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• Last updated: December 7, 2021

Podcast #759: To Drink or Not to Drink

As the title of his book — Drink? — suggests, world-renowned professor of neuropsychopharmacology David Nutt thinks the cost/benefit analysis around consuming alcohol is an open question. He’s not anti-alcohol — he regularly drinks himself — but he also thinks most people (more than 2/3 of folks around the world have had a drink in the past year) need to understand a lot more about drinking than they typically do in order to make an informed choice as to whether, and how much, to partake.

To that end, today on the show Dr. Nutt shares the ins and outs of something he calls both a fantastic, and a horrible, drug. We discuss how people acquire a taste for something that initially registers as a toxic poison and how alcohol affects the body and mind. We then delve into alcohol’s long-term health consequences, including its link to cancer, the fact that it kills more people via stroke than by cirrhosis, the way it has a feminizing effect on men, and what it does to your sleep. We discuss what influences someone’s chances of becoming alcoholic, and signs that you’ve got a drinking problem. David also argues that drinking has some benefits, and offers suggestions on how to imbibe alcohol in a way that helps manage its risks. We end our conversation with why more people are curbing their drinking, and the synthetic alcohol David is developing that mimics the relaxing effects of alcohol, without its negative downsides.

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Read the Transcript!

Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness podcast. As the title of his book, “Drink?” suggests, world-renowned professor of neuro-psychopharmacology, David Nutt thinks the cost-benefit analysis around consuming alcohol is an open question. He’s not anti-alcohol, he regularly drinks himself, but he also thinks most people, more than two-thirds of folks around the world that had a drink in the past year need to understand a lot more about drinking than they typically do in order to make an informed choice as to whether and how much to partake. To that end today on the show Dr. Nutt shares the ins and outs of something he calls both a fantastic and a horrible drug. We discuss how people acquire a taste for something that initially registers as a toxic poison and how alcohol affects the body and mind. We then delve into alcohol’s long-term health consequences, including its link to cancer, the fact that it kills more people via stroke than by cirrhosis, the way it has a feminizing effect on men and what it does to your sleep.

We discuss what influences someone’s chances of becoming an alcoholic, and the signs you’ve got a drinking problem. David also argues that drinking has some benefits and offers suggestions on how to imbibe alcohol in a way that helps manage its risk. We end the conversation with why more people are curbing their drinking and the synthetic alcohol David is developing that mimics the relaxing effects of alcohol without its negative downsides. After the show’s over, check out our show notes at aom.is/drink.

Alright, professor David Nutt, welcome to the show.

Dr. David Nutt: Thanks for having me.

Brett McKay: So you have a book out called Drink? The new science of alcohol and your health. And this is a deep dive about the health consequences of alcohol consumption. I’m curious, what led you down that path to write this book?

Dr. David Nutt: Well, I’m a doctor and like every doctor I’ve been confronted almost on a daily basis with the consequences of alcohol, but also, I’m a researcher and I’ve spent the last 40 years of my life researching, how we can help deal with the problems of alcohol. And I thought it was about time I distilled all my wisdom into a publication while I still got a memory to recall it all.

Brett McKay: Well, let’s talk about the state of alcohol consumption in the West today. What’s it like? You’re in the UK, is the United States pretty similar to the UK or maybe Canada, other English-speaking countries in terms of alcohol consumption?

Dr. David Nutt: Yeah, they’re all pretty similar. People are generally drinking considerably more than they should and certainly between 10 and 15% of the adult population have got alcohol-related problems.

Brett McKay: So are we drinking more today than in previous decades?

Dr. David Nutt: Yeah, that’s a difficult question to be precise about because, of course, there were periods when alcohol consumption was considerably higher than it is today. That’s before we had any regulations, like back in the 1800s and there were periods when it was lower like during the wartime when of course people were away doing other things, but if we look back, say over the last 60 years, back to the 1950s, consumption of alcohol in the West has generally risen fairly linearly. So certainly in the UK now people are drinking on an average twice what they were drinking in the 50s and 60s.

Brett McKay: And do you have any idea what’s causing the drive or do the researchers have any idea?

Dr. David Nutt: Oh yes, yes. We know a lot about it. There are two main drivers to this. The first is the price hasn’t kept pace with inflation. So alcohol is now a third the real cost it was when I was a student 40 odd years ago. That’s the first thing, it’s cheaper to drink now than it was before. And the second reason it’s gone up is the availability. In the UK we made a very big mistake in the 1990s, in which we made alcohol readily available in supermarkets and that massively increased the off sales consumption. All that increased consumption we have seen in the last 50 years has been people buying it in supermarkets rather than buying it in bars.

Brett McKay: And you’re also seeing alcohol in new forms, right? I guess this past year, or two years, the seltzer alcohol has been really popular.

Dr. David Nutt: Yes. Yeah, that’s got an interesting scam in a way, isn’t it? Because it’s selling alcohol as being healthy alcohol because it’s got fewer calories, but in reality, the calorie benefits are trivial and I think people get confused and people genuinely think that they’re doing that, they’re actually reducing the risks of alcohol by drinking it without mixers just as the seltzer water. But in fact, they’re not. They’re certainly not reducing the risk and it’s conceivable they might even be increasing the risk because at least if you drink alcohol with beer, you get some vitamins, some B vitamins and stuff whereas in water you get nothing but the ethanol.

Brett McKay: I thought it was interesting, this book really highlights the dangers. The risk of alcohol consumption and it’s something you don’t typically see. We’ve all seen documentaries or read articles about the dangers of cigarette smoking or tobacco consumption or other drug consumption, but we often forget that alcohol is a drug…

Dr. David Nutt: Correct.

Brett McKay: But we kind of pretend like it’s not. What do you think is going on there?

Dr. David Nutt: Well, that’s it. It’s an interesting psychology. The first is because so many of us drink, we don’t want it to be a drug, do we? [chuckle] We don’t want to be drug addicts. We don’t want to be drug users. Well, the first thing is that we have blinkers, deliberately blinker ourselves to the truth because we enjoy drinking and I have to say, the same is true for me. Alcohol is the ultimate social drug, most of us have multiple examples of really good social interactions which were lubricated by alcohol. So we want it to be safe because we want to use it.

Second thing is that the drinks industry has become very very wise. It hasn’t… It looked at what happened to the tobacco industry where the tobacco industry tried to hide the evidence or the risks and the addictiveness of tobacco and then were called out and very savagely attacked. The drinks industry admits that alcohol is a problem, but it says, the way you deal with that, is to drink responsibly, which of course I think is one of the most ridiculous statement of all because quite a lot of people drink to lose their sense of responsibility. And even if they don’t deliberately try to do that, alcohol takes away that control so but the industry has kind of protected itself by saying yeah, yeah, we know there’s a problem, we’re not denying the problem, but it’s your problem not our problem.

And then the third thing is that the drinks industry has been very good at lobbying to maintain its status. So for instance, in Britain, we can’t advertise tobacco on TV, but we can advertise alcohol ’cause the drinks industry has been such an efficient lobbying organization that it’s gotten most of our politicians and I think genuinely believing that alcohol is a good thing rather than a bad thing for people.

Brett McKay: And you also know, there’s some kind of, we can call them nefarious things, like you did some reports talking about how alcohol could be considered the most dangerous drug in the United Kingdom, if you look at all the…

Dr. David Nutt: Yes.

Brett McKay: But sometimes that gets left out of official reports, they don’t… They tend to ignore that.

Dr. David Nutt: Well, that was this famous report in my book, I describe this famous Blair government report on looking at how to deal with the harms of all drugs and then suddenly when it gets published, they’ve taken out the alcohol chapter. And I spoke to the secretary of the whole research program and she said, “Yeah, well, the drinks industry said there were good things from alcohol and you said there were bad things that we thought, well, how can we arbitrate.” We said, “Well, hang on, we’re the scientists when they are the drinks industry.” We kinda know the truth about both sides, they only care about their side.

Brett McKay: Alright, well, let’s talk about what happens to our bodies and mind when someone consumes alcohol. Let’s start when it goes into your mouth. And you talk about how alcohol is an acquired taste because everyone says that, “Oh, it’s an acquired taste.” You said, “Well, it’s an acquired taste ’cause alcohol by itself tastes really bad and is unpleasant.” What is it about alcohol that tastes bad and feels like burning when you drink it?

Dr. David Nutt: Well, it burns your mouth in the same way as it burns your skin when you put alcohol on the skin to kill bugs. Alcohol is an extremely toxic substance, it damages the cells of your skin, it irritates your nerves, which is why it burns and it does the same to your mouth. In fact, actually, all, the only alcohol we had available to everyone forever was neat rubbing alcohol. Most people wouldn’t drink because they’d hate the taste. When we drink alcohol, we are almost always drinking alcohol that has been changed, diluted, have had the taste of other things added, whether it’s in the process of making the alcohol like in beer, or whether it’s in the process of mixing the alcohol with mixers like with spirits.

Brett McKay: But even then, it’s still an acquired taste. But then, so if it kinda tastes unpleasant, what causes people to have that drive to drink?

Dr. David Nutt: Well, yes, so there are several factors and it’s… There are different factors at different stages of a person’s drinking history. So when you first drink, even alcohol when it’s in the form of beer or in the form of wine or in the form of, say, a whiskey or something, when it’s got other flavorings, those aren’t very pleasant either. So beginner drinkers often add sugar or lemonade to their drinks and that’s where Breezers come in. Breezers, these Rum Breezers, which have, basically like alcoholic lemonades, they make alcohol potable to young people. So the first thing is they, then, and then once they can drink it, they then get the effects and of course it’s the effects which are pleasurable. People drink alcohol largely for the effect, but in time they attribute the effects to the taste and then they get to like the taste.

Brett McKay: Okay, so let’s… It goes past your mouth, it’s a little unpleasant, it burns, but once you get the effects, it becomes desirable. What happens when alcohol gets to your stomach?

Dr. David Nutt: And I’ll just say, there’s just one aspect about drinking, it’s a bit like smoking when you get the catch at the back of your throat. With alcohol, particularly people drinking distilled spirits like a Scotch or a vodka, that burning in itself becomes associated with the pleasure that’s gonna happen in a few minutes. So that gets to be liked as well because it’s a kind of forewarner, “Oh great, now I’m gonna get hit in a little while.” So even that burning experience can end up being pleasant anticipatory, but then it goes down into your gullet and it burns down there a bit and then it gets to you stomach yeah, and then it gets absorbed.

And it goes through your liver and your liver tries to get rid of it ’cause the liver says, “This is really bad stuff, guys, this is… We’re being poisoned.” And the liver cells work like hell to get rid of it, but of course they can’t get rid of it all. And then some gets up through the liver into the brain and then, wow, the brain starts to say, “This is different, this is interesting. Hey, I’m chilling out. I like this. I’m calm and relaxed. I feel like I want to talk to that person at a party instead sitting in the corner being inhibited.” And that breakdown of social anxiety is where alcohol is such a powerful drug and that really is the main reason most people drink.

Brett McKay: Alright, so alcohol goes to your stomach, it goes through the liver, the liver is basically… Alcohol’s a poison, essentially, and so the liver’s, their job is like, “We’re gonna filter that stuff out.” And we’ll talk about what happens when the liver is constantly having to filter alcohol but let’s talk about what happens when the alcohol crosses the blood brain barrier. So you mentioned, okay, you start feeling more social a little more loose. What is going on in our brain, with the neurochemicals in our brain?

Dr. David Nutt: Yes. Well, alcohol is very complicated, but the very early stages, the very, when you’re beginning to get the effect of alcohol and the relaxing sociability effects that’s because alcohol is beginning to turn on what’s called the GABA system. GABA stands for gamma-aminobutyric acid, and it’s one of the two major neurotransmitters in the brain. And it’s the calming neurotransmitter. It keeps the brain calm and that’s pretty important ’cause if the brain isn’t calmed then you go on and have anxiety or you have seizures. So GABA is always working to calm the brain. But when you go into a circumstance where you get stressed, you need more GABA and you… Many people can’t make enough so alcohol tops up the GABA and starts to calm you down. And that is why it reduces anxiety in circumstances like parties. But also think about aeroplanes, what’s the first thing they do when the fasten seat belt sign is turned off. They start serving alcohol because of a vast number, a huge, probably a huge, almost a majority of people hate flying and they find alcohol is a good way of calming their nerves.

Brett McKay: And then also it does other things too, it increases dopamine which gives alcohol its… It makes it desirable, it that dopamine release.

Dr. David Nutt: Well, yes. So let’s be clear, different people value alcohol for different reasons. So some people value alcohol because it calms and relaxes, and some people value alcohol ’cause it deadens the pain and the misery of their lives. But some people like alcohol because it yeah, it gets them up and get them going and that is the dopamine release. And they enjoy the energy it gives them. And that’s why it’s a really quite remarkable drug, because it calms you down and yet it stimulates you at the same time. So like a poor man’s purple heart. Do you remember purple hearts in the Korean War and the Vietnam War? This combination of barbiturates and amphetamines? Well, alcohol is like a kinda cheaper, less powerful version of those.

Brett McKay: And then it also releases endorphins in addition to dopamine.

Dr. David Nutt: That’s right. It’s quite hard to find any neurotransmitter system in the brain that alcohol doesn’t affect. But we’re actually very clear, it does release endorphins. And that may be why it is very appealing to some people. It may also be one of the reasons why people become addicted to it because endorphins are basically the body’s equivalent of morphine and heroin. Not as potent as those drugs, but certainly work in the same way and can begin to drive people to an addictive use of alcohol.

Brett McKay: What happens in different stages of drunkenness? So you have that, maybe that first drink, what’s going on? So there’s GABA being released at that point, serotonin?

Dr. David Nutt: No, not released. Let me… It’s quite maybe a bit technical, but let me just… It’s not, alcohol doesn’t release GABA. What it does is it mimics…

Brett McKay: Oh okay.

Dr. David Nutt: GABA is being released and then alcohol comes along and it makes the released GABA better. It kind of facilitates, augments, gives a little bit of extra oomph to the GABA that’s there.

Brett McKay: Gotcha. Okay, so in the beginning it’s giving them oomph to the GABA that’s there. So that’s what causes maybe less inhibition, you start talking louder, more gesturing, etcetera.

Dr. David Nutt: Yeah, yeah, more relaxed. That’s right, it’s about taking away the inhibition, which is… Social inhibition is one of the cardinal features of humanity. Humans, quite rightly so, are very suspicious of other people because other people could be from other tribes and societies and people are generally… Yeah, anxiety is a good state to be in ’cause it protects you from doing ridiculous things, dangerous things. But alcohol… But, of course, anxiety is not really useful when you’re in a social situation, you wanna start chatting to someone in a party. But you can’t… Overcoming that is challenging, alcohol does reduce that anxiety, that social anxiety through potentiating GABA, yeah.

Brett McKay: At what point does reduced reaction times or slurred speech or stumbling start happening?

Dr. David Nutt: Yes. Right. So as you build up. So you start off by enhancing GABA. Then you begin to interact with the dopamine system and some people, people get energized and active. And then as you begin to increase it a bit more then people become maybe more empathetic, and then maybe a bit of serotonin is turned on and that is actually, serotonin plus GABA is a really good combination for socializing and just having fun and being with other people and warming to them, becoming affectionate. But then as you begin to push it up again, once you start to get over about 100 milligrams percent, which is twice the drink/driving limit in most countries. Then you begin to interfere with the system called glutamate. Now glutamate is the opposite. It’s the alter ego of GABA. GABA calms you down, glutamate activates you. But glutamate is the driver. Glutamate is like the electricity of the brain. And what alcohol does to glutamate is to block it. So let’s say, alcohol starts stopping the brain working properly and that’s where you begin to get into the experience of slurring your speech and becoming a little unsteady. And then of course, if you keep pushing the drink up and up and up, then you get into the situation where you start to forget what you’ve been doing because glutamate is vital for laying down memories.

Brett McKay: And then it can get to the point, I guess, where there’s so much glutamate blocked where you blackout or potentially just dying.

Dr. David Nutt: Yes, absolutely.

Brett McKay: That’s the ultimate thing that could happen to you.

Dr. David Nutt: Well, absolutely. Alcoholic blackouts are called blackouts because you can’t remember anything. When you block glutamate to a level, a certain level, you get blackouts, just like an anesthetic. That’s what many anesthetics do, they take away the glutamate so you’re not conscious and so you can’t remember. And then of course, if you keep on blocking glutamate, glutamate, because as I say, it’s the electricity of the brain, it’s just like eventually throwing the switch and people if you haven’t got enough glutamate to make your diaphragm and your chest muscles move, then you stop breathing and you are dead. And in Britain, about three young people a week die of alcohol poisoning. In America, it’s probably more like 10 or 20, I would think.

Brett McKay: Okay, so that’s what happens when you drink alcohol. Let’s talk about the next day, what happens afterwards? What is… And I think a lot of people have experienced a hangover, what causes, what’s going on when someone’s having a hangover after drinking alcohol?

Dr. David Nutt: It’s very hard to actually be precise about this. There’s almost no research been done on hangover, no scientific research. It’s one of the least, in terms of the research per impairment of life years, is one of the least studied aspects of humanity ’cause hangovers actually cause more burden. The cost of hangovers to society is greater than the medical costs of alcohol. In Britain, at least three times greater. And of course many people suffer from hangovers for so often, in fact a lot of people don’t realize that in Britain, the first constraint ever on the time people were allowed to drink, the beginning of licensing hours, which I think is true now in most countries, was in the First World War.

And we stopped people drinking at 10 o’clock in the evening so that they wouldn’t have hangovers, so they could go to work the next day ’cause there used to be this famous saying in the British mines, that basically the miners had a four-day week because they were so drunk at the weekend, they couldn’t go to work on a Monday. But anyway, put that to one side. Hangovers are hugely problematic economically but also they’re very distressing to the people who’ve got them. In fact, driving with a hangover is almost as impairing as driving when you’re drunk depending on how drunk you are but the hangover usually is as impairing as the threshold for drunk driving.

So, despite all that, there’s very little research, what we can say is that obviously hangovers relate to how much you drunk, and they relate to how long after you drunk. Obviously, they get better the longer you’ve been sober, the better they get. They often, to some extent, are worsened by the fact that we tend to drink at night. And therefore when we go to sleep, our sleep is disrupted by alcohols and the hangovers cause, we wake up early, so we’re sleep-deprived as well. And what’s actually going on in the brain is, as I say, not well understood. There is some evidence that it’s due to dehydration, and some people drink a lot of water before they go to bed to stave off hangovers, there’s a little bit of evidence for that. There’s growing evidence, it’s due to inflammation in the brain, which will explain why drugs such as acetaminophen which is paracetamol in the UK and ibuprofen can be useful either when you go to bed or when you wake up with a hangover to deal with the, not just the pain, but also the inflammation.

We’ve been doing some work recently showing that there are things called cytokines. That when you get ill, say, you get COVID or you get flu, your body pumps out cytokines. And some of them are good and some of them are bad, but the bad ones you get when you’ve got COVID or flu, you also get when you have a hangover. So it’s a… There’s some strong relationship with being ill and having a bad reaction is the same kind of biological drivers to both a hangover and feeling sick with, let’s say, influenza.

Brett McKay: Yeah, and you also talk about withdrawal or hangovers are basically, it’s a withdrawal. You’ve had this drug and your body is responding by… Now that it’s not… No longer has that drug.

Dr. David Nutt: Yes, let me just be clear about it. There are two separate elements to a hangover. There is absolutely the withdrawal, and the withdrawal is particularly around glutamate, when you get drunk enough to have a hangover, you have started to block the glutamate receptors. And what they do, because as I said, these are the crucial mediators of brain function. It is like the electricity of the brain. You’ve gotta keep your glutamate working. Now if you block glutamate receptors, it’s not working as well. So what the brain does is make more of the receptors to overcome, to offset the effects of the alcohol. And once it’s done that there’s more of them in the brain, so that when the alcohol levels start to fall overnight, you’ve actually got more receptors, so you’ve got more glutamate. So it’s like turning on the light. Turning on the noise in your brain because you’ve got more of throughput. So that’s the first thing. So that’s where you get the sleep disruption and the bright light and the noises are too loud, and the arousal and the pounding heart, etcetera, from a hangover. That’s because the glutamate system is turned on in withdrawal. But then the other components, particularly the pain components, are due to this inflammation.

Brett McKay: We’re gonna take a quick break for a word from our sponsors.

And now back to the show. We talked about what happens to our bodies and our brain whenever we drink alcohol. Let’s talk about the long-term health consequences of regular drinking. So let’s talk about the organ we most associate with alcohol and that’s the liver. What does alcohol do to the liver?

Dr. David Nutt: Well, it’s actually, generally not a good thing for the liver because the liver has to get rid of it and most of the breaking down the metabolism of alcohol is done in the liver. And the problem is that the alcohol gotta get into the liver and it’s toxic to the liver, but also it’s broken down. The first stage of the metabolism is to a molecule called acetaldehyde, and acetaldehyde is particularly toxic ’cause it’s very closely related to formaldehyde. And I think you probably all know that formaldehyde is the pickling agent, that dead bodies are pickled in, and it stops dead bodies going off because it basically seals all the proteins and enzymes in the body into an inactive form. Acetaldehyde does something similar and that is a bit of a problem because your liver gradually pickles itself, and eventually you get what’s called cirrhosis.

Brett McKay: And what’s cirrhosis? Cirrhosis is just hardening of the liver, right?

Dr. David Nutt: Well, cirrhosis basically is where the liver becomes fibrotic. It becomes very hard because cells that… Liver cells are dead and they get inflamed and then, as you know, if you get some inflammation in your skin, you get this… Get something under your skin for a while, the skin goes hard and the liver goes hard. And it’s because more and more of the liver is dying, so you’ve got less and less of the liver available to do the work of making proteins and also metabolizing alcohol.

Brett McKay: And that’s why… This could even happen acutely, you can get sort of a version, it’s not cirrhosis, but like a hepatitis from heavy drinking.

Dr. David Nutt: Absolutely, so this is a really important thing. And it’s something we tended not to say in the past, but more and more now we’re seeing young people binge drinking really heavily and getting what’s called acute alcoholic hepatitis. And this is when the liver gets so inflamed by huge amounts of poison, called alcohol, now the liver actually is damaged as if it’s been sort of punched. And that acute hepatitis, as the liver cells die, they release substances which kill other cells, and it’s like having a viral hepatitis and it can actually destroy the liver and people die, and we have now, we have wards of young people with hepatitis waiting for liver transplants.

Now previously people couldn’t afford to drink that much, it was a rare thing. When I was a medical student, you only saw it on sailors, they’d be at sea for three, four, five months. They come in and they spend all their money over a weekend getting completely wasted. And so it was something that you saw in the seaports, but now we’re seeing it amongst young people who are going on binge games and weekends of binging. So it’s a huge problem and it can be terminal. If you can’t get a transplant, then you may just die.

Brett McKay: And so acute alcohol hepatitis is a possibility if you drink a lot. The cirrhosis of the liver where the liver [0:25:27.7] ____ it’s fibers and stops doing its job, and then another consequence is, ’cause you’re constantly inflaming the liver with alcohol, is liver cancer. That’s another issue that can happen.

Dr. David Nutt: Yes, I mean, liver cancer tends to come after the liver becomes damaged and cirrhotic. So cirrhosis is a stepping stone to cancer as well, although some people get liver cancer without having cirrhosis. There’s an interesting paradox here. We actually don’t understand why some people are very vulnerable to cirrhosis and cancer others not. It’s probable that there are genetic factors which are predisposed to liver cancer in the same way as breast cancer but that’s not well established.

Brett McKay: Well, besides liver cancer, long-term drinking can also cause other cancers. What does the research say there?

Dr. David Nutt: Yes. What the research says… For a long time, we’ve known the relationship between drinking and mouth and Pharyngeal and gullet cancers and also stomach cancer. And perhaps the most interesting recent discovery is the relationship between drinking and breast cancer. Pancreatitis is something we haven’t talked about. And acute pancreatitis is gonna be occur in as a result of heavy drinking, but the pancreatitis is also a common consequence of chronic drinking, and very many cases of pancreatic cancer are probably related to long-term consumption of alcohol. And the pancreas is actually quite of course, a very… Is tucked away right at the back of the abdomen, so it’s… Pancreatic cancer often presents quite late and it’s very hard to treat. We don’t have any good treatments yet.

Brett McKay: Alright, so it causes other cancers. Another system that it affects in a bad way is our cardiovascular system. What happens to our cardiovascular system with regular drinking?

Dr. David Nutt: Yeah, this has been an area of huge debate. This is an area where there’s probably no… ‘Causes disagreements between even experts. So it used to be said, for a very long time, there was this phenomenon called the French paradox, the French drank lots and lots of wine, but they didn’t seem to die of heart attacks and everyone said, “Well, that’s… That’s because the wine was protecting them from the heart attacks.” Now, that has been looked at in a great deal of detail over the last 20, 30 years and it turns out that the protective effects of alcohol on the heart are really quite minimal. They may exist in France. If they do exist at all, they exist for red wine, and if they exist at all, they exist for small amounts of red wine. Like half a glass of red wine a day will optimize the protective effects if there are any, and they’re only ever been shown for men, not for women.

And so the question is, When you look at the overall burden of alcohol to the cardiovascular system, is that important? And the answer is probably not, because we know that alcohol kills more people through hypertension and stroke, than it kills from cirrhosis. In fact, alcohol is one of the major causes of high blood pressure, and it’s… We don’t know what the cause of high blood pressure in the majority of people with hypertension is. We call it idiopathic hypertension, which means we don’t know what causes it, but what we do know is that if you get people to cut down their drinking, their blood pressure is very likely to cut down. So it’s one of the first ports of call for a doctor dealing with someone with high blood pressure. And of course, as I said, the stroke consequences of high blood pressure are very considerable. It kills, causes strokes in adults, and of course causes heart attacks and heart failure.

And then if you go beyond that, heavy drinking can cause a Myopathy. It can cause a damage to the heart in the same ways it can cause a damage to the liver. The heart gets… Just begins to become inflamed and toxic, and so you go into chronic heart failure. And then on top of that, there’s also this phenomenon of hemorrhagic stroke where you have a bleed as opposed to a clot and alcohol precipitates or predisposes to hemorrhagic stroke because alcohol impairs your ability to essentially to clot if you are bleeding. So if you start to bleed in your brain, alcohol makes that worse. So there are a number of different factors predisposing to cardiovascular events. And then on top of that, you’ve also got the fact that alcohol, certainly in some people, particularly if they’re eating as well, the calorie load of alcohol will also contribute to conditions like obesity and lying down atherosclerosis, which of course then leads to the other kind of stroke, which is the Infarction, the blockage stroke as opposed to the hemorrhagic stroke.

Brett McKay: And so all these things, the cancer risk, the stress on our cardiovascular system. The study show the more you drink, the longer you drink. Your risk of dying increases. It’s exponential. You have a chart…

Dr. David Nutt: Well, that’s the really important point, Brett. I mean, I think… Let’s just go over that a bit slowly ’cause make sure people understand. Yeah, the relationship of alcohol to harm is, as you said, exponential. And what that means is the more you drink, the very much more harms you get. And let me give you an example. So for instance, if you’re drinking half a bottle of wine a day, or that equivalent, that will probably take maybe one year off your life over say a 50 year of life, adult life.

If you’re drinking a whole bottle of wine a day, that will probably take four. So you’ve doubled the consumption, but you’ve quadrupled the impact on health. And then if you go from one bottle of wine a day to two bottles of wine a day, you go from taking four years off your life to 16 years off your life. So at the high end, high consumption over about the equivalent of a bottle of wine a day, that does have a very big impact on your life expectancy.

Brett McKay: So beyond the cancer risk, the cardiovascular risk of alcohol consumption, alcohol also has been shown to negatively impact hormones and fertility. What does the research say there?

Dr. David Nutt: Well, it’s… Absolutely. It’s well-known that heavy drinking in men causes what we call feminization and that men grow breasts and they start to get stripes on their abdomen, they get less… Testosterone levels begin to fall. And that is because the alcohol essentially damages the ability of the body to produce testosterone and so they end up having a stir feet of estrogens. With women, you have a problem, alcohol can also affect fertility, it will disrupt the release of hormones from the pituitary, very often heavy drinking women stop having menstrual cycles. In the end, they will suffer other consequences of that, such as osteoporosis, damaged skin, thin skin, bleeding under the skin as well, the classic telltale marks, the little star-shaped marks that’s under the skin where the blood vessels get disrupted, and the red face, etcetera, so yes, pretty much most hormones in the body are negatively affected by alcohol.

Brett McKay: Okay, so we’ve been talking about the cumulative effects of drinking over time, but alcohol can also have some immediately negative effects. There’s drunk driving, of course, alcohol plays a role in something like half of all fatal car accidents. There’s also violence, drunk people have a tendency to get into fights, drunk people are more likely to be victims of violent crime because they are easy targets. On a less serious basis, alcohol also can significantly affect our sleep, which can have an impact on our health, our productivity, quality of life. And people think, “Oh, alcohol, that helps you get to sleep. I’m gonna have a nightcap.” But you say, the research says, “Yeah, it might help you get to sleep faster, but you’re not gonna have good sleep.”

Dr. David Nutt: Oh, don’t I know that. [laughter] Yes, I was just the other day, I had a couple of glasses of wine late at night watching a film and then I woke up at 5:00 the next morning, “Why am I waking up at five? What’s going on?” And I thought “Oh, oh, yeah, I had two glasses of wine the night before.” And so, I’ll talk you through the process ’cause it’s pretty well established now what’s going on. Yeah, so alcohol is a sedative, it does promote the effects of GABA and GABA helps you sleep, which is why a lot of people do drink before they go to the bed. But as I’ve already mentioned, with the glutamate system, and it’s also to some extent true with the GABA system, the brain compensates. So you’re sedated with the alcohol, you go to sleep but the brain is saying, uh, receptors in the brain are saying, “I’ve gotta do… ” They have to respond. There’s no conscious decision, if they’re over-stimulated or blocked, they’ve gotta respond, so they respond. So while you’re asleep, the brain is adapting to the effects of the alcohol and then you’ve got more glutamate and less GABA, so you wake up early. And that’s why alcohol is bad for sleep because the reaction to the alcohol promotes wakefulness.

Brett McKay: Let’s talk about the alcoholism, where someone… This is beyond you’re drinking socially, this is where you become dependent. Do we know why some people become alcoholics and some don’t?

Dr. David Nutt: Well, we know that there is a strong genetic component to alcoholism. What we don’t know is exactly what that is in most people. We know that alcoholism often runs in families, there seem to be some particular genetic groups that seem to be particularly prone to the binge drinking. It’s often seen in Northern Europeans. Some people think it’s a viking gene that got spread to Scotland and Ireland and then off to Canada where it occurs a lot in the northern latitudes, we don’t know what the gene is, but certainly there are strong genetic relationships. But it’s likely that that’s not just about alcohol, it’s likely that there are also genetic vulnerabilities to addiction itself. We know that identical twins have a very high likelihood of becoming alcoholic if one’s alcoholic, but also they also have increased risks of other addictions.

So yes, there’s definitely genetic risks, but as yet, we can’t really target them. All we can say is this, if you’re a male, if you’re a son of a male alcoholic, your risk of being an alcoholic goes up quite substantially, so be aware of that and monitor yourself carefully if you find yourself drinking more than other people. And in fact that actually is one of the most interesting pieces of research is actually around the GABA system in terms of alcohol vulnerability, because it seems that sons of male alcoholics are resistant to alcohol. Paradoxically, when they start drinking, they can drink more than their peers, but they don’t get drunk and so they’re seen as superstar, “Hey, this guy can out-drink us,” and they take on the challenge of drinking more than others and end up becoming damaged by that drinking, even though it’s not laying waste to them immediately as it does to other people.

Brett McKay: How does someone know if they have a drinking dependence, if they’re an alcoholic? Are there certain telltale signs that we look for?

Dr. David Nutt: Well, it’s very, very easy if you pay attention to what you do, and if you pay attention to what your friends say. So if you’ve ever… I’ll just give you a few of the really important ones. If you ever had to drink in the morning to overcome a hangover, to go to work, you’ve got a problem. If anyone’s ever said to you, “Hey, you looked pretty outrageous last night. Do you realize what a fool you made of yourself? You shouldn’t have done that.” Don’t say I’m talking rubbish. Of course, I wasn’t, ’cause you probably don’t remember it, ’cause you were probably so intoxicated, you didn’t remember, so if anyone criticizes your drinking, take it seriously, listen to them. If you ever get into fights or get arrested? Yeah, I think that’s probably a good sign you’re drinking too much. So evidence the alcohol is messing with your life, at the very beginning, you should start to think very objectively about what’s going on with your… And then take advice, make a diary, have a drink diary.

In my book, I talk about this plan that people should have. I think knowing how much you drink is as important as knowing what your body weight is, what your cholesterol is, what your blood pressure is. It’s a fact that everyone should know and have at hand. And you should always be trying… As you’re trying to always generate or reduce your weight and your cholesterol, you should always be trying to reduce your alcohol consumption. And even if you don’t succeed, you should be trying, ’cause if you don’t try, you’ll never succeed.

Brett McKay: Do we know what the best treatments are for alcoholism?

Dr. David Nutt: Well, there are very few good treatments, the success rates are very low. We are experimenting now with some rather unconventional treatments. Up until now, the treatments have been counseling, psychotherapy, Acamprosate, which is a glutamate blocker, Naltrexone, an opiate blocker to stop the endorphin rush, but their success rates are very low, maybe 2 in 10, 3 in 10. We’ve actually just done a study using MDMA, Ecstasy in alcoholics. And that disrupts a lot of the behavioral processes and the emotional processes which drive addiction. And when that was very successful, that gave us a three times greater response than our normal psychotherapy program. So we’re exploring that currently and also, some people are using Ketamine. Again, a couple of sessions of Ketamine can help break people’s compulsions to drink, break the habits of drinking. So these are just some of the exciting new developments, but currently, treatments are generally pretty poor.

Brett McKay: So we’ve been talking about the negative effects of alcohol. Are there any benefits to drinking?

Dr. David Nutt: Well, there must be, otherwise most of us wouldn’t do it, most of us aren’t addicted, so of course there are. And I like to say, it’s my favorite drug. I drink alcohol a few times a week and I enjoy it. Why do I enjoy it? For all the reasons that other people do because it relaxes me, it makes me more sociable, it makes me more convivial, it takes away some of the stress in life. I enjoy the reminiscences that it brings back in terms of the previous pleasures. So it is actually at one level, a fantastic drug. The problem is, it’s also quite a horrible drug.

Brett McKay: And also, besides the social benefit, there’s some studies that suggest that maybe alcohol can help with creativity as well because of that inhibition loosening that it causes.

Dr. David Nutt: Well, certainly, for most people, it gets them on the dance floor, which they wouldn’t do if they weren’t drinking, that’s a fact. Whether that’s a good thing or not, I don’t know, but this is amazing statistic, wasn’t it? Of the first six American Nobel Prize winners in literature, five of them were alcoholics. Yeah, no one knows whether it… Of course, there’s no controlled study, you can’t randomize Fitzgerald to alcohol and no alcohol in the beginning of his life. So there’s a strong relationship, yes. The writers think it’s helpful. Whether it is or not, I don’t know. Hard to prove.

Brett McKay: So, despite… You spend most of this book highlighting the real dangers of alcohol, but this isn’t a prohibitionist creed against it, in fact, you said no, no, no, you consume alcohol, regularly, but you just make the case that people need to know about the risks so that they can make informed decisions on whether to drink regularly or not. And then if people do decide to drink, you offer some suggestions on how to drink sensibly or as the alcohol companies would say, “Drink responsibly.”

Dr. David Nutt: Yes, I suppose.

Brett McKay: So what are… You offer… There’s a lot of ’em. What are some of the biggest pieces of advice you can offer people who… Just to manage the risks of drinking?

Dr. David Nutt: Well, monitor what you’re drinking and think about it. And then my favorite one, by the way, my favorite one is if you’re drinking as a couple, which most couples do now, over an evening… With an evening meal, never open a second bottle of wine. That’s probably the most important piece of advice I could give to any couple. If you don’t exceed the one bottle when you start drinking, then you’re gonna be… Both of you’d be in a range, as long as you share it, you’re gonna be in a range where it’s reasonably contained. Don’t drink every night, try to have at least two nights a week or two days a week when you’re not drinking. A good… Another ploy is to actually work out how to say no when people are offering you drinks, to say you… Have a limit. A lot of people actually say, “Okay, I’m driving, so I’m only going to have one drink tonight.” That’s a good way to say, I’m not gonna drink again anymore on that evening.

Another one I think is quite useful is to not drink with meals, because with meals, it’s very… You often take bigger mouthfuls to wash the food down. You don’t savour it ’cause you’ve got the taste of the food in your mouth, so the wine is just basically… You’re just using the wine as a lubricant. Use water to wash food down and then savour your wine or your drinks after the meal. In fact, don’t drink before meals, aperitifs are dangerous for two reasons. One is they encourage you to eat more and secondly they encourage you to drink more. And also, buy the most expensive wine or beer, or spirit you can, because the more expensive it is, the less you’re gonna drink and the more you’re gonna wanna savour it.

Brett McKay: You also note in the book there, about a growing trend of companies offering non-alcoholic versions of beer, you’re starting to see spirits now as well. What do you think is going on with that demand?

Dr. David Nutt: Well, it’s clear that a lot of people don’t wanna have the health harms of alcohol, and health hacking has become a big thing. Who’s not wearing a Fitbit telling them how many hours of sleep they got last night, which by the way, they don’t tell you very accurately. But anyway, a lot of people are interested in their health, and they should be. One of the staggering things in the US is that for the first time ever…

We are seeing life expectancy of middle-aged men declining. Why? They eat too much, they’re diabetic and they drink too much. So there are people saying, “Look, hang on, we know, let’s try to be healthier,” and a healthy relationship with alcohol is definitely better than an unhealthy relationship, so… Yeah. So people are turning to flavored drinks, which give you the flavors of alcohol, but without the calories and obviously the potential harms of alcohol. The problem with those drinks, is they don’t give you the benefits of alcohol, and that’s actually why I’ve spent the last 10 years of my life trying to develop alternatives, ’cause I would love to have the relaxing sociable effects of alcohol without the harms, and I’ve been working to try to invent substances and invent drinks that will do that. And we’re making progress. I think in a few years, we will have some on the market.

Brett McKay: Well, you have one right now that’s pretty close. What’s… It’s a synthetic alcohol. What is it called?

Dr. David Nutt: Well, we called it Alcarelle. The idea being, Alcarelle is for alcohol, what Canderel is for sugar. You get the pleasures, but without the calories or the harms. So we’re working on that. That’s beginning to go through safety testing, but we’ve also actually… We’ve got a herbal, a botanical drink on the market now in Europe called Sentia, where we’ve used well-established food herbs, which we know work on the GABA system to make a drink, which does give you some of the effects of alcohol, the GABA effects, the relaxation, the sociability. Unfortunately, we can’t sell it in the States yet, ’cause it’s so expensive to airfreight it over, but at some point, we hope to start manufacturing in the US.

Brett McKay: Oh, so you know what you’re doing with these alcohols. You’re trying to induce the GABA response within?

Dr. David Nutt: Correct, that’s right. Yes.

It’s interesting.

And the great thing is, if you just induce the GABA response, you do massively minimize a lot of the harmful consequences. Particularly… If you don’t target glutamate, then you can’t get blackouts and you won’t get the upregulation of the receptors, you won’t get the hyperexcitability and withdrawal, etcetera.

Brett McKay: Well, David, this has been a great conversation. Is there someplace people can go to learn more about the book and your work?

Dr. David Nutt: Yeah. Yes, you go onto my website, on the Imperial College website, you’ll learn a bit about that. And then you can go on to my website for my synthetic alcohol, it’s called GABALabs. If you go onto GABALabs’ website, you can learn more about it there.

Brett McKay: Fantastic. Well, David Nutt, thanks for your time, it’s been a pleasure.

Dr. David Nutt: It’s been an absolute delight and that’s a wonderful interview and thank you very much.

Brett McKay: My guest today was David Nutt, he’s the author of the book, Drink? With a question mark. It’s available on amazon.com. Also, check it at our show notes at aom.is/drink, where you can find links to resources we delve deeper into this topic.

Well, that wraps up another edition of The AOM podcast. Make sure to check out our website at artofmanliness.com where you can find our podcast archives, as well as thousands of articles written over the years, about pretty much anything you can think of. And if you’d like to enjoy ad-free episodes of the AOM podcast, you can do so on Stitcher premium. Head over to stitcherpremium.com, sign up, use code MANLINESS at checkout for a free month trial. Once you’re signed up, download the Stitcher app on Android or iOS and you can start enjoying ad-free episodes of the AOM podcast. And if you haven’t done so already, I’d appreciate if you take one minute to give us a review on Apple Podcast or Stitcher, it helps out a lot. And if you’ve done that already, thank you. Please consider sharing the show with a friend or family member who you think will get something out of it. As always, thank you for the continued support. Until next time, this is Brett McKay reminding each one of you listening to AOM podcast, to put what you’ve heard into action.

 

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