Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#24: Alcohol: Little or None? That Is The Question
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
Hi, I'm Dr Bobby Du Bois and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome everyone to episode 24.
Speaker 1:Alcohol, little or none? That's the question. As we head into the holidays. This is an important question that many of us will ask and certainly it's been a question I've been asking myself. Like many topics I discuss, there are often two sides of the evidence story and here it's really no different, and I hope I can bring some clarity and practical ways for you to decide what's best for you. Is it none or some? And let's explore how your health type can help you decide what's best for you. If you've taken the quiz and you 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 a report about your characteristics.
Speaker 1:So the topic of alcohol confuses a lot of people because the headlines and the studies seem to be on all sides of the issue. There's a Gallup poll 45% of Americans feel that one to two drinks a day causes harm. Another 45% say no, they don't think it causes harm. Interestingly, the folks in their 20s have a higher concern about alcohol than people in their 60s. I found that interesting. So the poll shows us that we are confused. The blue zones you hear about drinking one to two classes of wine a night in many of these countries and these people live to be long and productive lives. So that's confusing. And then there's been this set of studies that people hear about that suggests that a little bit of alcohol lowers your mortality compared to not drinking at all, associated with cardiovascular disease or cancer, meaning a little bit of alcohol seems to help you live longer. So it's really understandable, if you read the headlines, that you're going to be confused.
Speaker 1:Well, let me give you my story, as I like to do at the beginning of episodes. Thanksgiving I drank more than I planned and therefore I ate more than I should. I then slept poorly, woke up in the morning kind of tired, had several coffees to get going and then the cycle repeated for four days, since we had family in for four days. So it wasn't ideal, I realize. For me and alcohol, my challenge is social situations. For some people it's you had an argument, you feel like a drink, you had a stressful day at work, you want to drink. For me, it's social situation, so I can identify when I'm going to have a desire to drink and maybe have more than I've planned.
Speaker 1:So since Thanksgiving I've been wondering is less alcohol the right way to go? Should I cut out alcohol completely? Is there a relatively safe amount 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?
Speaker 1:Well, what I hope over the course of this episode is I'll give you the evidence, the evidence associated with various harms cancer and heart disease and cognitive decline and the like and I'll give you some tools to how to think about this, and then you can answer the question none or some? There isn't a right answer. There's only the right answer for you, and today we're going to walk through five areas that alcohol can be harmful, and then you can put this into a decision framework that we'll talk about towards the end. We're going to talk about weight and the impact of alcohol on that, on heart disease, on cancer, on our sleep and on cognitive decline. Now my focus today is about social drinking. You know, one to two glasses a day, seven to 14 a week, or less than that If you're drinking a lot more than that. That's not what I'm talking about today. There are real harms to heavy drinking and binge drinking, and you should talk to your doctor or counselor or someone about today. There are real harms to heavy drinking and binge drinking, and you should talk to your doctor or counselor or someone about that. My focus is on is it no alcohol or is it small amounts, and how do we make the best decision?
Speaker 1:Now I want to, before we dive in, answer a question that's come up a number of different times Are there ways to work more closely with me? And the answer is absolutely yes. We talk a lot about what to do to live long and well, but what should you specifically be doing? It's a tough question when there's so many things that you could do and, frankly, not enough time in the day to do all of them, and that's why I've created the Living Well Aging Strong program an intimate six-month experience to help you find the 20% of actions that give you, hopefully, 80% of the results. I'll help you create a customized, personalized plan that works for your unique health needs, teach you how to work with the health system to your advantage and how to gather health information so you can control how you're aging no matter what life throws at you, and I'm so excited about this. I'm even including a visit to our 170-acre exotic animal wellness ranch, complete with spa amenities. Spots are limited, so check out the wait list at drbobbilivelongandwellcom or click the link in the show notes.
Speaker 1:Well, back to the alcohol story. Well, the first question is how much do Americans typically drink? Well, there's a couple ways to answer this question. One, how much alcohol is sold in the United States, and then you divide it by the number of people that live here, and what that turns out to be is about 600 drinks a year, or about 10 to 12 drinks a week, you know, one, maybe two glasses of wine or such per day. Now there's been a Gallup poll and that comes up with a slightly different answer, which is about four drinks per week is an average. Now, interestingly, this number was much higher in the 1980s, then it fell and then over the last two decades it's been going up again. So something to be concerned about. Now. What's alcohol in the United States? Pretty much a split between wine, beer and spirits. Now different age groups drink different elements but roughly nationwide it's about a third. A third a third. Just to give a framework for how much alcohol.
Speaker 1:I want to put it into categories. So there's the none category you don't drink. Now that may seem like a simple category, but the reality is people who don't drink may have never drank alcohol, or almost never, or they may used to have drunk alcohol but now, for one reason or another, they don't. So the none category, as we'll see when we talk about some of the studies, can be confusing. Then there's minimal drinking. That's sort of a drink some days of the week, less than seven drinks a week. Then there's the mild, social drinker one to two drinks per day, up to seven to 14 per week. Then there's the moderate drinker, and that's two to four drinks a day and then severe or very heavy would be five drinks per day. Okay, before we get into the harms, which is really where I think folks have most of the uncertainties.
Speaker 1:Let's talk about the benefits. So drinking a cocktail, having wine, having a beer with friends is both a wonderful social experience. We like the taste, many people like the taste, and it's a way of being with others, in a way to collaborate and enjoy one another. Also, the benefit of alcohol is it's relaxing for many and for me, as I mentioned earlier, social situations. That's where alcohol, for me, is very nice. Well, there was an interesting survey that was done on the issue of social interactions and confidence in those type of circumstances. So they surveyed about 275 people, asked them about alcohol use, asked them about marijuana use, and what they found is that when people drank or smoked marijuana, they felt more comfortable in these social situations. So the anxiety of being in social circumstances was lessened. But when they drank some, then they wanted to drink more and that had some consequences associated with it.
Speaker 1:We also know that drinking alcohol can lower your blood pressure. Now, it's only lowering your blood pressure for a couple of hours, so it's not going to be a long-term benefit in that regard, but that's something that happens. It also raises your heart rate, which isn't necessarily good. All right, now let's turn to the harms, because that's where the real action and the real story it is. Everybody hears about DUI, motor vehicle accidents and how many are associated with alcohol. A lot, but in studies that have been done unrelated to motor vehicle accidents, there's about 50,000 people in the United States who die every year related to alcohol, and this has doubled in the past 20 years. Now we also know that if you drink a lot of alcohol, it's harmful to your liver or your pancreas, your nerves in your body, can cause seizures and obviously can cause problems elsewhere, like heart attacks and the like. Okay, let's turn from the really severe high amounts of alcohol problems to the more realistic ones, or more common ones, associated with social drinking.
Speaker 1:Well, let's just take it from a weight gain standpoint Now. Wine and beer and cocktails do vary, but it's about 125 calories per drink. Now, if you have one to two drinks 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 that alcohol represents for you, and over the course of the year that could be 12 to 24 pounds. So from a calories in standpoint, alcohol can be an important issue for people and for those trying to lose weight. This is something to keep in mind. There's another piece of the puzzle, which is, when you drink alcohol, you increase the amount you consume of food. It increases your appetite. That's what they call certain drinks an aperitif which prepares you to eat. And studies have been done where they didn't ask people to drink alcohol. They actually infused it in their veins to sort of bypass the drinking process to see if that had anything to do with it. But people who had alcohol in their veins, they ate about 10% more than when they did not. So that's really, really important. If you're struggling with weight gain or having a difficult time losing weight, all right.
Speaker 1:Next, heart disease. Now this is where the data gets quite confusing. Now why do I say that? Well, there's been many studies that suggest that people who drink some not a lot, but people who drink some have less heart disease, less stroke, than people who drink none, and that gave rise to a focus on red wine, that it has benefits and therefore a glass or two of red wine is a good thing for you. But now I will come back to the point I raised earlier. It may not be that small amounts of alcohol are helpful for your heart. It may be that the reason people drink no alcohol and have a higher heart risk is that they stop drinking for a reason Either they used to drink an awful lot and they were worried about their health, or they developed another illness and therefore they were like, uh-oh, I better cut back. And most of these studies don't eliminate people who never drank. They basically focus on have you been drinking lately?
Speaker 1:So when you do a very sophisticated analysis called Mendelian genetics, so you look at a population of people and because they have different genetic types, you can almost randomize the effect of alcohol. This is complicated and happy to answer questions if people want to raise them with me, but in this large study of over 500,000 people, when they did this Mendelian randomization, what they found was there was no relationship where that I just talked about, where no alcohol was worse than some alcohol. When you did this adjustment, it just looked like for a stroke. The risk went up and up and up from no drinking to more alcohol. Now, with the heart disease, you didn't see that dip. You just saw a no relationship for small amounts of alcohol. Now what does this mean? Do I think there's a benefit to drinking in reducing heart attack risks? I don't think so. I don't think the data have been analyzed well enough, other than these studies, to answer that question.
Speaker 1:But if you drink even small amounts, I think associated with an increased risk of cancer and people often hear about well, yeah, it's liver cancer or it's in your mouth or your esophagus and, frankly, these are pretty uncommon. But there is an increased risk in two very common cancers breast cancer and colon cancer, and it's felt that the alcohol itself is toxic and it's that impact that causes DNA damage and that leads to cancer. It's been estimated in Europe not in the US, but they estimated in Europe that about 12,000 breast cancer deaths are associated with alcohol use and about 28,000 colon cancer deaths are associated with alcohol use. Colon cancer deaths are associated with alcohol use and overall, something like 10% of cancer cases are felt due to alcohol, even at pretty low amounts of alcohol one to two drinks per day, per week and there's been some studies that show that more alcohol, more cancer, even more alcohol, even more cancer. So in a very large summary of studies that had about a half million cancers in it, they found a dose-response relationship, meaning the more you drank, the more cancers seemed to develop.
Speaker 1:And I'll give you an example in breast cancer, if you had small amounts of alcohol 4% increase in risk. Moderate amounts 23% increase in risk and large amounts of alcohol 61%. Now let me put this into some numbers that might make more sense. So, yes, let me put this into some numbers that might make more sense. So, yes, for drinking lots of alcohol, there is a substantial increase in risk of breast cancer. If you're a woman with no other sort of risk factors, there's about a 13% risk of breast cancer, not death, but risk of breast cancer Not death, but risk of breast cancer. Now, if you drank small amounts again this is in the sort of one to two glasses of wine or spirits it increases it by a factor of 4%. So a 13% risk becomes about a 13.5% risk. So for the average woman who has not had breast cancer, their risk of breast cancer drinking small amounts does go up, but it only goes up from, say, 13% to 13.5%. So that's a real increase, but it's a small amount and we'll come back to this later.
Speaker 1:Okay, impact of alcohol on sleep and I've spoken about this at some length when we had our episode on sleep. So here's a really, really interesting one. They gave people a couple of drinks in the afternoon and they then measured at the time they went to bed. A breathalyzer test and they found. Well, by the time they went to bed, you know, six, eight, 10 hours later, all of a sudden their breathalyzer test showed no alcohol. But even though the breathalyzer test showed no alcohol, it was still in their brain because the study subjects felt that their sleep wasn't as good. Their total sleep time, their REM sleep time and such were all impacted. So I found this fascinating. So people say, oh well, I don't feel like I have any alcohol in my system, therefore I can drink and it won't affect my sleep. Here it suggests that in fact it may just do that and may it be more impactful than you think.
Speaker 1:Now we've talked also about N of 1 studies, where you test things in yourself, you have a baseline, you do something different, you test again and see what happens. Well, this is a perfect example with alcohol. You can do the test in yourself and see what time of day it matters, or maybe any time of day the alcohol will affect your sleep. Maybe you'll wear an Oura ring or maybe you'll just ask yourself the next morning. How did I sleep?
Speaker 1:Okay, the next harm, and that's cognitive decline, and as Gail and I have been reviewing the studies, this is the one that gave us a wake-up call. Now it's been known, and there's really no controversy, that heavy drinking is associated with seizures and loss of brain volume, meaning your brain shrinks. Now the question is, what about mild drinkers, people that are drinking one glass of wine a day or less, or maybe one to two? Well, once again there was a meta-analysis and it showed a dose-response curve. But here we have that same wrinkle as we talked about with heart disease, where people who drank no alcohol had a higher risk of cognitive decline than people who had one to two drinks a day. Those people who had one to two drinks per day had about a 3% reduction in cognitive decline, but it started to go up if you had two or more drinks a day. But again, we got to remind ourselves that people who didn't drink may have stopped drinking because their memory wasn't doing so well, or they have some other problem, or they did drink too much in the past. So you have to be very careful when you say a little bit of alcohol seems good for you. I'm not so sure. Okay, we talked about that sophisticated approach, mendelian randomization, where again we use different characteristics of genes of people and see what that means in terms of alcohol.
Speaker 1:When the UK Biobank study did this approach, what they found was that impact of a little bit of alcohol reduces your risk. That went away. So you know it found that the more alcohol more risk. So you know it found that the more alcohol more risk. But what they found was that less than one drink a day, there wasn't any increased problem, it appeared. There was another study which did this, where they looked at MRI scans. Where they did MRI scans on lots and lots of people 36,000 people and then correlated how much alcohol they drank. And so they were wondering if people drank a lot, did they have thinning of their brain, meaning shrinkage of their overall brain, their gray matter, their white matter? This is something you definitely don't want to have happen. Their gray matter, their white matter this is something you definitely don't want to have happen. And what they found was that, yes, even drinking one to two glasses a day, or seven to 14 drinks a week, there was some thinning and shrinkage of the brain. And, as I said, this was the wake-up call for Gail and I. Now, when they looked at people who 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.
Speaker 1:All right, so where are we? Where do we net out with all this? Should we all basically give up alcohol, or is some okay? Remember I have quoted the Hunter S Thompson saying about sort of sliding into the end of your life with all the gusto and kind of being completely used up when you reach the end of your life. So life is to be lived Now. Is our goal that we will do anything to reduce health risks? Likely, for most people, the answer is no. Life is full of risk-benefit trade-offs. We know if we wanted to live as long as possible, we would never get in a car, because being in a car you run the risk of an accident and a drunk driving person causing your death. We know if you starve mice, meaning for the rest of the mice life, you give them a third reduction in food, or half a reduction in food In mice, they live longer. Now we don't yet know whether this would make a difference in people, but the question is would we make those trade-offs. No, I drive in a car and most everyone does. They're not just saying the only thing matters is health. So I think ultimately it comes down to a risk-benefit trade-off.
Speaker 1:What are the enjoyment and benefits of alcohol for you and what are the risks, and then decide for yourself. I believe that drinking alcohol has no benefit to your heart. Now, if you drink small, small amounts, I think the harms are minimal Cognitive decline, it seems like less than seven drinks a week, no major impact. And yes, for breast cancer, drinking might increase. Small amounts of drinking might increase a breast cancer risk from 13% to maybe 13.5%. So each and every one of you can look at these benefits and risks and decide for themselves.
Speaker 1:Well, what have I done? Well, I enjoy alcohol, I enjoy wine, I enjoy beer. I really enjoy whiskey. I really enjoy whiskey and in social situations it does make me more relaxed and I enjoy that. I do believe that drinking more than two glasses a night, 14 drinks per week, does have many problems and I don't want to be in that category. Is there a protective amount where small amounts are good for you? I don't think so. I would say the data is uncertain, but I would say I'm not looking at alcohol for that type of benefit. Is there harm of one to two drinks a day? There, probably is, but it's probably very small, associated with a stroke or maybe cognitive decline, maybe cancer, but small amounts. How much harm is there if you drink 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 am aiming to do less than seven drinks a week, so I might drink a glass or two of wine, one, two or three days a week, and I keep it under that seven per week, and I think it's pretty darn safe and it brings me enjoyment and I'm not willing at this point to give up on that amount.
Speaker 1:Well, how are you going to make your decision? I've presented you with evidence, but there's another way to think about this, which is your health type. I believe your health type, which explains how health fits into your life, how you approach decision making, how you approach setbacks, can help us with this question as well. And again, if you haven't taken the quiz, please do so. Help us with this question as well. And again, if you haven't taken the quiz, please do so.
Speaker 1:I'll give you a couple of examples. Let's say you're a purposeful path planner and these are individuals who really care about their health but often don't know what to do and what the decision is, because there's a lot of conflicting information For you. I hope I've provided you with the evidence so you can decide what's right for you, and that I've distilled it down to what is the true impact on weight gain, on your heart, on cancer, cognitive decline and sleep. All right, what if you're a contentment creator? And for these individuals, life is important, life is to be enjoyed, health is important, but it's got to kind of fit into your life and your lifestyle. Now, drinking wine may be really important to you. What I hope I've done is to provide information and evidence. And for a contentment creator, they may say look, those risks at low amounts are exactly what I'm willing to accept and I'm not going to change my life. But it might be a wake-up call in some areas. Maybe the contentment creator's never been fully happy with their sleep and they might say for that purpose, it might be worth changing their lifestyle. And lastly, the holistic health hacker this is someone who wants to dial in all aspects of health and really maximize everything they can do. Now they may look at the data on sleep and how they think alcohol might affect their sleep and 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 to get every advantage they can in improving their health.
Speaker 1:Now, practical tips for me. Not practical tips from me to you, but practical reminders for me which might be useful for you. First, find my triggers. So my trigger isn't a stressful day that doesn't send me to have a cocktail or a glass of wine. For me it's really social situations, and so I know my trigger and so I'm cognizant of that. Tip two for me I practice my pillars, meaning I do my exercise. I've recently gotten back into meditation, since I had sort of forgotten about the benefits there, and I'm doing San on a much more regular basis, and when I do I'm less likely to want to have a drink at the end of the day. So that's helpful for me.
Speaker 1:I find number three a tip for me is to be proactive. If I'm going to a social situation, I either say to myself I'm going to have one glass of wine or two glasses of wine, or I'm not drinking tonight. And as long as I am proactive, it does make it a little bit easier and there are non-alcoholic alternatives. So I'm not real excited about the non-alcoholic whiskeys or gin, but the non-alcoholic beers have gotten really, really good. I enjoy athletic beer. They're not a sponsor I have no sponsors but it is actually the fastest growing beer company that is on the market.
Speaker 1:Well, as I said, I've decided I'm going to accept some risk. I am not going to cut out alcohol to minimize absolutely 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 your health type and you can decide what's best for you, what's best for you. I am along with you on this journey and hope that this has helped you in the holiday season, where drinking may well be an option. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at at drbobbilivelongandwellcom. That's, doctor, as in D-R bobbilivelongandwellcom.