Drink? by Nutt
Ref: David Nutt (2020). Drink? The New Science of Alcohol and Your Health. Hachette Books.
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Summary
The author, Dr. David Nutt, was the UK government chief drugs advisor who was fired in 2009 for stating that the government drugs policy wasn’t evidence based.
In first world Western countries, alcohol is consumed by >80% of all adults. Of that 80%, only about one-fifth get into problems with it.
The WHO’s Global Status Report on Alcohol and Health 2018 said that in 2016 >3M people died as a result of harmful use of alcohol.
Alcohol causes more than 5% of the global disease burden.
30% of Americans don’t drink at all and 30% consume on average <1 drink (14g Alcohol) per week; at the other extreme, the top 10% of American drinkers consume an average of 74 drinks per week (>10 drinks per day)!
What I would like to help you do is think about your drinking. To know what the risks are if you go above the recommended limits. To know that even if you can’t stick to the limits all the time, you should not just give up and ignore them completely. To learn how to monitor your drinking. Perhaps, sometimes, to choose not to drink.
What drinking alcohol needs to be, above all, is a conscious act. You should treat it as more special than eating, more like—I would argue—it used to be treated in the past. Make drinking a positive, active pleasure rather than a reflex and habit, or something you’ve always done, or self-medication for stress or anxiety. My view is, try to reduce how much you are drinking as much as you can toward the recommended limit while maximizing your fun and pleasure. And have at least two days off a week.
Factors that affect your risk of health harms? How often you drink. How much you drink. Your general health. The poorer your health for other reasons, the more alcohol may affect you. Your age. The older you are, the more vulnerable you become to health harms. Your sex. Women and men have different health risks. Your genetic inheritance. The number of years you’ve been drinking. Most often, health issues due to alcohol only begin to show up 10 to 20 years after drinking began. The age you began drinking. The earlier you began drinking, the more you may have affected your health. Whether your family has a history of alcoholism; if it does, you are more likely to become dependent.
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Brain
Neurotransmitters: Chemical messengers that bridge the synapse sharing messaging between neurons. There are ~80 different types of neurotransmitters and there are even more types of receptors that they slot into. Each receptor is triggered by a different neurotransmitter. The two neurotransmitters that are the most common and the most powerful, because they are effectively the on–off switch of the brain, are GABA and glutamate. In essence these two neurotransmitters are the core of the brain. They do all the basic work such as sleeping, laying down memories, and thinking.
Acetylcholine (ACh): An organic chemical that functions in the brain and body as a neurotransmitter. Ach works primarily in muscles, helping to translate our intentions to move into actual actions as signals are passed from the neurons into the muscle fiber.
Adenosine (A): An organic compound and neurotransmitter that consists of an adenine attached to a ribose. A is one of the 4x nucleoside building blocks of RNA.
Dopamine (DA): The “Pleasure Chemical”; a compound present in the body as a neurotransmitter with a stimulating effect and a precursor of other substances including epinephrine.
Endocannabinoids: Retrograde neurotransmitters.
Endorphin: A pleasure peptide neurotransmitter secreted within the brain and nervous system which activate the body’s opiate receptors, causing an analgesic effect.
Gamma Aminobutyric Acid (GABA): One of the brains key neurotransmitters that turns off messages between neurons, causing the brain to relax or slow down. A sedating inhibitory neurotransmitter.
Glutamate: One of the brains key neurotransmitters that turns on messages between neurons, causing the brain to speed up (and stay awake). If not checked by GABA, can lead to anxiety, seizure, or brain damage.
Histamine: An organic compound released by cells in response to injury, allergic, and inflammatory reactions, causing contraction of smooth muscles and dilation of capillaries.
Noradrenaline: A neuromodulator that encodes emotions.
Norepinephrine (NE): A hormone and a neurotransmitter linked to mood, arousal, vigilance, memory and stress. NE plays a potential role in PTSD and Parkinson’s.
Orexin-A &-B (Hypocretin): A neurotransmitter produced by the hypothalamus and functional in the regulation of appetite and sleep.
Serotonin (5HT): The “calming chemical”; an empathy- producing neurotransmitter. A lack of 5HT has been linked to depression and related disorders.
Synapse: The gaps between neurons in the brain.
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Alcohol
Alcohol flows into your stomach, it begins to be absorbed through the walls of the stomach, then via the small intestine.
The Alcohol goes via the bloodstream into the liver, where it starts to be broken down, the main by-product being acetaldehyde.
This alcohol/acetaldehyde mixture travels through the bloodstream into the heart and also crosses the blood-brain barrier and enters your brain.
In the brain, alcohol releases endorphins, enhances GABA, serotonin, and dopamine while blocking glutamate and noradrenaline. The Frontal Cortex- the part of your brain that tells you to stay in control- is switched off.
Endorphins: Alcohol releases endorphins, the body’s natural opioids, causing a high.
GABA: Alcohol turns on the calming GABA system, so you start to feel relaxed.
However, if you turn the GABA system on too much, it can switch off parts of the brain you don’t want switched off, for example, your judgment or even your consciousness. And if you drink a great deal of alcohol and the GABA system is maximally potentiated, it turns off your brain, in the same way as an anesthetic, so you stop breathing. That’s one way you can die from alcohol (alcohol poisoning).
Serotonin: Alcohol increases the level of Serotonin, a mood enhancer, causing you to be more empathetic. Its pro-serotonin effect is also what makes other people seem more attractive.
Stimulation of a different serotonin receptor, one in the nerves of the stomach, can make you sick. Vomiting gets rid of enough alcohol so you stay alive.
Dopamine: Alcohol increase levels of dopamine, increasing drive, motivation, and energy. This is a factor in alcohol’s stimulant effect, which makes you feel exhilarated, more active, and gives you feelings of energy and enthusiasm. Dopamine makes you louder—this is an effect people get from cocaine too. With your Dopamine up and your self-control down, you may begin to get argumentative.
Being drunk releases a primitive, defensive aggression that you’d normally have intellectual control over. Your frontal cortex is no longer working optimally, so you are unable to put in place your usual rational approach to what you now see as provoking behavior.
Glutamate: Alcohol blocks glutamate receptors, causing your capacity for memory storage to decrease; you may begin repeating yourself.
Your brain compensates by increasing the quantity of glutamate receptors. As your BAC goes down during the night, you’re left with too many receptors and too much glutamate activity. And that is why you can wake up feeling alert.
The body releases the enzyme ADH to metabolize methanol, which releases formaldehyde (used to preserve bodies), formic acid (found in the stings of bees and ants) and ethanol, all of which are toxic. In the process, these form acetaldehyde, a poison and carcinogen. This is relatively quickly turned into acetate, then finally into CO2 and H20.
Most of the alcohol you drink is broken down in the liver, into energy plus acetaldehyde, which at one C atom longer than formaldehyde is even more toxic than alcohol and causes inflammation. Acetaldehyde produces free radicals which damage mitochondrial cells.
It takes about 1.5h for you to process one standard drink.
Alcohol + Drugs
Alcohol + Cocaine: Work together in the body to produce coca-ethylene (CE), a longer-acting form of cocaine that hangs around in the body for hours rather than minutes. And this makes it more toxic to the heart.
BAC: Effect (Neurotransmitters)
.02%: Relaxed, slightly altered mood, slightly warmer (GABA + Endorphins).
.05%: Less inhibition, louder speech, more gesturing, reduced coordination & eye focus (GABA + Serotonin).
.08%: Drunk-driving limit; Loss of coordination, balance, speech, hearing, and reaction times (GABA + Endorphins).
.1%: Slurred speech, reduced reaction times and physical control (GABA + Dopamine).
.15%: Euphoria, coordination reduced so much that you may fall over. Walking and talking become hard. Possibly vomiting (Serotonin + Dopamine + GABA).
.25%: Confusion, stupor, disorientation, loss of pain response. Nausea and vomiting may begin. Hard to stand and walk without help. Blackouts begin (Glutamate block + GABA).
.3-.4%: Possibility of falling unconscious (Glutamate block + GABA).
.4%: Stupor (Glutamate block + GAB).
.5%: Coma: (Glutamate block + GABA).
.6%: Breathing stops, death (Glutamate block + GABA).
Drink: Calories.
Large Glass of Regular Beer: 180cal.
12oz can of regular 5% Beer: 150cal.
5oz Medium Glass of 13% Wine: 130cal.
Glass of Champagne: 110cal.
1.5oz Shot of Spirits: 110cal.
Women: Have a higher % of fat and a lower % of water, and alcohol is diluted in the body’s water content.
Hang Over Cures: Anti-inflammatory medications, beta-blockers, hydration, food (to increase blood sugar), caffeine (coca cola provides carbs, fluids, and caffeine), exercise.
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Liver
Alcohol damages mDNA, particularly in the liver.
Liver Disease: Inflammation (hepatitis); the liver becomes swollen or inflamed; occurs when there are more toxins in the blood than the liver is able to manage.
Stage 1: Hepatic Steatosis (Fatty Liver); the liver gets fatty because it makes fat from the calories in the alcohol and stores it in its cells. If you stop drinking for two weeks, you can reverse fatty liver disease
Stage 2: Liver fibrosis (liver scarring) caused by chronic inflammation. Scarred tissue begins to replace healthy tissue, which reduces liver function and blood flow to the liver.
Stage 3: Cirrhosis; the most serious form of liver damage; occurs when, over decades, the mixture of alcohol and acetaldehyde permeates the tissues of the liver and begins to freeze all the metabolic activity.
In Cirrhosis, the tissues can’t even degenerate because the enzymes that usually digest the dead cells, are killed. In this state, the liver gradually solidifies and liver function is blocked by a fibrous tissue making it harder for blood to flow through it. As most of the blood from your gut goes through the liver, it has to go somewhere, so it starts going through little vessels in the walls of the gut and the gullet (esophagus), which start to carry far more blood than they were designed for. These veins get bigger and bulgier. The bulges are called varices and are similar to the bulges found in leg veins when you have varicose veins.
As Cirrhosis develops, your alcohol tolerance disappears because it can no longer metabolize the alcohol. That’s when you start to get drunk on small amounts of alcohol.
A small study by the UK’s leading alcohol and liver disease expert, Professor Nick Sheron, found that a third of patients with severe alcohol-induced liver damage had never even considered that they were drinking abnormally. They met the criteria for excessive drinking without ever having realized it.
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Cancer
Alcohol leads to cancer via two primary routes:
Acute toxic effect of alcohol on the skin of your mouth and gullet, where it burns and damages the tissue. This chronic inflammation leads to cancer through changes in DNA.
The production in cells of free radicals, which can lead to DNA damage that promotes cancer.
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Heart
Even light to moderate drinking raises your risk of cardiac arrythmia (irregular heartbeat), which may make you feel faint and short of breath.
Cardiac Arrythmia: Irregular heartbeat; even light to moderate drinking raises your risk, which may make you feel faint and short of breath.
Cardiomyopathy: Damage to the heart in which the heart muscle becomes less efficient, less powerful at pumping blood. Over years, alcoholism can lead to heart failure.
Hypertension: High blood pressure; alcohol is also the leading preventable cause of hypertension.
It seems the effect on blood pressure is reversible if you stop drinking. In one study, 13 out of 18 heavy drinkers saw their blood pressure return to normal levels after one month of abstinence. However, if you’re a heavy drinker, you’ll need to cut down slowly rather than cut it out immediately, or you may get a rebound effect of very high blood pressure from the noradrenaline surge that comes with withdrawal.
If you drink two or fewer drinks (24g of alcohol) per day, you’ll see no significant effect on blood pressure from drinking less (2017 Lancet Study).
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Brain
There are several reasons for the impact of alcohol on the brain. There’s the direct neurotoxic effect of the alcohol itself. There are indirect effects, such as the increased risk of stroke, diabetes, and hypertension. All of these raise the risk of Dementia.
Dementia: The leading preventable causes of dementia are head injury and the damage alcohol does to the brain. It’s thought at least 1:5 cases of dementia is probably due to alcohol.
Korsakoff’s Syndrome: A person who has lost the ability to lay down new memories. It’s usually found in very heavy drinkers, and it’s caused by a combination of excess alcohol and vitamin B1 (thiamine) deficiency damaging a key part of the brain that’s vital for laying down new memories.
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Pancreas
Alcohol inflames the pancreas, the main function of which is to secrete digestive enzymes into the small intestine. Once the pancreas is damaged by alcohol, it starts to digest itself, which is very painful. This effect is dose related, and usually happens after 10-20y of drinking.
Pancreas: Secretes digestive enzymes into the small intestines.
Pancreatitis: Damage to the pancreas which can lead to insulin-dependent diabetes.
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Stomach
Gastric Reflux: Occurs when the sphincter between your esophagus and stomach opens when you lie down at night, resulting in stomach acid entering your esophagus and burning it. Common in alcohol drinkers.
Stomach Ulcers: Caused by helicobacter. Alcohol makes it easier for the bacteria to absorb in the stomach lining.
Alcohol can impair the absorption of nutrients in the small intestine. Particularly for vitamin B1, the malabsorption of which leads to brain damage. It may also affect uptake or absorption of folic acid, thiamine, B12, Zn, and Se.
Leaky Gut: Occurs when the protective membrane of the gut wall becomes more permeable, allowing toxic substances produced by the gut bacteria into the blood; risk increases with alcohol use.
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Mental Health
One of the most common mental health issues linked with drinking is anxiety, followed by depression.
Regular, chronic alcohol use affects the serotonin system, disrupting the brain in the direction of low mood.
Impulsive people- possibly diagnosed with ADHD or an impulse control disorder—may be more vulnerable to abusing alcohol.
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Hormones
Endocrine System: The network of brain and nerve cells and secretory glands producing chemical messengers that interact with one another and affect all of the body and the brain.
Hormones: Set the background level of most functions in the body. They are the most important homeostatic regulators, keeping our body running smoothly hour to hour and day to day. Includes reproductive hormones, thyroid hormones, growth hormones, stress hormones, and many more.
Ghrelin: A hormone produced by the stomach to make you hungry and thirsty; it’s been shown to induce craving for alcohol as well as food.
Leptin: A hormone produced by the stomach when you are satiated.
Corticotrophin (CRF)-Releasing Hormone: A hormone released by the hypothalamus that travels in the blood down a special set of veins to the pituitary gland, releasing another hormone called Adreno-Cortico-Trophic-Hormone (ACTH), which travels through the bloodstream to the adrenals and prompts them to release the stress hormone, cortisol.
Prolactin: A hormone that promotes milk production. Although drinking does increase prolactin, beer’s effect on milk production is more likely to be due to the barley extract it contains—which explains why nonalcoholic beer has been shown to work just as well.
If you were wondering how much alcohol gets into breast milk, a study has shown that it is 5–6 percent of the dose the mother receives, a very low amount.
Hypothalamic-Pituitary-Adrenal (HPA) Axis: The main system where hormones are produced and interact. The HPA produce hormones that control the stress response.
Adrenal Glands: Sit atop the kidneys; release the stress hormones adrenaline and noradrenaline; the hormones that make your heart pump faster, make you feel alert and hyperactive.
Pituitary Gland: Sits just under the brain, in the middle of the head at the back of the eyes; the master gland of the endocrine system that controls most hormones.
Stress: The noradrenaline/adrenaline and cortisol systems work together to provide a coordinated response to stress. The first part of the stress response happens immediately; then, over the next minutes and hours, cortisol rises. If you drink every day, and thus turn on that system repeatedly every morning as you go into mini withdrawal, you’re pushing yourself toward high blood pressure. You always have to have some cortisol in your blood to keep you alive, but if it gets too high, tissue damage occurs. Too much cortisol is like taking steroids: it alters your ability to metabolize sugar, so it also pushes you to diabetes.
Testosterone: Alcohol lowers testosterone and increases levels of an enzyme that breaks it down and turns it into estrogen.
Acetaldehyde: Produced in the liver when alcohol is broken down; impairs the production of an enzyme that’s key for testosterone synthesis.
Feminization: Partly due to a drop in Insulin derived growth factor (IGF1) which leads to less muscle, less testosterone, and less sperm.
Fetal Alcohol Spectrum Disorders (FASD): A range of mental and physical problems caused by exposure to alcohol during pregnancy. As a poison, alcohol crosses the placenta and goes into the developing fetus, potentially causing a huge range of lifelong issues.
No level of consumption is safe, but the risk goes up particularly at ~28g (~two standard drinks per week).
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Skin
Alcohol causes dehydration, which not only makes your skin look less plump, but also makes dark eye bags more visible because it dilates blood vessels (vasodilation). This is also why drinking often leads to spider veins and to rosacea, which looks like flushing and redness on the cheeks.
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Sleep
Sleep
Alcohol puts you to sleep faster and into a deeper sleep more quickly too. However, alcohol disturbs REM sleep. Research suggests you’d have to drink 2+ drinks to disrupt your sleep significantly.
Snoring: A sign of an obstruction in the air going in and out of your lungs; can develop into sleep apnea.
Drinking makes snoring worse because alcohol relaxes your muscles, including those of your pharynx and palate, the soft tissues at the back of your mouth and in your throat.
Sleep Apnea: A condition in which the airways collapse making it difficult to get air into or out of your lungs. It deprives your brain of O, leading to hypoxia. Each hypoxic episode lasts 20-30 seconds until your brain gets so stressed that it fires off a massive fight-or-flight response, forcing you to take an abrupt breath that opens your airways for a few minutes, until you go back into a deeper level of sleep.
Tx: Use of a Continuous Positive Airway Pressure (CPAP) machine to keep the airways open.
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Addiction
Most people drink to relax rather than to get high and so don’t understand addiction.
Five Categories of Drinkers (UK Dept of Health):
Nondrinker.
Low-risk Drinker: Consumes 10 drinks or less weekly.
Hazardous Drinker (Moderate-Risk): Consumes 10-20 drinks per week (<30 for men). These people are probably not dependent physically, although they may be psychologically.
Harmful Drinker (High-Risk): Consumes 20+ drinks per week for women, 30+ for men. A pattern of alcohol consumption that’s causing mental or physical damage.
Dependent Drinker: Typically has a strong desire to drink and difficulties controlling its use. Continues to drink despite harmful consequences.
Addiction: A behavioral disorder underpinned by changes in the brain, which leads to continued use of a drug or substance in the face of problems such as withdrawal, and that your use of that substance interferes with your family and social life and causes you personal harms.
Dependence: Physical withdrawal reaction from a substance.
It’s when people start to drink to get rid of the symptoms of withdrawal that the downward spiral into alcohol dependence begins.
Tolerance: Adaptation of the body to the effects of a substance, so it’s prepared for it and you can drink more without being impaired.
As your brain gets tolerant to the increased levels of GABA, it’s also becoming sensitized to the increased dopamine and endorphins.
Brain circuits that underpin addiction:
Reward Circuit: That hit of dopamine or endorphins you get when you drink.
Memory Circuit: How you remember that alcohol is rewarding.
Drive (Motive) Circuit: The area that makes you want to eat, drink, and have sex.
Conscious Mind Circuit: Overrides the frontal cortex, remembering the great time you had and makes you forget your hangover.
During a detox, you are transferred from alcohol to another drug, usually the benzodiazepine Valium or Librium. Then, over the course of a week, the medication is reduced slowly, allowing your brain to adapt and recover.
Patterns of Alcoholism:
Young Men with a family history of alcoholism (a history of alcoholism leaves you 3-4x more likely to become an alcoholic).
You don’t just inherit alcoholism; in many cases, you inherit one or more of the various different traits that make it more likely you’ll be addicted, for example, impulsivity or conduct disorder.
People who drink to deal with the problems in their lives; generally, anxiety, depression, or stress. They tend to turn to alcohol for self-medication from their 30s onward.
Why People Drink:
Social: Drinking mainly to celebrate and have fun.
Conformity: Drinking to fit in.
Enhancement: Drinking because it’s exciting; craving the feeling of being drunk.
Coping: Drinking to forget your worries.
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Treatment
Psychiatric Treatments for Addiction
Acamprosate (Campral): An anti-glutamate drug, which reduces cravings for alcohol and possibly also symptoms of withdrawal.
Disulfiram (Antabuse): An alcohol treatment that blocks ALDH.
Nalmefene (Selincro): Reduces alcohol consumption in people who binge drink by reducing the pleasure of alcohol; approved in Europe, but not the USA.
Disulfiram (Antabuse): An alcohol treatment that blocks ALDH; a form of aversion therapy that makes people vomit, flush, and feel very ill with chest pain and a fast heartbeat when they drink, by blocking an enzyme needed for the body to process alcohol.
Naltrexone: Designed to reduce relapse in abstinence; works by blocking the endorphin system which removes the pleasure of drinking and can help people avoid a full relapse (also used to treat opioid misuse).
Sodium Oxybate (Alcover): Used recreationally as GHB; stops people from drinking in addition to reducing symptoms of withdrawal.
Discovered in Italy by a pharmacologist, Professor Gian Luigi Gessa. He bred a strain of rat called the Sardinian alcohol-preferring rat, then looked for drugs that would stop them from preferring alcohol. He first showed that sodium oxybate stopped rats from drinking as well as prevented them from having withdrawal symptoms, then demonstrated that the same happened in humans.
Baclofen: Works on the GABA system; used as a treatment for alcohol.
Discovered in the 1960s as a treatment for alcohol by famous French-American cardiologist Dr. Olivier Ameisen, an alcoholic who wanted to treat his own illness. When he started to take baclofen, which works on the GABA system, he found he was able to stop drinking.
Psychological Treatments for Addiction: The most common reason behind someone ending up in treatment is that they’ve lost something: their job, partner, kids, or their liberty. People often only make the decision that they want to change when their life reaches crisis point
Alcoholics Anonymous (AA).
Motivational Interviewing.
Cognitive Behavioral Therapy (CBT).
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Alcohol & Social Benefits
Of all the recreational substances we take, perhaps with the exception of ecstasy, alcohol creates the greatest sense of sociability.
There is some evidence to say alcohol can help you be creative. The psychological theory behind this is, alcohol stops you from focusing well and cuts down your working memory. And so, it widens the scope of things you have in mind, and, by doing this, allows you to think out of the box.
Benefits we get from addictive substances:
Hedonistic: Pleasure.
Identity: Allows an individual to socialize and be part of a group.
Auto-therapeutic: Soothes internal suffering and tension.
Economic: The value of production, sales, consumption, and so on, to society.
Social: Helps maintain social balance.
Cultural: Used for celebrations and social rituals.
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Alcohol & Children
Among high school students, during the past 30 days: 30% drank some amount of alcohol, 14% binge drank, 6% drove after drinking alcohol, and 17% rode with a driver who had been drinking alcohol (US Surgeon’s 2017 Youth Risk Behavior Survey).
Alcohol affects the development of bones and hormones, as well as the brain and other organs.
In Europe, 44% of 15-19yo drink Alcohol.
The earlier your child drinks, the more likely they will have problems with alcohol later in life.
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Sensible Drinking
Standard Drink Sizes in the USA: The measurement used to count alcohol consumption; 14g pure alcohol, equivalent to ~12oz beer (5%), 8oz malt liquor (7%), 5oz wine (12%), 1.5oz shot (40%).
Moderate Drinking: RECOMMENDED; no more than 1 standard drink a day for women and 2 for men.
Excessive Drinking: In a single occasion, 4+ drinks for women, 5+ for men.
SENSIBLE DRINKING RULES
Don’t drink when you’re thirsty.
Never allow anyone to top up your glass.
Say no to champagne.
Don’t wash down food with wine.
Refuse aperitifs.
Only have two drinks.
Aim never to get drunk.
Never have one for the road.
Volunteer to drive.
Take a week off drinking.
Helps reset your tolerance so you’ll need less booze to get the same effect.
Only buy booze as needed.
Adopt a curfew.
Alternate your drinks with water.
Don’t get alcohol delivered.
Buy expensive alcohol.
Find low- and no-alcohol drinks you like.
Find new activities.
Book in drink-free days.
Don’t pregame.
Don’t drink at home.
Don’t drink alone.
Don’t mindlessly drink (i.e., in front of a screen).
Don’t buy alcohol at the supermarket.
Avoid cheap alcohol.
Make sure you’re hydrated.
Enjoy what you drink.
Think of it as a delicious treat.
Never buy a wine box.
Never open a second bottle.
Don’t eat salty snacks.
Treat your stress first.
Count before you go out.
Practice saying “no, thank you.”
Talk to your doctor.
Surround yourself with nondrinkers.
Go out later.
No shots or cocktails.
Drink half a drink per hour.
On average, you process around two thirds of a standard drink an hour.
Get an app (DrinkCoach or the Global Drug Survey Drinks Meter).
Don’t drink at lunchtime.
Don’t drink on an empty stomach.
Schedule an early morning event.
Don’t use energy drinks as mixers.
Buy the third round.
Know your number.
Make your intake target two standard drinks a day or fewer.
Take pride in lowering your number.
Take two drink-free days per week.
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Misc Quotes
“Never drink ’til the sun is over the yardarm”: A British naval saying intended to stop people from drinking before noon.
“A 2011 study called the US state prison system the nation’s largest mental health institution.”
“China now consumes half of the trillion-dollar-a-year global alcohol market.”
“There’s a positive relationship between alcohol and exercise: that is, exercisers are more likely to be moderate drinkers and vice versa.”
“It provokes the desire, but it takes away the performance; therefore, much drink may be said to be an equivocator with lechery: it makes him, and it mars him; it sets him on, and it takes him off.”-Macduff in Shakespeare’s Macbeth.
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Terminology
Alcohol Dehydrogenase (ADH): An enzyme produced in the human body that metabolizes methanol releasing formaldehyde (which is used to preserve bodies) and formic acid (found in the stings of bees and ants) in the process, both of which are highly toxic, and ethanol, forming acetaldehyde, a poison and carcinogen. This is relatively quickly turned into acetate, then finally into CO2 and H20.
Alcohol: Derived from the Arabic al-kuhl, meaning ‘body-eating spirit’.
Alcohol Flushing Reaction: Redness of the cheeks and face when drinking alcohol; impacts ~70% of East Asians (Japanese, Chinese, Taiwanese, Korean) and 5% of European ethnic groups.
Aldehyde Dehydrogenase (ALDH): An enzyme that slows down the breakdown of the alcohol by-product acetaldehyde.
Anesthesia: Targets the brains GABA and Glutamate neurotransmitters. An anesthetic you’d have for a minor op would switch on GABA to put you to sleep. And for a major one, it’d switch off glutamate, which keeps you awake and alive.
Attention Deficit Hyperactive Disorder (ADHD): Thought to occur because the top-down control of behavior from the brain’s frontal cortex isn’t sufficient to control the bottom-up drives and impulses. This failure of control may be because the dopamine and noradrenaline systems in the frontal cortex haven’t developed adequately. That’s why the most effective treatments for ADHD are medicines that enhance dopamine function (e.g., amphetamines or Ritalin [methylphenidate]) or those that increase noradrenaline activity (e.g., Strattera [atomoxetine]). The other main treatment is CBT. This helps the person strengthen their frontal control regions and also learn ways to limit their urges.
Binge Drinking: A pattern of alcohol consumption that bring the BAC to .08% or more in a relatively short time; corresponds to 5+ drinks on a single occasion for men and 4+ drinks for women, generally within ~2h (CDC).
Bulimia: An eating disorder that involves binge eating followed by fasting and/or purging.
Congeners: Complex alcohols formed during the storage or “aging” process of liquor.
Drinkers Regret: Regret following a night of impulsive behavior and lack of judgement due to alcohol.
Epigenetic: Changes at the level of gene expression.
Ethanol (C2H5OH): The Most abundant alcohol in liquor. During fermentation, the glucose in the raw ingredients breaks down mostly into ethanol which is a carcinogen, a teratogen, and toxic to many body organs.
Free Radicals: Destructive elements that damage protein and DNA.
Oxidative Stress: Damage to the DNA caused by free radicals.
Mead: An alcoholic-like beverage fermented from honey.
Meow Meow: An Israeli drug originally created for controlling aphids.
Mitochondria: Energy-producing machines in every cell.
Narcolepsy: Inability to sleep due to deficiency in the neuromodulator, orexin.
Rapid Eye Movement (REM): A sleep stage where you dream and the brain consolidates memories.
Sleeping Beauty Syndrome (Kleine–Levin Syndrome- KLS): A rare neurological disorder where people, usually teenagers or young adults, fall asleep for 3-4 days at time.
Whole Genome Analysis: Measures changes in all the genes in the body.
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Chronology
1981: An accurate breathalyzer is first released to law enforcement agencies.-Drink by Nutt.
1967: The .08% BAC drinking/driving limit is first set. At this BAC, experts knew that people driving were under “significant impairment.”-Drink by Nutt.
1740: British Admiral Edward Vernon splits the rum ration into twice a day and decrees that it must be diluted 4x with water. His nickname was ‘Old Grog’. Later on, in an attempt to prevent scurvy, lime or lemon juice was added to the ration.-Drink by Nutt.
Early 1700s: Each naval man >18yo got half a pint of over 50% pure rum each day. The sailors’ way to prove it was of that strength was by seeing if gunpowder soaked in rum would still burn. This is where the term “percent proof” came from. As a pint taken all at once made most sailors too drunk.-Drink by Nutt.
~900: Spirits are first distilled from wine, probably in Arabia.-Drink by Nutt.
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