What Happens After Dry January? with Dr. Robert Brown

Episode Transcript

Faith: Welcome to Health Matters from NewYork-Presbyterian. I’m Faith Salie.

Many people started off the new year committing to a dry January. But what happens once the month is over?  How should we approach alcohol in February and beyond?

Whether you’re having a dry January or a damp January, Dr. Robert Brown, the chief of gastroenterology and hepatology at NewYork-Presbyterian and Weill Cornell Medicine, explains why being mindful of our alcohol consumption has many health benefits, and how we can sustain it.

Faith: Dr. Robert Brown. Thank you so much for joining us.

Dr. Brown: Oh, thank you for having me. This is going to be fun.

Faith: So we find ourselves in January, it’s the right time to have a sober but lively conversation about Dry January with you. What are the health benefits of participating in Dry January? And, of course, not necessarily January, but any month off from drinking. What’s going to happen to our bodies?

Dr. Brown: Well, I think it’s important to know that if you are drinking intermittently and socially, you don’t have anything to fear. Now there may be a benefit to taking a month off from alcohol. They are empty calories. There are benefits in terms of your weight and maybe a chance to eat something different, save money, whatever else, but where the real benefits I think of Dry January is, is it is a time to reflect on each person’s relationship to alcohol. Alcohol is an addictive substance and it is a mind altering substance and if we are going to use any of those, it shouldn’t be in control of our life. That’s when you start thinking about alcohol use disorder and addiction.

If you’re having trouble with the idea of Dry January, you likely need Dry January. And more for the effect of resetting your relationship to alcohol.

Faith: You know, there was a University of Sussex study, almost three quarters of the people who took part said they slept better. And had more energy when they gave up drinking. 86 percent saved money. And, hey, 54 percent reported better skin. So, who doesn’t want all those things?

Dr. Brown: As someone who likes to religiously track my sleep on a wearable device, I notice even a small amount of alcohol affects my heart rate during my sleep. My sleep becomes more fractured, I think even the process of thinking about do I need Dry January would force people to think about what is the role of alcohol, which is ubiquitous in our society.

If you go to a party and someone’s not drinking, your first thought is like, what’s wrong with them? You know, if they’re not pregnant, there’s got to be something wrong. And I think we have to get away from that. And you can have a healthy relationship to alcohol, and you can have an unhealthy relationship to alcohol.

And for those in that latter group, Dry January is a chance to get back to either a healthy attitude to alcohol or recognize that you can’t have a healthy attitude to alcohol, in which case abstinence is the only answer.

Faith: Are there overall nutritional benefits or, or metabolism benefits?

Dr. Brown: Alcohol has no real nutritious value. It’s carbohydrates. It has no protein. It has no good fats. And so reducing carbohydrate intake always has a beneficial effect. When I advise my people with liver disease on liver health, I always stress that diet is critically important and that a healthy diet for the liver is a low, but not no, low carbohydrate, low simple sugar diet with good fats — those are, you know, your unsaturated fats like olive oil and avocado. And protein that is mostly plant protein, less saturated fats, but good protein. And if you think about where alcohol is in that paradigm, it’s in the simple sugars. And so whether you’re drinking a skinny margarita or not, those are a lot of empty calories and if you can cut them out, great!

Faith: I also imagine if one chooses to participate in Dry January, there might be an increasing mindfulness around all the things you’re putting in your body, right? If you’re not reaching for a sort of ritual glass of wine, you might be thinking, Oh, what do I really crave right now? And what could my body need?

Dr. Brown: This could be your modification to Dry January is that you’re going to replace that drink with yoga or exercise or something that is actually positive on our health and then you’d have a win-win.

Faith: That’s a great idea. Do you have other specific tips for someone giving up alcohol for a month?

Dr. Brown: Try to think about what are going to be your alternate activities. And that varies person to person. You know, similar to when we approach people who need to lose weight for medical reasons. The approach is going to be different for different people. And that’s part of the reason we often fail as physicians or anyone advising patients, because it’s not one size fits all. The approach to the snacker is different than the approach to the person who has large portion sizes. And so, similar for people who drink, the approach to the binge drinker is different than the approach to someone who drinks every day to moderate or, or severe excess.

So for the binge drinker, you know, who goes out on Friday and Saturday night, to a bar and maybe you’re not going to go to a bar, you’re going to choose a different place to go on the weekends or get out of town and go hiking. Or if you think you can’t do that, well what is going to be your alternate drink that you’re going to drink? Are you going to ask for a club soda with a lime so that people don’t ask questions? Because there is a stigma. We have a stigma around people who have alcohol use disorder, or alcohol related liver disease, or liver disease in general, which is all blamed on alcohol. We also have a stigma around people who don’t drink.

And so, if what I tell my patients, if what you need to do is walk around with a club soda with a lime, no one’s gonna ask you questions.

Faith: Bring your little umbrella, right?

Dr. Brown: Right, but remember, some of those, tonic water has a lot of calories, so we don’t want to replace it with other sugared beverages if we can. But, um, yes, if you need a little umbrella, I’m all in. Who doesn’t love that little umbrella?

Faith: You know, you mentioned the social stigma. Who’s gonna support you in this endeavor, right? Whom do you want to enroll? Probably not your number one drinking buddy.

Dr. Brown: Unless you could get your number one drinking buddy to also agree to dry January and then we could help each other. So maybe instead of going to our local bar on Friday night, we’re gonna play chess. Play ping-pong. Whatever you’re gonna do, find an alternate activity that the two of you can do together.

I find so many people who’ve had an unhealthy relationship to alcohol, when they finally stop, they say, ah, you know, I was looking at life through a haze, and now I actually enjoy other people’s company more, and I can’t imagine they don’t enjoy your company more.

You need to be supportive and positive.

Faith: How can someone manage cravings and the desire to drink during this time?

Dr. Brown: There are effective medical treatments some which are specifically used for cravings and others which have been shown to reduce cravings that are alternate medications. So, for example, naltrexone, which we use for opiate use disorder, decreases cravings for alcohol.

We’re seeing that many of these so called GLP 1 drugs that are all in the news like semaglutide and terzepatide also seem to decrease alcohol cravings as they decrease food cravings.

Faith: Street name Ozempic, right?

Dr. Brown: Yes, Ozempic and the other drugs in those classes, and some medications that are used to treat depression can also reduce alcohol cravings, maybe because the depression is driving the alcohol cravings.

Faith: Do you have to take those medicines long term? Like, you know, like we take blood pressure medicine if you’re using it to combat alcohol craving?

Dr. Brown: I think if you have true addiction, you may need them long term, but I think if they’re linked with therapy and insight, eventually many people can come off. There is a physical addiction to alcohol, but much of it is psychological. And so, if you look at medications alone, they work.

Therapy alone, it works. Medications plus therapy, much better. And so I do think people can get to a point where they don’t need medications long term. If as long as we approach this as we should, as a medical illness, not a character flaw, weakness, a bad habit. If you need a medication, you take a medication.

Faith: And, and what if you fall off the wagon, as they say? It’s January 17th and you just have a drink of something. Can you, can you just call it a dryish January? A drier January? What should you do?

Dr. Brown: This really depends on whether you have a true alcohol use disorder. I would say if you have a problem, a slip is a slip and you just have to keep it from becoming a fall. So many people become disillusioned when they have a problem. I like to remind my patients that the people who successfully quit smoking, this doesn’t include the people who don’t successfully quit, the average times it takes before they successfully quit is three, which means that for every person who quit smoking on the first time, there’s someone who’s taking five or more and that’s among the successful people.

Those that don’t succeed. It’s many more. So the goal is really to move the ball down the field, to make progress and to either reduce or eliminate. And so if your intention was, I, you know, I go out every weekend and I drink six drinks on Saturday and six drinks on Sunday, and during the week I drink nothing.

And if you get to a Saturday in January and you have one drink and you don’t have any tendency to drink more, you may have achieved your goals for dry January. And don’t beat yourself up. If that one drink, the next week is two drinks, and the next week is three drinks. Then, you should recognize that you’re not gonna solve this problem with a month. You’re gonna need to solve this problem with something more. What are my goals, not for January, but for February?

And do I have a roadmap that when the end of dry January comes, February, I’m going to have a healthy relationship to alcohol, whether that healthy relationship is zero or staying under those safe limits because I can.

Faith: So when January is over, or your 30, 31 days is up, how do you reintroduce alcohol?

Dr. Brown: For people who don’t have a problem, what I say is, you know, keep it to one and keep it to special occasions. And if you do that, you still have wiggle room on the one. And two, every day is not a special occasion. Otherwise, it’s not special. It’s just every day, right? Yes, every day is special, but the truth is that, I don’t think that most of us need to be everyday drinkers.

Faith: Say you go out to dinner and you order a bottle of wine, it sounds like you don’t think, oh god, I paid for this, I gotta finish the bottle.

Dr. Brown: No, and you shouldn’t think that at all. I would say the same thing goes for that ginormous steak that comes. You know, we have this need to finish. Well, split it with more ways. If it’s just my wife and I, we won’t order a bottle. We’ll drink wine by the glass. I won’t order a bottle of wine unless there’s at least three or four of us.

Just the way I am, because I know there’s that temptation to finish the bottle. And my wife will not drink more than one. And so that will leave me with four. That’s probably not good for me.

Faith: Because the question is, at that point, really, what’s more valuable, right? Is it your money? Or…

Dr. Brown: …my health. And for me, it’s my health. I think if you do everything in moderation, you’re gonna be healthy. You don’t see me running a marathon, but I don’t sit still. And I like to have an occasional glass of wine, but I don’t drink to excess.

Faith: So, after a month of abstinence, a dry January, Does returning to alcohol in, in any amount, does it undo the benefits that we’ve done for our body and our liver?

Dr. Brown: If you return to excess alcohol, it will undo. You can imagine you you’ve set the clock back, but you’ve only set the clock back a month. And so you’re going to very rapidly undo any health benefits if you return to a problematic drinking level. But if you return to a lower drinking level, you’ll get not only the benefits of that month of none and the healing of your liver that occurs in that, but you’ll do less damage moving forward.

And you’re ordering that bottle of wine, you’re like, ‘Hmm, maybe just I’ll order it by the glass.’ If you get to that point, then I think you’ve made forward progress in your health.

Faith: Lastly, how can someone use their Dry January experience to develop healthy long term habits with alcohol?

Dr. Brown: Sometimes you don’t notice something until it’s not there, if you are in your Dry January period, I think it’s a good time to think about why I was drinking and when I was drinking, and when February comes, how am I gonna do differently so that I have a healthier relationship to alcohol.

For people who have addiction, it may be avoiding people who are pushing you down the wrong path if they’re not able to be supportive. Um, we know that for people with alcohol use disorder, social supports, positive reinforcement, alternate activities, all promote a longer relapse free period.

If you think about what you’re doing, why you’re doing it, what you want to do better, and how you’re going to do better, I think you will come out of Dry January a healthier person, and with a more mindful approach to alcohol. And if you use that in all your things you want to improve your health about, it probably would work more broadly.

Faith: Dr. Brown, you’re like the Ted Lasso of hepatologists. Your bio says you’re a physician scientist, but I feel like there’s life coach thrown in there, too. I like talking to you. You get me fired up to drink sparkling water,

Dr. Brown: There you go, if I’ve helped one person find a healthier approach to alcohol, we’ve, we’ve had a good day. And, uh, you know, I love Ted Lasso.

Faith: This has been far from a dry conversation. I am so grateful to get to talk to you, Dr. Brown. Thank you so much for joining us.

Dr. Brown: Maybe we’ll have a cocktail in February, but only one.

Faith: Exactly. You bring the umbrellas.

Dr. Brown: There you go.

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

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