The Mel Robbins Podcast - What Alcohol Does to Your Body: Harvard’s Dr. Sarah Wakeman With the Medical Facts You Need to Know

Episode Date: March 14, 2024

Today you’re getting a masterclass from one of the most renowned and respected experts on alcohol.She’s here to give you the latest research and science of how alcohol impacts your body, brain, and mind. She’s going to give you facts, dispel myths, and help you be informed about the decisions you are making when it comes to your mental, physical, and emotional health when it comes to alcohol consumption.Dr. Sarah Wakeman is Senior Medical Director of Substance Use Disorder at Mass General Brigham, home to nationally recognized hospitals and cutting-edge research. She's also an Associate Professor of Medicine at Harvard Medical School and the Program Director of Mass General Substance Use Addiction Services.How much is TOO much alcohol?Is some alcohol healthy?What happens to your brain when you drink?And how do you help someone you love who drinks too much?Get the latest research so that you make the most informed decisions about the role alcohol plays in your life. For lots more resources, click here for the podcast episode page. Connect with Mel: Get Mel’s free 29-page workbook to make this your best yearWatch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel’s newsletter Disclaimer

Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. I am so glad that you're here, and whether you're listening today for yourself or because someone that you love shared this episode with you, I want to welcome you to the Mel Robbins podcast family. It's a real honor to just spend some time with you today, and I also want to do acknowledge you for something. You know, you could be listening or watching a bazillion things right now, but you chose to spend your time listening to something that can help you create a better life and I just think that's so cool and today's episode, in particular, is not only going to help you do that, it could change your life or the life of someone that you love. Today on the show, you and I are getting a master class from one of the world's most respected

and renowned experts on alcohol and its impact on your body, your brain, and your life. I am really excited that you're here with me today, and I've been looking forward to this conversation for a long time, and I'm going to that you're here with me today, and I've been looking forward to this conversation for a long time, and I'm going to tell you why. Because I've been focused recently on getting super intentional about creating healthier habits, particularly around exercising more and taking better care of my brain.

And the more that I do that, the more I've been questioning my relationship to alcohol. Maybe you've been questioning your relationship with it too. I mean, if you kind of think about it, here you are eating all this healthy food and exercising and taking your supplements and trying to learn and grow, and then you basically end the day, if you're like me, by washing down a high noon or a glass of wine

or a gin and tonic. If you put it in that context, it's kind of dumb. And I don't know if you've ever been in this situation where you go to see your primary doctor and they ask you that question, so how many drinks do you have a week? I can't be the only one that has lied to their primary care doctor before because you suddenly know that the number's a little higher than it should be. I mean, I've been in that situation.

And the more that I find out about alcohol, and I'm talking the facts, the more I'm thinking, I got to do something about it. I have questions. Is there any health benefit to drinking? Is there any amount of alcohol that you can drink that's actually healthy for you? Is the only answer that's available, don't drink anything at all. Alcohol is constantly marketed to you and me.

It's like the thing that you need to have a great weekend, you gotta have it for a tailgate, you need it for every celebration, it's what you grab when you wanna wind down at night. But do you even know what's happening in your body and your brain when you consume alcohol? I don't. Do you know how it interferes

with the medications that you're taking? And here's how I wanted to approach this today. I don't wanna lecture you. I want you and I to feel empowered with facts because when you feel empowered, when you understand something at a deeper level, don't you feel more motivated and like really capable of making better choices for yourself? Of course you do. And one more thing I wanted to point out to you. If you're worried about

somebody in your life and they're drinking, this episode is a world-class resource for you. Just share it with them. Because if you haven't been able to get through to them about how concerned you are, I guarantee you our expert today will make them rethink their relationship with alcohol. Dr. Sarah Wakeman is here and she is one of the most renowned medical experts in the entire world. She's gonna break down how alcohol impacts your health, your body and your mind.

Dr. Wakeman is the Senior Medical Director of Substance Use Disorder at Harvard's Mass General Brigham, which has been ranked as the number one research hospital in the entire world. After studying at Brown University, Dr. Wakeman did her residency at Mass General, which is the best program in the country, where she was also the chief resident,

which means she was the number one medical resident in her class. She is an associate professor of medicine at Harvard Medical School and the program director of Mass General Addiction Medicine Fellowship. And she squeezed us in to her extraordinarily busy schedule, and she is here today in our studios in Boston to spend time with you and give you and your loved ones the facts, the science, and the research so that you and the people that you love can make an informed decision

about the role that alcohol plays in your life. So please help me welcome Dr. Wakeman to the Mel Robbins podcast. I'm so excited to be here. Thanks for having me. Well, thank you for taking the time out because I know you have an unbelievably busy schedule. So let's just jump right into it.

So Dr. Wakeman, can you explain what even is alcohol and how does it affect our bodies? Sure. So alcohol is a molecule. It's a water-soluble molecule that is readily absorbed in your body through your stomach and your small intestine when you drink it. And it affects all different parts of your body and body systems, in particular your brain, which is why we feel the effects of alcohol pretty soon after you start drinking. And we can talk through what those effects are, but it impacts our behavior, our sleep,

our mood, and many other parts of our body system. You talked about alcohol as a molecule. That sounds very science-y to me. What kind of molecule is it? Is it, you know, like is it a poison? Is it like, could you explain more about the makeup of what it actually is? Yes, I mean the way alcohol that we drink happens is through a process called fermentation. So something that has sugar like grape juice juice, or if you think about beer, barley, or potatoes, or other often starches are fermented. And in that transformation process,

they form an alcohol molecule that then has a different effect on our body. Alcohol is found in all sorts of different things. So obviously, it's intentionally made through fermentation to ingest. But we also use it in cleaning products, or rubbing alcohol, or mouthwash, hand sanitizer. So there are alcohols all around us and used for many different things.

Huh. Well, when you say the category cleaning, hand sanitizer, rubbing alcohol, thinking about use as in a hospital, and then I put that in the same family as something you would ingest in a cocktail, is it the same family as something you would ingest in a cocktail, is it the same molecule? It is, and in fact, some of my patients with the most severe forms of alcohol use disorder will drink hand sanitizer or rubbing alcohol or mouthwash if they can't get regular alcohol,

which tells you really the power of addiction once someone gets to that level of severity, but it's the same molecule with the same effect. I just already had something that I learned that is, if you're watching us on YouTube, you can see that my mouth is a gape. I don't know why I never connected the dots on that, that it is actually the same chemical. Exactly. The actual alcohol molecule that we think of in a

fancy cosmopolitan is not different from what's in rubbing alcohol, let's say. I never knew that. I think that's an indication of just how much we engage in it and don't really think about what we're doing. Absolutely. I mean, that, it is so socialized and a part of culture and a part of celebrations and events that I think it just feels like a part of life. Are there negative impacts to having like a beer or a glass of wine every night? I mean how does that impact you?

Yeah so this is probably the most fascinating area of research where things have changed and gone back and forth over many decades of science. And it's actually a somewhat tricky question to answer, which is why I think there have been very confusing sometimes and conflicting studies about this. So if you want to try to understand what is the impact of low-risk drinking, moderate-risk drinking, higher-risk drinking, you have to figure out how do you study that. So you need to follow population over time to see what happens and then you need to figure out how do we isolate the effect of alcohol. And so early on there are lots of studies showing that low-risk drinking or moderate-risk drinking were actually healthy. I think I remember something about like a glass of

red wine is really good for you, the antioxidants. I don't know if that's the red wine lobby telling us that. One criticism of those studies showing that low-risk drinking is healthy is that the group that is often used as sort of the telling us that. One criticism of those studies showing that low risk drinking is healthy is that the group that is often used as sort of the comparison group are people that don't drink at all. But it turns out that many people who don't drink at all may not be drinking because they have chronic health problems

or because they actually used to have an alcohol use disorder and they're now in remission or recovery. And they may have health consequences that are leading to higher mortality compared to people who are drinking at a low risk or infrequent level. So a lot of the newer studies have actually used infrequent drinkers as the sort of control group or the comparison group. And I think that's really helpful to understand the data that way. There was a really big study actually this year that looked at hundreds of thousands of people that had

been surveyed since the 1990s all the way through the mid-2000 and teens and did a really elegant job of trying to answer this question. And the things they did differently than other studies is first they controlled for other healthy behaviors, lifestyle behaviors, chronic conditions. Because one question is a person who's drinking a glass of wine a day, maybe they're also running every day and doing other sort of health promoting behaviors. And maybe that person who's chosen not to drink at all has lung cancer, and that's the reason they're not drinking.

And so they're actually controlled for all of that. And they did see that in the low risk category, there seemed to be a slight decrease in mortality. And it was not true for cancer. So any amount of alcohol is associated with an increased cancer risk. And that's a really important thing to know, especially if someone has a personal family

history of cancer. Breast cancer is one that's strongly associated with alcohol use. And so factoring that in as you're making your decisions about alcohol is really important. What is it about the molecule of alcohol that increases your risk for cancer? You know, it's different for every type of cancer, and I think we're just starting to

understand this. If you take breast cancer, there are things that seem to increase hormone levels are often associated with a risk of cancer. So I think that's an area of active research to understand why alcohol and breast cancer in particular are so closely linked. Other types of cancer, it's a little more clear. They tend to be cancers of the liver or the gut that are strongly associated with alcohol.

And that makes sense if you think of alcohol as a potential poison going into your gut, being metabolized by your liver, causing changes there. That's an area that we do see a lot of cancer risk. Can you talk about what you're seeing as it relates to alcohol and liver failure or just how it's impacting people's livers? Yeah, so one of the main health harms from alcohol, especially heavy alcohol use, is liver damage. And so what we see happen is this progression where the first

thing that happens is inflammation of the liver. And when your liver gets inflamed, you start getting fat deposit in the liver. So the first kind of step is what we sometimes call fatty liver. So it's fat deposition in your liver. And that actually can totally reverse if you stop drinking or you make changes. And that's the amazing thing with the liver. It's a really regenerative organ. So you could cut 80% of someone's liver out and they would be okay. But there is a point where you cross the threshold where you can no longer repair the damage. And that's when you get to a stage called cirrhosis. So from fat deposition, then you start getting scarring.

Your body lays down all the scar tissue because of the chronic inflammation in your liver. And when your liver becomes so scarred that it's really stiff and starts not functioning well, that's cirrhosis. And we often used to think of cirrhosis as something that happened to people decades down the road. I'm seeing people in their early 30s

with cirrhosis in the hospital. And I think those are some of the most heartbreaking cases, because people thought this wasn't on their bingo card. They did not even think this was a concern. They were drinking heavily. They thought their social circle was doing the same thing. And then all of a sudden, in their late 20s or late 30s in the hospital, liver failure.

And there's very little we can do at that point other than an organ transplant, which is a huge deal and not something that's accessible to everyone. Is this something that you're seeing happening increase at a younger and younger age? Yeah, and there's actually a lot of studies showing this. So between 2010 and 2020, there's been a significant increase in alcohol-related liver failure,

especially amongst women and younger and younger people. And even just after the onset of COVID, we saw somewhere around a 25% increase in alcohol-related death after the onset of the pandemic. So the pandemic was hard for many reasons, but it certainly increased alcohol use across the country and with that liver disease and liver failure. Wow.

How does alcohol impact the kidneys? So alcohol, one of the main effects that people have probably experienced is it makes your kidneys less sensitive to a hormone your body produces called ADH or antidiuretic hormone, and so you pee more. So if anyone's ever noticed that when they drank, they sort of pee a lot more. And it's not because you're hydrated,

because that's what I thought is why you pee more, is because, oh, I just have more liquid in me, but it's actually because it's blocking a hormone. Exactly, so even irrespective of how much volume you've drank, you pee more because of this blocking of the effect of a normal hormone function in your kidney. And so that can lead to dehydration, which is one of the many reasons you feel really

crummy the next day, because you get dehydrated from drinking. What about the gut microbiome? We're learning so much about the importance of healthy gut. How does alcohol impact that? Yeah, so alcohol, I think there's growing research on how it impacts the microbiome. Certainly, again, at heavy levels, it seems to harm the microbiome. And we see this in patients with liver disease, but also just the impact of alcohol itself. The kind of two main things it does, one is it creates more leakage in your gut.

So people may have heard of kind of leaky gut. You know, the walls of your intestine become more porous so that things that aren't meant to come out of your intestine do and can actually cross the blood-brain barrier. So this whole idea of kind of the brain-gut axis is a really growing area of research and knowledge. So alcohol can do that.

It can also change the makeup of your microbiome itself, as can high fat, high sugar, white flour, sort of the Western diet. But there's now a lot of studies showing that some of the modifiable things, if you want to improve your gut health, are decreasing alcohol consumption and steering away from that kind of Western diet of high fat, high sugar, high carb. You know, I'm sitting here listening to you, and I'm thinking, why the hell do I even drink this stuff? Yeah, I think it is important to understand what are the risks that we often don't talk about and assume that this is a harmless thing that's

just a part of life. My personal perspective is that every health behavior exists on a spectrum. And it's really important to understand what is that spectrum, where do I fall and then what are my personal health goals and actually stopping to sort of think how does alcohol fit in my life? Like what do I like about it?

What do I not like about it? What am I worried about it? What is this amount of alcohol doing to my health? Is there any health benefit to drinking alcohol? My opinion is that we shouldn't be thinking of it as a health benefit. So I would never, as a doctor, say to a patient, I think you should start drinking a glass of wine a day for your health.

We used to, people used to say that. Again, this idea of a glass of red wine is healthy. I think that framing is wrong. I think that doesn't mean that you can't drink any alcohol, and we should talk through that. But thinking of it as a health promoting behavior is probably not the best way to frame it. Now there are many things we do in life that the safest thing would be to do none of it. So if your goal is to have zero risk, you

should probably never drive your car, never go skiing, you know, never fly in an airplane, never eat bacon, never go out in the sun. And people aren't going to live that way. So I think it's really important to understand sort of what are the risks? How does this fit into my overall life, and when should I be concerned, and how can I actually make changes to decrease those risks. So if you're finding that you are really stressed in your life and you're reaching alcohol as a stress reliever,

it's probably not going to be a healthy way of coping with that and may lead to longer term problems. And especially if you're trying to live a life where you're being more mindful or more present or present for your kids or your partner or you're trying to get a life where you're being more mindful or more present or present for your kids or your partner, or you're trying to get in shape and you want to wake up in the morning to exercise. If you're drinking every night, you're probably going to feel not refreshed in the morning. You're going to notice it.

You don't have the same exercise capacity. So I think just figuring out sort of how this ritual, alcohol, what role it plays in your life. And it doesn't have to be that you stop drinking entirely. And I think that's a really important message because that may not be the goal for people. But if you are feeling like maybe this is causing some problems to me, maybe this is actually

counterproductive to my other health goals, making some changes, cutting back, taking a break, those are all really healthy ways that you can start to really explore your relationship with alcohol. Yeah, you know, I love the fact that you are a specialist in addiction and you have a very realistic approach, because I do agree with you that it does feel like it's either you're all in or you're all out.

And I think for a lot of people, it is scary to feel like there's only one option, which is you either drink or you don't. And for many people, not drinking at all is the absolute empowering option. But I love what you're saying, which is you need to wake up and understand what your motivators are and what you actually care about in this moment in your life. And if you care about producing more at work or being more present or reaching your potential, you gotta look at the role that alcohol

is playing in your life. So from a medical perspective, how much drinking is too much drinking? Yeah, so from a research standpoint, high risk drinking would be if you're having more than 10 ounces of hard alcohol a week or 35 ounces of wine in a week for a woman or for anyone over 65. So above that, we start seeing health risks like increased risk of dementia, impact on your liver, your digestive tract, and other serious conditions.

You know, I'm just sitting here thinking about you as a physician and a researcher and how I think a lot of us lie to our doctors about how much we're actually drinking and that we're not even aware of what the serving size truly is because when a lot of people make a cocktail at home, it's like glug, glug, glug, glug, glug and there's three shots right there. Or you've had a number of big glasses of wine, which basically mean you have had all seven glasses of wine in one night and thinking, oh, oh, mean you have had all seven glasses of wine in one night.

Yeah. And thinking, oh, I've just had a couple glasses. But I bet as you are seeing somebody get a scan, there's probably times where you're like, yeah, that's somebody that is a very heavy drinker because I can see it on the brain. Yeah. And I think there's so many important points buried in that. So first, we all lie.

I tell my dentist I floss every day. I don't. We want people to like us and approve of us. So I sort of expect people will lie to me, especially if they don't know me. And for most people, because of the tremendous stigma around substance use disorder, there's a lot of shame and worry. For many people, their experience has not been that good things happen to them when they share that they're having a problem with alcohol or other drugs. And so as a doctor, I feel like it's on me to earn someone's trust and also to educate them. I mean, there's nothing more heartbreaking to me than when I see someone, you know, in the terminal stages of liver failure, for example, from alcohol, and no

one has told them beforehand, like what the risks are that this is going that this could happen, what sort of lower risk drinking looks like. They've often never had that conversation. So we'll see people in their 30s come in. They literally die during that hospital admission. And you look back, and they had touch points with doctors. They maybe were drinking heavily, and no one stopped to sort of talk to them about it. And I think that is a real testament to how,

in the medical system, for so long, we have seen substance use and addiction as something separate from the rest of health care as sort of not our job or a behavioral issue or a moral issue or a willpower issue. But this is a health condition like any other. And I think the medical system and doctors need to get comfortable talking to patients about it, asking them the right questions, giving them

the right education, and partnering with people around making healthy changes. When you sit with somebody that comes into your practice, how do you help them figure out their relationship with alcohol? What are a list of symptoms that you would say, these are all indications that this could be a problem? Yeah, that's a great question. So I'll run through kind of the checklist that I'm thinking when I'm talking

to someone about alcohol. So first, understanding how much they're drinking, just the general quantity and how frequently is important as sort of a proxy for what their risk might be. But then the really important questions are, are they drinking more than they want to? So they may have set an intention for themselves and they're finding they're actually always drinking more or spending more time on drinking or recovering from drinking than they want to? So they may have set an intention for themselves, and they're finding they're actually always drinking more

or spending more time on drinking or recovering from drinking than they intended. Have they tried to make changes and not been able to? So if you tried to cut back or tried to stop and you actually weren't able to, that's a really important sign that you may have lost control of your drinking. Are you drinking despite the fact

that people in your life are worried about it or your spouse is expressed concern or it's impacting your work, or your ability to function in roles that matter to you. Are you drinking despite the fact that it actually makes you more anxious, or it's worsening your mental or physical health in some way? And then we often think about craving,

which is sort of a strong psychological urge to want to drink. So you can't get the idea of having a drink out of your mind. That's something that we can see with alcohol use disorder. And then there are two physical symptoms, which is that idea of, do you need to drink more to get the same effects? Do you need to drink four drinks now,

whereas before one or two would give you that effect? And do you feel sick if you stop drinking? So that's sort of the checklist we run through and I think really gets at those kind of general areas of losing control, using compulsively, using despite consequences, and then craving. That was so helpful. And one of the things that really resonated with me

is that you've tried to quit, you drink more than you want, you feel anxious and yet you continue to do it and you're in this cycle of wishing you could get control over this and yet feeling like you can't. And yet if you aren't stumbling around at night or you feel like I am able to carry on a conversation, I'm not getting behind the wheel of a car,

there's this assumption that it is under control, but I love how you just defined it, because you're making us really look at ourselves and ask ourselves the honest question, which is it really? And even just that question, are you drinking more than you want to be drinking? If you answer that question honestly, and whether you're listening right now for yourself

or you're listening for somebody that you love that you're concerned about, this is an amazing starting point because we're not bickering about how much you're drinking. We're not bickering about your behavior. We're really talking about the honest answer to, what is your relationship to it? And do you actually have control over your ability

to use it or not use it? And that is powerful. Now, Dr. Wakeman, where I want to pivot to next is, I'm starting to see this picture, where as a researcher and a renowned expert on this topic, that you are talking about kind of the big risks that can happen. I wanna focus a little bit on amplifying

the day to day impact that most of us are not present to. Yeah. That we reach for the alcohol at night because at least in my own experience, it's like an easy lever to pull to say to my brain, we're no longer working. This is the thing that I do as my ritual to move into the evening, to have a glass of wine. But we don't really understand what's happening and how it's actually impacting your experience of your life day to day. I want to take a quick pause so we can hear a word from our sponsors.

And I also wanna remind you that if you're worried about somebody, send them this episode right now as you're listening to our sponsors. Because oftentimes they can't hear it from you. But hearing it from somebody like Dr. Wakeman who has such a balanced approach and is a renowned expert on this topic, it might actually just be the thing that gets somebody to wake up and want to do better.

So I'll be waiting for you after a short word from our sponsors. Thank you for sharing this with anybody who needs to hear it and I'll see you right after at the break. Welcome back. I'm Mel Robbins and I'm so glad you're here. Thank you, thank you for sharing this episode with absolutely anybody in your life that you believe needs to hear this. You and I are spending time today with Harvard's Dr. Sarah Wakeman. So Dr. Wakeman, can you explain to us what are some of the other day-to-day things that people experience when they drink that they might not realize is

related to drinking? Yeah, it's a great question. So one really common thing is worsened acid reflux. So if you have heartburn, that's strongly associated with alcohol, which actually relaxes the part of your esophagus that allows acid to come back up. So oftentimes people are struggling with terrible heartburn and they don't realize that those two glasses of wine are probably having a direct impact on that. Other things, we know that alcohol can make you dehydrated. So you may notice that your skin changes.

It impacts how you sleep. So you may feel less rested when you wake up in the morning or wake up in the middle of the night and not be able to fall back asleep. So lots of little sort of day-to-day ways that alcohol may be impacting your health and your experience. What are some of the benefits that you would experience almost immediately if you quit drinking entirely or you cut way back? What kind of health benefit would you experience in your day-to-day life? Yeah, you'll see a lot of really quick things.

So when you'll sleep better and feel more restored, you may lose weight. There's a lot of calories in alcohol. So if your goal is to lose weight, you're drinking a ton of liquid calories. So you may find that that's better. You may find that your exercise capacity goes up because you're resting more and you're not having hangovers and you're able to exercise in a way that feels different. You may find that you're less irritable and more present

for your loved ones, that your mood is actually better over time. Your skin might look better. You're less dehydrated, your hormones are more regulated so you may have less acne. So all of those benefits you can often see in a very short time and that can be reinforcing as you decide what you want your long-term goals to look like to really see what life is like with less or without alcohol. How does alcohol impact the range of women's hormones from estrogen to progesterone to like all of it? How does alcohol impact the range of women's hormones,

from estrogen to progesterone to all of it? How does it impact your hormones? Yeah, this is, I think, an area of growing research and understanding. And I think people are really interested in sort of drinking during menopause as well, and what to think about all of that. A couple things.

I think many of the symptoms that people experience during menopause, like hot flashes, will be made worse by any amount of alcohol. Really? Yes, because alcohol dilates your blood vessels. So you may have experienced if you drink a couple glasses of wine, you actually feel flushed and feel warm. Well, it's just going to amplify the experience you're

having during hot flashes. So if you're trying to not have hot flashes, drinking is going to be your enemy in that, because it's just going to make that worse. Same things like sleep disturbance are really common in menopause. Mood changes, and alcohol may impact all of those. And it can be a tough cycle, because you may be drinking,

because your mood is actually low, and you're having a hard time falling asleep. But then alcohol is actually running counterproductive and making those symptoms worse over the long haul. Let's talk a little bit about sleep, because doesn't alcohol impact your sleep in a very negative way? Yeah.

And people may be surprised to hear that because it makes you fall asleep quicker. So often people are like, oh, alcohol helps me sleep because I fall asleep so quickly. But when we think about sleep architecture, there's different cycles to sleep. People are probably familiar with REM sleep is that deep rapid eye movement sleep. But there's different cycles that your brain naturally cycles through in the night. And the balance of those cycles is really important to get restorative sleep, which

is when your body rests and heals. And what alcohol does is it changes the makeup of those cycles. You go more quickly into deep sleep, and you have less time in the normal phases of sleep. And so your sleep architecture is disrupted, and you don't get that same restful sleep. So you may wake up at 2 in the morning, you know, after you've fallen asleep really

quickly, but then you wake up and can't fall back asleep. Or you may wake up in the morning and just feel not refreshed, even though you were completely, you know, asleep very deeply because your brain is not having the time to restore itself the way that it needs to. I have another question for you, Dr. Wigman. Can you walk us through what's happening in your body in terms of what we call a hangover? So you've had your night out, you've had a bit of alcohol, right? And you wake up, what is a hangover and what is actually happening in the body as you withdraw from the alcohol?

Yeah, hangover is fascinating and there I think people are still trying to understand exactly what is going on. Loosely defined, what we refer to as hangover often is a constellation of symptoms that include headache, feeling anxious, often actually having diminished exercise tolerance. So you don't have the same aerobic capacity that you did before, feeling irritable.

Those are all symptoms of symptoms of hangover that people have probably experienced. There is an older school of thought that actually it was mild alcohol withdrawal. So withdrawal is when you are drinking so much that when you stop drinking, you actually get symptoms. Seems like that is likely not the case. The constellation of symptoms is quite different.

And so the thinking is that it's a combination of really two things. One is dehydration. So we already talked about how alcohol make you pee more, and so you get dehydrated. And then the other is actually byproducts from the drink that you're drinking itself, either the breakdown products of alcohol, or there are certain types of liquors and drinks

that have other types of molecules, coginers, that can build up and make you feel even crumbier. So for example, clear alcohol tends to cause less of a hangover than dark alcohol. And that's probably because of the other substances that are in it. But it's really sort of toxic byproducts and dehydration, if I were to sum it up, of what's causing a hangover.

Why is anxiety one of the biggest kind of symptoms of a hangover and alcohol withdrawal? Yeah, it's probably the effect of these byproducts that then, you know, are still impacting the way your body functions, your brain, and it takes a long time for your body to excrete them. And so we can see just feeling that really anxious, restless, kind of gross feeling afterwards. Does alcohol impact cortisol or any of the other kind of hormones that are in your brain that are playing a part in anxiety? Yeah, it does, especially over time.

And so what we see when people have been drinking over a long time is actually your body starts to adjust because our bodies are very adaptable. So if your body is used to having three or four drinks every night, your body is going to start to accommodate to that. And so what we see is actually changes in the brain. So you see changes in the amount of receptors you have, the amount of hormones you have, your dopamine levels, your stress hormone levels. So your brain is actually adapting to the effects of alcohol.

So one thing you may see is that you actually don't get the same effect. So it used to be that two glasses of wine made you feel a certain way, and now you need three or four to feel the same way. That's a concept called tolerance, that your body is adapting to having that alcohol around all the time and your brain's actually changing. The reverse of that is if all of a sudden you stop drinking, you're gonna feel all out of sorts.

You're gonna feel shaky, you may have a headache, you may feel anxious, you may feel nauseous, and that's because your body's gotten so adapted to always having alcohol on board that it takes time actually for those changes to reset. Wow. When you really stop and think about the roller coaster, you're putting your brain and your hormones and your body through, like it does make you pause. And that's kind of that's what I wanted to do with this conversation is to make you stop and think about what's actually happening and the reasons why you reach for it. Can you talk a little bit about, for anybody that's taking prescription drugs for anxiety

or depression, the impact that alcohol can have? Yeah, there's a couple really important things to know. First, alcohol itself can cause depression and anxiety. So if you are, even though you feel like in the moment it's helping relieve symptoms, there's actually something called a substance-induced mood disorder, where you can look all the world like you have depression.

And it's actually caused by using alcohol heavily over time. So if you're drinking heavily, you may actually be working again at cross purposes with your efforts to try to manage your depression or anxiety. The other thing is there are some types of medications that are really dangerous when they mix with alcohol.

And anxiety medications in particular, especially any medication that also has a slowing down effect. So some people take medicines in a class called benzodiazepines, so things like Xanax or Klonopin or Ativan. Those when mixed with alcohol have sort of a combination effect that can actually slow down your breathing, could cause an overdose, could make you very sick, could make you more sort of impaired sooner. So really important to not

mix those medications with alcohol. How does alcohol compromise your memory? So alcohol affects all parts of the brain, including the amygdala, which is an area that lays down memory. And it, you know, has complicated actions in the brain. So it increases sort of more slowing down hormones. So we think of it as a depressant, because it sort of slows you down and relaxes you. And it decreases more excited or excitatory neurotransmitters. In the short term, because your consciousness is being affected, you won't be making new memories. Over the long term, heavy alcohol use can actually cause dementia.

It can cause severe memory problems. There's actually a unique condition that we only see with alcohol generally, where the part of your brain that lays down new memories gets damaged, and people get basically an amnesia syndrome, where they can't make new memories. So they can only remember things from the past, but they're unable to make any new memories. And that's a very extreme example,

but we see it in the hospital, and it's really scary when it happens. What do you see when you look at a brain where somebody's been a heavy drinker versus somebody that's occasional or very light? We actually see brain damage on people who've had chronic heavy alcohol use over many years. So if you take a picture of the brain, like with a CAT scan

or with an MRI, what we describe it as is volume loss. So normally, you want to see a big, healthy, robust brain. And as you age and with types of dementia, one thing that we see is the brain starts to shrink. So the actual functional parts of the brain are smaller. We see that process accelerated with heavy alcohol use. So often, take someone who's in their 50s, who really shouldn't have volume loss of their brain at that age.

But if they've been using alcohol at a very heavy amount for a long time, we'll often see their brain looks like a much older brain because of that shrinking. And then there are very extreme examples, like this rare memory condition, where we literally see that part of the brain almost die. Like you can see it light up

that it's been severely impacted. That's scary. It is really scary. We have so many listeners around the world who flooded us with questions when we told them that you were going to be here. And a lot of them are about how to deal with somebody that they love and they're drinking. And so I really want to hear your advice about what

specific things you should do and what mistakes we need to avoid when there's somebody in our lives that we're concerned about. Like, how do you approach this? What's the best way to bring it up? What is the worst? And by the way, I wanna remind you that if you're thinking about somebody in your life, while the sponsors are talking to you, please share this episode.

Let Dr. Wakeman talk to your loved one. It could be a life-changing gift for them to hear this. So thank you in advance for being generous with sharing this with people that you love. And I'll be waiting for you with Dr. Wakeman after a short break. Welcome back. I'm El Robbins, and you and I are here today with Harvard's Dr. Sarah Wakeman. Dr. Wakeman, I'd love to get your counsel on what you would recommend to somebody if your spouse doesn't think they have a drinking problem, but it's a problem for you. Yeah, I think these are such important questions.

And one of the greatest tragedies to me around substance use disorder is often family members and the general public have been fed the wrong thing to do. And so I think it's a great thing to talk about. First, it's important to define sort of what is an alcohol use disorder, because that's sort of what we're getting at. You know, there's heavy drinking where we're worried about the long-term health effects. And then there is where alcohol has become a problem in your life. And really, the definition of an alcohol use disorder is losing control over your drinking, compulsive use of alcohol, and using despite consequences. So, if you are continuing to drink despite the fact that your partner has shared that

they're really worried about you, or you've started to have problems at work because you're calling out sick, or you're continuing to drink despite health problems related to it. So, your doctor says, you know what? Your liver tests are elevated. You really need to cut back on drinking and you continue to drink. Those are all signs that alcohol has started to play a different role in your life. And about 15% of the population will have an alcohol use disorder in their life.

So this is a very common health condition, more common than many other conditions we see. The great news is that it's entirely treatable. Most people will get well. I think we often have in our minds that this is like a terrible, stigmatizing, recalcitrant condition that no one ever gets better from. That is not true. And that notion that this, you know, something to feel hopeless about,

I think drives a lot of the stigma and shame. There is good treatment out there. People will get well, but they do need care and they need support. So I think the first thing you can do if you're a loved one is just share your worries, not in a way that blames the person, not in a way that's judgmental, but in a loving way, just like you would about anything else with someone's health, that this is what you've observed, this is why you're worried, explore what the person thinks. And that becomes really important because when it comes to addiction, it really doesn't matter at all why I think someone should make changes to their alcohol use.

The only thing that matters is they think their life will get better in some way. And so really starting to sort of untangle what are this person's goals and how is alcohol getting the way of them reaching it, that becomes the work and a partner can be a wonderful mirror for that. You know, I know you're working towards a promotion at work and you mentioned that you had to call it sick twice this week and your boss is frustrated at you. What do you think about that? So really exploring it and ultimately, you're sort of empowering the person to feel like they can make a change and that you're supporting them, but you're not forcing it on them, which is often what people feel caught up in having to do. What is the mistake that you see people making? I think people have heard these notions of tough love, enabling, hitting bottom. Those are probably the biggest fallacies.

So for people who aren't familiar with those concepts, the idea that tough love is that you really should make things hard on a person, that if consequences pile up, the person will ultimately get better, enabling the idea that you're kind or caring to someone that you're actually hurting them in some way and hitting bottom is this idea that people have to just fall so far and suffer some terrible consequence before they make a change. Those are all really problematic concepts for a couple reasons. So first of all, the definition of alcohol use disorder is not being able to stop despite bad things happening

to you. And many people are drinking because it's a powerful coping mechanism. And some of the things that put you at risk for an alcohol use disorder, traumatic life experiences, untreated anxiety and depression, not feeling good about yourself. So having the only people that you sort of love and trust

in your life try to cut you down to size and tell you that you're doing something terrible and set some ultimatum is actually not going to help you get well. None of us make hard changes when we feel threatened or punished or not supported. We do it when we feel loved and safe and have hope that our life could be better.

And so as a loved one, that's probably the greatest gift you can give to the person. Now, it's complicated because you're impacted by their behavior. So it's very easy as a provider. One of the things I love about doing this work, because I've been on the other side and had family members, and it's a different experience, as a doctor,

like whether or not my patient continues to drink doesn't impact me personally. I can just be their partner, their champion, work with them. For families, there are times where the behavior becomes so unsafe that people have to keep themselves safe and set boundaries, and that's okay. I think the distinction there is that it's not doing it for the person's benefit. So if you kick someone out of your house, it's not going to necessarily help them get

better, but there may come a time and a place where people need to do that for their own emotional safety or well-being. But for that human being, to help someone get well, and a place where people need to do that for their own emotional safety or wellbeing. But for that human being to help someone get well, and this is where earlier conversations are so important, is to really sort of love and support them and work together on it and make sure they find access to good treatment, which is out there and available.

I wanna kind of just hover on this point that if somebody's reaching for alcohol and it's become a coping mechanism for dealing with stress or dealing with a health issue or mental health issue or whatever, insecurity, it's terrifying to give up the coping mechanism. And what do you see when it comes to that psychology of you're somebody whose family is like, you have a problem and we're worried about you, and yet it keeps on going.

Like how does shame or that fear that you have of, well, I can't actually get through if I don't have the alcohol or I, it's just easier. And what's the problem with having a glass of wine or two a night? Yeah, so many important pieces in there. I think there's so much stigma in our society about alcohol use disorder and substance use disorder and people rightfully so feel really ashamed and secretive and sometimes long after they've started to worry about themselves they're scared to tell anyone else because they think someone will judge them or treat them poorly.

And that stigma and fear of bad treatment or judgment actually keeps people from seeking help for a long time. I think the other really important piece is that when you're removing something that has played a powerful role in someone's life, you need to fill up those spaces with other things. I think our sort of Puritan roots as a society is we have this idea that like you're doing something bad, you need to just pull yourselves up by your bootstraps and knock it off and white knuckle it and in fact like it should be hard. You know that's often our sort of these ideas of tough love and hitting bottom is like well you're like you've done something

bad and you you know you don't have willpower so we're going to make it tough on you. When in fact like the broader concept is why would someone make changes and, so we're going to make it tough on you. When in fact, the broader concept is, why would someone make changes, and how is their life going to get better, and how do we make it easy to make a change? And so if you think about any change you made in your life, if you set yourself up for success, you're going to be far more likely to be

able to make that change. So if you're suffering from trauma, depression, anxiety, you're not going to be able to just stop drinking without help. You need help treating the anxiety, depression, trauma, and also treatment for the alcohol use disorder. That's not because you're weak. That's not a failing. And if you're not able to sort of meet

your goals with whatever intervention and support you're getting, that's a sign that that support is not enough for you. So really shifting from this idea that the person is failing to thinking like the system, the treatment, the resources are failing, and how do we adjust that instead of blaming the human being who's suffering? I just want to thank you.

I think it's very refreshing because so much that you listen to on this topic is don't drink. And I kind of expected Dr. Wakeman, you to come in here and just take your fist and slam it on the counter and talk about the lives ruined from alcohol. And, you know, you might have that experience in your family as you're listening to us, but what she's saying is you have to understand how somebody is feeling and what's actually going to work to get them to want to see that something else is possible for them. So Dr. Wakeman, I have another question for you.

A lot of parents writing in about college-age kids and binge drinking and 20-somethings that are also drinking too much. Do you have any scripts or lead-in sentences to even broach this topic? Because I feel like most of us don't know how to even bring it up. Yeah, I think ideally it starts young.

Ideally you're having these conversations very early on with kids in a pragmatic, not in a scare tactic way. So we know that things like dare, you know this like I'm going to scare you into this is what alcohol and drugs do to your brain. Actually, kids use more drugs after seeing that sort of stuff. It's not helpful.

Kids see right through adults when they're sort of all or nothing about things. So having these nuanced conversations of like you're going to be around friends who are drinking really heavy, what do you think about that? What's been your experience? What are some of the worries you might have about that? And talking about the very practical risks that are not necessarily like liver failure addiction, which are not going to be resonant for a 19 year old, but you know, have getting into a situation that doesn't feel safe, getting into a sexually vulnerable position with someone, doing something that you don't want to do,

missing class the next day. So talking about relevant, personalized issues that may come up for that kid. And then importantly, making the person that your child feels safe talking to you. You want them to feel comfortable coming to you about small things so that they'll come to you about big things.

And so you can share all of this in a way that doesn't feel judgmental, doesn't feel accusatory, really opens the door to ongoing conversations instead of making someone feel sort of, you know, like they're being blamed or judged by their parent. So for somebody that's never even broached this and alcohol is in the family, like this is a thing that's really triggering for all of us. Is there a way to break down the conversation just so that the person listening can take from us or take from this conversation?

All right, I'm going to express my feelings, then I'm going to ask them about theirs. Because most people get really defensive when you talk about this, and then that just shuts down the conversation. Totally. Well, first of all, it is not too late. You have not failed. None of us are perfect in this. These are hard conversations, and we haven't learned how to do it.

So it is never too late. It doesn't matter how many times you've ignored it or had an unproductive conversation. I think in that moment, probably the most important things you can communicate are, I love you. I'm worried about you, I'm here for you, I know that treatment works, this is how I can support you.

So like many things, you're sort of talking about yourself, you're talking about your care and concern, you're rooting everything in how much you love this person, and you're offering to be a partner in helping them find support and treatment. And it may not happen that day, it usually doesn't. So often the journey to recovery is the circuitous journey of 1,000 small steps.

It's very rarely that dramatic leap we see on TV. And so to not give up hope and to know that those small moments of kindness and support actually are progress and are part of the person's journey to ultimately getting well. If you're the one that really just wants to cut back. So if you're listening and you want to cut back on alcohol use, I think first figure out your why. How do you help them figure out their why as it relates to their relationship with alcohol?

Yeah, I think understanding first how alcohol fits in your life. And so people can do this at home by just keeping a drinking diary. So even just jotting down on your phone or in a notebook when you want to have a drink, sort of what activities you associate with drinking What you know when you do have a drink how many drinks you have over what time periods? It's sort of like keeping a food journal where it actually just makes you more mindful like oh I'm like triggered to want to snack on this thing because I'm feeling really upset about this fight I just had you can identify that with alcohol too. Like you mentioned this earlier I'm really stressed out at the end of the day, and so I come home and want

to reach for a glass of wine. Understanding how alcohol fits in your life is an important first step. And then figuring out what are the goals you're working on right now, and that could change over time. But again, if your goal is something related to fitness or wellness or health, you may find after learning more about alcohol and the role

it plays in your life that actually you want to change how much you're drinking. And so then you have your why. My why is I'm training for a marathon, and I've found that when I drink, I have a hard time waking up and going for my long runs. And so I'm only going to drink on this day, and I'm going to keep it to this amount.

So it's very specific. And that's important for behavior change. If you make this broad sort of general goal of, I'm never going to drink again because alcohol's bad, you're probably not going to do it, because that that's hard and it doesn't really relate to you as a human. So as much as you can make it specific, measurable, time-bound, so it's like the next three weeks I'm going to try this and then I'm going to reassess, that makes it much easier to actually

make change and stick to it over time. Well, it's great advice because I feel like so many of us have had that experience where you go to a big wedding and you're like, that's it, I'm never drinking again. I can't do this to myself. And three days later, you're going out for somebody's engagement and now you're like, ah, I should just have glass of wine. And you're back in it. And so I think getting very clear about what are your goals.

And I'm willing to bet if you write down your goals, that you're going to see that alcohol is not helping any of them. Exactly. And there's lots of tips out there, but you want to make it as easy as possible for yourself. So if your goal is to cut back on drinking, you don't want to have a week where you're packed with going out to happy hour with people. You want to really set yourself up for success. So organize your social activities around non-drinking activities. Come up with a plan if you're going to be in a situation where you would normally drink, that you're going to have a glass of club soda in your hand the minute you walk in the door.

You're going to have a friend who knows that you're working on this who's going to be your partner. Setting those intentions and those ideas and tools and tricks ahead of time will make it way easier for you to ultimately reach that goal of cutting back. If you quit drinking and you don't feel supported by your family or your partner or friends,

what advice do you have for people to navigate that? Great question. I think first, letting people know about your intentions. So sharing what your goal is is really important, because people can't support you if they don't know. And if you've always drank a certain way with your partner or friends and all of a sudden you're not, they're not going to be like, what's going on?

Whereas if you say to them, hey guys, I know you love me and support Eat Me. I want to share with you that my new goal is to not drink more than one drink a day or only drink on Friday and no more than two drinks or not drink at all. And this is my why. I'm doing this because I'm worried about myself or I'm doing this because it feels counterproductive

to my health and I really want your support and this is how you can support me. So then you're really framing it as they get to be a partner with you. You're not criticizing their drinking because often people feel then like, oh, I'm a little self-conscious. This person's going to be judging me or they think I'm bad. You're just asking for their help. And so maybe that looks like instead of meeting for drinks, you meet to go to yoga class or

you meet to go for a run or, you know, you let the person know why you're going to be ordering a soda water instead of a drink. And so you can be really concrete both for yourself and what those tools look like, but also for the people in your life to signal to them how they can help support you. And sometimes people can't do that. And that happens whenever we make any big change. People may have experienced that if they decided to have a weight loss journey or change their life in some way, that there are people that really fit in our lives for certain points and that can't journey with you

through that transformation, and that's sad. But if you find that despite those conversations, someone is actually destructive to the change that you wanna make and not supportive, then that may be a broader question about sort of the role of that relationship in your life. I thought I knew a lot about this topic, and it just goes to show you

there is always something new you can learn. So I have another question, Dr. Wegman. What is your message to someone who is struggling with their relationship to alcohol? Yeah, I think I'd like to just talk for a moment about alcohol use disorder. I think we've been covering sort of the health harms of alcohol use either at a low risk level or a moderate level or high level. For anyone who is struggling with alcohol use disorder. I think we've been covering sort of the health harms of alcohol use, either at a low risk level, or moderate level,

or high level. For anyone who is struggling with alcohol use disorder or is worried they may be struggling with alcohol use disorder, treatment works. You will get well. Finding sort of a trusted health care provider that you can partner with is a part of that journey. But to really have hope, this is not a hopeless condition.

It will not be with you forever. You will be in a place where you're free from this. And there are treatments that are out there and just getting those, much like you would for depression or diabetes or high blood pressure, is the most important thing. And this is not an issue of shame or willpower or being bad. And I hope that people will feel like they can come in and get the help that they need. And for the person who had this conversation shared with them from a family member who's probably concerned about their drinking, what is your message to that person? It can be really hard to hear this, especially in a

society that still stigmatizes alcohol use and alcohol use disorder. I think take this as a message of love. Someone loves you, they care about you, they're sharing their worries, and they're there to support you. And they want to be a part of this journey to help you live the best life you can possibly live in whatever way that means. And hopefully it will be a moment to pause and think and get the support you need to make some changes. Well, Dr. Sarah Wakeman, thank you so much for being here with us today. Thank you for the work that you're doing. You really are changing and saving people's lives,

and we appreciate the time and how much wisdom you poured into us. Thank you, Mel, for having me. This is a true pleasure, and hopefully these words will reach people who are working to better their lives or worried about someone they love. And I want to also just make sure that you're listening, that in case nobody else tells you that I tell you that I love you and I believe in you, I'll talk to you in a few days.

Yeah, okay, great. Here we go. All right, Coach is Tracy. Great. That's perfect. Thank you. That's okay. Hydraterate baby.

Like it's true but it makes you think doesn't it? As a oh I'm like I do not remember what the hell is going on today. What is happening? I don't know what's going on over here. In the garbage. Goodbye. Look how emotionally agile I am. What I want you to really he. Okay, hold on. What was I going? Where was I going with that? Dr. Wakeman, can you tell me about the race?

Lord, I didn't. So in. Okay. Is that okay? Okay. Holy cow. Awesome. Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you.

This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.

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