Reevaluating Alcohol
While toilet paper seems to have gotten most of the attention, many of us are stocking and restocking our alcohol during this lockdown. Between a more flexible at-home work schedule and an evening or afternoon (okay all day) centered around the television, drinking has become so…possible. There’s nothing quite like revisiting Mad Men that makes one want to get vodka martini blitzed on a Tuesday. Should a glass or 5 of red wine be part of our new daily ritual?
Alcohol is a ubiquitous part of our culture. It’s also a funky thing – on one hand it’s a low level toxin and on the other it’s a huge part of family and cultural celebration. Times of quarantine afford us a unique opportunity to reflect on our relationship to alcohol as a tool for connection, as a coping mechanism, and ultimately as a choice for us to navigate with some clear intention.
Can booze play a role in a healthy life?
Why exactly am I drinking in the first place?
And how might I strike a healthy balance with my relationship to alcohol?
Let’s discuss.
I know you thought this article was going to be a party, but first, let’s talk about what actually happens when we start drinking the sauce.
Metabolic Implications
Alcohol’s first pit stop is the stomach where a small amount is oxidized. This is called first pass metabolism. As any college kid will tell you, food will “coat your stomach bro” meaning it will slows down the rate of gastric emptying. If there is no food in your stomach, alcohol will quickly move into your small intestines where it is absorbed into your blood stream.
Once alcohol is in our blood, it permeates most of our tissue – alcohol goes wherever body water goes. As soon as alcohol hits our system, we also start to metabolize it (as previously mentioned, it is a low level toxin, so we’re not trying to keep it around.) The main player of alcohol metabolism is the liver through a process aptly named “oxidative alcohol metabolism.”
A Little More Science
The chemical name for alcohol is ethanol. A liver enzyme called alcohol dehydrogenase (ADH) breaks down ethanol into acetaldehyde which is highly toxic but relatively short lived. Acetaldeyde is then broken down into acetate which is less active. Finally, acetate is broken down into water and carbon dioxide which is easily discarded. For the record, there are other pathways by which we metabolize alcohol, but this is the primary one. (1) (2)
Obviously in order to get to water and carbon dioxide, we must first deal with acetaldehyde. Because of genetic and enzymatic differences, some of us are better at handling acetaldehyde than others (2). Those who are not good at handling acetaldehyde tend to have a more sever and unpleasant relationship with booze (the Ashley’s of the world.)
What else? Alcohol has a caloric value of ~7 kcal per gram. A quick reminder that carbs and protein contain 4 kcal per gram and fat contains 9 kcal, which makes alcohol relatively calorie dense. Unlike carbs and fat, which both can be stored by the body (as glycogen and triglycerides) alcohol is not stored. It remains in body water until it is eliminated. (2)
You can think of alcohol as a presidential motor cade. Everything else is put on hold while the motor cade rolls through town. For those interested in hypertrophy, this also means that alcohol will impair muscle protein synthesis within the first hour after intoxication and can be maintained for up to 24 hours, depending on the initial dose administered (3).
All of which is to say, alcohol has very little nutritional value. While there is occasionally a hopeful headline that resveratrol might be heart protective or alcohol itself might have a beneficial effect on cholesterol or vascular health, the truth is we don’t drink because it’s good for us. We drink for many other reasons.
T’was the Best of Times, T’was the Worst of Times
Upon some not-so-deep reflection, we probably agree we tend to drink the most when we have a really good day or when we have a really bad day. We drink a bit more when the weather takes a turn for the better and we enjoy some rosé with the local hipsters or we drink a bit more when the weather takes a turn for the worse and we’re pent up mid-winter with Game of Thrones. We drink when our team wins (Go Blue!) and we drink when our team loses (Go Lions!)
In the broadest sense, even the fancy social scientists agree that these are the two primary reasons we booze: we either drink to celebrate or we drink to cope. Said another way, we drink to connect or we drink to deal with our own psychology. Understanding why we drink is an important part of our renegotiation with alcohol. (4)
The connection aspects of alcohol are real and in proper dosage, generally regarded as healthy. For example, on a personal note, there are few things I enjoy more than sharing a gin martini with my grandfather. I’m fully aware that there are other ways we could bond, but he happens to be particularly fond of a gin martini (as am I) and his stories get louder and more chucklesome with each refill. The same could be said for throwing back a few beers with my fathers. Drinking to celebrate and connect adds value to my life, which feels healthy.
But the truth is, faced with a quarantine, most of us are not turning to alcohol as a point of connection. This isn’t a social pursuit. It’s the other one. It’s our strategy for mitigating unpleasant emotions. The uncertainty. The anxiety. The health of our immediate, extended, and work family. Our jobs. Rent. Even a trip to the grocery store seems to have enormously higher stakes. Drinking is one way of coping with these emotions.
This is Your Brain. This is Brain on Boones Farm.
Alcohol affects different sections of the brain in unique ways. To the prefrontal cortex, it acts as a depressant. The prefrontal cortex is responsible for decisions making, rational thought, planning, and assessment which helps explain why anxiety and inhibition are lowered. Alcohol also suppresses activity in the temporal lobes where memories are processed which helps explain why we sometimes wake up in Reno by surprise. Alcohol, however, speeds up a neurotransmitter called glutamate, which affects our reward centers. That’s why we feel warm and cuddly when we drink. In simple terms, we perceive less, forget more, and generally feel nice. (4)
This is a powerful combination, neurologically speaking. Alcohol does its job well if you’re looking to temporarily suppress reasoning and feel something that isn’t anxiety. But the question I’m left asking is, how much do I really want to use alcohol as a temporary coping mechanism?
There’s no correct answer here, only better questions. I’m sharing this with you not from a place of moral high ground (look at me, Mr. Healthy Choice Guy.) I’m sharing this with you because you’ll need to discover your own truth. You can’t take my word for it.
That said, here is the script I’ve been spending time with:
Perhaps there are other methods of stress relief that might serve me better? Instead of avoiding my anxiety, perhaps the brave choice is to spend time with my anxiety? To face it head on and commune with the discomfort I’m feeling right now? Having felt what I needed to feel, perhaps then I can better transition to problem solving mode, where I can start to figure out how to…adapt?
That, or I can go make another gin martini.
Mel and I don’t make it a habit of telling anyone what to do. We instead choose to empower our clients to make choices they feel aligned with. As for our own routine, I enjoy drinking far more than Mel. I am a (wanna be) writer after all and we have this terrible tendency to be raging alcoholics. As such, I have a few personal guidelines I follow:
1️⃣ I find it helpful to limit my alcohol intake to the weekends (Friday – Sunday). This isn’t a hard-and-fast rule, but I generally adhere to it around 90% of the time (even in quarantine.)
2️⃣ I only drink things I enjoy. If you like Pina Coladas (and getting caught in the rain), get down with your bad self. But drinking something you enjoy less because you think it’s “better for you” is a fool’s errand. “Healthy” drinking is like paying a prostitute for a hug.
Like all of our nutrition choices, our relationship with alcohol is nuanced and complex. There is no one-size-fits-all solution. Understanding the social, psychological, and metabolic implications of alcohol can helps us make wiser decisions, but the take home is relatively straightforward: if alcohol is causing more harm than good, may we be brave enough to find an alternative. But if alcohol adds value to your life…both I and my grandfather will cheers to that.
Works Cited
- “Alcohol Metabolism: An Update.” Alcohol Alert. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/aa72/aa72.htm.
- Cederbaum, Arthur I. “Alcohol Metabolism.” National Center for Biotechnology Information. April 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484320.
- Kimball, S. R., & Lang, C. H. “Mechanisms Underlying Muscle Protein Imbalance Induced by Alcohol.” Annual Review of Nutrition, 2018. https://doi.org/10.1146/annurev-nutr-071816-064642
- Gowin, Joshua. “Your Brain on Alcohol.” Psychology Today https://www.psychologytoday.com/us/blog/you-illuminated/201006/your-brain-alcohol.
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