Just As Well, The Women's Health Podcast - 9 Ways To Have a Healthy Relationship with Alcohol

Episode Date: July 1, 2020

Unless you’ve been living under a rock with no Wifi connection (and you've set all your WhatsApp groups to mute) you'll be aware that pubs and bars in the UK are reopening on 4th July. Think about how this makes you feel: jubilant about sitting down with a freshly-pulled pint? Thrilled that your gang are finally able to make merry in a place with actual working loos? Maybe you’ve cut your units right down during lockdown and have mixed feelings about social drinking opportunities showing up in your life again. Whichever way you're leaning, now is as good a time as any to take stock and start thinking about your drinking. Joining Roisín on today's show is David Nutt, professor of neuropsychopharmacology at Imperial College London, outspoken former government advisor and author of Drink: The New Science of Alcohol and Your Health (£16.99, Hodder & Stoughton). One of the world’s foremost experts on the impacts of drugs on the brain, he’s determined that everyone who drinks understands the impacts boozing has on their bodies and minds. Decidedly not ‘anti-booze’ (he’s a wine fan, FYI), Professor Nutt believes it is possible to have a healthy, wholly positive relationship with drinking alcohol - provided that you apply a few important principles. Here, he spells out what these habits look like - and how to apply them - whether you're going out or staying home. Follow Professor David Nutt on Twitter: @ProfDavidNutt Follow Women’s Health on Instagram: @womenshealthuk Follow Roisín Dervish-O’Kane on Instagram: @roisin.dervishokane Topics: Beyond the liver: how unhealthy drinking affects your health Why it’s important to address stress-drinking  The impact of the Covid-19 lockdown on our drinking habits  Counting your units: how to do it and why it matters How to stick within your limits when pubs re-open Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

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You're about to have a plague of outsiders descend on your town. Let me tell you this. It's going to be consequences. Mayor of Kingstown, new season now streaming on Paramount Plus. Hi and welcome everyone. You're listening to Going for Goal, the weekly women's health podcast. My name's Rochene. I'm senior editor on women's health and this is your weekly chance to plug in, be inspired and get expert advice on how to achieve the health and wellness goals that matter most to you. This week we're talking about drinking and looking at the goal of how you can form a healthier relationship with alcohol. Boozing, getting on it, taking the edge off. Whatever your people of choice and however you choose to use booze, my guest today, is adamant that we all need to do a lot more thinking about our drinking. He is Professor David Nutt. He's Professor of Neuropsychopharmacology, which is definitely probably not one to say after a few carvers at Imperial College, London, and full disclosure, he loves a wine now and then.

So he is so fascinated with alcohol and even though he studies the impacts of illegal drugs to everything from LSD to Ketamine, he's really outspoken about the need for us all to understand the potential harms that alcohol poses to our health and for us to be able to treat alcohol with respect and care in order for us to get the most benefit out of it. His new book is fascinating. It's called Drink, the New Science of Alcohol and Your Health. It came out a few months back, but the issues it goes into are so timely right now. As something I think we can all relate to is the fact that our drinking habits have probably been altered during lockdown and unlocked down and whatever stage we're in right now.

You know, maybe you use booze as stress salve and your units are really stacked up during lockdown. Or maybe you're more the kind of drinker who drinks to feel confident in social situation. So you cut right down while staying home and you felt the benefits, which is great. But now you're able to drink rosé in the park with your friends again. And this is being actively encouraged by all sides. You're wondering how to maintain these new moderate habits. We'll go into all of this in today's episode. This isn't a conversation that says don't drink or go sober.

This is just someone who's really qualified in this area, giving us all the tools to be able to take an honest, analytical view of the way that we drink in order for us all to have a happier and healthier relationship with booze. Because drinking, as he says, should be a positive thing. Here's what you need to know to keep it that way. Let's get stuck in. Professor David Nutt, welcome to going for goals. It's a pleasure to be on with you. No, thank you so much for coming on. And I think now is such an interesting time to be thinking about alcohol.

I think it's been a real topic of discussion during lockdown. You come at the discussion around alcohol from a very interesting perspective. Your new book, Drink, the new science of alcohol and your health, really merges both of these together. So you look at the science behind the effect that alcohol has on our health and you look at the dangers, but you're not, you're not anti-drinking, are you? No, I'm not anti-drinking. I drink. I enjoy drink. I think like many people, drink is a very important aspect of our lives. It's particularly a powerful way of engaging in social activity. And as everyone knows, you know, we use alcohol from the day we're born to celebrate the birth of a new baby to commiserate. with the death of a loved one. So alcohol has been part of human society for many thousands of years. So the challenge is, and what the book's about, is trying to understand it and there is a new science to it.

But also to come to terms with how we use it so we can maximize the benefits but minimize the drawbacks. Why is this something that we should be thinking about? Why is it a worthy health goal? Oh, well, that's a very very good question. And it's probably, you know, 40 or 50 years ago, people would have not understood the huge health impact of alcohol. But in those days, people thought, well, alcohol is a problem just for the people who drink excessively, become dependent, you know, end up losing their jobs and their families, etc., the alcoholic. But over the last 50 years, it's become much clearer that alcohol has an impact on, the lives of most people who drink. In fact, one of the most remarkable things I discovered in terms of researching the book

was that there is no real safe dose of alcohol. Every drink brings with it a little risk. And because consumption of alcohol in the UK has gone up a lot in the last 50 years, we've seen a big increase in the number of people who are coming to hospital with illnesses which are in part caused by alcohol. and those include things that your listeners will know well like liver cirrhosis, but also things they won't know about, such as stroke, such as breast cancer, and such as high blood pressure. And there's that realization that alcohol has a huge impact.

Alcohol was involved in over 200 different disorders. So we're beginning to realize that alcohol has more of a downside. And in fact, it's after tobacco, it's the leading cause of, you know, premature death in the world. So it's interesting to reflect on what's going to happen this year. COVID, coronavirus, there will be an excess deaths of probably a million in 2020. Well, alcohol will kill three and a half million in the world and tobacco of seven million. So, you know, it's a serious cause of premature death. And what's different from alcohol is different from coronavirus. tends to

often kills young people. I'm pretty sure if we carry on drinking the way we are drinking, it'll be the leading cause of death in women under the age of 50 within just a few years because women, we know are drinking more now than they were before, more than men even. It feels so personal when we talk about

someone's drinking habits. And I thought that was what was so brilliant about your book. I read it all in one sitting and it wasn't the most comfortable read because it's just there's so much there's so much information, but also you are very clear about how important it is to almost analyze where you're at and kind of understand your relationship with alcohol, maybe what you use alcohol for.

So one of the key messages in the book is just know what you're drinking, count you're drinking, think about your drinking. In the same way, I imagine most women who listen to this podcast will be extremely conscientious about what they eat and when they eat. But the reality is that unless you care about your alcohol, you're not going to optimize its value to you. And in my professional practice as a psychiatrist, I was working in the field in part of addiction.

Alcohol is many, many, many more people are addicted to alcohol and Britain than are addicted to heroin. So it's a huge problem at the level of psychiatry, at medicine, and in terms of general health and, in fact, in terms of global health. So the key message in the book, really, there's a simple strap line, which is thinking about drinking. Don't drink without thinking. Every drink you should savour in the same way as you would savor a food. You would decide, I'm going to have that particular meal.

I'm going to look forward to that meal. I'm going to have maybe a glass of wine with it. So just know how much you drink. I'm not saying don't drink. I'm saying, monitor what you drink and try to reduce it. And the best way to reduce it is to only drink drinks that are really useful to you. drinks it really that you can appreciate in terms of the taste or the effect. And only drink when you're getting a benefit like you drink socially, but don't drink just in front of the TV because

you just happen to have a bottle of wine and you don't want to, can't be bothered to put it back in the fridge. For some people, drinking is almost like an escape from thinking. It's almost like something that you don't need to think about. So actually this idea that you should then be thinking and engaging and really analyzing your drinking is quite scary. Well, you hit the now right on the head there because for most of us, the reason we drink is to reduce stress. We want to take away the need to think. Of course, that's one of the absurdities of the current government strategy about drinking,

which basically says drink responsibly. But for a lot of young people, the whole purpose of drinking is to lose responsibility. So alcohol is a very cunning drug in that sense. It changes your brain so that you actually welcome the effects rather than become concerned about them. And that's why you have to think before you drink. Because once you've started, it's very, very difficult,

in any particular drinking bout, it's very difficult then to put the brakes on because alcohol, it's moorish. It makes you want to have more of it. But also it takes away all those, that willpower that you had initially when you didn't want to want to have too much. In that sense, it's different to food. I mean, maybe chocolate's a bit similar.

Once people start, they often have to chew the way through the whole of the bar. But alcohol takes away the desire you have, the willpower you had to actually not drink too much. And for some people, of course, that turns them into binge drinkers. And once they've lost control, then there's no stopping them in any particular bout of drinking. there seems to be two camps and there was the people who and maybe they're more social drinkers. They're the people who haven't really touched a drop in lockdown because most of their social opportunities had gone and maybe they'd maybe occasionally have a drink on Zoom with someone, but their kind of drinking habits had slipped away.

And then there seemed to be the people who had ended up drinking more, more to kind of cope and more with the stress and it becoming more of a habitual. thing rather than a celebratory thing. That's a very good way of putting it, absolutely. Yeah, I mean, if people who only drank socially at parties or going out with their friends, who didn't drink at home generally, would probably have little problem in coping with reducing their drinking when they're on lockdown. And there were two reasons for that one is they're not used to drinking every night of the week,

so they don't miss it. And the other, of course, is that they're not tolerant. So the stopping drinking, even at the weekends, doesn't lead to any kind of withdrawal or craving. But the people who drink, and this is the majority of people who get into trouble with drinking, are drinking because they're using it to reduce stress. And if you're using it at home to reduce the stress of being at work, and you're drinking pretty much every night as a result of that, then lockdown is just another stress.

And it's actually in some ways, you know, it's a peculiar stress that you don't have any natural skills to deal with. You know, you've got the added stress. Are you going to get your job back? Are you getting enough money if you're on furlough? You've got the added stress of actually being in the room with, you know, with maybe a partner and maybe children that were going to drive a new mat. So those people use alcohol for stress going to find the lockdown a real problem. And we've seen this in the surveys that have been done. You know, some people have cut down their drinking, but others have increased their drinking.

I think the sales went up at the start, wasn't there? And then there was some back and forth about whether this was just people stockpiling or whether this was indicative of people drinking more. No, I think overall there's more drink. I think overall, I think the makers of booze are the people who've probably done best or at this, the lockdown. Even better than the supermarket is delivering food. Yeah, so interesting.

And I think what comes across really well in your book, as well as the fact that as well as the fact that you are not anti-boos on any level, but you are pro kind of empowering people with the information to allow them to enjoy drinking in the most positive way possible. Alongside that, there was also the sense of that you didn't really want people to get into a cycle of self-blame. And I think that is, I think that's really important with this discussion. And say if so, the conversation that we're having here about, people in lockdown drinking more and they're drinking it to cope. If someone's listening and going, oh my God, and they're kind of cringing in recognition

at what you're saying, what would you want them to know right now and what would be your suggestions for steps to go forward? The key message is to monitor what you're drinking and to work out why you're drinking. So much of the unless excess damage from alcohol is incurred because people don't actually know how much they are drinking. So if you are sitting at home now and listening to this with a glass of wine in your hand, think, ah, is that the first glass? Maybe that should be the only glass.

Maybe let's try to develop a relationship with alcohol where you get the greatest benefit. And that comes usually from the second glass. For most people, there's almost no benefit drinking more than that in a particular evening. say. So that's, so just, just know what you're, count, what's your drinking, work out, help you drinking, and then be aware that the relationship between how much you drink and the harm effects, it's not what we call linear, it doesn't go up, doesn't, if when you go from one to two, you don't double the risks, you actually increase the risks by about threefold, and then if you go from two to six, you increase the risk by about 20fold. So, so the next

key message is never never really drink excessively in any one time not just because that episode of drunkenness in binging is in itself very risky perhaps less so if you're sitting at home front of the TV you're not going to fall over and under a bus or anything but it the tolerance alcohol is a very cunning drug the tolerance it develops means that you can then drink more and actually need a bit more to have the effect so it kind of wind you up and gradually get onto this nasty, vicious cycle of drinking water to get the same effect. And then it's harder to stop because then you have withdrawal when you do stop. Something that you spell out really nicely in the book is you kind of almost give people a like a week by week plan. And it's like these steps in which

you can really analyze your drinking without going into all of it, obviously. Could you surmise or give one of the key steps that people should do and maybe in weeks one to four, So monitor what you're drinking. Keep a diary. Work out when you, you know, just write down, you know, what you don't. There's no shame, you know, just write it down as a fact. And then, and this is really critical, then try to work out which of those drinks really, really did what you wanted, you know, which of them really gave you the pleasure, the sociability, which of them really were worth drinking. And then if there are, then look at the ones at the bottom of the sort of priority. Why did you do that? Was it just a bad habit? Was it that you were forced to because your friends were drinking more than you wanted them to? You know, were there's pressures being put on? And obviously that's not quite the same in lockdown. It won't be quite as, you know, some of the motivations will be different. And then, of course, most importantly, monitor, write down, did you actually get any benefit from that?

Because if you can identify drinking on occasions or the way or the way or the people you were drinking with, which actually didn't give you any benefit at all, just wasted your money or even got you into trouble. You know, maybe you did things that you regret afterwards. Then look at the triggers for that. Why was that? Was it that you actually were dealing with something else? You know, are you actually drinking because you're very unhappy or because you're very stressed? And then if that's the case, get some help for that because alcohol is not a good treatment of depression or anxiety. So if someone is there and they've got to the point and they're thinking you're like, right, I am actually really unhappy and say maybe then they are going to

reach out and try and get some online counselling or something or they're going to get in touch with their GP to talk about medication or even if someone doesn't think that they have full symptoms of a mental illness, but they're thinking, right, my routine is out of whack. I'm not what the way I set up my days is not best serving me. I'm going to get serious about, I don't know, reinvigorating their meditation practice or making sure that they're picking up their exercise and their nutrition. How long does, obviously, you've got real understanding of the workings of the brain. How long if someone does try to put in these habits, so when they start saying,

okay, I'm going to say no to that drink because that doesn't make me feel good or I'm going to stop drinking on weeknight because it just makes me feel sluggish in the morning, how long will it take for the brain, for that to stop being really hard? If it's been a regular habit. Ontario, the weight is over. The gold standard of online casinos has arrived. Golden Nugget online casino is live. Bringing Vegas-style excitement and a world-class gaming experience right to your fingertips.

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Gambling problem call Connects Ontario 1866531-260. 19 and over, physically present in Ontario. Eligibility restrictions apply. See golden nuggetcassino.com for details. Please play responsibly. That's a great, yeah. For the average person, there won't be much withdrawal. So the average person won't get, you know, to have withdrawal,

you won't generally have to be drinking every night or having a bin. So, you know, if you've not been, if you've not been doing that, you won't get much withdrawal. So what you're trying to do then is you're trying to just forget or, as we call sort of, in technical terms, extinguished the habit of drinking. And that won't be easy in the sense that the temptations or the incidents or the occurrences which led you to drink inappropriately, they will reoccur. They will reemerge. You know, certainly after lockdown, they will.

If you used to go out every Thursday night with your mates, you'll probably start doing that again. And then if you've identified that as not being a good time for drinking, then you've, need a strategy. But let me come back to that in a second. Your specific point is that what you're trying to do essentially by changing your behaviour is to bring in better habits. And what's fascinating is you mentioned sort of meditation. Well, meditation is getting you into the same kind towards a similar brain state as you might get when you're drinking. It's a way of coping, detaching yourself for the stress and putting yourself into a place where you actually are more relaxed. So it's harder, it's harder. I mean,

meditation is a lot harder to do than drinking, but it does get you to the same place. So if you can get, if that's your, if you can replace some of your drinking with meditation, that's a question good thing for several reasons. And then exercise, interestingly, also exercise produces changes in the brain, which are not dissimilar to some of the chemical changes produced by alcohol. So, you know, that sense of well-being that you have after exercise is probably got to share as a chemical basis with alcohol. So those are ways of kind of replacing the need for alcohol to deal with stress. But when you get back to the, when you get to the kind of more social habits, then you've got to think really quite carefully because so much of our social lives are entwined with alcohol.

And as I said at the beginning, alcohol is the best drug for sociability. There is no, no, maybe ecstasy, but, you know, that's illegal. So, In reality, most of us become more social and more pleasant under the influence of alcohol. And if all your drinking is in a social situation, then you have to think, the social benefit, is it outweighing the harm? The social life is kind of the gears are like grinding back. It's kind of getting back to normal. Lots of it is related to alcohol and especially when people are so excited to see each other and they want to celebrate. and there's this sense of using a drink's metaphor here,

but like the cork being popped off the bottle, how do people stick to their guns? Well, the first thing is, remember that if you have really cut down your drinking as a result of lockdown, you are more vulnerable to getting drunk. So really be aware of that. If you were a heavy drinker,

and don't go straight back to drinking the levels that you previously drunk because you won't have the tolerance, and therefore you can come to much more harm. And actually, that's one of the benefits of cutting down, is that if you then resume drinking at a lower level, you'll get more benefit, you're more bang for your buck because your brain will be more sensitive

to the effects of alcohol if you've lost tolerance. So that's the first thing. Be very careful about not do it. Don't overdo it. There is no shame at present in saying, I don't want to eat the third cream cake because I'm on a diet. In fact, people say I'm on a diet all the time.

So why not say, look, I'm actually on a diet. I'm an alcohol diet. Alcohol's got, it's got a lot of calories in it. So I'm actually, you know, I'm not going to consume as much as I used to because I've realized, A, I don't need to. B, to drink more, it's not going to be very safe because I've cut down. And thirdly, you know, I don't want to run the risks and, you know, the calories and the potential So have that sensible discussion with your friends.

Speaking of then, like body composition, which is something that is really important to our listeners, how say if someone is exercising, our listeners exercise a lot, say they are exercising a lot and they are taking, like they are kind of mindful of their nutrition, but they would enjoy a couple of glasses of wine, say three or four nights a week, maybe more on, say like the Saturday. what effect is that going to have on the way their bodies hold on to fat? And what can they, does it, does their drinking cancel out their efforts in other areas? The issue of body, women and alcohol is an important one because they have a different body composition. Even the very athletic women have more of a higher level of fat, a ratio of fat to muscle than men,

which means that women get higher blood levels for a given amount of our, alcohol. Women are smaller and they've got more fat. So a woman, even a say a 70 kilo woman, a big woman compared with a 70 kilo man, will have a higher blood level of alcohol for the given level of alcohol intake. And that does make women more vulnerable to getting drunk, particularly if they drink fast. And that's one of the reasons. There are benefits of being a woman in the sense that the harms of alcohol are actually greater in men. So women get more intoxicated, faster, but I think a lot of women just work that out and don't drink so fast. But over time, a chronic with repeated drinking over many years, when men suffer more than women, the

relationship between consumption and harms for men is steeper than for women. And that's possibly, we think, due to Easterdens, and it's also a bit complicated because it's sort of tied up with the fact that men often fight and get drunk. What does 14 units, that's the recommendation, that's a recommended weekly amount that we should be consuming, what does that look like? So a unit is eight grams of alcohol. So that's 10 deceditors of alcohol. So the question is, what are you drinking? So if you're drinking a bottle of wine, then a bottle of wine will contain 750 mills of

fluid, okay? And so divide that by 10. So that's 75 mils of alcohol. So that's sort of, you know, that's getting up to about seven units, seven and a half units. Okay. So there you go. So it's two bottles of wine a week. If you're drinking like 10% wine, if it's stronger wine than that, then it would be more.

It would be less. It would be maybe just two bottles a week. So that's the kind of, that's where the threshold is for wine. And then for beer, you know, most. Pints of beer have got two units in them. A serving of, a small serving of a spirit would be about one unit. So that 14, it's very easy to get to 14 units in a week. Because we're in a society that we've got a very like lay safe air attitude to drinking and because we are a culture that sees drinking and heavy drinking is okay. I guess it's that no one's ever going to

tell you not to do it or no one's ever and you're and like as you say if you're never getting these signs a that you're dependent or you're never getting these horrendous side effects then there's almost nothing there's almost nothing physical telling you it's like you've almost kind of got to make that decision for yourself it's like you've kind of got to intervene for the majority of people the only time they discovered they were drinking excessively is when the doctor says oh you've got breast cancer you've got fatty liver or you've got fatty liver or you're not you're You've got, my goodness, your blood pressure is really high. For each of us, the real challenge is working out how to get the benefits of alcohol, if we like the alcohol.

And that's about drinking stuff you really enjoy drinking with, for people you really like drinking with. A really important piece of advice to anyone who's living alone is try not to drink alone. If you're a single, I mean, if you're a single mother or a single person, a single person, a single woman, just if you only drank socially, you would almost certainly rarely exceed what would be considered the safe threshold for drinking. I wanted to give two tips. The first tip in context, always ask for a, never ask for a large, right? Never ever ask for a large. Or if they say large or say, no, I want a medium or if you've got the balls, ask for a small. But the second thing, I want to get back to drinking at home. The key message I give to couples is, you know,

never open a second bottle. If you open a bottle of wine for a meal, well, the first is never drink with, never drink with a meal because that's a recipe for not really tasting the wine and not actually getting the benefit. But if you're going to drink with them, never ever open a second bottle. Because once you open the second bottle, you almost certainly drink that and then you both massively exceeded what would be a sensible daily in. But if you're a single person, it's much trickier, isn't it? If you're a single person, then, you know, once you've opened a bottle of wine, it's you know, it's, there's always this temptation to finish it. Professor Nutt, we have spoken, there is so much in there and this, like, absolutely fascinating conversation about drinking and how we do it healthily and how we do it in a way that serves us and kind of adds to our, adds to the experience of life rather than taking away from it. There is so much in there. If there is one tip that you have for our, that our listeners could take away

about how they can kind of foster this positive relationship with alcohol, what would it be? About 10 years now, I sent this to David Cameron when he took over as Prime Minister, trying to get a strategy together for how people should deal with drinking. The strategy for drinking for the country and for the individual should be exactly the same strategy as we all have for our weight. We all know what our weight is. for our cholesterol levels, hopefully we'll know what our cholesterol levels are,

for our blood pressure, we all know what our blood pressure is, what you should do. You should know how much you drink, you should monitor, in a very gentle way in your diary, just monitor over a couple of weeks, what you drink.

And if you are drinking above, certainly if you're drinking well above the threshold, the government's maximum threshold of 14 units a week, you should then try to reduce you're drinking in the same way as if you're putting on weight you should try to reduce your weight or if your blood pressure is going so know what you're drinking always try to reduce it and the best way to reduce it is to get rid of drinks that don't give you benefit so be be really

analytical do you really need that third gen and tonic to have fun when in fact all that happens is that you actually get ill and you can't go to work the next day so think about your drinking and try always to reduce how much you are drinking. Brilliant. Oh, Professor David, in that, it was so good to talk to you. Thanks very much for coming on going for goal. Thank you very much to all of you guys for listening. I hope you liked that episode.

And I hope it's given you lots to think about. It certainly has for me. We'll be sticking some resources for healthy drinking in the show notes. So do go check those out if you want some further guidance. and also the link to David's book is in there as well. All that's left to say is if you enjoy this episode, please do rate and review on Apple Podcasts. And remember to subscribe wherever you get your podcast

so that you don't miss an episode. And if you've got a health goal in mind, all you need to do is drop us a message on Instagram. We're at Women's Health, UK, by the way. But again, link to that is in the show notes. And tell us what you want our help with. Put Going for Goal and Capital Letters at the start of your message so we can't miss it.

And hopefully your health goal could be the topic of an upcoming episode. Right, that is enough from me, wittering on. I'll be back next week. Until then, take care, everyone. Bye.