Speaker 1: Emily. I don't know if I've ever told you this,
Speaker 1: but this is not the first podcast idea I've ever had. Well,
Speaker 1: this actually is the second on the list, and the first, okay,
Speaker 1: ready was going to be it's me and my wife
Speaker 1: were both doctors, as you know, and we were going
Speaker 1: to sit and drink alcohol and talk through medical studies together.
Speaker 1: And do you know what I was going to call it?
Speaker 2: No, But first of all, I love it, and I
Speaker 2: hope you should also. I think you should also make
Speaker 2: this if one podcast is not enough, I would listen
Speaker 2: to that. But what is the title?
Speaker 1: Docs on the Rocks?
Speaker 2: That is so plascular? I love everything about it. Is
Speaker 2: the problem that your wife is too smart to get
Speaker 2: involved with this with you?
Speaker 1: Yes, that is one hundred percent of problem. I was enthusiastic.
Speaker 1: I brought as I bought two microphones. I was like,
Speaker 1: and it'll be like date night. It's like, but we're
Speaker 1: going to record it and we're gonna have drinks and
Speaker 1: then there would be a segment at the end, maybe
Speaker 1: at the beginning of the end. I didn't really think
Speaker 1: it through, but like, what are we drinking tonight? Like
Speaker 1: maybe one night it's some wine, maybe something maybe it's
Speaker 1: a fancy cocktail of some kind, and you know, I
Speaker 1: would be me and she would be like a normal person,
Speaker 1: a more normal person. I think it works, and I
Speaker 1: think it's so.
Speaker 2: Great, and I'm also feel like she said no, and
Speaker 2: then you were like, who's next. I'll go to Emily.
Speaker 2: She'll probably come. You'll probably be Emily's game.
Speaker 1: But I'm excited that to at least like have a
Speaker 1: little bit of the vibe of docks on the rocks
Speaker 1: right now because we're talking about alcohol though it's early.
Speaker 2: When we're Perry, what are you drinking?
Speaker 1: Drink any It's just a vodka enema, so technically nothing.
Speaker 2: I'm drinking a Fair Life Nutrition Plan protein shake, which
Speaker 2: is a touch of gin.
Speaker 1: Okay, alcohol coming right up.
Speaker 2: I'm Emily. I'm an economist and a data expert.
Speaker 1: And I'm Perry Wilson. I'm a medical doctor.
Speaker 2: It's Thursday, July twenty third, twenty twenty six. And this
Speaker 2: is wellness.
Speaker 1: Actually, because you're getting a staggering amount of health and
Speaker 1: wellness information nowadays from every source imaginable, and some of
Speaker 1: it is awesome and.
Speaker 2: Some of it is well actually bull Fortunately, we are
Speaker 2: both people who know how to read studies, how to
Speaker 2: parse the data, and can tell you what's worth thinking
Speaker 2: about and what you can safely ignore.
Speaker 1: But before we dig in, a note that this podcast
Speaker 1: is for educational purposes and should not be construed as
Speaker 1: medical advice. We don't know your unique situation, so talk
Speaker 1: to your doctor for personal health decisions.
Speaker 2: This week we're asking what's the deal with alcohol? Harry
Speaker 2: and I will give the official smasher pass, and then
Speaker 2: we'll get to your question of the week. But first
Speaker 2: let's do the health news roundup. After the break.
Speaker 1: And we're back with the health news of the week. Emily,
Speaker 1: there is one thing that keeps coming across my health
Speaker 1: news feed over and over and over again as frequently
Speaker 1: as many people across the country are running to the bathroom,
Speaker 1: and that is, of course, cyclospora. What is the latest
Speaker 1: status of the cyclospora outbreak?
Speaker 2: So I should say we're recording this at ten thirty
Speaker 2: six am on Tuesday, so it is very possible that
Speaker 2: something else will have happened. I cannot explain to you
Speaker 2: how insane the public health messaging has been around this.
Speaker 2: So at the end of last week they had identified
Speaker 2: Iceberg Lettuce as a core cause. And the way they
Speaker 2: did that is like in Michigan, they talked to a
Speaker 2: subset of the people who had the explosive diarrhea, like
Speaker 2: a huge share of them had eaten a Taco Bell
Speaker 2: and of those, like ninety percent had eaten iceberg lettuce
Speaker 2: at Taco Bell. So it was like, okay, it's probably
Speaker 2: the iceberg letus from Taco Bell. And then they traced
Speaker 2: that back to Taylor Farms, who traced it back to
Speaker 2: a single plant in Mexico, who then said, okay, let's
Speaker 2: just recall all of the iceberg lettuce from that plant
Speaker 2: because it seems plausible it has cyclospora. That felt like, okay,
Speaker 2: we're kind of getting there. That seems like the answer.
Speaker 1: This is how epidemiology works.
Speaker 2: Then over the weekend, the FDA said that they had
Speaker 2: tested some iceberg lettuce, not from Taco Bell, but some
Speaker 2: other iceberg lettuce from Tailor Farms, and they had found
Speaker 2: cyclospora parasites on it. And it was like, okay, that's
Speaker 2: like check. Now we're even more sure.
Speaker 1: Yeah.
Speaker 2: Then they walked that back and they said, actually, that
Speaker 2: particular test maybe was a false positive. Okay, everything else
Speaker 2: is still true. All the taco bell stuff, all the epidemiology,
Speaker 2: all of this is still true. But then Taylor Farms said, oh,
Speaker 2: now the FDA has said it's not us, which is
Speaker 2: not what the FDA said. And then the FDA was like, no,
Speaker 2: we didn't, we didn't apologize, and then people started talking
Speaker 2: about how Taylor Farms had given Donald Trump a million
Speaker 2: dollars like over the weekend. And I think fundamentally the
Speaker 2: messages donate Iceberg. Let us right now. But it could
Speaker 2: not be more stupid.
Speaker 1: I confusing, It is so confusing. I did dig in
Speaker 1: a little bit to like the various tests that are
Speaker 1: used to essay for cyclospora and the false positive rates.
Speaker 1: I mean they're not zero, but they're very low. You know,
Speaker 1: they have specificity of ninety eight to one hundred percent,
Speaker 1: so false positive rates of sub two percent. So there's
Speaker 1: I mean, it's always possible.
Speaker 2: Of course, now you're the tin hat. You're joining the
Speaker 2: tin Hath conspiracy theory of like the FDA is being
Speaker 2: bought off by something.
Speaker 1: I'm just asking questions, Emily.
Speaker 2: It's a little suss, a little sus. If the kids
Speaker 2: would say, there's something going on, I don't know what
Speaker 2: it is.
Speaker 1: Can I tell you the most genius thing that happened
Speaker 1: this weekend is we were out celebrating a friend's birthday
Speaker 1: and it was like a fun night, and we go
Speaker 1: back to their house at the end of the night
Speaker 1: and someone's like, let's door dash bunch of taco bell
Speaker 1: and the theory here was there is no better time
Speaker 1: to door dash a bunch of talk. This is going
Speaker 1: to be the healthiest talk of my husband ever.
Speaker 2: Is as the economist firm of that which he's like,
Speaker 2: tacobo must be so cheap. Right now, we should go
Speaker 2: you know how much food you can get for almost
Speaker 2: nothing and there won't be any lines. Mean, we're thinking,
Speaker 2: we're thinking the same the time. But guys still avoid
Speaker 2: iceberg lettus for the moment unless you know where it
Speaker 2: was grown and it was like your backyard, all right.
Speaker 2: Next up, aging research is setting upper bounds on our
Speaker 2: human life span. Disappointing news for Brian Johnson and for
Speaker 2: the rest of us. But what does this say? How
Speaker 2: old could I live to be?
Speaker 1: These studies are entirely theoretical and always so interesting to me.
Speaker 1: Like people have asked the question, this isn't what this
Speaker 1: study is about. But people have asked the question, like
Speaker 1: what if you what if the only thing that could
Speaker 1: kill you was accidents? Right, like like you're basically a mortal,
Speaker 1: you're an l or something, but like you can get
Speaker 1: killed if you fall out of a tree or something
Speaker 1: like that, but you'll never get sick, you'll never get old.
Speaker 1: And you can model this mathematically because you know what
Speaker 1: like the rate of accidents, fatal accidents are And it
Speaker 1: turns out I'm not going to get exactly right, but
Speaker 1: it turns out like unaverage, people would live to be
Speaker 1: seven hundred or eight hundred years old if the only
Speaker 1: thing that could kill you was getting in an accident. Okay, cool.
Speaker 1: This study looked at DNA mutations, so as you age
Speaker 1: your DNA, you know, little gamma rays come from outer
Speaker 1: space and they mutate DNA, and they asked the question,
Speaker 1: if this is the only thing that can kill you,
Speaker 1: are these like random gamma rays? Like we fix everything else, right,
Speaker 1: there's no heart disease, there's no cancer, but we can't
Speaker 1: fix the random gamma rays mutating your DNA. What's the
Speaker 1: maximum you can live? And the overall answer it was
Speaker 1: one hundred and forty six to one hundred and ninety
Speaker 1: four years. This was limited mostly by problems in your heart,
Speaker 1: which the DNA mutation accumulation would cause fatal heart ysfunction
Speaker 1: at about one hundred and fifty years. Similar levels in
Speaker 1: the brain. Interestingly, the liver, which is always just like
Speaker 1: down to party, could go for thousands of years before
Speaker 1: it would kill you from just DNA mutations alone. And
Speaker 1: so the researchers are saying, like, Okay, this is like
Speaker 1: longevity people. You know, this is the upper limit here,
Speaker 1: like you fix all the other stuff, you know, this
Speaker 1: is what's going to get you. But of course, like
Speaker 1: if you fix all the other stuff, I don't know,
Speaker 1: can't wait fix totally.
Speaker 2: I mean, this seems ridiculous. I don't know if these
Speaker 2: people have not watched Futurama where you just put your
Speaker 2: heads in the in the continue to watch Futurama. That
Speaker 2: was so great. People just live forever and their heads
Speaker 2: were like and these like it was just their head
Speaker 2: in like a little tube or whatever. I don't know
Speaker 2: how it worked, but it's yeah, yeah, like all the less,
Speaker 2: so get with it, aging researchers. But but I think
Speaker 2: it's like, mathematically, this is a super interesting approach. I
Speaker 2: like it I like it a.
Speaker 1: Lot of Yeah, that's kind of fun. Let's move on
Speaker 1: to talk about Secretary of str I mean, I think
Speaker 1: legally it's still the Secretary of Defense, but whoever he
Speaker 1: is has a plan to test all I guess nope, male.
Speaker 2: Sorry, it's to test all people in the military for testosterone,
Speaker 2: including ladies. Spoiler, they don't have very much.
Speaker 1: Oh geez, Okay. I love when stories are even stupider
Speaker 1: than I assume more.
Speaker 2: Logic than than he was going with this.
Speaker 1: So I think the overall, at least the overall idea
Speaker 1: here is that they want to identify people with low
Speaker 1: testosterone and presumably to supplement it in order to increase
Speaker 1: the efficacy of the armed forces. If you want to
Speaker 1: go back in time to our testosterone replacement therapy episode,
Speaker 1: you can get all the science about why this is
Speaker 1: a bad idea, including the fact testosterone supplementation doesn't end
Speaker 1: up doing much for men except increasing libido, and testing
Speaker 1: testosterone levels is not really recommended unless you're having libido
Speaker 1: or rectile dysfunction problems. And I don't think that's what
Speaker 1: the Secretary of War is worried about. God, I hope
Speaker 1: it's not that.
Speaker 2: Yeah, I mean I think his you know, I think
Speaker 2: he's sort of pitching an idea here that's like, I mean,
Speaker 2: we've seen this, this is Captain America. But I think
Speaker 2: you know, FDA approved level of testosterone supplementation will not
Speaker 2: produce Captain America. No, So I'm not really sure where
Speaker 2: we're going with this issue.
Speaker 1: I mean, yeah, you could like juice up all the
Speaker 1: army people. You've give them real steroids, like anabolic steroids,
Speaker 1: and you know, have them go into roid rage in
Speaker 1: the battlefield. I'm not really sure that's what we want.
Speaker 1: I don't know. This feels I don't exactly know how
Speaker 1: to put this, but this obsession with testosterone and sperm
Speaker 1: count and stuff feels like this is what my kids
Speaker 1: would say. It's like small dick energy. Okay, that's what
Speaker 1: this is.
Speaker 2: That's what it is like.
Speaker 1: Just you don't have to prove your manliness constantly by
Speaker 1: like announcing it to the world and performing it just
Speaker 1: like be a good dude, Jesus, be a good dude.
Speaker 2: But consider getting your sperm count and disosterone levels and
Speaker 2: a small tattoo in a place that you know, just
Speaker 2: people might see, like on your cheek.
Speaker 1: Consider the lower back. That's what I want all our army,
Speaker 1: you know, like that's it, That's what I'm talking about.
Speaker 2: It's amazing, that's what I want.
Speaker 1: Let's make that manly, all right. I think with those
Speaker 1: news items under our belt, let's take a dive into alcohol.
Speaker 1: And you know, I think we can actually skip this
Speaker 1: entire episode because someone has summed it up more perfectly
Speaker 1: than you and I ever could. Emily. Let me play
Speaker 1: the clip to.
Speaker 3: Welcome because of and solution to all of life's problems.
Speaker 2: Homer is very wise. He's wise.
Speaker 1: This is the best episode if you're a Simpsons fan.
Speaker 1: The prohibition episode is so great when he becomes the
Speaker 1: beer baron and Marge is actually proud of him for
Speaker 1: doing something clever as he's filling bowling balls with hooch,
Speaker 1: and like there's a whole system of pipes that takes
Speaker 1: sit from the bowling alley to mose bar. Such a
Speaker 1: classic alcohol Emily has been around for quite some time.
Speaker 2: Yeah, people have been fermenting things for a very long time.
Speaker 2: I think the first confirm fermentation is seven thousand BCE,
Speaker 2: so that's what nine thousand years ago.
Speaker 1: That's a long time.
Speaker 2: I mean, fermentation is not hard, you leave stuff. You
Speaker 2: could imagine how this happens, right, You make some stuff
Speaker 2: with rice, you leave it out for a little while,
Speaker 2: you're thirsty, you taste it, you realize it doesn't taste
Speaker 2: that great. But boy, is this fun? And then we're
Speaker 2: kinda off to the races.
Speaker 1: Yeah. Absolutely, And it's not just humans who do this amazingly.
Speaker 1: So a brief list of animals who have been documented
Speaker 1: to actively seek out fermented fruits. So these are animals
Speaker 1: basically that like, there'll be a you know, fruit rotting
Speaker 1: essentially becomes alcoholic over time. Here's some animals that like
Speaker 1: to play around with these chimpanzees, black handed spider monkeys,
Speaker 1: African elephants, tree shrews, and even fruit flies. Although apparently
Speaker 1: fruitflies aren't getting drunk. They're laying their eggs in fermented
Speaker 1: fruit because the antiseptic properties of alcohol prevent some egg
Speaker 1: diseases on fruitfly eggs. That's nice.
Speaker 2: So people have been consuming alcohol, either for fun or
Speaker 2: you know, in some periods, beer was a sort of
Speaker 2: much safer way to consume liquid than water because it
Speaker 2: was much less likely to be full of cholera and
Speaker 2: so on. So we really, alcohol is you know, it's
Speaker 2: one of our oldest customs. The Romans loved wine. Every
Speaker 2: everybody loves alcohol.
Speaker 1: Everybody loves alcohol. Why are they telling us it's so
Speaker 1: bad for us?
Speaker 2: Then? I don't know. I guess we're ready to get
Speaker 2: into that. But it is. It has been popular for
Speaker 2: many millennia, let's put it that way.
Speaker 1: On the medical side, a bit of fun history of prohibition.
Speaker 1: Not that prohibition was that fun. So US Prohibition was
Speaker 1: from nineteen twenty to nineteen thirty three. The Eighteenth Amendment
Speaker 1: ban the sale of alcohol at that time, but it
Speaker 1: did carve out an exception for medicine, and so you
Speaker 1: could get a prescription for medicinal whiskey. And apparently in
Speaker 1: that period doctors wrote an estimated eleven million prescriptions for
Speaker 1: medicinal whiskey, treating ailments ranging from indigestion to depression, usually
Speaker 1: charging a hefty fee for those prescriptions.
Speaker 2: What else is new that sounds right? I mean, Prohibition
Speaker 2: is a very interesting historical episode, obviously, because there were
Speaker 2: a lot of social problems. There are a lot of
Speaker 2: social problems caused by alcohol. You can see the instinct,
Speaker 2: and yet you seem to really backfire in a lot
Speaker 2: of ways. It was certainly unpopular in addition to generating
Speaker 2: a lot of mob related crime and apparently fake prescriptions.
Speaker 1: You banned stuff that is really easy to make in
Speaker 1: your own home, and people are going to make it
Speaker 1: in their own home totally.
Speaker 2: Have you ever made your own alcohol?
Speaker 1: I have. I brew I've brewed my own beer. That's
Speaker 1: all I've done. I've never distilled anything, but I had
Speaker 1: fun brewing my own beer. I made this very delicious
Speaker 1: tasting IPA that was not very high in alcohol content,
Speaker 1: which is now like a popular thing.
Speaker 2: One time in college, one of my roommates brought back
Speaker 2: raisin based homemade liquor from Christmas break. It was bad. Actually,
Speaker 2: I wouldn't recommend making hard Linger out of raisins.
Speaker 1: One thing I used to see in Pennsylvania are people
Speaker 1: who would come in with chronic lead toxicity, which can
Speaker 1: present doctors as the triad of kidney disease, gout, and hypertension.
Speaker 1: And what we would occasionally trace it back to are
Speaker 1: people making moonshine, because in Appalachia, people will often distill
Speaker 1: the liquor. The moonshine liquor in old car radiators, which
Speaker 1: used to be lead lined and so the lead would
Speaker 1: leach out into the moonshine. Then they drink moonshine. They'd
Speaker 1: come and see us with gout and kidney disease.
Speaker 2: Yikes. Okay, all right, so don't make your moonshine and
Speaker 2: your car radiator more. You know, how does alcohol work,
Speaker 2: doctor Perry, Let's do it. What are the reasons the
Speaker 2: alcohol is fun? Basically, that's the first question.
Speaker 1: Yeah, it works in your brain. It actually works like
Speaker 1: a lot. We have drugs that kind of work in
Speaker 1: similar ways, and alcohol sort of touches on all of these.
Speaker 1: So the primary one that you'll read about is that
Speaker 1: if it stimulates the GABBA receptor in the brain. This
Speaker 1: is the same receptor that benzodiazepines like adavan, valuum, those
Speaker 1: types of drugs bind too, So it gives that sort
Speaker 1: of tired, sleepy, funky feeling that comes with stimulation of
Speaker 1: that receptor. But it also blocks the NMDA receptor. That
Speaker 1: is what ketamine does, so it has a little bit
Speaker 1: of the depressiant effect or the dissociative effect that you
Speaker 1: see with ketamine. It causes dopamine release in the brain,
Speaker 1: which is why it feels pleasant and happy and good
Speaker 1: at least for most people, and it releases endogenous opioids,
Speaker 1: so it has even an opioid effect in the brain.
Speaker 1: So it kind of it's like it's like an amazing
Speaker 1: cocktail note pun intended of drugs that people like to
Speaker 1: abuse because it makes their brain feel nice and it
Speaker 1: also makes you peel lot.
Speaker 2: Okay, So we talked about prohibition and and post prohibition,
Speaker 2: Americans have been drinking a lot. But actually in the US,
Speaker 2: the amount that people drink has been going down very
Speaker 2: precipitously over time. There was a sort of bump up
Speaker 2: over the last short period. There was a bump up
Speaker 2: during COVID wheneveryone was at home drinking, but it has
Speaker 2: continued a downward slide and we are now seeing both
Speaker 2: the sort of the lowest levels of drinking, the most
Speaker 2: number of people who are totally sober, and also a
Speaker 2: lot of discussion in I would say, the wellness and
Speaker 2: health space about how much alcohol is okay and more
Speaker 2: and more a message that none is okay. I would say,
Speaker 2: the kind of there's a piece of health messaging that
Speaker 2: comes some of it from the government, some of it
Speaker 2: from official sources, some of it from online that's in
Speaker 2: the space of you know, the appropriate amount is really none,
Speaker 2: and that even a small amount is bad for your health,
Speaker 2: and how bad is not so clear, and that's the
Speaker 2: piece of the messaging. I'm most interested in looking at
Speaker 2: the data on today because I think it's the piece
Speaker 2: that's most relevant for a lot of people. But before that,
Speaker 2: I actually do want to touch just briefly on the
Speaker 2: question of problematic drinking, because these are fundamentally somewhat different questions,
Speaker 2: And the question of you know, is it okay three
Speaker 2: times a week to have a glass of wine with
Speaker 2: dinner is pretty different from you know, how do we
Speaker 2: think about someone who from whom alcohol is getting in
Speaker 2: the way of their life or their family's life or
Speaker 2: other things. But that is an issue for many people.
Speaker 2: Alcohol is something a lot of people have a problem
Speaker 2: with and abuse. And it's also very clear in the
Speaker 2: data that heavy drinking is associated with quite a lot
Speaker 2: of bad outcomes. There are large estimates of amount of
Speaker 2: access death from heavy drinking. So I'm not even sure
Speaker 2: how to separate these, and I think it gets complicated
Speaker 2: because there's a continuum, it's not just two groups of people.
Speaker 2: But I do want to try hard in the discussion
Speaker 2: to sort of separate those two things.
Speaker 1: Yeah, I couldn't agree more. I think I think most
Speaker 1: people you know, if you have alcohol use disorder, if
Speaker 1: your alcohol use is affecting your daily life, if you
Speaker 1: feel guilty about drinking, if a loved one has brought
Speaker 1: it up to you that perhaps you're drinking too much,
Speaker 1: if you need to drink after you wake up in
Speaker 1: the morning, Like, there are plenty of signals of problematic drinking,
Speaker 1: and that is a group of people who need to
Speaker 1: seek some help because it definitely is associated with many
Speaker 1: bad health outcomes and of course life outcomes. And that's
Speaker 1: not really what we're talking about today. We're talking to
Speaker 1: the majority of people who may drink a bit, they
Speaker 1: drink moderately, who are hearing all these statements that every
Speaker 1: single glass of wine you have, every single drink is
Speaker 1: poison and want to know if that's true or not.
Speaker 1: And that's where we have to break down the data.
Speaker 2: Yeah, before we leave the question of problematic drinking, this
Speaker 2: is actually a space where we could do another episode
Speaker 2: on it. But there's a space where there is an
Speaker 2: increasingly interesting discussion about different possible treatments. There's been some
Speaker 2: evidence of gilp ones have improved alcohol use disorder. There's
Speaker 2: a drug called nltroc zone which people have used, and
Speaker 2: actually a variety of interesting ways to try to limit
Speaker 2: alcohol use. So that's for another day, but let me
Speaker 2: just leave here by saying, if you are struggling with
Speaker 2: alcohol use disorder, if you feel like alcohol is getting
Speaker 2: in the way of your life, that really is something
Speaker 2: to seek treatment for, and it is there are an
Speaker 2: increasing number of possible solutions that might be helpful.
Speaker 1: Sounds good for the rest of you. We are going
Speaker 1: to dig into the data about light to moderate drinking
Speaker 1: and its health effects if any.
Speaker 2: After the break, Okay, Perry, we are back and we're
Speaker 2: going to talk about what the data says on light
Speaker 2: to moderate drinking. And I want to play you a
Speaker 2: clip of somebody's feeling about this.
Speaker 4: It's one of those areas where you don't understand the
Speaker 4: hidden cost until you really give it up for a while.
Speaker 4: And then I think about my own relationship with drinking,
Speaker 4: and I stopped drinking at thirty years old and now
Speaker 4: thirty three, and I had just drank because I just drank.
Speaker 4: I'd never ran the experiment of just giving it up
Speaker 4: for a while, and then like, I don't know, must
Speaker 4: maybe I was at thirty one. I thought, you know,
Speaker 4: I have a drink again, because now I could really
Speaker 4: ab test it. I had a year of not drinking,
Speaker 4: decided to have a drink again. It ruined three days
Speaker 4: of my life. I had a couple of glasses of wine,
Speaker 4: didn't get drunk. It ruined three days of my life
Speaker 4: because of the domino effected course, sort it meant that
Speaker 4: I got worse sleep that night, and then because I
Speaker 4: got worse sleep that night, I more poorly the next
Speaker 4: day because my my dopamine system or whatever, the quartersole
Speaker 4: system was all messed up. And then I podcasted worse.
Speaker 4: I didn't go to the gym the day after that,
Speaker 4: that day all the day after because of that, because
Speaker 4: I felt really bad. I then slept worse. And I
Speaker 4: could track all of this on my week hashtag and
Speaker 4: hashtag sponsor, hashtag investor whatever. Yeah, And I was like,
Speaker 4: oh my god, the three glasses of wine had this
Speaker 4: hidden domino effect that I must have been living with, yeah,
Speaker 4: for my whole life.
Speaker 1: I like how one of his metrics was like, oh,
Speaker 1: I'm not as good at podcasting after I drink, which
Speaker 1: definitely I was like, oh, no, did you drink last night?
Speaker 1: I had a gossip of wine last night, or maybe
Speaker 1: slightly more than that.
Speaker 2: I don't. I don't drink, actually.
Speaker 1: You don't drink alcohol ever what not?
Speaker 2: Ever, I very occasionally drink, and I used to drink more,
Speaker 2: but at this point I maybe like maybe once every
Speaker 2: couple of months.
Speaker 1: I feel like they should have come out earlier in
Speaker 1: the episode. But that's okay.
Speaker 2: I will tell you I more or less quid drinking
Speaker 2: because it really affects my whoop recovery score. It's the
Speaker 2: same reason as every other thing I do. Very Actually,
Speaker 2: it's like twelve percent of my whoop and that's.
Speaker 1: It so amazing. I mean, how do you you know,
Speaker 1: forget your troubles at the end of the day. How
Speaker 1: do you.
Speaker 2: Wildly I just like, look at my whoop recovery score.
Speaker 2: I'm like, okay, I don't, I am it's not something
Speaker 2: I miss. I really like, I really non alcoholic beer.
Speaker 1: Yeah, I don't mind something not alcoholic.
Speaker 2: Bear fan of But yeah, anyway, I don't drink. So
Speaker 2: that's why I'm so much better at podcasting than you.
Speaker 1: I guess that does explain quite a bit. Everyone Emily
Speaker 1: is a teetotaler, and I there's this old joke which is,
Speaker 1: if you ask a doctor what the definition of an
Speaker 1: alcoholic is, the answer is, well, anyone who drinks more
Speaker 1: than I do.
Speaker 2: So so if you ask not a doctor. But the
Speaker 2: US dietary guidelines, we actually have some I would say
Speaker 2: they're fluid guidelines, but we have some US dietary guidelines
Speaker 2: about how much alcohol is considered recommended. And again these
Speaker 2: things are always like, what do you mean recommended, Like
Speaker 2: that's a good amount, that's too lit with. But those
Speaker 2: numbers in the US Dietary Guidelines from twenty twenty to
Speaker 2: twenty twenty five were less than or equal to one
Speaker 2: drink a day for women two drinks a day for men.
Speaker 2: In the twenty twenty six guidelines, they just went with less,
Speaker 2: so I don't know, that's not a number, But the
Speaker 2: twenty six guidelines are a bit different. So just not
Speaker 2: so much is where they want.
Speaker 1: I should have said fewer. I feel like that's okay.
Speaker 3: Fewer.
Speaker 2: The American Heart Association is in the range of like
Speaker 2: two drinks a day probably limited risk. The World Health
Speaker 2: Organization says none, So there is you know, everyone kind
Speaker 2: of agrees that you should keep it low, but people
Speaker 2: differ on what that means or how bad it is.
Speaker 2: And the reason for that is that the data is
Speaker 2: mostly trash. Actually, when we are talking about light drinking.
Speaker 1: Yeah, I think before we dig in, we're going to
Speaker 1: dig into some of the risks cancer, cardiovascular disease, and
Speaker 1: so on in a minute. But to set the stage,
Speaker 1: there is a problem in the literature. There's the standard
Speaker 1: problem of observational data, which we'll get to talk about
Speaker 1: this a lot. But there's another problem which is called
Speaker 1: or one way we can call it is linear extrapolation.
Speaker 1: And that's when you have have an exposure that has
Speaker 1: a dose. So it's not just like yes, no, you
Speaker 1: take a medication, but it has a dose associated with it,
Speaker 1: and you have a wide range of those doses, and
Speaker 1: you're looking at a large data set where some people
Speaker 1: have very high doses of the thing like alcohol, and
Speaker 1: some people are very low, and some people have none.
Speaker 1: And you look at the rates of some outcome and
Speaker 1: you draw a line, You fit a line of best
Speaker 1: fit to all of these data points. And one of
Speaker 1: the risks of doing that is that if the risk
Speaker 1: actually clusters at the high end fitting a line can
Speaker 1: be inappropriate. There can be threshold effects. For example, we
Speaker 1: see this not only with alcohol, but for example, with
Speaker 1: radiation dosages. So a lot of the sort of quote
Speaker 1: unquote risk of getting a chest X right for example,
Speaker 1: which is a vanishingly small amount of radiation, they'll be like, oh,
Speaker 1: it increases your risk of cancer by zero point zero
Speaker 1: zero zero three percent every chest X ray. Well, actually
Speaker 1: that data is coming from the cancer rate of people
Speaker 1: who were like in Hiroshima, Nagasaki and surrounding areas, who
Speaker 1: got you know, thousands of times the doses and then
Speaker 1: a linear extrapolation down to getting one one thousands of
Speaker 1: the dose, and that's just not always accurate in biology.
Speaker 1: So that's a big meta problem we're going to have
Speaker 1: to face with all this stuff. And I think that's
Speaker 1: why the who comes out and says like no level
Speaker 1: is safe, because they're extrapolating. They're extrapolating.
Speaker 2: And then of course we have our standard observational data problem.
Speaker 2: There's a little you know, we'll talk I think maybe
Speaker 2: at a couple of places where you've got a little
Speaker 2: bit of randomized data on sort of small things, but
Speaker 2: for the most part this is going to come from
Speaker 2: data that compares people who drink different amounts and looks
Speaker 2: at their outcomes and tries to adjust for some differences
Speaker 2: across them, but is not going to be able to
Speaker 2: do that in a complete way. And I actually think
Speaker 2: sometimes we talk about this, I think it can be
Speaker 2: quite opaque to people, like what do you mean They
Speaker 2: couldn't adjust for the things like what do you mean
Speaker 2: they couldn't see enough details about about people. But in
Speaker 2: these studies you will see things about people like did
Speaker 2: they go to college, how much income do they have?
Speaker 2: You know, kind of in some broad buckets, but you
Speaker 2: won't see all of the little details. And like, to
Speaker 2: go back to our conversation about our behaviors, you and
Speaker 2: I actually in these studies to this researchers would look
Speaker 2: very similar other than our gender, right, we both we
Speaker 2: actually went to the same college. Forget they never see that,
Speaker 2: but we went to you know, we both went to college.
Speaker 2: We probably are in similar income brackets, we have you know,
Speaker 2: similar other kinds of risk factors. But let's say you
Speaker 2: were running a study where the outcome was like you know,
Speaker 2: some kind of like votumax or some like sort of
Speaker 2: cardiovascular performance when we run that study, you drink more
Speaker 2: than I do, and we're going to see, like that's
Speaker 2: going to if you and I are like representative, it's
Speaker 2: going to look like, boy, not drink is really good
Speaker 2: for your VOTWO max. But actually the reason I don't
Speaker 2: drink is because I'm doing every possible thing in my
Speaker 2: whole life to invest in the VOTWO max, which the
Speaker 2: researchers will never see. And that's the kind of example
Speaker 2: of where like there's so much in the data and
Speaker 2: it's all causing itself that it's really hard to draw conclusions,
Speaker 2: especially when you're talking about you know, what's the impact
Speaker 2: of one drink or two drinks, which where those impacts
Speaker 2: are very very small relative to the size of these biases.
Speaker 1: Yeah, and this is one of the reasons I think
Speaker 1: red wine in particular, for like twenty years was a
Speaker 1: health food to some extent, because there was observational research
Speaker 1: that said, oh, you know, drinking a glass or two
Speaker 1: of red wine today is associated with the lower risk
Speaker 1: of cardiovascular disease and so on and so forth, And
Speaker 1: that is true associationally, like there's a correlation there, But
Speaker 1: who's the type of person who drinks red wine, especially
Speaker 1: versus other types of alcohol. Right, Yeah, it's rich people.
Speaker 1: It's you know, people who eat a very different diet
Speaker 1: than people who are drinking even beer or hard alcohol
Speaker 1: or things like that. And we sort of know this
Speaker 1: is BS because the explanation outside of confounding was, oh, no,
Speaker 1: red wine has these stuff in it, like recept stalls
Speaker 1: extre which is this special thing, and that's actually what's
Speaker 1: protecting your heart. And then they did a randomized child
Speaker 1: They're like, well, you don't need to the red wine.
Speaker 1: Let's just synthesize recever trawl and we'll give half the
Speaker 1: people that in half placebo and we'll see what their
Speaker 1: heart attack rate is and bupkus, nothing whatsoever.
Speaker 2: But I actually think that's a particularly good example of
Speaker 2: yet another problem here, which is we started telling people
Speaker 2: in the nineteen seventies red wine is good for you,
Speaker 2: and then who are the people who started drinking red wine?
Speaker 2: Is the people who are like, oh, I'm really interested
Speaker 2: investing in my health, I'm doing all this other stuff,
Speaker 2: I'm going to add some red wine. Then you come
Speaker 2: back to look at them later, it looks like red
Speaker 2: wine is even better because now it's even more selected
Speaker 2: so right right, anyway, this you know, you know how
Speaker 2: I feel about selection vibe.
Speaker 1: I know, but don't worry because I have a Mendelian
Speaker 1: randomization loiety and deep cut for podcast listeners. We know
Speaker 1: how much about my.
Speaker 2: Ex boyfriends in the studies here, all right.
Speaker 1: Let's talk about cancer. That's the elephant in the room.
Speaker 1: I think these days when we're talking about alcohol, and
Speaker 1: I will say from the doctor perspective that there's biologic
Speaker 1: plausibility here. Alcohol is metabolized in primarily in the liver,
Speaker 1: but also in the gut to acid aldehyde. Acid aldehyde
Speaker 1: damages DNA. It does. It is a DNA toxin. We
Speaker 1: know that that happens if you put outset aldehyde on
Speaker 1: cells in a petri dish. Therefore, if you have that
Speaker 1: floating around your body for too long, maybe it can
Speaker 1: damage DNA. Damaged DNA leads to cancer. It's so facto
Speaker 1: alcohol causes cancer.
Speaker 2: And in the observational data, you know, if you look
Speaker 2: at like you fit a trend to the entire distribution
Speaker 2: I'm drinking, you definitely see higher cancer rates with heavier drinking.
Speaker 2: But when you try to limit down to smaller amounts
Speaker 2: of drinking, even in these data, which again have these
Speaker 2: other biases. The effects are either zero or really really
Speaker 2: very tiny, and for example, a lot of these find
Speaker 2: kind of almost no increased risk for people who are
Speaker 2: saying not smokers, and that suggests that maybe some behaviors
Speaker 2: like smoking are also driving some of what we're seeing
Speaker 2: in the relationship, because those seem to move together.
Speaker 1: So yep, absolutely, there's the confounding of smoking, which is
Speaker 1: that when people who drink are more likely to smoke,
Speaker 1: and even when people drink, they might be more likely
Speaker 1: to smoke, even if they're not sort of chronic smokers.
Speaker 1: That's an issue. There is also likely some synergy here
Speaker 1: where the cancer promoting effects of smoke and the potential
Speaker 1: cancer promoting effects of alcohol sort of work together to
Speaker 1: increase the risk more dramatically. I think, Emily, you're referring
Speaker 1: to this big study of two hundred thousand health professionals
Speaker 1: in the US and the BMJ in fifteen, which basically
Speaker 1: showed that across kind of reasonable amounts of consumption, that
Speaker 1: there is no increased cancer risk among non smokers. There's
Speaker 1: an exception to this, which is breast cancer in women,
Speaker 1: and this is one that keeps coming up so it's
Speaker 1: very clear that alcohol doesn't increase the risk of all cancers.
Speaker 1: Even in the bad observational data. The cancers that are
Speaker 1: associated with alcohol intake mostly kind of lie in the
Speaker 1: GI trap, like the area of your body that gets
Speaker 1: exposed to the alcohol, so mouth and oral cancer, stomach cancer,
Speaker 1: colon cancer. But then breast cancer always stands out as
Speaker 1: a signal that we continue to see. So I am
Speaker 1: a little bit more worried about that. But you've heard
Speaker 1: that my wife is a breast cancer surgeon, so that
Speaker 1: one always is the monkey on my back.
Speaker 2: And I will say, even you know, in those the
Speaker 2: kind of size of the impact at small levels or
Speaker 2: drinking is very small. And I guess this gets to
Speaker 2: another piece of this, which is which we can sort
Speaker 2: of talk about it maybe more at the end. I
Speaker 2: think it's a it's a broader picture. But even the
Speaker 2: places where people would say, you know, maybe there's some
Speaker 2: hint of an increase in breast cancer, it's really really
Speaker 2: really small.
Speaker 1: Yeah, And it is not the major risk factor for
Speaker 1: breast cancer.
Speaker 2: It's not the major risk factor for breast cancer. And
Speaker 2: I think we want to think about, you know, like
Speaker 2: that trades off against say the fact that you might
Speaker 2: enjoy this, And this is surrounds all of this conversation
Speaker 2: that we're kind of looking for evidence that alcohol is
Speaker 2: like somehow good for you, as opposed to saying, you know,
Speaker 2: there are a lot of things we do that are
Speaker 2: not health investments and that maybe even have some small
Speaker 2: negative impacts that we like, and that's you know, yeah,
Speaker 2: there's other reasons that people engage in these activities other
Speaker 2: than that they're a health food.
Speaker 1: Yeah, and I did. I worked pretty hard. We'll get
Speaker 1: there to try to find actual hard data that alcohol
Speaker 1: is good for you. We'll get there in a minute.
Speaker 2: But I will say, like another place that that Like
Speaker 2: in this BMJ study, one of the things you see,
Speaker 2: for example, is people who drink a little bit relative
Speaker 2: to not at all, which is kind of the parison
Speaker 2: we're looking at, are actually quite a bit more likely
Speaker 2: to have had a mammogram. So that one interpretation of
Speaker 2: some of this is maybe some of the cancer that
Speaker 2: we're seeing is actually like screening and not actual diagnosis,
Speaker 2: which again gets into the hole like it's just really
Speaker 2: really hard to interpret observational data when you're seeing such
Speaker 2: small effects because a billion different things in the data
Speaker 2: billion different differences might drive them.
Speaker 1: Absolutely. Let's try to get away from observational data. So
Speaker 1: I'm going to talk to you about a Mendelian randomization study. Okay,
Speaker 1: let's do the one that appeared in Cancer in twenty
Speaker 1: twenty two. So for those of you who weren't here
Speaker 1: the last time when Emily, let's just say where it
Speaker 1: got heated about this study design. The idea of Mendelian
Speaker 1: randomization is that in this case, some people are genetically
Speaker 1: predisposed to drink more alcohol than others. We know that
Speaker 1: there are certain gene variants that just meet and that
Speaker 1: mean all else being equal, you're going to drink a
Speaker 1: little bit more. Maybe it hits you in the right way,
Speaker 1: it's more pleasurable. You all might know some people who
Speaker 1: actually genetically almost can't drink alcohol. You know, many people
Speaker 1: of Asian ancestry lack the aldehyde dehydrogenase activity to appropriately
Speaker 1: process alcohol, and it becomes very unpleasant to drink even
Speaker 1: small amounts of alcohol. So there are genetic determinants of
Speaker 1: how much alcohol you take. In this study in Cancer
Speaker 1: in twenty twenty two looked at breast cancer risk. Again,
Speaker 1: something I'm concerned about when it comes to alcohol intake,
Speaker 1: and the model that predicted alcohol intake full stop showed
Speaker 1: that people genetically predisposed to drink more alcohol over their
Speaker 1: lives had no higher risk of breast cancer. But another
Speaker 1: model which looked at the genetic risk of problematic drinking,
Speaker 1: which is a separate genetic risk model, did show an
Speaker 1: increase risk of breast cancer. And so one possible interpretation
Speaker 1: of that could be that, you know, load to moderate
Speaker 1: amounts of alcohol intake don't increase your risk of breast
Speaker 1: cancer equal, but problematic intake does.
Speaker 2: Okay, I guess, I mean sure, I guess that could
Speaker 2: be an introvert.
Speaker 1: Okay, let's move on before Emily says anything else.
Speaker 2: I hate this method. I've please just I can't do
Speaker 2: it again. But I think that there are a lot
Speaker 2: of other things that these genetic variants might be linked to.
Speaker 2: And I don't really think this is any better than
Speaker 2: anything else. But I will say that it is not
Speaker 2: inconsistent with this broader picture that maybe at high levels,
Speaker 2: problematic drinking could be linked with a higher risk of cancer.
Speaker 2: I'm not sure we learn anything particular from this particular
Speaker 2: stupid technology. All right, that's I'm going to leave it there.
Speaker 1: Bottom line cancer if you drink, don't smoke.
Speaker 2: My husband told me last week it was like too
Speaker 2: much Medellia completely, So I'm just gonna I'm just gonna stop.
Speaker 1: Okay, please see prior episode for Emily's rant. All right,
Speaker 1: alcohol maybe modest effects on cancer. We're not too worried
Speaker 1: about load of matter intake. Don't smoke while you are drinking.
Speaker 2: Smoke, don't smoke. Oh yeah, cooking is associated with cancer.
Speaker 1: Don't smoke, right, right, right, sorry, don't smoke at all. Okay, smoke,
Speaker 1: but also don't smoke while're drinking. Even just the one.
Speaker 1: Let's talk about heart disease. I think it actually back
Speaker 1: in the day that was the bigger sort of both conservative.
Speaker 1: First of all, is like is it cardioprotective? Then you're right,
Speaker 1: is it good for your heart? And then is it
Speaker 1: bad for your heart? One slam dunk effect I will
Speaker 1: give you for alcohol on the heart is blood pressure. Totally.
Speaker 1: We know from randomized trials. You take people in the lab,
Speaker 1: you give them alcohol, or you give them place Ebo
Speaker 1: alcohol and their blood pressure goes up. But this effect
Speaker 1: is small. So one meta analysis I was looking at
Speaker 1: that integrated these results from randomized trials and the journal Hypertension.
Speaker 1: This is sort of an older study, but I mean
Speaker 1: this has been study for a long time. One drink
Speaker 1: less per day led to about a one millimeters of
Speaker 1: mercury lower systolic blood pressure. That's the top numbers. So
Speaker 1: I believe this is true, but the effect is not huge.
Speaker 1: That being said, if you're struggling with high blood pressure,
Speaker 1: alcohol ain't helping.
Speaker 2: Yeah, I mean, I will say when I look when
Speaker 2: you dig into sort of some of the studies that
Speaker 2: make this up, they are mostly randomized trials that start
Speaker 2: with a population that's drinking quite a lot and then
Speaker 2: have to sort of encourage comes to drink to drink less.
Speaker 2: So like in one of these studies, you know, average
Speaker 2: consumption at the start is like thirty six strenths a week.
Speaker 2: That's a lot. I mean, that's more than that's more
Speaker 2: than five rimes.
Speaker 1: More than me.
Speaker 2: Like, that's just barely and so I think there's a
Speaker 2: There again, is a little bit of this interpolation issue,
Speaker 2: which is it's less clear if you are drinking one
Speaker 2: drink every day, if going down to zero would actually
Speaker 2: have an impact on your blood pressure. That would be
Speaker 2: that would be measurable, but it is worth saying, you
Speaker 2: know again, if you are struggling with this, it's something
Speaker 2: something to try based on that data.
Speaker 1: It is as nephrologists like me kidney doctors deal with
Speaker 1: complex hypertension. That's one of our sub sub specialties, and
Speaker 1: it's always on our checklist. Like, oh, you know, drink
Speaker 1: less alcohol.
Speaker 2: Heart disease in general has the J shaped curve. Drinking
Speaker 2: a little bit. J shaped curves love it because there's
Speaker 2: so much okay J shaped curve where, which means that
Speaker 2: the people with the lowest risk of heart disease are
Speaker 2: people who drink some but not very much or very little. Now,
Speaker 2: of course, people who drink a little bit are kind
Speaker 2: of different from both the people who don't drink in
Speaker 2: all of the people who drink a lot in ways
Speaker 2: that are observable and ways that are not observable, And
Speaker 2: so it has been very difficult to figure out whether
Speaker 2: this J shaped relationship is a real thing or just
Speaker 2: an artifact of observational bias.
Speaker 1: It's the second yeah, and it's the J shaped curve
Speaker 1: that led to a lot of that one to two
Speaker 1: drinks a day is heart healthy. There's just an other
Speaker 1: Simpsons quote where oh my god, another great episode where
Speaker 1: Homer gets hired by Hank Scorpio and their life is
Speaker 1: just perfect there, but the perfection of their life sort
Speaker 1: of gives them on Nui and Marge. You see her
Speaker 1: drinking and eventually they tell Homer that they can't live
Speaker 1: in this beautiful place anymore. And Marge is like, I'm
Speaker 1: drinking half a glass of wine a day. I know
Speaker 1: the doctors say you're supposed to drink a glass, but
Speaker 1: I just can't drink that much. So, you know, anyway, Sorry,
Speaker 1: that's what the doctors say. And it's this j shape
Speaker 1: curve that led to that belief. But one thing that
Speaker 1: sounds simple, but people really didn't account for in the
Speaker 1: early observational studies that people with chronic health conditions might
Speaker 1: be avoiding alcohol because they make their chronic health conditions worse.
Speaker 1: You know, people with cancer undergoing therapy are going to
Speaker 1: drink less than people who aren't, And so you get
Speaker 1: this tale where non drinkers have a higher risk of
Speaker 1: a lot of different things.
Speaker 2: Yeah, that is called reverse causality. We have a different
Speaker 2: name for them. And yeah, so that shows up there,
Speaker 2: and I think over time, people have kind of moved
Speaker 2: interesting aspect for me of this whole discussion is we
Speaker 2: had this J shape curve, and over time we've kind
Speaker 2: of moved away from the J shape curve into sort
Speaker 2: of arguing that this positive effect is gone and so
Speaker 2: it's really just only the increase. But somehow many people
Speaker 2: who are making that argument are making it like, well,
Speaker 2: the people who are not drinking at all are totally
Speaker 2: different from the people who drink a little bit, But
Speaker 2: those people are then unable to understand the argument that
Speaker 2: the people who drink a lot are also different. It's
Speaker 2: like we're only interested in understanding bias in support of
Speaker 2: view that we are hoping to hold right.
Speaker 1: Right right. For what it's worth, I did pull a
Speaker 1: Mendelian rantimization article Circulation Genomic and Precision Medicine twenty twenty
Speaker 1: which looked at cardiovascular disease based on genetic predisposition to
Speaker 1: alcohol intake and basically found more or less bup kiss.
Speaker 1: They did find higher risk of stroke in people who
Speaker 1: were genetically predisposed to alcohol intake and higher risk of
Speaker 1: peripheral arterial disease, but most of the other signals were
Speaker 1: pretty weak in that analysis. But no protection, certainly no
Speaker 1: heart health signal.
Speaker 2: Yeah, I don't think I don't think it's reasonable to say,
Speaker 2: based on the data that alcohol protects you from heart disease.
Speaker 2: I think there's also pretty limited evidence that at moderate
Speaker 2: levels it is bad for you.
Speaker 1: Yeah, bad for your heart.
Speaker 2: Okay, let's talk about a couple of things where I
Speaker 2: think this we maybe have better evidence that there are
Speaker 2: some impacts. So one is anxiety and depression, which alcohol
Speaker 2: use disorder in particular really makes quite a lot worse.
Speaker 2: And we have a lot of we have a lot
Speaker 2: of evidence on that.
Speaker 1: Yeah, it's just not this is not a treatment for anxiety.
Speaker 1: I know people think it is, and there's a lot
Speaker 1: of self medication going on with alcohol and anxiety and depression,
Speaker 1: but there's no evidence that people with those clinical diagnoses
Speaker 1: that alcohol has any benefit. In fact, there's quite a
Speaker 1: lot of evidence that it makes it worse. That ain't
Speaker 1: the solution. Now, this is different than alcohol acting as
Speaker 1: a social lubricant. We're not talking about just kind of
Speaker 1: I get a little anxious when I meet new people.
Speaker 1: We're talking about actual anxiety depression. But I just want
Speaker 1: to put it out there that this is not we're
Speaker 1: not going to see any benefit. We're only going to
Speaker 1: see harm with alcohol in those conditions.
Speaker 2: The other place I think is we're talking about is sleep.
Speaker 2: I think there's actually very little question that alcohol, even
Speaker 2: at relatively low levels, makes people sleep worse. Yeah, so
Speaker 2: people have you know, like it increases your resting heart rate,
Speaker 2: it lowers the quality of your sleep. And this is
Speaker 2: true for healthy people even with again sort of relatively
Speaker 2: mild amounts of alcohol consumption. So you know, I think
Speaker 2: this is the kind of thing that you can get
Speaker 2: into with the wellness. Like, you know, it made my
Speaker 2: resting heart rate three units hire and tiers. All of
Speaker 2: the problems with that, it's not really clear why. Again,
Speaker 2: sort of from a longevity or clinical meaningful health perspective,
Speaker 2: that matters. I will say, if you are looking to
Speaker 2: optimize tomorrow's performance in some you know, podcast or sporting event,
Speaker 2: you know it is perhaps not the best active Most
Speaker 2: people do not drink before a race. I will say that.
Speaker 1: Yeah, So give me some feedback everyone after this episode,
Speaker 1: how my performance, my performance was. I think it's worth
Speaker 1: mentioning that, yes, illlcohol clearly disrupts sleep. It also has
Speaker 1: an effect of suppressing rem sleep, which is dreaming sleep
Speaker 1: that's through that Gabba receptor antagonism, So benzodiazepines have the
Speaker 1: same effect. In fact, psychiatrists will use benzodiazepines to treat
Speaker 1: people who have chronic nightmares like PTSD induced nightmares and
Speaker 1: things like that, to suppress the dreams. But in general,
Speaker 1: you don't want to suppress your rem sleep. That's a
Speaker 1: lot of memory consolidation happens and learning happens, and so
Speaker 1: that's yet another reason to limit alcohol, especially right before bed.
Speaker 2: I think a lot of people, in the case of
Speaker 2: alcohol use disorder. It is common for people to use
Speaker 2: alcohol to fall asleep, and then they're often up in
Speaker 2: the middle of the night because alcohol will help you
Speaker 2: fall asleep at the beginning of the night to some extent,
Speaker 2: but then.
Speaker 1: You withdraw essentially exactly.
Speaker 2: Withdrawal disrupts your sleep later.
Speaker 1: Right, and and alcohol is constantly getting metabolized, and especially
Speaker 1: if you are a frequent user of alcohol, then that
Speaker 1: withdrawal that happens at two three am. I mean, we've
Speaker 1: all been there, maybe not you, Emily, but or in
Speaker 1: college if you remember, I.
Speaker 2: Have been there, You've been there.
Speaker 1: At the two to three am you wake up, you're
Speaker 1: sort of you feel hyper, you feel uncomfortable's hard to
Speaker 1: fall back asleep. Not great, not great, folks.
Speaker 2: Okay, but let's talk about where alcohol is great, which
Speaker 2: is making parties more fun. Right.
Speaker 1: Basically, this is it's like everything in medicine is risk benefit,
Speaker 1: and we've given you a lot of risks and we
Speaker 1: don't have much benefits to share except that it is
Speaker 1: fun and it makes social interactions, which is.
Speaker 2: A real benefit. I mean, I think that is, like,
Speaker 2: you know, it's an aspect of this conversation that's very frustrating. Again,
Speaker 2: is this piece of it where it's like we're looking
Speaker 2: for evidence that alcohol is like broccoli and it's not.
Speaker 2: It's not like broccoli. Okay, Broccoli like you can have
Speaker 2: as much of it as you want. It's super energy, dense,
Speaker 2: a lot of fiber, Nature's brew. Broccoli is great for you,
Speaker 2: a lot of vitamins. Whatever. Alcohol is not broccoli. But
Speaker 2: we're talking about it like if it's not broccoli, it's
Speaker 2: basically cocaine, and it's like at low levels, it's also
Speaker 2: not cocaine. And I think we got to kind of
Speaker 2: like find the middle here.
Speaker 1: Yeah, what is is it? Bacon?
Speaker 2: I think it's like dorito. It's like Dorito's or bacon
Speaker 2: or something. It's like it's like fun, It's like it's
Speaker 2: sometimes food, you know, all right.
Speaker 1: I like that. The studies of alcohol and its social
Speaker 1: effects are really fascinating. And whenever I read these, I
Speaker 1: get sad. The eye study kidney disease, and I don't
Speaker 1: actually get to run these trials. So these are studies.
Speaker 1: These alcohol researchers bring people into the lab. Some of
Speaker 1: them have their lab set up like a bar to
Speaker 1: like have the full experience, so they have a bar
Speaker 1: in their lab and then they're measuring out all these
Speaker 1: precise amounts of alcohol. There's a fun study in psychological
Speaker 1: science in twenty twelve. They took seven hundred and twenty
Speaker 1: people strangers in groups of three, and they put them
Speaker 1: in a room and they randomize them to drink alcohol
Speaker 1: versus placebo, and then they saw, you know, how they
Speaker 1: felt they just interacted and how they felt about each other.
Speaker 1: And those who got the alcohol reported as significantly enhanced
Speaker 1: positive affect, So good feelings about the other people are
Speaker 1: reduced negative affect and increased self reported bonding. In short,
Speaker 1: they had a good time and they made some friends.
Speaker 2: Yeah, which is really that's what that's what's for, man,
Speaker 2: that's what it's for. I don't know. I think that's
Speaker 2: what I'm curious here. What is the placebo like? Does
Speaker 2: it taste like alcohol?
Speaker 1: Yeah? They do. They have stuff that tastes alcohol ish,
Speaker 1: like medicinal I think maybe quinine or things. In some
Speaker 1: studies now they are using alcohol free beer and alcohol
Speaker 1: alcohol free wine de alcoholized wine, which now doesn't taste
Speaker 1: as crappy as it did ten years ago. A lot
Speaker 1: of advances I think. I don't know. Athletic I think
Speaker 1: is pretty.
Speaker 2: Good, but no, the beer is great, the alcohol free
Speaker 2: wine is I still haven't made any progress on that.
Speaker 1: Yeah. So yeah. And there are some other studies as
Speaker 1: well that show, for example, in social interactions with alcohol
Speaker 1: compared to without alcohol, alcohol consumption moderated seven of ten
Speaker 1: associations between state social anxiety and indicators of healthy social interactions.
Speaker 1: What this means is that you measure someone's general social anxiety,
Speaker 1: how nervous they are, and how well they interact with
Speaker 1: new people, and across seven of ten of those metrics,
Speaker 1: alcohol improved the social interaction. So you don't want to
Speaker 1: go too crazy when you're meeting new people like you know,
Speaker 1: but it smooth things over. It does, it.
Speaker 2: Does, and I think that's that's worth Uh, that's worth noting.
Speaker 2: I mean, interacting with other people who you haven't met
Speaker 2: before is one of my nightmares, and so I actually
Speaker 2: really appreciate this.
Speaker 1: I'm trying to imagine how you even do it. I
Speaker 1: assume you just say hi, I'm Emily. Here is my
Speaker 1: Whoop score for recovery score for today.
Speaker 2: I don't like it. I don't I'm for someone whose
Speaker 2: life is spent so aggressively in the public eye. I
Speaker 2: am surprisingly shy and weird at parties, so.
Speaker 1: I'm not entirely surprised that the nicest way you've a
Speaker 1: long time.
Speaker 2: I'm sure you were in college parties with me when
Speaker 2: I was probably also super weird.
Speaker 1: H No, you're always I was drinking.
Speaker 2: Okay, let's move on.
Speaker 1: Always wonderful and charming. I threw in a study for
Speaker 1: you about I always have to find something about endurance athletes.
Speaker 1: So do you buy the idea? As as told in
Speaker 1: Sports Medicine twenty twenty six, a journal, we like that
Speaker 1: the observational links between alcohol and death overall mortality were
Speaker 1: restricted to only the twenty percent of people who got
Speaker 1: the least amount of exercise. So if you're in the
Speaker 1: top eighty percent of exercisers, the alcohol effect goes away.
Speaker 1: Is that nice?
Speaker 2: No, don't don't. I don't believe in this because it
Speaker 2: is the set of people who are exercising are very
Speaker 2: different from the set of people who are not. In
Speaker 2: the people who are exercising wealth alcohol, like those differences
Speaker 2: are smaller. This just feels to me like it is
Speaker 2: entirely driven by different kinds of complicated biases. And so
Speaker 2: it's good to exercise, but it doesn't mean that you
Speaker 2: can just you shouldn't drink while you exercise. Don't put
Speaker 2: fight in you're in your water bottle, my friends, it's
Speaker 2: not good.
Speaker 1: At the same birthday party, I was telling you about
Speaker 1: that where the taco bell incident happened back in the
Speaker 1: news portion of the show. What we did is one
Speaker 1: of these group bikes where there's twelve people on a bike.
Speaker 1: I don't know if you have one ountain Rhode Island,
Speaker 1: and you bike around the city from bar to bar.
Speaker 1: But it's really hard, like you get a real workout.
Speaker 1: I was sweating and I loved it. I was drinking.
Speaker 1: I was exercising and I was like, this is a
Speaker 1: great combo. I feel good in so many ways.
Speaker 2: I feel like you're on the bike with twelve other
Speaker 2: people on the scene.
Speaker 1: Yeah, it's a big oval of pedals, and so there's
Speaker 1: a driver and everyone's pedaling together and the driver is
Speaker 1: steering it around the streets of New Haven. It's fun,
Speaker 1: but it's a work. I think you're at a hill
Speaker 1: and everyone's like, oh no, it's a hill, and then
Speaker 1: at the red lights he makes you drink. Wow.
Speaker 2: I mean, I grew up in New Haven and I
Speaker 2: never knew about this amazing bike. Okay, option, I'm totally
Speaker 2: doing that.
Speaker 1: All right. People are going to ask us, and so
Speaker 1: I'm going to ask you, Emily, who doesn't drink, and
Speaker 1: you can ask me who does. How much is okay
Speaker 1: to drink?
Speaker 2: I think, in my view, is in moderation, which is
Speaker 2: defined by yourself. So I would generally tell people I
Speaker 2: wouldn't have more than two drinks a day, because I
Speaker 2: think as you get up above there, you start seeing
Speaker 2: some of these impacts on more meaningful impacts on things
Speaker 2: like sleep. But I certainly would not tell people not
Speaker 2: to drink at all. I don't think that the data
Speaker 2: supports that.
Speaker 1: I agree. My party line is I tell people they
Speaker 1: can drink just enough, and it's their job to figure
Speaker 1: out what just enough is and to try to draw
Speaker 1: the line there. This is also something you can experiment with.
Speaker 1: I told you on a prior episode that I did
Speaker 1: dry January this year, so I didn't drink for a month,
Speaker 1: and I was waiting to feel as a maaz as
Speaker 1: everyone says you're going to feel, and it's like, oh,
Speaker 1: my sleep is so good and my energy and my focus,
Speaker 1: and I really just didn't feel any different. And that
Speaker 1: was a valuable experiment for me.
Speaker 2: But you can do that, and I will say I
Speaker 2: also experimented with this, had more or less the opposite experience,
Speaker 2: which is totally changes how I feel in the morning.
Speaker 2: And I think that's that's why self experimentation is helpful.
Speaker 1: All right, Emily, smash or pass alcohol?
Speaker 2: Smash in moderation.
Speaker 1: Yep, I am a smash. You know, alcohol is proof
Speaker 1: that God loves us. I believe it. So that's it.
Speaker 1: That's it for alcohol. You're mail bag question of the
Speaker 1: Week after the break.
Speaker 3: Hi, Emily and Perry. This is Kristen in Minneapolis. My
Speaker 3: question for you is about sleep apnea. Perry. You mentioned
Speaker 3: you had it in an earlier episode, and I was
Speaker 3: wondering if you would talk a little bit more about
Speaker 3: how to recognize it in someone someone who snores, like
Speaker 3: say my husband.
Speaker 2: Thanks so much, Okay, Perry, I'm going to pass this
Speaker 2: one to you as someone who has been through these
Speaker 2: this testing.
Speaker 1: Yeah, so for those of you who haven't gone through
Speaker 1: all the episodes. I have sleep apnia, use a seapap
Speaker 1: and that is something an intervention actually that has made
Speaker 1: I think my life a little better. I do think
Speaker 1: I have more energy using seapap. But more importantly, my
Speaker 1: wife still sleeps in the same bed with me, which
Speaker 1: is nice because snoring is the primary symptom of obstructive
Speaker 1: sleep apnia. Virtually everyone with obstructive sleep apnia is going
Speaker 1: to snore. Not everyone who snores has obstructive sleep apnia.
Speaker 1: That's how to think about this. The diagnosis of OSA
Speaker 1: requires a sleep study, that's the standard. This can be
Speaker 1: done in a sleep clinic where you actually go somewhere
Speaker 1: and you're in a bed and they have all sorts
Speaker 1: of monitors on you. But actually they've gotten really good
Speaker 1: now about doing this in your own home using portable devices,
Speaker 1: and what they're measuring for obstructive sleep apneas not snoring,
Speaker 1: but what are called apneas, so the cessation of breathing
Speaker 1: and hypopnias, which are periods of low levels of breathing.
Speaker 1: So they're measuring how your chest is moving up and
Speaker 1: down and their criteria for how many of those and
Speaker 1: how long they last to make the diagnosis.
Speaker 2: Is there a way to tell if you are just
Speaker 2: a person who's a very loud snorer whether you are
Speaker 2: not breathing like based on the noise? Is there a
Speaker 2: noise diagnostic?
Speaker 1: I mean spouses, bed partners can usually tell the person
Speaker 1: who is awake listening to you snore, will hear periods
Speaker 1: of apnea and or can hear periods of apnea and
Speaker 1: get nervous about it. You would think that someone would
Speaker 1: invent an app if that records you're snoring or something
Speaker 1: it gives you you would a risk store and maybe
Speaker 1: one exists, but none, certainly none are FDA approved for
Speaker 1: diagnostic diagnostic purposes. Tamor, our producer, just came up with
Speaker 1: the idea that it should be called app nia, which
Speaker 1: is genius patent pending wellness. Actually that's ours now. It'll
Speaker 1: be on the app store next week.
Speaker 2: My last question on this, and I'm just going to
Speaker 2: say this is just a personal question, is what's the
Speaker 2: let's say your partner is allowed snore but doesn't have
Speaker 2: sleep apnea. What are some ways other than kicking to
Speaker 2: get them to stop snoring?
Speaker 1: Yeah?
Speaker 2: Do you know?
Speaker 1: I do? Yeah? So yes, Waking them up not ideal
Speaker 1: because it'll come right back. Sleep position is the main one.
Speaker 1: So snoring happens usually for most people and they're sleeping
Speaker 1: on their back. People will tend to roll back onto
Speaker 1: their back once they fall asleep, if that's their comfortable
Speaker 1: sleep position. I have had some patients who have sown
Speaker 1: a tennis ball into a pajama shirt so that if
Speaker 1: they lie on their back, it sort of digs into
Speaker 1: them princess in the pea style, So they have to
Speaker 1: turn over to your sort of retraining. There are oral
Speaker 1: appliances that advance the jaw a little bit. I actually
Speaker 1: used one of these before I got my CPAP machine,
Speaker 1: and that opens up the oral pharynx so that snoring
Speaker 1: doesn't happen. They can be kind of uncomfortable. It's uncomfortable
Speaker 1: for me, but their dentists who specialize in this. There
Speaker 1: are surgeries that can eliminate snoring, soft palette surgeries, and
Speaker 1: then for people with an elevated BMI weight losses, a
Speaker 1: primary method to reduce storing.
Speaker 2: So I'm hearing kicking.
Speaker 1: Or tennis ball in the back of the.
Speaker 2: Shkicking or tennis ball.
Speaker 1: Okay, both are fun.
Speaker 2: All right? That is it for us today. Stick with
Speaker 2: us next week when we'll ask what's the deal with
Speaker 2: the sun.
Speaker 4: On?
Speaker 1: What the hell is?
Speaker 2: We'll get into it anyway.
Speaker 1: Is it? Is it a god?
Speaker 2: Come back? Next week you'll find out. Wellness Actually is
Speaker 2: produced in association with iHeartMedia. Our senior producer is Tamar Avishaik.
Speaker 2: Our executive producer at iHeart is Jennifer Bassett. Our theme
Speaker 2: music is by Eric Deutsch, and our content is for
Speaker 2: educational purposes only.
Speaker 1: If you like the show, help other people find us,
Speaker 1: leave a rating and review on Apple Podcasts or your
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Speaker 1: the show. You can follow us on Instagram at Wellness
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Speaker 1: Head over to Wellness Actually dot fm and leave us
Speaker 1: a question for our mailbag, or suggest a topic for
Speaker 1: a future show.
Speaker 2: We'll let the influencers have the last word. I don't
Speaker 2: want to alarm anyone, but I think there's a hockey
Speaker 2: call in this story. Do we have a word, sense
Speaker 2: of well being and any Sorry my speech, You're right,
Speaker 2: give me noth