Speaker 1: Among the blossoms, waits a jug of wine. I pour
Speaker 1: myself a drink. No loved one near raising my cup.
Speaker 1: I invite the bright moon and turn to my shadow.
Speaker 1: We are now three, but the moon doesn't understand drinking,
Speaker 1: and my shadow follows my body like a slave. For
Speaker 1: a time, Moon and shadow will be my companions, a
Speaker 1: passing joy that should last through the spring. I sing,
Speaker 1: and the moon just wavers in the sky. I dance,
Speaker 1: and my shadow whips around like mad while lucid still
Speaker 1: we have such fun together, but stumbling drunk, each staggers
Speaker 1: off alone, bound forever, relentlessly roam reunited at last on
Speaker 1: the distant.
Speaker 2: River of stars. Wow. I really like that little poem.
Speaker 2: I do too. So.
Speaker 1: That poem was by Lee Bi, also known as Lee Poe,
Speaker 1: who was, according to this source, one of the greatest
Speaker 1: poets of China's Tang dynasty, or of all of history.
Speaker 2: Perhaps.
Speaker 1: Lee Bi was a martial artist, an academic genius, and
Speaker 1: also a lover of wine and a member of the
Speaker 1: group Six Eyed of the Bamboo Brook, which was a
Speaker 1: group dedicated to literature and drinking.
Speaker 2: And in general.
Speaker 1: People at the time would only indulge socially So this poem,
Speaker 1: one of his most famous, is exploring the problems of
Speaker 1: drinking alone.
Speaker 3: Yeah, all the way back from the eighth century.
Speaker 2: The eighth century.
Speaker 1: And the poem that I read was translated by David
Speaker 1: Bowles from the original Chinese.
Speaker 2: And we'll post the link on our website.
Speaker 3: Yeah. Well, Hi, I'm Aaron Welsh and I'm Aaron Ollman Updike,
Speaker 3: and this is this podcast will kill you.
Speaker 1: It is and it's a It's a big episode for
Speaker 1: a couple of reasons.
Speaker 3: Reason number one is that it's our season finale.
Speaker 2: It's our season four finale.
Speaker 3: Yeah, four seasons four finales. This is a big one.
Speaker 1: Can you can you picture us four years to go
Speaker 1: when we were doing our first season in my back
Speaker 1: bedroom in my in our tiny house, Like can you
Speaker 1: could you ever have imagined that we would be here
Speaker 1: doing this now?
Speaker 3: Eric, You know what, I don't know if I like
Speaker 3: dared to hope that we would still be doing it.
Speaker 2: Yeah, But I.
Speaker 3: Think it's kind of funny because I think that neither
Speaker 3: of us maybe would have been that surprised because we
Speaker 3: had lists of like episodes we wanted to cover up to,
Speaker 3: like five seasons worth, all the way back then. I
Speaker 3: think the thing that would have really shocked us and
Speaker 3: we would not have believed is just like, is our
Speaker 3: listenership being so incredible and so supportive and so wonderful.
Speaker 1: Yeah, it's you all, listeners. Thank you so much. We
Speaker 1: would not be still making this podcast without you, or
Speaker 1: if we were, it definitely wouldn't be as much fun.
Speaker 3: Yeah, it's it's true. Yeah, so after this episode, don't worry,
Speaker 3: we will be coming back. So it's it's kind of
Speaker 3: like not that sad in a way, because you know
Speaker 3: we are. I think it would be a lie to
Speaker 3: say that we're not looking forward to the break a bit.
Speaker 2: You're highly looking forward to it.
Speaker 3: Yeah, just a little bit of time to rest our
Speaker 3: brains and to get some other stuff done that in
Speaker 3: the background. And you know, if you're looking for more
Speaker 3: of tpwk hy to like fill that need while you're gone,
Speaker 3: you should definitely check out our reading lists, our bookshop
Speaker 3: dot Org affiliate account, our Goodreads list, which, by the way,
Speaker 3: I've I'm not allowed to add any more books. I've
Speaker 3: capped it at one hundred, Like I've added one hundred
Speaker 3: books so far and so I can't add any more.
Speaker 3: So if there's a helpful listener out there that wants
Speaker 3: to add the books that I mentioned that would be lovely.
Speaker 2: That's hilarious.
Speaker 3: Oh my goodness, problems of a podcaster.
Speaker 1: Okay, so that's one of the reasons that this is
Speaker 1: a big episode. The other reason is because today we're
Speaker 1: talking about alcohol. Alcohol, like all of it, just alcohol.
Speaker 3: Yeah, you know, it sounded fun. It still sounds fun.
Speaker 2: It sounded manageable. Yeah.
Speaker 3: Yeah, well we'll see if it was yeah, you'd be
Speaker 3: the judge.
Speaker 2: Yeah, you guys, tell us.
Speaker 3: Well, it wouldn't be an episode of TPWKY or just
Speaker 3: an episode of a podcast about alcohol without a quarantiney exactly.
Speaker 3: So what are we drinking this week?
Speaker 1: We're drinking poor choices? Get it like po you are.
Speaker 1: I think this is the second poor related pun that we've.
Speaker 3: Done this season.
Speaker 2: Yep, this season. But it's a really good one. It is.
Speaker 3: It is a really good one. And in addition to
Speaker 3: having a really good name, it's also a really fantastic drink.
Speaker 3: And I'm I'm not exaggerating.
Speaker 2: Tell us what's in it? Aarin?
Speaker 3: So you start with mead, and we chose mead because
Speaker 3: meat is one of the oldest alcoholic beverages also known
Speaker 3: as honeywine. And then we kind of did a little
Speaker 3: fun sidestep. We're doing a shrub and if anyone hasn't
Speaker 3: had a shrub before, it's basically like you know, drinking vinegar.
Speaker 3: Like it's you make a little recipe with macerated fruit
Speaker 3: usually or like pulped fruit, and then some sort of
Speaker 3: sweetener and then vinegar and some spices if you want,
Speaker 3: and you let it sit and then you you know,
Speaker 3: filtered out and it's absolutely delicious. I made a shrub
Speaker 3: for this of honeycrisp apples and honey apple cide or vinegar,
Speaker 3: the zest of a lemon, all spice annis and cinnamon
Speaker 3: sticks yum.
Speaker 1: Also, don't be afraid of the sound of a vinegar drink.
Speaker 1: It's actually delicious.
Speaker 3: It's like really complex and delicious and you can do
Speaker 3: so much with them.
Speaker 1: Yeah, it makes a very good placy Brita. And don't worry,
Speaker 1: we'll post the full recipe for that quarantine and the
Speaker 1: non alcoholic Plasy Brita on our website, this podcast with
Speaker 1: kill you dot com and all of our social media channels.
Speaker 3: We will other business other business our website. There's lots
Speaker 3: of good stuff on there. You can find all of
Speaker 3: our sources for all of our episodes. You can find
Speaker 3: links to, like I said, our bookshop dot org affiliate account,
Speaker 3: and Goodreads list. You can find links to Patreon, to
Speaker 3: our merch to transcripts. And also I am excited to
Speaker 3: announce that Bloodmobile, who provides the music for this episode
Speaker 3: and all of our episodes, is now on Spotify, and
Speaker 3: we will post a link to that as well. So
Speaker 3: definitely check all of that stuff out.
Speaker 2: Is that all of our business today? Erin?
Speaker 3: I think? So should we dive in? Can we dive in?
Speaker 2: I think that we can. We'll take a sip and
Speaker 2: a break and then get to it. Perfect.
Speaker 3: Perfect.
Speaker 2: So alcohol, by which I mean Aaron ethanol? That's what
Speaker 2: you mean? Okay? Good?
Speaker 3: Yeah, by the way, I think we're going to be
Speaker 3: using these interchangeably throughout Okay.
Speaker 2: Well for sure. Yeah.
Speaker 1: Ethanol is the form of alcohol that we drink. It's
Speaker 1: the form that's used for recreational purposes. So when we
Speaker 1: say alcohol, that's what we're talking about in this context.
Speaker 1: All right, So ethanol. Alcohol is a psychoactive drug. I
Speaker 1: think it's important to frame it that way because a
Speaker 1: that is in fact what it is, and b it's
Speaker 1: not uncommon that we frame it either as something completely
Speaker 1: harmless or fairly harmless, or on the flip side, as
Speaker 1: a recreational substance or something that is really bad.
Speaker 3: Right, what is the definition of a psychoactive drug?
Speaker 2: So glad you asked Arin.
Speaker 1: I actually don't know if I have a formal definition,
Speaker 1: but it's a substance that acts directly on the brain,
Speaker 1: on the central nervous system. Okay, can you remember something
Speaker 1: else that we covered on this podcast that is also
Speaker 1: a psychoactive.
Speaker 3: Drug, caffeine.
Speaker 1: Caffeine, Yeah, exactly. So alcohol has direct effects on our brain,
Speaker 1: both in the short and the long term, that are
Speaker 1: not only important to understand, but are also fascinating. As
Speaker 1: per usual, I'm not going to be able to cover
Speaker 1: it all, and alcohol effects a lot more of your
Speaker 1: body than just your brain. But for most of this episode,
Speaker 1: I'll be focusing on the effects on the brain. I'll
Speaker 1: get in a little bit to some of the kind
Speaker 1: of long term effects on other organ systems. So let's
Speaker 1: get into it. Here's how I'm going to break this down. First,
Speaker 1: I'm going to talk about the direct effects of alcohol
Speaker 1: in kind of the short term and how it produces
Speaker 1: what we all know of as drunkenness. And then we'll
Speaker 1: talk about one of my favorite parts, which is the
Speaker 1: dreaded aftermath, the hangover. Yeah, all right, and to discuss that,
Speaker 1: we do have to get a little bit into the
Speaker 1: metabolism of alcohol, but I promise I'll keep it biochemistry light.
Speaker 1: And then Aaron, I want to hear from you about
Speaker 1: how long.
Speaker 2: We've been giving ourselves heny over.
Speaker 1: And then at the end we'll wrap it up with
Speaker 1: like this status of alcohol in the world today by
Speaker 1: at least a couple of measures that I have data on.
Speaker 2: All right, Okay, So alcohol, ethanol.
Speaker 1: It's freely absorbed across our GI tract the same way
Speaker 1: that water is, so it can easily pass through any
Speaker 1: and all of our biological membranes, including of course our
Speaker 1: blood brain barrier. So after you drink a beer or
Speaker 1: a glass of wine or a quarantinie, ethanol rapidly reaches
Speaker 1: peak concentrations in our bloodstream and tends to go first
Speaker 1: to areas of high blood flow, which includes our liver,
Speaker 1: where it causes lots of damage that we'll talk about later.
Speaker 1: Our kidneys and what it does in our kidneys. Is
Speaker 1: it interferes with water reabsorption. It does this by inhibiting
Speaker 1: the function of proteins that usually allow water to escape,
Speaker 1: and so it functions as a diuretic.
Speaker 3: Why does it do that? Is it just sort of.
Speaker 1: Why does it do The question of why Aaron is
Speaker 1: what I'm never going to be able to answer in
Speaker 1: this episode, fair warning. But it interacts with a specific
Speaker 1: protein called vasopressin, and vasopressin normally allows aquaporins to go
Speaker 1: into our kidneys, but it basically inhibits the function of
Speaker 1: that in our kidnies. So it causes you to lose
Speaker 1: a whole bunch of water, hence you pee a lot.
Speaker 1: And then of course it also goes to our brain,
Speaker 1: which is full of blood flow for important reasons. So
Speaker 1: ethanol enters our central nervous system. And in truth, it
Speaker 1: acts on so many different receptors in a lot of
Speaker 1: ways that are very complex, and we don't fully understand
Speaker 1: them despite loads of research. But what we do know
Speaker 1: is that a large part of the effect that ethanol
Speaker 1: has is on a specific receptor in our brain called
Speaker 1: our gabba receptors. And if you think in very basic
Speaker 1: terms of our brain as having both excitatory like stimulatory
Speaker 1: and inhibitory pathways, excitatory ones making you alert and vigilant
Speaker 1: or whatever, and inhibitory ones being more sedating or more calming,
Speaker 1: which is an oversimplification. But what alcohol does is it
Speaker 1: binds indirectly to GABA receptors, which are inhibitory receptors, and
Speaker 1: it makes these more active or more receptive to the
Speaker 1: effects of GABBA. So what that does in practice is
Speaker 1: it makes us feel more calm. Okay, and it's a
Speaker 1: sedating drug.
Speaker 3: Is that how all sedatives work? Like the basic mechanism.
Speaker 1: There are so Benzodiazepines are another class of drugs that
Speaker 1: are sedating that also act on the GABA receptors in
Speaker 1: a slightly different way. But there are lots of other
Speaker 1: sedata drugs that act on different.
Speaker 3: Receptors because different pathways. Okay, yeah, yeah, I have a
Speaker 3: question about diuretics. Okay, oh God, do diuretics sort of
Speaker 3: all function in the same way that alcohol does or
Speaker 3: like lead to the same you know water loss?
Speaker 1: You mean like diuretics, like other drugs that we have
Speaker 1: for diuretics. No, there are whole like tons of different
Speaker 1: classes of diuretics. That all act in different areas of
Speaker 1: the kidney on different ways.
Speaker 3: I need to know more about diuretics.
Speaker 2: Oh, we could do a whole episode about diuretics. I
Speaker 2: love it.
Speaker 3: Okay, okay, we You know what we can do.
Speaker 1: Is do an episode about heart failure and then we
Speaker 1: can talk a lot about diuretics.
Speaker 2: Oh oh, okay, okay. Yeah.
Speaker 1: Anyways, back to alcohol. So it makes us feel more calm.
Speaker 1: It also makes us feel more happy because alcohol also
Speaker 1: serves to stimulate the dopamine pathways our brain, which are
Speaker 1: our brain's innate reward system. So then how do we
Speaker 1: generally feel after a glass or maybe two of wine.
Speaker 1: We feel more relaxed, We might feel a boost in
Speaker 1: our happiness, we might feel even euphoric or super chatty
Speaker 1: because of those effects of dopamine. We feel generally good.
Speaker 1: And then maybe a tequila shot sounds like a good idea, friends,
Speaker 1: it is rarely a good idea. And as our blood
Speaker 1: alcohol content increases, that feeling of relaxation progresses, it might
Speaker 1: progress to suppression of our anxiety. It might suppress our
Speaker 1: stress response. But at the same time, our central nervous
Speaker 1: system is also becoming more depressed. We aren't able to
Speaker 1: think as clearly we might through both central nervous system
Speaker 1: and also just GI related effects, start having some nod
Speaker 1: or vomiting. Our motor and our sensory systems can start
Speaker 1: to become impaired and you lose especially that like motor coordination.
Speaker 1: And as that blood alcohol content continues to increase, our
Speaker 1: brain becomes flooded with ethanol, and then the blood flow
Speaker 1: to our brain is impaired, which can cause things like
Speaker 1: blurry vision, slurred speech, dizziness, confusion, eventually possible loss of consciousness, coma,
Speaker 1: and even death.
Speaker 3: Can you put this in terms of like blood alcohol
Speaker 3: content or like number of drinks type thing, which I
Speaker 3: know varies because tolerance really varies person to person, et cetera,
Speaker 3: et cetera.
Speaker 1: Yeah, so that question gets at a couple of different things,
Speaker 1: both how much of the ethanol that you consume is
Speaker 1: absorbed and how quickly does it take effect, as well
Speaker 1: as like what specific concentration of alcohol produces those special effects.
Speaker 1: And you're right, there isn't really a clear cut answer
Speaker 1: because there's a lot of variability. The rate at which
Speaker 1: alcohol is absorbed across the GI tract varies a lot.
Speaker 1: For example, if you have a full stomach, then it's
Speaker 1: absorbed a lot more slowly. If it's an empty stomach,
Speaker 1: it's absorbed more quickly. And then you also have not
Speaker 1: only metabolic differences in how quickly you metabolize alcohol, but
Speaker 1: also tolerance effects depending on how often you drink. In general, though,
Speaker 1: so we measure alcohol in your blood by blood alcohol concentration.
Speaker 1: So you've heard like point zero eight percent is like
Speaker 1: the legal limit in the US. At concentrations below point
Speaker 1: zero eight percent, in general, you're not having as much
Speaker 1: of the motor and cognitive deficits at concentrations above that,
Speaker 1: especially approaching point one percent. That's when you have like
Speaker 1: sedation impaired motor and sensory Once you get to like
Speaker 1: point three to point four or above, especially above point
Speaker 1: five percent, that's when you can see acute alcohol toxicity
Speaker 1: or death. It's hard to say exactly how many drinks
Speaker 1: it takes. It really varies person to person.
Speaker 3: Okay, so I feel like maybe this is just something
Speaker 3: that you hear in college and that's like, oh, eat
Speaker 3: a full meal before you drink and you won't get drunk.
Speaker 3: And I always kind of thought, well, I think it's
Speaker 3: just you get drunk more slowly, or it affects you
Speaker 3: more slowly. But like, is there actually a maximum at which,
Speaker 3: like your body just can't absorb a certain amount of
Speaker 3: alcohol in a certain time period. And you'll like, you
Speaker 3: know what I mean.
Speaker 2: Yeah, it's a good question.
Speaker 1: It does seem to be the case that if you
Speaker 1: have a full stomach, it leads not only to slower absorption,
Speaker 1: but over time to lower blood alcohol concentrations.
Speaker 2: So part of.
Speaker 1: That might be, and I'll get into this a little
Speaker 1: bit more in a minute, is that alcohol is metabolized
Speaker 1: by what's called zero order kinetics, so the rate of
Speaker 1: excretion is constant regardless of the concentration. So it could
Speaker 1: just be that if you're absorbing it more slowly because
Speaker 1: of a full stomach, then you are excreting it at
Speaker 1: a rate that is such that when you're absorbing it slowly,
Speaker 1: you don't your blood alcohol concentration doesn't rise.
Speaker 3: As high, Right, you keep up with the absorption exactly.
Speaker 2: Okay, Yeah, interesting.
Speaker 1: Yeah, eating does help, And as we can continue talking about,
Speaker 1: it's important the day after too, So let's talk about it.
Speaker 2: Yeah, Shall we move on to the biochemistry of a hangover?
Speaker 1: Perfect so to be eliminated from our bodies. Alcohol has
Speaker 1: to be metabolized, which just means broken down. Eventually, it's
Speaker 1: broken all the way down into carbon dioxide and water
Speaker 1: and at some point can be used for like actual
Speaker 1: energy production. But along the way, it's metabolized first into
Speaker 1: a toxic intermediate. We already talked about the direct effects
Speaker 1: of alcohol, so now we get to talk about these
Speaker 1: toxic intermediates and the aftermath. So alcohol is metabolized first
Speaker 1: into a compound called acid aldehyde, which is toxic in
Speaker 1: a whole number of ways. It first induces oxidative damage
Speaker 1: both directly and then, as we'll continue talking about, it
Speaker 1: has a lot of other downstream.
Speaker 2: Effects as well.
Speaker 1: Alcohol dehydrogenase is the enzyme that breaks alcohol down into
Speaker 1: acid aldehyde, and while it's present in a lot of
Speaker 1: our body, primarily alcohol is metabolized in our liver, like
Speaker 1: over ninety percent of it, and so this is where
Speaker 1: acid aldehyde tends to build up, and that's why drinking
Speaker 1: alcohol can have such drastic impacts on our liver and
Speaker 1: result in things like cirrhosis, which is chronic liver damage.
Speaker 1: But since this intermediate is toxic, our body obviously wants
Speaker 1: to get rid of it as quickly as it can,
Speaker 1: so it further breaks it down via another enzyme called
Speaker 1: aldehyde dehydrogenase, right, and then it breaks it into acetate,
Speaker 1: further breaks it down, et cetera, et cetera, et cetera.
Speaker 1: What's important to know about this metabolism of alcohol. What
Speaker 1: I think is so interesting is that this process inadvertently
Speaker 1: ends up interfering with a whole host of our normal
Speaker 1: metabolic processes, which explains some of the symptoms that you
Speaker 1: feel when you've been drinking alcohol. But also it explains
Speaker 1: a lot of the symptoms of a hangover, which anyone
Speaker 1: who's experienced a hangover knows. These symptoms can last a
Speaker 1: long time and really make you feel like trash. So,
Speaker 1: without getting into the weeds too much of the different
Speaker 1: biochemical cycles, let me just say this.
Speaker 2: We talked in our.
Speaker 1: Diabetes episode about how glucose is one of our main
Speaker 1: substrates that our body uses.
Speaker 2: We talked a lot about it.
Speaker 1: But our cells have a lot of different complex cycles
Speaker 1: that they use to break down different compounds to create
Speaker 1: ATP for energy so that our cells can use them.
Speaker 1: And all of these different cycles are interdependent. They overlap
Speaker 1: with each other and by overlap. What I mean is
Speaker 1: that these different metabolic pathways use a lot of the
Speaker 1: same cofactors. And cofactors are substances that are necessary as
Speaker 1: part of a chemical reaction, but they aren't the actual
Speaker 1: parts of the chemical reaction. They're like helpers that you
Speaker 1: need for this reaction to happen.
Speaker 3: This is like way flashbacks to sell bio and it's
Speaker 3: kind of given me the hebgen.
Speaker 1: I'm sorry, I'm trying to avoid saying like the TWCA cycle. Okay,
Speaker 1: So let's get back to alcohol, the process by which
Speaker 1: alcohol is metabolized first into acid aldehyde, and further and
Speaker 1: further all the way to like acetic acid. These steps
Speaker 1: of metabolism use up certain cofactors in our body and
Speaker 1: change the ratio of what's available for other essential cycles
Speaker 1: in our body. So what that looks like is a
Speaker 1: whole host of screw ups in the way our body
Speaker 1: is supposed to do basic metabolism.
Speaker 2: HM. Okay.
Speaker 1: So it's not alcohol directly, but it's the process of
Speaker 1: alcohol metabolism and the metabolites themselves that cause a lot
Speaker 1: of the symptoms that we know of as a hangover.
Speaker 1: So we can go through some specific examples if you
Speaker 1: want to.
Speaker 3: That's yeah, I do. But that's really interesting because one
Speaker 3: of the ways I remember hearing hangovers described is sort
Speaker 3: of the result of stealing happiness from tomorrow.
Speaker 2: Yeah, that's kind of true.
Speaker 3: Like you go out, you go drinking, you have lots
Speaker 3: of fun, and then you have used up the happiness
Speaker 3: that you like, the ability to kind of have a
Speaker 3: good day the next day, the night before you're the
Speaker 3: same as with cofactors.
Speaker 1: That's exactly what it is. You're using up your bodies
Speaker 1: NAD plus, which is a happiness. Okay, yeah, yeah, So
Speaker 1: we can go over some of the specifics.
Speaker 2: Okay, if you want to, Yeah, all right, course great.
Speaker 1: So one of the things that happens as a result
Speaker 1: of stealing these happiness cofactors is that the metabolism of
Speaker 1: alcohol ends up blocking the process of gluconeogenesis.
Speaker 2: This is the process.
Speaker 1: By which you make more glucose in your body in
Speaker 1: times when your glucose is low. So without the ability
Speaker 1: to do this, you end up with hypoglycemia, which we
Speaker 1: talked about in our diabetes episode. That can make you
Speaker 1: feel shaky, it makes you feel super hungry, probably nauseous, weak, trembling.
Speaker 1: But the thing about this is it's not always even
Speaker 1: a true hypoglycemia, it's what's called a relative hypoglycemia because
Speaker 1: you're not able to to make glucose from what you
Speaker 1: already have available in your body because you're missing these cofactors.
Speaker 1: And on top of that, because of missing these cofactors,
Speaker 1: you're also not able to undergo the right kind of
Speaker 1: catabolism to use what you do have already.
Speaker 3: Wow, water water everywhere, nor any drop to drink.
Speaker 2: That's exactly what it is.
Speaker 1: The metabolism of alcohol, as well as some of the
Speaker 1: actions of alcohol itself on our brain, also uses up
Speaker 1: all of our bodies glutamine stores. Glutamine is an amino
Speaker 1: acid which is used to make proteins. It's also an
Speaker 1: essential neurotransmitter in our brain. So by using up all
Speaker 1: of our glutamine, it makes us feel very tired, and
Speaker 1: then as our body makes more and our glutamine can rebound,
Speaker 1: it can lead to things like tremulousness, anxiety, restlessness, things
Speaker 1: that we might see in like alcohol withdrawal. We already
Speaker 1: talked as well about how alcohol is a big diuretic,
Speaker 1: so then you likely are going to end up dehydrated,
Speaker 1: which might make you feel awful in and of itself
Speaker 1: also give you things like a headache in the mid
Speaker 1: to longer term. The metabolism of alcohol also inhibits the
Speaker 1: breakdown of fatty acids, which means you have a bunch
Speaker 1: of fat, like little chunks of fat floating around, and
Speaker 1: your body then stores those in our liver, which causes
Speaker 1: further damage to your liver because of this inflammatory response
Speaker 1: to this fat. Interesting, so that is why you feel
Speaker 1: so creddy with a hangover.
Speaker 3: It makes sense.
Speaker 2: Yeah, So that's.
Speaker 1: All of kind of the acute symptoms of alcohol and hangovers.
Speaker 1: Of course, it's important to talk about long term exposure.
Speaker 1: Chronic high levels, especially of alcohol use, can lead to
Speaker 1: a lot of different health problems, and I'll just go
Speaker 1: through kind of the biggest ones which we've kind of
Speaker 1: already touched on as well, cirrhosis. Cirrhosis being chronic inflammation
Speaker 1: and eventual scarring of the liver. Happens both because, like
Speaker 1: I said, of the fats that are deposited causing inflammation,
Speaker 1: as well as direct damage from both acid aldehyde and
Speaker 1: alcohol in the liver itself.
Speaker 2: In your brain.
Speaker 1: Chronic alcohol use can also lead to a syndrome known
Speaker 1: as Wernicky Corsicov syndrome.
Speaker 2: Have you heard of this?
Speaker 3: Aarin, No, I don't think so.
Speaker 1: So Wernicky Corsicov It's actually it's two different syndromes that
Speaker 1: are kind of lumped together as one. It's Wernickey's encephalopathy,
Speaker 1: which is an acute and potentially fixable disorder, as well
Speaker 1: as a longer term, irreversible dementia that's known as Corsicov syndrome.
Speaker 1: Both of these are actually caused not by alcohol directly,
Speaker 1: but by a thiamine or a vitamin B one DIFFI.
Speaker 1: So this is a syndrome that can occur with no
Speaker 1: alcohol whatsoever. But today, because we like fourti fy flower
Speaker 1: and things like that, over ninety percent of cases tend
Speaker 1: to be associated with chronic, long term alcohol use. And
Speaker 1: alcohol results in vitamin deficiencies. I can see your face
Speaker 1: that you're going.
Speaker 2: To ask, how.
Speaker 3: Gotta so?
Speaker 1: Alcohol use results in vitamin deficiencies, not just thiamine, but
Speaker 1: especially thiamine in a few different ways. It can reduce
Speaker 1: overall absorption of our vitamins by just interfering with our gut.
Speaker 1: The metabolism of alcohol uses up cofactors we know that
Speaker 1: that are essential in the recycling of thiamine as well
Speaker 1: as other vitamins as well. The effects of alcohol on
Speaker 1: our kidneys also cause us to lose thiamine more easily,
Speaker 1: so we're peeing more thiamine out. And then alcohol use,
Speaker 1: also in part because of its effect on the care,
Speaker 1: affects our overall electrolyte balance, including magnesium, which is an
Speaker 1: important electrolyte and an essential cofactor in thiamine utilization.
Speaker 3: It really is all about the cofactors.
Speaker 2: It really is all about the cofactors.
Speaker 1: And then on top of that, alcohol itself and acid
Speaker 1: aldehyde both do cause chronic damage to our brain that
Speaker 1: can lead to generalized volume loss. So it does a
Speaker 1: lot of different things in a lot of different ways. Yeah,
Speaker 1: So I mentioned already that alcohol is excreted by what
Speaker 1: we call zero order kinetics.
Speaker 2: What that means is.
Speaker 1: That no matter how much alcohol that you have in
Speaker 1: your system, so even at very low concentrations or even
Speaker 1: at very high concentrations, the enzyme that breaks down alcohol,
Speaker 1: that alcohol dehydrogenase, has such a strong affinity for ethanol
Speaker 1: that it gets completely bound up. Like all of the
Speaker 1: ada the alcohol dehydrogenase gets completely saturated with ethanol, even
Speaker 1: at really low concentrations, so it's working at its max
Speaker 1: from day one. But we know that tolerance exists. And
Speaker 1: so one thing that it seems is that when alcohol
Speaker 1: use is chronic, it actually serves to upregulate a different
Speaker 1: type of alcohol metabolism. So it uses a completely different
Speaker 1: set of enzymes, and this is called the microsomal ethanol
Speaker 1: oxidating system. This is a separate enzyme in our liver.
Speaker 1: That's just basically another way that ethanol can be metabolized.
Speaker 2: Everyone does it at.
Speaker 1: A low level, but in some people or over time
Speaker 1: for some people, this kind of gets upregulated as a
Speaker 1: bigger chunk of how much alcohol is metabolized, if that
Speaker 1: makes sense. Yeah, And what's really interesting is that along
Speaker 1: those lines, there's actually a lot of genetic variation in
Speaker 1: alcohol metabolism. Yeah, right, So there are certain alleles, certain
Speaker 1: genetic changes that have been identified that result essentially in
Speaker 1: an increase in that same system that gets upregulated with
Speaker 1: chronic use. And so this means that some people just
Speaker 1: genetically are much faster metabolizers of alcohol, which is so fascinating.
Speaker 3: It is interesting. And then there's the flip side.
Speaker 2: Of that, and not on a flip side.
Speaker 1: There's other genetic variants, not in alcohol dehydrogenase, but in
Speaker 1: aldehyde dehydrogenase a LDH that downstream metabolism and it makes
Speaker 1: that super slow. What that leads to is a build
Speaker 1: up not of alcohol, but of acid aldehyde, the toxic intermediate.
Speaker 2: Yeah, and so it's really not good.
Speaker 1: So that's why for some people they have like one
Speaker 1: single drink and they end up flushed, nauseous, feeling terrible,
Speaker 1: just bodily feeling awful, without even any of the cognitive
Speaker 1: effects that we attribute to drunkenness.
Speaker 2: It's like going straight to a hangover. Uh huh. Right,
Speaker 2: So there's a lot.
Speaker 1: Of genetic and also just individual variation in how people
Speaker 1: metabolize alcohol. Pretty cool, Right.
Speaker 3: It's interesting, And I'm gonna talk a little bit more
Speaker 3: about it in the history of section.
Speaker 2: Oh good, I can't wait. Yeah.
Speaker 3: So do you have any questions, Arin, I mean so,
Speaker 3: I guess I have lots of questions. One has to
Speaker 3: do with sort of how either the role of genetics
Speaker 3: or the way that we metabolize alcohol, how that plays
Speaker 3: a role in addiction. And the other thing is also
Speaker 3: about like alcohol and people who are not yet adults,
Speaker 3: whether that means like exposure while a fetus or exposure
Speaker 3: while you're young. What are the effects of alcohol on you?
Speaker 1: Oh, great questions. So I don't have a good answer
Speaker 1: to your first question about sort of genetic variation in
Speaker 1: sort of susceptibility to alcohol addiction. Okay, that would be
Speaker 1: a really interesting topic that I just didn't have that
Speaker 1: time to research with all of the other things. But yeah,
Speaker 1: I feel like the genetics of addiction are really really
Speaker 1: fascinating in general, and there is a very strong genetic
Speaker 1: component to alcohol use disorder. But to my knowledge, at
Speaker 1: least from what I found, I didn't see any specific
Speaker 1: genes that are necessarily related to it, like individual genes,
Speaker 1: So it's a lot of probably g by e gene
Speaker 1: by environment interactions that seem to affect it.
Speaker 3: Right, of course, in terms.
Speaker 1: Of the effects of alcohol on the young, certainly anything
Speaker 1: that affects your central nervous system is going to have
Speaker 1: more drastic effects on people that are younger. Alcohol crosses
Speaker 1: the placenta freely, the same way that it crosses our
Speaker 1: blood brain barrier, so it's able to reach a developing
Speaker 1: fetus and to reach that fetus's central nervous system. We
Speaker 1: have very very good data of the effects of moderate
Speaker 1: to high levels of alcohol use on the fetus, which
Speaker 1: produces a syndrome known as fetal alcohol syndrome, which is
Speaker 1: a real constellation of a lot of different potential problems,
Speaker 1: ranging from mild cognitive deficits all the way up to
Speaker 1: more severe or even spontaneous pregnancy loss type complications. I
Speaker 1: think the thing that's important to point out is that
Speaker 1: while we have very very clear data of the harms
Speaker 1: that can come from drinking moderate to heavy amounts of
Speaker 1: alcohol during pregnancy, obviously all of these studies are very
Speaker 1: difficult to do in humans for so many different reasons,
Speaker 1: and a lot of them are sort of epidemiological studies
Speaker 1: that are rife with things like recall bias, et cetera.
Speaker 1: But in general, the kind of consensus among public health
Speaker 1: agencies is that there is no evidence of a safe
Speaker 1: level of alcohol consumption during pregnancy. There was a study
Speaker 1: that came out in twenty seventeen that suggested, like and
Speaker 1: it got a lot of press at the time, that like, oh,
Speaker 1: less than thirty two grams a week, which is two
Speaker 1: alcoholic drinks. Those like two glasses of wine a week
Speaker 1: or something. There was only a modest risk of premature
Speaker 1: birth and small for gestational age babies. Both of those
Speaker 1: can carry serious downstream health problems, and I'm not sure
Speaker 1: how long that study actually followed those babies after birth.
Speaker 1: But other studies have also shown things like an increased
Speaker 1: risk of spontaneous pregnancy loss. But most of those were
Speaker 1: with five or more drinks per week, So we don't
Speaker 1: have a lot of good data for like smaller amounts
Speaker 1: of alcohol. But in general, the public health agencies, both
Speaker 1: here in the US and across the world take the
Speaker 1: stance of no level is known to be safe.
Speaker 3: So is that I mean that's also sort of the
Speaker 3: same stance for just alcohol consumption generally, right, I mean,
Speaker 3: like you know, I feel like every other week there's
Speaker 3: a study that's like, oh, a glass of red wine.
Speaker 3: Oh no, a beer, Oh no, it's actually you have
Speaker 3: to do like this very particular recipe.
Speaker 1: And yeah, it's interesting because if you look at sort
Speaker 1: of all cause mortality and especially cardiac mortality, there is
Speaker 1: a kind of J shaped curve where it seems like
Speaker 1: one to two drinks a week might be a little
Speaker 1: bit protective in epidemiological studies against cardiac mortality. I think
Speaker 1: that in general, a lot of the public health thought
Speaker 1: is that there are so many known risks to alcohol
Speaker 1: that the maybe small evidence that there could be a
Speaker 1: maybe benefit to cardiac mortality is probably outweighed by all
Speaker 1: of the other risks, if that makes sense.
Speaker 2: So there's not like.
Speaker 1: Super strong dated I don't think in general, it's something
Speaker 1: that is recommended as a thing to keep you healthy
Speaker 1: by any means, right, right, Yeah, that makes sense.
Speaker 2: But so that's pretty much the biology of alcohol. Aaron's
Speaker 2: a lot.
Speaker 3: I have one more question, and it has to do
Speaker 3: with hangovers. Okay, and so if we know what causes hangovers, like,
Speaker 3: how do you replenish cofactors besides just time?
Speaker 2: Time eron? Yeah, did you read the paper?
Speaker 1: I found a paper that was just eighteen pages of
Speaker 1: hangover cures.
Speaker 3: No, oh, my gosh, I have nothing about hangovers in
Speaker 3: my history sections.
Speaker 1: Okay, well, I will post a paper that's like eighteen
Speaker 1: or more pages of just old timey hangover cures.
Speaker 2: It's a mold gosh, you would love it.
Speaker 3: Oh, I didn't see that.
Speaker 1: Yeah, none of them are real to actually treat a hangover,
Speaker 1: A sleep is important because alcohol messes with your sleep cycles,
Speaker 1: and so even if you pass out, you're not getting
Speaker 1: quality sleep. Right, So sleep is important. Drinking lots of
Speaker 1: water because you're dehydrated, eating food because you know your hypoglycemic.
Speaker 1: Ibuprofen or other medicines that are inhibitors of prostaglandin synthesis
Speaker 1: tend to have at least a modicum of evidence that
Speaker 1: there may be a little bit.
Speaker 3: Helpful, like ibuprofen specifically, not aceta menifin.
Speaker 1: Right, So, Aceta menifin is thailenol, which is, yeah, going
Speaker 1: to go to your liver, So you don't take that
Speaker 1: while you're drinking. Please don't take ibuprofen while you're drinking either.
Speaker 1: I'm talking about the next day.
Speaker 3: Yeah, yeah, yeah, yeah.
Speaker 1: There's also some thought that B vitamins, since those are
Speaker 1: cofactors for a lot of different forms of metabolism, if
Speaker 1: you replenish those levels, maybe, but yeah, none of those
Speaker 1: have like actual data. It's really just time. And also
Speaker 1: hair of the dog does not work.
Speaker 3: No, it does not work.
Speaker 2: Yeah, Okay, is that it? You have more questions?
Speaker 3: I think that's it for now.
Speaker 2: That was a lot. It was pretty long. Sorry, so
Speaker 2: can you tell me how long have we had a hangover? Collectively? Oh?
Speaker 3: Boy, I can't wait. I will get started right after
Speaker 3: this break. Okay, the history of alcohol.
Speaker 2: Yes, all of it.
Speaker 3: It's simple enough, right, And I'm going to try to
Speaker 3: not do the thing that we always do, which is
Speaker 3: apologize in advance for not including every tiny piece of
Speaker 3: information about the topic we're covering, even though I'm like,
Speaker 3: right now, I'm actively resisting the urge to apologize.
Speaker 2: I know I do it every time. I know.
Speaker 3: It's really it's really hard not to. And everyone knows
Speaker 3: the drill anyway, right, Like, we're not experts, and this
Speaker 3: is not a comprehensive audio textbook on alcohol. It would
Speaker 3: be very challenging to do that, and it would require
Speaker 3: like a whole team of people, not just two people,
Speaker 3: two humans. Instead, I'm going to tell you what I
Speaker 3: am going to cover and hope that we all have
Speaker 3: fun along the way, even if I miss some things
Speaker 3: like here and there, And if you're left wanting more,
Speaker 3: that's great because curiosity is the best. And you can
Speaker 3: check out further reading for the topic on our website
Speaker 3: post for the episode where we include all our sources
Speaker 3: and also there is no shortage of books about alcohol,
Speaker 3: you know, as like specific as like the history of
Speaker 3: Bourbon in this one county, and as broad as like
Speaker 3: the global history of alcohol. So there's anything you want, Okay,
Speaker 3: So what am I going to cover about the history
Speaker 3: of alcohol? Basically, the way that I set this up
Speaker 3: is to first talk a bit about the evolutionary origins
Speaker 3: of alcohol metabolism or ethanol metabolism, So when did humans
Speaker 3: and other animals evolve this ability and how much does
Speaker 3: it vary across species, and then just kind of like
Speaker 3: play the hits in the history of intentional alcohol production
Speaker 3: by humans, starting all the way back at the beginning
Speaker 3: thousands of years ago and ending at today or at
Speaker 3: least like the last few decades or so, because yeah, anyway,
Speaker 3: there's a lot there. Let's get started. Aaron, you answered
Speaker 3: how humans can metabolize ethanol and what it does to
Speaker 3: us and all that good and bad stuff. But I
Speaker 3: want to get at the why of this, like why
Speaker 3: we possess this ability, Where did it come from, and
Speaker 3: when did it come from under what circumstances? And then
Speaker 3: I might dabble a bit in another why, like why
Speaker 3: we get drunk? What are the benefits and drawbacks of
Speaker 3: alcohol consumption from an evolutionary perspective, Do the pros outweigh
Speaker 3: the cons But first things first, many many organisms possess
Speaker 3: the ability to metabolize ethanol, but humans are somewhat unique
Speaker 3: in that we possess a particular form of that alcohol
Speaker 3: dehydrogenase gene, and it's specifically for if you're interested, the
Speaker 3: alcohol dehydrogenase for enzyme, and this this mutated form allows
Speaker 3: us to metabolize alcohol much more efficiently than most other animals,
Speaker 3: like forty times more efficiently as compared to the non
Speaker 3: mutated version.
Speaker 2: I did not know it was that big of a difference.
Speaker 3: Yeah, it's really big. And I say somewhat unique because
Speaker 3: we aren't the only animals to have this mutation. Chimpanzees, bonobos,
Speaker 3: and gorillas also have the same type of mutation at
Speaker 3: the same spot in that gene four eighth four alcohol dehydrogenase.
Speaker 3: From this point on, I'm just going to call it
Speaker 3: alcohol dehydrogenase and acknowledge freely that it is just one
Speaker 3: of the enzymes, Okay, not all of them. But there
Speaker 3: are other animals that also have the same type of
Speaker 3: mutation at that same spot. And that is the large
Speaker 3: fruit bat, the common vampire bat Iis and koalas.
Speaker 2: What there's such a random assortment?
Speaker 3: Well or is it?
Speaker 2: Oh?
Speaker 3: And then there are a couple other animals, a couple
Speaker 3: other species of bats that also have a mutation in
Speaker 3: that gene, but not the same exact kind. So we
Speaker 3: also don't really know, like beyond chimpanzees, bonobos and gorillas,
Speaker 3: we're not really sure, you know, physiologically, vampire bats, the
Speaker 3: large fruit bat Iies koalas, they have like different gastrointestinal
Speaker 3: systems compared to like grade apes, right, and so whether
Speaker 3: the function of that mutated alcohol dehydrogenase is the same
Speaker 3: in those as it is in these you know, grade apes,
Speaker 3: we don't know for sure. But there's also like some
Speaker 3: hints that it might be at least somewhat similar. Okay,
Speaker 3: basically there's a lot that we don't know about alcohol
Speaker 3: metabolism in other species. But what is the whole point
Speaker 3: of this section? Well, it's okay, it's one thing for
Speaker 3: a mutation to occur, like it happens all the time,
Speaker 3: but it's another for it to stick around. In order
Speaker 3: for that to happen, it has to be a useful mutation.
Speaker 3: Generally speaking, could just be you know, drift whatever. But
Speaker 3: it turns out that this mutation in the gene for
Speaker 3: alcohol dehydrogenase appeared in the ancestor of humans, chimpanzees, and
Speaker 3: gorillas about ten million years ago. So that's when this mutation,
Speaker 3: this new enhanced form, first appeared, and that's right around
Speaker 3: the same time that our primate ancestor started venturing down
Speaker 3: onto the ground from the trees, becoming more terrestrial than arboreal.
Speaker 3: On the ground, they would have found a great food source,
Speaker 3: fallen and fermenting fruit.
Speaker 2: That's right, that's right, Okay, yeah.
Speaker 3: And some of this fruit would have contained ethanol concentrations
Speaker 3: as high as like eight point one percent. Wow, this
Speaker 3: new mutation which helps us metabolize ethanol more efficiently. It
Speaker 3: would have been a big advantage in utilizing this new
Speaker 3: food source and also not getting too impaired by it
Speaker 3: and getting picked off by predators or you know, your neighbors.
Speaker 3: So it makes sense that it was retained and then
Speaker 3: spread throughout subsequent generations all the way down to modern humans.
Speaker 3: The other animals that have this mutation chimpanzees, bonobos, gorillas,
Speaker 3: Iies et. Cetera. These are animals also known to forage
Speaker 3: extensively on fruit and nectar, which may also be fermented
Speaker 3: and may also contain ethanol. So it seems as though
Speaker 3: diet plays a big role in the evolution of these
Speaker 3: genes for the metabolism of ethanol, why we can process
Speaker 3: it more efficient, and why some animals have actually lost
Speaker 3: the ability altogether. So there's a recent study from twenty
Speaker 3: twenty by janiac at All that showed that the gene
Speaker 3: for eighty h four for this alcohol dehydrogenase four enzyme,
Speaker 3: is non functional in some animal species, meaning that it
Speaker 3: was once there and it once worked, and then it
Speaker 3: accumulated at least one mutation that would have made it
Speaker 3: stop working.
Speaker 2: Huh yeah. Interesting.
Speaker 3: And it turns out that there's a pattern among these
Speaker 3: animals with the non working alcohol dehydrogenase. They don't really
Speaker 3: have nectar or fruit in their diets, and so it
Speaker 3: wouldn't have been that important to keep that functional gene,
Speaker 3: so relaxed selection and boom, some of them just lost it. Okay,
Speaker 3: So I feel like I've already gotten a bit into
Speaker 3: the weeds here, but I wanted to bring this up
Speaker 3: because I think It's an absolutely fascinating look not just
Speaker 3: at the evolutionary origins of the way humans metabolized dietary ethanol,
Speaker 3: but also why this ability might vary across the animal kingdom,
Speaker 3: Like what are you eating and how is that affecting
Speaker 3: your physiology in the way you metabolize certain compounds. And
Speaker 3: I also should end this part with a caveat that
Speaker 3: is that this is just looking at one enzyme for
Speaker 3: a dietary ethanol metabolism. Granted, it is the first enzyme
Speaker 3: that would encounter ethanol after it's consumed, because it's the
Speaker 3: one that's like in your you know, the first part
Speaker 3: of your gastrointestinal tract and whatever. And that there are
Speaker 3: many other enzymes involved that are part of this process
Speaker 3: and that metabolize other forms of alcohol as well, such
Speaker 3: as some that would be encountered by like consuming certain
Speaker 3: plant leaves for example. All Right, so we've now established
Speaker 3: the likely origin story of our enhanced ability to metabolize
Speaker 3: alcohol and to some degree why it gave us an
Speaker 3: evolutionary advantage because it allowed us to use a new foods.
Speaker 3: Fermentation can actually increase the nutritional value of things, make
Speaker 3: it like more bioavailable I guess.
Speaker 1: So drink your kombucha, that's what you're trying to say.
Speaker 3: And also, don't forget that it can decrease the prevalence
Speaker 3: of harmful pathogens and parasites.
Speaker 2: Yeah, that's pretty major.
Speaker 3: It's pretty major. And that's something that became especially more
Speaker 3: important later on. The importance of dietary ethanol to humans
Speaker 3: and other primates is also maybe illustrated by just how
Speaker 3: sensitive we are to the smell of it, a smell
Speaker 3: that signaled to our evolutionary ancestors. Hey, here's some ripe
Speaker 3: fruit to eat. Here's some good food here. Interesting, Like,
Speaker 3: it's interesting to think about what we're more sensitive to
Speaker 3: in terms of smell, in terms of like taste. Yeah,
Speaker 3: all of these things might have roots. Yeah, and let's
Speaker 3: also not forget that we're sensitive to the effects that
Speaker 3: it has on our bodies. It makes us drunk, it
Speaker 3: makes us feel good, It triggers these reward systems in
Speaker 3: our brains that evolve to encourage adaptive behavior, like, hey,
Speaker 3: dietary ethanol is a good food source. Keep seeking it out.
Speaker 3: And this hijacking of our reward systems like it might
Speaker 3: have worked out great when the sources of alcohol were
Speaker 3: limited to the piles of fermenting fruit on the forest floor.
Speaker 3: But then once humans began to actually intentionally produce alcohol,
Speaker 3: some more of the downsides began to appear, and there
Speaker 3: still seems to be some debate on when this was
Speaker 3: like when humans began to first intentionally produce alcohol, It's
Speaker 3: like this question of chicken or egg, but instead of
Speaker 3: chicken or egg, it's what came first, beer or bread.
Speaker 3: Did humans begin to settle in large groups and domesticate
Speaker 3: grains aka the agricultural revolution, and then noticed that rain
Speaker 3: soak grains produced a fermented alcoholic beverage. Or did they
Speaker 3: settle in large groups and domesticate grains so they could
Speaker 3: produce alcohol?
Speaker 2: Huh.
Speaker 3: Over the past few decades, the second hypothesis the beer
Speaker 3: before bread one, it's become increasingly popular. Rather than the
Speaker 3: agricultural revolution providing the means and locations for large gatherings
Speaker 3: for which alcohol might have been produced, those might have
Speaker 3: led to the agricultural revolution.
Speaker 2: Huh.
Speaker 3: So people started to settle because of the large gatherings
Speaker 3: rather than able to settle because of agriculture.
Speaker 1: They started to get together, hang out more in groups,
Speaker 1: eat fermented fruit, and be like we should be able
Speaker 1: to make more of this, Like why don't we try
Speaker 1: and do it ourselves here, let's plant some barley.
Speaker 3: Yeah what yeah? I mean yeah, it is like there
Speaker 3: is some support from our chaeological evidence, such as what
Speaker 3: we see as go Beckley Tepe, a super old, like
Speaker 3: eleven thousand years old archaeological site in what's now Turkey.
Speaker 3: It's really cool. You should definitely read more about it.
Speaker 3: I am fascinated by it. And at the site, which
Speaker 3: was constructed at the very beginning of the agricultural revolution,
Speaker 3: there's evidence of big fermentation vats and storage basins used
Speaker 3: to brew beer, and that's not that surprising, except for
Speaker 3: the fact that some archaeologists believe that this was not
Speaker 3: a continually occupied site, but more of a site that
Speaker 3: like groups of nomadic hunter gatherers would congregate at during
Speaker 3: certain times, so it was like sort of a meeting place.
Speaker 2: Yeah. Interesting.
Speaker 3: I will say that more recently, the supposed like transient
Speaker 3: use of the site has been called into question and
Speaker 3: some people are saying, well, maybe it was continually occupied. Okay,
Speaker 3: all right, but there's still more In the Fertile Crescent,
Speaker 3: some of the earliest archaeological sites show tools and grains
Speaker 3: that are more in line with beer making than bread making. Okay,
Speaker 3: personally this is my opinion. I feel like it doesn't
Speaker 3: necessarily have to be one then the other, Like, right,
Speaker 3: why can't humans have begun to settle in large groups
Speaker 3: and domesticate grains for both beer and bread?
Speaker 1: Right?
Speaker 2: And also like, what do you do with the grains
Speaker 2: when you're done fermenting them? You make bread?
Speaker 3: Uh huh?
Speaker 2: So do you do both? You do both?
Speaker 3: Waste not want not wait exactly. But anyway, the point
Speaker 3: that I'm trying to make here is that humans around
Speaker 3: the globe have been intentionally making alcohol for a very
Speaker 3: long time. Yeah, like they saw this, they tasted it,
Speaker 3: they recognized it, and said, I want to be able
Speaker 3: to have this all the time. And to underline that,
Speaker 3: here are some examples. Yes, there's a twenty thousand year
Speaker 3: old carving from south west France that shows a woman,
Speaker 3: possibly a fertility goddess, drinking out of a horn. Maybe
Speaker 3: it's been speculated it was some fermented beverage. Maybe it's
Speaker 3: thought that some strains of yeast associated with wine and
Speaker 3: sake production might have been domesticated over twelve thousand years ago. WHOA,
Speaker 3: which is really.
Speaker 1: Cool domestication now I know, let me say wow.
Speaker 3: Oh yeah. The oldest physical evidence of an alcoholic beverage
Speaker 3: comes from the Yellow River Valley of China from around
Speaker 3: seven thousand BCE, and it was made from like wild grapes,
Speaker 3: hawthorn fruit, rice, and honey. Grapes were domesticated in what
Speaker 3: is now Georgia from around seven thousand to six thousand BCE.
Speaker 3: In what is now Iran, there is evidence of grape
Speaker 3: wines in ceramics from fifty five hundred to five thousand BCE.
Speaker 3: In Armenia, there's an ancient cave that seems to have
Speaker 3: been a winery, complete with grape stomping basins, presses, fermentation vats,
Speaker 3: storage jars, drinking vessels. The oldest surviving recipe is a
Speaker 3: recipe for beer from thirty four hundred.
Speaker 2: BCE, fascinating Aaron.
Speaker 3: The oldest preserved liquid alcohol was found in China and
Speaker 3: dates back to nineteen hundred BCE, and there are references
Speaker 3: to alcohol in our oldest surviving literary document, the Epic
Speaker 3: of Gilgamesh from eighteen hundred BCE, and in our oldest
Speaker 3: law document, Hammerabi's Code from seventeen seventy BCE, which regulated
Speaker 3: the strength and price of beer and forbade women from
Speaker 3: drinking it.
Speaker 2: Oh oh, okay, a lot of woes on that.
Speaker 3: Yeah.
Speaker 2: Also, we're going like way back further than the Ebers Papyrus.
Speaker 2: Is that what you're telling me here?
Speaker 1: Oh?
Speaker 3: Oh yeah, I mean I'm sure that it's in the
Speaker 3: Ebers Papyrus. Shame on me for not finding it explicitly.
Speaker 2: Wow mm hmm.
Speaker 3: It's yeah. I mean the evidence for like early and
Speaker 3: thoughtful production and consumption of alcohol is like vast and varied,
Speaker 3: as are the ingredients used in fermentation.
Speaker 1: It's so interesting to me that you brought up grapes
Speaker 1: so early, like grape people were like, hey, grapes, grapes
Speaker 1: make really good alcohol from day one.
Speaker 2: That's so interesting.
Speaker 3: Really, it's really interesting, And I think I don't know
Speaker 3: much about the domestication process of grapes, but grapes for
Speaker 3: like just one of many ingredients that people used. And
Speaker 3: I'll definitely go into some more of these or at
Speaker 3: least like, you know, a list of examples the things
Speaker 3: that people used later on. Okay, so now we're in
Speaker 3: the agricultural revolution.
Speaker 2: We're there.
Speaker 3: I'm taking us there. And so with this period of
Speaker 3: time and of huge change, alcohol took on many other
Speaker 3: important roles, not just as a food source, but also
Speaker 3: as a medicine or a good to trade, as a
Speaker 3: component of religious ritual or celebration, you know, Dionysus, Jesus.
Speaker 3: There were many gods or religious figures associated with like
Speaker 3: certain alcoholic beverages, wine in particular. But the availability of
Speaker 3: alcohol in large quantities also revealed, of course, its dark side.
Speaker 3: In many ways. These structured rituals or ceremonies at which
Speaker 3: alcohol was consumed helped to regulate consumption. Like they created
Speaker 3: these boundaries between what was acceptable drinking and what was
Speaker 3: too much. They weren't like free for alls. It was
Speaker 3: very like, you know what, you want to be respectful
Speaker 3: of the gods. You want to commune with them in
Speaker 3: a way that is like the right way. Drinking too
Speaker 3: much was seen to have negative health consequences, to lead
Speaker 3: to alcohol all dependence, to lead to accidents, and at
Speaker 3: the very least lead to negative social interactions. For about
Speaker 3: as long as humans have been making alcohol intentionally, we
Speaker 3: have also been issuing proclamations against it.
Speaker 2: Huh.
Speaker 3: The most famous is probably of course the prohibition of
Speaker 3: alcohol in Islam, which began in the seventh century CE,
Speaker 3: but even before then. China attempted to ban alcohol in
Speaker 3: the second century BCE, and it wasn't necessarily all or nothing.
Speaker 3: Like in many places, alcohol consumption and moderation was fine,
Speaker 3: but excessive drinking was looked down upon. Like, for example,
Speaker 3: there's an inscription on a stadium in ancient Greece that
Speaker 3: forbids spectators from bringing wine into the arena, which it
Speaker 3: cracks me up because I'm like that is still unlike
Speaker 3: every stadium, every concert hall, every whatever.
Speaker 2: You can't bring your own Oh my goodness.
Speaker 3: Yep, yeah, I wonder if they I wonder if they
Speaker 3: sold it for like you know, of course they sold
Speaker 3: it fifteen dollars for like three ounces of wine.
Speaker 2: Goodness.
Speaker 3: Humans have long recognized the cost of alcohol consumption, even
Speaker 3: if we've been able to quantify it or like understand
Speaker 3: the nuances of it, only you know, more recently, and
Speaker 3: the costs are substantial. Aaron, you went over a lot
Speaker 3: of them, both in the short term and the long term,
Speaker 3: and like you said, there's like most public health officials
Speaker 3: or groups will conclude that there is no real safe
Speaker 3: level of alcohol, no tablespoon amount of red wine that's
Speaker 3: going to make us like live longer. Right, So that
Speaker 3: begs the question, maybe why do we drink it? And
Speaker 3: maybe not that so much as why haven't we evolved
Speaker 3: to dislike it to undo that pleasure center hijacking, and
Speaker 3: we kind of have actually, So Aarin, you talked a
Speaker 3: little bit about aldh aldehyde dehydrogenase that causes this build
Speaker 3: up these like immediate negative effects of you know, like
Speaker 3: a hangover immediately, this buildup of acid aldehyde with these
Speaker 3: symptoms of facial flushing, hives, nausea, heart palpitations, difficulty breathing,
Speaker 3: et cetera, et cetera. Basically, it makes drinking alcohol extremely unpleasant.
Speaker 1: Right.
Speaker 3: Some people speculate that this mutation, which evolved independently in
Speaker 3: parts of East Asia, the Middle East, and Europe, may
Speaker 3: have evolved in response to the increase in alcohol consumption
Speaker 3: as a way of curbing the negative effects of alcohol. So,
Speaker 3: looking at one of the evolution events, it originated between
Speaker 3: seven thousand to ten thousand years ago in East Asia,
Speaker 3: which is around the time that rice based agriculture was
Speaker 3: spreading and thus the availability of rice wine. So is
Speaker 3: this a defense mechanism against drinking too much. It's not
Speaker 3: clear if it is. We might expect it to be
Speaker 3: more widespread than it is if it confers such a
Speaker 3: strong selective advantage. And other researchers think that it might
Speaker 3: protect against fungal poisoning, and like the alcohol is just
Speaker 3: a side effect by that, Yeah, and especially the fungal
Speaker 3: strains that would have affected you know, stored grains, or
Speaker 3: it might protect against tuberculosis. I don't know, but I
Speaker 3: think the other thing to consider is how we're looking
Speaker 3: at this equation of the pros and cons of alcohol
Speaker 3: consumption in the ancestors of humans. The advantages were clear,
Speaker 3: like I've gone over them, right, But did the ability
Speaker 3: to metabolize alcohol outlive its usefulness? Was it all just
Speaker 3: backfiring and hijacking after the agricultural Revolution? The author of
Speaker 3: one of the books I read for this episode says no,
Speaker 3: that while there are clear disadvantages to the consumption of
Speaker 3: alcohol and an evolutionary sense, there are also reasons why
Speaker 3: it would have been selectively advantageous, even like after or
Speaker 3: during the agricultural revolution, for a long time, probably at
Speaker 3: least since humans have been settling in large groups the
Speaker 3: primary adaptive challenge that humans have faced is not the
Speaker 3: environment and overcoming the environment, but it's other humans.
Speaker 2: Everything we talk about in this podcast.
Speaker 3: And like from a more social standpoint, like humans don't
Speaker 3: just need food, shelter, and water to survive. We've evolved
Speaker 3: to exist in groups where social cooperation, creativity, and tolerance
Speaker 3: and trust of non reliveives is necessary. The author of
Speaker 3: this book suggests that alcohol and moderation can help with
Speaker 3: those things quote by enhancing creativity, dampening stress, facilitating social contact,
Speaker 3: enhancing trust and bonding, forging group identity, and reinforcing social
Speaker 3: rules and hierarchy. Intoxicants have played a crucial role in
Speaker 3: allowing hunting and gathering humans to enter into the hive
Speaker 3: life of agricultural villages, towns, and cities.
Speaker 2: It does make you more sociable, it does.
Speaker 3: So I bring this up not because I necessarily agree
Speaker 3: or disagree with it, but I think it's interesting food
Speaker 3: for thought or beer for thought. But I also think
Speaker 3: it shows that it's important to consider how the pros
Speaker 3: and cons equation of alcohol is specific to a time
Speaker 3: and place and even to an individual when you're talking
Speaker 3: about it, or I also have to say maybe it's
Speaker 3: not as complicated as all that. This book had a
Speaker 3: very adaptationist perspective on the consumption of alcohol, where like
Speaker 3: there has to be some evolutionary reason for it, some
Speaker 3: way it increased our ability to survive and reproduced, just
Speaker 3: beyond the fact that we like the way we feel
Speaker 3: when we drink it. Yeah. Maybe, as my younger sister
Speaker 3: would say, it's not that deep. Maybe the reason humans
Speaker 3: drink alcohol is just because we like it, right, and
Speaker 3: that's reason enough for it to have persisted for so
Speaker 3: so long.
Speaker 1: Definitely, yeah, yeah, it makes you feel good, literally.
Speaker 3: Yeah, exactly. Okay, evolution talk over, Do you want to
Speaker 3: hear a very general history of alcohol?
Speaker 2: Always?
Speaker 3: Okay, where did I leave off? So I've already covered
Speaker 3: some of the ch logical and historical evidence of early
Speaker 3: alcohol consumption and production around the world, and I think
Speaker 3: that it shows not only how important alcohol was to
Speaker 3: many cultures, but also how creative humans are at coming
Speaker 3: up with new ways to make it. For instance, in
Speaker 3: the Orkney Islands, people included oats and barley with some
Speaker 3: additional flavors and maybe a light hallucinogen or two to
Speaker 3: make a kind of beer spice it up. In Tasmania,
Speaker 3: sap from a gum tree was fermented, and what is
Speaker 3: now Victoria in Southeast Australia, people mixed flowers, honey and
Speaker 3: gum into a liquor. In parts of Africa people made
Speaker 3: banana beer and palm wine, which was also made in
Speaker 3: parts of South Asia. In Mexico people made pulke from
Speaker 3: the fermented sap of the agave plant, and in Southeast
Speaker 3: Asia people made to pie from fermented cassava. And of
Speaker 3: course there was wine and beer and mead made in many,
Speaker 3: many different places. Much of the very early history of
Speaker 3: alcohol is a bit like guesswork, but starting around three
Speaker 3: thousand BCE and on is when our knowledge gets a
Speaker 3: bit more refined, and this is when we see the
Speaker 3: spread of technology for alcohol production along trade and exploration routes.
Speaker 3: Wine making knowledge and technology, for instance, seems to have
Speaker 3: originated in Western Asia like modern day eastern Turkey, eastern Iraq,
Speaker 3: northwestern Iran, and then was brought to the eastern Mediterranean
Speaker 3: and Egypt, and then on to Crete Greece and southern
Speaker 3: Italy before arriving to the rest of Europe around two
Speaker 3: thousand years ago. Helped along After that point, very much
Speaker 3: by the spread of Christianity, which directly led to the
Speaker 3: spread of wine making technology throughout the Western Roman Empire.
Speaker 3: Beer production, on the other hand, seems to have begun
Speaker 3: simultaneously in many different places, such as Egypt and Scotland.
Speaker 3: In ancient Egypt, wine making technology seems to have been
Speaker 3: well integrated into the culture, with production seriously ramped up.
Speaker 3: In one thousand BCE, there's a list of five hundred
Speaker 3: and thirteen vineyards owned by temples, mostly in the Nile Delta. Wow. Yeah,
Speaker 3: like full on production scale type stuff.
Speaker 2: Wow.
Speaker 3: And there are other writings from ancient Egypt showing that
Speaker 3: beer was a common form of payment, especially for the
Speaker 3: lower classes, and from the beginning there seems to have
Speaker 3: been in many wine and beer drinking cultures a class
Speaker 3: structure to these drinks. The wealthy and elite drank wine,
Speaker 3: the poorer drink beer, and the poorest drank water. The
Speaker 3: inherent greater value placed on wine does make sense in
Speaker 3: some ways. There was a shorter growing season, it could
Speaker 3: be produced in the same quantities as beer, and it
Speaker 3: kept better than beer, which was important in long distance trading.
Speaker 3: And these qualities led wine to be scarcer and thus
Speaker 3: more valuable than beer, which is one of the reasons
Speaker 3: why wine was included in rituals and ceremonies more often
Speaker 3: than beer, and why it was written about like we
Speaker 3: have more ancient writings, it seems like of wine than
Speaker 3: we do, or references to wine than we do of beer.
Speaker 2: That makes a lot of sense, actually, yeah, and it.
Speaker 3: Also led to a class division between these drinks, one
Speaker 3: that we'll see time and time again throughout history. Beer
Speaker 3: was cheap, it was consumed by everyone, but wine was
Speaker 3: consumed only by those who could afford it. This attitude
Speaker 3: carried over into ancient Greece and Rome, where the climate
Speaker 3: was more suitable for grape growing, and beer was seen
Speaker 3: as like the drink of barbarians, coming from like those
Speaker 3: northern German tribes that you know, they couldn't grow wine
Speaker 3: up there, so they were clearly not cultured.
Speaker 2: Goodness.
Speaker 3: Yeah, wine production turned into like a full on industry
Speaker 3: in Greece, even more so than it was in Egypt,
Speaker 3: and by four hundred to three hundred BCE it took
Speaker 3: its place alongside olive oil and grain as one of
Speaker 3: the big three products of economy and commerce in the Mediterranean.
Speaker 3: In addition to transporting enormous quantities of wine in amphoras,
Speaker 3: and I mean enormous. So there's one shipwreck I read
Speaker 3: about that contains ten thousand amphoras, which is about three
Speaker 3: hundred thousand leaders of wine. Ooh yeah, or about four
Speaker 3: hundred thousand modern wine bottles.
Speaker 2: Whoa, uh huh.
Speaker 3: Yeah. And ancient Greece also held symposia where wine was
Speaker 3: consumed in moderation with strict rules. The word symposium actually
Speaker 3: means fellow drinker or drinking together. I know that, yeah,
Speaker 3: And it was first used for these wine parties attended
Speaker 3: by upper and middle class men from which women were
Speaker 3: excluded except to serve. And boy does this echo throughout history.
Speaker 3: Uh huh. In many cultures throughout history, there are laws
Speaker 3: that deal in some way with restricting women from drinking alcohol,
Speaker 3: usually on the grounds that women who drink alcohol will
Speaker 3: commit adultery or be sexually promiscuous or whatever. In ancient Rome,
Speaker 3: there was a law that allowed a man to divorce
Speaker 3: his wife if she had been drinking, and alcohol consumption
Speaker 3: by women could also be punishable by death, which is
Speaker 3: which is what happened to one woman, death via starvation
Speaker 3: in her case, who had been caught not drinking, but
Speaker 3: just caught with the keys to the wine cellar.
Speaker 2: Oh my goodness, gracious.
Speaker 3: In the early Middle Ages in Europe, women in a
Speaker 3: household were the ones doing the brewing primarily. That's why
Speaker 3: you hear the term like ale wives or brewsters, and
Speaker 3: so it would be like beer made at each house, right,
Speaker 3: each household had their beer. But this changed starting in
Speaker 3: the fourteen hundreds, when women were essentially excluded from making
Speaker 3: beer as beer began to be made in commercial production
Speaker 3: facilities rather than an individual households as cities.
Speaker 1: Grew, right like once it became a job rather than
Speaker 1: a household job.
Speaker 3: Sure right, yeah, commercial brewing was regulated and required licenses,
Speaker 3: which women were forbidden from applying for, and this also
Speaker 3: marked the start of taverns. The first tavern license in
Speaker 3: London was actually in eleven eight nine, was like really old, yeah,
Speaker 3: But also women were forbidden from entering taverns as well
Speaker 3: for the most part. And these shifts to exclude women
Speaker 3: from beer production, they weren't just accidents of history like
Speaker 3: a natural consequence, but intentional misogynistic exclusion, which is pretty
Speaker 3: easily seen in the depictions from this time showing women
Speaker 3: brewers as dishonest and unhygienic, and women who drank in
Speaker 3: taverns as immoral. Of course, I mean, and this whole
Speaker 3: thing gets repeated again in Europe in the fifteen hundreds
Speaker 3: or so, when distillation began to be widespread, with women
Speaker 3: starting small scale distilleries and then being shoved aside because
Speaker 3: they were forbidden to have licenses. But that's getting a
Speaker 3: bit ahead of things. The Middle Ages in Europe led
Speaker 3: to an increase in beer and wine making technology, a
Speaker 3: shift toward its commercial production of these alcoholic beverages, and
Speaker 3: a big growth in long distance trade as the preservation
Speaker 3: of wine and beer improved, for example through the addition
Speaker 3: of hops to ale. All of these things marked a
Speaker 3: shift where alcohol had moved beyond just being something reserved
Speaker 3: for rituals, and the huge spread of Christianity had certainly
Speaker 3: cemented wine as a sacred part of ritual by this
Speaker 3: point or for just personal household consumption. Alcohol at this
Speaker 3: point was now a key part of the economy. Alcohol
Speaker 3: production and consumption began to be taxed, and those taxes
Speaker 3: funded many a government, and the growth of cities and
Speaker 3: trade also led to a larger consumer market where variety
Speaker 3: was demanded. People wanted to choose what they drank, what vintage,
Speaker 3: from what region, and some places began to like specialized
Speaker 3: in this. They began to be known for their wine
Speaker 3: or beer, and then distilled spirits entered the picture.
Speaker 2: I'm excited for this.
Speaker 3: Distillation is a fairly old concept with fairly old technology.
Speaker 3: Experimental distillation was practiced in ancient China, India, Egypt, Mesopotamia,
Speaker 3: and Greece, with the technology most probably originating in the
Speaker 3: area around the border between modern Pakistan and India, but
Speaker 3: it wasn't really until the thirteenth century in China and
Speaker 3: the sixteenth through the eighteenth centuries in Europe that it
Speaker 3: became widespread. Brandy distilled from wine was the first spirit
Speaker 3: produced in large quantities in Europe, and then there was whiskey, gin,
Speaker 3: vodka and others that followed. Production of distilled spirits became
Speaker 3: especially popular in places where the climate had prohibited growing
Speaker 3: grapes for wine, so, for instance, vodka meaning little water
Speaker 3: was developed in northeastern Europe in what is now parts
Speaker 3: of Russia, Poland, Belarus and Ukraine. Rum, on the other hand,
Speaker 3: which was not the first liquor made from sugar cane.
Speaker 3: There were earlier ones in China and India. Rum was
Speaker 3: made in the sugar plantations in British and French colonies
Speaker 3: in the Caribbean by distilling molasses which had increased in
Speaker 3: availability due to the huge numbers of people they were enslaving.
Speaker 3: This rum would then be used in trade, and this
Speaker 3: is where distilled spirits absolutely were far superior to wine
Speaker 3: or beer for long distance travel. And rum would also
Speaker 3: be added to water barrels on boats, with each member
Speaker 3: of the crew getting a ration of rum, which is
Speaker 3: sort of how like sailors and pirates around this time
Speaker 3: became to be so associated with the drink, and contrary
Speaker 3: to popular belief, the Puritans drank their fair share of alcohol.
Speaker 3: I just wanted to mostly I bring this up because
Speaker 3: I wanted to include these numbers. Is just a visualization
Speaker 3: of how much alcohol people brought with them on journeys. Okay,
Speaker 3: on the Puritan ship Arbella, which carried around seven hundred
Speaker 3: people from England to Massachusetts in sixteen thirty, there were
Speaker 3: ten thousand gallons of wine, forty two tons of beer,
Speaker 3: fourteen tons of water, and twelve gallons of brandy.
Speaker 2: Oh my, goodness.
Speaker 3: Yeah, yes, the introduction of distilled liquors was kind of huge,
Speaker 3: and it really changed the way people interacted with alcohol. Historically,
Speaker 3: beer and wine averaged maybe two to four percent or
Speaker 3: six to twelve percent, respectively. Like, it's actually much more
Speaker 3: alcoholic nowadays, Like your standard beer or wine is more
Speaker 3: alcoholic than they used to be. But distilled spirits, like
Speaker 3: they can be incredibly alcoholic, right, I mean, I would
Speaker 3: say the range was typically twenty percent to one hundred percent,
Speaker 3: like just pure ethanol. And this was an amount of
Speaker 3: ethanol in any distilled spirit far beyond what our primate
Speaker 3: ancestors had ever encountered.
Speaker 2: Oh my goodness.
Speaker 3: Yeah, and some people like use that to their advantage.
Speaker 3: The role of alcohol and colonialism is obviously deserving of
Speaker 3: much more attention than I can give it here, but
Speaker 3: I do want to mention some of the ways that
Speaker 3: European colonizers used alcohol to subjugate and control the people
Speaker 3: whose lands they invaded. Generally speaking, most of the places
Speaker 3: that Europeans sought out to colonize already had a relationship
Speaker 3: with alcohol. Like alcohol, like I said, had almost a
Speaker 3: global distribution by this point, with one notable exception in
Speaker 3: North America, where fermented beverages were less common, although not
Speaker 3: entirely absent, and rituals did not typically include alcohol. But
Speaker 3: that's painting with a very broad brush, and there are
Speaker 3: exceptions to that. But when Europeans invaded those places, whether
Speaker 3: they had a relationship with alcohol or not, they didn't
Speaker 3: drink the local fair but rather they just drank the
Speaker 3: alcohol that they brought with them, wine, beer, spirits. And
Speaker 3: when they set up permanent settlements there, they often planted
Speaker 3: vineyards or built breweries to make beer and wine for trade,
Speaker 3: for religious ceremonies, because most colonizers practiced Christianity, and to
Speaker 3: just drink themselves. But it wasn't drink and let drink.
Speaker 3: It was let's ban all of the local drinks because
Speaker 3: they were mentioned in the Bible. Oh that didn't work, Okay, Well,
Speaker 3: let's just tax only those drinks instead. Colonizers also used
Speaker 3: alcohol as a currency or as payment for workers, with
Speaker 3: the intention of dulling the impact of horrific working and
Speaker 3: living conditions and keeping them in a state of subordination.
Speaker 3: It was a weapon, like alcohol was a weapon. A
Speaker 3: tool of colonization. In North America, colonizers created and spread
Speaker 3: the stereotype of the quote drunken Indian, which was used
Speaker 3: to exclude and undermine Native Americans from any discussions of
Speaker 3: government policies or treaties that affected them, and was then
Speaker 3: used as justification to prohibit the sale of alcohol and
Speaker 3: guns to Native Americans twenty eight years before the nineteen
Speaker 3: twenty legislation that led to the US wide alcohol prohibition,
Speaker 3: and this specific prohibition wasn't repealed until nineteen fifty three,
Speaker 3: which is twenty years after nationwide prohibition ended. I'm sorry, yeah,
Speaker 3: and like similar things just like that happened in Canada,
Speaker 3: but with slightly different time frames, which brings me to
Speaker 3: the last part of the history of alcohol. I'm going
Speaker 3: to cover, also not in any great detail, prohibition, specifically
Speaker 3: prohibition in the US. Don't get too excited. There's like
Speaker 3: not that much detail. I'm so sorry. Like I mentioned
Speaker 3: a long time ago in this episode, people have been
Speaker 3: trying to ban or limit the use of alcohol for
Speaker 3: about as long as we've been making it, with some
Speaker 3: bands or restrictions more effective than others. And I'm going
Speaker 3: to focus primarily on the trend towards prohibition that began
Speaker 3: in the late seventeen hundreds early eighteen hundreds, and then
Speaker 3: like you know, culminated in the early twentieth century in
Speaker 3: places like the US, Russia, Mexico, Canada, Belgium, Japan, and Finland,
Speaker 3: among others. It was like surprisingly widespread, more than I
Speaker 3: had realized starting around this time. Starting in the late
Speaker 3: seventeen hundreds, morality around alcohol began to change, possibly due
Speaker 3: to the increasing availability of safe drinking alternatives such as
Speaker 3: tea or coffee see our caffeine episode, and also the
Speaker 3: growth of distilled spirits, which was seen by many as
Speaker 3: like a negative consequence or like a negative thing. The
Speaker 3: gin craze in parts of England, which is like a
Speaker 3: thing that happened, took place between seventeen hundred and seventeen fifty.
Speaker 3: This may have had something to do with it, but
Speaker 3: many accounts are super exaggerated and probably just like an
Speaker 3: example of moral panic. But essentially what happened was that
Speaker 3: gin like to men. By gin, I mean all grain
Speaker 3: based alcohol, not just juniper flavored. It increased in popularity
Speaker 3: in England from around seventeen hundred to seventeen fifty following
Speaker 3: a brandy shortage, and this led to people saying that
Speaker 3: women were unable to resist the call of gin, and
Speaker 3: that they were leading their unborn children to be addicted,
Speaker 3: and that you know, it was a lot of Oh,
Speaker 3: gin is disrupting family life, and the father has to
Speaker 3: care for the children. Crime and immorality are on the rise,
Speaker 3: et cetera, et cetera. Overall, the gin craze seems to
Speaker 3: be more of like a class and gender war, which
Speaker 3: is not that surprising considering how drinking had long been portrayed,
Speaker 3: right If you were poor, it was a criminal issue.
Speaker 3: If you were rich, it was a moral failing. But
Speaker 3: don't worry. All is forgiven. Tomorrow is a new day.
Speaker 3: These class dictions around drinking and moral panic about alcohol
Speaker 3: consumption by women sort of like fed into each other,
Speaker 3: especially as industrialization meant denser populations and cities and a
Speaker 3: larger working class, both of which alarmed the wealthier classes,
Speaker 3: who wanted to shut down the bars and taverns and
Speaker 3: public houses that were frequented by the working class, which
Speaker 3: the wealthier classes saw as the breeding grounds for criminality,
Speaker 3: especially like the consumption of distilled spirits playing this big,
Speaker 3: you know, scary role, and the consumption of distilled spirits
Speaker 3: did massively increase. Like I said, it changed the relationship
Speaker 3: between humans and alcohol. So over the eighteen hundreds, for example,
Speaker 3: in Paris, although this trend is repeated in many other places,
Speaker 3: per capita consumption of pure alcohol from spirits rose from
Speaker 3: two point nine leaders in the early eight eighteen hundreds
Speaker 3: to five point one leaders in the eighteen forties to
Speaker 3: nine point one leaders in the late eighteen hundreds. So
Speaker 3: that's like if you just take what they were drinking
Speaker 3: and then calculated the pure alcohol concentration of it. With
Speaker 3: the introduction of distilled spirits, there was a lot of like, Okay,
Speaker 3: this is scary, there's too much drinking. But alcohol is here.
Speaker 3: It's been such a part of our lives. Maybe drink
Speaker 3: in moderation, and that was sort of the temperance movement.
Speaker 3: That's what it started out as, just drink in moderation
Speaker 3: and you know, try not to overconsume. This gained a
Speaker 3: lot of traction in the second half of the eighteen
Speaker 3: hundreds with a push to replace alcohol with like tea
Speaker 3: or coffee or hot chocolate or water, and then starting
Speaker 3: in like the early nineteen hundreds, it turned into just
Speaker 3: prohibition no alcohol period. Eugenesis took up the cause kind
Speaker 3: of by listing alcoholism, which was first used as a
Speaker 3: term in eighteen forty nine by Swedish physician Magnus Huss.
Speaker 3: They listed alcoholism as an undesirable trait that shouldn't be
Speaker 3: passed on to deep spring. It's always I mean, yeah,
Speaker 3: I know, always, always, there's always a tie to eugenics
Speaker 3: and morality statistics were used to support the claims of
Speaker 3: anti alcohol writers.
Speaker 2: Morality statistics.
Speaker 3: Uh huh, okay, yeah, I know, I know. A big
Speaker 3: turning point came in World War One. During that time,
Speaker 3: there was a change in the gender balance of some pubs,
Speaker 3: where women who were increasingly joining the workforce began to go.
Speaker 3: They began to like, actually, you know, frequent these bars
Speaker 3: and taverns and pubs, and this led of course to
Speaker 3: increased regulations on drinking and fewer operating hours. I read
Speaker 3: a quote in one of the books for this episode.
Speaker 3: It was something like men have always historically been anxious
Speaker 3: about the consumption of alcohol by women, which I think
Speaker 3: is like a very very valid statement.
Speaker 2: So interesting.
Speaker 3: Alcohol was viewed also during this time as weakening the
Speaker 3: soldiers and the morale of those at home. By nineteen sixteen,
Speaker 3: forty five US states had enacted prohibition statutes. The social
Speaker 3: cause of prohibition had been turned into a political one
Speaker 3: as politicians realized how strongly people felt about the issue,
Speaker 3: like strong enough to get them on their side to vote,
Speaker 3: And on January first, nineteen twenty, the Eighteenth Amendment took effect,
Speaker 3: which banned the production, sale, transportation, and importation of alcohol
Speaker 3: for beverage purposes. And if you want to know more
Speaker 3: about that part of it, there's a whole can burns
Speaker 3: five and a half hour documentary on prohibition in the US,
Speaker 3: which I did not watch, but I want to. But
Speaker 3: from the research I did, it seems that the long
Speaker 3: and short of it, this period of prohibition, it didn't
Speaker 3: actually seem to slow drinking.
Speaker 2: Rates all that much.
Speaker 3: But what it did seem to do was maybe normalize
Speaker 3: social and public drinking, which had been under attack for
Speaker 3: the preceding decades as the temperance movement and prohibition movement
Speaker 3: sort of ramped up. And it also made drinking less gendered,
Speaker 3: with more women attending speakeasies than they had attended bars
Speaker 3: in the years before prohibition. There was also an increase
Speaker 3: in unsafe alcohol production and consumption since there was no
Speaker 3: regulatory oversight to ensure that people weren't drinking just like
Speaker 3: methanol rather than ethanol for instance, Yeah, big deal m H.
Speaker 3: And thirteen years later it was repealed by Franklin Elean R.
Speaker 3: Roosevelt FDR, largely because of a need for tax revenue,
Speaker 3: which grew actually incredibly was like very a big source
Speaker 3: of tax revenue in the years after, and FDR ran
Speaker 3: on a repeal platform, still a political issue back then,
Speaker 3: and he won pretty handedly, probably in part because of
Speaker 3: the way people had come to see prohibition, which was
Speaker 3: as an unwelcome intrusion into the private lives of US citizens.
Speaker 3: Most countries that attempted some form of prohibition or other
Speaker 3: did so in a fairly short window of time from
Speaker 3: around nineteen fourteen to nineteen thirty three, with most never
Speaker 3: making it off the ground or ending up being repealed,
Speaker 3: showing how difficult or even impossible, it is to ban
Speaker 3: any commodity or service for which there is significant consumer demand,
Speaker 3: and that often regulation and education and oversight might be
Speaker 3: more helpful than anything. I don't know. It feels ridiculous
Speaker 3: that I am going to try to sum up the
Speaker 3: rest of the twentieth century and alcohol in like two sentences.
Speaker 3: But that's just how big the history is. Since prohibition,
Speaker 3: our relationship with alcohol and our understanding of it has
Speaker 3: changed like quite a bit. Yes, our good old friend
Speaker 3: to Louis Pasture discovered the process of fermentation in the
Speaker 3: mid eighteen hundreds, which kicked off germ theory, but it
Speaker 3: wasn't until the nineteen forties that we understood the exact
Speaker 3: mechanism of fermentation, which allowed for quantification of blood alcohol
Speaker 3: content and more specific guidelines for what could be considered
Speaker 3: you know, quote safe consumption, question mark minimum drinking age
Speaker 3: was instituted in some places. Attitudes towards alcohol, on both
Speaker 3: individual and cultural levels became more nuanced as we gained
Speaker 3: a better handle on what it does to our bodies,
Speaker 3: to our health, to our relationships with each other. Alcohol
Speaker 3: use disorder has been increasingly part of the discussion. Alcoholics
Speaker 3: Anonymous was first founded in nineteen thirty five, and the
Speaker 3: stigma surrounding not drinking for whatever reason you choose has
Speaker 3: also lessened somewhat, although still like kind of a long
Speaker 3: way to go there. When someone says, oh, I don't
Speaker 3: drink alcohol, and someone just goes, why why don't you
Speaker 3: drink alcohol. Come on, have you tried it before? You
Speaker 3: should try it? Like, maybe, don't do that. Alcohol is
Speaker 3: a complicated subject. The biology is complicated, the history is complicated,
Speaker 3: our feelings about it are complicated, and I'm sure that
Speaker 3: the current status is also complicated.
Speaker 2: Yeah.
Speaker 3: So, Aaron, what's happening with alcohol today?
Speaker 1: Let's let's try and find out, at least right after
Speaker 1: this break. So we'll just go over I don't know,
Speaker 1: maybe the worst of it at first, and then try
Speaker 1: and end on a semi higher note.
Speaker 2: I don't know, let's see what we can do here, Arin, Okay, Okay.
Speaker 1: So, looking first at the US, in a paper from
Speaker 1: twenty nineteen, I found that between two thousand and six
Speaker 1: and twenty ten, so this is kind of old data still,
Speaker 1: the annual number of alcohol associated deaths in the United States.
Speaker 1: So this encompasses anything from things like drunk driving or
Speaker 1: accidents where alcohol is involved, but also things like orrhosis
Speaker 1: or more chronic causes of alcohol associated death, et cetera.
Speaker 1: Just any kind of alcohol associated death in the US
Speaker 1: was about eighty eight thousand a year, which represents almost
Speaker 1: ten percent of all deaths.
Speaker 2: In the United States. Wow. Yeah, that's a lot higher
Speaker 2: than I realized.
Speaker 1: Yeah, in twenty ten, and remember that in the US
Speaker 1: have to be taken with a grain of salt, but
Speaker 1: the estimated alcohol related costs in the United States were
Speaker 1: almost two hundred and fifty billion dollars, seventy seven percent
Speaker 1: of which were attributable to binge drinking.
Speaker 3: Okay, so yeah, we didn't really talk about binge drinking.
Speaker 1: Yeah, but that, yeah, we didn't. Bine drinking is very
Speaker 1: bad if we take a broader perspective and look worldwide. Worldwide,
Speaker 1: according to the World Health Organization, about three million deaths
Speaker 1: every year result from harmful use of alcohol, which worldwide
Speaker 1: represents five point three percent of all deaths. Wow, and
Speaker 1: overall about five point one percent of the global burden
Speaker 1: of disease and injury. So the disability adjusted life years
Speaker 1: measure is attributable to alcohol, which is way more than
Speaker 1: I would ever have guessed. And what is important is
Speaker 1: that if you actually look back a little bit further,
Speaker 1: there's a paper from two thousand and four from the
Speaker 1: World Health Organization, because that data that I just said
Speaker 1: is from twenty eighteen, but at two thousand and four
Speaker 1: paper estimated that one point five percent of global deaths
Speaker 1: were attributable to alcohol, and three point five percent of
Speaker 1: disability adjusted life years were associated with alcohol.
Speaker 2: So that's a huge change.
Speaker 3: Yeah, what's happening.
Speaker 1: Yeah, that's a good question. I don't have the answer
Speaker 1: to that. Is it better reporting where we're getting better
Speaker 1: at identifying not just acute but also chronic causes that
Speaker 1: are associated with alcohol. Is it better awareness of the
Speaker 1: types of deaths that we might be contributing to alcohol,
Speaker 1: or is it because alcohol use is increasing. I don't
Speaker 1: have a good answer for it, quite honestly, but interesting,
Speaker 1: it is interesting. So you mentioned at the end of
Speaker 1: your history section EIR and alcohol use disorder. So the
Speaker 1: DSM five, which I think that we've talked about on
Speaker 1: this podcast before.
Speaker 3: Right, I think so think a long time ago, A
Speaker 3: long time ago.
Speaker 1: The DSM five is in the United States the Manual
Speaker 1: of Psychiatric Diagnoses. It encompasses very specific criteria on how
Speaker 1: to diagnose a whole number of psychiatric diagnoses, including what
Speaker 1: is now called alcohol use disorder. And I won't go
Speaker 1: through the very specific criteria, but essentially they all tend
Speaker 1: to revolve around things like trying to cut down on
Speaker 1: drinking and not being able to or taking an alcohol
Speaker 1: in larger amounts or over a longer time period than
Speaker 1: was intended, missing out on personal or occupational or social
Speaker 1: obligations because of alcohol use. Basically alcohol use interfering with
Speaker 1: your daily life, as well as symptom of tolerance or
Speaker 1: withdrawal symptoms, which we didn't even get into in detail.
Speaker 1: But withdrawal symptoms are actually really important because alcohol withdrawal,
Speaker 1: unlike withdrawal from a lot of other recreational substances, can
Speaker 1: actually be fatal in and of itself in what way,
Speaker 1: So alcohol withdrawal because of its effects on the brain,
Speaker 1: especially with chronic use of alcohol, the effects on the
Speaker 1: brain sudden withdrawal can precipitate seizures, which can then lead
Speaker 1: to death. Okay, so alcohol withdrawal is very very serious,
Speaker 1: and we talked a little bit about this a lot
Speaker 1: earlier on but in terms of like the overall risks
Speaker 1: of alcohol use disorder, since you talked so much erin
Speaker 1: about how all humans for the most part, are able
Speaker 1: to metabolize alcohol in the same way alcohol is affecting
Speaker 1: our brains in essentially the same way hijacking these dopamine pathways,
Speaker 1: any human and has the potential of being susceptible to
Speaker 1: an alcohol use disorder, to an addiction associated with alcohol.
Speaker 1: But we also know that there are variation in things
Speaker 1: like metabolism. There are genetic components to alcohol use disorder,
Speaker 1: but again I don't know of any specific genes that
Speaker 1: would make one more or less susceptible per se that
Speaker 1: we have a lot of evidence for. And then there
Speaker 1: are of course a lot of environmental risk factors, especially
Speaker 1: increased stressors that lead to increased risk, so things like
Speaker 1: a history of abuse of any kind, household instability, other
Speaker 1: psychiatric disorders, etc. And I think what's really depressing is
Speaker 1: that alcohol use disorder and its risk actually peaks among
Speaker 1: young adults age eighteen to twenty five. But of course
Speaker 1: any age group is also susceptible. I think to their,
Speaker 1: like you said, Aaron, there's so much stigma surrounding alcohol,
Speaker 1: alcohol use, alcohol use disorder, and.
Speaker 2: Drinking alcohol not drinking alcohol.
Speaker 1: Right, It goes on so many different spectrums, and I
Speaker 1: think it varies so much culture to culture, as well
Speaker 1: as varying so much over time. So I was trying
Speaker 1: to find like data on like real data on the
Speaker 1: perceptions and stigma, but I didn't really find data on it,
Speaker 1: but I do think that these sort of dichotomous perceptions
Speaker 1: of like is alcohol good? Is alcohol what you know?
Speaker 1: Rich people drink alcohol? Or is alcohol for? Is it
Speaker 1: what poor people do? Is it associated with you know?
Speaker 3: Is it good for you when you drink red wine?
Speaker 3: Or is it bad for you when you drink beer
Speaker 3: or whatever.
Speaker 2: Or vodka or whatever? Right?
Speaker 1: I think that these sort of dichotomous perceptions really wax
Speaker 1: and wane over time. So I wish that we could
Speaker 1: just not stigmatize one way or the other and rather
Speaker 1: just kind of understand this drug, understand the effects that
Speaker 1: it's having on our brain and why it's making us
Speaker 1: feel the way that we feel, and understand what it
Speaker 1: means if we do and vibe versus don't im vibe.
Speaker 2: I don't know, that's just me.
Speaker 3: Yeah, I mean I think like more nuanced discussion. And
Speaker 3: that's what I think is really frustrating about a lot
Speaker 3: of the headlines that you see, whether it's about you know,
Speaker 3: a glass of red wine or coffee or whatever, like
Speaker 3: it's sort of well, here's the sound bite, here's the
Speaker 3: one bottom line exactly, and that is that it's going
Speaker 3: to help you, and that's it's way more complicated than that.
Speaker 1: It's so much more complicated than that as usual.
Speaker 3: As usual, and it's never going to be like, it's
Speaker 3: never going to be as simple as right, I don't know, Yeah,
Speaker 3: we always like I feel like the increasingly persistent theme
Speaker 3: in this season is nuance months.
Speaker 2: Yeah we are so title next.
Speaker 3: Season four nuance.
Speaker 2: It is, though, it really is, especially when it comes
Speaker 2: to alcohol, you know, m.
Speaker 3: Right, It's like, I mean, I found this episode challenging
Speaker 3: to research on a number of levels. One is like
Speaker 3: the sheer overwhelming, you know, abundance of literature.
Speaker 2: About the subject.
Speaker 3: But the other is sort of like all of the
Speaker 3: stuff that I found was very you know, there was
Speaker 3: a certain bias to it, yes, whether it was pro
Speaker 3: alcohol or whether it was anti alcohol, Like there was something,
Speaker 3: you know, and I really don't want to present my
Speaker 3: you know, views as the right views, right, this is
Speaker 3: the truth or this is not the truth, Like I
Speaker 3: wanted to present a variety of things I wanted to
Speaker 3: I don't know, but yeah, I found it challenging to
Speaker 3: do also in thinking about how I feel about alcohol.
Speaker 1: Right, trying not to put our own biases into it.
Speaker 1: Obviously we make quarantine for every one of these episodes.
Speaker 3: Right, but we also make plasy beritas every one of
Speaker 3: these every one of these episodes, and sometimes they're way
Speaker 3: more delicious then and way more appetizing.
Speaker 2: Definitely try the plasi berita for this episode. It's great.
Speaker 2: It is no.
Speaker 1: I know, it's a difficult subject to navigate. I will
Speaker 1: say in talking a little bit more specifically about alcohol
Speaker 1: use disorder, because I think, especially when it comes to
Speaker 1: alcohol use disorder, there is such a heavy stigma with addiction.
Speaker 1: In general, addiction is so heavily stigmatized. So I do
Speaker 1: want to mention that we have a lot of new
Speaker 1: therapies to treat alcohol use disorder. There was a time
Speaker 1: where we had nothing in terms of pharmacologic treatment, and
Speaker 1: kind of for a while it was like AA is
Speaker 1: the only thing. And then there was a Cochrane review
Speaker 1: from two thousand and six that concluded there was no
Speaker 1: evidence to show that AA so that's Alcoholics Anonymous, or
Speaker 1: any other treatment modality was more effective or even effective
Speaker 1: at all. And then another review came out in twenty
Speaker 1: twenty which media reports were like AA and other twelve
Speaker 1: step programs were the only thing that works in there
Speaker 1: the best. That's how the media reported it, of course,
Speaker 1: but there were kind of a lot of methodological flaws
Speaker 1: in that analysis and the two studies, the two thousand
Speaker 1: and six and twenty twenty study, they don't really actually
Speaker 1: use the same outcome measures. And Okay, maybe this is
Speaker 1: me expressing my bias, but I also found a commentary
Speaker 1: on the most recent Cochrane review that was pointing out
Speaker 1: that the studies really just measured the total amount of abstinence,
Speaker 1: like the total days of abstinence, as their main outcome measure,
Speaker 1: and like, maybe that's not the best outcome measure that
Speaker 1: we should be using as treatment success because, for one,
Speaker 1: a lot of people might be deterred from ever seeking
Speaker 1: treatment at the prospect of having to have lifelong abstinence
Speaker 1: be the only correct outcome, right, non abstinate goals might
Speaker 1: be a lot more.
Speaker 2: Attainable for a lot of people.
Speaker 1: And also, just in general, quality of life and psychological
Speaker 1: well being weren't considered as outcomes in these studies. I
Speaker 1: will post all three of those articles so that people
Speaker 1: can freely read and choose and judge them for themselves.
Speaker 1: But we do also now have a number of different
Speaker 1: pharmacological treatments for alcohol use disorder. We actually have one
Speaker 1: that's not great. It's called disulfram and it basically inhibits
Speaker 1: aldehyde dehydrogenase.
Speaker 3: Oh so it's like it's like that basically mimicking that.
Speaker 1: That genetic Yeah, right, that's exactly what it does. So
Speaker 1: you have to take it if you plan on drinking
Speaker 1: or you think that you're going to drink, and then
Speaker 1: if you drink, you will feel terrible and you will
Speaker 1: barf and you'll be flesh and you will feel awful.
Speaker 3: You'll have all of the symptoms of exactly.
Speaker 1: So it's not very effective because if you just don't
Speaker 1: take it, if you want to drink.
Speaker 2: You know what I mean.
Speaker 1: So it takes a lot of willpower to take that
Speaker 1: and then know etc. There are other pharmacologic treatments that
Speaker 1: interact more directly on your brain to basically decrease the
Speaker 1: dopamine mediated reward effects of alcohol, so you don't get
Speaker 1: that feel good reward system as much, and it has
Speaker 1: been shown to reduce alcohol consumption.
Speaker 3: Huh.
Speaker 1: And then there are other ones as well that seem
Speaker 1: to have evidence to help maintain abstinence in people who
Speaker 1: have already started to abstain and want to continue to abstain.
Speaker 1: And then there are still more that are not necessarily
Speaker 1: in the US FDA approved but are used in other
Speaker 1: countries or maybe are used off label. So I think
Speaker 1: the overall message is that if somebody feels like they
Speaker 1: might have alcohol use disorder, or like they might want
Speaker 1: to get help with their alcohol use but they don't
Speaker 1: know where to look, there is help out there.
Speaker 2: And I think that's important to know.
Speaker 1: Because there's a lot of studies that demonstrate how widespread
Speaker 1: alcohol use disorder is in the United States and in
Speaker 1: other countries as well, but how few people ever actually
Speaker 1: seek help for it.
Speaker 2: Yeah, that's all I.
Speaker 3: Have here in Oh, are we done? Two hours later?
Speaker 3: Just two short hours, this was I learned a lot. Yeah,
Speaker 3: I mean I always do, but this one was sort
Speaker 3: of hit a lot of different corners of my brain.
Speaker 3: Should we do sources?
Speaker 2: Yeah we should. So.
Speaker 3: I read a couple of great papers about sort of
Speaker 3: the evolutionary origins of alcohol dehydrogenase. One I already mentioned
Speaker 3: jenik at All from twenty twenty, and there's another one
Speaker 3: from Carrigan at All twenty fourteen. And I also read
Speaker 3: a couple of books. One is by Rod Phillips and
Speaker 3: it's just called alcohol a History. It's very thorough. And
Speaker 3: the other one is by Edward Slingerland and it is
Speaker 3: called Drunk. And so this is the one that talks
Speaker 3: a lot about why humans drink and why do we
Speaker 3: keep drinking. So I will say I have mixed feelings
Speaker 3: about it simply because I don't know if there necessarily
Speaker 3: has to be a reason, like an evolutionary reason for
Speaker 3: all the things that we do or choose to do
Speaker 3: it just anyway, But I talked a lot about that
Speaker 3: in the history section. So anyway, Aaron, I.
Speaker 1: Have a large number of papers for this episode, a
Speaker 1: whole bunch that go into way more detail than I
Speaker 1: did on the pharmacokinetics of alcohol metabolism as well as
Speaker 1: the chronic effects of alcohol, et cetera. I will post
Speaker 1: all three of those, the two Cochran reviews and the
Speaker 1: response commentary to the Cochran review about Alcoholics, Anonymous and
Speaker 1: other twelve step programs, and a whole host more, including
Speaker 1: that really great paper of a list of common hangover
Speaker 1: cures throughout.
Speaker 3: History, and you can't glad to read that.
Speaker 2: It's really good.
Speaker 1: You can find all of our sources from this episode
Speaker 1: and every one of our episodes on our website this
Speaker 1: podcast will kill You dot com.
Speaker 3: Thank you to Bloodmobile for providing the music for this
Speaker 3: episode and all of our episodes.
Speaker 2: Thank you to the Exactly Right Network, of whom we
Speaker 2: are so proud to be a part.
Speaker 3: And thank you to you listeners like you made it
Speaker 3: not only through this long episode, but also this long season.
Speaker 2: Yeah, and like three seasons before it too.
Speaker 3: Yeah, and hopefully you'll wait for us on the other
Speaker 3: side for season five.
Speaker 1: Thank you also to patrons who support us on Patreon.
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Speaker 1: In the meantime, Exactly Right has a whole host of
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Speaker 3: Exactly Right Well until next season, Yeah, wash your hands.
Speaker 2: You feel the animals
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