine. Pure alcohol is absorbed rapidly on an empty stomach, reaching its peak blood level in a half hour. If alcohol absorption goes on over a longer period of time, the body will have time to remove it before it reaches its peak level. Alcohol absorption is slowed down by food in the stomach, including beer itself. Eating a meal while drinking is the best way to slow absorption of alcohol, and those pretzels, popcorn and chips help a little if you fill up before you drink, not after. Worth remembering.

(2) HOW QUICKLY ALCOHOL IS REMOVED. There is tremendous variation from one person to another in alcohol  metabolism, and this accounts for the major difference in alcohol tolerance. Alcohol is metabolized by its conversion to acetaldehyde in the liver by an enzyme called ADH (alcohol dehydrogenase). Acetaldehyde might make your breath smell like a drunk, give you a headache, nausea or a hangover, but it is not intoxicating. The more rapid the metabolism, the lower BAC achieved with a drink.

Alcohol is metabolized at a constant rate, regardless of your BAC or how much you consumed. This rate is determined by the amount of ADH in your liver. The ADH level varies tremendously from person to person, and is the primary determinant of who can hold their liquor, and who can’t. A person of average metabolism can clear .015 to 0.02% of blood alcohol per hour–that’s about 1/3 to 1/2 of a beer per hour. A seasoned drinker can do better, and a chronic can double or triple that rate–unless they have damaged their livers to the point of cirrhosis, when ADH drops to a very low level. An experienced drinker will develop a feel for his alcohol metabolic rate and can achieve a “steady state” wherein the amount consumed is equal to the amount removed by the body. The key, then, is to increase your alcohol metabolism so your steady state rate increases.

The good news is that you can gradually raise the level of ADH in your liver; the bad news is that it takes days to weeks to increase. Regular consumption of alcohol is the best way to increase your liver enzymes–for this purpose, daily consumption is better than binge drinking. Some medications will increase your ADH, as will some medical conditions. Estrogens and androgens increase your ADH, so levels drop as we age and hormones decline. Menopause or “Man”o-pause is a curse to the beer drinker. Ironically, pregnant women have very high levels of ADH!

Putting it all together, here is the Beer Doctor’s advice on how to hold your beer:

1) Don’t drink on an empty stomach. Eat first, and keep food in your stomach if you’re planning to drink a lot.

2) Don’t chug your beer, especially if you’re not eating. If you’re thirsty, fill up on water or soft drinks first, or start with a light beer.

3) Pace yourself, keeping an eye on the beer’s alcohol content, and try not to exceed your body’s metabolic rate.

4) Remember that your alcohol level will continue to go up if you are drinking with food in your stomach, so keep count and slow down if necessary.

5)  Increase your tolerance  by gradually increasing your alcohol consumption over a few days to weeks. This will raise your ADH.

But–what if you miscalculated? Supposing you find you’ve had too much to drink and want to sober up. Sadly, there is no way to get alcohol out of your system once it is in your blood–short of kidney dialysis. If there is still alcohol in your stomach, vomiting will get rid of it, and keep your alcohol level from going higher. Black coffee, aspirin, water, salty food–you name it–nothing lowers your BAC except your own liver, and it goes at its own pace. All you can do is wait or sleep it off, until your blood level drops, at about 1/2 beer per hour. Keep up with fluids, since alcohol makes you pretty dehydrated, which will worsen your inevitable hangover.

What about your drinking companions? If you notice that someone is excessively intoxicated you will, of course, make sure they don’t drive, and keep them from drinking any more alcohol. Get them to a safe place to sleep it off, and make sure they are well-hydrated. Be concerned if you see signs of alcohol poisoning. If they pass out and you can’t wake them up, they may need to be taken to a hospital for medical treatment. Hopefully, neither you nor your drinking companions will ever get to that place.

*Note: A chronic alcoholic may still be conscious with a BAC over 0.4%! When I was an intern, I tended to a man in the emergency department with a BAC almost 0.5%. He was a big guy, nicknamed “Animal.” He had fallen off a balcony and we were trying to talk him into a head X-ray to make sure he didn’t have any serious damage. We could not restrain him. However, his wife talked him down and his X-ray was normal.

  0.01 to 0.1 %  Euphoria (happiness, a “high”); slight loss of coordination and attention span.
  0.1 to 0.2%   Some loss of coordination and balance, poor attention, impaired judgment, slurred speech, mood swings.
  0.2 to 0.3%   Severe loss of coordination, incoherent thoughts, confusion, nausea and vomiting.
  0.3% to 0.4%   Drowsiness, memory lapse, loss of consciousness. Similar to surgical anesthesia.
  over 0.4%   Severe alcohol poisoning, slowed or stopped breathing, coma and death.


Next column: Alcohol – The Dark Side.

{ 4 comments… read them below or add one }

Jacky October 30, 2011 at 1:22 pm

Unfortunately, I am one of those exceptions that has an enzymatic intoleran ce- I metabolize alcohol VERY VERY slowly. This also happens for certain medications as well, such as local anesthetics. This makes me a “Cheap Drunk” – it costs very little $ money to get me drunk since I am capable of staying getting drunk and staying drunk for a LONG time with very little alcohol. Oh well- it still tastes good.


Richard November 1, 2011 at 11:50 pm

Whenever I desire the flavor of beer while driving or operating dangerous machinery, I use Old Chub Scotch Ale Lip Balm. It satisfies my craving without the ill effects of alcohol consumption.
A woman friend of mine chooses to use a lip gloss by Heinekens. Due to the low viscosity of this product, I find it much too messy.


admin November 9, 2011 at 3:18 pm

All the above is simply awesome. We’re wondering if Cerise flavored lip balm will attract fruit flies.


Richard November 10, 2011 at 3:56 am

Most fruit flies are a very sophisticated and discriminating bunch. You will not attract them by simply applying Cerise Balm to your parched lips. They will insist that you also provide a chilled glass of Cerise Fermented Ale paired with Caramelized Apple & Ohio Bleu Cheese Salad with Walnuts served with an Orange Vinaigrette. Since their average life span is so short (30 days), they are living it to the fullest!


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