The Art of Manliness - To Drink or Not to Drink

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 0.74

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 0.80

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 0.99

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 0.99

00:32:31.020 you know alcohol can also get affect fertility it will disrupt the release of hormones from the 0.98

00:32:37.160 pituitary very often heavy drinking women stop having menstrual cycles and in the end there will 0.99

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 0.99

00:37:47.380 outrageous last night you know do you realize you know what a fool you made of yourself you shouldn't 0.99

00:37:51.520 have done that don't say don't talking rubbish of course i wasn't because you probably don't 0.99

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

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00:47:22.180 you

The Art of Manliness - November 29, 2021

To Drink or Not to Drink

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