Food and alcohol: What you need to know

Note: this post was updated in November 2023 to reflect new resources available to students and trainees.

Nutrition is an important topic for everyone and may be particularly relevant for the 61% of Johns Hopkins undergraduate students who drank alcohol in the past year, according to the 2021 Maryland College Alcohol Survey. 

There are many ways in which alcohol and food intersect; here are a few of the things we think are most crucial for Hopkins students to know. 

1. While alcohol may have calories, it has little to no nutritional value. It is not the same as food and cannot be used as a replacement for food.

Food provides calories, or energy, which are necessary to fuel our bodies. Calories come from the three macronutrients: carbohydrates, protein, and fat. Most foods will also have additional nutrients such as vitamins, minerals, or fiber. 
 
While alcohol sources contain calories, the calories from alcohol do not come packaged with additional nutrients that help our bodies function effectively. And because alcohol is technically a toxin, our bodies will always prioritize the breakdown of alcohol over food, delaying or decreasing the availability of nutrients. Therefore, 150 calories from alcohol does not fuel your body the same way that 150 calories of a sandwich (or any other food source) fuels your body. Alcohol is not a food replacement and should not be used as one.

2. If you choose to consume alcohol, eat food before drinking.

Most alcohol is absorbed by the small intestine. Some is also absorbed by the mouth and stomach. By eating before drinking, the rate at which alcohol reaches the small intestine is slowed, helping to taper absorption to a pace that your body can more easily manage. This can help individuals to avoid feeling too drunk too quickly. 
 
Consuming food when drinking alcohol increases the rate of alcohol elimination from the blood stream by 25-45%. Typically, the best options will be foods that contain a mixture of protein, fat, and carbohydrates. Examples include: 

• A burger with sweet potato fries
• Salmon with rice pilaf and roasted asparagus
• Egg and cheese sandwich
• Tofu bowl with rice and stir-fried vegetables
• Paneer or chicken tikka
• Bean burrito with cheese and vegetables

3. Alcohol can increase hunger and food cravings. 

Alcohol can temporarily increase serotonin levels, which can affect hunger levels and food cravings. (Serotonin is a neurotransmitter that plays a role in appetite control, as well as sleep and mood.) 
 
Additionally, alcohol lowers inhibitions, which makes it more likely that you may choose foods or portions that are significantly different from what you may choose to consume when not drinking.

4. If you choose to consume alcohol, alternate alcoholic drinks with water. 

Drinking water between alcoholic beverages serves a dual purpose. First, doing so gives your body time to process the alcohol that has been consumed. (See No. 5 on this list for why this choice is important.) Secondly, alcohol is a diuretic (which means it increases the rate of urination) so drinking water can also help prevent dehydration. Dehydration can lead to fatigue, dizziness, confusion, and even serious complications like urinary tract infections, kidney stones, and seizures.

5. If you choose to consume alcohol, do so moderately. Binge drinking can cause considerable damage to the body.

Alcohol absorption occurs in the mouth, stomach, and small intestines. But alcohol is processed, or metabolized, by the liver.

While the liver can process 1-2 standard drinks fairly easily for many people, binge drinking (defined by the NIH as consuming more than 5 standard drinks for male-bodied people or 4 standard drinks for female-bodied people* in two hours) can lead to a significant build-up of free radicals from the metabolic process. Free radicals are molecules with unpaired electrons that will attempt to steal electrons from neighboring cells. Over time, excessive amounts of free radicals can cause considerable damage to the body.

Additionally, excessive alcohol use causes stomach and intestinal inflammation, which can result in many serious side effects, including:

• Decreased nutrient absorption due to damage of the gastric cells and intestinal lining. Nutrient deficiencies that are particularly common include vitamin B1 (thiamin) and vitamin B12 deficiency.
  • A deficiency of thiamin related to alcohol abuse can lead to a serious condition called Wernicke-Korsakoff Syndrome. The first stage of this syndrome, Wernicke’s Encephalopathy, results in a swelling of the brain that can cause side effects such as dizziness, confusion, and vision problems. The second stage, Korsakoff’s Psychosis, occurs when diagnosis and treatment is not implemented timely, and deficiency becomes severe. Symptoms at this stage can include amnesia, tremors, and coma. Some side effects become irreversible at this stage.
  • When gastric cells are inflamed, they are not able to release intrinsic factor (IF), which is necessary for adequate absorption of vitamin B12 in the intestine. Because vitamin B12 plays a role in the formation of red blood cells (which carry oxygen throughout the body), symptoms of deficiency can include fatigue, shortness of breath, and difficulty concentrating. If diagnosis and treatment are not implemented in a timely manner, long-lasting damage to the nervous system can occur and some symptoms, such as numbness and tingling in the extremities and memory loss, can become permanent.

• Disruption of the gut microbiome. Recent research on the gut-brain connection has demonstrated the innate connection between the health of our gastro-intestinal tract and mental health . This bi-directional relationship means that if damage occurs to the epithelial barrier in the gut or if there is an imbalance in the microbiota environment, it can affect mood and cognitive functioning. When alcohol is consumed in excess, levels of good gut bacteria decrease and levels of harmful gut bacteria increase. This shift towards a poor balance of intestinal bacteria is known as dysbiosis. Symptoms that can occur due to dysbiosis include: 
  • Depression 
  • Anxiety 
  • Decreased stress tolerance 
  • Difficulty concentrating  
• Impaired immune function. Alcohol can decrease the innate immune response in the intestines, which can lead to increased exposure to pathogens and higher rates of illness. Once pathogens get past the intestinal barrier and into the blood stream, they can travel to other parts of the body (including the liver and brain) and cause further damage and inflammation.

6. Hopkins has resources to support you if you would like to further discuss nutrition or alcohol use. 

While alcohol can certainly be enjoyed in moderation as an accompaniment to meals and enhancement to social gatherings, it is important to drink responsibly and recognize when drinking may be causing negative affects due to amount or frequency of consumption. All Johns Hopkins affiliates can take eCHECKUP TO GO for personalized feedback on how much alcohol is too much for their body and steps they can take to stick to their limit. 

The Office of Health Promotion and Well-Being works with students, learners, and trainees one-on-one using motivational interviewing to support behavior change with alcohol, marijuana, or tobacco. Email us at [email protected] for more information.

Nutritional therapy is available through the Office of Primary Care.

*If you are interested in learning more about the intersection of alcohol and biological sex and gender, check out this excellent fact sheet from Cornell Wellness.