Sometimes ignorance is better than the devil you know. I wish I hadn't listened to Dr Andrew Huberman's talk on the impact of alcohol, even for average alcohol consumption. Unfortunately I can't undo it now, for anyone else interested...
Learning Points
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Alcohol's Toxic Nature and Widespread Effects:
- Alcohol (ethyl alcohol/ethanol) is a known toxin that is both water- and fat-soluble, allowing it to easily pass into all cells and tissues of the body, including the brain.
- It is metabolised in the liver into acetaldehyde, a more potent poison that indiscriminately damages and kills cells.
- The calories from alcohol are "empty" as the metabolic process is costly and provides no nutritive value (vitamins, amino acids, fatty acids).
- Being drunk is essentially a poison-induced disruption of neural circuits.
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Brain Health and Neurodegeneration:
- High alcohol consumption (12-24 or more drinks per week) causes neurodegeneration, particularly in the neocortex.
- Even low to moderate alcohol consumption (e.g., 1-2 drinks per day or 7-14 drinks per week on average) is associated with thinning of the neocortex and other brain regions (loss of neurons).
- Alcohol suppresses the prefrontal cortex, which is involved in thinking, planning, and inhibiting impulsive behaviour, leading to increased impulsivity and reduced forethought.
- It significantly suppresses neural networks involved in memory formation and storage, which explains why blackouts occur even when a person is awake and active.
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Changes in Brain Circuits and Behaviour:
- Regular drinking (even once or twice a week) can physically change neural circuits that control habitual and impulsive behaviour, making individuals more impulsive and habitual even when not drinking. This involves a growth of synapses in these circuits. These changes are reversible with 2-6 months of abstinence for most people, though long-term heavy use can lead to lasting impacts.
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Mood, Stress, and Hormonal Systems:
- Alcohol initially causes a short-lived spike in dopamine and serotonin, leading to feelings of well-being, but this is followed by a long and slow reduction in these neurotransmitters, leading to diminished mood and motivation.
- Regular drinking, even at low to moderate levels, causes changes in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in increased baseline cortisol levels and heightened feelings of stress and anxiety when not drinking.
- Alcohol increases the conversion of testosterone to estrogen (aromatisation) in both men and women, which can contribute to estrogen-related cancers in women (e.g., breast cancer) and effects like gynecomastia, diminished sex drive, and increased fat storage in men.
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Gut-Liver-Brain Axis and Inflammation:
- Alcohol severely disrupts the gut microbiome by killing healthy bacteria.
- Alcohol metabolism in the liver is proinflammatory, releasing inflammatory cytokines.
- This combination leads to leaky gut, allowing bad bacteria to enter the bloodstream. These effects converge in the brain, disrupting circuits that control alcohol intake and increasing the desire to drink more.
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Cancer Risk:
- Alcohol significantly increases cancer risk by altering DNA methylation and gene expression.
- There is a 4-13% increase in breast cancer risk for every 10 grams of alcohol consumed, which is roughly one standard drink in the US per day. This risk has been documented since the late 1980s.
- Alcohol both increases tumor growth and reduces the immune system's ability to combat cancer.
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Genetic Predisposition and Age of Onset:
- Individuals who, after a few drinks, become more alert, talkative, and energetic (rather than sedated) are often those with a genetic predisposition to alcoholism or are chronic drinkers, indicating a higher risk.
- Starting drinking at younger ages (e.g., 13-15 or younger) significantly increases the risk of developing alcohol dependence/Alcohol Use Disorder (AUD), even without a family history of alcoholism. Conversely, delaying onset until legal drinking age (e.g., 21 in the US) substantially lowers this risk.
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Hangovers:
- Hangovers are a multifaceted phenomenon involving disrupted sleep, dehydration/electrolyte imbalance, increased stress hormones (hangxiety), disruption of the gut microbiome, and the presence of congeners (compounds in drinks that give flavour and contribute to hangover, unrelated to sugar content).
- Drinks with higher congener content (e.g., brandy, red wine, rum, whiskey) tend to cause worse hangovers than those with fewer (e.g., beer, vodka, gin, ethanol diluted in orange juice).
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No Health Benefits from Alcohol:
- The best amount of alcohol for overall health is zero consumption.
- The idea that resveratrol in red wine provides health benefits sufficient to justify drinking is not supported by science, as the amount needed would be outweighed by alcohol's negative effects.
- There is no evidence that alcohol consumption, even in small amounts, is beneficial for cellular resilience through hormesis.
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Pregnancy and Foetal Alcohol Syndrome:
- Pregnant individuals should absolutely not consume alcohol. Fetal alcohol syndrome leads to permanent diminished brain, limb, and organ development.
- There is no evidence that any specific type of alcohol is safer for a developing foetus. Alcohol is a mutagen that disrupts precise embryonic development.
Action Points
- Informed Decision-Making: Make informed decisions about alcohol consumption (zero, low-to-moderate, or excessive) based on the comprehensive understanding of its effects.
- Minimise Brain Degeneration: Be aware that even low to moderate drinking can lead to brain changes. If you drink, consider ways to offset negative effects, or reduce intake/abstain.
- Slow Absorption: If you choose to drink, consume a meal (especially one with carbohydrates, fats, and proteins) before or during drinking to slow alcohol absorption into the bloodstream.
- Recognise Risk Factors for Alcoholism:
- If you find that alcohol increases your energy and alertness for long periods, or if you've experienced blackout episodes, be very cautious as this may indicate a predisposition to alcoholism.
- Delay alcohol consumption until at least the legal drinking age (e.g., 21 in the US) to significantly reduce the risk of developing Alcohol Use Disorder, even if you have a genetic predisposition.
- If you notice requiring more drinks to achieve desired effects, you are likely disrupting your brain's dopamine and serotonin systems. Abstinence can help reset these systems.
- Support Gut Health:
- Consume two to four servings of low-sugar fermented foods daily (e.g., kimchi, sauerkraut, natto, low-sugar kefir/yogurt) to reduce inflammation and improve gut microbiome health. This can help repair the gut-liver-brain axis and mitigate some negative effects of alcohol. Probiotic or prebiotic supplements may also be considered.
- Manage Stress and Anxiety:
- Be aware that reducing or stopping alcohol consumption may initially lead to increased anxiety and stress due to changes in the HPA axis. Utilise stress modulation tools (behavioural, nutritional, supplementation, exercise-based) to manage these feelings.
- Hangover Management (Safely):
- Hydrate adequately: Drink at least two glasses of water for every alcoholic drink, and consider water with electrolytes, especially before bed and upon waking after drinking.
- Do NOT consume more alcohol to relieve a hangover; it only delays a worse one.
- Avoid non-steroid anti-inflammatory drugs (NSAIDs) like aspirin or Advil for hangover headaches, as they can further burden the liver and gut, which are already stressed by alcohol.
- Consider deliberate cold exposure (e.g., cold showers/ice baths) ONLY when sober to potentially accelerate alcohol clearance and boost dopamine/adrenaline, helping with hangover recovery. NEVER do this while inebriated due to the severe risk of hypothermia and drowning.
- If you drink, choose types of alcohol with fewer congeners (e.g., beer, vodka, gin) to potentially reduce hangover severity.
- Reduce Cancer Risk:
- Be aware of the increased cancer risk, especially breast cancer, associated with alcohol consumption.
- Consuming adequate folate and other B vitamins (especially B12) might partially offset some of this increased cancer risk, but will not eliminate it.
- Complete Abstinence During Pregnancy: Absolutely no alcohol consumption during pregnancy is recommended to prevent Foetal Alcohol Syndrome.