Journey to the Sunnyside

Mike: [00:00:00] Hey there and welcome to Journey to the Sunnyside. I'm your host Mike Hardenbrook and today we're kicking things off with a new format where episodes will be shorter and broken down into two part themes. Today we'll be diving into some key alcohol facts that doctors really want you to know. So whether you're a casual drinker or someone who drinks more often, it's always a good idea to know how alcohol impacts your health both short term and long term.

And today I'm joined with Dr. Rishi Keshbalani, primary care director of L. A. County Health Services, assistant professor at UCLA, and a medical advisor here at Sunnyside. Dr. Balani's expertise covers everything from alcohol use disorder to mindful drinking. And today he's here to shed light on health risks that often fly under the radar.

So let's get right into it with Dr. Balani.

So the first question I have for you as a medical doctor, can you share [00:01:00] some insights on trends that you're seeing when it comes to alcohol and health?

Dr. Belani: Sure. And first, just say thanks, Mike, for having me on. Really excited. Yeah, I think there's been definitely a really notable shift in how healthcare providers and the healthcare industry and, you know, recommendations about healthcare and so government organizations are viewing alcohol based on the data that's coming out.

And really, we've shifted to this idea that or this notion that. There is no healthy amount of alcohol, right? And so more data has linked alcohol use to negative outcomes. And so we can't, we can no longer view alcohol even in moderate or low doses as healthy. There can be safe consumption, but the messaging now is really changed to, to really say that there's no healthy consumption.

Mike: Yeah, that makes sense. What do you think? Is there anything that just recently happened that you think that all of a sudden there's [00:02:00] more attention on this subject?

Dr. Belani: I think it's just a culmination of multiple studies and availability of more data. And so there was a recent WHO report, I think for 2023, that, you know, basically came and said, after reviewing all the data, after looking at the benefits and risks, There's really zero amount of healthy alcohol, right?

And so there was always a thought that, Oh, you know, in France, people who drink red wine, but they smoke a lot, they don't have to, you know, have as much cardiovascular disease. So it didn't make sense. It was like a paradox when you look in other countries. So I think there was always a thought that, you know, maybe there is a role for alcohol, but when they, you break it down, it's, it's not, it wasn't just the alcohol in, in that situation.

It's multiple other factors and maybe some, you know, um, different ingredients, et cetera, different, you know, enzymes or chemicals that, that you might be getting or nutrients that you might be getting. That didn't really bear out and what we're seeing is that [00:03:00] cancer risk, you know, on an accidental death, just longevity in general is more negatively affected than any positive effects that might be attributed to health.

Mike: That makes sense. I was reading an article the other day that said potentially the FDA may came, come out in 2025 with, a different ruling on a safe quote unquote amount of alcohol. Have you, do you have any awareness of that or have any insight?

Dr. Belani: Yeah, I think they're definitely working on it. I think that, you know, I don't know exactly what the FDA is planning to do, but societies from, you know, like the WHO, society in Canada are really trying to look at the level of risk.

associated with the volume of alcohol you're, you're in, you intake now. And so I think right now the CDC, you know, uh, Centers for Disease Control and Prevention in the United States kind of categorizes moderate risk as two drinks or less in a day for men and one drink [00:04:00] or less for a day, a day for women.

Zero, if you're pregnant, zero, if you have. You know, other health conditions that might be affected by alcohol.

Mike: Yeah, well, thanks for correcting me on misquoting with the FDA and the CDC, so, you know, that makes sense. And, you know, you quoted, this brings up a question in my mind, you quoted, you know, like in France, that potentially, like, you know, the cardiovascular health, and there's some conflicting information, or at least people are trying to debate it.

Are there any patterns when it comes to alcohol that you're seeing in different groups that are affected in different ways? I, I don't know that

Dr. Belani: we're seeing, I think it's really more about what the risks that we're starting to see and so, you know, cancer risk is a big one and liver disease is a big one.

And so in general, you know, the data is basically Being more, I don't know if we would call it surprising, um, but it's becoming more clear [00:05:00] that it's not just heavy drinking, you know, that is, is, is putting you at risk. So I think thinking about women or people, you know, born, assigned the female sex at birth, right?

Even low consumption of alcohol. So I think as low as three to six drinks per week compared to people who abstain. Had a, an increased risk in breast cancer. So it wasn't what we initially thought where it's like, Oh, if you're a heavy alcohol user, you know, you get liver disease, pretty well known, uh, you're, you're a very high risk for liver disease.

If you're a heavy alcohol user, it makes sense that. You get, um, a higher, be at higher risk for breast cancer or colorectal cancer, but I think data is becoming more clear now that it's not just, um, that high consumption, but even low consumption can adjust your risk, uh, compared to if you don't drink any alcohol.

Mike: Yeah, that makes sense. Well, as you know, as an advisor here at [00:06:00] Sunnyside, You know, the goal of many of the people listening right now are to moderate and be more mindful of their drinking. So are there any lesser known risks that even casual drinkers should keep in mind?

Dr. Belani: I think there's a lot that alcohol can affect, uh, you know, on, on a day-to-day basis, even at, at the low consumption level and, and stuff that we don't really, I think stuff that you learn maybe or you experience, but then you kind of forget about.

So, you know, definitely sleep. Your sleep can be disrupted from alcohol use in any, any level, just depending on your body. Anxiety or stress levels, athletic performance. You know, if you're trying to meet your muscle mass gains, you might, or hit a certain target in, in your cardiovascular exercise, you might not get to that personal record as fast if you're, if you're, you know, drinking regularly.

Other kinds of things that we, we don't tend to think about, but you know, [00:07:00] we're seeing a rise in. A drill fibrillation is, which is an abnormal heart rhythm and there may be effect, you know, alcohol may be contributing to that.

Mike: Yeah. You know, I think one of the lesser known things that I realized, I think a lot of us realize that sleep is affected when you drink.

But when I was making changes in my habits and I went from daily drinker to moderate drinker to long, you know, long stretches without having alcohol, but in that process, knowing that alcohol actually was affecting my sleep for days after the last drink, I just found that like really surprising and also difficult.

Dr. Belani: Right? And not something that we would normally think about unless we actually focused in on it. And so when you actually take the chance to say, Oh, you know what happens if I. Don't drink a bit of what happens if I do and kind of performing these assessments on ourselves, then you start to see how nuanced it can be in terms of how [00:08:00] different substances can affect your body.

Mike: Yeah, for sure. So I love that you're a doctor. I can ask you specific questions. And this one is how important is it because a lot of us like to lie on those forms to be upfront with their doctors about how much alcohol they're actually drinking. And I think there's a little. Like not, I don't know if you would call it a running joke, but a multiple the doctors put to that form or something like that.

Dr. Belani: Yeah, I think for most of our habits and most things that we screen or ask about, right, there's, there's a thought that for, for whatever reason that, you know, you're never going to get the full story from a patient. And part of that is, is not necessarily a mistrust with your primary care doctor or whichever doctor's VA.

But part of that is just kind of the way the human brain works and human nature, right? When things are pounded into our head that they're quote unquote bad or white or might not be good, then obviously we're going to try and represent [00:09:00] ourselves as good as possible. And so, yeah, whether it comes to, you know, drinking or eating, you know, we always kind of tend to that or estimate up.

That being said, like, I think, you know. A good doctor is not supposed to be, or is going to be, judging you, and they're not supposed to be judgmental of their patients. But there's supposed to be a partner and a coach in your health journey. And so the more data they have, the better they can help make a care plan for you, help assess your specific situation and correlate that with the science and the evidence.

So I'm, you know, primary care physician for adult patients. And then I also work with patients specifically who live with HIV. And then I, I work with patients who are experiencing substance use disorders. So Yeah, the, the more accurate, the more specific you can be, it's a no judgment though, and it's a safe zone, you know, physician patient [00:10:00] interactions are confidential, so it's really all about just getting to exactly what's going on so we can actually make a plan that works to get to the goals that you want to get to.

Mike: Yeah. No, that makes total sense. And I mean, I've definitely probably been guilty of that. I don't really know why it's, yeah, it just, it's just like, yeah, I don't know if it was that I didn't want to have the conversation or that I didn't want to actually own up to how much I was drinking. If I sat there and counted it out, I'm not sure it's been a while.

So. But what is, I would say, let's take it out a step further. What's like one thing that you wish your patients would tell you or tell doctors? And it doesn't even have to necessarily be just on the form related to alcohol.

Dr. Belani: Yeah. No, the joke is the truth, right? Like, how often are you, you know, if we, anything from, if we started a medication, did you actually take it?

Did you miss it? Or, right. And so I think with alcohol, really, it's, And sometimes we forget, and, and I think [00:11:00] that's the toughest part, right, because as we know, alcohol can, even in small amounts, you know, change your, uh, state of consciousness, and, uh, affect your memory, and you, you may forgot, forgot exactly how much you, you had at that wedding or that party, but in general, I think what we want to know is, What's your usual consumption, right?

Like if you're having a beer after work, is it really a beer or are you actually drinking three to five? Because then it really helps us get to know, you know, what you're actually taking in your body, the stress that your body might be enduring because of the consumption, or maybe that it's not a big deal at all based on your risk profile.

And so, and I think this really is important when it comes to it. binge drinking, right? Because especially in younger, healthy people who don't really drink on a day to day basis, but then they do engage in that kind of binge [00:12:00] drinking and, you know, okay, I. healthy all week, but I'm a weekend warrior. Go to a party, throw, you know, six shots back, 12 beers or whatever it is, you know, four cocktails, cause you're having a good time and you're, you're at that party or at that, uh, then that's really important to know because it's the frequency of that, you know, then there is data that says, Oh, maybe you're going to be at higher risk for this or for, for that.

And then we can start to think about ways to bring that back.

Mike: Let's get into that because that brings up a question that I often ask myself is what's the difference? What's the risk or harm? Between I wouldn't even say moderate, but you know regular drinking maybe not as high of a level as binge drinking and Less drinking and been during the week and much more drinking in one sitting during the weekend Like we'll break that down at like a physical level.

Dr. Belani: Yeah, I mean, I think the [00:13:00] What we worry about in that binge drinking setting is like we think about acute damage. I think there's two ways to think about it, kind of two buckets to put it in what is going to happen in the acute phase or the immediate phase. So versus, you know, what's your risk probability over time, what's the damage that's happening to your body over time.

So in that binge drinking situation, I think we have to think about it in a couple of ways. It's like. You know, in that, like, I think that a flag goes off. So like when you're binge drinking, you are going to be at risk for blacking out, for maybe getting acute liver damage, for alcohol toxicity. So just too much alcohol in your body at one time.

And then when you think about young, healthy people, but they are binge drinking and you start to see, oh, maybe. And then this is more like the long term effect, right? That you start to see, oh, maybe the weight is going up a little bit, maybe they're having anxiety issues, kind of the more [00:14:00] insidious, subtle symptoms of, you know, maybe their, uh, blood pressure is just a little bit high, but it doesn't make sense because they seem to be exercising.

And eating healthy and in a low stress, you know, environment, et cetera. But then you're like, Oh, but you're actually drinking a lot on the weekends or, you know, frequently. So then we start to see maybe there's a correlation there between your total consumption and your long term chronic health effects.

Mike: So I've read that binge is worse. Is that correct?

Dr. Belani: Yeah, that's what I understand. Like, I think, when you think about this, the risk we talked about with, like, breast cancer, you know, there, there, definitely binge is going to put you at higher risk. But it's on a spectrum, and so we, we, we still worry about your risk even at moderate consumption.

But binge, Drinking is definitely, I think, um, more concerning than if you're having like [00:15:00] one a day.

Mike: Got it. So what, what are some early warning signs that someone should consider cutting back on their drinking habits, like I guess at a physical level? Obviously we have things in your immediate life, like it's affecting other people, but like kind of more of at a medical standpoint, are there some early warning signs?

Dr. Belani: Yeah, I mean, some of those things I just mentioned, right? So suddenly you're seeing some way of getting unwanted to thinking about, uh, alcohol, um, as the, uh, contributor to that just poor sleep in general, like we talked about and you notice that you're, you're, you're. I'm tired all week, what's going on, hangovers, blood pressure is, is another really important one for cardiovascular health.

So if you're getting your, uh, annual physical coming into your doctor or, you know, getting a blood pressure check randomly and it's high and you don't have other risk factors otherwise, then I think that's a, an important sign to kind of do [00:16:00] a deep dive into your alcohol use. Anxiety is another one, so mental health issues.

I think that's a huge one, probably one that we don't do enough kind of investigation into how alcohol use might be contributing to that. And so, you know, any kind of change in mood or patterns that you're noticing, I think that's another sign that maybe there's some correlation to alcohol consumption.

Mike: Got it. Yeah, you know, funny enough is that when I did drink regularly, my blood work came back just fine and then I didn't have anything for eight months and my liver enzyme was elevated and you know, it was mostly directly related to diet, to diet, even though my diet wasn't really all that bad, but it did definitely get in 2020 much worse, more eating like fat takeout food and stuff like that.

But it did have me thinking, you know, if somebody goes in for blood work, are there timelines for how long they have before they can [00:17:00] stop the behavior before it doesn't come unreversible?

Dr. Belani: Yeah, that's a complicated question in terms of like timelines. I think there's no real good understanding of, of like what the threshold for converting into end organ damage or like real organ damages.

So we're in that pre stage that risk stage, like. I don't think we have a great way to do a risk assessment unless you actually experience some, some of those signs, right? So, you know, if, if, if you, you start to have high blood pressure, right, or pre, pre hypertension, right? Early, like your blood pressure starting to elevate and you're not necessarily in what we call that hypertension level.

But you're in that prehypertensive level. I don't know that there's, you know, it's like, Oh, you have two months. Otherwise you're going to be completely, your blood pressure is going to be high for the rest of your life, right? Like there's no real, that's really not that kind of date [00:18:00] of things, but with things like liver damage, sorry about that, with things like liver damage, you know, elevations in your liver enzymes might indicate some inflammation in your liver that might be due to alcohol.

We might actually see some fatty change to the liver and that might be due to alcohol. I don't know that, you know, I think the guidance really is at that point, the faster you stop, the better to reverse these processes. But I don't know that it's, uh, clear beyond that, like, well, you know, you have X number of months before you convert to liver failure or the liver damages are reversible.

Mike: Yeah, that makes sense.

Dr. Belani: I mean, to kind of thumb that up, I think we. We are getting better data on, on the, the amount of alcohol consumption and what that your risk is, right? Like what puts you at risk, like, [00:19:00] Oh, in the next 10 years, you have X amount of risk of getting X, Y, and Z, but until now, what really, or until we get that, you know, until the near future, when we really have a handle on that data, I think what really we've experienced is, you know, there's, There's moderate drinking and then there's heavy drinking.

And then we know in people who heavy drink, a lot of them, you know, experience organ damage. And then once you start to hit that, we're going to have is you're, you're really in the danger zone. And so it's really about stopping, uh, the minute that happened.

Mike: Yeah. Well, sorry to kind of load up a loaded question for you there, because I think there's probably also genetics at play as well, and probably all kinds of other factors.

Yeah,

Dr. Belani: right. Yeah. Yeah. Everybody's different and, and, uh, the trends and, and population data can And studies, you know, they aim to be as [00:20:00] generalizable as possible, but there's always going to be variations.

Mike: Yeah. Well, this kind of leads us to a conclusion which I want to get your feedback on. So obviously people are listening here.

Stopping forever knowing that something's bad is just like asking you never eat a piece of pie or, you know, whatever your favorite treat is. And so, how can people that are listening that are Sunnyside members or thinking about it or just want to cut back in general, how can they view knowing that, yeah, this isn't healthy for us, but what's the proper view from, I guess, your perspective that they should be looking at alcohol from?

Dr. Belani: Yeah, I think it's, it's kind of some of those things we talked about, right? Obviously, if you have a tangible or already, you know, risk of or already have organ damage or a condition that's worsened by alcohol, I think that's very clear cut, right? Like in those cases, pretty much, it makes sense, talk to your doctor.

And for the most part, in those cases, it's, you know, we [00:21:00] have a plan that we need you to go. To be at zero just for your own sake. But if you're otherwise healthy, and you know, you enjoy alcohol, I think it's just important to know this change that, you know, there's no justification of healthiness to drinking.

But that doesn't mean you can't be safe and drink. And so really, it's, it's, It's about these kinds of wellness, these personal wellness ideals and personal wellness goals, and really just understanding how did alcohol fit into my life, into my lifestyle, just the way that pie does, right? So, if you love pie, we're not gonna stop you from, you know, having a piece of pie.

But if you have diabetes or if you're trying to, if you have diabetes risk in your family and maybe you're, you're working towards a weight goal or some other health, well, or wellness goal, then you know, you have to decide what is the risk and benefit of pie and what is my [00:22:00] efficiency to pie, similar lead to alcohol.

And that doesn't mean you can't have it, but it, it, I think it, it's really good to be aware of what does it actually mean that, you know, when I, when I have a drink and what is it, how is it affecting me? Uh, and so if it is, you know, causing you to have poor sleep and hangovers, as it is causing you to have unwanted weight gain, if your doctor is telling you that your blood pressure is on the rise.

If your, you know, loved ones and friends are telling you they hear more anxious or irritable, or you are seeing, you know, performance issues in your work or, or, uh, relationships, etc. Then yeah, then maybe, maybe that's something you can look at just like you would look at the pie if you're, If you're packing on the pound, uh, relationships, et cetera, um, then yeah, then maybe, maybe that's something you can look at just like you would look at the [00:23:00] pie if you're,

Mike: if you're packing on the pound.

That wraps up this episode of Journey to the Sunnyside. Huge thanks to Dr. Balani for sharing these important insights onto alcohol and health. And before we go, I want to give you a special shout out to my wife, Dr. Balani, who's been sneak peek into our next episode, where Dr. Boulani will be back to share a doctor approved method for cutting back on drinking in a way that fits your lifestyle.

And if today's episode made you think about your own habits, head on over to sunnyside. co and take our three minute quiz for personal insights on your drinking habits. And don't forget to follow us on Instagram at join sunnyside for daily tips, inspiration, and real stories From people just like you.

And if you haven't already, be sure to subscribe so you don't miss out on part two. See you next time.