Booze is Poison

This summer a lot of science news bubbled up out of the quantum foam, but the one thing that really caught my attention was booze. And not Oregon’s world-famous craft beers. A study landed that allegedly found that any amount of alcohol — any — is bad for you. Now, this news hit hard for a few reasons. First, it contradicts a long list of studies that correlated booze with good health, and second… really?! Is there nothing left in this world to enjoy? Thanks, science. Thanks a lot. Pretty much everybody was blowing a gasket over this one, and the journalist in me immediately thought it was just a scientist’s ploy to gain notoriety — and secure funding. And considering that scientists are people too, it’s quite possible. But then I took the time to examine the study, published in the Scientific Journal The Lancet, which let’s be honest is a creepy name, and… wow.

Researchers reviewed data from the Global Burden of Diseases, Injuries, and Risk Factors Study of 2016. There were 694 data sources, along with 592 other studies on the risk of alcohol use. Altogether, the data measured health effects of alcohol use in 195 countries from 1990 to 2016. It’s a lot of data, and a ton of work by hundreds of people. The list of collaborators for this study takes up more screen real estate than the collected works of Shakespeare. It was a massive effort by countless researchers, and so it probably shouldn’t be taken lightly. So what, exactly, did they find? They found that alcohol is a leading risk factor for disease burden worldwide. It accounts for almost 10 percent of global deaths of people between the ages of 15 to 49 — about 2.8 million people a year. And in general they found that the more people drink, the worse their health is. More cancer, heart disease, kidney and liver problems, pretty much everything. No amount of alcohol, they found, is safe.

In their words:

“Our results show that the safest level of drinking is none. This level is in conflict with most health guidelines, which espouse health benefits associated with consuming up to two drinks per day. Alcohol use contributes to health loss from many causes and exacts its toll across the lifespan, particularly among men. Policies that focus on reducing population-level consumption will be most effective in reducing the health loss from alcohol use.”

The results seem pretty clear, but there could be other factors affecting health in drinkers. Poverty, for instance, has been consistently shown to adversely affect health. So has depression. Of course, all of these are intimately connected — When you’re struggling financially, you get stressed and depressed, and you drink. Probably too much. But what about all those studies that said moderate drinkers have a lower risk of heart disease? A team of researchers working with the National Institutes of Health did a meta study of those studies last year. They found a pretty consistent, but minor correlation between moderate drinking and decreased rates of heart disease. But they found more. Again, in their words:

“Moderate drinkers tend to be younger, leaner, more physical active, of higher socioeconomic status, and more likely to be married compared with people who abstain or drink rarely. All of these factors have been shown to influence one’s risk of coronary heart disease.”

So there may be correlation, but not causation. People who drink moderately tend to be in overall better health than those who abstain. And you can’t attribute their health to how much wine they drink.

I also searched for someone who could refute or criticise the Global Burden of Diseases study, but I was only able to find articles in publications with ties to the alcohol industry. Like the Lorax said, “Business is business, and business must grow, regardless of crummies in tummies, you know.”

Interestingly, the whole study was sponsored by the Gates Foundation, which was founded by Bill and Melinda Gates, and Warren Buffett. Buffett famously abstains from alcohol and claims to never have had a sip in his life. It’s not clear whether Bill and Melinda enjoy a glass of wine now and again, but Bill has been known to drink water distilled from human waste. He was demonstrating a really cool machine called the Omniprocessor that can turn poop into energy and clean drinking water. The machine was funded by the Gates Foundation and actually shows a lot of promise in being able to clean up human waste in places without water treatment facilities.

But I digress. The evidence is mounting that alcohol, in general, is pretty bad for you. Now, I’m definitely no teetotaler, and I can’t tell you how to pilot your meat vehicle, but I can tell you what booze does to your body. Or my body. Or any body, really.

Much of this comes from an excellent article on the venerable HowStuffWorks.com titled, How Alcohol Works. Some also comes from the now famous Lifehacker article by Kevin Purdy titled “What Alcohol Actually Does to Your Brain and Body.” I’ll link to both in the show notes.

First, let’s start with alcohol itself. When we’re talking booze, we’re talking ethyl alcohol or ethanol. There are other types of alcohol, but you definitely shouldn’t drink them because you’ll die. Methanol, or wood alcohol, is used to make formaldehyde and as a fuel additive. Isobutyl alcohol is used to strip paint and to make plastic.

The ethanol in booze, beer, and wine is a fairly simple compound of carbon, oxygen, and hydrogen. Back in high school chemistry you could write it as: C2H5OH. It’s volatile and highly flammable and was even used as rocket fuel in the early days. In stronger concentrations it can be used as a solvent for paints and inks.

The stuff we drink, however, is typically suspended in water. Beer contains around 3 to 9 percent alcohol, wine between 10 and 16 percent, and liquor 40 percent and more.

So what happens when you drink?

Most of the sauce is absorbed in your stomach and the rest gets sucked up by your small intestine. Then it dissolves into your bloodstream and gets the party started. It can immediately irritate the linings of the stomach and intestine. It also increases blood flow to those areas, and boosts stomach acid secretion. Blood flows to the skin, causing flushing, sweating, and that nice warm glow we’re all familiar with. It also reduces blood flow to muscles, which can lead to muscle aches later on. Overall blood pressure drops.

But the real fun happens in your brain box. Alcohol essentially gums up the works. Brain cells communicate using electrical and chemical signals. Alcohol blocks some chemical signals and enhances others.

It increases the release of dopamine, which is usually called the pleasure molecule in popular culture. But dopamine does a ton of things in the nervous system and in the body. In the brain, it’s involved in movement, pleasure, attention, mood, and motivation. In the rest of the body, dopamine is involved in nausea, kidney function, and even heart function. When we’re talking alcohol and drugs, dopamine is really about pleasure and anticipating reward. If you’re a regular drinker, just thinking about mixing a mid-day martini can cause a spike in dopamine. When you take that first sip, you get even more dopamine. This is why alcohol is so addictive.

Beyond the initial rush of pleasure, alcohol enhances the effects of another neurotransmitter called GABA. GABA is an inhibitor — it makes things sluggish. Alcohol also weakens the excitatory neurotransmitter glutamine, slowing things down even more. It depresses inhibitory centers, making you more talkative, self-confident, and less inhibited. It slows down information processing from the senses, making it more difficult to see, hear, feel, and taste. And, as we all know, it inhibits thought processes, leading to poor judgement.

Hold my beer.

Booze also acts on the limbic system, which has a lot to do with emotion and memory. Again, it weakens the normal checks we have on our emotions. This leads to, as the How Stuff Works article points out, “exaggerated states of emotion.” It can also make it difficult to form and retain memories.

The more you drink, the more alcohol affects your brain. Those affects begin in the higher order parts of the brain — thinking and emotion. Then, after Jaeger shot number three or so, they start to affect the cerebellum, which has a lot to do with movement. That leads to the teetering, stumbling, and flailing about of, well, our ‘20s. Booze also makes us hornier. It depresses the nerve centers in the hypothalamus that control sexual arousal and performance. But the more you drink, the more sexual performance declines — for men, especially. Our favorite How Stuff Works article quotes a few lines from Shakespeare’s MacBeth, and what kind of podcaster would I be if I didn’t perform a dramatic reading:

Macduff: What three things does drink especially promote? Porter: Marry sir, nose-painting, sleep, and urine. Lechery, sir it provokes, and unprovokes; it provokes the desire, but it takes away the performance…

Part of this has to do with how alcohol affects hormones. Studies have shown that even a single drink can lower levels of testosterone in men. And low levels of testosterone have been associated with an array of medical problems, including osteoporosis, decreased muscle and prostate function, anemia, altered immune function, and, of course, a decrease in sperm count.

The porter from MacBeth also points out something we haven’t covered: Pee. Alcohol makes you pee, a lot. And that’s not just because you’re drinking water. Alcohol is a diuretic, which means it makes your kidneys kick into high gear. It inhibits the secretion of the hormone vasopressin, which tells the kidneys to reabsorb water. The end result is a lot of pee, and dehydration, which is a key component of a wicked hangover.

The breakdown of alcohol is also thought to contribute to wicked hangovers. Alcohol is broken down in the liver to form acetaldehyde, which is further broken down into acetic acid, the main part of vinegar. Which is why you can feel pretty pickled after a night of heavy drinking.

Alcohol also really messes up your sleep. Just one drink can disrupt sleep cycles, slashing the amount of REM (or dream) sleep you get. REM sleep helps metal recovery and rejuvenation, and could play a central role in depression. Remember GABA and glutamine? Those two neurotransmitters that get thrown out of whack when you drink? When the alcohol wears off, they return to normal levels, causing wakefulness. Researchers call it the rebound effect, and it happens a few hours after you go to sleep. This, along with the urge to pee, means you’ll probably be up all night. And because your sleep cycle has been disrupted, it’ll be more difficult to get back to sleep. This is the final and probably biggest cause of hangover symptoms. The way alcohol affects sleep could be the biggest reason it’s so bad for you. Research has shown that lack of sleep is terrible. Poor sleep causes increased rates of cancer and heart disease, premature aging, muscle loss, increased inflammation, you name it. The effects of a bad night’s sleep are truly disastrous, and worth an entire podcast series. For a good summary of sleep and how it influences health, check out the excellent book Why We Sleep by neuroscientist Matthew Walker. Walker does a great job of breaking down the mechanisms of sleep and explains decades’ worth of sleep studies and what they mean for your health.

So. This is all what happens when you have a single cocktail at happy hour after work. But what about if you keep up the habit?

Simply put, it’s really bad.

Long-term alcohol abuse absolutely wrecks your body and mind. The more you drink, and the more often you drink, the more your body tries to adapt. Your liver kicks into high gear, producing more of the chemicals used to break alcohol down. All that extra work burns up liver tissues. Cells die prematurely, and liver tissue begins to harden, leading to cirrhosis of the liver.

Your brain amps up the amount of glutamine and tanks the amount of GABA to compensate for all the booze. The result is increased anxiety and agitation when you’re not drinking. The same thing happens in nerve cells throughout your body — they increase activity to compensate for being drunk. Without booze, heavy drinkers can experience uncontrollable tremors and shakes.

A few drinks now and then won’t kill brain cells, but long-term alcohol abuse can. Remember how booze kicks your kidneys into high gear, producing more urine and dehydration? Over time, that process can flush a lot of vitamin B out of your system. Vitamin B is crucial to brain health and without it you can develop Wernicke–Korsakoff Syndrome, which is essentially brain damage. It causes confusion, memory loss, and a reduction of overall brain mass.

That same leaching process can also lead to iron deficiencies and anemia.

Long-term alcohol abuse can also lead to hypertension and heart disease. When you drink, blood pressure drops. Your heart then pumps harder to compensate. Over time it’ll just keep pumping harder, leading to overall increased blood pressure. Finally, alcohol abuse drastically reduces testosterone levels in men.

And this is all just the health effects of alcohol. The social harm alcohol does is almost immeasurable. It wrecks families, ruins careers, incites violence, causes crime, and kills. The Center For Disease Control estimates that approximately 88,000 people die from alcohol-related causes every year in the US. The World Health Organization estimates that 3.3 million people die from alcohol-related causes every year worldwide. There are many more sobering statistics on the National Institutes of Health website, but you get the picture.

Considering all this, it’s extremely difficult to take any studies showing alcohol is good for you seriously. Weighing the evidence, and alcohol’s documented effects on the human body, there’s really only one conclusion: Alcohol is bad for you. But that doesn’t mean you shouldn’t drink.

Renowned statistics professor Sir David John Spiegelhalter stated it well in an interview with the BBC: “There is no safe level of driving, but governments do not recommend that people avoid driving. Come to think of it, there is no safe level of living, but nobody would recommend abstention,” he said.

Living is risky. It’s up to you to decide how much risk you want to take, and whether the joy of drinking alcohol is worth the consequences. Booze has inspired great works of art, eased troubled souls, and strengthened relationships since the dawn of humanity. It’s powerful stuff, and it has a price. I’m willing to pay it, but I’m definitely going to cut back after this podcast. Especially considering that I want to remain physically fit as long as possible. Looks like I’ll be limiting my consumption to special occasions. Probably.

Here are some interesting statistics about alcohol consumption from the Global Burden of Diseases study: Denmark has the highest percentage of drinkers. 97 percent of men and 95 percent of women in the country drink. Norway, Argentina, Germany, Poland, and France aren’t far behind with prevalence in the 93 to 94 percent range. Pakistan has the lowest prevalence for males at nine tenths of a percent. Bangladesh is the lowest for females at three tenths of a percent.

Romanian men drink an average of 8.2 drinks per day. Portuguese men 7.3. Ukrainian women, 4.2 drinks a day. Women in the UK drink an average of 3 a day. Spanish men have 5.8. Swiss women, 2.8. And remember, these are just averages, which means some people drink far, far more every day. I’m hungover just thinking about it.

That’s it, thank you for listening. This was a big one, and I encourage you to do your own digging. I’ve linked to my sources in the show notes. There are a lot, so be prepared to do a great deal of reading. Don’t say I didn’t warn you. If you liked this podcast, subscribe on Apple, Google Play or Podbean. There’s more to come.

If you’re looking for a delightful compendium of craft cocktails, check out the book Vintage Spirits and Forgotten Cocktails by historian Ted Haigh. You can learn how to make everything from the Alamagoozlum to the Zombie 100. It’s a hoot. If you’re in the pacific northwest, grab some Portland Syrups Rose City Tonic and some Freeland Spirits Gin. No they’re not sponsors, but they are my go-tos for G&T.

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