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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Yeah, well, remember I said ethanol, which is the molecule, crosses the blood-brain barrier. And so especially when you're having these high levels of blood alcohol, that ethanol is sort of bathing your brain. And if you think about what we talked about, inflammation and changes to cells and to DNA and proteins, that is happening at the brain level.
The other thing that can accelerate the brain damage we see with alcohol is actually nutritional deficiencies. So people may be drinking a lot, and they're actually not getting really crucial nutrients in their diet. And that can accelerate the process of brain damage.
We can even see a very like sudden onset amnesia from heavy alcohol use in the setting of not getting enough nutrients in your diet.
That's the brain. So the brain, for sure. The next is the mouth and your esophagus. So obviously, you're drinking alcohol. It's bathing your mouth. It's bathing your esophagus and your stomach. So we do see an increase in cancer, like we talked about, and that's accelerated by smoking. But we also see benign but annoying and problematic health conditions, most notably acid reflux, so heartburn.
So if you notice, like, I'm always having heartburn. I'm having to pop all these antacids and take this medicine. you might want to think, like, how much am I drinking? Is that contributing to my heartburn? So that's a very common thing. The heart is affected by alcohol. So, you know, the heart is an organ where at low risk levels, there doesn't seem to be harm from alcohol.
But once you get into the moderate and high, we see harms. And the harms can be A couple folds. One is something called atrial fibrillation, which is basically where your heart starts beating really irregularly. So in your heart, there's four chambers, the two chambers at the top. So this is really showing the ventricles and the atrium. So there's two chambers that blood flows through.
And in a normal heart, your electrical activity comes from the top of your heart, goes down to the bottom of your heart, and tells the heart to pump. And so you get a single impulse that goes to the bottom of the heart, says pump, and that pumps blood out to your brain and your body and your organs and your liver. Right.
In atrial fibrillation, the top of the heart is just kind of quivering with this abnormal electrical activity, and so the heart can't pump in a normal way. There's a term in medicine called holiday heart because we see sometimes people drink a ton over the holidays and will end up in this abnormal rhythm just from that binge drinking pattern.
And then over time, if you're drinking at high levels, your heart actually dilates, and you can end up with congestive heart failure from a cardiomyopathy, which means the heart muscle gets kind of weak and thin and floppy and can't pump the way that it needs to.
Yeah, because they have less body water, and alcohol doesn't go into your body fat. So essentially, it's like if you took a glass of water and you dropped red dye in it, you're going to diffuse into that water. So the more water you have, the more diffuse it'll be and the lower your blood alcohol content. So if you have very low body fat, you probably have more body water.
And so two drinks for you is going to diffuse into a larger amount of water.
No. I mean, so first of all, I think the interesting story there, one is not just the body fat, but also that people metabolize alcohol at different rates. You probably, I don't know if you found this feature, you probably had fewer hangovers than your friend because hangover does seem to be related to the amount, how high that your blood alcohol level gets.
So people who don't metabolize alcohol as quickly tend to have worse hangovers. So that may have been something you experienced, but it doesn't protect you from the other health harms of alcohol, like liver damage, like cancer. like over time, you know, heart problems or esophageal problems.
Yeah, hangover is a fascinating thing that people are, you know, there's a lot of emerging evidence about it and trying to understand what happens. It seems to be most related to how high the ethanol concentration in your brain gets because they've actually done a ton of studies with mice and with people.
It was initially thought to be due to the byproducts of alcohol, like that acetyl aldehyde molecule we talked about, but it doesn't seem to be related to that. It seems to be related to ethanol. But essentially, it's this syndrome where after you drink, once your blood alcohol content comes down to zero, you feel sort of apathetic, you're tired, you have a headache, you often feel nauseous.
And so it's sort of that sequelae of your brain essentially being bathed in this ethanol. And then as it leaves, you just feel totally crappy.
Yeah, it is not just being dehydrated. There's actual sort of effects of ethanol on your brain that lead to the hangover. I think if you are drinking at an amount that you're getting a hangover, it is a good sign that you're drinking above a limit that would be considered okay for your body.
There is some element of dehydration, don't get me wrong. And that's partly because, right, if you think, again, alcohol is diffused in water. So if your total body water is contracted because you're dehydrated, your ethanol level is going to be higher. So drinking is going to help you sort of flush it out and feel better. I'm drinking water. But it's not only because of dehydration.
Well, first, like there's no judgment here. So a molecule of ethanol is not more moral or immoral than a molecule of glucose. You could say the same thing about diet. We have lots of awareness now about processed foods and white flour and white sugar. That doesn't mean that everyone's going to live this like ascetic lifestyle where they never eat dessert.
So I think it really is like you need to go in with eyes wide open and understand what are the risks, what matters to you, and how do you make that calculus. So if you decide it's a choice you want to make, you want to set yourself up for success.
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