Dr. Joe's Holiday Drinking Guide

THE GUIDE YOU DIDN'T KNOW YOU WANTED.

Author: Joe Fisher MD, PhD / Category: Drinking / Published: December 24, 2019 /

Well, its that time of the year for parties and more parties; work, friends and family. Why another holiday drinking guide? After all aren't they everywhere now...how to make the best spiked eggnog, what's the best New Year's cocktail with Aperol, or what IPA goes best with Xmas dinner? To be honest, although I think many of these are fun reading they're not too hard to find right now. This guide isn't going to dwell on what to drink but entirely on HOW TO DRINK.

"And now for something completely different."                                --Monty Python's Flying Circus

Party Season

Common sense is not enough.

If you are a drinker with any real experience with alcohol you probably think that common sense is more than enough to deal with the holidays and drinking in general. Don't get me wrong, I'm all for common sense. However, there are some lesser known facts about alcohol, drinking, and physiology that most people don't know much about and it's those things I want to cover here.


"Hold the Acetaldehyde, please." ALCOHOL METABOLISM

First off, when you drink Alcohol (Ethanol) it gets converted into other stuff in your body. Alcohol, in moderate amounts, is viewed as pretty positive by many people (hence yellow) and its psychic effects are what makes people generally want to consume it. However, an enzyme (1, Alcohol Dehydrogenase) in your liver (and other tissues including your stomach lining) breaks it down into something quite nasty, Acetaldehyde ("ACET"). ACET is a very reactive molecule and is a potent carcinogen so having it around for very long is not good. It is thought that ACET is one of the primary factors why the amount of alcohol that you consume is correlated with increased risk for many types of cancer. Fortunately for most people, another enzyme (2, Aldehyde Dehydrogenase) converts it to Acetic Acid; this molecule is good (green) as it is either excreted in your urine or gets converted into energy. Unfortunately, a significant proportion of Asian populations has a variant of (2) which does not work very well and the ACET accumulates; this results in the famous "Asian flushing reaction" and an increased cancer risk.

So, the bottom line is you want to keep ACET as low as possible which means you need to keep your blood alcohol concentration (BAC) at a moderate level. Apart from increasing your risk of accidents and making potentially life-altering stupid decisions, high BACs also result in increased circulating ACET levels which can have bad long-term consequences for your health. Independent of cancer, high circulating levels of alcohol are also associated with many other long term health risks as well. So let's go through some ways to help you enjoy alcohol while lessening some of your risk.


"How complicated and unpredictable the machinery of life really is."   --Kurt Vonnegut

1) Realize that alcohol absorption is variable.

Wouldn't you think that if the same person drank exactly the same drink, in the same way, with the same stomach contents, on different occasions it would work out the same way? Well, it turns out that alcohol absorption shows a variability that isn't completely understood. A number of clinical trials have demonstrated that in addition to large differences BETWEEN individuals, even the SAME individuals tested on multiple occasions absorb alcohol quite variably. So if you think you know how your drink is going to make you feel based on past experience, you may want to add some wiggle room.

Below is a controlled experiment I conducted on myself. I ate the identical lunch, then fasted for six hours (to empty my stomach), then had a two drink equivalent (exactly the same cocktails each time) consumed over 10 minutes, and then measured my BAC with a calibrated breathlyzer. I did this on three separate non-consecutive days and tried to keep my activity levels as close to each other as possible.

The results were pretty surprising to me. The second time I had the drink, my BAC got up to 25% higher than the first time. The third time, it went back down to "normal". Why the big difference, who really knows? I'm not sure what the total range of my variability is, but it is safe to say it is at least 25% and that is pretty significant. I certainly FELT the difference and didn't need any breathalyzer to confirm it.


2) Drink more slowly and watch what you drink.

How FAST you drink, and WHAT you drink also effect your peak BAC; that information should definitely be taken into account. Let's start with what you're drinking. Generally speaking, drinks with lower alcohol concentration have been found to be absorbed more slowly and more incompletely than those with higher concentration. In the chart below you can see the same group of people (n=15) tested 3 times with the SAME AMOUNT OF ALCOHOL in the form of either beer, wine, or 20% alcohol cocktail. As you can see there are significant differences to be seen, the beer BAC peak substantially less than the cocktail. This is only one study under one set of conditions, and everyone is somewhat different, but it is a result you should keep in mind when you are drinking.

From Mitchell MC et al. (2014) Alc Clin Exp Res 38:(5).

Of course, how fast you drink also has a big impact as well. The alcohol dehydrogenase we discussed above only works at a fixed rate so the faster the alcohol goes in, the less the enzyme can inactivate it in your stomach (gastric 1st pass metabolism) or when it passes through the liver (hepatic 1st pass metabolism). Slow and steady wins the race.


"Food is an important part of a balanced diet."  --Fran Lebowitz

3) Food, the final piece of the drinking puzzle.

Most people who drink already know that food is important for reducing alcohol absorption. However, most don't know how much or what type of food, or when to eat it, can have most impact on the process. This information, along with what was covered in 1 and 2 above, should give you all the tools you need to be prepared for the holidays. How much, how quickly, and the type of drink(s) you consume are really important, but food can also have a strong moderating effect if eaten strategically. The mechanism of how food impacts alcohol absorption is covered in detail on the Food & Drink 101 page, but if you have not seen that here it is in a nutshell.

When you eat food, your stomach empties more slowly in order to control the digestive process. If you consume alcohol during or after you have eaten food, it sits in your stomach longer and is released into your small intestine more gradually. This is important because alcohol is more slowly absorbed from the stomach than the small intestine. Also, the stomach lining has enzymes (as described above) that can inactivate it. So, by eating food right before you drink you can have the biggest impact on alcohol absorption (5-15 minutes) since your stomach has started to slow even before the alcohol arrives. Eating while you drink will have some effect too but not as much; eating after you have finished drinking has only a minimal effect. I've heard people talk about eating certain types of food after they have already finished drinking to "soak up" the alcohol. This is pretty much nonsense...food eaten afterwards has a stimulatory effect on eliminating alcohol but not that much.

But what to eat? The most important thing is to eat something before you start drinking, ideally over 200 calories worth to get a moderating effect on the alcohol absorption. However, based on the medical literature and studies conducted at Zeno Functional Foods (case studies and clinical trial), all foods don't have the same effectiveness per calorie eaten. If calories don't matter to you then eat whatever is desirable, consistent with your diet. However, if you are like me and tend to easily gain weight when drinking, you may want to reference the food pyramid shown below to try get the most out of your calories.

The pyramid shows some representative types of foods and how they impact alcohol absorption . These are general buckets, often foods don't fit nicely in any one (pizza has simple carbohydrates but substantial milk protein and fat). Based on experiments used for my patent filings and clinical trial data, the worst performing foods were predominantly rich in simple carbs, like bread, crackers, or snack mixes without nuts. Next best were foods with higher fat content, ideally with some protein and fiber, like nuts. A handful of nuts is a great bet before you start to drink and they are often portable and convenient. Foods higher in protein, like beans (also have fiber) are great if they are an option but are often not. Cheese if quite good due to its high content of milk protein and fat. Based on this information, the SOBAR was designed to be most efficient and has a high concentration of milk protein and insoluble fiber, a somewhat unlikely combination. This was borne out in a clinical trial which compared it other foods under identical conditions.

SUMMARY.

To put it all together:

  1. Be cautious when you drink, particularly if your stomach does not have much food in it. Alcohol absorption is inherently variable and unpredictable (up to >25%).
  2. Whatever you choose to drink, don't drink too quickly and pace yourself. You must also be aware that drinks with about 20% by volume alcohol are likely to be absorbed the most rapidly.
  3. ALWAYS EAT before and while you drink. At least 200 calories worth before you start to drink would be ideal. Remember that after 1-2 hours, much of the food you ate has emptied from your stomach so eat closer to when you start to drink and continue to eat as you drink.
  4. All foods are not the same in terms of how they effect alcohol absorption. Aim for foods with higher protein content, in particular milk protein, and try to avoid lots of simple carbs.  

The information above was derived reputable scientific sources and the author's interpretations and opinions. It is not meant to serve as medical advice and you should be aware that all individuals respond differently to alcohol and its combination with various foods. Please drink responsibly and make sure you always eat some food before and during drinking. Happy Holidays!

THE GUIDE YOU DIDN'T KNOW
YOU WANTED.

Author: Joe Fisher MD, PhD / Category: Drinking / Published: December 24, 2019 /

Well, its that time of the year for parties and more parties; work, friends and family. Why another holiday drinking guide? After all aren't they everywhere now...how to make the best spiked eggnog, what's the best New Year's cocktail with Aperol, or what IPA goes best with Xmas dinner? To be honest, although I think many of these are fun reading they're not too hard to find right now. This guide isn't going to dwell on what to drink but entirely on HOW TO DRINK.

"And now for something completely different."                                --Monty Python's Flying Circus

Party Season

Common sense is not enough.

If you are a drinker with any real experience with alcohol you probably think that common sense is more than enough to deal with the holidays and drinking in general. Don't get me wrong, I'm all for common sense. However, there are some lesser known facts about alcohol, drinking, and physiology that most people don't know much about and it's those things I want to cover here.


"Hold the Acetaldehyde, please."
ALCOHOL METABOLISM

First off, when you drink Alcohol (Ethanol) it gets converted into other stuff in your body. Alcohol, in moderate amounts, is viewed as pretty positive by many people (hence yellow) and its psychic effects are what makes people generally want to consume it. However, an enzyme (1, Alcohol Dehydrogenase) in your liver (and other tissues including your stomach lining) breaks it down into something quite nasty, Acetaldehyde ("ACET"). ACET is a very reactive molecule and is a potent carcinogen so having it around for very long is not good. It is thought that ACET is one of the primary factors why the amount of alcohol that you consume is correlated with increased risk for many types of cancer. Fortunately for most people, another enzyme (2, Aldehyde Dehydrogenase) converts it to Acetic Acid; this molecule is good (green) as it is either excreted in your urine or gets converted into energy. Unfortunately, a significant proportion of Asian populations has a variant of (2) which does not work very well and the ACET accumulates; this results in the famous "Asian flushing reaction" and an increased cancer risk.

So, the bottom line is you want to keep ACET as low as possible which means you need to keep your blood alcohol concentration (BAC) at a moderate level. Apart from increasing your risk of accidents and making potentially life-altering stupid decisions, high BACs also result in increased circulating ACET levels which can have bad long-term consequences for your health. Independent of cancer, high circulating levels of alcohol are also associated with many other long term health risks as well. So let's go through some ways to help you enjoy alcohol while lessening some of your risk.


"How complicated and unpredictable the machinery of life really is."   --Kurt Vonnegut

1) Realize that alcohol absorption
    is variable.

Wouldn't you think that if the same person drank exactly the same drink, in the same way, with the same stomach contents, on different occasions it would work out the same way? Well, it turns out that alcohol absorption shows a variability that isn't completely understood. A number of clinical trials have demonstrated that in addition to large differences BETWEEN individuals, even the SAME individuals tested on multiple occasions absorb alcohol quite variably. So if you think you know how your drink is going to make you feel based on past experience, you may want to add some wiggle room.

Below is a controlled experiment I conducted on myself. I ate the identical lunch, then fasted for six hours (to empty my stomach), then had a two drink equivalent (exactly the same cocktails each time) consumed over 10 minutes, and then measured my BAC with a calibrated breathlyzer. I did this on three separate non-consecutive days and tried to keep my activity levels as close to each other as possible.

The results were pretty surprising to me. The second time I had the drink, my BAC got up to 25% higher than the first time. The third time, it went back down to "normal". Why the big difference, who really knows? I'm not sure what the total range of my variability is, but it is safe to say it is at least 25% and that is pretty significant. I certainly FELT the difference and didn't need any breathalyzer to confirm it.


2) Drink more slowly and
    watch what you drink.

How FAST you drink, and WHAT you drink also effect your peak BAC; that information should definitely be taken into account. Let's start with what you're drinking. Generally speaking, drinks with lower alcohol concentration have been found to be absorbed more slowly and more incompletely than those with higher concentration. In the chart below you can see the same group of people (n=15) tested 3 times with the SAME AMOUNT OF ALCOHOL in the form of either beer, wine, or 20% alcohol cocktail. As you can see there are significant differences to be seen, the beer BAC peak substantially less than the cocktail. This is only one study under one set of conditions, and everyone is somewhat different, but it is a result you should keep in mind when you are drinking.

From Mitchell MC et al. (2014) Alc Clin Exp Res 38:(5).

Of course, how fast you drink also has a big impact as well. The alcohol dehydrogenase we discussed above only works at a fixed rate so the faster the alcohol goes in, the less the enzyme can inactivate it in your stomach (gastric 1st pass metabolism) or when it passes through the liver (hepatic 1st pass metabolism). Slow and steady wins the race.


"Food is an important part of a balanced diet."  --Fran Lebowitz

3) Food, the final piece of the
    drinking puzzle.

Most people who drink already know that food is important for reducing alcohol absorption. However, most don't know how much or what type of food, or when to eat it, can have most impact on the process. This information, along with what was covered in 1 and 2 above, should give you all the tools you need to be prepared for the holidays. How much, how quickly, and the type of drink(s) you consume are really important, but food can also have a strong moderating effect if eaten strategically. The mechanism of how food impacts alcohol absorption is covered in detail on the Food & Drink 101 page, but if you have not seen that here it is in a nutshell.

When you eat food, your stomach empties more slowly in order to control the digestive process. If you consume alcohol during or after you have eaten food, it sits in your stomach longer and is released into your small intestine more gradually. This is important because alcohol is more slowly absorbed from the stomach than the small intestine. Also, the stomach lining has enzymes (as described above) that can inactivate it. So, by eating food right before you drink you can have the biggest impact on alcohol absorption (5-15 minutes) since your stomach has started to slow even before the alcohol arrives. Eating while you drink will have some effect too but not as much; eating after you have finished drinking has only a minimal effect. I've heard people talk about eating certain types of food after they have already finished drinking to "soak up" the alcohol. This is pretty much nonsense...food eaten afterwards has a stimulatory effect on eliminating alcohol but not that much.

But what to eat? The most important thing is to eat something before you start drinking, ideally over 200 calories worth to get a moderating effect on the alcohol absorption. However, based on the medical literature and studies conducted at Zeno Functional Foods (case studies and clinical trial), all foods don't have the same effectiveness per calorie eaten. If calories don't matter to you then eat whatever is desirable, consistent with your diet. However, if you are like me and tend to easily gain weight when drinking, you may want to reference the food pyramid shown below to try get the most out of your calories.

The pyramid shows some representative types of foods and how they impact alcohol absorption . These are general buckets, often foods don't fit nicely in any one (pizza has simple carbohydrates but substantial milk protein and fat). Based on experiments used for my patent filings and clinical trial data, the worst performing foods were predominantly rich in simple carbs, like bread, crackers, or snack mixes without nuts. Next best were foods with higher fat content, ideally with some protein and fiber, like nuts. A handful of nuts is a great bet before you start to drink and they are often portable and convenient. Foods higher in protein, like beans (also have fiber) are great if they are an option but are often not. Cheese if quite good due to its high content of milk protein and fat. Based on this information, the SOBAR was designed to be most efficient and has a high concentration of milk protein and insoluble fiber, a somewhat unlikely combination. This was borne out in a clinical trial which compared it other foods under identical conditions.

SUMMARY.

To put it all together:

  1. Be cautious when you drink, particularly if your stomach does not have much food in it. Alcohol absorption is inherently variable and unpredictable (up to >25%).
  2. Whatever you choose to drink, don't drink too quickly and pace yourself. You must also be aware that drinks with about 20% by volume alcohol are likely to be absorbed the most rapidly.
  3. ALWAYS EAT before and while you drink. At least 200 calories worth before you start to drink would be ideal. Remember that after 1-2 hours, much of the food you ate has emptied from your stomach so eat closer to when you start to drink and continue to eat as you drink.
  4. All foods are not the same in terms of how they effect alcohol absorption. Aim for foods with higher protein content, in particular milk protein, and try to avoid lots of simple carbs.  

The information above was derived reputable scientific sources and the author's interpretations and opinions. It is not meant to serve as medical advice and you should be aware that all individuals respond differently to alcohol and its combination with various foods. Please drink responsibly and make sure you always eat some food before and during drinking. Happy Holidays!


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