Journey to the Sunnyside

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Mike: [00:00:00] Hey, welcome to Journey to the Sunnyside. I'm your host, Mike Hardenbrook, and today we're digging into a critical topic. What happens when you mix alcohol and medication? Whether you're taking over the counter or prescription drugs, alcohol can have serious effects on how they work. Joining me is Phil Cowley, a pharmacist with over 20 years of experience.

Phil's not only a pro at breaking down complex health topics, but he's also become a social media influencer. His Instagram has over 600, 000 followers and is packed with fun, easy to understand health information that helps people manage their health in an approachable way. Today, Phil's going to help us uncover the risks of mixed drugs.

with your meds. And give you some practical tips to stay safe.

All right, let's dive in with Phil Callie, the owner and pharmacist at Cache Valley Pharmacy. Phil, thanks for coming on. How fun is this? This is such a great topic to talk to people about. Thank you so much. Yeah, I mean, this is a joy. We were talking [00:01:00] before this that I really love your Instagram account.

I'm a follower. I'm a fan. So this is fun for me in that way. Well, I do appreciate that with everybody, because it's been such a weird ride to this point. Well, let's just jump right in. And actually, this is not even related just to alcohol. This is maybe a personal question for me is, how should people think about their pharmacist as part of their health care team?

And what are the best ways to interact with your pharmacist?

Phil: Well, when you consider that everything a pharmacist does could potentially have deadly outcomes, it's really important that he's your friend, too. So what you want to do is you want to make sure that they're part of that team, talk to them, make sure you know who they are, and when you do that, they'll take a personal interest in you as well, and that makes it so they are very aware of what's going on in your life, to make sure you stay safe, and that you're really getting what you need.

Mike: I love that. I mean, I think most people are really used to interacting with their doctors and don't realize that they have another member of their team that they could do more than just go and have a little bit of counter experience. But it seems like it [00:02:00] could go further than that. Well,

Phil: for sure. And we've got used to not having face to face interactions with people to begin with.

So with your doctor, you have to because they're right there. With your pharmacist, you're gonna have to go to a little extra effort, but when you do that, the pharmacist will fill that and they'll take you in as one of theirs rather than just a person coming in the store.

Mike: So, actually, let me flip the, the coin on the other side.

Are there any misconceptions that we do or don't know about what a pharmacist does?

Phil: You know, the one thing I always tell people is I think pharmacists have more bosses than anybody else. You've got the DEA, the FDA, the state boards, you've got insurances. So, So most of the frustrations people have with their pharmacist, it's really just coming from somebody who's bossing them around.

So when you get frustrated, start thinking. If you start seeing the fact that there's somebody pushing them from behind and they're doing their best to advocate for you, it starts seeing the whole process a little bit different, makes it easier for the patient as well as the pharmacist.

Mike: So I get this sense you like to push the boundaries.

How do you feel [00:03:00] like you may be pushing some boundaries in the field that you're in? It's education.

Phil: It's always been very quiet because there's so many pieces to it. And there's a lot of people, well, there's been a few that haven't liked it a whole lot. But the truth is, is that I believe people are smart and the education you give them makes them safer and healthier.

And so when you push a boundary that makes people look behind doors and see what's really going on and it helps them to be smarter and wiser and healthier. I don't really, it doesn't bother me that it bugs a few people out there. It's, it's really important. People become educated. The healthcare system isn't set up anymore for you to be able to go into anything blind.

Mike: Yeah, I see it in your content and the education. So it's coming right through. So let's jump into the topic at hand today. And that is how does alcohol generally impact medications, including over the counter medications and also prescription drugs, everything we swallow

Phil: has to be processed. You're either going to process it through your liver or you're going to process it through your kidney.

When you [00:04:00] drink heavily versus light, your liver does two different things. When it's heavily, it starts clogging up many of the pathways that you need in order to get rid of medications. What was safe when your doctor gave it to you becomes unsafe because you clogged up the filter to get rid of it. It also has long lasting effects on the way that you will end up processing all of the metabolites that you have from those medications.

Medications often have a metabolite and those metabolites can have activity. So not only are you a little bit hung over, but now your blood pressure's a little bit hung over too, and it's just compounding all the issues.

Mike: So you pretty much goes through two organs

Phil: and is affected in that way. That's, that's it.

It's either the liver or the kidney. And if you think that everybody dehydrates themselves out while they're drinking, so the kidneys already kind of clogged up and then you're hitting that liver really hard. You're slowing traffic flow through everywhere. There's no side roads. You just got to go through the nice slow detour you've got in front of you.

Mike: Got it. You read most labels and [00:05:00] almost all of them are going to say either be cautious or don't drink with it and it starts to get Lose its meaning, I think, in some ways, because you never know how high risk or medium risk it is, unless you really want to get deep and maybe do some research on your own.

Are there any specific types of prescription medications that we should be especially cautious with?

Phil: So antihistamines jump out right away. So when you drink. You induce a larger amount of GABA, which is a depressant, which is, you know, settles you down, makes you feel less anxious. That's the reason why a lot of people who have self medicating type alcoholism going on, they drink it.

The problem is, is that now that you've depressed the system just a little bit, the way you wake up is either adenosine or histamine. When you take an antihistamine, now you put yourself into the slump, but you also block the way to wake up. So it really can lead to major issues with. You know aspiration it has so [00:06:00] you you choke on your own vomit at times You have a lot of people whose effects of alcohol gets so severe and they can't clear them out They also get in the way of clearing each other out many of the antihistamines do Antihistamines with alcohol your NyQuil, Benadryl things like that can become very dangerous very quickly But the truth is all of your listeners who have drink and taken a Benadryl already know this to be a fact You Because they see it happen so rapidly.

This isn't new news. If you're taking an antihistamine, they already know it really works you over if you've been drinking.

Mike: So is there a way you can actually take it, or is it just best to avoid it altogether?

Phil: That's always a loaded question. Are we talking one drink? Are we talking ten drinks? Did you go out to forget the night, or are you having a nightcap?

There's always a safe way to mix almost every medication or alcohol together. But You should know your limits before you start because when your inhibition goes down with alcohol and you've already taken your antihistamine, then you're doubling and tripling your [00:07:00] risk for having all the side effects you don't want.

And so it's really important that if you can't drink in moderation, I wouldn't do it. But if you really can, and there are people that can, this is a completely different story.

Mike: Well, that makes sense. What about things like antibiotics and antidepressants?

Phil: You know, there's one out there called metronidazole and if you take metronidazole while you drink it'll remind you not to do it because you'll start puking like almost immediately.

So it's one that really jumps out. There's others like isoniazid and a few others that are important that you have to be careful with them. Most of them are okay as long as the doses aren't too high and you're not on them for long periods of time. There's another one, rifampin, you gotta watch out for and there's a few.

But there are a few that are really dangerous, but metronidazole, you'll always remember that because you'll spend most of the night with your head in the toilet.

Mike: Yeah, that sounds like no fun. Most of the people here that are listening are either on a journey to mindful drinking or some combo of maybe moderation to eventually quit.

If we're talking [00:08:00] about over the counter stuff, what about supplements? Are there things that we need to be wary of as well? You know, the interesting

Phil: thing is that people are starting to replace some of their alcohol with kava. Like it's a it's a push that they're putting into but kava at high levels can be really detrimental to the liver So people who take kava and they know it they know that they there's a limit to it The one concern that I start to have with kava Is that when you're taking them together and you haven't started to moderate your drinking, but rather just have a plan to have we injured that liver even more, the other thing that's jumping out right now are supplements that they say, help you get rid of your blood alcohol level.

They're jumping all over the place. In most cases, those have between three and five stimulants. And that that's disconcerting for someone who has been a longtime drinker or a heavy drinker. Because you're already at a higher risk for cardiac issues once you've drank for a long time. And now you're throwing in enough, the one I looked at, I don't think I'd sleep for a week with how much they had caffeine in it.

They had phenylephrine in it. They had [00:09:00] so many types. So when you look at the stimulants, that's a concern. And kava, if you don't know what you're doing, you're just adding both together at large amounts, you can run into trouble.

Mike: Yeah, that makes sense. That makes me think about what's your opinion on sort of these hangover remedies that are either preventative or can reduce it the next day.

Phil: There's some in other countries, not, not here, not in the UK, but they use a type of vitamin B6. So it's a, it's a phospholated vitamin B6 and they found in an IV form that it helps reduce that blood alcohol level. So many of these supplements have thrown that. Uh, into their supplement. They also add NAC, which is N acetylcysteine, which helps raise your glutathione, which theoretically is a secondary pathway, could help with the aldehyde part of, uh, and that's probably all boring.

So anybody that bored, I apologize. But there is, there are some mechanisms that they put in there that are interesting to me. So I don't want to completely wipe out the whole thing, but the major, what most of them do is add a lot of stimulants. So if you'll [00:10:00] imagine you took a gallon of alcohol and put it in your car.

If the car goes at one RPM, you burn that alcohol over an hour. Let's just say, right? If I rev that up to six RPMs, like you would with a stimulant, you take it on yourself. Now that alcohol burns through really fast. But all you've done is rev that engine. And is that really a healthy way to get rid of your alcohol?

Mike: I just think that there's

Phil: no silver bullet to anything, you know. Isn't there a danger to, don't you think, I always think there's a danger when you tell somebody they can drink more than they already know they should.

Mike: That sparks an interest that I've had around kava and a lot of people that are moderating or using kava as a substitute or even potentially related to what you just said in between drinks.

Is there much risk in that relation to liver that I've read about in relation to kava? What's your opinion on that? Um, so I think that

Phil: any substance that you take. That helps alter your, your mental state could potentially have a problem. So I'm going to just give you a background. My dad's [00:11:00] got, there's seven boys in my dad's family.

Five of them are alcoholics. So for someone like me and for my kids, I've told them over and over again, our tolerance, there's no such thing as moderation in our family. I already know where we're headed. My mom's side has just about as many in them. Growing up in Utah. You'd think I'd have less. But the truth is we'd go to family reunions and there were more than anything else.

And so I already knew where I was at. When you look at kava, or if you look at caffeine or anything else, our brains are really hardwired for addiction. We like pathways, we want to go back to the pathway. And so I don't think that necessarily there's such thing as a bad substance out there. I think there's a great place for kava.

But if you've had problems with heavy drinking and you're trying to get away from it, anything that you put in that could re alter that mental state. Could have the same issue. So it's all about knowing you, knowing your limits and understanding where an equilibrium moves to unhealthy when it comes switching from alcohol to kava.

Mike: [00:12:00] And it's good that you have a lot of self awareness on family history and just knowing yourself there.

Phil: Yeah. So like my uncle, my uncle, Jim used to have to ride his bike to work. So I would go work at my dad's garage door company and my uncle Jim had to ride his bike to work. And it was because he had posted bail for his twin brother for a DUI charge.

And then the brother jumped town, and he lost his license, and then Jim got a couple of DUIs driving with it, so he lost his license. And I'd watch Jim drive in every day, and then he'd go home at lunch, and he would come back, and he had drank all lunch. So when we were in high school, everybody else was like, this is fun, this is socially acceptable.

I would see Jim. In all of these people and I knew what it actually looked like and I knew that I really I really loved my uncle But I loved him in the morning way better than I did in the afternoon and I knew what alcohol did So for me, I feel really lucky That I didn't have to learn that lesson like most people do, like in college and high school, they'd want to drink.

I'm like, yeah, [00:13:00] good luck with that. I know what you're going to look like when you're 55. So have fun.

Mike: Hey, you can go one of two directions. When that happens, you can either adopt it, you know, and end up being repeating the pattern or you, I guess you could say you rebelled and did the opposite.

Phil: That's it.

I just, I looked at it. My dad, there's not been very many times that I've been able to follow this advice. My dad said a wise man learns from a mistake and a wiser man, I know he got it from someplace else, but a wiser man learns from everybody else's. And he used to tell me that all the time and I looked at it and I thought, that's one mistake.

Now I made all the others, but that's one mistake I wasn't going to make. Love

Mike: that. Well, going back to you wearing your pharmacy hat, or as a pharmacist. Are there things that we could be doing that we're not even aware of, so we're taking medications and we're not getting that violently ill reaction of the one medication that you mentioned, like names escaping me.

Are there things that we should be, that could creep up on us, that maybe might be showing some symptoms, maybe a worse hangover, maybe more cloudy headed, are there [00:14:00] some things that we should be looking out for, for early symptoms? If we're talking about just medications, are we

Phil: talking about everything in the pharmacy world?

Mike: Oh, let's, let's keep it to medications for this one to keep it more simple.

Phil: You know, a lot of people actually do see very big variations from medication usage by how much they're drinking and when they're drinking. Although there's not severe, um, interactions with many medications, there's minor ones. So we'll see people's blood pressure or blood sugars move substantially up and down.

And we can't, we cannot level out their medications because their blood sugars are moving with their alcohol consumption and we're not able to factor that in. Which leads to worse in case of diabetes. We see people with cardiac risks when they start drinking. Then we see that the metabolism of their medications move up and down.

So we're seeing their blood pressures jump up or down or their heart rates jump up and down. It's, it's a rare occasion for anybody who does more than very, very moderate drinking for them not to have seen some sort of interaction with one of their medications. But you usually just think, Oh, that medication was really severe side effects and you don't realize the [00:15:00] medication is not the problem.

It's everything else I was doing.

Mike: Well, what about.

Phil: The efficacy of the medications. Oh yeah. They'll drop. There's times where somebody who's been heavily drinking for years, the alcohol dehydrogenase, when it jumps up, we'll make it. So you burn through your medications faster. Your liver gets so accustomed to breaking apart things with that enzyme.

It could break up. There are antibiotics. It'll break up too fast. There are heart medications that'll break up too fast. There are, there's antihistamines people take. So it induced so many workers to break apart alcohol. Those workers now start breaking everything up too fast as well.

Mike: So I love the fact that I got to sit down with a pharmacist and ask these questions, Dirac.

Rapid fire with you. What? Can you leave us with a philosophy? That people should be approaching things that are on this moderation path. So they're not going out, they're not binging, they're not doing excessive. They're just alcohol is still in their life. And they still, obviously some people have to take medications or over the counter [00:16:00] or supplementation.

Is there like a philosophy that they should be approaching this with?

Phil: Like, I'm a huge, huge fan of equilibrium. If you take too many medications, you're in trouble. If you drink too much, you're in trouble. If you eat too much, you're in trouble. And every one of us knows. the glutton within us when, when we overstep that equilibrium.

If you can come to an equilibrium, it helps you have better neural pathways that are healthier for you. You live a happier, healthier life. And when you start to step off that equilibrium, you need to check yourself on a routine basis because we all get out of equilibrium. So it's not a matter of not doing something or doing something.

It's when we decide we're all in that it becomes very dangerous.

Mike: That's it for today's episode on journey to the sunny side. A huge thanks to Phil Kali for sharing his insights on how alcohol can affect your medications and overall health. It's definitely an important topic for us to keep in mind. But Phil and I aren't done talking.

Join us tomorrow when Phil and I start talking about something that affects all of us. Why [00:17:00] alcohol is messing with your sleep and what you can do to fix it. In the meantime, head on over to sunnyside. co and take our three minute quiz to learn more about your drinking habits. It's a great way to get personalized insights.

Also be sure to follow us on Instagram at join sunny side for more daily tips, resources, and success stories. Plus don't forget to enroll in our free masterclass. You can find that link right in the Instagram bio. If you've enjoyed today's episode, hit that subscribe button. So you never miss an update from journey to the sunny side.

And until then, let's keep moving forward with a healthier, more mindful relationship with alcohol.