Dr. Sarah Wakeman
speaker
484 appearances
2 recordings
2 series
first heard Jan 2025
last heard May 2025
Dr. Sarah Wakeman’s voice in public audio — every appearance, attributed to the second.
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Because one question is a person who's drinking a glass of wine a day, maybe they're also running every day and, you know, 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.
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, there are 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...
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.
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. You know, they were drinking heavily. They thought it was 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, you know, 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.
Yeah, and there's actually a lot of studies showing this. So between, you know, 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.
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?
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 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, you know, 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?
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