ZOE Science & Nutrition - Alcohol: Can it ever be healthy?

Episode Date: March 17, 2022

For many of us, it's a ritual to help us wind down after a long day, an excuse to catch up with friends, or a lubricant to an awkward social situation. Alcohol can be delicious, but our relationship with it is often complicated.  Good times with friends aren’t without sacrifice, and many of us feel the morning after impact of a few too many drinks. For an unfortunate minority, alcohol can lead to addiction and even death.  What we want to know is, can alcohol ever be healthy? Is any amount of alcohol a sure path to an early grave, or could a glass of red wine be the best thing for your heart health? This episode examines these contradictions to see what the science says.  Jonathan speaks to two leading scientists to better understand the effects of alcohol: Tim Spector - scientific co-founder at Zoe and one of the top 100 most cited scientists in the world Dr. Sarah Berry - one of the world's leading experts in human nutrition, with over 30 randomised human clinical trials to her name Download our FREE guide — Top 10 Tips to Live Healthier: https://zoe.com/freeguide Timecodes: 00:00 - Intro 00:10 - Jonathan’s introduction 01:25 - Episode start 01:45 - Tim’s favourite alcohol 02:24 - Is red wine healthy? 04:56 - How does alcohol relate to our microbiomes? 08:41 - What’s the cause of alcohol's positive effects? 11:16 - The importance of the amount of alcohol consumed 15:47 - Understanding the adverse effects of alcohol 17:48 - Why do hangovers get worse with age? 21:41 - Does alcohol influence weight? 24:48 - Alcoholic beers vs non-alcoholic beers in relation to sugar 28:34 - Avoid alcohol if you have these conditions! 29:54 - How does fermentation of beer differ from kombucha? 32:21 - Organic and natural wine 35:10 - Summary 38:03 - Outro Follow Sarah: https://twitter.com/saraheeberry Follow Tim: https://twitter.com/timspector Follow ZOE on Instagram: https://www.instagram.com/zoe/ This podcast was produced by Fascinate Productions.

Welcome to ZOE Science and Nutrition, where world-leading scientists explain how their research can improve your health. For many of us, it's a ritual to help us wind down after a long day, an excuse to catch up with friends, or a lubricant to an awkward social situation. Alcohol can be delicious, while our relationship with it is often complicated. Good times with friends don't come for free, and many of us have felt the morning-after impact Alcohol can be delicious, while our relationship with it is often complicated. Good times with friends don't come for free, and many of us have felt the morning-after impact of a few too many drinks.

For an unfortunate minority, alcohol can lead to addiction and even death. So is alcohol ever healthy? If you're like me, you're probably deeply confused. Is any amount of alcohol a sure path to an early grave? Or is a glass of red wine the best thing for your heart health? You might have read both things in the same newspaper in the same week. In this episode, we look to the very latest science to find out, answering questions like which alcohol is best for your health? Which drinks make you gain the most weight? And is alcohol killing off the good microbes in my gut?

I'm joined by Tim Spector, my scientific co-founder at Zoe, and one of the top 100 most cited scientists in the world, and Dr. Sarah Berry, one of the world's leading experts in human nutrition, with over 30 randomized human clinical trials to her name. So I'm very excited to welcome back to our podcast two of my very good friends. And since I know you both so well, I can also say with some confidence that you're not just world-leading scientists who can talk about our bodies and alcohol in the abstract, but I know that you both regularly like to do some personal experiments on the impact of wine

at varying quantities. So there's plenty of personal expertise here. Tim, your favourite tipple of choice? Well, I have to say it would be a good quality red wine, really. And my choice does vary depending on what I'm offered. So an aged, full-bodied red wine, a nice Barolo from Italy, a nice Chateau Margaux from France, some Priorat from Spain. These are some of my favorites, but I like a drop of wine, but I also do drink other alcohols as well. So I try and keep my hand in all of them. That's good. Good to keep your hand in. And what's going on, Tim, when you're drinking the red wine,

healthy or not healthy? Well, I've actually felt better about drinking red wine in the last 10 years since I discovered it has magic properties, make it differ from most other alcohols in that it's still got a close connection with the fruit and the skin of the grape because red wine, unlike white wine, is left for a long time. The grape skin is left in contact with the mixture. So all the good chemicals in the grape skin, which mainly we're talking about polyphenols, which are this group of defense chemicals used to be known as antioxidants. These leak into the liquid and actually then undergo, with the fermenting process of microbes, multiply. So you get over 100 different types of polyphenol chemicals in your glass of wine, which we now know, we didn't know, are actually very good for

you. So it's starting to explain why red wine, these studies have consistently shown red wine to be different to other types of alcohol in terms of its health benefit, at least for the heart. And some people say that might explain the so-called French paradox that was about 30 years ago, but why, say, the French had much fewer heart attacks than the Americans for three or four times less heart problems. I think it's probably exaggerated to say it's all due to red wine, but that started this whole quest. And I think as we discover more about food and nutrition and really take a scientific approach, we're starting to pick apart what it is in all these drinks. And it's these polyphenols, which are actually rocket fuel for your microbes.

So if you're drinking hundreds of these polyphenols, you are, despite the alcohol, regardless in the way of the alcohol, you're feeding your gut microbes further down the chain. And they're paying you back by helping your immune system and your heart and your metabolism in general. So I think that's sort of what it is. The trick is to get the dose just right, as always. That's something that we all struggle with. And, of course, it's very individual. That's why this government approach across most countries saying there's a certain amount of units that men or women should have is all the same is always going to be problematic because just like with food, your response to alcohol

is highly personalized. And of course, some people can't drink it at all. Hi, I'm Zoe's US Medical Director, Dr. Will Bolsowitz, and I'm excited to tell you about a free resource that's going to kickstart your journey to better gut health. If you're a regular listener, you probably already know how a healthy gut microbiome is important for digestion, immune support, and mental well-being. And that a high-fiber diet is a great way to improve your gut health. But where to start? And what exactly does a high-fiber shopping list look like? With 95% of US adults deficient in fiber, clearly this is not common knowledge. Zoe's Gut Guide has the answers. To get yours for free, simply go to zoe.com

slash gut guide and start feeling the benefits of a healthier gut today. And tell us a bit about what's going on with the alcohol. So like, in a sense, this is a great story, right? It's like, as long as you've had bacteria fermented the grapes into wine, that's good. Then when it gets in our guts, there's more bacteria. There's even more good stuff. That all sounds great. Clearly, there's this other stuff going on with the alcohol, which is, I guess, what's balancing out the reason that you're not suggesting we should all drink a liter of red wine every

day. Yeah, that's right. We've only recently started to unpick this because the studies have consistently said that people who drink a lot of alcohol are less healthy than people that drink a small amount of alcohol. And there's been some debate about teetotalers because they might be a strange group. But generally, there's been a curve that goes up with ill health the more you drink. But consistently, you've had red wine showing this reduced heart disease when you're drinking less than two glasses a day on average.

So we think that alcohol, on one hand, is probably, in large amounts, definitely harmful for you. But in small amounts, it might be OK. And that allows what else is in the drink to give you that benefit so i think that's our sort of current thinking of why we've got these rather confusing messages but of course what's really difficult is to work out what is the minimum amount you can drink get that right for any one person whether it's a male or a female depending on your weight your whether you have asian alcohol genes or or you have European genes that are better able to metabolize alcohol.

And how does this relate to your gut microbes? And how does it relate directly to your heart? And it's all starting to come into place now. So we did a study in my department a few years ago where we looked at about 5,000 to 8,000 people across different countries in Europe and the US and found that, again, red wine was the only drink really that came out as being beneficial for your gut microbes. So all the others, the more alcohol you drank, actually the less healthy your gut health was looking like. So that was quite supportive that the benefits are actually due to your gut microbes rather than some direct effect of polyphenols on your heart. So the

microbes seem to be quite key in this. Do you agree, Sarah? Yeah, I think there's also other benefits to alcohol and wine in addition to the gut microbiome, which I think, again, you know, like you said, Tim, it's really difficult to pick apart what's due to alcohol, what's due to the polyphenols, for example, in wine or beer. And there's been lots of really interesting studies where they will feed people either red wine or white wine, then de-alcoholinized. So they take the alcohol out and feed the kind of good bits, so to say, say of the drink or will give spirits and then they can look at all these different kind of mechanisms so aside from the

microbiome that we know are impacted by alcoholic drinks so mechanisms are involved in how our blood clots in how our blood sugar is processed in how our blood lipids change, so whether we have an increase in good cholesterol or bad cholesterol, in also how our blood vessels function. So we often use a term called the endothelial function, which basically is a way of looking at how healthy the lining of our blood vessels are. And there's been actually quite a lot of short term studies to look at when you drink wine, or you drink the alcohol like nised wine or gin or other spirits you know versus a controlled drink like a sugar drink what are the effects and what we see is that with all alcohol so regardless of whether it's got polyphenols in so even spirits you

actually see in the long term an increase in good cholesterol, which we call our HDL cholesterol. Now, that's up to a certain point. And Sarah, can you help to explain what's going on? So I'm having this alcohol. It's presumably transferring into my bloodstream, I guess, in the same way as when I'm eating something. What's going on afterwards? Why is it having these effects? Yes, I think a really nice way to visualize it is to think of having a glass of wine with your dinner and what happens when you're consuming your dinner and what happens when you then add the wine, you know, the glass of wine with it. So when you consume a mixed nutrient containing meal, and I know we've discussed this many times

on previous chats that we've had, you have an increase... For our listeners, that's just like a regular meal, isn't it, Sarah? Yeah. So if you have a regular meal that has a balance of fat, carbohydrate, protein in the meal, you have increases in blood sugar, in blood fat, in say, two to six hours after consuming that meal. And this kind of kickstarts a cascade of quite unfavorable effects like oxidative stress and inflammation and ultimately in the really short term this can actually impact that very special lining of your blood vessels i mentioned this endothelial lining so we often think of this endothelial lining being like teflon that nothing sticks to it if it's working properly but it kind of gets rid of that non-stick that you have so that in that kind of two to six hours after consuming a meal, you're then causing

this very transient short-term damage to your blood vessels. Now, if you have red wine with your meal and there's studies have actually shown this, you don't get that damage. You have a real attenuation. So you have a reduction in your oxidative stress in your inflammatory markers, and you don't see this kind of damage, teflon lining of your blood vessels and that happens really short terms that happens in that six hours which is a really favorable effect now that's been shown to happen predominantly with wine with red wine we also see it with beer as well because beer has polyphenols and this is a mechanism that's slightly separate to the good mechanisms that Tim was talking about relating to the gut microbes.

But what's important to remember as well is alcohol on its own, alcohol without any of these other polyphenolic substances over the long term does actually improve your HDL cholesterol. Now, the dose, as we've mentioned, is so, so important so we have this j-shaped curve and we see this with a lot of dietary exposures where you have very very low amounts you're actually increased risk of certain diseases where you're at moderate amounts and this applies to alcohol you have favorable effects on many diseases but then once you go to higher amounts the risk rapidly increases you know as the dose increases and what else is the alcohol doing sarah so you've talked about potentially when i'm drinking red wine actually there might be some protective thing well we all know if you drink too much you fall over and you can't remember

things and like there's a lot of stuff going on there do a little bit more about what's going on and i guess how does this tie into this rather complex idea right which you're saying small amounts might be good but large amounts are bad it's unusual we're more used to the idea it's cake like small amounts aren't really very good for you but it's okay large amounts are bad. It's unusual. We're more used to the idea it's cake, like small amounts aren't really very good for you, but it's okay. Big amounts are bad, but you're saying actually there's a sort of strange inversion here compared to most of the things we talk about. Yeah, I think a way to think about it is really whether you're going to tip the scale in terms of the benefit of, depending obviously on what you're drinking, the benefit of the polyphenols that are in the drink versus the unfavorable effects of the alcohol when it's at higher intake. So we know that as soon as you go above maybe one or two drinks a day in terms of the alcohol content,

we know that it has unfavorable effects on lots of mechanisms such as oxidative stress and inflammation. Now, if you're thinking of kind of, you know, scales and having that in balance with the amount of polyphenols that you're delivering, when you're at that level of about one or two units, so one or two drinks a day, then you're balancing out any of the negative effects of alcohol by the positive effects of some of these bioactives, so these polyphenolic compounds that are in the drink, as soon as you increase your alcohol above that moderate level or the safe level, favourable level, then you're tipping the balance

of the unfavourable effects of alcohol and not having enough of this counterbalance effect. And that's when it becomes a problem. And this is why- Sarah, most alcohols don't actually have much polyphenols. So anything that's distilled is basically got everything removed. So I think you need to plants that made it have long gone and that same is true for vodka gin etc so i think we've got to look at the the broad epidemiology does say that there is a you know there's no such thing as a safe level there isn't a certain cutoff when

you look at epidemiology which slightly contradicts the uh short-term experimental studies there's quite a lot of lack of clarity around these low-dose effects and whether you should be having... I think it's worth reminding people what alcohols do have polyphenols in them. Tell us, Tim, if we were going to say, I really want to drink tonight, what is the, it sounds like, fairly short list of things that is positively approved from my microbes? Yeah, I used to say red wine beats everything, but actually I've found some artisan ciders. And for the US, an English cider is an alcoholic cider similar to beer.

And these have actually high polyphenol levels. So I think we'll be seeing more of those coming through as sort of health drinks, if you like. Then you drop down to things like rosé wine, white wine, and champagnes, proseccoes, etc. And about that level, you've got lager beers, and you get slightly more from traditional warm British ales. And some Belgian beers also contain polyphenols and some yeasts. And I believe to have some beneficial properties, at least according to the Belgians, that is, but not everyone believes them. So and then that's pretty much it. There's

not much else really that has much to feel microbes to munch on, if you like. And I think that's part of the problem. So then it becomes more complicated about, you know, then you start talking about sugars and other things, which we might want to touch on later but the menu is relatively limited but most people don't realize how much less polyphenols there are in white wine compared to red wine you've got to drink three times as much white wine as red wine to get the same benefits so it's not generally recommended that's why i drink white wine that's my excuse tim that you say I should drink three times as much. That's right and you can you can tell a polyphenol also because it gives you that funny taste or that sort of astringency on the tongue and that astringency the way it sort of in a way dries

out your tongue is a sign that the tannins in there and the more tannins there are they're classic polyphenols so it's an an interesting way to judge wines as well, which may probably vary quite a lot within them. No one's really testing them yet or sticking that on the label, but I think in the future they probably will be. And I'm not a big drinker. So you've definitely convinced me that red wine is the place to go. I like red wine, so that's fantastic. But I definitely feel a whole bunch of negative effects after my second glass. And that's not about long-term health anymore. That's fantastic. But I definitely feel a whole bunch of negative effects right after my second glass. And that's not about long-term health anymore, right? That's actually about like, I'm going to feel a hangover the next day. I may start to feel effects probably even within the

next hour. There's clearly some negative stuff that's going on there. Can you sort of help to explain? Because I guess that's this sort of key trade-off that you're talking about in addition to long-term health, which is very different. And I think why you're saying there's not necessarily any safe level, these things are quite personalized. What's going on here? Well, alcohol is a neurotoxin really, and gets broken down at different speeds in different people. And you have these genes that generally metabolize it either faster or slower. So the speed at which it gets to you or affects your brain or your cognition depends on A, how much you're used to it, and B, also what genes you might have inherited.

And it probably also involves your gut microbes and your individuality. So huge differences between people. And that's why one glass for you might be three glasses for Sarah. And just because metabolically, you're going to process them rather differently. So it's very hard to give rules. And I think what you're describing, Jonathan, is quite common. People saying, as soon as I go above one glass, I get all these side effects. And I don't sleep well at night and all these kind of extra things, which that really difficulty with alcohol, it's a really difficult drug in a way to get right in terms of dose and timing. That's why everyone has their own story about what makes them feel good or bad. And so in general, I think the idea is in general, probably better off without alcohol, I believe overall. But if you are going to drink in a thing, pick something with red wine,

which has some proven effect on the heart or increasingly these apple-based drinks that might do you some good or you just drink it because you know it helps your social life and makes life more interesting and do you know why hangovers get worse with age i know people talk anecdotally about that is it to do with the enzymes involved there's masses of literature on hangovers none of it conclusive in any way at all other than everyone blames everything else for it and there was this whole thing about blaming congenins and things like distilled brandies and things like this and but it's turning out to be much more complicated than that but

interesting they have done some microbiome experiments in mice, giving them hangovers and show that you can actually prevent some hangovers or reduce the toxic effects of alcohol by giving them probiotics or poo transplants. So they've done a few human studies as well, showing that you can actually, by manipulating the microbes, help people recover more from alcohol. But I'm not sure anyone's yet advertised those yogurts for that specific purpose but it shows it's complicated and that probably what you're eating the day before what you've got in your stomach also plays an impact on how you that two or three extra glasses is going to affect you the next morning just like we're learning in personalized nutrition you know it's often outside the window you're thinking about that influences

your body and all these other kind of ways so drink at a different time with your meal rather than on empty stomach later in the day rather than at the end of the day all have different effects on the body and the brain now i came across a really interesting study a couple of weeks ago that was looking at amount of alcohol, I think, versus the way in which you're consuming it. So your drinking habits versus your drinking amount. And it actually showed a really strong impact of your drinking habits. So, you know, what time of the day do you have it? Do you have it with a main meal versus actually the amount of alcohol? So going back, Tim, to what you said about all of the work that we're finding with the Zoe Predict studies, showing the importance of your dietary patterns as well. So how you eat

and the same holds true for the alcohol intake. And what was better, Sarah? Having it with your meal, having it with the main meal of the day, the time of the day didn't seem to have a big impact, although they were looking at, I think if I remember correctly, lunch versus dinner. I don't think there's many people that consume it, hopefully for breakfast or with their breakfast, not nowadays, although many years ago they did. But that having the same amount of alcohol with a meal versus without a meal has significantly different impact in some of these health outcomes. And it's one of the few things where genes actually do make a difference. So when we did the ZOE PREDICT studies, genes had little impact on most foods and responses to them, but two sort of exceptions to that. One is how you deal with milk through the lactase gene,

and the other is alcohol dehydrogenase gene, which through evolution has changed. And actually, Europeans have mutated to be able to break down alcohol faster so it doesn't cause those toxic effects. And there have been some studies actually in students where they gave them all a triple shot of vodka, monitored them over time in a controlled experiment. And huge differences between individuals in how they responded to that standard dose of alcohol in terms of hangovers, et cetera. So I think there's a whole other industry there if we wanted to go to personalizing your alcohol behavior, but I'm not sure we should go there.

No, it's interesting. I think about my university education as being a bit like a controlled experiment in alcohol consumption. I came up with almost no tolerance. By the time I was 22, I had really high tolerance, much higher tolerance than I've had subsequently. I now drink very little, but at that point, and this was, I guess, 25 years ago, I think that students today drink less. It was a sort of central part of my experience. So I definitely remember that shift. We had a couple of fantastic questions that came in on Instagram overnight when people heard we were doing this question. And one of them, which I think fits right in here is we've talked about the health bits, but what about weight? Does alcohol make you gain weight? And the follow-on

to that, isn't it killing your microbes? Cause it seems like it kills everything else. What's going on there? I'm happy to touch on the weight bit, Tim, but I'll give you the bugs to talk about. So again, with weight, just like we see with the association with alcohol and cardiovascular disease, type two diabetes, we see this similar J-shaped curve actually as well. Why that is, I'm not sure, you know, obviously if you have excessive alcohol, you're consuming a lot of sugar, you're consuming a lot more calories and these empty calories. Why a moderate intake is associated potentially with a lower weight than no intake could be a byproduct of some of these metabolic favorable effects, particularly from alcohol that's containing the polyphenols that Tim mentioned. Hi, I love that you're listening to this. It means a lot to me and the whole team

who put such a lot of hours into this podcast each week. We release this show for free without ads to help millions of people improve their health with cutting edge science. In return, all I ask is that you help us on this mission. If you know someone who'd benefit from listening to this episode, please send them a link to this show. And you know someone who'd benefit from listening to this episode, please send them a link to this show. And if you haven't already, hit follow wherever you're listening right now. Thank you, and on with the show. But in general, alcohol increases your blood sugar, doesn't it, on average? Most of the conventional drinks will increase your blood sugar or not. Because definitely in some of the twins we did see responses I had one particular energetic set of twins identical twins who were party lovers and did a prosecco test

where they both drank prosecco at the same time with the glucose monitors on and only one of them was getting peaks and the other one wasn't which upset the one who was. So the sugar in the drink will obviously cause an increase in blood sugar, although it's really different between different people. So some people actually the sugar can dip and this is because it interferes with the way that the liver produces glucose as well. So you might have some sugar coming in from what you're drinking, but you're having a disturbance in production of sugar from the liver. Hence why it's really variable. Hence why one of the twins might have had an increase and one of them might not have.

And Sarah, I seem to remember a text messaging me at around 10pm one night while wearing a CGM. Do you remember this story? I do. The one and only time I've worn a CGM was quite troubled why my blood sugar had dipped so dramatically after my X number of wine, which is actually white wine, didn't have these nicer polyphenols in or a large amount. And I was really surprised that it had dipped. So yeah, I have since looked into it. And some people, they do get an increase. So some people actually impairs insulin sensitivity acutely.

So this is one of those signs of very big personalized differences, right? I think that was part of what we ended up talking a lot about, right? About trying to understand impact on blood sugar, that it was, we were not seeing a very consistent pattern across the whole population. But also it depends on the alcohol you're having. Again, going back to thinking about the type of alcohol. So we know that certain polyphenols, certain flavonols actually interfere with how glucose is absorbed. So if you have a high dose of flavonols with a high sugar drink, we know that you can reduce your postprandial glycemic response. And there's been quite a few trials on this actually in our department that have looked at this, not with alcoholic drinks, but with non-alcoholic drinks, giving different

polyphenols. And so again, if you have red wine wine you're less likely to have such a big increase in postprandial blood sugar after consuming that drink. I sometimes have zero alcohol beers, non-alcoholic beers. I try and have a day or two off alcohol during the week and this really helps and they've got really good recently if people haven't tried them. So this particular German beer it was and I was wearing a CGM and found it actually gave me a considerable sugar peak, whereas the regular version of it with alcohol didn't. Can you explain that?

I could guess that it's to do with the polyphenols. Although you said they're quite low, we know that polyphenols, like I said, interfere with the uptake of glucose in the intestine, the way it's absorbed into the bloodstream. So it's absorbed at a slower pace. So you don't have that short shot, you know, that very rapid rise and rapid drop. I don't think it's just more sugar in the non-alcohol beer than to make up for the lack of alcohol. I have a feeling that they do tend to do that. Alcohol is a very complex

sort of flavor to try and mimic. so i think they they often add in other things to it so it's just something to be aware of yeah do you know there's been quite a few studies where they've looked at beer and then they've looked at the same beer but with the alcohol removed so non-alcoholic beer and they've looked at the impact on some of the favorable effects that i talked about earlier to do with the blood vessel function to do with oxy stress and inflammation and they actually see the same effects between the ones with alcohol and the ones without now whether they're matching exactly the sugar in the drink i don't know i think we're going to see many more non-alcoholic or low alcoholic wines and beers in the future that are going to be getting better and better and i think this has got a very different conversation

in a few years' time about the health benefits of some of these, taking the best things of the fermenting process, but then at the end stage, just cutting out the alcohol. I think we're going to see much more of that. Yeah. And I guess what people have to be aware of, right, is that these are still drinks that have sugars in them

or things that get turned into sugars and that for people who have less good blood sugar control, which is most of us in the Western world as we get older, that that can have quite a big impact on those blood sugar spikes in the way that Sarah, you talked about earlier and the negative effects. So I guess there was this question about beer and presumably sort of the quantity of beer and the quantity of sugar is one of the things that is not true, Tim, if you're having your half a bottle of non-alcoholic beer, but rather different if you're going to drink a large amount. Yeah. If you're having three or four pints of beer in a single session, then that's a huge

amount of sugar, really refined sugar that you're getting. So huge hit that you're having in a single setting, which we know is bad for us. Plus that's more than your daily intake that you should be having of refined sugar. And that ties into the weight, presumably coming back to this question around like alcohol and weight. So the polyphenols aren't completely magic, right? So we've already said the beer is lower, but I think that's important, right? They'll always, because we have a lot of these discussions, right? That's your J shape again, is it Sarah?

You're saying like, okay, so in small quantities, this is good, but it doesn't mean, oh, I'm drinking magically my cider with a super high polyphenols. I can go and drink pints and pints and pints of it, or that I can indeed drink bottles of wine without expecting not only the health issues, but the sort of weight issues that I guess, you know, we tend to associate with people who drink a great deal regularly. Yeah. And I think it's also important to mention that a lot of what I've been talking about are mechanisms associated with cardiovascular disease, type two diabetes, you know, so what we call metabolic diseases, but we need to be mindful that for certain kinds of cancers, there's strong evidence to show that even moderate intake of alcohol has an unfavorable

effect. So particularly cancers of the gastrointestinal tract, for example, I wouldn't encourage people, particularly people that are increased risk of consuming anything above moderate intakes of alcohol. You've talked about how personalized it is. What are the other life conditions or situations where actually sort of skipping alcohol altogether is important? So I think if you have hypertension, so if you have high blood pressure, then the flex point in that J-shaped curve is shifted a little bit

so that whilst one to two glasses a day might be okay for the majority of people, if you do have high blood pressure, then you should try and limit it a little bit further. Now there still is a J-shaped curve for people that have high blood pressure, but it's a lot lower. So it's instead of it being, you know, up to say 12 units a week, it's lower than that. So maybe a glass of wine every few days, for example. Also, if you have very high blood lipids and particularly blood triglyceride levels, so this is slightly different to your cholesterol levels, but we know if you have high triglyceride levels. So this is slightly different to your cholesterol levels. But we know if you have high triglyceride levels, that again, alcohol can actually make that a little bit worse. And that's because it increases the production of triglycerides from the liver. But it also impedes

the breakdown of triglycerides from the fat that you consume in your meal when you consume a meal. So you have it kind of a double whammy at both ends there. And so that's where you need to be a little bit more careful as well. I had another great question from our members, and it comes back to beer, right, which is sort of in this middle ground, right? It's not truly terrible, not really great. And the question is, how does fermentation of beer differ from kombucha? Because, you know, Tim, you're always telling us how fantastic kombucha is, because of all this fermentation and all of these bugs, you know, beer, that sounds like it's fermented as well. Put aside maybe if you drink too much and there's too much alcohol, why is beer not as good as kombucha? It's a great question. I'm no beer fermenting expert, but I do make kombucha on a regular basis. You get your mother blob and you

add brewed tea and you add lots of sugar to it and you wait 10 days and the 30 different species of bug in there will change that tea the bitter tannins of tea into a very complex mixture of actually alcohol it's about half or one percent alcohol slightly sparkly and give it a bit of a punch and these rich flavors from the cetic acid, et cetera. And that's really all you do. It's extremely simple. Whereas a beer making process involves artificial yeasts, which you add to barley, hops, all these various grains, various stages, you tend to sterilize it.

So you don't have out of control bacteria in there. So it's involved in the process, but one ends up basically a sterile product. And the other one is actually a live product. The Belgians claim that some of the yeast left in the bottom of the beer is actually still potentially live and just resting and therefore might have some biological properties. But I think the jury's still out on that. So that's very different from something with all of these live bacteria, some of which should make it through that really tough condition in your stomach and actually get into your gut. Is that the...

That's right. And I think we have to realize that there's no hard evidence that beer is good for you, despite some of the adverts you see, yes. And presumably you tend to drink smaller quantities of kombucha, so you also don't tend to have as much of the sugar spike and everything that we're talking about with beers and those big downsides. Yeah, well, most of the sugar is turned into either alcohol or these acetic acids or various other byproducts. So most kombucha, if you make it yourself, is not very sweet, although some of the commercial varieties actually do add in other sugars. So you have to be a bit careful on that. Yes, I know that you're quite negative on a lot of kombucha you can actually buy in the store.

It's not been very different from the sort of sugary drinks that get terrible Zoe scores. But it's getting better and there's huge variety. So, you know, remember, there is a small amount of alcohol in that. So, you know, some people do include kombucha when they talk about alcohols, less than 1%. Other question we had was about organic and natural wines. So we've talked a lot about wine and how great it is. In general, processing too much is often something that reduces the quality of food. Any views on that? The big movement in this in the last few years, both for natural wines and organic wines, and definitions vary in each country about exactly

what that means. And there's still no universal standard. In general, organic wines tend to not use any added chemicals and artificial ingredients and be very careful about what they're using. But the extreme end, you've got natural wines, which might be made without preservatives and also vineyards that might not be using fertilizers, for example. So very natural products. So the terms are used interchangeably, but they're generally based on the idea that if you worry about the vine itself and the land, it's a sustainable system, and therefore we should be supporting these as opposed to the mass market type wines and grapes, which just use masses of fertilizers, spray it with pesticides, herbicides, and you get actually more product. So what they produce is smaller, less of it, but higher quality,

and increasingly a lot of people are preferring natural wines, organic wines. Of course, the original natural wines are still made in Georgia where they were put in amphora in the ground and you just basically threw your grapes in there with a bit of water, closed the barrel and waited six months and then drank what happened after that. It's a bit like your kombucha, Tim. Yeah, exactly. So, and had all the bits in it and other things.

So, you know, that's the extreme example. So, but I don't think there's any evidence yet for organic food being better for you. The evidence is really not there yet. Very hard to do the experiments. But in theory, yes, less chemicals, generally better, less harmful for your gut microbes, less things to upset them. Because like all foods, if there's less spraying with herbicides, like glyphosate, for example, we know that has an effect on your gut microbes. And so that is beneficial. So in theory, it's better, but we don't have any proof. One of the reasons that we're talking about this today is that we spent a lot of time over the last few months doing these updates to the Zoe scores to score alcohol for the first time, having not done that with our previous releases, because we just didn't feel that we'd had enough data and and at this point i know that we've just released it in a fundamentally non-personalized basis because you know we're not yet comfortable with our ability to be accurate enough did we learn anything sort

of particularly interesting that we haven't covered and i'm also interested in sort of the differences between what we saw in the us and the UK as we were comparing these two populations and how we can think about that. For advice to any listener who's still hanging on at this point in the podcast. We've covered most of the points. I think the kind of things that we really considered very carefully when we were implementing the alcohol scores was around this habits that we talked about how how it's consumed so the scores were a lot more favorable if the alcohol was consumed as part of a meal because of the reasons that we discussed earlier and also the scores are hugely different depending on the type of alcohol consumed as we've talked about throughout this podcast and then the dose so the dose was key and i think it's really

important to mention that I know I've been quite favourable over the last half an hour about the favourable effects of alcohol that it's really important to reiterate that as soon as you go above this low to moderate intake of one to two small glasses of wine or beer a day it has a very detrimental effect on health and that's really important to note and so that's been a really careful consideration for when we were developing the scores as well to make sure that we're only ensuring a favorable dose as well and the frequency was part of our consideration as well. I've been lucky I tested myself with various alcohols I don't seem to get much of a glucose spike whereas some people do so bear in mind there is this quite a bit of variability

in how we respond so it's always and it might differ with different alcohols which we're going to progressively get to in the zoe app but i don't think we've got all the data we need to to sort that out yet and of course remember things we haven't yet added in that we probably will be you know things like ethnicity and other other elements to alcohol could be quite big factors as well that's important so um but yeah realizing that alcohol is part of you know our lifestyle as a food you know or is it something that we see small amounts of alcohol drinking in long-lived populations, so the blue zone countries. The little old ladies age 90 are still going down for their beer or their glass of wine once a day. It may not be necessarily the alcohol that's keeping them alive, but it's the fact they're having a social activity and interaction with their friends. And so there's a lot of confounding

factors in alcohol that depend very much on the context of which you're eating it. But if you can enjoy a small amount in a social context that improves your general well-being, then it can be very good for you regardless of the actual biological mechanism. So context is also very important. Drinking on your own in binges as opposed to meeting your friends in a Mediterranean cafe, I think are very different. I think that's a brilliant place to stop. I think we would all like to be in a Mediterranean cafe right now. So hopefully soon. I've really enjoyed the conversation.

I think it's been very wide ranging. It's good to know that the conclusion is red wines at the top. White wine is just about acceptable, Sarah. Beer at a real pinch. Everything else, you know, think carefully. Thank you both of you, Tim and Sarah, for joining me on today's Zoe Science Podcast. We hope that you liked the episode.

If you did, please remember to leave us a review and subscribe. If you're interested in learning more about Zoe and the best foods and drinks for your body, you can head to joinzoe.com slash podcast and get 10% off your purchase of the Zoe program. As always, I'm your host, Jonathan Wolfe. The Zoe Science Podcast is supported by Sharon Federer and Kirsten Cade here at Zoe. See you next time.