Should I Take a Break from Alcohol? with Dr. Robert Brown

Courtney: At a party I went to over the holidays, I asked a few questions about alcohol—and it was interesting to hear how ideas about drinking are changing.

Courtney: Do you feel like there is an expectation to drink alcohol at social gatherings like this?

Guest 1: Yes I do, and I feel like it’s because in conversations everybody tends to be holding a drink in their hand and you want something to do, you want to feel included.

Courtney: Do you have any questions about alcohol, drinking habits?

Guest 2: Is there any amount of alcohol that is either tolerable, or in some respects, some have even said, like, maybe it’s beneficial?

Guest 3: The advice I used to hear was like drink in moderation and now I hear health experts are saying any amount of alcohol is actually really bad for you.

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

For lots of people, having an alcoholic drink is a natural part of any social gathering. Yet study after study has shown that no amount of alcohol is good for us. And with the news that the Surgeon General is calling for alcohol to have warning labels for cancer risk, it raises the question: how should we think about alcohol, especially as we kick off a new year?

To find out, we talked to Dr. Robert Brown, chief of gastroenterology and hepatology at NewYork-Presbyterian and Weill Cornell Medicine. He joined us last year on the show to explain the impact of alcohol on the body. And he was the perfect expert to check in with to learn about what studies are finding about the link between alcohol and cancer, and the dangers of binge drinking.

Courtney: Dr. Brown, thank you so much for coming back on the show.

Dr. Robert Brown: Oh, it’s my pleasure, Courtney. Great to be back.

Courtney: So, to start, what do we currently know about the effects of alcohol on the body? I feel like just more and more comes out about it’s not so good.

Dr. Robert Brown: Yeah, I think that in many ways we paid a price of the story that maybe a small amount of wine, particularly red wine, might be actually beneficial for your health.

And that has been later shown to be untrue. That perhaps it was people who were drinking a small amount of wine who are just healthier people. But that there is no true beneficial effect of alcohol on our life. And that alcohol affects many organs in our body, not just our liver, but our heart, our brain, our metabolism, the pancreas, multitude of organs.

But that there are probably safe limits that one can stay under and not worry about the adverse health impact.

Courtney: What are those limits?

Dr. Robert Brown: The limits are really one per four hour time period for women and two for men. And I think if people stay within those limits, their worry is really small. So how I put that in context for my patients is if you and your partner are sharing a bottle of wine each night, which has five glasses — the glasses are measured in four to five ounce glasses — one of you is exceeding the safe limit. And, more importantly, you cannot save, you can’t bank your safe limit and then do seven on Saturday. But, you know, to me, if you’re out on a social engagement, you know, you can go through one or two, depending on the number of hours, and whether a man or a woman, and still, in my mind, have equal enjoyment to having two to three. And if you aren’t, then it’s time for introspection.

Courtney: Mm hmm.

Dr. Robert Brown: Really into what brings you pleasure in this world? And to me, you should be able to have pleasure without having to be impaired or intoxicated.

Courtney: You mentioned how it affects all different organs.

Something I thought was really interesting is the role of alcohol in cancer. We read that the American Cancer Society lists alcohol as the third leading modifiable risk factor for cancer, after tobacco use and excess weight. So can you elaborate on the role of alcohol and cancer?

Dr. Robert Brown: We’ve known for a long time that alcohol is connected to several cancers. Alcohol leads to cirrhosis and cirrhosis is the major risk factor for primary liver cancer.

But alcohol is also related to other cancers, particularly when in combination with smoking. So we see a strong correlation between alcohol, smoking, and esophageal cancer. Alcohol also increases the risk of pancreatic cancer, which is one of the most deadly cancers. And many other cancers. And so if we think about modifiable risks of cancer, you know, stopping smoking and quitting drinking are there.

And so many patients have regrets when it’s too late.

Courtney: Yeah.

Dr. Robert Brown: You know, if I had known I never would have. And it’s better to think proactively and say, I want to do the things that I can do that will reduce my risk down the road.

Courtney: Absolutely. Can you elaborate a bit on how it affects the brain or any other organs?

Dr. Robert Brown: Its effect on the brain is more subtle and over time, but it can be linked to dementia and loss of brain function. And then it’s also toxic to the heart. And that has sort of two functions that can disturb the rhythm of the heart and lead to what we call atrial fibrillation, can lead to, you know, what we call a dilated cardiomyopathy or a heart that doesn’t function well and heart failure.

And its impact on the pancreas increases the risk of pancreatitis or inflammation of the pancreas over time of diabetes, and insufficiency of the pancreas, which can lead to both chronic pain as well as maldigestion, where you can’t digest your foods properly. But, oftentimes what happens is alcohol replaces other calories in healthy foods and can lead to vitamin deficiencies, inadequate protein intake, because this is all carbohydrate calories, and muscle wasting. Alcohol also affects hormone levels, low testosterone, furthering muscle mass loss which then increases the risk of being insulin resistant and gets you into a cycle where poor nutrition begets poor nutrition.

Courtney: What about younger people? Do you see any of these health conditions you’re talking about happening to younger people as a result of drinking?

Dr. Robert Brown: Well, you know, there are two problems you could have with drinking. One is from long term overuse, and the second is from binge drinking.

And so in young people, we see the adverse effects of binge drinking. And there is a form of liver injury that can happen, you know, in a relatively short period of time from excessive binge drinking where their liver does get sick. We call that acute alcohol related hepatitis and they can become jaundiced or yellow and get really sick and even need a liver transplant.

And that happens in their twenties, thirties, or young forties. But binge drinking is also very, you know, detrimental to people’s health.

Courtney: Can you talk a little about how professional advice has evolved and what’s the current advice for alcohol consumption?

Dr. Robert Brown: So when I ask my patients, I don’t start with, do you drink?

I ask, how much do you drink? You know, in an average week? And they, most people don’t have a good answer. And then I just try to give them random numbers. Is it 10 drinks a week? Is it 20? Is it 30? If they’re not balking at 30, you know, you’re in a problematic range. If they say, well, it isn’t 10, then, you know, this isn’t an issue.

Courtney: Right.

Dr. Robert Brown: And the second question that is generally recommended from the National Institute of Alcohol is how many times a year do you drink more than four for women or five for men? And that would be a trigger that there’s probably an issue and then you can get to more detailed questions.

We have to get away from this all or none approach and say, how can we get to a safe level of drinking in a time period? And for someone with an addiction, the safe amount may only be zero. But for many people, they can get from a higher level to a lower, safer level because it’s not a true addiction. It’s actually a habit.

Courtney: Can you share your thoughts on how drinking culture shapes people’s perception of alcohol?

Dr. Robert Brown:  Well, I think it normalizes it.

Courtney: Yeah.

Dr. Robert Brown: And I think it normalizes even excessive drinking, you know, it’s not just the wine culture, it’s the boozy brunch. If you’re at one of these functions and someone’s not drinking the first question, of course, is are they pregnant?

Courtney: Right.

Dr. Robert Brown: And then if they’re not pregnant, then what’s the problem?

Courtney: Right.

Dr. Robert Brown: And I think we have to get away from that. It’s okay to not drink, and it’s okay to drink in moderation, and yet we put more negative energy into the people who don’t drink than into the people who drink to excess.

Courtney: Yeah. And I wonder what that’s about. Cause even when I’ve had friends who quit drinking, I mean, I’ve admired them. Like I’m like, that’s really cool. You know, I want to try that.

Dr. Robert Brown: Yes. Except the first statement that many people have is: They must have had a problem. Right? And it’s not that, you know, if people go gluten free, no one assumes they had a problem.

Courtney: Right.

Dr. Robert Brown: That’s just cool. And it’s going to make you healthy.

Courtney: Yeah. So, could you share what inspired your work on alcohol’s impact on health? Why is this topic important to you?

Dr. Robert Brown: Well, as a liver disease doctor, we see the effects of alcohol every day in our clinical practice.

And I was struck by a few things. And this goes all the way back to my training. One was how variable alcohol was in its impact on people’s health. I hear from all my patients, well, I have friends who drink more than I do. And that may be true. You know, why did alcohol affect some people’s health more than others?

But then the second aspect was why alcohol was so acceptable in our society and yet addiction or an alcohol use disorder was so stigmatized in our society?

If you have Diabetes, nobody blames you. They feel bad for you. And yet if you have problematic drinking or any addiction, there is an enormous amount of blame, both self blame and external blame.

And both of those blames adversely affect the ability of people to get well because they tend to lie or misrepresent what they’re doing. And two, they tend to avoid care.

Courtney: So for someone who might be feeling pressure to drink, what advice do you have for them?

Dr. Robert Brown: Well, I think you have to decide where that pressure is coming from. Is it really coming from the outside? Or is it how you are perceiving the outside?

Courtney: Yeah.

Dr. Robert Brown: You know, if you chose not to do it, would your friends really leave you? If the answer is yes, they’re terrible friends.

Courtney: Yeah.

Dr. Robert Brown: But usually the answer is no. Oftentimes, yes, there is pressure, but it is our, you know, taking in of that pressure and our desire to fit in that is really what the lesion is. I think there will also be people who say, you know, that’s really cool.

Courtney: It’ll be interesting to see how people reframe their relationship with alcohol.

Dr. Robert Brown: Yeah!

Courtney: Thank you, Dr. Brown.

Dr. Robert Brown: Let’s do it again soon. This was fun.

Courtney: Our many thanks to Dr. Robert Brown. I’m Courtney Allison.

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