Steve Quintana is a 52-year-old Hispanic male with a family history of alcoholism. He is 6 feet 1 inch tall and
weighs 238 pounds, with much of his excess weight around his middle. He considers himself a social drinker
although he has been arrested for driving under the influence of alcohol twice in the past five years. He recently has
been diagnosed with diabetes and takes an oral medication to control his blood glucose. He also has high cholesterol
and has recently started on a lipid-lowering medication. Recent tests have revealed Steve has fatty liver, which he
feels is a result of his eating too much fat in his diet. He also reports having occasional low blood glucose
(hypoglycemia) and feeling shaky and dizzy.
1. From information in this chapter, explain to Steve how his alcohol intake may be contributing to fatty liver.
2. What might explain the low blood sugar reactions Steve has been having?
3. Describe how the MEOS system described in Highlight 7 might affect the efficacy of the medications Steve
takes.
4. What specific nutrient deficiencies is Steve at risk for due to excessive alcohol use?
5. Give Steve at least 3 health-related reasons to encourage him to seek help in abstaining from alcohol.
6. List at least 3 practical tips you would give to people who only drink alcohol occasionally and who want to stay
within current recommendations for health and safety.
Answer Key
1. Alcohol is broken down in the liver in preference over fatty acids, which then accumulate. Alcohol also
permanently changes the structure of liver cells, which impairs the liver’s ability to metabolize fats and can lead
to fatty liver.
Suggested Classroom Activities
To teach metabolism well—that is, to teach it so that students do not try to memorize fragments of it blindly but
become intrigued with it, feel comfortable with it, and really understand it—is a challenge. It helps when you are
enthused about the subject. It also helps to have your objectives clearly in mind, and not to be unrealistically
ambitious. Do you want students to memorize and spit back all of the TCA cycle intermediates with their structures,
or do you want them to be able to tell you in words what kinds of transformations can occur among amino acids,
fatty acids, and glucose? Offer as much as students are able to assimilate in the available time. It usually doesn’t pay
to get into the details of the TCA cycle at the beginning level; too few gain any real understanding.