February 24, 2026 • 47 mins
Leading preventive neurologist Dr. David Dodick joins the show to unpack what alcohol is really doing inside the body. We dive into how it affects the brain, why it’s linked to an increased cancer risk, how it influences the immune system, and what makes alcohol especially impactful for women navigating perimenopause and menopause.
If you’ve ever wondered what alcohol use might mean for your long-term health, this conversation is for you.
Special thanks to Antonia Lyons
Links to resources mentioned in this episode:
Office of the Surgeon General: Alcohol and Cancer Risk
Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
Note: In this show, we use “women” as shorthand for people with XX chromosomes. We understand sex and gender are more complex, and acknowledge the experiences we describe reach beyond that word.
See omnystudio.com/listener for privacy information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:17):
Pushkin.
Speaker 2 (00:24):
This show is not a substitute for professional medical advice, diagnosis,
or treatment. It is for informational purposes. Please consult your
healthcare professional with any medical questions. Also in this show,
we use women as shorthand for people with XX chromosomes.
We understand sex and gender are more complex and acknowledge
(00:47):
the experiences we describe reach beyond that word.
Speaker 3 (00:54):
There was a time not long ago, when I would
come home after long day at work and pour myself
some bourbon. I'd take a seat in the living room.
I would just savor the taste and the moment. It
was a way for me to close out the day,
wind down and fall asleep quicker. But then my life changed.
I was diagnosed with cancer. It was a real wake
(01:16):
up call for myself and my health, and that diagnosis
made me reevaluate my relationship with alcohol. Over time, it
became clear to me that this evening ritual no longer
served me or my health, and these days I hardly
drink it all.
Speaker 4 (01:32):
You know, everybody knows visually.
Speaker 5 (01:35):
They understand that when you pop.
Speaker 4 (01:37):
A cigarette and that whatever's in that goes into your lungs,
that that can cause lung cancer.
Speaker 5 (01:43):
People get that, but people don't, and.
Speaker 4 (01:46):
I was one of them who really never understood the
profound effect that alcohol can have on your risk of cancer.
Speaker 3 (01:55):
That's doctor David Dodeck. He's a world of renowned preventivem neurologist.
He serves as Atria's chief science and medical officer, which
means he's also my boss.
Speaker 1 (02:07):
I wanted to have.
Speaker 3 (02:08):
Doctor Dodock on the show because he's passionate about all
of his better understanding the way alcohol impacts our brains
and many other systems in our bodies. Based on the
statistics midlife, women today are drinking larger quantities and more
frequently than in the past to cope with the number
of responsibilities, including family demands, high pressure jobs, and other
(02:29):
forms of caregiving. But women actually metabolize alcohol differently than men,
and more importantly, as we age, Women who drink even
moderately are a greater risk of developing breast cancer and
other diseases when compared to women who abstain from alcohol.
This is decoding women's health, and I'm doctor Elizabeth Pointer.
(02:52):
Today on the show will break down what happens in
our bodies when we consume alcohol, and will also discuss
the associations between menopause symptoms and drinking behaviors, but all
hope is not lost. Doctor Doduck also notes that for
some maintaining a healthy lifestyle and managing other risk factors
(03:13):
can help lessen adverse outcomes. You're the chief science Officer
and chief medical Officer at the Atria Health and Research
Institute devoted to proactive and preventive care. So you approach
(03:38):
the topic of alcohol from both lenses, right, both from
preventive care and from the neurologic impacts that alcohol can have.
So let's start with the neurology angle first. When we
say that alcohol is a neurotoxin, what do we mean
by that? What is exactly happening?
Speaker 4 (03:58):
Yes, so, a neurotoxin is a chemical that disrupts the
normal structure or architecture of the brain and the normal
functioning of the brain. Alcohol can shut down them memory
organ inside the brain. It can affect the wiring of
the brain. So if you think about the brain, there's
(04:19):
the gray matter or the cortex. Think about it as
the computer, and think about all of the connections that
are made the wiring, if you will, which is kind
of like the high speed fiber optic cables. Alcohol affects
both the computer and those fiber optic cables. So as
you can imagine with eighty billion cells, each cell making
(04:43):
ten thousand different connections to ten thousand other cells. When
you affect the cell and when you affect the wiring,
and when you affect brain chemistry, you're affecting the way
the brain operates and functions. And if you do that
on a chronic basis, if you're drinking alcohol every day,
(05:03):
then the brain kind of rewires it cell to try
to deal with the toxin that's ever present. When you
talk about a toxin, that toxin think about changing.
Speaker 5 (05:15):
The structure, the architecture, and the function of that organ.
Speaker 3 (05:20):
So for the science nerds and geeks in us, what
is alcohol doing at the cellular level, what does ethanol
do and what does acid aldehyde do? Because these are
both components of the neurotoxicity.
Speaker 4 (05:33):
Sure, so alcohol or ethanol. Be it a hard liquor,
be it wine, be it deer, be it any kind
of spirit, it's ethanol. When ethanol gets into the body,
it's metabolized by the liver into something, as you mentioned, known.
Speaker 5 (05:50):
As acid aldehyde.
Speaker 4 (05:52):
And acid aldehyde is an even more potent toxin than
ethanol itself. So what does acid aldehyde and what does
ethanol do to the brain? I think about it in
a couple.
Speaker 5 (06:06):
Of different ways.
Speaker 4 (06:07):
The brain is a greedy organ so it demands twenty
percent of the blood flow, twenty percent of the blood sugar,
and twenty percent of energy to function. So imagine alcohol
affecting the blood flow to the brain because it affects
blood vessels over time and the integrity of those blood vessels,
(06:29):
so it actually can reduce the flow of blood and
the flow of nutrients to the brain. It also affects
at the cellular level what we call mitochondria, which are
those little organelles inside the cell that produce the energy
needed for the brain to function.
Speaker 5 (06:49):
And when you.
Speaker 4 (06:49):
Affect both blood flow to the brain and the organelle
the mitochondria that takes that sugar and turns it into energy,
if you will, you're reducing the energy that the brain
can generate.
Speaker 5 (07:04):
The other thing that.
Speaker 4 (07:05):
Alcohol does is it causes, for lack of a better term,
a leaky gut. Flames the gut and then toxins that
are generated from the trillions of organisms in the gut
can leak into the blood, and that can affect both
the barrier that separates the blood from the brain, allowing
inflammation or molecules to.
Speaker 5 (07:25):
Get into the brain that shouldn't.
Speaker 4 (07:27):
Be there, but it also drives and activates another cell
in the brain called the microglia. Microglia are there as
a defense mechanism. They're inflammatory cells that are supposed to
fight invaders, but when chronically turned on, they actually continue
to release molecules of inflammation that damage brain tissue. So
(07:51):
this constant state of neuroinflammation, which is one of the
main drivers of neurodegeneration and neurodegenerational course, is ultimately what
causes things like dementia and Alzheimer's disease.
Speaker 5 (08:06):
But also this.
Speaker 4 (08:08):
Reduction in energy supply. It's very damaging to the brain.
Speaker 5 (08:13):
The other thing that.
Speaker 4 (08:14):
The alcohol does is it kind of strips the insulation
off of those fiber optic cables, so it slows down
and it disrupts the flow of.
Speaker 5 (08:24):
Information in the brain.
Speaker 4 (08:26):
So at a cellular level, there's a lot of damage
being done to the brain, both from inflammation, which again
drives up the need for more energy, while at the
same time you're starving the brain of both the nutrients
that it needs to make energy and its ability to
drive energy production that drives the function of each cell
(08:48):
in the brain.
Speaker 3 (08:49):
Do you think that when you drink the night before,
one or two drinks, that that changes your cognitive ability
that energy change or blood flow change in the brain.
Is it impactful immediately after a couple of drinks, like
the next morning, do you see people's cognitive abilities change?
Speaker 4 (09:07):
Yeah, no question about it for a variety of reasons,
not least what I just mentioned. But the other thing
that alcoholol does is it disrupts sleep. So you know
the so called nightcap that people take to relax to
maybe get to sleep sooner. It may work, But what
it does is it really disrupts the architecture if you sleep.
(09:28):
So what do I mean by that? Well, there are
two important times during sleep that the brain uses to
consolidate memory, which is rem sleep and deep sleep. Deep
sleep also flushes out the brain of the proteins and
toxins that build up during the day. It's kind of
(09:49):
the waste management of the brain, if you will. So
here you have alcohol, that's it's disrupting waste management. You
can't flush things out that need to be flushed out,
and you're not allowing enough rem sleep to occur when
emotional regulation and memory consolidation is both as supposed to occur.
(10:11):
The other thing that alcohol does is it activates the
sympathetic nervous system, and so you might notice when you're
the next morning, if you wear a wearable, that your
heart variability drops, and that's because the sympathetic nervous system
is activated. The other thing that alcohol does is when
(10:31):
you drink alcohol, you get sleepy, and you get sleepy
and get sedated a bit because it promotes the most
inhibitory chemical or transmitter in their brain called gabba.
Speaker 5 (10:44):
What it also does is it reduces.
Speaker 4 (10:48):
The excitable nerroor transmitter called glutamate. And so the next day,
think about what happens. You've disrupted your sleep and you
get this sort of anxiety, if you will, where the
brain sort of revolts and produces more glutamate, which is
an excitatory neuro transmitter, which may make you more anxious
(11:11):
and more vigilant. So that hangover or anxiety and the
brain fog that you experience the next day is a
direct result of alcohol's effect on the brain and on
sleep architecture, which, again, if you don't sleep well, you
don't think well the next day. So even though you
(11:32):
think you're getting sleep, if you've changed your sleep architecture,
the way you feel the next day is going to
be dramatically impacted.
Speaker 3 (11:40):
Can you unpack a little bit about the risk of
cancer with alcohol use, which cancers are increased and why
that would be?
Speaker 4 (11:50):
Yeah, this is a this is a big one. You know,
everybody knows visually, they understand that when you pop a
cigarette and that whatever is in that goes into your lungs,
that that can cause lung cancer.
Speaker 5 (12:04):
People get that, but.
Speaker 4 (12:06):
People don't And I was one of them who really
never understood the found effect that alcohol can have on
your risk of cancer.
Speaker 5 (12:16):
So how does it do that?
Speaker 4 (12:19):
Well, in addition to everything I talked about at the
cellular level that alcohol does, it also acts like a
wrench in your DNA and it's sort of tears it
open or tears it apart a little bit. And you know,
every day we're having a little DNA damage that occurs,
(12:40):
and we have mechanisms that repair that damage. Alcohol not
only acts as a wrench on the DNA and damages it,
but it actually prevents its repair. When that happens, cells
are more prone to become cancerous. I think the other
thing alcohol does is it creates the milieu or the
(13:01):
environment one of inflammation that allows cancer cells to grow,
expand spread. The other thing alcohol does is, you know,
when you think about our immune system, immunos senesceence where
the aging immune system is.
Speaker 5 (13:20):
The reason why.
Speaker 4 (13:20):
For example, cancer is more common as we age and
infections become more severe as we age. Our immune system
just likes the rest of our body ages. Alcohol accelerates
that aging. I'll give you an example. There's a cell
called a natural killer cell. They're kind of like immune soldiers,
(13:41):
and alcohol damages those natural killer cells. So at the
same time as it's sort of breaking up the DNA,
injuring the DNA, impairing its ability to repair itself, reducing
the immune surveillance those immune soldiers that normally take it out,
it's a sort of perfect storm that allows cancer cells
(14:04):
to actually emerge, grow, expand, and develop into a tumor.
So for those reasons, just like asbestos, tobacco, and other
type one carcinogens, alcohol is a Grade wander type one carcinogen.
Some governments like Ireland and Canada have recognized that and
(14:27):
those of you who might have heard the Surgeon General
last year talked about putting warning labels on alcohol, not
just for expecting mothers not to be drinking, but also
the fact that it increases the risk of cancer.
Speaker 3 (14:42):
When I first started oncology, the guidance was that one
drink a day for women was acceptable. And now I
think they've really come out and said that no amount
of alcohol is safe for women when it comes to
breast cancer risk, and that takes us into midlife women.
You know, a lot of patients will ask me if
alcohol is bad for my total body health and overall
well being? Can I drink at all? What if I
(15:04):
enjoy a glass of wine at night to unwind? Can
I drink any drinks? Is there any amount of alcohol
that I can drink that's safe.
Speaker 5 (15:11):
Yeah, that's a good question.
Speaker 4 (15:13):
I mean, it really is how much kindling, if you will,
to which alcohol is a sort of a gas that
ignites a fire. Let me, let me, let me explain
what I mean by that.
Speaker 5 (15:29):
When you combine.
Speaker 4 (15:30):
Genetic risk with other lifestyle risks. For example, your diet's
not great, your sleep is poor, you're not moving, you're
not exercising, you're not managing your vascular risk.
Speaker 5 (15:44):
Factors the way they need to be managed, like.
Speaker 4 (15:47):
Blood sugar insulin sensitivity Lvl eight bl b, your blood
pressure is not optimally managed. So when you have all
of these modifiable risk factors that aren't well controlled, then
adding any alcohol to that is just like adding fuel
(16:09):
to a kindling fire.
Speaker 3 (16:11):
Right.
Speaker 4 (16:11):
But if you are in every other way looking after yourself, right,
and you're modifying those vascular risk factors, and you're exercising
and you're not smoking, and you're socially connected and you're
cognitively active, if you're doing all those things right, and
(16:33):
you're sleeping and you're taking your sleep seriously and you
eat a predominantly plant based diet with fiber, if you're
doing all of those things, is a glass of wine
with dinner occasionally?
Speaker 5 (16:46):
Is that like a no?
Speaker 4 (16:47):
No? Does everybody who drinks a cocktail or has an
occasional glass of wine going to develop dementia? No? But
it certainly depletes that cognitive reserve. And if you're genetically
at risk and you're not managing those other modifiable risk factors,
then it's the fuel to the fire, so to speak.
And in women in particular, you know oncologists right now
(17:11):
are kind of treating alcohol in women who are at
risk for breast cancer as a no no, you know,
one drink per day appears to increase the risk of
breast cancer by up to ten percent. I guess the
one other thing I will say is, in addition to
damaging DNA, there's something called the epigeno or epigenetics. So
(17:32):
we're born with, you know, our genetics, but the genes
that are active at any one time changes over the
course of your life, and it changes primarily in response
to your environment and your lifestyle. So you can turn
genes on and you can turn genes off. So one
(17:55):
of the things that alcohol does is it turns off
genes that are responsible for immune surveillance immune health, and
it turns on genes that can promote the development of cancer,
something we call onca genes. So I don't want the
listeners to be, you know, overwhelmed by all of this,
except to know that there's no doubt that alcohol is
(18:16):
not only a neurotoxin but a carcinogen. And science has
figured out and continues to figure out all the mechanisms
by which it does that. And by the way, you know,
as a neurologist, and as a preventive neurologist, I'm not
the alcohol police. I'm more like a brain health coach
(18:37):
where I can sit down with the patient and have
this kind of discussion with that. So am I an
absolutist where I would say that you know, one should
never touch alcohol. No, but there are some people who
never should touch alcohol, and I hope I've described who
that person is versus the person who enjoys an occasional
(18:59):
glass of wine with dinner, which at this point in time,
I will say it's okay, so long as they're managing
everything else in their life that protects their brain.
Speaker 3 (19:11):
Coming up after the break, doctor Dotick and I dive
deeper into the science and discuss genetics, dopamine, and alcohol's
effect on midlife women during perimenopause and menopause. Will be
right back. Are there genetic tests for alcohol metabolism that
(19:40):
you can tell genetically that somebody may be at more
risk from alcohol use than another person?
Speaker 4 (19:48):
You know, I don't do genetic testing for alcohol, but
you know there is something called a polygenic risk core
where where there may be hundreds of different genes that
increase the risk of alcohol use disorder, and so sometimes
it's good to be aware of that. There are pharmacogenomic
(20:10):
tests that w can do to determine the way in
which you metabolize certain medications that some people go on
that actually curbs your appetite for alcohol. Let's say the
GLP one antagonist, for example, the ozepic ozepics in the
moonjarro Those actually curb appetite for alcohol. Then there's something
(20:32):
called alcohol dehydrogenase, which is the principal enzyme that breaks
down alcohol into acid aldehyde. Women actually have less of it,
so they don't metabolize alcohol as well. But for people
who might have had a variant in the acid aldehyde
dehydrogenase G that may affect your propensity to drink.
Speaker 5 (20:55):
I'll give you an example.
Speaker 4 (20:57):
Some people rapidly produce acid aldehyde and they don't feel well,
They get flushed, they get nauseated. Just alcohol makes them
feel bad, so they don't drink. There are others people
who can so called drink people under the table, and
they have a high tolerance for alcohol, so they may
have to have three drinks or four drinks to feel
the buzz that someone with different metabolism feels after one drink.
Speaker 5 (21:22):
That's actually dangerous.
Speaker 4 (21:24):
Those people who can drink others under the table consume
more alcohol, and that neurotoxin is having an effect even
when you're not feeling the buzz. And remember that the
liver can only metabolize one drink per hour.
Speaker 5 (21:43):
That's the kind of metabolism it has.
Speaker 4 (21:45):
So the more you drink, and the more rapid you drink,
the more you know. Basically, the alcohol just keeps circulating
and keeps bathing your brain while it's waiting for the
liver to be freed up so that the enzymes can
metabolize it. So combine that with if you're one of
(22:05):
those people who, because of genes, can drink someone under
the table, you're really bathing your brain in a very
toxic soup, even though you may not be feeling the
buzz or feeling intoxicated.
Speaker 5 (22:20):
When you do drink.
Speaker 4 (22:22):
So if you're going to drink, and if you're going
to have more than one drink, boy, you're better spread
it out.
Speaker 3 (22:29):
So let's talk midlife women, dopamine, perimenopause, hormonal fluctuations, and
vulnerability to alcohol. In my reading of the research in literature,
currently alcohol use is dropping amongst younger populations except midlife women.
Estrogen fluctuations are occurring which impact the brain. They impact
the brain, energetics, blood flow to the brain, amyloid in
(22:53):
tao right at midlife? Are women more vulnerable to alcohol
problems in midlife in terms of the impact of alcohol
as a neurotoxin? And the second part to this question
is dopamine have anything to do with it? Because as
estrogen levels fluctuate, opamine goes down. Are women seeking more
(23:14):
alcohol maybe in this time of their lives or our lives?
Perhaps I should say because of dopamine. Do you see
any link there?
Speaker 4 (23:23):
Yeah, you know, it's the very population on which alcohol
can have the most profound effect, or midlife women, I
believe because of that. You know, profound fluctuation and estrogen
that occurs around the perimenopause and the menopause. And I'm
talking to a world expert right now, so I'm feeling
(23:44):
rather conspicuous. But you know what happens in the perimenopause
and the menopausal state. If you look at you know,
sometimes that gets distributed differently around the abdomen and viscera.
Sleep gets disrupted. Yes, you have symptoms like hot flashes
and nice sweats, changes in bone density occur brain fock.
(24:09):
You know, women are experiencing brain fog during that period
of time. And when you think about the effect of
alcohol on sleep, which we talked about, we didn't talk
about its effect on bone, but alcohol actually activates what
we call osteoclass, which break down bone and inhibit osteoblasts.
Speaker 5 (24:28):
Which form new bone.
Speaker 4 (24:29):
They also affect the way the liver activates vitamin D
and affects the way the kidney regulates calcium, so it
can have a profound effect on bone density. We've already
talked about brain fog and the effect that it can
have on women's brain, not the least of which estrogen
is neuroprotected, and so you've lost a hormone that was
(24:51):
protecting the brain and now you're trying to make up
with alcohol to correct that sort of dopamine gap. You
mentioned dopamine, and I just talked about the fact that
you know, as estrogen drops, the dopamine drops, that rewards
circuit is not as active, and alcohol of tends to
(25:12):
make up that gap, at least temporarily. You know the
other thing that alcohol does is, you know, for women
who are prone or at risk or breast cancer. Alcohol
can actually increase levels of estrogen and other hormones which
are associated with hormone receptive positive breast cancer. So that's
the reason why. Of course, on colleges, as you mentioned,
(25:33):
are are kind of becoming a binary decision for women.
Speaker 5 (25:39):
Where if they're at risk, they're told not to drink.
You know, women during midlife are.
Speaker 4 (25:47):
Trying to nurture and raise a family well at the
same time, trying to grow and build a career at
the same time, also trying to care be a caregiver
for aging parents. So this thirty five to sixty five
age range is very unique. It's kind of a there
being sandwiched between caring for children, caring from aging parents,
(26:11):
and trying to nurture and grow their own careers. And
this wine culture we're marketing heavily targets this demographic braining
alcohol is kind of a reward or a coping mechanism
for all of the invisible.
Speaker 5 (26:28):
Labor that women perform.
Speaker 4 (26:30):
It's really harmful. So, you know, I would say that
in many ways, the metabolic, the brain, the cardiac issues
that women face during this midlife are all exacerbated by alcohol,
(26:53):
and so the most vulnerable population which are women during
midlife are actually probably the population that shouldn't be consuming
alcohol or consuming it at a very modest level.
Speaker 3 (27:09):
The issue that I find that I get asked the
most and I find the most problematic is women will
say to me, it's closure to my day. I sit down,
I put my feet up, I have a glass of wine.
For me, it was a glass of bourbon or a
shot of bourbon. Or how do you respond to that
when people say I need some closure, I need something
(27:30):
to wind down. How do you coach somebody or what
do you recommend to a woman to replace that glass
of Chardonnay or that shot of Kentucky bourbon.
Speaker 4 (27:43):
The tough one because everybody has different social circumstances, different
family circumstances.
Speaker 5 (27:50):
But I think, you.
Speaker 4 (27:51):
Know, women tend not to delegate, and they certainly tend
not to divine. They tend to take all of the
responsibility on themselves, and I think they need time to
focus on themselves and do something positive, good and healthy
for themselves. And whether that's for these thirty to forty
five minutes, I'm actually going to get into a song.
(28:14):
I'm going to take a hot bath, I'm going to exercise.
I'm going to do something positive and good for myself
and with awareness of if they were aware of what
they're doing to their bodies, and the fact that you know,
when they take the edge off, if you will, with that.
Speaker 5 (28:31):
Glass of wine or that glass of.
Speaker 4 (28:32):
Bourbon in the evening, it disrupts their sleep. It may
actually promote hot flashes night sweats, It may actually promote
brain fog the next day.
Speaker 5 (28:43):
So it's a biological.
Speaker 4 (28:44):
Thief actually, and it is short term gain for long
term pain. And I think many of the anxiety that
I talked about. You know, alcohol has a profound effect
on mood as well.
Speaker 5 (28:59):
Part of the area of the brain. One of the
areas of the.
Speaker 4 (29:01):
Brain that alcohol effects causes what we call anhedonia, or
a lack of pleasure. So the very things that people
used to take pleasure and they don't get to much
pleasure out of anymore. So, given the effect on moved
and anxiety and sleep and cognitive function or brain flock,
coupled with the fact that it increases blood pressure as
(29:25):
a negative effect on the heart and cardiovascular disease is
still a primary cause of morbidity and mortality in women.
Bone health insulin sensitivity. All of these things are compounded
by the effects of alcohol.
Speaker 5 (29:43):
So I think if.
Speaker 4 (29:44):
Women, especially during midlife, had greater awareness of the profound
effect of alcohol at a multi organ level and the
very issues that they're dealing with for which they take
a glass of alcohol, which is which may be stress
or anxiety, it actually makes it worse over time. I
don't want to oversimplify things, and I don't want to
(30:06):
be accused of not being sensitive sense to everybody's life circumstances,
but it actually will exacerbate some of the very symptoms
for which you're actually taking that glass.
Speaker 5 (30:18):
Of wine or bourbon at night.
Speaker 3 (30:20):
Let's just talk very briefly about exercise at night. I
was always under the belief that you should not exercise
before you go to bed because it jacks up your
nervous system and can get you rubbed up. And indeed
that's kind of like not true and kind of the opposite, right,
So for me, I replaced my evening bourbon with core work,
or with push ups, or with taking a long walk.
(30:43):
Does exercise disrupt sleep or can it help us to
get better sleep? And we can substitute maybe a glass
of alcohol for a little bit of core work, a
little bit of setups or a long walk.
Speaker 4 (30:53):
Actually, oh, one hundred percent. I mean I think you know,
I exercise mostly in the evening actually, and it actually
has improved my sleep considerably. You know, my sleep scores
now are much better than they used to be, just
simply by not getting up early in the morning. I
mean some people, everybody's schedule in calendar is different.
Speaker 5 (31:15):
But for me to get up at four.
Speaker 4 (31:17):
Thirty or five o'clock in the morning and to get
a workout in before work, I used to feel good
doing it, But I feel better if I'm exercising in
the evening and my sleep is actually better in the
evening now. I don't mean like exercising at ten o'clock
at night and then trying to go to bed at eleven,
but I mean exercising in the evening before dinner that
(31:40):
actually will have a better effect on your insolent sensitivity,
on your metabolism, and on your ability to sleep then
perhaps exercising it at other times of the day. But yeah,
for women who are struggling, particularly midlife, with some of
the perimenopausal symptoms, including sleep, exercise is the best prescription
(32:04):
that I can write and is the most important prescription
for people to fill, especially women during that midlife I
love to hear that.
Speaker 3 (32:15):
Coming up, doctor Dodeck talks about the field of preventive
neurology and the ways in which we can protect the
brain and other organs before symptoms appear.
Speaker 1 (32:24):
More in a minute, Welcome back to the show.
Speaker 3 (32:41):
When I first came to Atria, I had a daily
meeting every morning with doctor Dodeck, and I quickly realized
I had to be really on my game at these meetings.
So another reason I actually quit drinking almost completely was
because of those daily meetings. I realized that my mind
wasn't as sharp as it could be if I had
(33:01):
had a drink at the night before. Looking back now,
it seems so obvious. I wanted doctor Doda to really
unpack for us all the ways that alcohol impact our health,
including his own specialty, preventive neurology. Let's talk a little
bit about the emerging field and exciting emerging field of
preventive neurology. Can you tell us a little bit about
(33:23):
what preventive neurology is, the research around alcohol and dementia prevention,
and how alcohol use counseling is being utilized as part
of the preventive neurology programs in order to prevent dementia.
Speaker 4 (33:40):
So preventive neurology is really a proactive shift in medicine
and in neurology in particular. So what I mean by
that is, instead of waiting to treat a stroke or
to treat someone's dementia or memory loss after it occurs,
neurologists now are looking at the lifestyle insults, like alcohol
(34:02):
being one of them that accumulates over decades. In fact,
there was a rather significant publication from the Lancet Commission
published in the Lancet and there have been three versions
of this on dementia prevention. And what they did was
they looked at how much dementia could be prevented if
(34:23):
you optimized, in other words, reduced or eliminated these risk
factors that are modifiable, and it turned out that about
forty five percent or almost half of all dementia could
be prevented if you optimized or modified those risk factors.
And alcohol is a profound risk factor. It's kind of
(34:47):
a monotonic risk factor. In other words, there's no amount
of alcohol that's actually safe for the brain. Unfortunately, because
as we talked about earlier, it's a neurotoxin. Obviously there's
a dose response, so that the more that you drink,
the more damage that can occur. And in those who
have serious issues alcohol use disorders or alcoholism, you can
(35:09):
have alcohol really to dementia. So it can directly cause
dementia as opposed to increasing the risk or other types
of dementia like Alzheimer's disease. You know, I talked about
what alcohol can do to the brain at the cellular level.
The other thing that it does is it actually activates
(35:31):
one of the enzymes in the brain that produces amyloid.
Not only that, but those who drink, you know, eight
or more drinks per week have actually been shown to
have increased levels of TOWL in the brain. And amyloid
and TOW are two proteins that aggregate or clump and
accumulate in the brain, and we believe those are the
(35:53):
two major protein insults that gives rise to Alzheimer's disease
and other types of dementia. They also increase the levels
of TOW and amyloid in the brain. And based on
what I said about sleep, reduce your ability to flush
out at night during deep sleep, so you can see
(36:15):
that alcohol has sort of a multidimensional and multi pronged
effect on the brain that you can see why it's
now a modifiable risk factor for dementia and the way
you know, neurologists are looking at preventive neurology now, it's
all about cognitive reserve. You know, think about your bank account.
Each time you make a withdrawal, you deplete the reserve
(36:38):
in your bank account.
Speaker 5 (36:40):
You think about the brain the same way.
Speaker 4 (36:42):
Each time you insult the brain, you reduce that cognitive
preserve because it's about what kind of cognitive independence and
cognitive longevity can I have when of them in my seventies, eighties,
and nineties, if I live that long. I actually believe
that the most devastating neurological diseases like stroke and dementia
(37:02):
are largely preventable.
Speaker 5 (37:05):
In addition to all.
Speaker 4 (37:06):
The other things that women are at risk for at
a significant higher risk than men, Alzheimer's disease is another one,
and especially women in midlife. If you knew that the
risk is two to three times of a woman developing
Alzheimer's disease than men, which is true, and you knew
(37:30):
that alcoholism, neurotoxin potentiates that risk.
Speaker 5 (37:34):
This is where precision medicine comes into things.
Speaker 4 (37:36):
So, doctor Poynter, if we do whole genome sequencing here
at Atria, as you know, if I have a young woman,
and I have plenty of young women right now in
the practice who have a genetic risk for Alzheimer's disease
and a family history, so they have one or two
(37:57):
copies of this risk gene called apo E four. For
a woman who has two copies of apo E four
or even one copy of APOLI four, who have that
genetic risk and who aren'toly optimized, I would say no
amount of alcohol is safe. And so there is an
example of someone who I would say no. The decision
(38:18):
here is binary, no alcohol zero if you don't want
to deplete quite rapidly that cognitive reserve. So I think
that's where precision medicine comes in. To say that nobody
should actually have any alcohol is an overgeneralization that medicine
(38:40):
is moving away from. We're getting into precision medicine now.
And so if I have a molecular phenotype of a
patient and I know what their insulin sensitivity is, and
I know what their blood pressure is, and I know
what their LDL is, and I know what their hemoglobinating
one sees. I know how metabolically healthy or unhealthy they are.
(39:02):
I know what their risk for cancer is. I know
what the risk for Alzheimer's disease is. I know what
their risk for heart diseases. Because we're assessing that. Then
to throw alcohol on those embers, I would say it's
a binary decision.
Speaker 5 (39:21):
And the answer to that is no.
Speaker 4 (39:22):
If you have someone who has a neuroprotectivegy for example,
and there are plenty of them who are metabolically optimized,
could that person have an occasional glass of wine with dinner. Yes, yes,
it's a neurotoxin, but it's.
Speaker 5 (39:40):
The body into which you put it.
Speaker 4 (39:43):
How much is that person at risks for some of
the detrimental consequences that alcohol can amplify. That's really the magic.
That's where medicine is going. It's all about precision prevention,
and that's the nuanced conversation that we're able to have
with patients now, given our ability to test and to
(40:05):
risk stratify, to identify people who are at that elevated risk.
My conversation with that person that young thirty two year
old woman who has two copies of AIGHTO E four
is very different than the young woman, thirty two year
old woman who has no copies of a bo E
four and is metabolically Christine and doing all the things
(40:27):
like bragging about her sleep score, exercising right, eating a
plant based diet, a Mediterranean diet. My conversation about alcohol
is going to be very different with those two people,
despite the fact that they're both thirty two year old
women or forty two year old women or shifty two
year old women.
Speaker 3 (40:43):
So taking it away from one recommendation into a highly
personalized recommendation, absolutely, can we undo the damage that's done.
Speaker 5 (40:51):
The answer is yes and no.
Speaker 4 (40:54):
On the on the positive side, if you stopped drinking,
assuming you're in other ways healthy, it actually has been
shown that if you stop drinking, that gray matter that cortex,
the sort of skin of the apples, so to speak,
starts to increase some volume. We know that even low
amounts of alcohol will shrink the gray matter, but we've
(41:16):
also seen that gray matter expands when you stop drinking.
We also know that you remember I talked about the
insulation that stripped off the fiber optic cabling the wiring
in the brain. We know that that can repair itself
as well. So yes, if you stop drinking and you
start looking after your body by focusing on nutrition, exercise, sleep,
(41:41):
you'll start to clear out and flush out some of
that accumulated protein.
Speaker 5 (41:45):
That's collective. Of course. When I said yes and no.
Speaker 4 (41:48):
I mean no insofar as if you continue, like I
talked about a dose response, the more you drink and
the longer you drink, some of the damage is not repairable.
But the good news is that if you stop drinking,
you start to see the beneficial effects of that almost immediately,
and then over time there's repair.
Speaker 5 (42:10):
There's repair that can occur.
Speaker 4 (42:11):
And we also know that the brain, even into older age,
is a very plastic organ and if you do all
of the things that we do in our brain health
program to optimize the health of the brain and to
optim we can actually optimize I think copative function over time.
I mean we've actually seen in our practice where not
(42:33):
only does cortical thickness and the volume of the gray
matter and cortex expand over time, but sometimes the hippocanphi,
which are these two little memory organs, and the temporal
lobes of the brain that are responsible. They're like the
save button on your computer, right, They store memories. They
put it into your hard drive, and now you have
(42:53):
that memory, those start to enlarge and work better as well.
You know, Look, if I could go back and tell
my eighteen or twenty five year old self what I
know now, I probably would have done things differently on
many different levels.
Speaker 5 (43:08):
I wouldn't have been eating, you know, the fast food
that I'm light have eaten.
Speaker 4 (43:11):
I wouldn't have been having the beer or any alcohol,
or it would have been certainly in very much moderation.
Speaker 5 (43:20):
But I can't do that now.
Speaker 4 (43:23):
But what I do know is that if you look
after the brain, regardless of what age you were, you
can improve that cognitive reserve over time and mitigate against
any sort of withdrawal continuing to withdraw on that reserve,
because if you don't, then you're going to get into
trouble over time.
Speaker 3 (43:43):
Doctor Dodick, thank you so much for today. You've been
a wealth of knowledge, and I know we're going to
get a lot of actionable points for our listeners. I
so appreciate it. We also appreciate it.
Speaker 5 (43:53):
Oh it's my pleasure. Thank you so much for having me.
Speaker 3 (43:56):
After this interview wrapped, I kept replaying doctor Dodick's words
in my mind that alcohol is a biological thief. Sure,
alcohol might make you feel better in the moment, and
I know for a lot of people it can be helpful.
Social situations are simply a habit that's formed over many years. Honestly,
(44:16):
it still feels new for me to go to a
party and not have a bourbon in my hand. But
when I think about the havoc it's wreaking on my health.
Plus the fact that I'm just not going to really
feel well the next day, I'm reminded why I stopped.
I can't afford to have a day where I don't
feel so great. Cutting back on alcohol may help improve
your sleep, protect your brain, and mitigate your long term
(44:40):
health risk. But I understand that cutting drinking entirely might
seem really unappealing to some people listening right now, even
knowing all the health risk. When I was researching for
this episode, I spoke with an academic who has studied
alcohol and human behavior. She told me about participants in
her studies, often women in midlife, who reported drinking wine
(45:02):
at night. Did this help take the edge off or
is a way to connect with their partner. I get that,
I really do. But I hope that this this conversation
has given you more context about the impact alcohol has
on your overall health and maybe even some new strategies
for ways to reframe your relationship with alcohol. Maybe you
(45:23):
take a long walk with your partner, or maybe you
even just exercise after work to close out your day.
It's okay to let go of old rituals. This will
make space for new habits and new routines. Coming up,
on the next episode of Decoding Women's Health, I'll be
(45:45):
answering some of our listeners really great intelligent questions about
my favorite topic, hormones and midlife women's health. Which BHRT
is most effective transdermal creams, gels or vagil cream's inserts
or oral pills?
Speaker 2 (45:59):
Okay, first, before we get into it, can you explain
or define be HRT?
Speaker 3 (46:04):
And if you like this podcast, please consider leaving us
a review wherever you're listening now it helps new people
find the show.
Speaker 1 (46:12):
Thanks so much.
Speaker 3 (46:14):
Decoding Women's Health is a production of Pushkin Industries and
the Atria Health and Research Institute. This episode was produced
by Rebecca Lee Douglas. It was edited by Amy Gaines McQuaid,
mastering by Sarah Burguare. Our associate producer is Sonya Gerwit.
Our executive producer is Alexandra Garreton. Our theme song was
(46:34):
composed by Hannes Brown. Concept creative development and fact checking
by Shavon O'Connor. A special thanks to Alan Tish, David Saltzman,
Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagdorn, Owen Miller,
Jordan McMillan, and Greta Cohne.
Speaker 1 (46:55):
If you have a.
Speaker 3 (46:55):
Question about women's health in midlife, leave us a voicemail
at four FO five two O one three three eight five,
or send us a message at Decodingwomen's Health at pushkin
dot FM. I'm doctor Elizabeth Pointer and thanks for listening.
Until next time.
Pushkin.
Speaker 2 (00:24):
This show is not a substitute for professional medical advice, diagnosis,
or treatment. It is for informational purposes. Please consult your
healthcare professional with any medical questions. Also in this show,
we use women as shorthand for people with XX chromosomes.
We understand sex and gender are more complex and acknowledge
(00:47):
the experiences we describe reach beyond that word.
Speaker 3 (00:54):
There was a time not long ago, when I would
come home after long day at work and pour myself
some bourbon. I'd take a seat in the living room.
I would just savor the taste and the moment. It
was a way for me to close out the day,
wind down and fall asleep quicker. But then my life changed.
I was diagnosed with cancer. It was a real wake
(01:16):
up call for myself and my health, and that diagnosis
made me reevaluate my relationship with alcohol. Over time, it
became clear to me that this evening ritual no longer
served me or my health, and these days I hardly
drink it all.
Speaker 4 (01:32):
You know, everybody knows visually.
Speaker 5 (01:35):
They understand that when you pop.
Speaker 4 (01:37):
A cigarette and that whatever's in that goes into your lungs,
that that can cause lung cancer.
Speaker 5 (01:43):
People get that, but people don't, and.
Speaker 4 (01:46):
I was one of them who really never understood the
profound effect that alcohol can have on your risk of cancer.
Speaker 3 (01:55):
That's doctor David Dodeck. He's a world of renowned preventivem neurologist.
He serves as Atria's chief science and medical officer, which
means he's also my boss.
Speaker 1 (02:07):
I wanted to have.
Speaker 3 (02:08):
Doctor Dodock on the show because he's passionate about all
of his better understanding the way alcohol impacts our brains
and many other systems in our bodies. Based on the
statistics midlife, women today are drinking larger quantities and more
frequently than in the past to cope with the number
of responsibilities, including family demands, high pressure jobs, and other
(02:29):
forms of caregiving. But women actually metabolize alcohol differently than men,
and more importantly, as we age, Women who drink even
moderately are a greater risk of developing breast cancer and
other diseases when compared to women who abstain from alcohol.
This is decoding women's health, and I'm doctor Elizabeth Pointer.
(02:52):
Today on the show will break down what happens in
our bodies when we consume alcohol, and will also discuss
the associations between menopause symptoms and drinking behaviors, but all
hope is not lost. Doctor Doduck also notes that for
some maintaining a healthy lifestyle and managing other risk factors
(03:13):
can help lessen adverse outcomes. You're the chief science Officer
and chief medical Officer at the Atria Health and Research
Institute devoted to proactive and preventive care. So you approach
(03:38):
the topic of alcohol from both lenses, right, both from
preventive care and from the neurologic impacts that alcohol can have.
So let's start with the neurology angle first. When we
say that alcohol is a neurotoxin, what do we mean
by that? What is exactly happening?
Speaker 4 (03:58):
Yes, so, a neurotoxin is a chemical that disrupts the
normal structure or architecture of the brain and the normal
functioning of the brain. Alcohol can shut down them memory
organ inside the brain. It can affect the wiring of
the brain. So if you think about the brain, there's
(04:19):
the gray matter or the cortex. Think about it as
the computer, and think about all of the connections that
are made the wiring, if you will, which is kind
of like the high speed fiber optic cables. Alcohol affects
both the computer and those fiber optic cables. So as
you can imagine with eighty billion cells, each cell making
(04:43):
ten thousand different connections to ten thousand other cells. When
you affect the cell and when you affect the wiring,
and when you affect brain chemistry, you're affecting the way
the brain operates and functions. And if you do that
on a chronic basis, if you're drinking alcohol every day,
(05:03):
then the brain kind of rewires it cell to try
to deal with the toxin that's ever present. When you
talk about a toxin, that toxin think about changing.
Speaker 5 (05:15):
The structure, the architecture, and the function of that organ.
Speaker 3 (05:20):
So for the science nerds and geeks in us, what
is alcohol doing at the cellular level, what does ethanol
do and what does acid aldehyde do? Because these are
both components of the neurotoxicity.
Speaker 4 (05:33):
Sure, so alcohol or ethanol. Be it a hard liquor,
be it wine, be it deer, be it any kind
of spirit, it's ethanol. When ethanol gets into the body,
it's metabolized by the liver into something, as you mentioned, known.
Speaker 5 (05:50):
As acid aldehyde.
Speaker 4 (05:52):
And acid aldehyde is an even more potent toxin than
ethanol itself. So what does acid aldehyde and what does
ethanol do to the brain? I think about it in
a couple.
Speaker 5 (06:06):
Of different ways.
Speaker 4 (06:07):
The brain is a greedy organ so it demands twenty
percent of the blood flow, twenty percent of the blood sugar,
and twenty percent of energy to function. So imagine alcohol
affecting the blood flow to the brain because it affects
blood vessels over time and the integrity of those blood vessels,
(06:29):
so it actually can reduce the flow of blood and
the flow of nutrients to the brain. It also affects
at the cellular level what we call mitochondria, which are
those little organelles inside the cell that produce the energy
needed for the brain to function.
Speaker 5 (06:49):
And when you.
Speaker 4 (06:49):
Affect both blood flow to the brain and the organelle
the mitochondria that takes that sugar and turns it into energy,
if you will, you're reducing the energy that the brain
can generate.
Speaker 5 (07:04):
The other thing that.
Speaker 4 (07:05):
Alcohol does is it causes, for lack of a better term,
a leaky gut. Flames the gut and then toxins that
are generated from the trillions of organisms in the gut
can leak into the blood, and that can affect both
the barrier that separates the blood from the brain, allowing
inflammation or molecules to.
Speaker 5 (07:25):
Get into the brain that shouldn't.
Speaker 4 (07:27):
Be there, but it also drives and activates another cell
in the brain called the microglia. Microglia are there as
a defense mechanism. They're inflammatory cells that are supposed to
fight invaders, but when chronically turned on, they actually continue
to release molecules of inflammation that damage brain tissue. So
(07:51):
this constant state of neuroinflammation, which is one of the
main drivers of neurodegeneration and neurodegenerational course, is ultimately what
causes things like dementia and Alzheimer's disease.
Speaker 5 (08:06):
But also this.
Speaker 4 (08:08):
Reduction in energy supply. It's very damaging to the brain.
Speaker 5 (08:13):
The other thing that.
Speaker 4 (08:14):
The alcohol does is it kind of strips the insulation
off of those fiber optic cables, so it slows down
and it disrupts the flow of.
Speaker 5 (08:24):
Information in the brain.
Speaker 4 (08:26):
So at a cellular level, there's a lot of damage
being done to the brain, both from inflammation, which again
drives up the need for more energy, while at the
same time you're starving the brain of both the nutrients
that it needs to make energy and its ability to
drive energy production that drives the function of each cell
(08:48):
in the brain.
Speaker 3 (08:49):
Do you think that when you drink the night before,
one or two drinks, that that changes your cognitive ability
that energy change or blood flow change in the brain.
Is it impactful immediately after a couple of drinks, like
the next morning, do you see people's cognitive abilities change?
Speaker 4 (09:07):
Yeah, no question about it for a variety of reasons,
not least what I just mentioned. But the other thing
that alcoholol does is it disrupts sleep. So you know
the so called nightcap that people take to relax to
maybe get to sleep sooner. It may work, But what
it does is it really disrupts the architecture if you sleep.
(09:28):
So what do I mean by that? Well, there are
two important times during sleep that the brain uses to
consolidate memory, which is rem sleep and deep sleep. Deep
sleep also flushes out the brain of the proteins and
toxins that build up during the day. It's kind of
(09:49):
the waste management of the brain, if you will. So
here you have alcohol, that's it's disrupting waste management. You
can't flush things out that need to be flushed out,
and you're not allowing enough rem sleep to occur when
emotional regulation and memory consolidation is both as supposed to occur.
(10:11):
The other thing that alcohol does is it activates the
sympathetic nervous system, and so you might notice when you're
the next morning, if you wear a wearable, that your
heart variability drops, and that's because the sympathetic nervous system
is activated. The other thing that alcohol does is when
(10:31):
you drink alcohol, you get sleepy, and you get sleepy
and get sedated a bit because it promotes the most
inhibitory chemical or transmitter in their brain called gabba.
Speaker 5 (10:44):
What it also does is it reduces.
Speaker 4 (10:48):
The excitable nerroor transmitter called glutamate. And so the next day,
think about what happens. You've disrupted your sleep and you
get this sort of anxiety, if you will, where the
brain sort of revolts and produces more glutamate, which is
an excitatory neuro transmitter, which may make you more anxious
(11:11):
and more vigilant. So that hangover or anxiety and the
brain fog that you experience the next day is a
direct result of alcohol's effect on the brain and on
sleep architecture, which, again, if you don't sleep well, you
don't think well the next day. So even though you
(11:32):
think you're getting sleep, if you've changed your sleep architecture,
the way you feel the next day is going to
be dramatically impacted.
Speaker 3 (11:40):
Can you unpack a little bit about the risk of
cancer with alcohol use, which cancers are increased and why
that would be?
Speaker 4 (11:50):
Yeah, this is a this is a big one. You know,
everybody knows visually, they understand that when you pop a
cigarette and that whatever is in that goes into your lungs,
that that can cause lung cancer.
Speaker 5 (12:04):
People get that, but.
Speaker 4 (12:06):
People don't And I was one of them who really
never understood the found effect that alcohol can have on
your risk of cancer.
Speaker 5 (12:16):
So how does it do that?
Speaker 4 (12:19):
Well, in addition to everything I talked about at the
cellular level that alcohol does, it also acts like a
wrench in your DNA and it's sort of tears it
open or tears it apart a little bit. And you know,
every day we're having a little DNA damage that occurs,
(12:40):
and we have mechanisms that repair that damage. Alcohol not
only acts as a wrench on the DNA and damages it,
but it actually prevents its repair. When that happens, cells
are more prone to become cancerous. I think the other
thing alcohol does is it creates the milieu or the
(13:01):
environment one of inflammation that allows cancer cells to grow,
expand spread. The other thing alcohol does is, you know,
when you think about our immune system, immunos senesceence where
the aging immune system is.
Speaker 5 (13:20):
The reason why.
Speaker 4 (13:20):
For example, cancer is more common as we age and
infections become more severe as we age. Our immune system
just likes the rest of our body ages. Alcohol accelerates
that aging. I'll give you an example. There's a cell
called a natural killer cell. They're kind of like immune soldiers,
(13:41):
and alcohol damages those natural killer cells. So at the
same time as it's sort of breaking up the DNA,
injuring the DNA, impairing its ability to repair itself, reducing
the immune surveillance those immune soldiers that normally take it out,
it's a sort of perfect storm that allows cancer cells
(14:04):
to actually emerge, grow, expand, and develop into a tumor.
So for those reasons, just like asbestos, tobacco, and other
type one carcinogens, alcohol is a Grade wander type one carcinogen.
Some governments like Ireland and Canada have recognized that and
(14:27):
those of you who might have heard the Surgeon General
last year talked about putting warning labels on alcohol, not
just for expecting mothers not to be drinking, but also
the fact that it increases the risk of cancer.
Speaker 3 (14:42):
When I first started oncology, the guidance was that one
drink a day for women was acceptable. And now I
think they've really come out and said that no amount
of alcohol is safe for women when it comes to
breast cancer risk, and that takes us into midlife women.
You know, a lot of patients will ask me if
alcohol is bad for my total body health and overall
well being? Can I drink at all? What if I
(15:04):
enjoy a glass of wine at night to unwind? Can
I drink any drinks? Is there any amount of alcohol
that I can drink that's safe.
Speaker 5 (15:11):
Yeah, that's a good question.
Speaker 4 (15:13):
I mean, it really is how much kindling, if you will,
to which alcohol is a sort of a gas that
ignites a fire. Let me, let me, let me explain
what I mean by that.
Speaker 5 (15:29):
When you combine.
Speaker 4 (15:30):
Genetic risk with other lifestyle risks. For example, your diet's
not great, your sleep is poor, you're not moving, you're
not exercising, you're not managing your vascular risk.
Speaker 5 (15:44):
Factors the way they need to be managed, like.
Speaker 4 (15:47):
Blood sugar insulin sensitivity Lvl eight bl b, your blood
pressure is not optimally managed. So when you have all
of these modifiable risk factors that aren't well controlled, then
adding any alcohol to that is just like adding fuel
(16:09):
to a kindling fire.
Speaker 3 (16:11):
Right.
Speaker 4 (16:11):
But if you are in every other way looking after yourself, right,
and you're modifying those vascular risk factors, and you're exercising
and you're not smoking, and you're socially connected and you're
cognitively active, if you're doing all those things right, and
(16:33):
you're sleeping and you're taking your sleep seriously and you
eat a predominantly plant based diet with fiber, if you're
doing all of those things, is a glass of wine
with dinner occasionally?
Speaker 5 (16:46):
Is that like a no?
Speaker 4 (16:47):
No? Does everybody who drinks a cocktail or has an
occasional glass of wine going to develop dementia? No? But
it certainly depletes that cognitive reserve. And if you're genetically
at risk and you're not managing those other modifiable risk factors,
then it's the fuel to the fire, so to speak.
And in women in particular, you know oncologists right now
(17:11):
are kind of treating alcohol in women who are at
risk for breast cancer as a no no, you know,
one drink per day appears to increase the risk of
breast cancer by up to ten percent. I guess the
one other thing I will say is, in addition to
damaging DNA, there's something called the epigeno or epigenetics. So
(17:32):
we're born with, you know, our genetics, but the genes
that are active at any one time changes over the
course of your life, and it changes primarily in response
to your environment and your lifestyle. So you can turn
genes on and you can turn genes off. So one
(17:55):
of the things that alcohol does is it turns off
genes that are responsible for immune surveillance immune health, and
it turns on genes that can promote the development of cancer,
something we call onca genes. So I don't want the
listeners to be, you know, overwhelmed by all of this,
except to know that there's no doubt that alcohol is
(18:16):
not only a neurotoxin but a carcinogen. And science has
figured out and continues to figure out all the mechanisms
by which it does that. And by the way, you know,
as a neurologist, and as a preventive neurologist, I'm not
the alcohol police. I'm more like a brain health coach
(18:37):
where I can sit down with the patient and have
this kind of discussion with that. So am I an
absolutist where I would say that you know, one should
never touch alcohol. No, but there are some people who
never should touch alcohol, and I hope I've described who
that person is versus the person who enjoys an occasional
(18:59):
glass of wine with dinner, which at this point in time,
I will say it's okay, so long as they're managing
everything else in their life that protects their brain.
Speaker 3 (19:11):
Coming up after the break, doctor Dotick and I dive
deeper into the science and discuss genetics, dopamine, and alcohol's
effect on midlife women during perimenopause and menopause. Will be
right back. Are there genetic tests for alcohol metabolism that
(19:40):
you can tell genetically that somebody may be at more
risk from alcohol use than another person?
Speaker 4 (19:48):
You know, I don't do genetic testing for alcohol, but
you know there is something called a polygenic risk core
where where there may be hundreds of different genes that
increase the risk of alcohol use disorder, and so sometimes
it's good to be aware of that. There are pharmacogenomic
(20:10):
tests that w can do to determine the way in
which you metabolize certain medications that some people go on
that actually curbs your appetite for alcohol. Let's say the
GLP one antagonist, for example, the ozepic ozepics in the
moonjarro Those actually curb appetite for alcohol. Then there's something
(20:32):
called alcohol dehydrogenase, which is the principal enzyme that breaks
down alcohol into acid aldehyde. Women actually have less of it,
so they don't metabolize alcohol as well. But for people
who might have had a variant in the acid aldehyde
dehydrogenase G that may affect your propensity to drink.
Speaker 5 (20:55):
I'll give you an example.
Speaker 4 (20:57):
Some people rapidly produce acid aldehyde and they don't feel well,
They get flushed, they get nauseated. Just alcohol makes them
feel bad, so they don't drink. There are others people
who can so called drink people under the table, and
they have a high tolerance for alcohol, so they may
have to have three drinks or four drinks to feel
the buzz that someone with different metabolism feels after one drink.
Speaker 5 (21:22):
That's actually dangerous.
Speaker 4 (21:24):
Those people who can drink others under the table consume
more alcohol, and that neurotoxin is having an effect even
when you're not feeling the buzz. And remember that the
liver can only metabolize one drink per hour.
Speaker 5 (21:43):
That's the kind of metabolism it has.
Speaker 4 (21:45):
So the more you drink, and the more rapid you drink,
the more you know. Basically, the alcohol just keeps circulating
and keeps bathing your brain while it's waiting for the
liver to be freed up so that the enzymes can
metabolize it. So combine that with if you're one of
(22:05):
those people who, because of genes, can drink someone under
the table, you're really bathing your brain in a very
toxic soup, even though you may not be feeling the
buzz or feeling intoxicated.
Speaker 5 (22:20):
When you do drink.
Speaker 4 (22:22):
So if you're going to drink, and if you're going
to have more than one drink, boy, you're better spread
it out.
Speaker 3 (22:29):
So let's talk midlife women, dopamine, perimenopause, hormonal fluctuations, and
vulnerability to alcohol. In my reading of the research in literature,
currently alcohol use is dropping amongst younger populations except midlife women.
Estrogen fluctuations are occurring which impact the brain. They impact
the brain, energetics, blood flow to the brain, amyloid in
(22:53):
tao right at midlife? Are women more vulnerable to alcohol
problems in midlife in terms of the impact of alcohol
as a neurotoxin? And the second part to this question
is dopamine have anything to do with it? Because as
estrogen levels fluctuate, opamine goes down. Are women seeking more
(23:14):
alcohol maybe in this time of their lives or our lives?
Perhaps I should say because of dopamine. Do you see
any link there?
Speaker 4 (23:23):
Yeah, you know, it's the very population on which alcohol
can have the most profound effect, or midlife women, I
believe because of that. You know, profound fluctuation and estrogen
that occurs around the perimenopause and the menopause. And I'm
talking to a world expert right now, so I'm feeling
(23:44):
rather conspicuous. But you know what happens in the perimenopause
and the menopausal state. If you look at you know,
sometimes that gets distributed differently around the abdomen and viscera.
Sleep gets disrupted. Yes, you have symptoms like hot flashes
and nice sweats, changes in bone density occur brain fock.
(24:09):
You know, women are experiencing brain fog during that period
of time. And when you think about the effect of
alcohol on sleep, which we talked about, we didn't talk
about its effect on bone, but alcohol actually activates what
we call osteoclass, which break down bone and inhibit osteoblasts.
Speaker 5 (24:28):
Which form new bone.
Speaker 4 (24:29):
They also affect the way the liver activates vitamin D
and affects the way the kidney regulates calcium, so it
can have a profound effect on bone density. We've already
talked about brain fog and the effect that it can
have on women's brain, not the least of which estrogen
is neuroprotected, and so you've lost a hormone that was
(24:51):
protecting the brain and now you're trying to make up
with alcohol to correct that sort of dopamine gap. You
mentioned dopamine, and I just talked about the fact that
you know, as estrogen drops, the dopamine drops, that rewards
circuit is not as active, and alcohol of tends to
(25:12):
make up that gap, at least temporarily. You know the
other thing that alcohol does is, you know, for women
who are prone or at risk or breast cancer. Alcohol
can actually increase levels of estrogen and other hormones which
are associated with hormone receptive positive breast cancer. So that's
the reason why. Of course, on colleges, as you mentioned,
(25:33):
are are kind of becoming a binary decision for women.
Speaker 5 (25:39):
Where if they're at risk, they're told not to drink.
You know, women during midlife are.
Speaker 4 (25:47):
Trying to nurture and raise a family well at the
same time, trying to grow and build a career at
the same time, also trying to care be a caregiver
for aging parents. So this thirty five to sixty five
age range is very unique. It's kind of a there
being sandwiched between caring for children, caring from aging parents,
(26:11):
and trying to nurture and grow their own careers. And
this wine culture we're marketing heavily targets this demographic braining
alcohol is kind of a reward or a coping mechanism
for all of the invisible.
Speaker 5 (26:28):
Labor that women perform.
Speaker 4 (26:30):
It's really harmful. So, you know, I would say that
in many ways, the metabolic, the brain, the cardiac issues
that women face during this midlife are all exacerbated by alcohol,
(26:53):
and so the most vulnerable population which are women during
midlife are actually probably the population that shouldn't be consuming
alcohol or consuming it at a very modest level.
Speaker 3 (27:09):
The issue that I find that I get asked the
most and I find the most problematic is women will
say to me, it's closure to my day. I sit down,
I put my feet up, I have a glass of wine.
For me, it was a glass of bourbon or a
shot of bourbon. Or how do you respond to that
when people say I need some closure, I need something
(27:30):
to wind down. How do you coach somebody or what
do you recommend to a woman to replace that glass
of Chardonnay or that shot of Kentucky bourbon.
Speaker 4 (27:43):
The tough one because everybody has different social circumstances, different
family circumstances.
Speaker 5 (27:50):
But I think, you.
Speaker 4 (27:51):
Know, women tend not to delegate, and they certainly tend
not to divine. They tend to take all of the
responsibility on themselves, and I think they need time to
focus on themselves and do something positive, good and healthy
for themselves. And whether that's for these thirty to forty
five minutes, I'm actually going to get into a song.
(28:14):
I'm going to take a hot bath, I'm going to exercise.
I'm going to do something positive and good for myself
and with awareness of if they were aware of what
they're doing to their bodies, and the fact that you know,
when they take the edge off, if you will, with that.
Speaker 5 (28:31):
Glass of wine or that glass of.
Speaker 4 (28:32):
Bourbon in the evening, it disrupts their sleep. It may
actually promote hot flashes night sweats, It may actually promote
brain fog the next day.
Speaker 5 (28:43):
So it's a biological.
Speaker 4 (28:44):
Thief actually, and it is short term gain for long
term pain. And I think many of the anxiety that
I talked about. You know, alcohol has a profound effect
on mood as well.
Speaker 5 (28:59):
Part of the area of the brain. One of the
areas of the.
Speaker 4 (29:01):
Brain that alcohol effects causes what we call anhedonia, or
a lack of pleasure. So the very things that people
used to take pleasure and they don't get to much
pleasure out of anymore. So, given the effect on moved
and anxiety and sleep and cognitive function or brain flock,
coupled with the fact that it increases blood pressure as
(29:25):
a negative effect on the heart and cardiovascular disease is
still a primary cause of morbidity and mortality in women.
Bone health insulin sensitivity. All of these things are compounded
by the effects of alcohol.
Speaker 5 (29:43):
So I think if.
Speaker 4 (29:44):
Women, especially during midlife, had greater awareness of the profound
effect of alcohol at a multi organ level and the
very issues that they're dealing with for which they take
a glass of alcohol, which is which may be stress
or anxiety, it actually makes it worse over time. I
don't want to oversimplify things, and I don't want to
(30:06):
be accused of not being sensitive sense to everybody's life circumstances,
but it actually will exacerbate some of the very symptoms
for which you're actually taking that glass.
Speaker 5 (30:18):
Of wine or bourbon at night.
Speaker 3 (30:20):
Let's just talk very briefly about exercise at night. I
was always under the belief that you should not exercise
before you go to bed because it jacks up your
nervous system and can get you rubbed up. And indeed
that's kind of like not true and kind of the opposite, right,
So for me, I replaced my evening bourbon with core work,
or with push ups, or with taking a long walk.
(30:43):
Does exercise disrupt sleep or can it help us to
get better sleep? And we can substitute maybe a glass
of alcohol for a little bit of core work, a
little bit of setups or a long walk.
Speaker 4 (30:53):
Actually, oh, one hundred percent. I mean I think you know,
I exercise mostly in the evening actually, and it actually
has improved my sleep considerably. You know, my sleep scores
now are much better than they used to be, just
simply by not getting up early in the morning. I
mean some people, everybody's schedule in calendar is different.
Speaker 5 (31:15):
But for me to get up at four.
Speaker 4 (31:17):
Thirty or five o'clock in the morning and to get
a workout in before work, I used to feel good
doing it, But I feel better if I'm exercising in
the evening and my sleep is actually better in the
evening now. I don't mean like exercising at ten o'clock
at night and then trying to go to bed at eleven,
but I mean exercising in the evening before dinner that
(31:40):
actually will have a better effect on your insolent sensitivity,
on your metabolism, and on your ability to sleep then
perhaps exercising it at other times of the day. But yeah,
for women who are struggling, particularly midlife, with some of
the perimenopausal symptoms, including sleep, exercise is the best prescription
(32:04):
that I can write and is the most important prescription
for people to fill, especially women during that midlife I
love to hear that.
Speaker 3 (32:15):
Coming up, doctor Dodeck talks about the field of preventive
neurology and the ways in which we can protect the
brain and other organs before symptoms appear.
Speaker 1 (32:24):
More in a minute, Welcome back to the show.
Speaker 3 (32:41):
When I first came to Atria, I had a daily
meeting every morning with doctor Dodeck, and I quickly realized
I had to be really on my game at these meetings.
So another reason I actually quit drinking almost completely was
because of those daily meetings. I realized that my mind
wasn't as sharp as it could be if I had
(33:01):
had a drink at the night before. Looking back now,
it seems so obvious. I wanted doctor Doda to really
unpack for us all the ways that alcohol impact our health,
including his own specialty, preventive neurology. Let's talk a little
bit about the emerging field and exciting emerging field of
preventive neurology. Can you tell us a little bit about
(33:23):
what preventive neurology is, the research around alcohol and dementia prevention,
and how alcohol use counseling is being utilized as part
of the preventive neurology programs in order to prevent dementia.
Speaker 4 (33:40):
So preventive neurology is really a proactive shift in medicine
and in neurology in particular. So what I mean by
that is, instead of waiting to treat a stroke or
to treat someone's dementia or memory loss after it occurs,
neurologists now are looking at the lifestyle insults, like alcohol
(34:02):
being one of them that accumulates over decades. In fact,
there was a rather significant publication from the Lancet Commission
published in the Lancet and there have been three versions
of this on dementia prevention. And what they did was
they looked at how much dementia could be prevented if
(34:23):
you optimized, in other words, reduced or eliminated these risk
factors that are modifiable, and it turned out that about
forty five percent or almost half of all dementia could
be prevented if you optimized or modified those risk factors.
And alcohol is a profound risk factor. It's kind of
(34:47):
a monotonic risk factor. In other words, there's no amount
of alcohol that's actually safe for the brain. Unfortunately, because
as we talked about earlier, it's a neurotoxin. Obviously there's
a dose response, so that the more that you drink,
the more damage that can occur. And in those who
have serious issues alcohol use disorders or alcoholism, you can
(35:09):
have alcohol really to dementia. So it can directly cause
dementia as opposed to increasing the risk or other types
of dementia like Alzheimer's disease. You know, I talked about
what alcohol can do to the brain at the cellular level.
The other thing that it does is it actually activates
(35:31):
one of the enzymes in the brain that produces amyloid.
Not only that, but those who drink, you know, eight
or more drinks per week have actually been shown to
have increased levels of TOWL in the brain. And amyloid
and TOW are two proteins that aggregate or clump and
accumulate in the brain, and we believe those are the
(35:53):
two major protein insults that gives rise to Alzheimer's disease
and other types of dementia. They also increase the levels
of TOW and amyloid in the brain. And based on
what I said about sleep, reduce your ability to flush
out at night during deep sleep, so you can see
(36:15):
that alcohol has sort of a multidimensional and multi pronged
effect on the brain that you can see why it's
now a modifiable risk factor for dementia and the way
you know, neurologists are looking at preventive neurology now, it's
all about cognitive reserve. You know, think about your bank account.
Each time you make a withdrawal, you deplete the reserve
(36:38):
in your bank account.
Speaker 5 (36:40):
You think about the brain the same way.
Speaker 4 (36:42):
Each time you insult the brain, you reduce that cognitive
preserve because it's about what kind of cognitive independence and
cognitive longevity can I have when of them in my seventies, eighties,
and nineties, if I live that long. I actually believe
that the most devastating neurological diseases like stroke and dementia
(37:02):
are largely preventable.
Speaker 5 (37:05):
In addition to all.
Speaker 4 (37:06):
The other things that women are at risk for at
a significant higher risk than men, Alzheimer's disease is another one,
and especially women in midlife. If you knew that the
risk is two to three times of a woman developing
Alzheimer's disease than men, which is true, and you knew
(37:30):
that alcoholism, neurotoxin potentiates that risk.
Speaker 5 (37:34):
This is where precision medicine comes into things.
Speaker 4 (37:36):
So, doctor Poynter, if we do whole genome sequencing here
at Atria, as you know, if I have a young woman,
and I have plenty of young women right now in
the practice who have a genetic risk for Alzheimer's disease
and a family history, so they have one or two
(37:57):
copies of this risk gene called apo E four. For
a woman who has two copies of apo E four
or even one copy of APOLI four, who have that
genetic risk and who aren'toly optimized, I would say no
amount of alcohol is safe. And so there is an
example of someone who I would say no. The decision
(38:18):
here is binary, no alcohol zero if you don't want
to deplete quite rapidly that cognitive reserve. So I think
that's where precision medicine comes in. To say that nobody
should actually have any alcohol is an overgeneralization that medicine
(38:40):
is moving away from. We're getting into precision medicine now.
And so if I have a molecular phenotype of a
patient and I know what their insulin sensitivity is, and
I know what their blood pressure is, and I know
what their LDL is, and I know what their hemoglobinating
one sees. I know how metabolically healthy or unhealthy they are.
(39:02):
I know what their risk for cancer is. I know
what the risk for Alzheimer's disease is. I know what
their risk for heart diseases. Because we're assessing that. Then
to throw alcohol on those embers, I would say it's
a binary decision.
Speaker 5 (39:21):
And the answer to that is no.
Speaker 4 (39:22):
If you have someone who has a neuroprotectivegy for example,
and there are plenty of them who are metabolically optimized,
could that person have an occasional glass of wine with dinner. Yes, yes,
it's a neurotoxin, but it's.
Speaker 5 (39:40):
The body into which you put it.
Speaker 4 (39:43):
How much is that person at risks for some of
the detrimental consequences that alcohol can amplify. That's really the magic.
That's where medicine is going. It's all about precision prevention,
and that's the nuanced conversation that we're able to have
with patients now, given our ability to test and to
(40:05):
risk stratify, to identify people who are at that elevated risk.
My conversation with that person that young thirty two year
old woman who has two copies of AIGHTO E four
is very different than the young woman, thirty two year
old woman who has no copies of a bo E
four and is metabolically Christine and doing all the things
(40:27):
like bragging about her sleep score, exercising right, eating a
plant based diet, a Mediterranean diet. My conversation about alcohol
is going to be very different with those two people,
despite the fact that they're both thirty two year old
women or forty two year old women or shifty two
year old women.
Speaker 3 (40:43):
So taking it away from one recommendation into a highly
personalized recommendation, absolutely, can we undo the damage that's done.
Speaker 5 (40:51):
The answer is yes and no.
Speaker 4 (40:54):
On the on the positive side, if you stopped drinking,
assuming you're in other ways healthy, it actually has been
shown that if you stop drinking, that gray matter that cortex,
the sort of skin of the apples, so to speak,
starts to increase some volume. We know that even low
amounts of alcohol will shrink the gray matter, but we've
(41:16):
also seen that gray matter expands when you stop drinking.
We also know that you remember I talked about the
insulation that stripped off the fiber optic cabling the wiring
in the brain. We know that that can repair itself
as well. So yes, if you stop drinking and you
start looking after your body by focusing on nutrition, exercise, sleep,
(41:41):
you'll start to clear out and flush out some of
that accumulated protein.
Speaker 5 (41:45):
That's collective. Of course. When I said yes and no.
Speaker 4 (41:48):
I mean no insofar as if you continue, like I
talked about a dose response, the more you drink and
the longer you drink, some of the damage is not repairable.
But the good news is that if you stop drinking,
you start to see the beneficial effects of that almost immediately,
and then over time there's repair.
Speaker 5 (42:10):
There's repair that can occur.
Speaker 4 (42:11):
And we also know that the brain, even into older age,
is a very plastic organ and if you do all
of the things that we do in our brain health
program to optimize the health of the brain and to
optim we can actually optimize I think copative function over time.
I mean we've actually seen in our practice where not
(42:33):
only does cortical thickness and the volume of the gray
matter and cortex expand over time, but sometimes the hippocanphi,
which are these two little memory organs, and the temporal
lobes of the brain that are responsible. They're like the
save button on your computer, right, They store memories. They
put it into your hard drive, and now you have
(42:53):
that memory, those start to enlarge and work better as well.
You know, Look, if I could go back and tell
my eighteen or twenty five year old self what I
know now, I probably would have done things differently on
many different levels.
Speaker 5 (43:08):
I wouldn't have been eating, you know, the fast food
that I'm light have eaten.
Speaker 4 (43:11):
I wouldn't have been having the beer or any alcohol,
or it would have been certainly in very much moderation.
Speaker 5 (43:20):
But I can't do that now.
Speaker 4 (43:23):
But what I do know is that if you look
after the brain, regardless of what age you were, you
can improve that cognitive reserve over time and mitigate against
any sort of withdrawal continuing to withdraw on that reserve,
because if you don't, then you're going to get into
trouble over time.
Speaker 3 (43:43):
Doctor Dodick, thank you so much for today. You've been
a wealth of knowledge, and I know we're going to
get a lot of actionable points for our listeners. I
so appreciate it. We also appreciate it.
Speaker 5 (43:53):
Oh it's my pleasure. Thank you so much for having me.
Speaker 3 (43:56):
After this interview wrapped, I kept replaying doctor Dodick's words
in my mind that alcohol is a biological thief. Sure,
alcohol might make you feel better in the moment, and
I know for a lot of people it can be helpful.
Social situations are simply a habit that's formed over many years. Honestly,
(44:16):
it still feels new for me to go to a
party and not have a bourbon in my hand. But
when I think about the havoc it's wreaking on my health.
Plus the fact that I'm just not going to really
feel well the next day, I'm reminded why I stopped.
I can't afford to have a day where I don't
feel so great. Cutting back on alcohol may help improve
your sleep, protect your brain, and mitigate your long term
(44:40):
health risk. But I understand that cutting drinking entirely might
seem really unappealing to some people listening right now, even
knowing all the health risk. When I was researching for
this episode, I spoke with an academic who has studied
alcohol and human behavior. She told me about participants in
her studies, often women in midlife, who reported drinking wine
(45:02):
at night. Did this help take the edge off or
is a way to connect with their partner. I get that,
I really do. But I hope that this this conversation
has given you more context about the impact alcohol has
on your overall health and maybe even some new strategies
for ways to reframe your relationship with alcohol. Maybe you
(45:23):
take a long walk with your partner, or maybe you
even just exercise after work to close out your day.
It's okay to let go of old rituals. This will
make space for new habits and new routines. Coming up,
on the next episode of Decoding Women's Health, I'll be
(45:45):
answering some of our listeners really great intelligent questions about
my favorite topic, hormones and midlife women's health. Which BHRT
is most effective transdermal creams, gels or vagil cream's inserts
or oral pills?
Speaker 2 (45:59):
Okay, first, before we get into it, can you explain
or define be HRT?
Speaker 3 (46:04):
And if you like this podcast, please consider leaving us
a review wherever you're listening now it helps new people
find the show.
Speaker 1 (46:12):
Thanks so much.
Speaker 3 (46:14):
Decoding Women's Health is a production of Pushkin Industries and
the Atria Health and Research Institute. This episode was produced
by Rebecca Lee Douglas. It was edited by Amy Gaines McQuaid,
mastering by Sarah Burguare. Our associate producer is Sonya Gerwit.
Our executive producer is Alexandra Garreton. Our theme song was
(46:34):
composed by Hannes Brown. Concept creative development and fact checking
by Shavon O'Connor. A special thanks to Alan Tish, David Saltzman,
Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagdorn, Owen Miller,
Jordan McMillan, and Greta Cohne.
Speaker 1 (46:55):
If you have a.
Speaker 3 (46:55):
Question about women's health in midlife, leave us a voicemail
at four FO five two O one three three eight five,
or send us a message at Decodingwomen's Health at pushkin
dot FM. I'm doctor Elizabeth Pointer and thanks for listening.
Until next time.
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