December 12, 2024 • 33 mins
Link to Health Type Quiz
Link to Living Well, Aging Strong 6-month group experience
As the holiday season approaches, the question of how much alcohol is too much becomes ever more pressing. What if the festive cheer of a drink or two could be clouded by the potential for long-term health risks?
Dr. Bobby unpacks the complex and often contradictory research around alcohol, helping listeners navigate the decision: is it best to have none, or is a little okay? By exploring the impacts of alcohol on weight/appetite, heart disease, cancer, sleep, and cognitive health, and by considering personal health types, listeners can make more informed choices about their drinking habits.
Key Topics Covered:
- Conflicting Headlines and Research:
Discussing the confusion around alcohol’s health effects, from Gallup poll insights to studies highlighting both potential benefits and risks.
Health Risks Explored:
Weight Gain: Alcohol adds calories and increases appetite, contributing to potential weight gain (study on caloric intake).
Heart Disease: Early studies suggested moderate benefits for small amounts of alcohol, but advanced analyses, like Mendelian randomization, challenge this assumption, not showing a protective effect (study on genetic analysis).
Cancer Risks: Alcohol consumption has been linked to several cancers, including breast and colon cancer. (WHO fact sheet).
Sleep Impacts: Alcohol disrupts sleep quality, even if consumed earlier in the day (small study on sleep effects).
Cognitive Decline: Even mild drinking shows potential risks for brain health, with larger consumption exacerbating damage (UK Biobank study).
Defining Drinking Levels:
Categories from non-drinker to heavy drinking were clarified, helping listeners identify where they stand (National Survey on Drug Use and Health).
Personal Stories and Practical Decisions:
Dr. Bobby shares his personal experience with holiday indulgence and offers practical strategies for mindful drinking.
Role of Health Types:
Leveraging your health archetype (e.g., Purposeful Path Planner or Contentment Creator) to guide decisions about alcohol consumption.
Takeaways:
Know Your Limits: For most, keeping alcohol under seven drinks per week minimizes risks without eliminating enjoyment.
As we navigate the complexities of alcohol's impact on health, I share my personal approach of allowing myself up to seven drinks a week, accepting some level of risk for the sake of balance. With the Living Well Aging Strong program, we provide tools to create personalized health plans, empowering you to make choices that align with your lifestyle. Let's embark on this journey together, equipped with knowledge and support, as we strive for imp
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:11):
Hi, I'm Dr Bobby Du Bois and welcome to Live Long
and Well, a podcast where wewill talk about what you can do
to live as long as possible andwith as much energy and figure
that you wish.
Together, we will explore whatpractical and evidence-supported
(00:32):
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome everyone to episode 24.
(00:59):
Alcohol, little or none?
That's the question.
As we head into the holidays.
This is an important questionthat many of us will ask and
certainly it's been a questionI've been asking myself.
Like many topics I discuss,there are often two sides of the
(01:19):
evidence story and here it'sreally no different, and I hope
I can bring some clarity andpractical ways for you to decide
what's best for you.
Is it none or some?
And let's explore how yourhealth type can help you decide
(01:40):
what's best for you.
If you've taken the quiz andyou know your health type,
wonderful.
If you haven't taken the quiz,great opportunity for you to do
that and just go to my website,drbobbylivelongandwellcom, and
you can take it and you'll get areport about your
characteristics.
(02:01):
So the topic of alcohol confusesa lot of people because the
headlines and the studies seemto be on all sides of the issue.
There's a Gallup poll 45% ofAmericans feel that one to two
drinks a day causes harm.
(02:23):
Another 45% say no, they don'tthink it causes harm.
Interestingly, the folks intheir 20s have a higher concern
about alcohol than people intheir 60s.
I found that interesting.
So the poll shows us that weare confused.
The blue zones you hear aboutdrinking one to two classes of
(02:45):
wine a night in many of thesecountries and these people live
to be long and productive lives.
So that's confusing.
And then there's been this setof studies that people hear
about that suggests that alittle bit of alcohol lowers
your mortality compared to notdrinking at all, associated with
(03:09):
cardiovascular disease orcancer, meaning a little bit of
alcohol seems to help you livelonger.
So it's really understandable,if you read the headlines, that
you're going to be confused.
Well, let me give you my story,as I like to do at the beginning
of episodes.
Thanksgiving I drank more thanI planned and therefore I ate
(03:33):
more than I should.
I then slept poorly, woke up inthe morning kind of tired, had
several coffees to get going andthen the cycle repeated for
four days, since we had familyin for four days.
So it wasn't ideal, I realize.
For me and alcohol, mychallenge is social situations.
(03:55):
For some people it's you had anargument, you feel like a drink
, you had a stressful day atwork, you want to drink.
For me, it's social situation,so I can identify when I'm going
to have a desire to drink andmaybe have more than I've
planned.
So since Thanksgiving I've beenwondering is less alcohol the
(04:17):
right way to go?
Should I cut out alcoholcompletely?
Is there a relatively safeamount and how am I supposed to
figure this out?
Now?
If I can't figure this out,then how are my listeners going
to know?
So which is it?
None or some?
Well, what I hope over thecourse of this episode is I'll
give you the evidence, theevidence associated with various
(04:40):
harms cancer and heart diseaseand cognitive decline and the
like and I'll give you sometools to how to think about this
, and then you can answer thequestion none or some?
There isn't a right answer.
There's only the right answerfor you, and today we're going
(05:01):
to walk through five areas thatalcohol can be harmful, and then
you can put this into adecision framework that we'll
talk about towards the end.
We're going to talk aboutweight and the impact of alcohol
on that, on heart disease, oncancer, on our sleep and on
(05:23):
cognitive decline.
Now my focus today is aboutsocial drinking.
You know, one to two glasses aday, seven to 14 a week, or less
than that If you're drinking alot more than that.
That's not what I'm talkingabout today.
There are real harms to heavydrinking and binge drinking, and
(05:44):
you should talk to your doctoror counselor or someone about
today.
There are real harms to heavydrinking and binge drinking, and
you should talk to your doctoror counselor or someone about
that.
My focus is on is it no alcoholor is it small amounts, and how
do we make the best decision?
Now I want to, before we dive in, answer a question that's come
up a number of different timesAre there ways to work more
(06:05):
closely with me?
And the answer is absolutelyyes.
We talk a lot about what to doto live long and well, but what
should you specifically be doing?
It's a tough question whenthere's so many things that you
could do and, frankly, notenough time in the day to do all
(06:26):
of them, and that's why I'vecreated the Living Well Aging
Strong program an intimatesix-month experience to help you
find the 20% of actions thatgive you, hopefully, 80% of the
results.
I'll help you create acustomized, personalized plan
(06:46):
that works for your uniquehealth needs, teach you how to
work with the health system toyour advantage and how to gather
health information so you cancontrol how you're aging no
matter what life throws at you,and I'm so excited about this.
I'm even including a visit toour 170-acre exotic animal
(07:06):
wellness ranch, complete withspa amenities.
Spots are limited, so check outthe wait list at
drbobbilivelongandwellcom orclick the link in the show notes
.
Well, back to the alcohol story.
Well, the first question is howmuch do Americans typically
drink?
Well, there's a couple ways toanswer this question.
(07:29):
One, how much alcohol is soldin the United States, and then
you divide it by the number ofpeople that live here, and what
that turns out to be is about600 drinks a year, or about 10
to 12 drinks a week, you know,one, maybe two glasses of wine
(07:50):
or such per day.
Now there's been a Gallup polland that comes up with a
slightly different answer, whichis about four drinks per week
is an average.
Now, interestingly, this numberwas much higher in the 1980s,
then it fell and then over thelast two decades it's been going
(08:10):
up again.
So something to be concernedabout.
Now.
What's alcohol in the UnitedStates?
Pretty much a split betweenwine, beer and spirits.
Now different age groups drinkdifferent elements but roughly
nationwide it's about a third.
A third a third.
Just to give a framework forhow much alcohol.
(08:39):
I want to put it into categories.
So there's the none categoryyou don't drink.
Now that may seem like a simplecategory, but the reality is
people who don't drink may havenever drank alcohol, or almost
never, or they may used to havedrunk alcohol but now, for one
reason or another, they don't.
So the none category, as we'llsee when we talk about some of
the studies, can be confusing.
(08:59):
Then there's minimal drinking.
That's sort of a drink somedays of the week, less than
seven drinks a week.
Then there's the mild, socialdrinker one to two drinks per
day, up to seven to 14 per week.
Then there's the moderatedrinker, and that's two to four
drinks a day and then severe orvery heavy would be five drinks
(09:24):
per day.
Okay, before we get into theharms, which is really where I
think folks have most of theuncertainties.
Let's talk about the benefits.
So drinking a cocktail, havingwine, having a beer with friends
is both a wonderful socialexperience.
(09:45):
We like the taste, many peoplelike the taste, and it's a way
of being with others, in a wayto collaborate and enjoy one
another.
Also, the benefit of alcohol isit's relaxing for many and for
me, as I mentioned earlier,social situations.
(10:08):
That's where alcohol, for me,is very nice.
Well, there was an interestingsurvey that was done on the
issue of social interactions andconfidence in those type of
circumstances.
So they surveyed about 275people, asked them about alcohol
use, asked them about marijuanause, and what they found is
(10:29):
that when people drank or smokedmarijuana, they felt more
comfortable in these socialsituations.
So the anxiety of being insocial circumstances was
lessened.
But when they drank some, thenthey wanted to drink more and
that had some consequencesassociated with it.
(10:50):
We also know that drinkingalcohol can lower your blood
pressure.
Now, it's only lowering yourblood pressure for a couple of
hours, so it's not going to be along-term benefit in that
regard, but that's somethingthat happens.
It also raises your heart rate,which isn't necessarily good.
All right, now let's turn tothe harms, because that's where
the real action and the realstory it is.
(11:11):
Everybody hears about DUI,motor vehicle accidents and how
many are associated with alcohol.
A lot, but in studies that havebeen done unrelated to motor
vehicle accidents, there's about50,000 people in the United
States who die every yearrelated to alcohol, and this has
(11:34):
doubled in the past 20 years.
Now we also know that if youdrink a lot of alcohol, it's
harmful to your liver or yourpancreas, your nerves in your
body, can cause seizures andobviously can cause problems
elsewhere, like heart attacksand the like.
Okay, let's turn from thereally severe high amounts of
(11:59):
alcohol problems to the morerealistic ones, or more common
ones, associated with socialdrinking.
Well, let's just take it from aweight gain standpoint Now.
Wine and beer and cocktails dovary, but it's about 125
(12:20):
calories per drink.
Now, if you have one to twodrinks a day, or somewhere in
the seven to 14 drinks per week,now that turns out to be one to
two pounds a month that thatalcohol represents for you, and
(12:42):
over the course of the year thatcould be 12 to 24 pounds.
So from a calories instandpoint, alcohol can be an
important issue for people andfor those trying to lose weight.
This is something to keep inmind.
There's another piece of thepuzzle, which is, when you drink
alcohol, you increase theamount you consume of food.
(13:07):
It increases your appetite.
That's what they call certaindrinks an aperitif which
prepares you to eat.
And studies have been donewhere they didn't ask people to
drink alcohol.
They actually infused it intheir veins to sort of bypass
the drinking process to see ifthat had anything to do with it.
(13:28):
But people who had alcohol intheir veins, they ate about 10%
more than when they did not.
So that's really, reallyimportant.
If you're struggling withweight gain or having a
difficult time losing weight,all right.
Next, heart disease.
Now this is where the data getsquite confusing.
(13:51):
Now why do I say that?
Well, there's been many studiesthat suggest that people who
drink some not a lot, but peoplewho drink some have less heart
disease, less stroke, thanpeople who drink none, and that
gave rise to a focus on red wine, that it has benefits and
(14:13):
therefore a glass or two of redwine is a good thing for you.
But now I will come back to thepoint I raised earlier.
It may not be that smallamounts of alcohol are helpful
for your heart.
It may be that the reasonpeople drink no alcohol and have
a higher heart risk is thatthey stop drinking for a reason
(14:38):
Either they used to drink anawful lot and they were worried
about their health, or theydeveloped another illness and
therefore they were like, uh-oh,I better cut back.
And most of these studies don'teliminate people who never
drank.
They basically focus on haveyou been drinking lately?
(15:00):
So when you do a verysophisticated analysis called
Mendelian genetics, so you lookat a population of people and
because they have differentgenetic types, you can almost
randomize the effect of alcohol.
This is complicated and happyto answer questions if people
want to raise them with me, butin this large study of over
(15:24):
500,000 people, when they didthis Mendelian randomization,
what they found was there was norelationship where that I just
talked about, where no alcoholwas worse than some alcohol.
When you did this adjustment,it just looked like for a stroke
.
The risk went up and up and upfrom no drinking to more alcohol
(15:50):
.
Now, with the heart disease,you didn't see that dip.
You just saw a no relationshipfor small amounts of alcohol.
Now what does this mean?
Do I think there's a benefit todrinking in reducing heart
attack risks?
I don't think so.
I don't think the data havebeen analyzed well enough, other
than these studies, to answerthat question.
(16:14):
But if you drink even smallamounts, I think associated with
an increased risk of cancer andpeople often hear about well,
(16:38):
yeah, it's liver cancer or it'sin your mouth or your esophagus
and, frankly, these are prettyuncommon.
But there is an increased riskin two very common cancers
breast cancer and colon cancer,and it's felt that the alcohol
(16:59):
itself is toxic and it's thatimpact that causes DNA damage
and that leads to cancer.
It's been estimated in Europenot in the US, but they
estimated in Europe that about12,000 breast cancer deaths are
(17:19):
associated with alcohol use andabout 28,000 colon cancer deaths
are associated with alcohol use.
Colon cancer deaths areassociated with alcohol use and
overall, something like 10% ofcancer cases are felt due to
alcohol, even at pretty lowamounts of alcohol one to two
drinks per day, per week andthere's been some studies that
(17:44):
show that more alcohol, morecancer, even more alcohol, even
more cancer.
So in a very large summary ofstudies that had about a half
million cancers in it, theyfound a dose-response
relationship, meaning the moreyou drank, the more cancers
(18:05):
seemed to develop.
And I'll give you an example inbreast cancer, if you had small
amounts of alcohol 4% increasein risk.
Moderate amounts 23% increasein risk and large amounts of
alcohol 61%.
Now let me put this into somenumbers that might make more
(18:27):
sense.
So, yes, let me put this intosome numbers that might make
more sense.
So, yes, for drinking lots ofalcohol, there is a substantial
increase in risk of breastcancer.
If you're a woman with no othersort of risk factors, there's
about a 13% risk of breastcancer, not death, but risk of
breast cancer Not death, butrisk of breast cancer.
(18:50):
Now, if you drank small amountsagain this is in the sort of
one to two glasses of wine orspirits it increases it by a
factor of 4%.
So a 13% risk becomes about a13.5% risk.
So for the average woman whohas not had breast cancer, their
(19:15):
risk of breast cancer drinkingsmall amounts does go up, but it
only goes up from, say, 13% to13.5%.
So that's a real increase, butit's a small amount and we'll
come back to this later.
Okay, impact of alcohol on sleepand I've spoken about this at
(19:37):
some length when we had ourepisode on sleep.
So here's a really, reallyinteresting one.
They gave people a couple ofdrinks in the afternoon and they
then measured at the time theywent to bed.
A breathalyzer test and theyfound.
Well, by the time they went tobed, you know, six, eight, 10
(19:59):
hours later, all of a suddentheir breathalyzer test showed
no alcohol.
But even though thebreathalyzer test showed no
alcohol, it was still in theirbrain because the study subjects
felt that their sleep wasn't asgood.
Their total sleep time, theirREM sleep time and such were all
(20:21):
impacted.
So I found this fascinating.
So people say, oh well, I don'tfeel like I have any alcohol in
my system, therefore I candrink and it won't affect my
sleep.
Here it suggests that in factit may just do that and may it
be more impactful than you think.
Now we've talked also about N of1 studies, where you test
(20:45):
things in yourself, you have abaseline, you do something
different, you test again andsee what happens.
Well, this is a perfect examplewith alcohol.
You can do the test in yourselfand see what time of day it
matters, or maybe any time ofday the alcohol will affect your
sleep.
Maybe you'll wear an Oura ringor maybe you'll just ask
(21:07):
yourself the next morning.
How did I sleep?
Okay, the next harm, and that'scognitive decline, and as Gail
and I have been reviewing thestudies, this is the one that
gave us a wake-up call.
Now it's been known, andthere's really no controversy,
that heavy drinking isassociated with seizures and
(21:31):
loss of brain volume, meaningyour brain shrinks.
Now the question is, what aboutmild drinkers, people that are
drinking one glass of wine a dayor less, or maybe one to two?
Well, once again there was ameta-analysis and it showed a
dose-response curve.
But here we have that samewrinkle as we talked about with
(21:57):
heart disease, where people whodrank no alcohol had a higher
risk of cognitive decline thanpeople who had one to two drinks
a day.
Those people who had one to twodrinks per day had about a 3%
reduction in cognitive decline,but it started to go up if you
(22:19):
had two or more drinks a day.
But again, we got to remindourselves that people who didn't
drink may have stopped drinkingbecause their memory wasn't
doing so well, or they have someother problem, or they did
drink too much in the past.
So you have to be very carefulwhen you say a little bit of
alcohol seems good for you.
(22:40):
I'm not so sure.
Okay, we talked about thatsophisticated approach,
mendelian randomization, whereagain we use different
characteristics of genes ofpeople and see what that means
in terms of alcohol.
When the UK Biobank study didthis approach, what they found
(23:02):
was that impact of a little bitof alcohol reduces your risk.
That went away.
So you know it found that themore alcohol more risk.
So you know it found that themore alcohol more risk.
But what they found was thatless than one drink a day, there
(23:23):
wasn't any increased problem,it appeared.
There was another study whichdid this, where they looked at
MRI scans.
Where they did MRI scans onlots and lots of people 36,000
people and then correlated howmuch alcohol they drank.
And so they were wondering ifpeople drank a lot, did they
(23:51):
have thinning of their brain,meaning shrinkage of their
overall brain, their gray matter, their white matter?
This is something youdefinitely don't want to have
happen.
Their gray matter, their whitematter this is something you
definitely don't want to havehappen.
And what they found was that,yes, even drinking one to two
glasses a day, or seven to 14drinks a week, there was some
thinning and shrinkage of thebrain.
And, as I said, this was thewake-up call for Gail and I.
(24:15):
Now, when they looked at peoplewho drank less than one drink a
day or less than seven a week,it did not appear that there
were any changes in the brain.
All right, so where are we?
Where do we net out with allthis?
Should we all basically give upalcohol, or is some okay?
(24:36):
Remember I have quoted theHunter S Thompson saying about
sort of sliding into the end ofyour life with all the gusto and
kind of being completely usedup when you reach the end of
your life.
So life is to be lived Now.
(24:57):
Is our goal that we will doanything to reduce health risks?
Likely, for most people, theanswer is no.
Life is full of risk-benefittrade-offs.
We know if we wanted to live aslong as possible, we would
never get in a car, becausebeing in a car you run the risk
(25:18):
of an accident and a drunkdriving person causing your
death.
We know if you starve mice,meaning for the rest of the mice
life, you give them a thirdreduction in food, or half a
reduction in food In mice, theylive longer.
Now we don't yet know whetherthis would make a difference in
(25:40):
people, but the question iswould we make those trade-offs.
No, I drive in a car and mosteveryone does.
They're not just saying theonly thing matters is health.
So I think ultimately it comesdown to a risk-benefit trade-off
.
What are the enjoyment andbenefits of alcohol for you and
(26:04):
what are the risks, and thendecide for yourself.
I believe that drinking alcoholhas no benefit to your heart.
Now, if you drink small, smallamounts, I think the harms are
minimal Cognitive decline, itseems like less than seven
drinks a week, no major impact.
(26:26):
And yes, for breast cancer,drinking might increase.
Small amounts of drinking mightincrease a breast cancer risk
from 13% to maybe 13.5%.
So each and every one of youcan look at these benefits and
risks and decide for themselves.
Well, what have I done?
(26:47):
Well, I enjoy alcohol, I enjoywine, I enjoy beer.
I really enjoy whiskey.
I really enjoy whiskey and insocial situations it does make
me more relaxed and I enjoy that.
I do believe that drinking morethan two glasses a night, 14
(27:09):
drinks per week, does have manyproblems and I don't want to be
in that category.
Is there a protective amountwhere small amounts are good for
you?
I don't think so.
I would say the data isuncertain, but I would say I'm
not looking at alcohol for thattype of benefit.
Is there harm of one to twodrinks a day?
There, probably is, but it'sprobably very small, associated
(27:32):
with a stroke or maybe cognitivedecline, maybe cancer, but
small amounts.
How much harm is there if youdrink less than seven glasses a
week?
If any, I think it's a really,really small risk.
And so what I net out is I amaiming to do less than seven
drinks a week, so I might drinka glass or two of wine, one, two
(27:56):
or three days a week, and Ikeep it under that seven per
week, and I think it's prettydarn safe and it brings me
enjoyment and I'm not willing atthis point to give up on that
amount.
Well, how are you going to makeyour decision?
I've presented you withevidence, but there's another
way to think about this, whichis your health type.
(28:18):
I believe your health type,which explains how health fits
into your life, how you approachdecision making, how you
approach setbacks, can help uswith this question as well.
And again, if you haven't takenthe quiz, please do so.
Help us with this question aswell.
(28:38):
And again, if you haven't takenthe quiz, please do so.
I'll give you a couple ofexamples.
Let's say you're a purposefulpath planner and these are
individuals who really careabout their health but often
don't know what to do and whatthe decision is, because there's
a lot of conflictinginformation For you.
I hope I've provided you withthe evidence so you can decide
(29:00):
what's right for you, and thatI've distilled it down to what
is the true impact on weightgain, on your heart, on cancer,
cognitive decline and sleep.
All right, what if you're acontentment creator?
And for these individuals, lifeis important, life is to be
enjoyed, health is important,but it's got to kind of fit into
(29:24):
your life and your lifestyle.
Now, drinking wine may bereally important to you.
What I hope I've done is toprovide information and evidence
.
And for a contentment creator,they may say look, those risks
at low amounts are exactly whatI'm willing to accept and I'm
not going to change my life.
(29:44):
But it might be a wake-up callin some areas.
Maybe the contentment creator'snever been fully happy with
their sleep and they might sayfor that purpose, it might be
worth changing their lifestyle.
And lastly, the holistic healthhacker this is someone who
wants to dial in all aspects ofhealth and really maximize
(30:07):
everything they can do.
Now they may look at the dataon sleep and how they think
alcohol might affect their sleepand they might say well, from
what Dr Byerby shares with me,maybe I'll reduce my alcohol
because I think it might help.
And again, they're trying toget every advantage they can in
improving their health.
(30:27):
Now, practical tips for me.
Not practical tips from me toyou, but practical reminders for
me which might be useful foryou.
First, find my triggers.
So my trigger isn't a stressfulday that doesn't send me to
have a cocktail or a glass ofwine.
(30:48):
For me it's really socialsituations, and so I know my
trigger and so I'm cognizant ofthat.
Tip two for me I practice mypillars, meaning I do my
exercise.
I've recently gotten back intomeditation, since I had sort of
forgotten about the benefitsthere, and I'm doing San on a
(31:11):
much more regular basis, andwhen I do I'm less likely to
want to have a drink at the endof the day.
So that's helpful for me.
I find number three a tip for meis to be proactive.
If I'm going to a socialsituation, I either say to
myself I'm going to have oneglass of wine or two glasses of
wine, or I'm not drinkingtonight.
(31:32):
And as long as I am proactive,it does make it a little bit
easier and there arenon-alcoholic alternatives.
So I'm not real excited aboutthe non-alcoholic whiskeys or
gin, but the non-alcoholic beershave gotten really, really good
.
I enjoy athletic beer.
(31:55):
They're not a sponsor I have nosponsors but it is actually the
fastest growing beer companythat is on the market.
Well, as I said, I've decidedI'm going to accept some risk.
I am not going to cut outalcohol to minimize absolutely
(32:15):
every risk, but, as I mentioned,I'm going to aim for less than
seven drinks a week.
Now you have the information.
You hopefully will know yourhealth type and you can decide
what's best for you, what's bestfor you.
I am along with you on thisjourney and hope that this has
(32:42):
helped you in the holiday season, where drinking may well be an
option.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
(33:03):
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at at
drbobbilivelongandwellcom.
That's, doctor, as in D-Rbobbilivelongandwellcom.
Hi, I'm Dr Bobby Du Bois and welcome to Live Long
and Well, a podcast where wewill talk about what you can do
to live as long as possible andwith as much energy and figure
that you wish.
Together, we will explore whatpractical and evidence-supported
(00:32):
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome everyone to episode 24.
(00:59):
Alcohol, little or none?
That's the question.
As we head into the holidays.
This is an important questionthat many of us will ask and
certainly it's been a questionI've been asking myself.
Like many topics I discuss,there are often two sides of the
(01:19):
evidence story and here it'sreally no different, and I hope
I can bring some clarity andpractical ways for you to decide
what's best for you.
Is it none or some?
And let's explore how yourhealth type can help you decide
(01:40):
what's best for you.
If you've taken the quiz andyou know your health type,
wonderful.
If you haven't taken the quiz,great opportunity for you to do
that and just go to my website,drbobbylivelongandwellcom, and
you can take it and you'll get areport about your
characteristics.
(02:01):
So the topic of alcohol confusesa lot of people because the
headlines and the studies seemto be on all sides of the issue.
There's a Gallup poll 45% ofAmericans feel that one to two
drinks a day causes harm.
(02:23):
Another 45% say no, they don'tthink it causes harm.
Interestingly, the folks intheir 20s have a higher concern
about alcohol than people intheir 60s.
I found that interesting.
So the poll shows us that weare confused.
The blue zones you hear aboutdrinking one to two classes of
(02:45):
wine a night in many of thesecountries and these people live
to be long and productive lives.
So that's confusing.
And then there's been this setof studies that people hear
about that suggests that alittle bit of alcohol lowers
your mortality compared to notdrinking at all, associated with
(03:09):
cardiovascular disease orcancer, meaning a little bit of
alcohol seems to help you livelonger.
So it's really understandable,if you read the headlines, that
you're going to be confused.
Well, let me give you my story,as I like to do at the beginning
of episodes.
Thanksgiving I drank more thanI planned and therefore I ate
(03:33):
more than I should.
I then slept poorly, woke up inthe morning kind of tired, had
several coffees to get going andthen the cycle repeated for
four days, since we had familyin for four days.
So it wasn't ideal, I realize.
For me and alcohol, mychallenge is social situations.
(03:55):
For some people it's you had anargument, you feel like a drink
, you had a stressful day atwork, you want to drink.
For me, it's social situation,so I can identify when I'm going
to have a desire to drink andmaybe have more than I've
planned.
So since Thanksgiving I've beenwondering is less alcohol the
(04:17):
right way to go?
Should I cut out alcoholcompletely?
Is there a relatively safeamount and how am I supposed to
figure this out?
Now?
If I can't figure this out,then how are my listeners going
to know?
So which is it?
None or some?
Well, what I hope over thecourse of this episode is I'll
give you the evidence, theevidence associated with various
(04:40):
harms cancer and heart diseaseand cognitive decline and the
like and I'll give you sometools to how to think about this
, and then you can answer thequestion none or some?
There isn't a right answer.
There's only the right answerfor you, and today we're going
(05:01):
to walk through five areas thatalcohol can be harmful, and then
you can put this into adecision framework that we'll
talk about towards the end.
We're going to talk aboutweight and the impact of alcohol
on that, on heart disease, oncancer, on our sleep and on
(05:23):
cognitive decline.
Now my focus today is aboutsocial drinking.
You know, one to two glasses aday, seven to 14 a week, or less
than that If you're drinking alot more than that.
That's not what I'm talkingabout today.
There are real harms to heavydrinking and binge drinking, and
(05:44):
you should talk to your doctoror counselor or someone about
today.
There are real harms to heavydrinking and binge drinking, and
you should talk to your doctoror counselor or someone about
that.
My focus is on is it no alcoholor is it small amounts, and how
do we make the best decision?
Now I want to, before we dive in, answer a question that's come
up a number of different timesAre there ways to work more
(06:05):
closely with me?
And the answer is absolutelyyes.
We talk a lot about what to doto live long and well, but what
should you specifically be doing?
It's a tough question whenthere's so many things that you
could do and, frankly, notenough time in the day to do all
(06:26):
of them, and that's why I'vecreated the Living Well Aging
Strong program an intimatesix-month experience to help you
find the 20% of actions thatgive you, hopefully, 80% of the
results.
I'll help you create acustomized, personalized plan
(06:46):
that works for your uniquehealth needs, teach you how to
work with the health system toyour advantage and how to gather
health information so you cancontrol how you're aging no
matter what life throws at you,and I'm so excited about this.
I'm even including a visit toour 170-acre exotic animal
(07:06):
wellness ranch, complete withspa amenities.
Spots are limited, so check outthe wait list at
drbobbilivelongandwellcom orclick the link in the show notes
.
Well, back to the alcohol story.
Well, the first question is howmuch do Americans typically
drink?
Well, there's a couple ways toanswer this question.
(07:29):
One, how much alcohol is soldin the United States, and then
you divide it by the number ofpeople that live here, and what
that turns out to be is about600 drinks a year, or about 10
to 12 drinks a week, you know,one, maybe two glasses of wine
(07:50):
or such per day.
Now there's been a Gallup polland that comes up with a
slightly different answer, whichis about four drinks per week
is an average.
Now, interestingly, this numberwas much higher in the 1980s,
then it fell and then over thelast two decades it's been going
(08:10):
up again.
So something to be concernedabout.
Now.
What's alcohol in the UnitedStates?
Pretty much a split betweenwine, beer and spirits.
Now different age groups drinkdifferent elements but roughly
nationwide it's about a third.
A third a third.
Just to give a framework forhow much alcohol.
(08:39):
I want to put it into categories.
So there's the none categoryyou don't drink.
Now that may seem like a simplecategory, but the reality is
people who don't drink may havenever drank alcohol, or almost
never, or they may used to havedrunk alcohol but now, for one
reason or another, they don't.
So the none category, as we'llsee when we talk about some of
the studies, can be confusing.
(08:59):
Then there's minimal drinking.
That's sort of a drink somedays of the week, less than
seven drinks a week.
Then there's the mild, socialdrinker one to two drinks per
day, up to seven to 14 per week.
Then there's the moderatedrinker, and that's two to four
drinks a day and then severe orvery heavy would be five drinks
(09:24):
per day.
Okay, before we get into theharms, which is really where I
think folks have most of theuncertainties.
Let's talk about the benefits.
So drinking a cocktail, havingwine, having a beer with friends
is both a wonderful socialexperience.
(09:45):
We like the taste, many peoplelike the taste, and it's a way
of being with others, in a wayto collaborate and enjoy one
another.
Also, the benefit of alcohol isit's relaxing for many and for
me, as I mentioned earlier,social situations.
(10:08):
That's where alcohol, for me,is very nice.
Well, there was an interestingsurvey that was done on the
issue of social interactions andconfidence in those type of
circumstances.
So they surveyed about 275people, asked them about alcohol
use, asked them about marijuanause, and what they found is
(10:29):
that when people drank or smokedmarijuana, they felt more
comfortable in these socialsituations.
So the anxiety of being insocial circumstances was
lessened.
But when they drank some, thenthey wanted to drink more and
that had some consequencesassociated with it.
(10:50):
We also know that drinkingalcohol can lower your blood
pressure.
Now, it's only lowering yourblood pressure for a couple of
hours, so it's not going to be along-term benefit in that
regard, but that's somethingthat happens.
It also raises your heart rate,which isn't necessarily good.
All right, now let's turn tothe harms, because that's where
the real action and the realstory it is.
(11:11):
Everybody hears about DUI,motor vehicle accidents and how
many are associated with alcohol.
A lot, but in studies that havebeen done unrelated to motor
vehicle accidents, there's about50,000 people in the United
States who die every yearrelated to alcohol, and this has
(11:34):
doubled in the past 20 years.
Now we also know that if youdrink a lot of alcohol, it's
harmful to your liver or yourpancreas, your nerves in your
body, can cause seizures andobviously can cause problems
elsewhere, like heart attacksand the like.
Okay, let's turn from thereally severe high amounts of
(11:59):
alcohol problems to the morerealistic ones, or more common
ones, associated with socialdrinking.
Well, let's just take it from aweight gain standpoint Now.
Wine and beer and cocktails dovary, but it's about 125
(12:20):
calories per drink.
Now, if you have one to twodrinks a day, or somewhere in
the seven to 14 drinks per week,now that turns out to be one to
two pounds a month that thatalcohol represents for you, and
(12:42):
over the course of the year thatcould be 12 to 24 pounds.
So from a calories instandpoint, alcohol can be an
important issue for people andfor those trying to lose weight.
This is something to keep inmind.
There's another piece of thepuzzle, which is, when you drink
alcohol, you increase theamount you consume of food.
(13:07):
It increases your appetite.
That's what they call certaindrinks an aperitif which
prepares you to eat.
And studies have been donewhere they didn't ask people to
drink alcohol.
They actually infused it intheir veins to sort of bypass
the drinking process to see ifthat had anything to do with it.
(13:28):
But people who had alcohol intheir veins, they ate about 10%
more than when they did not.
So that's really, reallyimportant.
If you're struggling withweight gain or having a
difficult time losing weight,all right.
Next, heart disease.
Now this is where the data getsquite confusing.
(13:51):
Now why do I say that?
Well, there's been many studiesthat suggest that people who
drink some not a lot, but peoplewho drink some have less heart
disease, less stroke, thanpeople who drink none, and that
gave rise to a focus on red wine, that it has benefits and
(14:13):
therefore a glass or two of redwine is a good thing for you.
But now I will come back to thepoint I raised earlier.
It may not be that smallamounts of alcohol are helpful
for your heart.
It may be that the reasonpeople drink no alcohol and have
a higher heart risk is thatthey stop drinking for a reason
(14:38):
Either they used to drink anawful lot and they were worried
about their health, or theydeveloped another illness and
therefore they were like, uh-oh,I better cut back.
And most of these studies don'teliminate people who never
drank.
They basically focus on haveyou been drinking lately?
(15:00):
So when you do a verysophisticated analysis called
Mendelian genetics, so you lookat a population of people and
because they have differentgenetic types, you can almost
randomize the effect of alcohol.
This is complicated and happyto answer questions if people
want to raise them with me, butin this large study of over
(15:24):
500,000 people, when they didthis Mendelian randomization,
what they found was there was norelationship where that I just
talked about, where no alcoholwas worse than some alcohol.
When you did this adjustment,it just looked like for a stroke
.
The risk went up and up and upfrom no drinking to more alcohol
(15:50):
.
Now, with the heart disease,you didn't see that dip.
You just saw a no relationshipfor small amounts of alcohol.
Now what does this mean?
Do I think there's a benefit todrinking in reducing heart
attack risks?
I don't think so.
I don't think the data havebeen analyzed well enough, other
than these studies, to answerthat question.
(16:14):
But if you drink even smallamounts, I think associated with
an increased risk of cancer andpeople often hear about well,
(16:38):
yeah, it's liver cancer or it'sin your mouth or your esophagus
and, frankly, these are prettyuncommon.
But there is an increased riskin two very common cancers
breast cancer and colon cancer,and it's felt that the alcohol
(16:59):
itself is toxic and it's thatimpact that causes DNA damage
and that leads to cancer.
It's been estimated in Europenot in the US, but they
estimated in Europe that about12,000 breast cancer deaths are
(17:19):
associated with alcohol use andabout 28,000 colon cancer deaths
are associated with alcohol use.
Colon cancer deaths areassociated with alcohol use and
overall, something like 10% ofcancer cases are felt due to
alcohol, even at pretty lowamounts of alcohol one to two
drinks per day, per week andthere's been some studies that
(17:44):
show that more alcohol, morecancer, even more alcohol, even
more cancer.
So in a very large summary ofstudies that had about a half
million cancers in it, theyfound a dose-response
relationship, meaning the moreyou drank, the more cancers
(18:05):
seemed to develop.
And I'll give you an example inbreast cancer, if you had small
amounts of alcohol 4% increasein risk.
Moderate amounts 23% increasein risk and large amounts of
alcohol 61%.
Now let me put this into somenumbers that might make more
(18:27):
sense.
So, yes, let me put this intosome numbers that might make
more sense.
So, yes, for drinking lots ofalcohol, there is a substantial
increase in risk of breastcancer.
If you're a woman with no othersort of risk factors, there's
about a 13% risk of breastcancer, not death, but risk of
breast cancer Not death, butrisk of breast cancer.
(18:50):
Now, if you drank small amountsagain this is in the sort of
one to two glasses of wine orspirits it increases it by a
factor of 4%.
So a 13% risk becomes about a13.5% risk.
So for the average woman whohas not had breast cancer, their
(19:15):
risk of breast cancer drinkingsmall amounts does go up, but it
only goes up from, say, 13% to13.5%.
So that's a real increase, butit's a small amount and we'll
come back to this later.
Okay, impact of alcohol on sleepand I've spoken about this at
(19:37):
some length when we had ourepisode on sleep.
So here's a really, reallyinteresting one.
They gave people a couple ofdrinks in the afternoon and they
then measured at the time theywent to bed.
A breathalyzer test and theyfound.
Well, by the time they went tobed, you know, six, eight, 10
(19:59):
hours later, all of a suddentheir breathalyzer test showed
no alcohol.
But even though thebreathalyzer test showed no
alcohol, it was still in theirbrain because the study subjects
felt that their sleep wasn't asgood.
Their total sleep time, theirREM sleep time and such were all
(20:21):
impacted.
So I found this fascinating.
So people say, oh well, I don'tfeel like I have any alcohol in
my system, therefore I candrink and it won't affect my
sleep.
Here it suggests that in factit may just do that and may it
be more impactful than you think.
Now we've talked also about N of1 studies, where you test
(20:45):
things in yourself, you have abaseline, you do something
different, you test again andsee what happens.
Well, this is a perfect examplewith alcohol.
You can do the test in yourselfand see what time of day it
matters, or maybe any time ofday the alcohol will affect your
sleep.
Maybe you'll wear an Oura ringor maybe you'll just ask
(21:07):
yourself the next morning.
How did I sleep?
Okay, the next harm, and that'scognitive decline, and as Gail
and I have been reviewing thestudies, this is the one that
gave us a wake-up call.
Now it's been known, andthere's really no controversy,
that heavy drinking isassociated with seizures and
(21:31):
loss of brain volume, meaningyour brain shrinks.
Now the question is, what aboutmild drinkers, people that are
drinking one glass of wine a dayor less, or maybe one to two?
Well, once again there was ameta-analysis and it showed a
dose-response curve.
But here we have that samewrinkle as we talked about with
(21:57):
heart disease, where people whodrank no alcohol had a higher
risk of cognitive decline thanpeople who had one to two drinks
a day.
Those people who had one to twodrinks per day had about a 3%
reduction in cognitive decline,but it started to go up if you
(22:19):
had two or more drinks a day.
But again, we got to remindourselves that people who didn't
drink may have stopped drinkingbecause their memory wasn't
doing so well, or they have someother problem, or they did
drink too much in the past.
So you have to be very carefulwhen you say a little bit of
alcohol seems good for you.
(22:40):
I'm not so sure.
Okay, we talked about thatsophisticated approach,
mendelian randomization, whereagain we use different
characteristics of genes ofpeople and see what that means
in terms of alcohol.
When the UK Biobank study didthis approach, what they found
(23:02):
was that impact of a little bitof alcohol reduces your risk.
That went away.
So you know it found that themore alcohol more risk.
So you know it found that themore alcohol more risk.
But what they found was thatless than one drink a day, there
(23:23):
wasn't any increased problem,it appeared.
There was another study whichdid this, where they looked at
MRI scans.
Where they did MRI scans onlots and lots of people 36,000
people and then correlated howmuch alcohol they drank.
And so they were wondering ifpeople drank a lot, did they
(23:51):
have thinning of their brain,meaning shrinkage of their
overall brain, their gray matter, their white matter?
This is something youdefinitely don't want to have
happen.
Their gray matter, their whitematter this is something you
definitely don't want to havehappen.
And what they found was that,yes, even drinking one to two
glasses a day, or seven to 14drinks a week, there was some
thinning and shrinkage of thebrain.
And, as I said, this was thewake-up call for Gail and I.
(24:15):
Now, when they looked at peoplewho drank less than one drink a
day or less than seven a week,it did not appear that there
were any changes in the brain.
All right, so where are we?
Where do we net out with allthis?
Should we all basically give upalcohol, or is some okay?
(24:36):
Remember I have quoted theHunter S Thompson saying about
sort of sliding into the end ofyour life with all the gusto and
kind of being completely usedup when you reach the end of
your life.
So life is to be lived Now.
(24:57):
Is our goal that we will doanything to reduce health risks?
Likely, for most people, theanswer is no.
Life is full of risk-benefittrade-offs.
We know if we wanted to live aslong as possible, we would
never get in a car, becausebeing in a car you run the risk
(25:18):
of an accident and a drunkdriving person causing your
death.
We know if you starve mice,meaning for the rest of the mice
life, you give them a thirdreduction in food, or half a
reduction in food In mice, theylive longer.
Now we don't yet know whetherthis would make a difference in
(25:40):
people, but the question iswould we make those trade-offs.
No, I drive in a car and mosteveryone does.
They're not just saying theonly thing matters is health.
So I think ultimately it comesdown to a risk-benefit trade-off
.
What are the enjoyment andbenefits of alcohol for you and
(26:04):
what are the risks, and thendecide for yourself.
I believe that drinking alcoholhas no benefit to your heart.
Now, if you drink small, smallamounts, I think the harms are
minimal Cognitive decline, itseems like less than seven
drinks a week, no major impact.
(26:26):
And yes, for breast cancer,drinking might increase.
Small amounts of drinking mightincrease a breast cancer risk
from 13% to maybe 13.5%.
So each and every one of youcan look at these benefits and
risks and decide for themselves.
Well, what have I done?
(26:47):
Well, I enjoy alcohol, I enjoywine, I enjoy beer.
I really enjoy whiskey.
I really enjoy whiskey and insocial situations it does make
me more relaxed and I enjoy that.
I do believe that drinking morethan two glasses a night, 14
(27:09):
drinks per week, does have manyproblems and I don't want to be
in that category.
Is there a protective amountwhere small amounts are good for
you?
I don't think so.
I would say the data isuncertain, but I would say I'm
not looking at alcohol for thattype of benefit.
Is there harm of one to twodrinks a day?
There, probably is, but it'sprobably very small, associated
(27:32):
with a stroke or maybe cognitivedecline, maybe cancer, but
small amounts.
How much harm is there if youdrink less than seven glasses a
week?
If any, I think it's a really,really small risk.
And so what I net out is I amaiming to do less than seven
drinks a week, so I might drinka glass or two of wine, one, two
(27:56):
or three days a week, and Ikeep it under that seven per
week, and I think it's prettydarn safe and it brings me
enjoyment and I'm not willing atthis point to give up on that
amount.
Well, how are you going to makeyour decision?
I've presented you withevidence, but there's another
way to think about this, whichis your health type.
(28:18):
I believe your health type,which explains how health fits
into your life, how you approachdecision making, how you
approach setbacks, can help uswith this question as well.
And again, if you haven't takenthe quiz, please do so.
Help us with this question aswell.
(28:38):
And again, if you haven't takenthe quiz, please do so.
I'll give you a couple ofexamples.
Let's say you're a purposefulpath planner and these are
individuals who really careabout their health but often
don't know what to do and whatthe decision is, because there's
a lot of conflictinginformation For you.
I hope I've provided you withthe evidence so you can decide
(29:00):
what's right for you, and thatI've distilled it down to what
is the true impact on weightgain, on your heart, on cancer,
cognitive decline and sleep.
All right, what if you're acontentment creator?
And for these individuals, lifeis important, life is to be
enjoyed, health is important,but it's got to kind of fit into
(29:24):
your life and your lifestyle.
Now, drinking wine may bereally important to you.
What I hope I've done is toprovide information and evidence
.
And for a contentment creator,they may say look, those risks
at low amounts are exactly whatI'm willing to accept and I'm
not going to change my life.
(29:44):
But it might be a wake-up callin some areas.
Maybe the contentment creator'snever been fully happy with
their sleep and they might sayfor that purpose, it might be
worth changing their lifestyle.
And lastly, the holistic healthhacker this is someone who
wants to dial in all aspects ofhealth and really maximize
(30:07):
everything they can do.
Now they may look at the dataon sleep and how they think
alcohol might affect their sleepand they might say well, from
what Dr Byerby shares with me,maybe I'll reduce my alcohol
because I think it might help.
And again, they're trying toget every advantage they can in
improving their health.
(30:27):
Now, practical tips for me.
Not practical tips from me toyou, but practical reminders for
me which might be useful foryou.
First, find my triggers.
So my trigger isn't a stressfulday that doesn't send me to
have a cocktail or a glass ofwine.
(30:48):
For me it's really socialsituations, and so I know my
trigger and so I'm cognizant ofthat.
Tip two for me I practice mypillars, meaning I do my
exercise.
I've recently gotten back intomeditation, since I had sort of
forgotten about the benefitsthere, and I'm doing San on a
(31:11):
much more regular basis, andwhen I do I'm less likely to
want to have a drink at the endof the day.
So that's helpful for me.
I find number three a tip for meis to be proactive.
If I'm going to a socialsituation, I either say to
myself I'm going to have oneglass of wine or two glasses of
wine, or I'm not drinkingtonight.
(31:32):
And as long as I am proactive,it does make it a little bit
easier and there arenon-alcoholic alternatives.
So I'm not real excited aboutthe non-alcoholic whiskeys or
gin, but the non-alcoholic beershave gotten really, really good
.
I enjoy athletic beer.
(31:55):
They're not a sponsor I have nosponsors but it is actually the
fastest growing beer companythat is on the market.
Well, as I said, I've decidedI'm going to accept some risk.
I am not going to cut outalcohol to minimize absolutely
(32:15):
every risk, but, as I mentioned,I'm going to aim for less than
seven drinks a week.
Now you have the information.
You hopefully will know yourhealth type and you can decide
what's best for you, what's bestfor you.
I am along with you on thisjourney and hope that this has
(32:42):
helped you in the holiday season, where drinking may well be an
option.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
(33:03):
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at at
drbobbilivelongandwellcom.
That's, doctor, as in D-Rbobbilivelongandwellcom.
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