To Drink or Not to Drink
Episode Stats
Summary
Dr. David Nutt is a world-renowned professor of neuropsychopharmacology and author of the new book, 'Drink: The New Science of Alcohol and Your Health' which delves into the long-term health consequences of alcohol, including its link to cancer, the fact that it kills more people via stroke than by cirrhosis, and the feminizing effect it has on men, and what it does to your sleep.
Transcript
00:00:00.000
brett mckay here and welcome to another edition of the art of manliness podcast as the title of
00:00:11.360
his book drink question mark suggest world-renowned professor of neuropsychopharmacology
00:00:16.000
david nutt thinks the cost-benefit analysis around consuming alcohol is an open question
00:00:20.380
he's not anti-alcohol he regularly drinks himself but he also thinks most people more
00:00:24.600
than two-thirds of folks around the world have had a drink in the past year need to understand
00:00:28.240
a lot more about drinking than they typically do in order to make an informed choice as to whether
00:00:32.420
and how much to partake to that end today on the show dr nutt shares the ins and outs of something
00:00:36.960
he calls both a fantastic and a horrible drug we discuss how people acquire a taste for something
00:00:41.540
that initially registers as a toxic poison and how alcohol affects the body and mind we then delve into
00:00:46.400
alcohol's long-term health consequences including its link to cancer the fact that it kills more
00:00:50.700
people via stroke than by cirrhosis the way it has a feminizing effect on men and what it does to your
00:00:55.340
sleep we discuss what influences someone's chances of becoming an alcoholic and the signs you've got
00:00:59.340
a drinking problem david also argues that drinking has some benefits and offers suggestions on how to
00:01:03.760
imbibe alcohol in a way that helps manage its risk we enter conversation with why more people are curbing
00:01:08.540
their drinking and the synthetic alcohol david is developing that mimics the relaxing effects of
00:01:12.640
alcohol without its negative downsides after the show's over check out our show notes at aom.is
00:01:17.200
slash drink all right professor david nutt welcome to the show thanks for having me so you have a
00:01:37.380
book out called drink question mark the new science of alcohol and your health and this is a deep dive
00:01:43.700
about the health consequences of alcohol consumption i'm curious what what led you down that path to
00:01:48.880
write this book well i'm a doctor like every doctor i've been confronted almost on a daily basis with
00:01:55.540
the consequences of alcohol but also i'm a researcher and i've spent the last 40 years of my life
00:02:00.900
researching how we can help deal with the problems of alcohol and i thought it was about time i distilled
00:02:06.840
all my wisdom into a publication while i still got a memory to recall it all well let's talk about the
00:02:13.100
state of alcohol consumption in the west today what's it like you're in the uk is the united
00:02:17.980
states pretty similar to the uk or maybe canada other english-speaking countries in terms of alcohol
00:02:23.040
consumption yeah they're all pretty similar people are generally drinking considerably more than they
00:02:28.720
should and certainly between 10 and 15 percent of the adult population have got alcohol related
00:02:34.240
problems so are we drinking more today than in previous decades yeah that's a difficult question to be
00:02:41.320
precise about because of course there were periods when alcohol consumption was considerably higher
00:02:47.400
than it is today that's before we had any regulations like back in the 1800s and there were periods when
00:02:53.620
it was lower like during the wartime and of course people were away doing other things but if we look back
00:02:59.140
say over the last 60 years back to the 1950s consumption of alcohol in the west has generally risen
00:03:06.680
fairly linearly so certainly in the uk now people are drinking on average twice what they were drinking
00:03:13.860
in the 50s and 60s and what do you do we have any idea what's causing the drive or do researchers have
00:03:18.920
any idea oh yes yes we know a lot about it i mean there are there are two main drivers to this the first is
00:03:24.860
the price hasn't kept pace with inflation so alcohol is now a third the real cost it was when i was a
00:03:31.300
student you know 40 odd years ago that's the first thing it's cheaper to drink now than it was before and the
00:03:35.800
second reason it's gone up is it availability in the uk we made a very big mistake in the 1990s which
00:03:43.420
we made a bit alcohol readily available in supermarkets and that massively increased the
00:03:48.820
off-sales consumption in fact all the increased consumption we have seen in the last 50 years
00:03:53.760
has been people buying it in supermarkets rather than buying it in them in bars and you're also seeing
00:04:00.320
alcohol in new forms i right i guess this past year two years like the seltzer alcohol has been
00:04:06.960
really popular yeah that's quite an interesting scam in a way isn't it because it's selling alcohol as
00:04:12.420
being healthy alcohol because it's got fewer calories but in reality the calorie benefits are trivial
00:04:17.540
and i think people are just people get confused and people genuinely think that they're doing that
00:04:22.820
they're actually reducing the risk of alcohol by drinking it without mixers just as a seltzer water but in fact
00:04:28.480
they're not they're certainly not reducing the risk and it's conceivable they might even be increasing
00:04:33.880
the risk because at least if you drink alcohol with beer you get some vitamins some b vitamins and
00:04:38.760
stuff whereas in water you get nothing but the ethanol well i thought it was interesting this book i
00:04:44.520
mean really highlights the dangers the risk of alcohol consumption and something you don't typically see
00:04:50.100
i mean we've all seen documentaries or read articles about the dangers of cigarette smoking or tobacco
00:04:55.840
consumption or you know other drug consumption but we often forget you know alcohol is a drug
00:05:00.960
correct but we kind of pretend like it's not what do you think's going on there
00:05:04.700
well that's it there's some interesting psychology the first is because so many of us drink
00:05:10.620
we don't want it to be a drug do we we don't want to be drug addicts we don't want to be drug users
00:05:16.400
but the first thing is you know that we've we have blinkers deliberately blinker ourselves to the
00:05:22.060
truth because we enjoy drinking and have to say you know the same is true for me you know alcohol is
00:05:27.800
is the ultimate social drug most of us have multiple examples of really good social interactions which
00:05:35.720
were lubricated by alcohol so we want it to be safe because we want to use it second thing is that
00:05:43.240
the drinks industry has become very very wise it hasn't it looked at what happened to the tobacco
00:05:49.360
industry where the tobacco industry tried to hide the evidence of the risks and the addictiveness of
00:05:54.580
tobacco and they were called out and and very savagely attacked the drinks industry admits that alcohol
00:06:00.760
is a problem but it says the way you deal with that is to drink responsibly which of course i think is
00:06:05.660
one of the most ridiculous statements of all because quite a lot of people drink to lose their sense of
00:06:11.440
responsibility and even if they don't deliberately try to do that alcohol takes away that control so
00:06:17.560
but the industry has kind of protected itself by saying yeah yeah you know we we know there's a
00:06:22.780
problem we're not denying a problem but it's your problem not our problem and then the third thing is
00:06:27.120
that the um the drinks industry has been very good at lobbying to maintain its status so for instance in
00:06:33.980
britain we can't advertise tobacco on tv but we can advertise alcohol because the drinks industry has
00:06:40.780
been such an efficient lobbying organization that it's got most of our politicians i think genuinely
00:06:46.600
believing that alcohol is a good thing rather than a bad thing for people and you also know i mean
00:06:51.100
there's some some kind of i don't know what's you can call them nefarious things like you were you
00:06:55.360
did some reports talking about how alcohol could be considered the most dangerous drug in the united
00:07:01.260
kingdom if you look at all those but sometimes that gets left out of official reports they don't
00:07:06.860
tend to ignore that well there was this famous report in my book i described this famous
00:07:10.520
blair government report on looking at how to deal with the harms of all drugs and then
00:07:15.580
suddenly when it gets published they've taken out the alcohol chapter
00:07:18.420
and i spoke to the secretary of the of the whole um whole research program and she said yeah well you
00:07:24.700
know the drinks industry said there were good things from alcohol and you said there were bad things
00:07:27.600
so we thought well how can we arbitrate and we said well hang on we're the scientists
00:07:32.080
when they're the drinks industry we kind of know the truth about both sides they only care about
00:07:37.960
their side all right let's talk about what happens to our our bodies and mind when someone consumes
00:07:43.080
alcohol let's start when it goes into your mouth and you you talk about how alcohol is an acquired taste
00:07:49.800
because is everyone who says that oh it's it's an acquired taste you said well it's an acquired taste
00:07:54.140
because alcohol by itself tastes really bad and is unpleasant what is it about alcohol that
00:08:00.960
tastes bad and feels like burning when you drink it well it burns your mouth in the same way as it
00:08:06.060
burns your skin when you put alcohol on the skin to kill bugs alcohol is extremely toxic substance it
00:08:11.740
damages the cells of your skin it irritates your nerves which is why it burns and does the same to
00:08:16.280
your mouth you could you know if actually all the only alcohol we had available to everyone forever
00:08:22.000
was kind of neat rubbing alcohol most people wouldn't drink because they'd hate the taste when we drink
00:08:30.160
alcohol we were almost always drinking alcohol that has been changed diluted have had the taste of
00:08:36.100
other things added whether it's in the process of making the alcohol like in beer or whether it's in
00:08:40.720
the process of mixing the alcohol with mixers like with spirits but even then it's still an acquired
00:08:46.260
taste but then so if it kind of tastes unpleasant like what causes people to have that drive to drink
00:08:52.360
well yes so that it's there are several factors and it's there are different factors at different
00:08:57.100
stages of a person's drinking history so when you first drink even alcohol when it's in the form of
00:09:03.200
beer or in the form of wine or in the form of i'll say a whiskey or something where it's got other
00:09:08.740
flavorings those aren't very pleasant either so beginner drinkers often add sugar or or lemonade to
00:09:16.560
their drinks and that's where breezers come in breezers these run breezers which are basically like
00:09:21.880
alcoholic laminades they make alcohol potable to young people so the first thing is they you know
00:09:28.220
then and then once they can drink it they then get the effects and of course it's the effects which are
00:09:33.400
pleasurable people drink alcohol largely for the effects but in time they attribute the effects to the
00:09:40.860
taste and then they get to like the taste okay so let's it goes past your mouth it's a little unpleasant
00:09:46.960
it burns but once you get the effects it becomes desirable what happens when alcohol gets to your
00:09:52.540
stomach and i'll just say it's a there's one just one aspect about drinking it's a bit like smoking
00:09:57.900
when you get the catch at the back of your throat with alcohol particularly people drinking um distilled
00:10:02.340
spirits like a scotter of vodka that burning in itself becomes associated with the pleasure that's
00:10:08.320
going to happen in a few minutes so that gets to be liked as well because it's a kind of forewarner
00:10:13.220
you know great now i'm going to get hit in a little while so even that burning experience can
00:10:19.160
end up being pleasant anticipatory but then it goes down into your gullet and it burns down there a bit
00:10:24.940
and then it gets to your stomach there and then it gets absorbed and it goes through your liver and
00:10:29.740
your liver tries to get rid of it because the liver says this is a this is really bad stuff guys this is
00:10:33.360
we're being poisoned and the liver cells work like hell to get rid of it but of course they can't get rid
00:10:37.220
of it all and if some gets up through the liver into the brain and then wow the brain starts to say
00:10:42.020
this is different this is interesting hey i'm chilling out hey i like this i'm calm i'm relaxed
00:10:48.720
i feel like going to talk to that person at a party instead of sitting in the corner being inhibited
00:10:52.940
and that that breakdown of social anxiety is where alcohol is such a powerful drug and that really is
00:10:58.940
the main reason most people drink all right so alcohol goes to your stomach it goes through the
00:11:04.360
liver the liver is basically i mean alcohol is a poison yeah essentially and so the livers their job is
00:11:10.540
like we're going to filter that stuff out yeah and we'll talk about what happens when the liver is
00:11:14.440
constantly having to filter alcohol but let's talk about what happens when the alcohol crosses the
00:11:19.300
blood brain barrier so you mentioned okay you start feeling more social a little more loose like what
00:11:24.440
is going on in our brain with the neurochemicals in our brain well alcohol has is very complicated but
00:11:30.620
the very early stages the very the when you're beginning to get the effect of alcohol it's in the
00:11:36.600
relaxing sociability effect that's because alcohol is beginning to turn on what's called the GABA system
00:11:42.620
GABA stands for gamma amino butyric acid and it's one of the two major neurotransmitters in the brain
00:11:49.320
and it's the calming neurotransmitter it keeps the brain calm and that's pretty important because if
00:11:54.700
the brain isn't calmed then you go on and have anxiety or you have seizures so GABA is always working
00:11:59.880
to calm the brain but when you go into a circumstance where you get stressed you need more GABA and you
00:12:05.740
many people can't make enough so alcohol tops up the GABA and starts to calm you down and that is why
00:12:13.460
it reduces anxiety in circumstances like parties but also think about airplanes what's the first thing
00:12:19.880
they do when the fasten seat belt sign is turned off they start serving alcohol because
00:12:26.320
a vast number a huge probably a huge almost the majority of people hate flying and they they
00:12:32.080
find alcohol is a good way of calming their nerves and then also it does other things too it increases
00:12:38.180
dopamine which gives alcohol it's you know you want it it makes it desirable is that dopamine release
00:12:44.480
well yes so i mean let's be clear that different people value alcohol for different reasons
00:12:51.380
so some people value alcohol because it calms them and relaxes them and some people value alcohol
00:12:57.800
because it deadens the pain and the misery of their lives but some people like alcohol because it
00:13:02.560
yeah it gets them up and gets them going and that is the dopamine release and they they enjoy the energy
00:13:07.480
it gives them and that's why it's a really quite remarkable drug because it calms you down and yet it
00:13:12.480
stimulates you at the same time so like a poor man's purple heart you remember purple hearts in the
00:13:16.960
korean war and the vietnam war this combination of barbiturates and amphetamines well alcohol is like
00:13:22.920
a kind of cheaper less powerful version of those and then it also releases endorphins in addition to
00:13:29.080
dopamine that's right it's quite hard to find any neurotransmitter system in the brain that alcohol
00:13:35.740
doesn't affect but we're absolutely very clear it does release endorphins and that may be
00:13:41.300
why it is very appealing to some people may also be the one of the reasons why people become addicted
00:13:48.300
to it because endorphins are basically the body's equivalent of morphine and heroin and not as potent
00:13:53.880
as those drugs but certainly work in the same way and can begin to drive people to an addictive use of
00:14:00.120
alcohol what happens like in different stages of drunkenness so you have that you know maybe that first
00:14:05.260
drink what's going on so there's gaba being released at that point serotonin it's quite
00:14:11.140
maybe a bit technical but let me just it's not alcohol doesn't release gaba what it does is it
00:14:16.400
mimics it okay gab is being released and then alcohol comes along and it makes the release gaba better
00:14:22.040
it kind of facilitates augments gives a little bit of extra oomph to the gaba that's there
00:14:28.660
gotcha okay so in the beginning it's giving that oomph to the gaba that's there so that's what causes
00:14:34.820
maybe less inhibition you start talking louder more gesturing etc yeah more relaxed that's right
00:14:41.100
it's about taking you know you're taking away the inhibition which is i mean social inhibition is
00:14:47.480
one of the cardinal features of humanity humans is quite likely so very suspicious of other people
00:14:53.640
because you know other people could be from other tribes and societies and you know you people
00:14:59.360
generally yeah anxiety is a kind of good state to be in because it protects you from doing ridiculous
00:15:04.380
things dangerous things but alcohol but of course anxiety is not really useful when you're in a social
00:15:09.740
situation you want to start chatting to someone in a party but you can't overcoming that's
00:15:14.540
challenging alcohol does reduce that anxiety that social anxiety through potentiating gaba yeah
00:15:20.360
at what point does you know reduced reaction times or slurred speech or you know stumbling start
00:15:26.140
happening right so as you as the as you build up so you start off by by enhancing gaba then you begin
00:15:32.920
to interact with the dopamine system and some people you people get energized and active and
00:15:36.920
and and then as you begin to increase it a bit more then people become maybe more empathetic and
00:15:42.360
then maybe a bit of serotonin is uh is turned on and that that is actually serotonin plus gaba is a
00:15:48.000
really good combination for socializing and just having fun and being with other people and warming to
00:15:52.980
them becoming affectionate but then as you begin to push it up again once you start to get over
00:15:58.660
about a hundred milligrams per cent which is sort of twice the drink driving limit in most countries
00:16:03.320
then you begin to interfere with the system called glutamate now glutamate is the opposite it's the
00:16:09.860
alter ego of gaba gaba calms you down glutamate activates you but glutamate is the driver glutamate
00:16:17.840
is like the electricity of the brain and what alcohol does to glutamate is to block it
00:16:22.640
so that's a alcohol starts stopping the brain working properly and that's where you begin to get into
00:16:31.380
the experience of slurring your speech and becoming a little unsteady and then of course if you keep
00:16:37.520
pushing the drink up and up and up then you get into the situation where um you start to forget what
00:16:43.420
you've uh been doing because uh glutamate is vital for laying down memories and then you can get to the
00:16:49.280
point i guess where there's so much glutamate block where you black out or potentially just dying that's
00:16:54.980
the that's the well the thing that happened absolutely alcoholic blackouts are called blackouts
00:17:00.360
because you can't remember anything when you block glutamate to a level a certain level you get
00:17:06.320
blackouts it's like an anesthetic you know that's what many anesthetics do they take away the glutamate
00:17:10.680
so you you're not conscious um so you can't remember and then of course if you keep on blocking
00:17:16.080
glutamate glutamate because it's the as i say it's the electricity of the brain it's just like switch
00:17:20.520
eventually flurring the switch and people if you haven't got enough glutamate to make your diaphragm
00:17:28.420
and your chest muscles move then you start breathing and you are dead and in britain about
00:17:35.000
three young people a week die of alcohol poisoning in america it's probably more like 10 or 20 i would
00:17:39.240
think okay so that's what happens when you you drink alcohol let's talk about the next day
00:17:44.720
what happens afterwards what is i think a lot of people have experienced a hangover what causes
00:17:50.280
what's going on when someone's having a hangover after drinking alcohol it's very hard to actually
00:17:54.880
be precise about this there's almost no research been done on a hangover no scientific research
00:18:00.280
it's one of the least in terms of the research per impairment of life years it's one of the least
00:18:08.980
studied aspects of humanity because hangovers actually cause more burden the cost of hangovers
00:18:16.280
to society is greater than the medical costs of alcohol in britain at least three times greater
00:18:22.880
and of course many people suffer from hangovers just so often in fact a lot of people don't realize that
00:18:28.720
in britain the first constraints ever on the time people are allowed to drink the beginning of
00:18:37.620
licensing hours which i think is true now in most countries was in the first world war and we stopped
00:18:44.360
people drinking at 10 o'clock in the evening so that they wouldn't have hangovers so they could go
00:18:47.980
work go to work the next day because it used to it used to be this famous saying in the british mines
00:18:54.100
that basically the miners did a four-day week because they were so drunk at the weekend they couldn't
00:18:58.540
go to work on a monday but anyway put that to one side hangovers are hugely problematic
00:19:02.700
economically but also they're you know very distressing to the people who've got them
00:19:07.560
in fact driving with a hangover is almost as impairing as driving when you're drunk depending on how
00:19:14.920
drunk you are but the hangover usually is as impairing as the threshold for drink driving
00:19:19.980
so despite all that there's very little research what we can say is that obviously hangovers relate to
00:19:26.780
how much you've drunk and they relate to how long after you've drunk obviously they get better the
00:19:32.960
longer you've been sober the better they get they often to some extent are worsened by the fact that
00:19:38.860
we tend to drink at night and therefore when we go to sleep our sleep is disrupted by alcohols and
00:19:44.220
the hangovers we wake up early so we're sleep deprived as well and what's actually going on in
00:19:49.500
the brain is as i say not well understood there is some evidence it's due to dehydration and some
00:19:55.280
people drink a lot of water before they go to bed to stave off hangovers a little bit of evidence for
00:19:59.460
that there's growing evidence it's due to inflammation in the brain which will explain why
00:20:04.360
drugs you know such as acetaminophen and which is paracetamol in the uk and ibuprofen can be useful
00:20:11.140
either when you go to bed or when you wake up with a hangover to deal with the not just the pain but also
00:20:16.380
the inflammation we've been doing some work recently showing that there are things called cytokines
00:20:21.420
and when you get ill say you get covid or you get flu your body pumps out cytokines and some of them
00:20:28.380
are good and some of them are bad but the bad ones you get when you've got covid or flu you also get
00:20:33.460
when you have a hangover so it's a it's there's a sort of strong relationship with being ill and having
00:20:39.920
a bad reaction is the same kind of biological drivers to both the hangover and and feeling sick with
00:20:46.360
let's say influenza yeah and you also talk about you know withdrawal or i mean hangovers are basically
00:20:51.820
it's a withdrawal like you you've had this drug and your body is responding by now that it's not no
00:20:57.940
longer has that drug yes let me just be clear about it there are two separate elements to hangover
00:21:04.980
there is absolutely the withdrawal and the withdrawal is particularly around glutamate that when you get
00:21:12.140
drunk enough to have a hangover you have started to block the glutamate receptors and and what they do
00:21:18.400
because as i said these are the crucial mediators of brain function it is like the electricity of the
00:21:24.980
brain you if you you've got to keep your glutamate working now if you block glutamate receptors it's not
00:21:30.960
working as well so what the brain does is make more of the receptors to overcome to offset the effects of
00:21:37.700
the alcohol and once it's done that there's more of them in the brain so that when you when the alcohol
00:21:43.020
levels start to fall overnight you've actually got more receptors so you've got more glutamate so it's
00:21:48.680
like turning on the light turning on the noise in your brain because you've got you got more throughput
00:21:53.920
so that's the first thing so that's the that's where you get the steep disruption and the the bright
00:21:59.620
lights and the noises are too loud and and uh the arousal and the pounding heart etc from a hangover
00:22:08.180
that's because the glutamate system is in with is turned on in withdrawal but then then the other
00:22:13.160
components particularly the pain components are due to this inflammation we're going to take a quick
00:22:18.000
break for your words from our sponsors and now back to the show so let's we talk about what happens to
00:22:25.000
our bodies and our brain whenever we drink alcohol let's talk about the long-term health consequences
00:22:31.240
of regular drinking so let's talk about the the organ we most associate with alcohol and that's the
00:22:37.740
liver what does alcohol do to the liver well it's actually generally not a good thing for the liver
00:22:44.020
because the liver has to get rid of it most of the breaking down the metabolism of alcohol is done in
00:22:49.740
the liver and the problem is that the alcohol gut's got to get into the liver and it's toxic to the
00:22:55.320
liver but also it's broken down the first stage of the metabolism is to a molecule called acetaldehyde
00:23:02.920
and acetaldehyde is particularly toxic because it's very closely related to formaldehyde and i think you
00:23:10.280
probably all know that formaldehyde is the pickling agent dead bodies are pickled in and it stops dead bodies
00:23:18.120
going off because it basically seals all the proteins and enzymes in the body into an inactive
00:23:24.100
form so acetaldehyde does something similar and that is a a bit of a problem because your liver
00:23:29.500
gradually pickles itself and eventually you get what's called cirrhosis and what's cirrhosis i mean
00:23:35.460
cirrhosis is just a hardening of the liver right well cirrhosis basically is where the liver becomes
00:23:40.100
fibrotic it becomes very hardened because cells the liver cells are dead and they get inflamed and then
00:23:46.340
as you know if you get some inflammation in your skin you get this get something under your skin
00:23:50.580
for a while the skin goes hard and the liver goes hard and and it's because the more and more the
00:23:55.740
liver is dying so you've got less and less of the liver available to do the work of from of making
00:24:01.180
proteins and also metabolizing alcohol and that's why i mean this can even happen acutely you can get
00:24:06.520
sort of aversion it's not cirrhosis but like a hepatitis from heavy drinking absolutely so this is a really
00:24:13.720
important thing and it's something we tended not to say in the past but more and more now we're seeing
00:24:20.300
young people binge drinking really heavily and getting what's called acute alcoholic hepatitis
00:24:26.640
and this is when the liver gets so inflamed by huge amounts of poison called alcohol that the
00:24:33.440
liver actually is damaged as if it's been sort of punched and that acute hepatitis as the liver cells die
00:24:40.440
they reduce release substances which kill other cells and it's like having a viral hepatitis and
00:24:45.960
it can actually destroy the liver and people die and we have now we have wards of young people with
00:24:51.440
hepatitis waiting for liver transplants now previously people couldn't afford to drink that
00:24:56.140
much they tend it was a rare thing when i was a medical student you only saw it on sailors they'd be
00:25:01.820
a sea for three four five months they'd come in and they spend all their money over a weekend getting
00:25:05.700
completely wasted and so it was something that you saw in the seaports but now we're seeing it amongst
00:25:11.040
young people who are you know going on binge games and weekends of binging so it's a it's a huge problem
00:25:18.120
and it can be like it can be terminal if you can't get a transplant then you may just die all right so
00:25:23.580
acute alcohol hepatitis is a possibility if you drink a lot the cirrhosis of the liver where the liver
00:25:28.180
just really gets fibrous and stops doing its job and then another consequence is because you're
00:25:33.700
constantly inflaming the liver with alcohol is liver cancer that's another issue that can happen
00:25:40.340
yes i mean liver cancer tends to come after this the liver becomes damaged and cirrhotic so cirrhosis
00:25:48.480
is a stepping stone to um to cancer as well although some people get liver cancer without having cirrhosis
00:25:55.200
i mean there's an interesting paradox here we actually don't understand why some people are very
00:26:00.560
vulnerable to cirrhosis and cancer and others not it's it's probable that there are genetic
00:26:05.220
factors which are predisposed to liver cancer in the same way as breast cancer but that's not well
00:26:10.540
established well besides liver cancer long-term drinking can also cause other cancers what does
00:26:15.620
the research say there yes well the research says for a long time we've known the relationship between
00:26:21.600
drinking in mouth and pharyngeal you know gullet cancers and also stomach cancer and and perhaps the
00:26:28.900
most interesting recent discovery is the relationship between drinking and breast cancer pancreatitis is
00:26:35.820
something we haven't talked about and acute pancreatitis can occur in as a result of heavy
00:26:41.680
drinking but the pancreatitis is also a common consequence of chronic drinking and very many
00:26:48.160
cases of pancreatic cancer are probably related to long-term consumption of alcohol and the pancreas is
00:26:54.820
actually quite of course a very it's tucked away right at the back of the abdomen so it's um
00:26:59.180
pancreatic cancer often presents quite late and it's very hard to treat we don't have any good
00:27:04.220
treatments yet all right so cause other cancers another system that it affects in a bad way is our
00:27:11.680
cardiovascular system what happens to our cardiovascular system with your regular drinking
00:27:17.520
yeah this has been an area of huge debate this is an area where there's probably the most
00:27:24.600
greatest disagreements between even experts so it used to be said for a very long time that we had
00:27:32.520
there was this phenomenon called the french paradox the french drank lots and lots of wine but they
00:27:36.920
didn't seem to die of heart attacks and everyone said well that's that's because the wine was protecting
00:27:42.380
them from the heart attacks now that has been looked at in a great deal of detail over the last 20 30
00:27:47.920
years and it turns out that the protective effects of alcohol on the heart are really quite minimal
00:27:54.200
they may they may exist in france they if they do exist at all they exist for red wine and if they exist
00:28:02.600
at all they they exist for small amounts of red wine you know like you know half a glass of red wine a day
00:28:10.940
will optimize the protective effects if there are any and only ever been shown for men not for women
00:28:18.480
and so the question is when you look at the overall burden of alcohol to the cardiovascular system
00:28:25.720
is that important and the answer is probably not because we know that alcohol kills more people
00:28:32.920
through hypertension and stroke than it kills from cirrhosis in fact alcohol is
00:28:40.700
one of the major causes of high blood pressure and it's uh we don't know what the cause of high
00:28:49.760
blood pressure in the majority of people with hypertension is we call it idiopathic hypertension
00:28:54.560
which means we don't know what causes it but what we do know is that if you get people to cut down
00:29:01.360
their drinking their blood pressure is very likely to come cut down so it's one of the first parts of
00:29:06.920
call for a doctor dealing with someone with high blood pressure and of course as i said the stroke
00:29:11.360
consequences of high blood pressure are very uh very considerable it it kill causes stroke and it
00:29:18.040
also of course causes heart attacks and heart failure and then if you go beyond that uh heavy
00:29:25.520
drinking can cause a myopathy can cause a damage to the heart in the same ways it can cause a damage to
00:29:30.540
the liver the heart gets just begins to become inflamed and toxic and so you go into chronic
00:29:38.080
heart failure and then on top of that there's also this phenomenon of hemorrhagic stroke where you
00:29:43.800
you have a bleed as opposed to a clot and alcohol precipitates or predisposes to hemorrhagic stroke
00:29:49.940
because alcohol impairs your ability to essentially to to clot if you are bleeding so if you start to
00:29:56.340
bleeding your brain alcohol makes that worse so that there are a number of different factors um
00:30:02.580
predisposing to cardiovascular events and then on top of that you've also got the fact that alcohol
00:30:08.200
certainly in some people if particularly if they're eating as well the calorie load of alcohol will also
00:30:15.100
contribute to conditions like obesity and laying down atherosclerosis which of course then leads to the
00:30:22.580
other kind of stroke which is the um infarction you know the blockage stroke as opposed to the
00:30:28.620
hemorrhagic stroke so all these things the cancer risk the stress on our cardiovascular system i mean
00:30:35.780
the studies show if the more you drink the longer you drink your risk of dying increases it's it's it's
00:30:42.340
exponential you have a chart well that's the really important point brett i mean i think let's just go
00:30:46.480
over that a bit slowly because make sure people understand yeah the relationship of alcohol to
00:30:52.480
harm is as you said exponential and what that means is the more you drink the very much more harms you
00:31:01.840
get and let me give you an example so for instance if you're drinking half a bottle of wine a day
00:31:07.760
or that equivalent that will probably take maybe one year off your life over say a 50 year of life adult
00:31:16.480
life if you're drinking a whole bottle of wine a day that will probably take four so you've you've
00:31:24.220
doubled the consumption but you've quadrupled the impact on health and then if you go from one bottle
00:31:30.320
of wine a day to two bottles of wine a day you'll go from taking four years off your life to 16 years
00:31:37.440
off your life so at the high end high consumption over about the equivalent of a bottle of wine a day
00:31:44.400
that does have a very big impact on your life expectancy so beyond the cancer risk the
00:31:49.860
cardiovascular risk of alcohol consumption alcohol also has been shown to negatively impact
00:31:55.700
hormones and fertility what does the research say there well it's uh absolutely it's i mean it's well
00:32:01.760
known that heavy drinking in men causes what we call feminization and that men grow breasts
00:32:09.440
and they start to get three stripes on their on their abdomen and they get less testosterone levels
00:32:16.760
begin to fall and that is because the the alcohol essentially damages the the ability of the body to
00:32:23.900
produce testosterone and so they end up having a surfeit of estrogens with women you have a problem
00:32:31.020
you know alcohol can also get affect fertility it will disrupt the release of hormones from the
00:32:37.160
pituitary very often heavy drinking women stop having menstrual cycles and in the end there will
00:32:44.200
suffer other consequences of that such as um osteoporosis damaged skin thin skin bleeding in the
00:32:50.960
under the skin as well this is the classic telltale marks you know the little star-shaped marks that
00:32:56.520
under the skin where the blood vessels get disrupted and the red face etc so so yes it have pretty much
00:33:03.300
most most hormones in the body are negatively affected by uh by alcohol okay so we've been
00:33:08.720
talking about the cumulative effects of drinking over time but alcohol can also have some immediately
00:33:14.380
negative effects i mean there's drunk driving of course i think alcohol plays a role in something
00:33:19.860
like half of all fatal car accidents there's also violence drunk people have a tendency to get into
00:33:25.560
fights drunk people are more likely to be victims of violent crime because they're easy targets
00:33:31.220
i mean on a less serious basis alcohol also can significantly affect our sleep which can have
00:33:37.640
an impact on our health our productivity and quality of life and people think oh you know alcohol that
00:33:43.220
helps you get to sleep uh i'm gonna have a nightcap but you say i mean the research says yeah it might
00:33:49.560
help you get to sleep faster but you're not going to have good sleep oh don't i know that
00:33:54.280
yes i was just the other day i i had a couple of glasses of wine late at night watching a film
00:34:00.960
and then i i woke up at five the next week why am i waking up at five what's going on and i thought
00:34:05.420
oh yeah i had two glasses of wine the night before and yeah so i'll talk you through the process because
00:34:10.900
it's it's pretty well established now what's going on yeah so alcohol is a sedative it does
00:34:16.140
promote the effects of GABA and GABA helps you sleep which is why a lot of people do drink before
00:34:21.780
the glucose bed but so as i've already mentioned with the glutamate system and it's also to some
00:34:26.600
extent true with the GABA system the brain compensates so you're sedated with the alcohol
00:34:32.440
you go to sleep but the brain is saying huh you know the receptors in the brain are saying you know
00:34:37.000
i've got to do you know they have to respond there's no conscious decision if they're if they're
00:34:42.340
overstimulated or blocked they've got to respond so they respond so while you're asleep the brain is
00:34:48.340
adapting to the effects of the alcohol and then you've got more glutamate and less GABA so you
00:34:53.380
wake up early and that's why alcohol is bad for sleep because it's the reaction to the alcohol
00:35:00.140
promotes wakefulness let's talk about the alcoholism where someone this is beyond your drinking socially
00:35:06.840
this is where you become dependent do we know why some people become alcoholics and some don't
00:35:12.780
well we know that there is a strong genetic component to alcoholism what we don't know
00:35:21.660
is exactly what that is in most people we know that there are you know alcoholism often runs in
00:35:29.980
families there seem to be some particular genetic groups that seem to be particularly prone to the
00:35:37.480
binge drinking it's often seen in the sort of northern europeans you know some people think
00:35:42.040
it's a viking gene that got spread to scotland and ireland and then off to canada why it occurs a lot
00:35:48.020
in the northern latitudes we don't know what the gene is but it's certainly there is there are strong
00:35:52.520
genetic relationships but it's likely that that's not just about alcohol it's likely that there are also
00:35:59.000
genetic vulnerabilities to addiction it's them itself we know that identical twins have a very high
00:36:05.820
likelihood of becoming not alcoholic if they one's alcoholic but also they also have increased risk
00:36:11.500
of other addictions so yes it's um there's definitely genetic risks but we as yet we can't
00:36:18.180
really target them i mean what all we can say is this if you're a if you're a male if you're a son
00:36:24.120
of a male alcoholic your risk of being an alcoholic is got goes up quite substantially so be aware of that
00:36:30.840
and monitor yourself carefully if if you find yourself drinking more than other people and in
00:36:37.680
fact that actually is one of the most interesting pieces of research is actually around the um the
00:36:43.140
gabba system in terms of alcohol vulnerability because it seems that sons of male alcoholics
00:36:51.100
are resistant to alcohol paradoxically when they start drinking they can drink more than their peers
00:36:57.040
but they don't get drunk and so they're seen as superstar hey you know this guy can out drink us
00:37:02.160
and they they take on the challenge of of drinking more than others and end up becoming damaged by that
00:37:07.680
drinking even though it's not laying waste to them immediately as it does to other people how does
00:37:13.000
someone know if they have a drinking dependence and if they're an alcoholic are there certain telltale
00:37:18.180
signs we look for well it's very very easy if you pay attention to what you do and if you pay
00:37:26.060
attention to what your friends say so you know if you have you ever a few a few really i'll just give
00:37:33.000
you a few of the really important ones if you ever had to drink in the morning to overcome a hangover
00:37:39.340
to go to work you've got a problem if anyone's ever said to you dave you know uh you were pretty
00:37:47.380
outrageous last night you know do you realize you know what a fool you made of yourself you shouldn't
00:37:51.520
have done that don't say don't talking rubbish of course i wasn't because you probably don't
00:37:56.780
remember it because you were probably so intoxicated you didn't remember so if anyone criticizes your
00:38:00.780
drinking take it seriously listen to them if you ever get into fights or get arrested yeah i think
00:38:07.100
that's probably a good sign you're drinking too much so evidence that alcohol is messing with your
00:38:14.080
life at the very beginning you know you should start to think very objectively about what's going
00:38:19.700
on with your you know and then take advice make a make a diary have a drink diary in my book i talk
00:38:26.760
about this plan that people should have i think knowing how much you drink is as important as knowing
00:38:33.300
what your body weight is what your cholesterol is what your blood pressure is it's a fact that
00:38:37.740
everyone should know and have at hand and you should always be trying as you're trying to always
00:38:42.380
generate or reduce your weight and your cholesterol you should always be trying to reduce your alcohol
00:38:46.800
consumption and even if you don't succeed you should be trying because if you don't try you'll never
00:38:52.060
succeed do we know what the best treatments are for alcoholism well there are very few good treatments
00:38:59.660
i mean the success rates are very low and we're experimenting now with some rather unconventional
00:39:05.320
treatments up till now the treatments have been counseling psychotherapy acamprosate which is a
00:39:11.740
glutamate blocker naltrexone and opiate blocker to stop the endorphin rush but the success rates are
00:39:17.640
very low maybe you know two in ten three in ten we've actually just done a study using mdma ecstasy
00:39:23.600
in alcoholics and that that disrupts a lot of the behavioral processes and the emotional processes
00:39:31.160
which drive addiction and where that was very successful that gave us a three times greater response
00:39:37.320
than our normal psychotherapy program so we're exploring that currently and also some people are
00:39:43.660
using ketamine again a couple of sessions of ketamine can help break people's compulsions to
00:39:50.060
drink break the habits of drinking so so these are some of the exciting new developments but currently
00:39:54.760
treatments are generally pretty poor so we've been talking about the negative effects of alcohol are there
00:40:00.500
any benefits to drinking well there must be otherwise most of us wouldn't do it most of us aren't addicted
00:40:06.480
so of course there are you know and i like to say i mean it's my favorite drug i drink alcohol a few
00:40:11.680
times a week and i enjoy it why do i enjoy it for all the reasons that other people do because it relaxes
00:40:17.740
me it makes me more sociable it makes me more convivial it takes away some of the stress in life yeah
00:40:25.100
it's i you know i enjoy the reminiscences that it brings back in terms of the previous pleasures
00:40:30.980
so it's actually at one level a fantastic drug the problem is it's also quite a horrible drug
00:40:37.100
and in the also besides the social benefit there's some studies that suggest that maybe alcohol can help
00:40:42.660
with creativity as well because that because of that inhibition loosening that it causes
00:40:47.080
well certainly for most people it gets them on the dance floor which they wouldn't do if they weren't
00:40:54.080
drinking that's a fact whether that's a good thing or not i don't know but uh this is amazing
00:40:59.240
statistic wasn't it of the first six american nobel prize was in literature five of them were
00:41:03.780
alcoholics yeah no one knows whether it you could of course there's no controlled study you can't
00:41:09.860
randomize fitzgerald to alcohol or no alcohol in the beginning of his life so there's a strong
00:41:14.920
relationship yes the writers think it's helpful whether it is or not i don't know it's hard to prove
00:41:20.700
so despite you spend most of this book highlighting the real dangers of alcohol but this isn't a
00:41:25.760
prohibitionist screed against it in fact you just said no you consume alcohol regularly but you just
00:41:31.640
make the case that people need to know about the risk so that they can make informed decisions on
00:41:36.020
whether to drink regularly or not and then if people do decide to drink you offer some suggestions
00:41:41.760
on how to drink sensibly or as the alcohol companies say drink responsibly so what are you offer there's a
00:41:48.700
lot of them what are some of the biggest pieces of advice you can offer people who just to manage
00:41:53.940
the risk of drinking well monitor what you're drinking and think about it and my favorite one
00:41:59.860
by the way my favorite one is if you're drinking as a couple which most couples do now over an evening
00:42:05.060
with an evening meal never open a second bottle of wine that's probably the most important piece of
00:42:11.860
advice i could give to any couple if you don't exceed the one bottle when you start drinking then
00:42:17.780
you know you're going to be both of you be in a range as long as you share it you're going to be
00:42:22.380
in a range where it's reasonably contained don't drink every night try to have at least two nights a
00:42:28.780
week or two days a week when you're not drinking a good another ploy is to actually work out how to
00:42:35.280
say no when your people are offering you drinks to say you have you know have a limit i mean a lot of
00:42:40.260
people actually say okay i'm driving so i may only have one drink and that's a good way to say i'm not
00:42:44.980
going to drink again anywhere on that evening um another one i think quite useful is to not drink
00:42:51.720
with meals because with meals it's very you you often take bigger mouthfuls to wash the food down
00:42:57.340
you don't savor it because you've got the taste of the food in your mouth so the wine's just basically
00:43:01.320
you're just using the wine as a lubricant use water to wash food down and then savor your wine
00:43:06.480
or your drinks after the meal in fact don't drink before meals i mean aperitifs are dangerous for two
00:43:13.260
reasons one is they encourage you to eat more and secondly they encourage you to drink more
00:43:17.020
and and also buy the most expensive wine or beer or or spirits you can because the more expensive it is
00:43:25.180
the less you're going to drink and the more you're going to want to savor it you also know in the book
00:43:28.640
they're about a growing trend of companies offering non-alcoholic versions of beer you're starting to
00:43:35.860
see spirits now as well what do you think is going on with that that demand well it's clear that a lot
00:43:41.720
of people don't don't want to have the health harms of alcohol and health hacking has become a big thing
00:43:47.880
you know who's not wearing a fitbit telling them how many hours sleep they got last night which by
00:43:52.280
the way they don't tell you very accurately but anyway you know people there are a lot of people
00:43:56.400
interested in their health and they should be i mean one of the staggering things in the u.s is that
00:44:00.720
for the first time ever we are seeing life expectancy of middle-aged men declining why they eat too much
00:44:10.860
they're diabetic and they drink too much so there are people saying look hang on you know let's uh let's
00:44:15.480
try to be healthier and a healthy relationship with alcohol is definitely better than an unhealthy
00:44:20.920
relationship so yes so people are turning to flavored drinks which give you the flavors of alcohol but
00:44:27.800
without the calories and the obviously the potential harms of alcohol the problem with those drinks is
00:44:33.900
they don't give you the benefits of alcohol and that's actually why i've been spent the last 10
00:44:38.320
years of my life trying to develop alternatives because i i would love to have the relaxing sociable
00:44:44.160
effects of alcohol without the harms and i've been working to try to invent substances and invent
00:44:49.920
drinks that will do that and we're we're making progress i think you know in a few years we'll have
00:44:54.260
some on the market well yeah you got one right now that's pretty close what's it's a synthetic alcohol
00:44:59.040
what uh what is it called well we call it alcohol the idea being alcohol is for alcohol what candor
00:45:07.000
is for sugar you get the pleasures but without the calories or the harms so we're working on that
00:45:12.160
that's um beginning to go through safety testing but we've also actually we've got a herbal
00:45:15.720
a botanical drink on the market now in in europe called sentia where we've used well-established
00:45:22.100
food herbs which we know work on the gabba system to make a drink which um does give you you know
00:45:27.640
some of the effects of alcohol the gabba effects the relaxation the sociability unfortunately can't
00:45:32.500
sell it in the states yet because it's too expensive to air freight it over but at some point we hope to
00:45:36.460
start manufacturing in the u.s all right so what you're doing with these alcohol you're trying to
00:45:40.260
induce the gabba response correct that's right with it it's interesting and the great thing is if you
00:45:45.180
just induce the gabba response you do massively minimize a lot of the harmful consequences
00:45:50.600
particularly you know if you don't target glutamate then you can't get blackouts and you
00:45:55.000
won't get the the upregulation of the receptors you won't get the hyper excitability and withdrawal
00:46:00.120
etc well david this has been a great conversation is there some place people can go to learn more
00:46:04.160
about the book in your work yeah well you go into yes you go into my website on the imperial
00:46:09.240
college website you learn a bit about that um and the you can go on to my website for my synthetic
00:46:14.820
alcohol it's called gabba labs if you go on the gabba labs website you can you can learn more
00:46:19.160
about it there fantastic well david nutt thanks for your time it's been a pleasure
00:46:22.340
been an absolute delight and that's a wonderful interview and thank you very much my guess it
00:46:28.680
was david nutt he's the author of the book drink the question mark it's available on amazon.com
00:46:32.620
also check out our show notes at aom.is slash drink we find links to resources we delve deeper
00:46:36.740
into this topic well that wraps up another edition of the aom podcast make sure to check out our
00:46:48.120
website at art of manlies.com where you find our podcast archives well as thousands of articles
00:46:51.780
written over the years about pretty much anything you think of and if you'd like to enjoy ad free
00:46:55.080
episodes of the aom podcast you can do so on stitcher premium head over to stitcher premium.com
00:46:58.940
sign up use code manlies at checkout for a free month trial once you're signed up download the stitcher
00:47:02.920
app on android ios and you can start enjoying ad free episodes of the aom podcast and if you haven't
00:47:06.960
done so already i'd appreciate if you take one minute to give us a review on apple podcast or
00:47:09.860
stitcher it helps out a lot if you've done that already thank you please consider sharing the show
00:47:13.440
with a friend or family member who you think would get something out of it as always thank you for the
00:47:16.860
continued support until next time's brett mckay remind you to only list the aom podcast but put what