Alcohol poisoning? Better give you more alcohol.

Why does drinking wood alcohol cause blindness? When would a doctor infuse alcohol for treatment? The answer lies in the fact that there are more types of alcohols than just what we drink.  Alcohol refers to a broad class of chemicals, only one of which is found in beer or wine.

Ethanol is the compound that we are most familiar with. It is a simple molecule consisting of a two carbon chain attached to a hydroxyl group:

The little guy pictured above is the cause of all those great Saturday nights and awful Sunday mornings. Despite how bad ethanol might make us feel the day after imbibing too much of it, our body is pretty good at handling its breakdown (Hangover science).  What the body is not set up for is ethanol's little brother, methanol:

Methanol is the type of alcohol produced by fermenting wood.  The two chemicals might look very similar and both will give you a nice buzz, but methanol ingestion is a medical emergency.  Methanol itself isn't the problem, its what the body does to it that makes it poisonous.  Alcohol dehydrogenase and acetylaldyhyde dehydrogenase, the enzymes that break down simple alcohols, can't tell the difference between the methanol/ethanol and end up poisoning the body.

 

This shows the breakdown of the two molecules. You don't need to know any organic chemistry to see that alcohol dehydrogenase and acetylaldehyde dehydrogenase are doing the exact same thing, just look at the lines.  Alcohol dehydrogenase removes an "H" and adds another bond, or line, to oxygen. Acetylaldehyde dehydrogenase adds an "OH" to the intermediate molecule in both reactions.

In ethanol's case the result is acetic acid, a harmless molecule that can be used for energy.  However, methanol first breaks down into formaldehyde and finally formic acid. Formic acid is nasty. Ants use it to make their stings more potent and in amounts seen with methanol ingestion it destroys the optic nerve causing blindness.

So what can you do for someone that has taken a big swig of wood alcohol? Get them even drunker on the way to the hospital. Alcohol dehydrogenase and acetylaldehyde dehydrogenase both like to work with ethanol much more than methanol.  The trick is to saturate them with ethanol so that they can't break down methanol into formic acid.  The kidneys will slowly filter out methanol before any damage is done.

In fact, an IV infusion of ethanol along with dialysis used to be the preferred treatment in hospitals before the advent of alcohol dehydrogenase inhibitors. These avoid the complications of keeping a patient drunk for 8 hours but they sure take some of the fun out of the treatment.

The best (physiologic) way to prevent yourself from getting too drunk.

I have a problem with my brakes when it comes to alcohol.  I rarely drink, but when I do I don't stop.  This is fine for the most part but if I am at an event where I'm expected to remain socially coherent, I need to do everything I can to make it to closing time before my fiance is holding my hair back.  There are many home remedies, but only one that is scientifically proven - eating a greasy meal before drinking.

The limiting step in absorbing alcohol is gastric emptying, or how fast alcohol leaves your stomach. The majority of alcohol absorption occurs in your small intestine, which if you are not anatomically inclined is just down the road from your stomach.  Once liquor gets here its fast-tracked to the blood stream. Therefore, the longer you can keep that shot of tequila in your belly, the longer you have to break down whatever you drank that made you think tequila was a good idea.

Greasy food is better than anything at slowing gastric emptying for the simple fact that fats are difficult to break down. When a cheeseburger hits your duodenum, a sort-of pouch where fat digestion takes place, a hormone called cholecystokinin (CCK) is released.  CCK does two things: it signals the pancreas and gallbladder to release more enzymes to help dissolve the fat, and it tells the stomach "Slow down for a bit, I have my hands full here." The stomach's sphincter tightens up and presto, the flow of alcohol slows to a trickle.

As most people intuitively know, the reverse of this method is also true.  If you go drinking without eating, the stomach is a wide open pipe and alcohol is going to be absorbed super fast.  The trick to avoiding this situation is eat your meal twenty minutes before you plan on imbibing, to give the food time to start to digest.

Creatine Supplements Are Bullshit...Or Are They?

Many supplements hit the market promising huge gains, only to fall out of favor after results don't quite match up to marketing claims.  Creatine has managed to stick around for years and is a staple in many atheletes' diet regimen.  However, there is still a lot of controversy surrounding not only creatine's effectiveness, but its method of action.  I'm going to try and keep this as easy to read for the lay-person as possible but beware, I might nerd-out at points.

First, a basic look at creatine and its function. ATP is the muscle's gasoline, its what gives your pecs the energy for a 300 pound bench press.  ATP is made in little powerplants inside your muscle called mitochondria. These powerplants aren't always running full steam though, there's no need for them to be pumping out massive amounts of energy when your laying in bed or watching TV.  In this case, mitochondria enough ATP to fill the reserve tanks and then shut down.

The reserve tank is creatine. ATP is attached to creatine and stored like a battery, in case you need to throw a punch or jump away from a predator. The consensus is that most muscles have about 3-5 seconds of ATP-creatine, which is all they need because by that time the mitochondria have ramped up and are providing all the ATP that the muscle needs.

Here is where most people are confused about how creatine supplements work. More creatine must mean a bigger reserve, which has to let your muscles work longer right? Well there are two problems with that line of reasoning. The first is that muscles don't need more creatine because they have enough to cover the small time interval before the mitochondria ramp back up.  It would be like trying to run a car via the battery once the engine is turning - its not necessary.

The second problem is that increasing the amount of creatine does not actually increase the supply of energy to a muscle. It seems that if the amount of creatine was increased, then the amount of ATP attached to creatine would increase and therefore a muscle would have more reserve, right? Unfortunately, that is not how things work out.  Get ready to put your nerd pants on.

The chemical reaction were talking about is governed by something called Gibbs free energy:

Where K = [ATP][Cr] /[ADP]*[P-Cr].

The math looks really complex but most of the variables are constants.  When we clean up the equation and keep whats relevant to us, it actually says something more like this:

Rate of ATP synthesis =(ATP/used ATP)* (creatine/ATP bound creatine)

For an in-depth look at how this was derived, check the comments.

What this means is that the amount of ATP synthesized is determined not by the amount of ATP bound to creatine, but the ratio of ATP bound creatine versus free creatine.  This ratio does not change when you take supplements so neither does the energy output.

Debunking is fun, but at the end of the day the empirical data shows that creatine does help performance in "burst" type activities like sprinting and weight lifting. There is no certainty to the mechanism behind this effect, but the general consensus is that its osmotic.  While the previously mentioned ratio doesn't change, the amount of creatine in the muscle does increase. The increased load causes other substances like water, nutrients, and electrolytes to move into the muscle - accounting for the swollen look the muscles acquire after supplementation.  As far as I have read, there is no definite culprit to what is causing the increased performance, just that more "stuff" is getting to the muscles.

Would I recommend creatine to someone looking for gains in strength/performance? Absolutely. Its cheap, effective, and has stood the test of time.  Safety-wise, it is completely harmless. There has been some worry as to kidney issues due to people confusing creatine with its metabolite creatinine - a measure of kidney function.  Creatinine is used as a marker for kidney failure, not to be confused with a cause of kidney failure. I personally use creatine when I'm bulking and consider a worthwhile supplement.

Hangover Science Time!

Most everyone knows what a hangover feels like, but few know exactly what is going on in the body. "Why does my head hurt?", "Why am I so shaky?", and "Why can't I fall back asleep?" are all common questions that go along with a night out on the town.  Here is a scientific explanation of just exactly how deranged your body becomes after intaking too much alcohol.

Firstly, yes a major part of a hangover is dehydration. Alcohol inhibits a hormone called anti-diuretic hormone. Its what your body releases to tell the kidneys "Hey! stop pissing out all my good water." This is why when you "break the seal" you pee out huge amounts of nice clear urine. The kidneys are not concentrating the urine but are just letting all the fluid that reaches them go to the bladder.

However, you're not going to stop a hangover just by replacing fluids. Alcohol is metabolized into acetic acid, but on its way it becomes something called acetylaldehyde. Acetylaldehyde is the nasty toxin that makes you ache the next day and gives you the water on the brain feeling. How quickly you metabolize this chemical depends on genetics and duration/frequency of alcohol exposure. Many alcoholics don't get hangovers because their body has produced enough metabolic enzymes, called acetylaldehyde dehydrogenase, to clear away this chemical before it affects them. Lots of Asians lack this enzyme and the acetylaldehyde builds up quickly - hence they flush red and feel sick with just a few beers.

Just to hammer this point in, Disulfuram is a medication given to alcoholics to help them control their drinking. It is nothing more than an enzyme that instantly converts alchohol to acetylaldehyde. If someone takes a drink while on disulfuram, instant hangover.

And there's more. Alcohol also inhibits glutamate's effect on the brain. This amino acid is used to by your body to stimulate you and wake you up. When alcohol stops it from working, your body releases a TON of glutamate to make up for it. What sucks is that your body clears the alcohol away faster than the new glutamate. This means that all of a sudden, the extra glutamate you released, plus the glutamate you had before, are no longer being inhibited. This is why you can be tired as hell after a late night drinking but still wake up early and not be able to fall back asleep. Its your body's revenge- "No way you're going to sleep this off, you stay awake and think about what you've done."