The Peter Attia Drive - Qualy #1 - What are Peter's thoughts on alcohol consumption and health?

Episode Date: August 6, 2019

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD   

Welcome to the Qualies, a subscriber exclusive podcast. Qualies is just a shorthand slang for a qualification round, which is something you do prior to the race, just a little bit quicker. Qualies podcast features episodes that are short, and we're hoping for less than 10 minutes each, which highlight the best questions, topics, tactics, etc. discussed on previous episodes of the drive. We recognize many of you as new listeners to the podcast may not have the time to go back and listen to every episode, and those of you who have already listened may have forgotten. So the new episodes of the quality is going to be released Tuesday through Friday,

and they're going to be published exclusively on our private subscriber-only podcast feed. Now occasionally we're going to release quality episodes in the main feed which is what you're about to hear now. If you enjoy these episodes and if you're interested in hearing more as well as receiving all of the other subscriber exclusive content which is growing by the month you can visit us at peteratiamd.com forward slash subscribe. So without further delay I hope you enjoy today's quality. So without further delay, I hope you enjoy today's quality. Alcohol, thoughts on consumption of alcohol. It's just a little generic. Okay.

So I put this into a couple of categories. The first is just a purely physiologic, what is the effect of the molecule ethanol on the body? And just as I sort of talk about sugar or other things, it's really important to understand that ethanol is a toxin, but of course the dose makes the poison. Now, the thing that I think many people forget who are not in the world of toxicology is that

there is a probability distribution that drives the impact of a toxin on a population. And there are gonna be some people at one end of the spectrum who are largely unimpacted by certain toxins, and there are gonna be others who are not. And so ethanol is no exception to that, just as Tylenol or pick your favorite poison could be. So again, Tylenol meaning like,

even though at low doses, very efficacious as an analgesic, at high enough doses, it's hepatotoxic. So, start with position one. I'm not convinced that there is a single benefit to ethanol, the molecule, in the human body. So, ethanol in its metabolic pathway, in its uniquely metabolized by the liver, one of the byproducts is something called aldehyde, which is a toxin. It really has two, and this is a bit of an oversimplification, but it has two effects. So there's an effect on the liver, and then there's effect on the brain. The effect on the brain is what people drink alcohol for. It's the buzz.

It's the CNS depression that also comes with some euphoria. So it's a bit of a paradox there, because ethanol, it's effect in the CNS, is that of a GABA agonist and GABA, of course, being is a non-excitatory or depressing neurotransmitter. But I think as most people will understand, certainly ethanol can have an excitatory effect. So you've got this brain-effective alcohol, you've got this liver effect. The liver effect is very similar to that of sugar or fricose. They have very similar metabolic pathways,

not identical, but also not surprising that they overlap, given that friccos is fermented to make ethanol. So from that standpoint, no benefit to ethanol. But again, different people tolerate it through different amounts. As a general rule, each beverage, and I'm not talking the kind you pour yourself where they're a little longer, a little taller, but an ounce of distilled spirits is about 15 grams of ethanol. An appropriate, maybe four ounce glass of wine is also about 15 grams of ethanol, as is a beer, 10 ounces, 12 ounces, again, depending on the alcohol content. So as a general rule of thumb, each drink is about 15 grams of ethanol. One of the things, if a patient asks me this question that I'm thinking is, well, what's

your liver function right now? And the best proxy we have for that is the ALT, one of the transaminases. And, you know, so when I see a patient that's walking around with an ALT that's already at the upper limit of what we consider normal by range today, which I do not consider normal, which is probably 42 on our lab. I consider below 20 normal. I'm always asking the question,

do they have fatty liver right now? And if they do, is it more in response to ethanol or is it more in response to fructose? That said, I have at least two patients that I've taken care of, either in the past or currently, who consume seemingly unbelievable quantities of ethanol, some of them averaging between eight and twelve drinks a day. And by ultrasound, their livers are normal.

By LFTs, their livers are normal. Looking at coagg studies, every other marker you can look at, their liver function is perfect. And these guys are sort of the genetic outliers who have a remarkable tolerance to alcohol. So the point I'm trying to make here is I want to get a sense of how much harm is coming purely in a hepatic sense from alcohol and then make sure we're drawing a line well below that. But the second point is perhaps the bigger point, which is the why. The why are we drinking alcohol?

And I say this as a guy who likes alcohol just as much as the next person, but certainly in my life, I've started to ask, am I drinking just for the sake of drinking? Am I drinking because I'm trying to soothe some other issue? And does my drinking lead to a behavior that I'm otherwise not happy about? And in my case, personally, that generally tends to loosening the reins on what I eat.

And I don't think I'm unique in that. I've got many patients that, when confronted, will say the same thing, which is, yeah, ultimately, that's the problem with ethanol. You go out, you get a couple of drinks in you, and things that you otherwise wouldn't eat, you just start eating. So not that this is at all scientific, but my rule of thumb is the following. As a general rule, I don't wanna drink. If I'm going to drink, it's going to be good alcohol. I'm going to make it purpose-driven drinking.

So I don't drink on airplanes because the alcohol sucks. Like I'm not gonna, just because they're pouring me some half-ass glass of wine, I'm not gonna drink it. But if I wanna drink wine, I'm gonna drink wine that is exceptional. If I'm gonna going to just because they're pouring me some half-ass glass of wine, I'm not going to drink it. But if I want to drink wine, I'm going to drink wine that is exceptional. If I'm going to drink tequila, I'm going to drink tequila that is exceptional. But if I'm going to drink beer, it's going to be exceptional. And because somebody's going to ask, what are my favorites? My favorite wine is Cleo, which is a Spanish blend. And I've been drinking it since 2007. And I've had every bottle from 07 to 14, and I'm fully expecting that people listening to this

are not gonna go and start buying Cleo like crazy, because sometimes it's hard to find that I'm gonna be really pissed off if I can't get it. Tequila, I know everybody raves about 1942, and I think it's good, but the Class A azul repassato is absolutely my favorite. It must be consumed neat, no ice, no lime, no nothing. And my favorite beer, I'm not willing to say what it is

because it is so hard to find. And honestly, not to be a selfish prick, but I'm simply not willing to share it with anybody. One of the guys who works for me's part time job is sourcing it across the United States and Belgium. So I'm sorry guys, I'm not gonna let on with that. So that's my thoughts on alcohol. Okay, can I make a follow-up?

Please. Okay, so more or less you said there's nothing beneficial. I'm sure you're gonna get, but what about the French paradox? What about red wine? Isn't a glass of red wine maybe two for men? Maybe three? Maybe six? Depending on who you ask, isn't that associated with better health? red wine. Isn't a glass of red wine, maybe two for men, maybe three, maybe six, depending on who you ask, isn't that associated with better health or less cardiovascular disease

or more longevity? Yeah, I mean, I think the red wine thing came about through two things that you mentioned. One is the French paradox, which is, boy, the French seem to live a lot longer and they drink more or go, it's got to be that. Of course, I think that to get into that topic in detail would sort of take the rest of our AMA and it really has to do with just a poor understanding of epidemiology. So there are a lot of things that explain the French paradox. They also smoke more. I don't think that necessarily means smoking is better. So it probably has a little bit more to do with what they eat than what they drink or don't drink. The other thing that I think has a lot of people with this lingering idea that, you know,

a glass of red wine a day must be healthy. And I wanna be clear, I'm not saying a graph of a glass of red wine a day is harmful, but I'm saying it's not benefiting your health. Is the Rosvera-Trol story. So, Rosvera-Trol is a compound that is identified in very small quantities in red wine. And there was one lab in particular at Harvard

that many years ago, and I say many years ago, like probably 15 years ago, maybe 10 years ago, David Sinclair's lab had studied this in high concentrations, and they showed that it enhanced longevity. And that created like this huge wave of everybody wanting to take risk. Veritas supplements, there are two issues with this.

The first is, even if you believe those data, which I categorically do not, and no lab has ever been able to reproduce them, and I'm not even convinced that Sinclair today would believe that those were valid, you would not get that amount of risk-baratrol in a glass of red wine. It's sort of like the, should I be eating more dark chocolate to live longer? Maybe, but you're probably better off just taking cocoa flavonoids if you buy that that's the active ingredient that's going gonna enhance nitric oxide production.

The one thing I guess I'm glad you asked this follow-up question because I have some patients who will argue this and honestly, maybe they're right, which is there are some patients who say, look, just a single glass of wine a day helps me unwind a little bit and isn't there any benefit in that? And I guess the answer is possibly.

And so the question is, does the net benefit of that, which could be a lower amount of cortisol, a lower amount of emotional distress, could those things be beneficial relative to any of the potential drawbacks of ethanol, such as increased appetite dysregulation, or I'm not even getting into sort of pathologic behaviors. Maybe. One thing I have observed in the Aura ring has made it very easy for me to track this is one drink in the evening, does not impact my sleep, two or more, absolutely does and does so in a profound way.

The two things that happens are my resting heart rate will be 10 beats higher. It will take very long for me to reach my resting heart rate. So what you want is your resting heart rate to be achieved within the first third of your sleep cycle. And more importantly, and perhaps more surprising to me is my heart rate variability gets squashed. So I have a very low average heart rate variability when I have more than two drinks and even the volatility of my variability is very low. And that is reflected in my sleep.

It also definitely compresses rem cycles. So even though when you have a few drinks, you're groggy and you think you're sleeping better, you're just less conscious, but you're actually sleeping worse. I hope you enjoyed today's quality. Now sit tight for that legal disclaimer. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice.

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