The Peter Attia Drive - Qualy #1 - What are Peter's thoughts on alcohol consumption and health？

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00:01:03.140 alcohol thoughts on consumption of alcohol which is a little generic okay so i put this into a couple

00:01:10.960 of categories the first is just a purely physiologic what is the effect of the molecule ethanol on the

00:01:19.420 body and just as i sort of talk about sugar or other things it's really important to understand that

00:01:27.080 ethanol is a toxin but of course the dose makes the poison now the thing that i think many people

00:01:33.900 forget who are not in the world of toxicology is that there is a probability distribution that drives

00:01:40.880 the impact of a toxin on a population and there are going to be some people at one end of the spectrum

00:01:47.240 who are largely unimpacted by certain toxins and there are going to be others who are not and

00:01:52.200 so ethanol is no exception to that just as you know tylenol or pick your favorite poison could be

00:01:59.880 so again tylenol meaning like even though it's at low doses very efficacious as an analgesic at high

00:02:06.500 enough doses it's hepatotoxic so start with position one i'm not convinced that there is a single benefit

00:02:13.680 to ethanol the molecule in the human body so ethanol in its metabolic pathway and it's uniquely

00:02:20.160 metabolized by the liver one of the byproducts is something called aldehyde which is a toxin

00:02:24.220 it really has two and this is a bit of an oversimplification but it has two effects there's

00:02:29.100 an effect on the liver and then there's effect on the brain the effect on the brain is what people

00:02:32.520 drink alcohol for it's the buzz it's the cns depression that also comes with some euphoria so

00:02:39.440 it's a bit of a paradox there because ethanol its effect in the cns is that of a gaba agonist and gaba

00:02:45.700 of course being is a non-excitatory or depressing neurotransmitter but i think as most people will

00:02:52.500 understand certainly ethanol can have an excitatory effect so you've got this brain effect of alcohol

00:02:58.320 you've got this liver effect the liver effect is you know very similar to that of sugar or fructose

00:03:03.640 they have very similar metabolic pathways not identical but also not surprising that they overlap

00:03:09.440 given that fructose is fermented to make ethanol so from that standpoint no benefit to ethanol but

00:03:16.660 again different people tolerate it to different amounts as a general rule each beverage and i'm not

00:03:22.920 talking the kind you pour yourself where they're a little longer a little taller but you know like an

00:03:27.960 ounce of distilled spirits is about 15 grams of ethanol an appropriate you know maybe four ounce

00:03:34.440 glass of wine is also about 15 grams of ethanol as is a beer you know kind of like 10 ounces 12

00:03:40.140 ounces again depending on the alcohol content so as a general rule of thumb each drink is about 15

00:03:46.120 grams of ethanol one of the things if a patient asked me this question that i'm thinking is well what's

00:03:52.120 your liver function right now and the best proxy we have for that is the alt one of the transaminases and

00:03:57.660 you know so when i see a patient that's walking around with an alt that's already at the upper

00:04:03.040 limit of what we consider normal by range today which i do not consider normal which is probably 42

00:04:08.040 on our lab i consider below 20 normal i'm always asking the question do they have fatty liver right

00:04:14.940 now and if they do is it more in response to ethanol or is it more in response to fructose

00:04:19.400 that said i have at least two patients that i've taken care of either in the past or currently who

00:04:25.160 consume seemingly unbelievable quantities of ethanol some of them averaging between 8 and 12

00:04:31.380 drinks a day and by ultrasound their livers are normal by lfts their livers are normal looking at

00:04:39.140 coag studies every other marker you can look at their liver function is perfect and these guys are

00:04:45.060 sort of the genetic outliers who have a remarkable tolerance to alcohol so the point i'm trying to make

00:04:51.300 here is i want to get a sense of how much harm is coming purely in a in a hepatic sense from alcohol

00:04:57.940 and then make sure we're drawing a line well below that but the second point is perhaps the bigger

00:05:04.040 point which is the why the why are we drinking alcohol and i say this as a guy who likes alcohol

00:05:09.640 just as much as the next person but certainly in my life i've started to ask am i drinking just for

00:05:16.760 the sake of drinking am i drinking because i'm trying to soothe some other issue and does my

00:05:22.920 drinking lead to a behavior that i'm otherwise not happy about and in my case personally that generally

00:05:28.040 tends to loosening the reins on what i eat and i don't think i'm unique in that i've got many patients

00:05:34.180 that when confronted will say the same thing which is yeah ultimately that's the problem with ethanol

00:05:38.840 is you go out you get a couple of drinks in you and things that you otherwise wouldn't eat you just

00:05:43.780 start eating so not that this is at all scientific but my rule of thumb is the following as a general

00:05:49.800 rule i don't want to drink if i'm going to drink it's going to be good alcohol i'm going to make

00:05:54.900 it purpose-driven drinking so i don't drink on airplanes because the alcohol sucks like i'm not

00:06:00.800 gonna just because they're pouring me some half-assed glass of wine i'm not gonna drink it but if i want

00:06:05.680 to drink wine i'm gonna drink wine that is exceptional if i'm gonna drink tequila i'm gonna drink

00:06:09.740 tequila that is exceptional and if i'm gonna drink beer it's going to be exceptional and because

00:06:14.480 somebody's going to ask what are my favorites my favorite wine is cleo which is a spanish blend and

00:06:19.460 i've been drinking it since 2007 and i've had every bottle from 07 to 14 and i'm fully expecting that

00:06:26.220 people listening to this are not going to go and start buying cleo like crazy because sometimes it's

00:06:30.580 hard to find that i'm going to be really pissed off if i can't get it tequila i know everybody raves

00:06:36.100 about 1942 and i think it's good but the classe azul reposado is absolutely my favorite it must be

00:06:42.400 consumed neat no ice no lime no nothing and my favorite beer i'm not willing to say what it is

00:06:50.600 because it is so hard to find and honestly not not to be a selfish prick but i'm simply not willing

00:06:56.800 to share it with anybody one of the guys who works for me's part-time job is sourcing it across

00:07:02.280 the united states and belgium so i'm sorry guys i'm not gonna let on what that is so that's my

00:07:07.220 thoughts on alcohol okay any can i make a follow-up question please okay so more or less you said

00:07:13.700 there's nothing beneficial i'm sure you're gonna get but what about what about the french paradox what

00:07:19.460 about red wine isn't a glass of red wine maybe two for men maybe three maybe six depending on who you

00:07:25.840 ask isn't that associated with better health or less cardiovascular disease or more longevity yeah

00:07:32.480 i mean i think the red wine thing came about through two things that you mentioned one is the french

00:07:37.840 paradox which is boy the french seem to live a lot longer and they drink more ergo it's got to be

00:07:42.100 that of course i think that to get into that topic in detail would sort of take the rest of our ama and

00:07:48.000 it really has to do with just a poor understanding of epidemiology so there are a lot of things that

00:07:53.480 explain the french paradox they also smoke more i don't think that that necessarily means smoking

00:07:57.400 is better so it probably has a little bit more to do with what they eat than what they drink or don't

00:08:02.040 drink the other thing that i think has a lot of people with this lingering idea that you know a glass

00:08:06.640 of red wine a day must be healthy and i want to be clear i'm not saying a glass of red wine a day is

00:08:11.240 harmful but i'm saying it's it's not benefiting your health is the resveratrol story so resveratrol

00:08:17.860 is a compound that is identified in very small quantities in red wine and there was one lab in

00:08:24.600 particular at harvard that many years ago and i say many years ago like probably 15 years ago maybe

00:08:28.940 10 years ago david sinclair's lab had studied this in high concentrations and they showed that it

00:08:34.420 enhanced longevity and that created like this huge wave of everybody wanting to take resveratrol

00:08:39.480 supplements there are two issues with this the first is even if you believe those data which i

00:08:43.600 categorically do not and no lab has ever been able to reproduce them and i'm not even convinced that

00:08:48.180 sinclair today would believe that those were valid you would not get that amount of resveratrol in a

00:08:54.760 glass of red wine so it's sort of like the uh should i be eating more dark chocolate to live longer

00:08:59.060 maybe but you're probably better off just taking coco flavonoids if you buy that that's the active

00:09:04.080 ingredient that's going to enhance nitric oxide production the one thing i guess i'm glad you asked this

00:09:08.740 follow-up question because i have some patients who will argue this and honestly i maybe they're right

00:09:12.580 which is there are some patients who say look just a single glass of wine a day helps me unwind a

00:09:17.800 little bit and isn't there any benefit in that and i guess the answer is possibly and so the question

00:09:22.300 is does the net benefit of that which could be a lower amount of cortisol a lower amount of emotional

00:09:28.020 distress could those things be beneficial relative to any of the potential drawbacks of ethanol such as

00:09:35.100 you know increased you know appetite dysregulation or i'm not even getting into sort of pathologic

00:09:40.240 behaviors maybe one thing i have observed and the aura ring has made it very easy for me to track this

00:09:46.820 is one drink in the evening does not impact my sleep two or more absolutely does and does so in a

00:09:55.960 profound way the two things that happen are my resting heart rate will be 10 beats higher it will take

00:10:02.960 very long for me to reach my resting heart rate so what you want is your resting heart rate to be

00:10:07.940 achieved within the first third of your sleep cycle and more importantly and perhaps more surprising to

00:10:14.620 me is my heart rate variability gets squashed so i have a very low average heart rate variability when i

00:10:21.560 have more than two drinks and even the volatility of my variability is very low and that is reflected in

00:10:29.440 my sleep it also definitely compresses rem cycles so even though when you have a few drinks you're

00:10:36.440 groggy and you think you're sleeping better you're just less conscious but you're actually sleeping

00:10:40.700 worse i hope you enjoyed today's quali now sit tight for that legal disclaimer this podcast is for

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The Peter Attia Drive - August 06, 2019

Qualy #1 - What are Peter's thoughts on alcohol consumption and health？

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