Is Any Amount of Alcohol Safe for My Health? with Dr. Robert Brown

Episode Transcript

Faith: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

Recent surveys have shown that more than 60% of Americans are alcohol drinkers. But is there such a thing as a safe amount of alcohol? How does alcohol impact your health?

This week, I’m joined by the Chief of Gastroenterology and Hepatology at NewYork-Presbyterian and Weill Cornell Medicine, Dr. Robert Brown. He helps to explain the risks associated with consuming excessive alcohol and gives recommended intakes for men and women.

Faith: Hello, Dr. Brown!

Dr. Brown: Hey there.

Faith: Thanks for joining us once again. Last time you were here on Health Matters we spoke about Dry January, and the many, many positive impacts we experience when we stop drinking for a month. This time, I want to dive a little deeper into the effects of alcohol on our livers. But first – can you kind of give us a general idea about recommended intakes for men and women when it comes to alcohol consumption?

Dr. Brown: So, I think it’s important to know that no amount of alcohol use is healthy. That being said, unlike cigarettes, there is an accepted safe limit to alcohol intake. And that’s generally viewed as about one drink per day for women, and two drinks per day for men.

And it is important to know what a drink is. Right? You know, you see those cartoons, I only drink one drink per day and the glass is bigger than your head. So I like to start with, well, beer is the easiest. A standard beer, it’s 12 ounces. Malt liquor would be less because it’s stronger. 

For wine, it’s four to five ounces. And so, there are five glasses in a bottle. So if you and your partner are splitting one bottle, one of you is drinking too much. 

And then for spirits, which is often the hardest, it’s an ounce and a half or one shot, standard shot glass, of hard liquor. And that’s harder to do because in many bars in New York City and elsewhere, when you order a cocktail, there may be two or three drinks in that cocktail, even though you’re only ordering one. 

Faith:  Wow.

Dr. Brown: And this has to do with metabolism, because you can metabolize alcohol safely at a certain rate, and when you exceed your ability to metabolize, that’s when liver damage can occur. And so part of it is amount, and of course part of it is time. And there are other risk factors that increase the likelihood of liver damage. But in general, if you stay below those safe limits, you can enjoy having a drink with your friends or your family, without terrible worry. But you can recognize how easy it is to exceed those limits.

And for people who have a problem, who develop tolerance to alcohol, to the psychoactive effects of alcohol, the loss of inhibitions, the sedating aspects of it, they don’t really develop as much tolerance to the toxic effects. And so then the pattern of drinking can then escalate into a dangerous mode.

Faith: Dr. Brown, you said the L word – liver. So can you elaborate on what happens specifically to our livers?

Dr. Brown: So, the liver is the center of attention when it comes to damage from alcohol, though alcohol can affect many organs in your body, including the brain, the red blood cells, even your heart. But, because alcohol is metabolized in the liver, it’s the one that’s gonna lay itself down to protect the rest of you. And it is where most of the damage occurs. And if we think about alcohol related deaths in the United States, about half of them are due to liver disease. The other half – also preventable, are due to traffic accidents and other things that people do that are dangerous when they’re intoxicated.

When you drink too much alcohol, the first thing that happens is strangely enough, it deposits fat in the liver. The alcohol gets turned into fat in the liver, if you want to think of it in the simplest term. And that fat can damage the liver cells. And when that damage occurs, there’s inflammation. So, first there’s inflammation. And that’s reversible. The fat and the inflammation, you stop drinking, it goes away.

Faith: Well, that’s good news!

Dr. Brown: That is. Over time, anything that inflames an organ leads to scarring, so you can think of it as the body trying to contain inflammation, which it always really thinks about as a foreign invader. If you’re inflamed, it usually was, if you think about ancient man, due to an infection, you wall it off with scar tissue. So, if your liver is inflamed from any cause, you’re gonna lay down scar tissue, and that scar tissue, when it becomes more advanced, distorts the liver and its function, and when it gets to that point, we call it cirrhosis. So cirrhosis is from the Latin cirrhus, which is scarring, and that is the advanced stage of scarring of the liver, and it is the scarring that causes the problem in the liver.

Faith: Can cirrhosis be reversed with a cessation of drinking?

Dr. Brown: Yes. At its very advanced stage, you probably do get to a point of no return, but as long as your liver is functioning normally, if people stop drinking, I tell all of my patients, if you stop now, you will be able to live out your life with the liver that God gave you. Your liver will stabilize or improve to a point that you can actually live the rest of your life even with some scarring of your liver, as long as it’s not too advanced.

Faith: Our livers sound very valiant. They’re our first line of defense, and they sound actually very hearty.

Dr. Brown: Being a liver doctor, of course, I think of the liver as the most noble of organs!

Faith:  Obviously – don’t tell the others! [laughs]

Dr. Brown: [laughs] And so, everything that you eat, everything you put in your mouth that goes into your intestine goes first to the liver. And so, the liver is your barrier to entry and determines what’s healthy and what’s not healthy, processes your food and says, food is good, we’re gonna build the building blocks of your body. Bacteria, toxins, viruses – no good. We’re gonna get rid of them and that barrier function that the liver does is why it’s so essential, but also why it tends to be among the first to be, um, in the line of fire when bad things come into your body, whether those are infections or toxins. You know, the only other way into your body is obviously breathing in, or through your skin.

Faith: Are there any other health risks associated with regular alcohol consumption that you want to outline for us that don’t necessarily focus on the liver?

Dr. Brown: Excessive alcohol use can affect all organs of the body. We worry most about the effects on the brain over time. Significant alcohol use can lead to actual dementia-like illness in its heaviest states, and in its acute form, almost psychosis-like state.

And these are worsened if alcohol is replacing calories and people are malnourished. So vitamin deficiencies, particularly in thiamine, can lead to a worsening of the mental effects of alcohol. Excessive alcohol is also toxic to the heart and there is an alcohol related cardiomyopathy or heart disease related to heavy alcohol use.

It suppresses the formation of healthy red blood cells. And it can affect reproductive organs too, particularly in men, where it leads to loss of testosterone. That’s why men who drink excessively can develop bigger breasts, smaller testicles, and lose their fertility.

Faith: Ah, ok. And so what about women? Will you explain to me why women are at a greater risk from alcohol consumption?

Dr. Brown: It- it really has to do with size, mostly, probably some genetic differences in metabolism that are hormonally based, but most of it is size related. The bigger you are, the bigger your liver is also, the more you can metabolize. So much of the gender differences are size based, but there is clearly other factors that lead women to be more prone to alcohol related liver injury.

And certainly when we look at alcohol-related liver disease, it is rising at the highest rate in women. Though men still have more liver disease and more alcohol-related liver disease than women because the consumption still hasn’t been matched.

Faith: And so a woman would metabolize the alcohol more slowly, right? If her liver is smaller?

Dr. Brown: Yes.

Faith: Okay, now that you’ve reframed my whole appreciation for the liver, I really see why it deserves reverence!

Dr. Brown: You’re preaching to the choir!

Faith: Thank you so much for joining us.

Dr. Brown: You too. Take care.

Faith: Our many thanks to Dr. Robert Brown. I’m Faith Salie.

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Dr. Brown: I am the Chief of Gastroenterology and Hepatology here at Weill Cornell Medicine in New York, New York.

Faith: So close to being a herpetologist. Just, just a few letters off!

Dr. Brown: Yes, and that is an issue because I – I like snakes. And fortunately, eventually the spell checker stopped changing my “hepatologist” to “herpetologist” every time I wrote it. But I, I wanted to be a veterinarian initially, so I guess herpetologist –

Faith: Did you?

Dr. Brown: -is not so bad! Yes, I did.

Faith: A herpetologist also studies amphibians, which are, you know, cuter, slimier.

Dr. Brown: Yep, I guess I could be broad in the reptile and amphibian world.