Why Do Alcoholics Eat So Little? (Alcohol Ketoacidosis)

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Why Do Alcoholics Eat So Little? (Alcohol Ketoacidosis)

Alcoholics eat so little because alcohol abuse messes with one's normal psychological and metabolic process, including their cravings. (1)

Alcohol tricks one's body to feeling full, which triggers bloating, engenders hangover, and causes Alcoholic Ketoacidosis.

Alcohol abuse, diagnostically known as Alcohol Use Disorder (AUD), negatively impacts the GI tract. This is because it gets frontline exposure to alcohol. It irritates, inflames, and affects normal digestion and metabolism.

Alcoholic ketoacidosis/ alcoholic ketosis, or alcoholic acidosis is the condition that results from not eating while drinking binge alcohol. This condition causes the body to go overboard and bypass its normal processes, which affect the body’s overall health. (2)

People suffering from alcohol abuse tend to eat less, appear lean and skinny, and don’t gain weight.

What Causes Alcoholic Ketoacidosis?

Alcoholic ketoacidosis comes as a result of severe alcohol use disorder where the alcohol controls one’s body. Here are a few reasons how this happens: (2)

Alcohol Makes One Crave Alcohol Instead Of Food

This is the simplest explanation for alcohol ketoacidosis. Alcohol use disorder causes alcoholics to eat little or, in worse cases, not eat anything at all. The mindset of anyone suffering from chronic alcohol use disorder is set on alcohol as a priority. (3)

The individual cares less about getting enough nutrients to feed the body but eager to drink only alcohol and not eat, taking the next opportunity to get that drunken feeling.

In some cases, alcoholics intentionally skip meals to avoid stuffing their stomach in order to save every space of their stomach for liquor.

This leads to a condition known as ‘metabolic acidosis’ where the stomach is filled with too much acid.

Abdominal pain is almost always an expected occurrence. To check on the acidity levels, urine tests are done for Arterial blood gas during treatment. (4)

Alcohol Makes One Feel Full

Although alcohol is filled with empty calories, it still brings in many calories and fills one’s tummy. This makes one feel full and sends signals to the brain to stop craving for actual food. It is one of the main symptoms of alcoholic ketoacidosis.

When one is binge drinking and not eating, the volume of liquor intake is relatively higher than when one has consumed food.

When excess alcohol makes its way to the digestive systems, it sends the normal metabolic process into overdrive, thus prolonging the person’s ability to feel hunger.

Other than Alcoholic ketoacidosis, chronic alcoholism leads to diabetic ketoacidosis. This is because alcohol leads to depleted hepatic glycogen stores and the ethanol metabolism will impair gluconeogenesis.

This leads to a reduction in glucose availability, and the alcoholic could end up suffering from hypoglycemia with an increased reliance on free fatty acid release.

Alcohol Is An Inflammatory Substance

In most cases, after alcohol is consumed, one starts feeling puffy, gassy, and bloated, This is a normal occurrence with alcohol addiction. (5)

Vomiting and abdominal pain and bloating are characterized by swelling on the face, lower extremities, stomach, and the frequent passing of gas. This is one of the severe symptoms of excessive alcohol intake and negative consequences of drinking without eating.

Alcohol, being an inflammatory substance, causes swelling in the body and irritates the GI tract. The irritation causes bloating, which makes a person feel full and heavy, even without eating healthy food.

Alcohol consumed with sugary carbonated substances makes the lactic acidosis worse as it leads to gassiness, more bloating, and stomach discomfort with alcohol consumed.

Excessive alcohol consumption also causes dehydration. This is when the body does not receive proper hydration, the vital organs are forced to hold more water to be able to continue their normal body functions. (6)

The water accumulated in the organs leads to puffiness and more bloating. Treatment in this case includes intravenous saline to help rehydrate the body.

Bloating and gassiness both bring discomfort; thus, the urge to eat food is set aside to focus more on dealing with the discomfort rather than sufficing the body’s basic need to address hunger. 

Additionally, alcohol diminishes hepatic gluconeogenesis and leads to decreased insulin secretion leading to ketone acidosis. (7)

This is the possible underlying mechanism of the body, and the reason why heavy alcohol use leads to less intake of food.

During alcohol withdrawal, the addict’s current alcoholic ketoacidosis must first be corrected. This means that the alcoholism treatment includes the addition of healthy food in the diet.

Any pre-existing medical condition is also treated to help prevent other issues related to alcoholic ketoacidosis.

The symptoms of alcoholic ketoacidosis can be easy to spot as they include an extremely thin body frame.

Alcoholic Ketoacidosis/Metabolic Acidosis

Alcoholic Ketoacidosis, also known as metabolic acidosis, is a life-threatening condition that requires immediate treatment and intervention. (1)

The Emergency Medicine Journal on Alcoholic Ketoacidosis clearly states that; when the body burns fat as an energy source, byproducts called ketone bodies are produced, leading to severe metabolic acidosis. (8)

When the body constantly burns fat, ketone bodies accumulate in the bloodstream; this condition is called ketoacidosis or ketone metabolism.

Alcohol Ketoacidosis occurs when the body is deprived of enough glucose supply, and the pancreas produces low to zero insulin.

Cells need glucose to function correctly, while insulin allows cells to process glucose for energy.

The negative impact of alcoholism on one’s appetite and eating habits affects the body’s glucose supply. And alcohol’s effect on the pancreas limits, if not hinders, the production of insulin. 

This leaves the body with no choice but to break down fats as an energy supply, and this is where alcoholic ketoacidosis occurs.

One of the many symptoms of Alcohol Ketoacidosis is lack of appetite. This explains the reason why people with AUD who developed Alcoholic Ketoacidosis eat so little.

Does Alcohol Use Disorder Cause Appetite Loss?

Yes. Alcoholics lose their appetite for food because heavy alcohol use temporarily suppresses the appetite, which makes one feel full. (9)

What’s worse is, drinking sessions and sprees last for a couple of hours which means that one keeps on feeding their body with alcohol and prolonging the feeling of fullness and satiety.

Recurrent episodes of alcohol intake causes one to get used to not eat food at all.

When one does not eat food for long periods of time while still indulging in excess alcohol use, it could lead to sudden death from substance abuse.

Usually, for medium and occasional drinkers, alcohol is an appetite stimulant. But for chronic alcoholics who drink until they pass out, there’s barely enough time for the body to stimulate an appetite. 

Now, other than lactic acidosis, excessive alcohol consumption can also lead to other more serious conditions such as liver disease, cardiac arrest, kidney failure, etc.

Alcohol poisoning is also a serious complication with alcoholism, and in most cases the alcoholic may require emergency medicine or intensive care unit to eliminate the alcohol from he body, and create an acid base balance.

Vomiting And Alcohol Abuse

One of the expected consequences of excessive drinking is vomiting. This messes with one’s gastric juices that work in digesting the food one ingests. (10)

Puking also leaves a bitter or tangy aftertaste that makes one lose their appetite even more.

An additional stressor such as vomiting or dehydration can cause an increase in counterregulatory hormones such as glucagon, cortisol and growth hormone which may further increase fatty acids and fat cells release and ketone production.

Treatment options in the hospital will include a complete blood count, checking for liver disease, and ethylene glycol poisoning. This can also cause alcoholic hepatitis and gastritis.

Gastroesophageal Reflux Disease (GERD)

Alcohol substance abuse is a significant contributor to GERD. It is known to be directly associated with the disease because alcohol can irritate, inflame, and eventually damages the lower esophageal sphincter. (11)

This sphincter acts as a barrier that keeps the gastric contents down.

Alcohol also worsens GERD symptoms since the mucosal lining of the oesophagus and stomach are directly exposed to alcohol.

It often leads to distortion of the normal forward movement in the digestive processes.

GERD patients experience acid reflux, heartburn, and loss of appetite. The acidic aftertaste also spoils one’s cravings for food, thus limiting one’s interest in eating.

To prevent alcoholic ketoacidosis, or the build up of lactic acid in the stomach, the best option would be to stop drinking.

There are various treatment options available to alcoholics including joining alcoholics anonymous and treatment clinics.

There are instances where the electrolyte disturbances in the body can lead to hypokalemia or hypomagnesaemia.

These lead to high anion gap in the body and can develop into diabetic ketoacidosis.

How does alcohol affect nutrition?

Alcohol affects nutrition because it interferes with the body’s normal digestion, metabolism, mineral absorption, and vitamin utilization. (12)

Because one’s body has a problem absorbing Vitamin A, D and E, they are likely to develop Thiamine deficiency which can lead to a brain disorder known as Wernick-Korsakoff.

These are irreversible health conditions and organ dysfunction, including impaired fetal development among pregnant women.

As a result, chronic heavy drinkers often suffer from double negative impacts.

Impaired Digestion

Alcohol inhibits the body’s normal digestive process.

  • The pancreas starts to diminish its supply of digestive enzymes.

  • Damages the cell lining in the GI tract that causes nutrient malabsorption.

  • Interferes with nutrient transport into the bloodstream.

  • Absorbed nutrients are left unutilized due to altercation in the storage, transport, and excretion process.

  • Kills and damages the body’s normal pH level and flora.

  •  Nutritional deficiencies damage the cells of the small intestines that leads to malabsorption of nutrients.

Abnormal Energy Supply

Food-derived calories contain vitamins, minerals, and beneficial nutrients that help maintain and develop the body.

Alcohol, on the other hand, brings in empty calories. And when it enters the system, it forces the body to resume its metabolic process using alcohol calories as an energy supply.

Furthermore, when alcohol is used as an energy supply for carbohydrates, this results in weight loss.

Over some time, this may lead to a rapid decrease in blood sugar or hypoglycemia.

Disrupts Vitamin Utilization

Vitamins play an essential role in sustaining normal body functions, regulating physiological processes, and maintaining our overall health.

Every organ in the body uses vitamins to deliver its optimum growth, development, and normal metabolism.

Alcohol influences food intake, which diminishes nutrient supply in the body and causes diverse effects which inhibit the body’s proper absorption, metabolism, and utilization of vitamins.

 This is the reason why alcoholics often suffer from vitamin A, B, C, D, E, and K deficiencies.

These deficiencies can pose serious health threats such as weakening of bones, delayed blood clotting, night blindness and impaired cell maintenance.

Inhibits Mineral Absorption

Although alcohol does not directly suppress the absorption of minerals, alcohol-related conditions contribute to or negatively impact mineral absorption.

For instance, decreased nutritious food intake may lead to calcium deficiency and zinc deficiency.

Magnesium deficiency may occur due to lack of food ingestion, frequent urination, vomiting, and diarrhoea.

Furthermore, GI bleeding due to alcoholism may lead to iron deficiency. Mineral deficiency, just like vitamin deficiency, can cause serious health complications that, if left untreated, may lead to irreversible damages.

Suppresses Protein Nutrition

Amino acids function as building blocks of protein and play a role in synthesizing hormones and brain chemicals, building muscle mass, and maintaining cell health.

Cells are mostly made up of proteins. Animal and plant-based proteins are great sources of amino acids.

According to the National Institute on Alcohol Abuse and Alcoholism, alcohol negatively impacts protein nutrition by suppressing protein digestion to amino acids. (13)

Further, it inhibits the processing of amino acids by the small intestines and liver, improper protein synthesis derived from the amino acid, and decreased protein secretion from the liver.

Dangers Of Drinking Alcohol And Not Eating

Drinking alcohol and not eating for days poses health dangers, including Spasmodic Diarrhea, elevated Blood Alcohol Concentration (BAC), Nausea and Vomiting, and Alcohol Ketoacidosis. (14)

Drinking too much alcohol alone is dangerous to one’s health. But drinking alcohol and not eating brings the issue to a different level of danger.

Aside from the usual alcohol poisoning characterized by hangover symptoms, this can lead to more severe health conditions that require medical attention and intervention.

Dangers of Drinking Alcohol and Not Eating

Spasmodic Diarrhea

The GI tract, from mouth down to the intestines, gets direct exposure to alcohol every time one drinks. (15)

Alcohol, regardless of concoction and form, irritates the GI tract, specifically the lining of one’s stomach and gut.

The longer the contact, the higher the chance that one’ll develop stomach upset and spasmodic diarrhoea the next day after the happy drinking spree.

According to Tamara Freuman, eating food before drinking decreases the chance of developing stomach discomfort and loose stool. (16)

Because the body identifies alcohol as a toxin, it therefore tries to process and flush it out. This process causes the liver to secrete the alcohol dehydrogenase enzyme and converts them into ethanol.

The ethanol then travels to the bloodstream and into the aldehydes. The aldehyde dehydrogenase then converts the alcohol into acetic acid. This is what makes one feel sick after taking alcohol.

A Rapid Increase in BAC Levels

The Blood Alcohol Level increases rapidly when drinking without eating a proper meal. (17)

Without food that acts as a stomach coating, digestive motility is higher, which leads to quicker absorption of alcohol in the bloodstream. This results in a high BAC level.

Elevated BAC affects one’s judgment, coordination, and other brain function. This is where the danger comes in.

Due to minimal brain function, one is prone to accidents, self-inflicted injury,  and making illogical decisions that one will most likely regret the next day when they sober up.

Nausea and Vomiting

The presence of food contents in one’s digestive tract slows down the digestion process.

This minimizes the impact of alcohol in one’s intestines and allows one’s body to produce enzymes for proper digestion.

Alcohol Ketoacidosis

For chronic drinkers who adapted a habit of eating so little or skipping meals to drink more alcohol, they are at high risk of alcohol ketoacidosis.

This happens when the body doesn’t get enough glucose from food, and the pancreas doesn’t produce enough insulin.

To generate energy, the body uses fat instead of food-derived glucose to compensate for the absence of food supplied to the body.

Metabolic byproducts called ketone bodies are produced and eventually accumulate in the bloodstream over some time.

This condition requires hospital care and, if left untreated, can cause fatal effects.

Conclusion

A a case report and review of the literature by Oxford Medical Case shows that ketoacidosis is almost always accompanied by hypoglycemia. (18)

Most people use alcohol to acquire coping skills for life’s many issues, but this quickly turns fata when the drinking turns into alcohol use disorder.

Healthcare professionals will use differential diagnosis to diagnose alcoholism. When this happens, one should seek treatment at an alcohol addiction treatment facility near them.

Toxic alcohol ingestion could also result in similar symptoms such as diabetic ketoacidosis, and starvation ketosis.

Abbeycare services are available all over the UK. Call us today.

Last Updated: January 18, 2023

About the author

Peter Szczepanski

Peter has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. Peter also co-authored the new 6th edition of Drugs In Use by Linda Dodds, writing Chapter 15 on Alcohol Related Liver Disease. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.