Medical Hypotheses (2001) 57(6), 667±672 & 2001 Harcourt Publishers Ltd doi: 10.1054/mehy.2001.1339, available online at http://www.idealibrary.com on 1 The consequences of imbibing alcohol in the absence of adequate nutrition: The salt and water hypothesis A. Kokavec, S. F. Crowe School of Psychological Science, La Trobe University, Bundoora, Australia, 3083 Summary Alcohol can have an effect on almost every cell in the human body and it is becoming increasingly clear that when alcohol is consumed the prior nutritional status of the individual may be an important factor for long-term health. The salt and water hypothesis integrates the biochemical findings from the current alcohol literature and proposes a mechanism by which alcohol consumption prior to food intake may cause a transient alteration in the functioning of the hypothalamic±pituitary±adrenal axis due to an alcohol-induced impairment in electrolyte regulation. & 2001 Harcourt Publishers Ltd INTRODUCTION Where alcohol is metabolized is dependent on the nutri- tional status of the individual (1). Research has shown that when alcohol is consumed in the absence of ade- quate nutrition the alcohol is absorbed intact from the gastrointestinal tract, taken up by the systemic circulation, and transported to the liver where it is metabolized (2). Alternatively, the consumption of alcohol following food intake results in alcohol metabolism occurring in the stomach (3). Before any hypothesis can be derived with respect to how alcohol consumption may affect the human body, it is important to understand what alcohol actually is. Nutritional analysis has shown that despite alcohol being a high-energy macromolecule, the calories in alcohol are `empty' calories because uniquely alcohol has little nutritional value (4). The lack of nutrients in alcohol is easily understood however when we consider that alcohol is the end-product of carbohydrate metabolism (5), performed under anaerobic conditions in yeast and other micro-organisms (6), and nutrients found in food are usually extracted during the digestion process (7). Thus, in effect when an alcoholic beverage is consumed a substance that is an end-product of carbohydrate metabolism in one species (i.e. yeast) is being placed into the initial stage of carbohydrate metabolism in another species (i.e. humans). This immediately raises the issue that a substance which is the end-product of carbohy- drate metabolism is not usually found in the human digestive tract, and what effect (if any) does consuming such a substance have on metabolic processes within the human body. In the next few sections an attempt will be made to map some of the biochemical changes that occur in the human body after an alcoholic beverage is consumed, and where necessary compare these events with the changes observed during normal food consumption in order to address this issue. 667 Received 5 October 2000 Accepted 31 January 2001 Published online 16 October 2001 Correspondence to: Simon F. Crowe, Associate Professor, School of Psychological Science, La Trobe University, Bundoora, Australia, 3083. Phone: (03) 9479 1380; Fax: (03) 9479 1956; E-mail: s.crowe@latrobe.edu.au