Alcohol-Related Eating Patterns (And Their Impact on Your Health)

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Alcohol and eating disorders can associate with each other, with all genders being affected.¹ The relationship between these two disorders holds the risk for potentially serious health consequences.

Eating Disorders Versus Disordered Eating

Eating disorders and disordered eating are distinct from one another, but both can co-occur with alcohol misuse and alcohol addiction.¹

Eating disorders are mental health conditions marked by disordered food intake and disordered eating beliefs and personal rule sets around food. Eating disorders are often accompanied by a disordered self-perception, especially regarding their body weight and shape, which may be classified as body dysmorphia. ² However, eating disorders can occur in individuals of any body size and, while eating disorders often cause dramatic weight fluctuations, weight changes are not an accurate predictor of whether a person has an eating disorder.

The primary eating disorder diagnoses recognized are:

• Anorexia nervosa—Anorexia is primarily characterized by food restriction and personal regulations around food, such as when a person eats or which types of food they eat. Compulsive exercise can also occur. Caloric restriction, nutritional restriction (e.g., eliminating food groups), or meal restriction may result in dramatic and potentially dangerous weight loss.
• Bulimia nervosa—Bulimia is primarily characterized by cycles of binge eating and purging. Purging can include several types of behavior and may include or be accompanied by compensatory exercise, or exercise intended to “compensate” for what has been eaten. Bulimia can cause profound weight fluctuations and may pose risks related to specific purging behaviors, such as aspiration bronchitis.
• Binge eating disorder—Binge eating disorder is primarily characterized by episodes of binge eating past the point of fullness and potentially to the point of physical illness multiple times in a week over a period of three months or more. This binge eating may be clinically identical to binge eating seen with bulimia, but is not accompanied by purging or compensatory behaviors and is independent of any restrictive behaviors.
• Other specified feeding or eating disorder (OSFED)—There are many atypical versions of each eating disorder. However, OSFED is the diagnosis characterized by mixed eating disorder behaviors that meet the clinical threshold of an eating disorder, but do not fall under any other diagnosis.

Eating disorders always include disordered eating, but disordered eating habits may not always qualify as an eating disorder. A distinction can be made by the severity of the disordered eating and the length of time that the disordered eating has occurred.²

Disordered eating habits can range from engaging in a short-term fad diet to severe behaviors like binge eating, removing certain foods or fluids from your diet, and chronic meal skipping.² These disordered eating habits can result in eating disorders but may not become severe or frequent enough to fall under the eating disorder classification.²

Yet, even if not considered a clinical eating disorder, the disordered eating habits associated with alcohol misuse and alcoholism can have long-term damaging effects on the body and warrant medical attention.

Binge Eating

The most frequent disordered eating habit associated with alcohol is binge eating. Unfortunately, this often is seen in conjunction with binge drinking, with both potentially leading to adverse outcomes.

Binge drinking is best understood as a period of episodic, excessive alcohol indulgence over a short period, leading to severe impairment and intoxication. Binge drinking can also be associated with limited self-control.³

Binge drinking is considered dangerous, as it can lead to: ³

• A rapid increase in blood alcohol concentration
• Severe intoxication
• Depression of the central nervous system
• Risk of coma
• Risk of permanent or life-threatening oxygen loss

Binge eating while drinking alcohol follows a similar pattern to binge drinking, where the individual consumes a large amount of food over a short period with their self-control impaired. This episodic behavior does not typically lead to the compulsory purging that is seen with bulimia or the compensatory exercise behaviors that are associated with weight control.^5,6

Understanding the connection between binge eating and drinking is still ongoing. Research indicates that binge behaviors may be used to seek relief from unpleasant emotions, physical pain, or when engaging in impulsive and spontaneous behavior.⁷

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Improper Eating

Improper eating is also a disordered eating habit seen with alcohol misuse. When using alcohol or when dependent on alcohol, alcohol may become a higher priority than meal choices. Improper eating may include making less nutritionally suitable food choices than you would make while sober or patterns of behavior such as going long periods of time between eating.⁸

Food choices may relate to a number of factors, such as the: ⁸

• Time required to prepare a full meal versus the time required to pick up convenience foods
• Association of certain foods with being “hangover food” or a “hangover cure”
• Foods that may already be in your home as opposed to food choices you might make when sober that you must operate a vehicle, interact with store personnel, and so on to get

These unhealthy eating habits are seen more often with high or excessive levels of alcohol intake than when a single glass of alcohol is enjoyed.⁸ Additionally, it is common for people who drink chronically to take over-the-counter medications, such as antacids or pain-relievers, for hangovers, but mixing alcohol with these medications can cause additional harm.

Dehydration

Severe dehydration from alcohol is also seen among those engaging in heavy or binge drinking, as alcohol itself can cause dehydration. Using alcohol can also contribute to impaired thinking and forgetting to hydrate.⁹

Extreme dehydration associated with alcohol misuse can lead to electrolyte deficiency causing:¹⁰

• Nausea
• Diarrhea
• Fatigue

Dehydration can be managed at home with proper fluid intake, but more severe cases may require medical care.¹⁰ Severe electrolyte imbalance can exhibit as confusion, muscle weakness, chest pain, or irregular heart rate.

Health Consequences

Over time, engaging in alcohol misuse and disordered eating habits can affect your physical and emotional health.

Binge eating, especially when combined with heavy alcohol use, can contribute to a myriad of health issues, including:^11,12.

• High blood sugar
• Weight cycling
• Cardiovascular disease
• Type 2 diabetes
• Obesity-related cancers
• Osteoarthritis

Choosing convenience food over nutrient-dense foods can also contribute to negative health consequences, such as:^{13, 7}

• Folate deficiency
• Anemia, or low iron
• Hypoglycemia, or low blood sugar
• Other nutritional deficiencies

Without adequate nutrition, the body can lose essential micronutrients. These micronutrients are found primarily in nutrient-dense foods. Micronutrients are associated with bone, skin, and organ health, and overall well-being.^14,15,16

If nutritional deficiencies stemming from prolonged and heavy alcohol use remain unresolved, several organs can be affected and may develop progressive, alcohol-related conditions, including the:^17.

• Liver
• Heart
• Bone marrow

One of the most serious potential health consequences of alcohol misuse and disordered eating habits is the risk of alcoholic ketoacidosis.¹⁸ This clinical syndrome is usually seen after a heavy binge-drinking period coupled with behaviors and symptoms associated with disordered eating such as food restriction, vomiting, and dehydration.¹⁹ Although usually treatable, severe cases can be dangerous for the patient.²⁰

Hypoglycemia may also become a more serious health consequence, as the condition can lead to coma and become life-threatening if not treated promptly.⁷

If untreated, these health consequences may lead to mild or moderate cognitive function that may continue to progress as long as the underlying issues are unresolved. The cognitive areas impaired depend on the severity of the health issues but most often get seen with intellectual and visual-spatial tasks.²¹

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Treatment for Eating Disorders and Alcohol Use

Knowing the risks of disordered eating behaviors, such binge eating and drinking, seeking treatment is beneficial for short– and long-term health and well-being.

Since alcohol misuse and disordered eating are related to compulsive behavior and self-perception, both are often treated as addictive disorders. Treatment and support methods offered for disordered eating and alcohol misuse may include:⁵

• Cognitive-behavioral therapy
• Solutions-focused therapy
• Family counseling
• Medication therapy

While working toward recovery with these treatment methods, distorted thoughts are identified and restructured to facilitate more positive and healthy behaviors.

Complete medical evaluations will also prove helpful to assess and treat any nutrient deficiencies or improve any limited system functioning.⁵ Concrete goals will most likely include abstinence from alcohol or a decrease in the amount used. Other options may include an alteration in the amount of food consumed, be it less, more, or different food choices. ⁵ These changes may be made under the supervision of a registered dietician (RD) or other specialized nutrition counselor.

Once these areas are addressed, the potential for sobriety from alcohol increases substantially, and a positive shift in eating habits occurs. Some individuals may need support to maintain a positive relationship with food and alcohol, but recovery is possible.

If you or a loved one would like more information on programs for alcohol misuse, please call 800-948-8417 Who Answers? .

Resources

1. Lilenfeld, L. R., & Kaye, W. H. (1996). The Link Between Alcoholism and Eating Disorders. Alcohol health and research world, 20(2), 94–99.
2. Alvarenga, M. & Pereira, R. . Disordered Eating: Identifying, Treating, Preventing, and Differentiating It From Eating Disorders. Diabetes Spectrum, 20(3), 141- 148.
3. Gmel, G., Rehm, J., & Kuntsche, E. (2003). Binge drinking in Europe: definitions, epidemiology, and consequences. Sucht, 49(2), 105-116.
4. Korsten, M. A. (1989). Alcoholism and pancreatitis; does nutrition play a role?. Alcohol Health & Research World, 13(3), 232-238.
5. Kelly‐Weeder, S. (2011). Binge drinking and disordered eating in college students. Journal of the American Academy of Nurse Practitioners, 23(1), 33-41.
6. Birch, C. D., Stewart, S. H., & Brown, C. G. (2007). Exploring differential patterns of situational risk for binge eating and heavy drinking. Addictive Behaviors, 32(3), 433-448.
7. FREDERICKS, E. J., & Lazor, M. Z. (1963). Recurrent hypoglycemia associated with acute alcoholism. Annals of internal medicine, 59(1), 90-94.
8. Morley, K., Logge, W., Riordan, B., Brannon, S., Haber, P., & Conner, T. (2021). Daily experiences of hangover severity and food consumption in young adults.
9. Jewell, T. (2019, May 23). Does Alcohol Dehydrate You?
10. Martin, H.E., McCuskey Jr., Charles, & Tupikova, N. (1959). Electrolyte Disturbance in Acute Alcoholism: with Particular Reference to Magnesium. The American journal of clinical nutrition, 7(2), 191-196.
11. Hsu, L. K. G., Mulliken, B., McDonagh, B., Das, S. K., Rand, W., Fairburn, C. G., Rolls, B., McCrory, M.A., Saltzman, E., Shikora, S., Dwyer, J., & Roberts, S. (2002). Binge eating disorder in extreme obesity. International journal of obesity, 26(10), 1398-1403.
12. Dixon, J. B. (2010). The effect of obesity on health outcomes. Molecular and cellular endocrinology, 316(2), 104-108.
13. Lindenbaum, J., & Roman, M. J. (1980). Nutritional anemia in alcoholism. The American journal of clinical nutrition, 33(12), 2727-2735.
14. New, S. A. (1999). Bone health: the role of micronutrients. British medical bulletin, 55(3), 619-633.
15. Park, K. (2015). Role of micronutrients in skin health and function. Biomolecules & therapeutics, 23(3), 207.
16. Prasad, K. N. (2019). Micronutrients in Health and Disease. CRC Press.
17. Raskin, N. H. (1975). Alcoholism or acetaldehydism? The New England Journal of Medicine, 292, 422-423.
18. Howard, R. D., & Bokhari, S. R. A. (2017). Alcoholic Ketoacidosis. Treasure Island (FL): StatPearls Publishing.
19. Jenkins, D. W., Eckel, R. E., & Craig, J. W. (1971). Alcoholic Ketoacidosis. JAMA, 217(2), 177-183.
20. Fulop, M. & Hoberman, H. (1993). Alcoholic Ketoacidosis. Endocrinology and metabolism clinics of North America, 22(2), 209-219.
21. Molina, J. A., Bermejo, F., Del Ser, T., Jiménez‐Jiménez, F. J., Herranz, A., Fernández‐Calle, P.,Ortuño, B., Villanueva, C., & Sainz, M. J. (1994). Alcoholic cognitive deterioration and nutritional deficiencies. Acta neurologica scandinavica, 89(5), 384-390.