Hey, it's your friend Mel, and welcome to the Mel Robbins podcast.
Now, I don't know if you've heard this or not, but the Surgeon General, who is basically America's doctor, just put out an advisory saying alcohol is the leading preventable cause of cancer, and that all alcoholic drinks should have a cancer warning label on them, just like cigarettes do.
Wow. So if you've ever felt curious about cutting back, or you've been worried about someone you love and they're drinking.
This episode today, it's for you.
Because today, one of the world's most renowned medical experts on how alcohol impacts your body, brain, and health is here in our Boston studios.
And here's what I love about her.
She is brilliant. She's a researcher.
She treats patients.
She's practical and zero judgment.
She is here to share the science and to help you make the best decisions for your health.
So whether you're questioning your own drinking habits like I am, or you're worried about someone you love, or you're just curious, this conversation is dedicated to you.
Because there is no doubt in my mind, it's going to change how you think about alcohol and what it does to your body, brain, and your health forever.
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I am so excited that you're here.
You know, it's always such an honor to spend time with you and to be together.
And I also wanted to say, if you're brand new, welcome to the Mel Robbins Podcast family.
And you know, because you made time to hit play and to listen to this particular episode, here's what I know about you.
You're the type of person who not only values your time, but you're also interested in learning about ways that you can improve your life and your health.
And I think that's really cool.
And by the way, if you're someone who hit play because someone that you love shared this episode with you, that's a beautiful thing because our expert today is world -renowned.
And so the person that shared this episode with you, they wanted you to have the benefit of being able to learn from her.
And that's just amazing because today's episode is going to help you understand what alcohol does to your body, brain, and health.
And what you're about to learn, it could change your life or the life of somebody that you care about.
So I just want to thank you.
Thank you for listening to this.
Thank you for sharing this.
Now, there's a couple of reasons why I wanted to have this conversation with you today.
First of all, for me personally, I have been thinking a lot about my relationship with alcohol.
In fact, I've been thinking about it for years.
And one of the reasons why it's been on my mind is because my husband, Chris, he basically doesn't drink.
I mean, he'll occasionally have a bourbon on the rocks, but that's it.
But for me, alcohol has been a huge part of my life socially for as long as I can remember.
And even though I've been cutting back, it's become just a way that I turn my brain off after work.
And here's the thing.
I'm a super conscientious and healthy person.
So on one hand, I don't do a lot of, quote, bad things.
I don't have a lot of bad habits.
So I've kind of given myself a little bit of slack when it comes to alcohol, because I'm like, God, like, you don't really do a lot of bad things, Mel, so what's the big deal?
But on the other hand, I'm like, if you care about longevity in your health, and you care about your brain, Mel, why are you not cutting back?
Maybe you're thinking these same things too.
Another reason why I want to have this conversation is sober curious is on the rise.
Every single year, more and more people participate in dry January, or at least they talk about doing it.
But the truth is, as much as I may be kind of kidding around a little bit, alcohol, your relationship to alcohol, what it actually does to your brain, your body, your health, it's not really something to joke about because I think we all know it's not good for you, but it just is fun and it tastes good
and it's a great stress reliever and it's always a part of every celebration.
And even as I was talking about the fact that we were going to be having a conversation about this today with our team, somebody said, yeah, and it helps you sleep.
And I was like, yeah, it kind of knocks you out, but does it help you sleep?
The other reason why I want to talk about it is because the subject of alcohol and your health, it is all over the news right now.
Here in the United States, the Surgeon General, who is basically America's doctor, just put out this advisory report.
It has this warning, and in it he says, alcohol is the leading preventable cause of cancer.
And you want to know something?
I had spent 55 years of my life not knowing that there was a link between alcohol and cancer.
How did I not know that?
That's probably why the Surgeon General's now talking about it.
In fact, the Surgeon General says that all alcoholic drinks, based on the research, should have a cancer label warning on them, just like cigarettes do.
And so now, of course, that the report is out, everybody is talking about, every news organization is writing about.
This warning from the Surgeon General, holy cow, it has struck a nerve everywhere, and it's taking the internet by storm.
If you haven't seen the articles that are flying all over the place, well, you're going to now.
And the articles have titles like this.
I like to drink. Do I have to feel bad about alcohol now?
How much alcohol does it take to raise your cancer risk?
Alcohol warnings won't make me quit, but a little moderation wouldn't hurt.
Those kind of hit home, don't they?
Don't you want the answers to those questions?
We're going to talk about all of it today.
And on a more personal note, you know, I've already shared this, but one of my own goals this year is to drink less.
And what do I mean by that.
What I mean is I don't want to drink during the week.
Like on the weekends, that's fine.
But during the week, I got to stop reaching for a gin and tonic or a tequila on the rocks or a glass of wine when work ends as a way to turn off my brain.
So let me ask you a quick question.
Before I tell you about Dr.
Wakeman, I want you to consider this.
Think about your relationship to alcohol.
Do you think you may be drinking a little too much?
Have you ever thought about cutting back?
Because I know you're listening to this because you're interested in understanding more about how alcohol impacts your body, your brain, and your health.
And so I really want you to think about yourself and your goals and your life.
And here's a question I'm going to ask you to consider as you're listening to Dr.
Wakeman. For years, one of the reasons why I didn't cut back on my drinking is because I always felt like I was going to miss out on something by not drinking.
Now I'm wondering, what am I missing out on because I am drinking?
Just stop and consider that.
What are you missing out on because of your drinking?
A better night's sleep?
More focus? Being more energized and present in your life?
Feeling better? Getting better results?
Achieving your goals?
Maybe that's what we're all missing out on.
And that's exactly what Dr.
Sarah Wakeman is going to tell you.
and you're gonna love her.
She's gonna give you the science so you can make the call for yourself about you and your relationship to alcohol and having the facts about how alcohol impacts your health, your body, and your brain, that's what's gonna empower you.
And look, I thought about, why don't I just have a brand new conversation on the podcast today in light of what the Surgeon General said?
And then I thought, well, wait a minute.
Last year, Dr. Sarah Wakeman was here and that conversation was life -altering.
not only for me, but for the millions of you that listened to it.
I started drinking a lot less and now I feel so much better.
And even though I drink less, I'm wondering, should I cut back even more?
And I'll tell you what, as I consider that question, what am I missing out on because of the drinking?
I knew I needed to hear this information again because Dr.
Wakeman is the best of the best of the best.
This is an exceptional resource for you.
And if you happen to have the chance to hear or watch this last year, trust me, you need to spend time with Dr.
Sarah Wakeman again, and so do I.
And here's why. Because where you are in your life right now is very different than where you were last year.
And maybe right now you've got some massive goals.
Maybe you're going through a major change or a huge tragedy.
Maybe you're in the middle of reinventing yourself or you're starting a bold, new, amazing chapter.
So this is the perfect time for you to ask yourself this question.
What are you missing out on because of your drinking?
And how could changing your relationship with alcohol support you in being happier, healthier, and achieving your goals this year?
I cannot wait for you and I to dig into this episode again.
So let me introduce you to the incredible Dr.
Sarah Wakeman. She is one of the most renowned medical experts in the entire world.
Dr. Wakeman is the senior medical director of substance use disorder at Harvard's Mass General Brigham Hospital here in Boston, which has been ranked as the number one research hospital in the entire world.
After studying at Brown University, Dr.
Wakeman did her residency at Mass General, which is the best program in the country, where she was also the chief resident, which means she was the number one medical resident in her class.
She is an associate professor of medicine at Harvard Medical School, and the program director of Mass General Addiction Medicine Fellowship.
And she took time out of her extraordinarily busy schedule to come to our Boston studios for one reason, to give you and the people that you love the facts, the science, and the research, so that you can make an informed decision about the role that alcohol plays in your life and how it is impacting
your brain, your body, and your health.
So without further ado, please help me welcome Dr.
Sarah Wakeman to the Mel Robbins podcast.
I'm so excited to be here.
Thanks for having me.
Well, thank you for taking the time out because I know you have an unbelievably busy schedule.
So let's just jump right into it.
So Dr. Wakeman, can you explain what even is alcohol and how does it affect our bodies?
Sure, so alcohol is a molecule.
It's a water -soluble molecule that is readily absorbed in your body through your stomach and your small intestine when you drink it.
And it affects all different parts of your body and body systems, in particular your brain, which is why we feel the effects of alcohol pretty soon after you start drinking.
And we can talk through what those effects are, but it impacts our behavior, our sleep, our mood, and many other parts of our body system.
You talked about alcohol as a molecule.
That sounds very science -y to me.
so what kind of molecule is it is it you know like is it a poison is it like could you explain more about the makeup of what it actually is yes i mean the way alcohol that we drink happens is through a process called fermentation so something that has sugar like grape juice or you think about beer you
know barley or potatoes or other often starches are fermented and in that transformation process, they form an alcohol molecule that then has a different effect on our body.
Alcohol is found in all sorts of different things.
So obviously it's intentionally made through fermentation to ingest, but we also use it in cleaning products or like rubbing alcohol or mouthwash, hand sanitizer.
So there are alcohols all around us and used for many different things.
Huh. Well, when you say the category cleaning, hand sanitizer, rubbing alcohol, thinking about uses in a hospital and then I put that in the same family as something you would ingest in a cocktail.
Is it the same molecule?
It is. And in fact, some of my patients with the most severe forms of alcohol use disorder will drink hand sanitizer or rubbing alcohol or mouth wash if they can't get regular alcohol, which tells you really the power of addiction once someone gets to that level of severity.
But it's the same molecule with the same effect.
I just already had something that I learned that is if you're watching us on YouTube, you can you can see that my mouth is a gape.
I don't know why I never connected the dots on that, that it is actually the same chemical.
Exactly. The actual alcohol molecule that we think of in a fancy, you know, cosmopolitan is not different from what's in rubbing alcohol, let's say.
I never knew that. I think that's an indication of just how much we engage in it and don't really think about what we're doing.
Absolutely. I mean, it is so socialized and a part of culture and a part of celebrations and events that I think it just feels like a part of life.
Are there negative impacts to having like a beer or a glass of wine every night?
I mean, how does that impact you?
Yeah. So this is probably the most fascinating area of research where things have changed and gone back and forth over many decades of science.
And it's actually a somewhat tricky question to answer, which is why I think there've been very confusing sometimes in conflicting studies about this.
So if you want to try to understand what is the impact of low risk drinking, moderate drinking, higher risk drinking, you have to figure out how do you study that.
So you need to follow population over time to see what happens.
And then you need to figure out how do we isolate the effect of alcohol?
And so early on, there were lots of studies showing that low risk drinking or moderate drinking were actually healthy.
I think I remember something about like a glass of red wine is really good for you, the antioxidants.
I don't know if that's the red wine lobby telling us that.
One criticism of those studies showing that low risk drinking is healthy is that the group that is often used as sort of the comparison group are people that don't drink at all.
But it turns out that many people who don't drink at all may not be drinking because they have chronic health problems or because they actually used to have an alcohol use disorder and they're now in remission or recovery and they may have health consequences that are leading to higher mortality compared
to people who are drinking at a low risk or infrequent level.
So a lot of the newer studies have actually used infrequent drinkers as the sort of control group or the comparison group and I think that's really helpful to understand the data that way.
There is a really big study actually this year that looked at hundreds of thousands of people that had been surveyed since the 1990s all the way through the mid -2000s and did a really elegant job of trying to answer this question.
And the things they did differently than other studies is first, they controlled for other healthy behaviors, lifestyle behaviors, chronic conditions.
Because one question is, a person who's drinking a glass of wine a day, maybe they're also running every day and doing other sort of health -promoting behaviors.
And maybe that person who's chosen not to drink at all has lung cancer, and that's the reason they're not drinking.
And so they actually controlled for all of that.
And they did see that in the low -risk category, there seemed to be a slight decrease in mortality.
And it was not true for cancer.
So any amount of alcohol is associated with an increased cancer risk.
And that's a really important thing to know, especially if someone has a personal family history of cancer.
Breast cancer is one that's strongly associated with alcohol use.
And so factoring that in as you're making your decisions about alcohol is really important.
What is it about the molecule of alcohol that increases your risk for cancer?
You know, it's different for every type of cancer.
And I think we're just starting to understand this.
If you take breast cancer, things that seem to increase hormone levels are often associated with a risk of cancer.
So that's an area of active research to understand why alcohol and breast cancer in particular are so closely linked.
Other types of cancer, it's a little more clear.
They tend to be cancers of the liver or the gut that are strongly associated with alcohol.
And that makes sense if you think of alcohol as a potential poison going into your gut, being metabolized by your liver, causing changes there.
That's an area that we do see a lot of cancer risk.
Can you talk about what you're seeing as it relates to alcohol and liver failure or just how it's impacting people's livers?
Yeah, so one of the main health harms from alcohol, especially heavy alcohol use, is liver damage.
And so what we see happen is this progression where the first thing that happens is inflammation of the liver.
And when your liver gets inflamed, you start getting fat deposit in the liver.
So the first kind of step is what we sometimes call fatty liver.
So it's fat deposition in your liver.
And that actually can totally reverse if you stop drinking or you make changes.
And that's the amazing thing with the liver.
It's a really regenerative organ.
So you could cut 80 % of someone's liver out and they would be okay.
But there is a point where you cross the threshold where you can no longer repair the damage.
And that's when you get to a stage called cirrhosis.
So from fat deposition, then you start getting scarring.
Your body lays down all this scar tissue because of the chronic inflammation in your liver.
And when your liver becomes so scarred that it's really stiff and starts not functioning well, that's cirrhosis.
And we often used to think of cirrhosis as something that happened to people like decades down the road.
I'm seeing people in their early 30s with cirrhosis in the hospital.
And I think those are like some of the most heartbreaking cases because people thought like this wasn't on their bingo card.
they did not even think this was a concern.
They were drinking heavily.
They thought their social circle was doing the same thing.
And then all of a sudden, they're in their late 20s, early 30s in the hospital and liver failure.
And there's very little we can do at that point other than an organ transplant, which is a huge deal and not something that's accessible to everyone.
Is this something that you're seeing happening increase at a younger and younger age?
Yeah. And there's actually a lot of studies showing this.
So between 2010 and 2020, there's been a significant increase in alcohol -related liver failure, especially amongst women and younger and younger people.
And even just after the onset of COVID, we saw somewhere around a 25 % increase in alcohol -related death after the onset of the pandemic.
So the pandemic was hard for many reasons, but it certainly increased alcohol use across the country and with that liver disease and liver failure.
Wow. How does alcohol impact the kidneys?
So alcohol, one of the main effects that people have probably experienced is it makes your kidneys less sensitive to a hormone your body produces called ADH or antidiuretic hormone.
And so you pee more.
So if anyone's ever noticed that when they drink, they sort of pee a lot more.
And it's not because you're hydrated, because that's what I thought is why you pee more is because, oh, I just have more liquid in me.
But it's actually because it's blocking a hormone.
Exactly. So even irrespective of how much volume you've drank, you pee more because of this blocking of the effect of a normal hormone function in your kidney.
And so that can lead to dehydration, which is one of the many reasons you feel really crummy the next day because you get dehydrated from drinking.
What about the gut microbiome?
We're learning so much about the importance of healthy gut.
How does alcohol impact that?
Yeah, so alcohol, I think there's growing research on how it impacts the microbiome.
Certainly, again, at heavy levels, it seems to harm the microbiome.
And we see this in patients with liver disease, but also just the impact of alcohol itself.
The kind of two main things it does, one is it creates more leakage in your gut.
So people may have heard of kind of leaky gut.
You know, the walls of your intestine become more porous so that things that aren't meant to come out of your intestine do and can actually cross the blood -brain barrier.
So this whole idea of kind of the brain -gut axis is a really growing area of research and knowledge.
So alcohol can do that.
It can also change the makeup of your microbiome itself, as can high fat, high sugar, white flour, sort of the Western diet.
But there's now a lot of studies showing that some of the modifiable things, if you want to improve your gut health, are decreasing your alcohol consumption and steering away from that kind of Western diet of high fat, high sugar, high carb.
You know, I'm sitting here listening to you and I'm thinking, why the hell do I even drink this stuff?
Yeah, I think it is important to understand sort of what are the risks that we often don't talk about and assume that this is a harmless thing that's just a part of life.
My personal perspective is that every health behavior exists on a spectrum and it's really important to understand sort of what is that spectrum?
Where do I fall? And then what are my personal health goals?
And actually stopping to sort of think, how does alcohol fit in my life?
Like, what do I like about it?
What do I not like about it?
What am I worried about it?
What is this amount of alcohol doing to my health?
Is there any health benefit to drinking alcohol?
My opinion is that we shouldn't be thinking of it as a health benefit.
So I would never as a doctor say to a patient, I think you should start drinking a glass of wine a day for your health.
People used to say that, you know, again, this idea of a glass of red wine is healthy.
I think that framing is wrong.
I think that doesn't mean that you can't drink any alcohol and we should talk through that.
But thinking of as a health promoting behavior is probably not the best way to frame it.
Now, there are many things we do in life that the safest thing would be to do none of it.
So if your goal is to have zero risk, you should probably never drive your car, never go skiing, you know, never fly in an airplane, never eat bacon, never go out in the sun.
And people aren't going to live that way.
So I think it's really important to understand sort of what are the risks?
How does this fit into my overall life?
And when should I be concerned?
And how can I actually make changes to decrease those risks?
So if you're finding that you are really stressed in your life and you're reaching alcohol as a stress reliever, it's probably not going to be a healthy way of coping with that and may lead to longer term problems.
And especially if you're trying to live a life where you're being more mindful or more present or present for your kids or your partner, or, you know, you're trying to get in shape and you want to wake up in the morning to exercise.
If you're drinking every night, you're probably going to feel not refreshed in the morning.
You're going to notice it, you know, you don't have the same exercise capacity.
So I think just figuring out sort of how this ritual alcohol, what role it plays in your life.
And it doesn't have to be that you stop drinking entirely.
And I think that's a really important message because that may not be the goal for people.
But if you are feeling like maybe this is causing some problems to me, maybe this is actually counterproductive to my other health goals, making some changes, cutting back, taking a break, those are all really healthy ways that you can start to really explore your relationship with alcohol.
Yeah. You know, I love the fact that you are a specialist in addiction and you have a very realistic approach.
Because I do agree with you that it does feel like it's either you're all in or you're all out.
And I think for a lot of people, it is scary to feel like there's only one option, which is you either drink or you don't.
And for many people, not drinking at all is the absolute empowering option.
But I love what you're saying, which is you need to wake up and understand what your motivators are and what you actually care about in this moment in your life.
And if you care about producing more at work or being more present or reaching your potential, you gotta look at the role that alcohol is playing in your life.
So from a medical perspective, how much drinking is too much drinking?
Yeah, so from a research standpoint, high -risk drinking would be if you're having more than 10 ounces of hard alcohol a week or 35 ounces of wine in a week for a woman or for anyone over 65.
So above that, we start seeing health risks like increased risk of dementia, impact on your liver, your digestive tract, and other serious conditions.
You know, I'm just sitting here thinking about you as a physician and a researcher and how I think a lot of us lie to our doctors about how much we're actually drinking and that we're not even aware of what the serving size truly is because when a lot of make a cocktail at home it's like glug glug glug
glug glug and there's three shots right there yeah or you've had a number of big glasses of wine which basically mean you have had all seven glasses of wine in one night and thinking oh oh I've just had a couple glasses but I bet as you are seeing somebody get a scan there's probably times where you're
like yeah that's somebody that has is a very heavy drinker because I can see it on the brain yeah and I think there's so many important points buried in that.
So first, we all lie.
I tell my dentist I floss every day.
I don't. We want people to like us and approve of us.
So I sort of expect people will lie to me, especially if they don't know me.
And for most people, because of the tremendous stigma around substance use disorder, there's a lot of shame and worry.
For many people, their experience has not been that good things happen to them when they share that they're having a problem with alcohol or other drugs.
And so as a doctor, I feel like it's on me to earn someone's trust and also to educate them.
I mean, there's nothing more heartbreaking to me than when I see someone in the terminal stages of liver failure, for example, from alcohol.
And no one has told them beforehand what the risks are, that this could happen, what sort of lower risk drinking looks like.
They've often never had that conversation.
So we'll see people in their 30s come in.
They literally die during that hospital admission.
And you look back and they had touch points with doctors.
They maybe were drinking heavily and no one stopped to sort of talk to them about it.
And I think that is a real testament to how in the medical system for so long we have seen substance use and addiction as something separate from the rest of health care is sort of not our job or a behavioral issue or a moral issue or a willpower issue.
But this is a health condition like any other.
And I think the medical system and doctors need to get comfortable talking to patients about it, asking them the right questions, giving them the right education and partnering with people around making healthy changes.
When you sit with somebody that comes into your practice, how do you help them figure out their relationship with alcohol?
Like, what are a list of symptoms that you would say, these are all indications that this could be a problem?
Yeah, that's a great question.
So I'll run through kind of the checklist that I'm thinking when I'm talking to someone about alcohol.
So first, you know, understanding how much they're drinking, just the general quantity and how frequently is important as sort of a proxy for what their risk might be.
But then the really important questions are, are they drinking more than they want to?
So they may have set an intention for themselves and they're finding they're actually always drinking more or spending more time on drinking or recovering from drinking than they intended.
Have they tried to make changes and not been able to?
So have you tried to cut back or tried to stop and you actually weren't able to?
That's a really important sign that you may have lost control of your drinking.
Are you drinking despite the fact that people in your life are worried about it or your spouse's expressed concern or it's impacting your work or your ability to function in roles that matter to you?
Are you drinking despite the fact that it actually makes you more anxious or it's worsening your mental or physical health in some way?
And then we often think about craving, which is sort of a strong psychological urge to want to drink.
So you can't get the idea of having a drink out of your mind.
That's something that we can see with alcohol use disorder.
And then there are two physical symptoms, which is that idea of like, do you need to drink more to get the same effects?
Do you need to drink four drinks now, whereas before one or two would give you that effect?
And do you feel sick if you stop drinking?
So that's sort of the checklist we run through and I think really gets at those kind of general areas of losing control, using compulsively, using despite consequences and then craving.
That was so helpful.
And one of the things that really resonated with me is that you've tried to quit.
You drink more than you want.
You feel anxious and yet you continue to do it.
And you're in this cycle of wishing you could get control over this and yet feeling like you can't.
And yet if you aren't stumbling around at night or you feel like i am able to like carry on a conversation i'm not getting behind the wheel of a car there's this assumption that it is under control but i love how you just defined it because you're you're making us really look at ourselves and ask ourselves
the honest question which is it really and even just that question are you drinking more than you want to be drinking?
If you answer that question honestly, and whether you're listening right now for yourself or you're listening for somebody that you love that you're concerned about, this is an amazing starting point because we're not bickering about how much you're drinking.
We're not bickering about your behavior.
We're really talking about the honest answer to what is your relationship to it?
And do you actually have control over your ability to use it or not use it.
And that is powerful.
Now, Dr. Wakeman, where I want to pivot to next is I'm starting to see this picture where as a researcher and a renowned expert on this topic that you are talking about kind of the big risks that can happen.
I want to focus a little bit on amplifying the day -to -day impact that most of us are not present to.
That we reach for the alcohol at night because at least in my own experience, it's like an easy lever to pull to say to my brain, we're no longer working.
This is the thing that I do as my ritual to move into the evening, to have a glass of wine, but we don't really understand what's happening and how it's actually impacting your experience of your life day -to -day.
I wanna take a quick pause so we can hear a word from our sponsors.
And I also want to remind you that if you're worried about somebody, send them this episode right now as you're listening to our sponsors, because oftentimes they can't hear it from you.
But hearing it from somebody like Dr.
Wakeman, who has such a balanced approach and is a renowned expert on this topic, it might actually just be the thing that gets somebody to wake up and want to do better.
So I'll be waiting for you after a short word from our sponsors.
Thank you for sharing this with anybody who needs to hear it.
And I'll see you right after the break.
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Welcome back. I'm Mel Robbins and I'm so glad you're here.
Thank you, thank you for sharing this episode with absolutely anybody in your life that you believe needs to hear this.
You and I are spending time today with Harvard's Dr.
Sarah Wakeman. So Dr.
Wakeman, can you explain to us what are some of the other day -to -day things that people experience when they drink that they might not realize is related to drinking?
Yeah, it's a great question.
So one really common thing is worsened acid reflux.
So if you have heartburn, that's strongly associated with alcohol, which actually relaxes the part of your esophagus that allows acid to come back up.
So oftentimes people who are struggling with terrible heartburn, and they don't realize that those two glasses of wine are probably having a direct impact on that.
Other things, we know that alcohol can make you dehydrated.
So you may notice that your skin changes.
It impacts how you sleep.
So you may feel less rested when you wake up in the morning or wake up in the middle of the night and not be able to fall back asleep.
So lots of little sort of day -to -day ways that alcohol may be impacting your health and your experience.
What are some of the benefits that you would experience almost immediately if you quit drinking entirely or you cut way back?
What kind of health benefit would you experience in your day -to -day life?
Yeah, you'll see a lot of really quick things.
So when you'll sleep better and feel more restored.
You may lose weight.
There's a lot of calories in alcohol.
So if your goal is to lose weight, you're drinking a ton of liquid calories.
So you may find that that's better.
You may find that your exercise capacity goes up because you're resting more and you're not having hangovers and you're able to exercise in a way that feels different.
You may find that you're less irritable and more present for your loved ones, that your mood is actually better over time.
Your skin might look better.
You're less dehydrated.
Your hormones are more regulated so you may have less acne.
So all of those benefits you can often see in a very short time And that can be reinforcing as you decide what you want your long -term goals to look like to really see what life is like with less or without alcohol.
How does alcohol impact the range of women's hormones from estrogen to progesterone to start like all of it?
How does it impact your hormones?
Yeah, this is, I think, an area of growing research and understanding.
And I think people are really interested in sort of drinking during menopause as well.
And what, you know, what are the what what to think about all of that?
But a couple of things, I think many of the symptoms that people experience during menopause, like hot flashes, will be made worse by any amount of alcohol.
Really? Yes, because alcohol dilates your blood vessels.
So you may have experienced if you drink a couple of glasses of wine, you actually feel flushed and warm.
Well, it's just going to amplify the experience you're having during hot flashes.
So if you're trying to not have hot flashes, drinking is going to be your enemy in that because it's just going to make that worse.
Same things like sleep disturbance are really common in menopause.
Mood changes and alcohol may impact all of those.
And it can be a tough cycle because you may be drinking because your mood is actually low and you're having a hard time falling asleep, but then alcohol is actually running counterproductive and making those symptoms worse over the long haul.
Let's talk a little bit about sleep because doesn't alcohol impact your sleep in a very negative way?
Yeah. And people may be surprised to hear that because it makes you fall asleep quicker.
So often people are like, oh, alcohol helps me sleep because I fall asleep so quickly.
But when we think about sleep architecture, there's different cycles to sleep.
People are probably familiar with like REM sleep is that deep, rapid eye movement sleep, but there's different cycles that your body, your brain naturally cycles through in the night.
And the balance of those cycles is really important to get restorative sleep, which is when your body rests and heals.
And what alcohol does is it changes the makeup of those cycles.
So you go more quickly into deep sleep and you have less time in sort of the normal phases of sleep.
And so your sleep architecture is disrupted and you don't get that same restful sleep.
So you may wake up at two in the morning, you know, after you've fallen asleep really quickly, but then you wake up and can't fall back asleep.
Or you may wake up in the morning and just feel not refreshed, even though you were completely asleep very deeply because your brain is not having the time to restore itself the way that it needs to.
I have another question for you, Dr.
Wakeman. Can you walk us through what's happening in your body in terms of what we call a hangover?
So you've had your night out, you've had a bit of alcohol, right?
And you wake up, what is a hangover and what is actually happening in the body as you withdraw from the alcohol?
Yeah, hangover is fascinating and I think people are still trying to understand exactly what is going on.
Sort of loosely defined what we refer to as hangover often is a sort of constellation of symptoms that include headache, feeling anxious, often actually having diminished sort of exercise tolerance.
So you don't have the same aerobic capacity that you did before, feeling irritable.
Those are all sort of symptoms of hangover that people have probably experienced.
There's an older school of thought that actually it was mild alcohol withdrawal.
So withdrawal is when you are drinking so much that when you stop drinking, you actually get symptoms.
Seems like that is likely not the case.
The constellation of symptoms is quite different.
And so the thinking is that it's a combination of really two things.
One is dehydration.
So we already talked about how alcohol make you, you know, make you pee more.
And so you get dehydrated.
And then the other is actually byproducts from the drink that you're drinking itself, Either the breakdown products of alcohol, or there are certain types of liquors and drinks that have other types of molecules, cogeners, that can build up and make you feel even crummier.
For example, clear alcohol tends to cause less of a hangover than dark alcohol, and that's probably because of the other substances that are in it.
But it's really toxic byproducts and dehydration, if I were to sum it up, of what's causing a hangover.
Why is anxiety one of the biggest kind of symptoms of a hangover and alcohol withdrawal?
Yeah, it's probably the effect of these byproducts that then are still impacting the way your body functions, your brain, and it takes a long time for your body to excrete them.
And so, we can see just feeling that really anxious, restless, kind of gross feeling afterwards.
Does alcohol impact cortisol or any of the other kind of hormones that are in your brain that are playing a part in anxiety yeah it does especially over time and so what we see when people have drinking have been drinking over a long time is actually your body starts to adjust because our bodies are very
adaptable so if your body's used to having three or four drinks every night your body's going to start to accommodate to that and so what we see is actually changes in the brain so you see changes in the amount of receptors you have the amount of hormones you have your dopamine levels your stress hormone
levels your brain is actually adapting to the effects of alcohol.
So one thing you may see is that you actually don't get the same effect.
So it used to be that two glasses of wine made you feel a certain way and now you need three or four to feel the same way.
That's a concept called tolerance, that your body is adapting to having that alcohol around all the time and your brain's actually changing.
The reverse of that is if all of a sudden you stop drinking, you're going to feel all out of sorts.
You're going to feel shaky, you may have a headache, you may feel anxious, you may feel nauseous.
And that's because your body's gotten so adapted to always having alcohol on board that it takes time actually for those changes to reset.
Wow. When you really stop and think about the roller coaster, you're putting your brain and your hormones and your body through.
Like it does make you pause.
And that's kind of that's what I wanted to do with this conversation is to make you stop and think about what's actually happening.
Yeah. And the reasons why you reach for it.
Can you talk a little bit about for anybody that's taking prescription drugs for anxiety or depression, the impact that alcohol can have?
Yeah, there's a couple of really important things to know.
First, alcohol itself can cause depression and anxiety.
Even though you feel like in the moment it's helping relieve symptoms, there's actually something called a substance -induced mood disorder where you can get, you can look all the world like you have depression and it's actually caused by using alcohol heavily over time.
So you may, if you're drinking heavily, you may actually be running, you know, working again at cross purposes with your efforts to try to manage your depression or anxiety.
The other thing is there are some types of medications that are really dangerous when they mix with alcohol and anxiety medications in particular, especially any medication that also has sort of a slowing down effect.
So some people take medicines in a class called benzodiazepine.
So things like Xanax or Klonopin or Ativan, those when mixed with alcohol have sort of a combination effect that can actually slow down your breathing, could cause an overdose, could make you very sick, could make you more sort of impaired sooner.
So really important to not mix those medications with alcohol.
How does alcohol compromise your memory?
So alcohol affects all parts of the brain, including the amygdala, which is an area that lays down memory.
And it has complicated actions in the brain.
So it increases sort of more slowing down hormones.
So we think of it as a depressant because it sort of slows you down and relaxes you.
And it decreases more excitatory neurotransmitters.
In the short term, because you're sort of your consciousness is being affected, you won't be making new memories.
Over the long term, heavy alcohol use can actually cause dementia.
It can cause severe memory problems.
There's actually a unique condition that we only see with alcohol generally, where the part of your brain that lays down new memories gets damaged, and people get basically an amnesia syndrome where they can't make new memories.
So they can only remember things from the past, but they're unable to make any new memories.
And that's a very extreme example, but we see it in the hospital and it's really scary when it happens.
What do you see when you look at a brain where somebody's been a heavy drinker versus somebody that's occasional or very light?
We actually see brain damage on people who've had chronic heavy alcohol use over many years.
So if you take a picture of the brain like with a CAT scan or with an MRI, what we describe it as is volume loss.
So normally you want to see a big, healthy, robust brain and as you age and with types of dementia, one thing that we see is the brain starts to shrink.
So like the actual functional parts of the brain are smaller.
We see that process accelerated with heavy alcohol use.
So often take someone who's in their 50s who really shouldn't have volume loss of their brain at that age, but if they've been using alcohol at a very heavy amount for a long time, we'll often see their brain looks like a much older brain because of that shrinking.
And then there are very extreme examples like this rare memory condition where we literally see that part of the brain almost die.
Like you can see it light up that it's been severely impacted.
That's scary. It is really scary.
We have so many listeners around the world who flooded us with questions when we told them that you were going to be here.
And a lot of them are about how to deal with somebody that they love and they're drinking.
Yeah. And so I really want to hear your advice about what specific things you should do and what mistakes we need to avoid when there's somebody in our lives that we're concerned about.
Like, how do you approach this?
What's the best way to bring it up?
What is the worst? And by the way, I want to remind you that if you're thinking about somebody in your life, while the sponsors are talking to you, please share this episode.
Let Dr. Wakeman talk to your loved one.
It could be a life -changing gift for them to hear this.
So thank you in advance for being generous with sharing this with people that you love.
And I'll be waiting for you with Dr.
Wakeman after a short break.
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Welcome back. I'm Mel Robbins, and you and I are here today with Harvard's Dr.
Sarah Wakeman. Dr. Wakeman, I'd love to get your counsel on what you would recommend to somebody if your spouse doesn't think they have a drinking problem, but it's a problem for you.
Yeah, I think these are such important questions.
And one of the greatest tragedies to me around substance use disorder is often family members and the general public have been fed the wrong thing to do.
And so I think it's a great thing to talk about.
First, it's important to define sort of what is an alcohol use disorder because that's sort of what we're getting at.
You know, there's heavy drinking where we're worried about the long -term health effects.
And then there is where alcohol has become a problem in your life.
And really, the definition of an alcohol use disorder is losing control over your drinking, compulsive use of alcohol and using despite consequences.
So if you are continuing to drink despite the fact that your partner has shared that they're really worried about you, or you've started to have problems at work because you're calling out sick, or you're continuing to drink despite health problems related to it.
So your doctor says, you know what?
Your liver tests are elevated.
You really need to cut back on drinking and you continue to drink.
Those are all signs that alcohol has started to play a different role in your life.
About 15 % of the population will have an alcohol use disorder in their life.
So this is a very common health condition, more common than many other conditions we see.
The great news is that it's entirely treatable.
Most people will get well.
I think we often have in our minds that this is like a terrible, stigmatizing, recalcitrant condition that no one ever gets better from.
That is not true. And that notion that this, you know, something to feel hopeless about, I think drives a lot of the stigma and shame.
There is good treatment out there.
People will get well, but they do need care and they need support.
I think the first thing you can do if you're a loved one is just share your worries, not in a way that blames the person, not in a way that's judgmental, but in a loving way, just like you would about anything else with someone's health, that this is what you've observed.
This is why you're worried.
Explore what the person thinks.
And that becomes really important because when it comes to addiction, it really doesn't matter at all why I think someone should make changes to their alcohol use.
The only thing that matters is they think their life will get better in some way.
And so really starting to sort of untangle what are this person's goals and how is alcohol getting in the way of them reaching it, that becomes the work.
And a partner can be a wonderful mirror for that.
I know you're working towards a promotion at work and you mentioned that you had to call it sick twice this week and your boss is frustrated at you.
What do you think about that?
So really exploring it.
And ultimately, you're sort of empowering the person to feel like they can make a change and that you're supporting them, but you're not forcing it on them, which is often what people feel caught up in having to do.
What is the mistake that you see people making?
I think people have heard these notions of tough love, enabling, hitting bottom.
Those are probably the biggest fallacies.
So for people who aren't familiar with those concepts, the idea that tough love is that like you really should make things hard on a person that if sort of consequences pile up, the person will ultimately get better.
Enabling is the idea that you're kind or caring to someone that you're actually hurting them in some way and hitting bottom is this idea that people have to just fall so far and suffer some terrible consequence before they make a change.
Those are all really problematic concepts for a couple of reasons.
So first of all, the definition of alcohol use disorder is not being able to stop despite bad things happening to you.
And many people are drinking because it's a powerful coping mechanism.
And some of the things that put you at risk for an alcohol use disorder are traumatic life experiences, untreated anxiety and depression, not feeling good about yourself.
So having the only people that you sort of love and trust in your life try to cut you down to size and tell you that you're doing something terrible and set some ultimatum is actually not going to help you get well.
None of us make hard changes when we feel threatened or sort of punished or not supported.
We do it when we feel loved and safe and have hope that our life could be better.
And so as a loved one, that's probably the greatest gift you can give to the person.
Now it's complicated because you're impacted by their behavior.
So it's very easy as a provider.
One of the things I love about doing this work, because I've been on the other side and had family members and it's a different experience.
As a doctor, whether or not my patient continues to drink doesn't impact me personally.
I can just be their partner, their champion, work with them.
For families, there are times where the behavior becomes so unsafe that people have to keep themselves safe and set boundaries.
And that's okay. I think the distinction there is that it's not doing it for the person's benefit.
So if you kick someone out of your house, it's not going to necessarily help them get better.
But there may come a time and a place where people need to do that for their own emotional safety or well -being.
But for that human being to help someone get well, and this is where earlier conversations are so important, is to really sort of love and support them and work together on it.
and make sure they find access to good treatment, which is out there and available.
I want to kind of just hover on this point that if somebody's reaching for alcohol and it's become a coping mechanism for dealing with stress or dealing with like a health issue or mental health issue or whatever insecurity, it's terrifying to give up the coping mechanism.
And what do you see when it comes to that psychology of you're somebody whose family is like, you have a problem and we're worried about you and yet it keeps on going.
Like how does shame or that fear that you have of, well, I can't actually get through if I don't have the alcohol or I, it's just easier.
And what's the problem with having a glass of wine or two a night?
Yeah, so many important pieces in there.
I think there's so much stigma in our society about alcohol use disorder and substance use disorder.
And people rightfully so feel really ashamed and secretive.
And sometimes long after they've started to worry about themselves, they're scared to tell anyone else because they think someone will judge them or treat them poorly.
And that stigma and fear of bad treatment or judgment actually keeps people from seeking help for a long time.
I think the other really important piece is that when you're removing something that has played a powerful role in someone's life, you need to fill up those spaces with other things.
I think our sort of Puritan roots as a society we have this idea that like you're doing something bad, you need to just pull yourselves up by your bootstraps and knock it off and white knuckle it.
And in fact, like it should be hard.
You know, that's often our sort of these ideas of tough love and hitting bottom is like, well, you're, you're like I've done something bad and you, you know, you don't have willpower.
So we're going to make it tough on you.
When in fact, like the broader concept is why would someone make changes?
And how is their life going to get better?
And how do we make it easy to make a change?
And so if you think about any change you made in your life, if you set yourself up for success, you're going to be far more likely to be able to make that change.
So if you're suffering from trauma, depression, anxiety, you're not going to be able to just stop drinking without help.
You need help treating the anxiety, depression, trauma, and also treatment for the alcohol use disorder.
That's not because you're weak.
That's not a failing.
And if you're not able to sort of meet your goals with whatever intervention and support you're getting, that's a sign that that support is not enough for you.
So really shifting from this idea that the person is failing to thinking like the system, the treatment, the resources are failing.
And how do we adjust that instead of blaming the human being who's suffering?
I just want to thank you.
I think it's very refreshing because so much that you listen to on this topic is don't drink.
And I kind of expected Dr.
Wakeman, you to come in here and just take your fist and slam it on the counter and talk about the lives ruined from alcohol.
And you might have that experience in your family as you're listening to us.
But what she's saying is you have to understand how somebody is feeling and what's actually going to work to get them to want to see that something else is possible for them.
So Dr. Wakeman, I have another question for you.
A lot of parents writing in about college age kids and binge drinking and 20 somethings that are also drinking too much.
Do you have any scripts or lead -in sentences to even broach this topic?
Because I feel like most of us don't know how to even bring it up.
Yeah, I think ideally it starts young.
Ideally, you're having these conversations very early on with kids in a pragmatic, not in a scare tactic way.
So we know that things like dare, you know, this like, I'm going to scare you into this is what alcohol and drugs do to your brain.
Actually, kids use more drugs after seeing that sort of stuff.
It's not helpful. Kids see right through adults when they're sort of all or nothing about things.
So having these nuanced conversations like you're going to be around friends who are drinking really heavy.
What do you think about that?
What's been your experience?
What are some of the worries you might have about that?
And talking about the very practical risks that are not necessarily like liver failure addiction, which are not going to be resonant for a 19 year old.
But, you know, getting into a situation that doesn't feel safe.
You know, getting into a sexually vulnerable position with someone doing something that you don't want to do.
Missing class the next day.
So talking about sort of relevant, personalized issues that may come up for that kid.
And then importantly, that your child feels safe talking to you.
You know, you want them to feel comfortable coming to you about small things so that they'll come to you about big things.
And so you can share all of this in a way that doesn't feel judgmental, doesn't feel accusatory, really opens the door to ongoing conversations instead of making someone feel sort of, you know, like they're being blamed or judged by their parent.
So for somebody that's never even broached this and alcohol is in the family, like this is a thing that's really triggering for all of us.
Is there a way to break down the conversation just so that the person listening can take from us or, you know, take from this conversation?
All right, I'm going to express my feelings.
Then I'm going to ask them about theirs, because most people get really defensive when you talk about this.
And then that just shuts down the conversation.
Totally. Well, first of all, it is not too late.
You have not failed.
None of us are perfect in this.
These are hard conversations and we haven't learned how to do it.
So it is never too late.
It doesn't matter how many times you've ignored it or had an unproductive conversation.
I think in that moment, probably the most important things you can communicate are, I love you.
I'm worried about you.
I'm here for you. I know that treatment works.
This is how I can support you.
So like many things, you're sort of talking about yourself.
You're talking about your care and concern.
You're rooting everything and how much you love this person.
and you're offering to be a partner and helping them find support and treatment.
And it may not happen that day.
It usually doesn't.
So often the journey to recovery is their circuitous journey of a thousand small steps.
It's very rarely that dramatic leap we see on TV.
And so to not give up hope and to know that those small moments of kindness and support actually are progress and are part of the person's journey to ultimately getting well.
If you're the one that really just wants to cut back.
So if you're listening and you want to cut back and I'll call you, I think first figure out your why.
How do you help them figure out their why as it relates to their relationship with alcohol?
Yeah, I think understanding first how alcohol fits in your life.
And so people can do this at home by just keeping a drinking diary.
So even just jotting down on your phone or in a notebook when you want to have a drink, sort of what activities you associate with drinking, what, you know, when you do have a drink, how many drinks you have over what time periods.
It's sort of like keeping a food journal where it actually just makes you more mindful of like, oh, I'm like triggered to want a snack on this thing because I'm feeling really upset about this fight I just had.
you can identify that with alcohol too like you mentioned this earlier I'm really stressed out at the end of the day and so I come home and want to reach for a glass of wine understanding sort of how alcohol fits in your life is an important first step and then figuring out what are the goals you're
working on right now and that could change over time but again if your goal is something related to fitness or wellness or health you may find after learning more about alcohol and the role it plays in your life that actually you want to change how much you're drinking and so then you have your why
my why is I'm you know training for a marathon and I found that when I drink I have a hard time waking up and going for my long runs.
And so I'm only going to drink on this day and I'm going to keep it to this amount.
So it's very specific and that's important for behavior change.
If you make this broad sort of general goal of I'm never going to drink again because alcohol's bad, you're probably not going to do it because that's hard and it doesn't really relate to you as a human.
So as much as you can make it specific, measurable, time bound, so it's like the next three weeks, I'm going to try this and then I'm going to reassess.
That makes it much easier to actually make change and stick to it over time.
Well, it's great advice because I feel like so many of us have had that experience where you go to a big wedding and you're like, that's it.
I'm never drinking again.
I can't do this to myself.
And three days later, you're going out for somebody's engagement.
And now you're like, ah, I should just have a glass of wine and you're back in it.
And so I think getting very clear about what are your goals.
And I'm willing to bet if you write down your goals, that you're going to see that alcohol is not helping any of them.
Exactly. And there's lots of tips out there, but you want to make it as easy as possible for yourself.
So if your goal is to cut back on drinking, you don't want to have a week where you're packed with going out to happy hour with people.
You want to really set yourself up for success.
So organize your social activities around non -drinking activities.
Come up with a plan if you're going to be in a situation where you would normally drink that you're going to have a glass of club soda in your hand the minute you walk in the door.
You're going to have a friend who knows that you're working on this, who's going to be your partner.
Setting those intentions and those ideas and tools and tricks ahead of time will make it way easier for you to ultimately reach that goal of cutting back.
If you quit drinking and you don't feel supported by your family or your partner or friends, what advice do you have for people to navigate that?
Great question. I think first letting people know about your intentions.
So sharing what your goal is is really important because people can't support you if they don't know.
And if you've always drank a certain way with your partner or friends and all of a sudden you're not, they're not going to be like, what's going on?
Whereas if you say to them, hey, guys, I know you love me and support EatMe.
I want to share with you that my new goal is to, you know, not drink more than one drink a day or only drink on Friday and no more than two drinks or whatever, or not drink at all.
And this is my why.
I'm doing this because I'm worried about myself or I'm doing this because, you know, it feels counterproductive to my health and I really want your support and this is how you can support me.
So then you're really framing it as they get to be a partner with you.
You're not criticizing their drinking because often people feel then like, oh, I'm a little self -conscious.
This person's going to be judging me or they think I'm bad.
You're just asking for their help.
And so maybe that looks like instead of meeting for drinks, you meet to go to yoga class or you meet to go for a run or, you know, you let the person know why you're going to be ordering a soda water instead of a drink.
And so you can be really concrete both for yourself and what those tools look like, but also for the people in your life to signal to them how they can help support you.
And sometimes people can't do that.
And that happens whenever we make any big change.
People may have experienced that if they decided to have a weight loss journey or change their life in some way that there are people that really fit in our lives for a certain point that can't journey with you through that transformation and that's sad but if you find that despite those conversations
someone is actually destructive to the change that you want to make and not supportive then that may be a broader question about sort of the role of that relationship in your life.
I thought I knew a lot about this topic and it just goes to show you there is always something new you can learn.
So I have another question Dr.
Wakeman. What is your message to someone who is struggling with their relationship to alcohol?
Yeah, I think I'd like to just talk for a moment about alcohol use disorder because I think we've been covering sort of the health harms of alcohol use either at a low risk level or a moderate level or high level.
For anyone who is struggling with alcohol use disorder or is worried they may be struggling with alcohol use disorder, treatment works.
You will get well. Finding sort of a trusted healthcare provider that you can partner with is a part of that journey, but to really have hope, this is not a hopeless condition.
It will not be with you forever.
You will be in a place where you're free from this.
And there are treatments that are out there and just getting those much like you would for depression or diabetes or high blood pressure is the most important thing.
And this is not an issue of shame or willpower or being bad.
And I hope that people will feel like they can come in and get the help that they need.
And for the person who had this conversation shared with them from a family member, who's probably concerned about their drinking, what is your message to that person?
It can be really hard to hear this, especially in a society that still stigmatizes alcohol use and alcohol use disorder.
I think take this as a message of love.
Someone loves you, they care about you, they're sharing their worries, and they're there to support you, and they want to be a part of this journey to help you live the best life you can possibly live in whatever way that means.
And hopefully it will be a moment to pause and thank and get the support you need to make some changes.
Well, Dr. Sarah Wakeman, thank you so much for being here with us today.
Thank you for the work that you're doing.
You really are changing and saving people's lives and we appreciate how much wisdom you poured into us.
Thank you, Mel, for having me.
This was a true pleasure.
And hopefully these words will reach people who are working to better their lives or worried about someone they love.
And I want to also just make sure that you're listening that in case nobody else tells you that I tell you that I love you and I believe in you, I'll talk to you in a few days.
Yeah. Okay, great. Here we go.
All right. Coaches, Tracy.
Great. That's perfect.
Thank you. That's okay.
Hydrate, baby. Like it's true, but it makes you think, doesn't it?
As a, oh, I'm like, I do not remember what the hell is going on today.
What is happening? I don't know what's going on over here.
in the garbage goodbye look how emotionally agile i am what i want you to really he okay hold on what was i going where was i going with that um dr wakeman can you tell me about the race lorda i didn't so it's okay is that is that okay okay holy cow awesome Awesome.
Oh, and one more thing.
And no, this is not a blooper.
This is the legal language.
