EPISODE 31 - ALCOHOL: IMPACTS ON HEALTH (& DURING PERINATAL PERIOD)

EPISODE 31 – ALCOHOL AND THE PERINATAL PERIOD

Since 7000 B.C in China, humans have been drinking alcohol! It’s been generally a socially and culturally accepted ‘crutch’ or tool to help us feel better or to celebrate with family and friends.

Some quick statistics from Australia;

• In 2016 Australians spent $666 billion on general living costs, $14.9 billion was on alcohol vs $1.6 billion on tea and coffee (https://moneysmart.gov.au/australian-spending-habits

 

• The ABS data released on 21.3.22; 1 in 4 Australians aged 18 years and over exceeded the Australian Alcohol Guidelines in 2020-21

 

• Men were more likely to exceed the Guidelines than women (33.6% vs 18.5%)

 

• Those living in Inner and Outer Regional and remote areas were more likely to exceed the Guidelines than those living in Major Cities.

What are we covering today?

• EFFECTS OF ALCOHOL, HOW IT WORKS (biochemistry, short-term & long-term effects, and what an alcohol emergency looks like)

 

• WHAT ARE THE NHMRC ALCOHOL GUIDELINES: National Health and Medical Research Council

 

• WHAT IS A STANDARD DRINK?

 

• ALCOHOL AND SLEEP RELATIONSHIP

 

• MEDICATION SAFETY AND INTERACTIONS (As a pharmacist, medication safety and drug interactions are hugely important topics with alcohol! Hearing or watching people combine seemingly ‘benign’ over the counter medications with alcohol is always a trigger point for me!

 

• PREGNANCY AND ALCOHOL

 

• BREASTFEEDING AND ALCOHOL

 

• MOTHERHOOD/PARENTHOOD AND ALCOHOL

 

• AMA; EMOTIONAL AND PHYSICAL

 

• WHAT TO DO IF YOU ARE CONCERNED WITH YOUR DRINKING OR A LOVED ONE?

In terms of my own experience, I have shared on a number of podcasts, how inflammatory alcohol is for me personally, and how much my body speaks to me to reduce, if not eliminate it from my lifestyle. My body tends to become swollen, inflamed in my fingers/face/legs and feet, as well as my tonsils always becoming inflamed, with it taking a good 5-7 days to return to ‘normal’.

I do however, enjoy the relaxation aspect that it brings me, which is why I have not been able to ‘cut it out’ completely from my menu! I do try to drink higher quality wines with fewer preservatives and trialling one ‘type’ at a time; but I still haven’t quite worked it out! My ‘Google’ research has suggested that red wines, vodka and gin are the least inflammatory; but haven’t worked out my secret recipe or solution here!

So, I bring up alcohol from a MENTAL HEALTH space and also from the PERINATAL period space, because it is quite a complex and intricate balance between understanding;

+ the biochemical impacts that it has on our system

+ as well as safely considering all the aspects that need to be thought of when drinking

So I wanted to launch into each topic in some detail to help SHINE THE LIGHT on one of the most commonly used substances across the globe!

1. EFFECTS OF ALCOHOL, HOW IT WORKS (biochemistry, short-term & long-term effects, and what an alcohol emergency looks like)

https://www.betterhealth.vic.gov.au

CNS depressant chemical; one of the oldest and most commonly used recreational drug. Slows down the processes in your brain and CNS, and can initially make you feel less inhibited and RELAXED.

However, your body can get ‘used to this’, so enter the ‘fight or flight’ mode without alcohol in your body or as it wears off, and it can create a vicious cycle of needing alcohol to FEEL relaxed, but not having it in your system creates this heightened CNS.

Tolerance can occur, which means that you need more alcohol to exert the same effect.; which puts you at a greater risk of alcohol dependence.

In terms of MENTAL HEALTH and the impact that alcohol can have, on the www.drinkaware.co.uk website, they have this statement;

‘if you drink more than the UK Chief medical officers low risk drinking guidelines, it can have a negative effect on your brain chemistry and lead to worse mental health.

It also states that ‘binge drinking is found to have more likely to have symptoms of depression, with people who reported regular hangovers as most at risk.’ (with binge drinking being more than 8 units of alcohol in a single session for men, or 6 for women in the UK).

It continues to state that cutting out alcohol completely for just 4 weeks makes a clear difference in how they feel.

Alcohol is a CNS depressant and works in the brain primarily by;

• Small amount of alcohol can stimulate GABA (the inhibitory neurotransmitter), which causes a relaxation effect, but heavy drinking can deplete GABA, causing increased tension and feelings of panic
• It impacts other neurotransmitter systems of GLUTAMATE, GLYCINE, ACETYLCHOLINE, SEROTONIN.
• The pleasurable effects occur due to the increased level of DOPAMINE and ENDOGENOOUS OPIOIDS in the reward pathway of the brain.
• All of these contribute to alcohol’s ‘’reinforcement related’’ adverse effects of; ADDICTION, DEPENDENCE and WITHDRAWAL

How much alcohol impacts the body will depend upon;

• How much you drink
• Your pattern of drinking
• The quality of alcohol you drink
• Body size and composition
• Age
• Drinking experience
• Genetics
• Nutritional status
• Metabolism
• Social factors

What are SHORT TERM effects?

• Lowered inhibitions
• Feeling of relaxation
• Inducer of sleep due to the drowsiness/sedation
• Interpersonal conflict
• Falls and accidents
• Altered behaviour; including risky or violent behaviour
• Hangover
• Alcohol poisoning

Alcohol triggers a number of reactions in the body;

-frequent urination and dehydration

-inflammatory response from your immune system

-irritation to the stomach lining by increasing gastric acid secretion (it can enhance complications with people with PUD or H. pylori)

-a drop in blood sugar

-expansion of blood vessels

-can cause liver damage; due to accumulation of fats in the liver as a result of alcohol metabolism. It can cause cell death within the liver

What are symptoms of a ‘Hangover’?

Hangover symptoms usually last up to 24 hours and resolve on their own;

• Thirst, headache, muscle aches, diarrhoea, nausea, fatigue, weakness, trembling or shaking, rapid heart rate, increased blood pressure, dry mouth and eyes, poor concentration, increased sensitivity to light and sound, feeling like the room is spinning or dizziness
• Anxiety, depression, irritability and mood disturbances
• Feeling jittery
• Poor, restless or less sleep

 

Hangovers tend to be worse if;

• Drink on empty stomach
• Use other drugs and smoking nicotine is known to make it worse
• Sleep poorly after drinking
• Drink dark coloured alcohol such as brandy, rum and whiskey

What is an ‘’ALCOHOL POISONING EMERGENCY’’?

This is a life-threatening emergency due to the number of organ systems involved with alcohol poisoning.

Call 000 if you notice any;

• Confusion
• Vomiting
• Seizures
• Slow breathing, less than 8 breaths per minute or irregular breathing (a gap of more than 10 seconds between breaths)
• Blue tinged or pale skin
• Hypothermia; low body temperature
• Difficulty remaining conscious
• Passing out/unconscious and can’t be woken

The AMOUNT of alcohol required to reach this poisoning will be DIFFERENT for everyone based on the above factors discussed. If in doubt, check it out!

What are LONG TERM EFFECTS?

The WHO indicates that alcohol contributes to more than 200 different diseases and injury types.

Some examples;

-road and other accidents

-mental health conditions; such as anxiety and depression; as well as interference with antidepressant medication

-domestic and public violence

-crime

-family breakdown and social dysfunction

-cardiovascular disease

-cancers

-overweight and obesity

-risk to unborn babies

-liver disease, long term cognitive impairment, self-harm

 

What are WITHDRAWAL SYMPTOMS?

• confusion, paranoia, anxiety, insomnia, agitation, tremors, fever, nausea, vomiting, seizures and hallucinations, delirium

 

2. WHAT ARE THE NHMRC ALCOHOL GUIDELINES: National Health and Medical Research Council

The lifetime risk from drinking alcohol increases the more you drink.

For healthy men and women, the guidelines are;

• Drinking no more than 10 standard drinks per week reduces the lifetime risk of harm from alcohol related disease or injury

 

• Drinking no more than 4 standard drinks of one day reduces the risk of alcohol related injury arising from that occasion

 

• Children under 18 years should not drink alcohol to reduce the risk of injury and harms to health

 

• Women who are pregnant; to prevent harm from alcohol to the unborn child, women who are pregnant or planning to become pregnant should not drink alcohol

 

• Women who are breastfeeding; not drinking alcohol is the safest for your baby

 

3. WHAT IS A STANDARD DRINK?

 

1 standard drink contains 10 grams of pure alcohol irrespective of;

 

+ the type of alcohol

+ if is mixed with ice, juice or water etc.

The volumes of different types of alcohol will change to give this 10 grams of alcohol.

Excellent visual of different types of alcohol and what is a standard drink on the health.gov website; https://www.health.gov.au/topics/alcohol/about-alcohol/standard-drinks-guide

 

4. ALCOHOL AND SLEEP

Excellent article at; https://www.sleepfoundation.org/nutrition/alcohol-and-sleep

Alcohol is a SLEEP INDUCER with the drowsiness and sedation it brings to the CNS.

A normal sleep cycle has 4 different stages; 3 Non REM (rapid eye movement) and 1 REM stage all lasting between 90-120 minutes. Alcohol induces sleep quickly, but can fall into deep sleep quickly, which disrupts the usual balance between SLOW-WAVE sleep and REM sleep.

This reduces the quality and the duration of sleep, and can increase symptoms of SLEEP APNOEA by 25%. You feel more tired the next day, so lean on stimulants such as caffeine, which can in turn impact sleep, possibly rely on alcohol again to INDUCE sleep, but impair the quality and duration again!

Given that sleep is a vital PILLAR of HEALTH in both Western medicine and Eastern Ayurveda, alcohol disrupting the sleep cycle is going to have an impact on our ability to THRIVE and feel full of VITALITY.

If we think of what sleep deprivation can do to us in the newborn baby stage, then repeated nights of poor quality of sleep as a result of alcohol will have the same disruption to our quality of life.

 

5. MEDICATION SAFETY AND INTERACTIONS

Understanding that alcohol affects several neurotransmitters as mentioned, as well as understanding that our detoxifying organs the kidney and liver in particular, are placed under extra stress by drinking as we need to detoxify it from our body.

If you think about adding medication, whether OTC or prescription, or herbal, consider;

1. The extra work and burden placed onto your kidney and liver to clear them all (all seen as foreign)
2. That medications that make you drowsy, depress the CNS; can have additive effects with alcohol and cause CNS sedation; which can be fatal with respiratory depression as an example
3. Seemingly innocuous and benign combinations as say sedating antihistamines, can really have fatal consequences…and Paracetamol. It is my big trigger point if I ever hear friends or people speak of saying what OTC thing they have taken and drink; and laugh…when I am horrified by the sheer risk of what they are doing…

It is crucial to chat with your pharmacist about medication that you take before drinking alcohol to check if it is safe.

Some antibiotics, anti-inflammatories, OTC preps (herbal and medicinal) ALL have the capacity to interact with alcohol.

Equally there are medications that you should not stop suddenly, in fact if doing so can cause very serious adverse reactions within the body and so CORRECT advice on what to do is VITAL.

What is also interesting that medications to treat anxiety, should not be combined with alcohol as t has an additive impact on the CNS and can cause severe drowsiness, and machinery should not be operated on.

If we also consider the vicious cycle with anxiety and alcohol, then we may end up using more anti-anxiety medication thinking the anxiety is getting worse, when it could be the alcohol that is causing and exacerbating it.

If we think that alcohol is a CNS depressant, and we consider antidepressants being complex of course, but really trying to boost serotonin, noradrenaline and dopamine, then alcohol impacting the brain biochemistry is going to make it

1. hard to know if medication is working, and
2. make the medication potentially less efficacious; until there is a homeostasis within the body and it is clear as to how the biochemistry is, without adding another variable of alcohol into it.

So, before you combine any medication with alcohol check first. Certainly if you are struggling with anxiety and depression, look into your drinking habits and reduce, if not cut out completely. Then of course, if you need support then we will go into this a bit further.

6. PREGNANCY AND ALCOHOL

Current guidelines stipulate that it is the safest to not drink alcohol if planning to fall pregnant or whilst pregnant.

This is evidenced with an uprise in advertisements and labelling on alcohol to spread this health advice. This advice is present as alcohol can lead to poorer perinatal outcomes including;

-low birthweight

-being small for gestational age

-pre-term birth

-miscarriage, stillbirths, birth defects

-foetal alcohol spectrum disorder (FASD); which can have a range of adverse physical, learning and behavioural effects after exposure to alcohol during pregnancy.

Women were more likely to drink alcohol in pregnancy if;

-they lived remote or in very remote areas

-were indigenous

-were teenage mothers

Alcohol can affect the fertility of men and women, which is why the advice of not drinking alcohol if planning to fall pregnant is there.

Also, when I was pregnant with Ari our eldest but I did not know it at the time, I felt SO guilty as I remember having 2 glasses of plum wine at a dinner with friends! The guilt far outweighed the joyof drinking it in hindsight!

7. BREASTFEEDING AND ALCOHOL

https://www.breastfeeding.asn.au/resources/alcohol-and-breastfeeding

• The concentration of alcohol in breastmilk follows the amount of alcohol in your blood

 

• Alcohol will be in your breastmilk 30-60 minutes after you start drinking

 

• A number of factors affect how much alcohol gets into your milk;

 

+ the strength and amount of alcohol in your drink

+ what and how much you have eaten

+ how much you weigh

+ how quickly you are drinking

 

• As a general rule:

It takes 2 hours for an average woman to be free of the alcohol from 1 standard drink and therefore 4 hours for 2 drinks, 6 hours for 3 drinks and so on.

 

• The time taken is from the start of drinking

 

• The Feed Safe app can help to work out the times more accurately

 

• Only time will reduce the amount of alcohol in your breasts

 

• Pumping and dumping will not reduce the amount of alcohol in your milk, and you don’t need to do this once the alcohol has passed through your system as alcohol is not stored in your milk.

The best advice is to plan ahead!

The safest option is to not drink; but if you are planning to drink, then express some milk before you start drinking.

If you are unsure if you have had too much to drink, or it’s too soon, then call the Breastfeeding Helpline and talk to one of the breastfeeding counsellors about your unique situation: 1800 686 268 24/7

8. MOTHERHOOD/PARENTHOOD AND ALCOHOL:

I can definitely understand how as parent’s days are stressful, full, sensory overload, chaos, movement and everything in between! Reaching for a glass of wine at the end of the day feels like a beautiful reward to ‘take the edge’ off the stretched nervous system!

It will make you initially feel relaxed due to GABA stimulation, it can ‘induce’ sedation and sleep…but as we have learned, that our kidney/liver have to work hard metabolising it, it impairs our quality and duration of sleep, heavier drinking causes a reduction in GABA, impacts our mood and can enhance anxiety, it may cause tolerance so we drink more heavily…sleep is poorer so rely more on caffeine!

This cycle then affects how we feel through the day and the quality of sleep that we get at night!

So, what is the solution?

Ideally we want to observe our drinking; how it makes our body feel, how often we are ‘relying’ on it to make us feel calm…and to lean into other alternatives that may not have a rippling effect on our system;

+ reaching for a herbal tea with chamomile, lavender or lemon balm to help us feel relaxed

+ magnesium salt baths, with a candle and soft music (clear the kids toys out of sight!)

+ boiled milk with ginger, turmeric, cinnamon and cloves with a splash of honey once cooled down a little. The spices will calm the VATA system to bring heat and grounding to the nervous system

+ warm sesame oil massage on the body; if not just on the scalp, back of the neck, wrists and soles of the feet…again to bring grounding and EARTH qualities to our aggravated VATA system

+ Exercise through the day (not within 90 minutes of sleep), ideally first thing in the morning to help MELATONIN regulation and assist in the circadian rhythm and sleep cycle re-set

+ Bliss ball with grounding nuts and natural sweeteners to bring that comfort and grounding that alcohol may bring…looking for healthier alternatives to alcohol

+ Read a book, journal through your feelings

+ Listen to soothing music

+ Meditate

+ Gentle stretching or yoga…

AIM is to REPLACE the reliance upon ALCOHOL with an alternative.

Hopefully SLEEP quality improves, the reliance on CAFFEINE through the next day reduces, and this can help you FEEL better and allow your ADRENAL system to THRIVE.

At social gatherings, replace every second drink with a non-alcoholic beverage, bring your own non-alcoholic beverage that looks just like it so you feel part of the gathering, or drink so much water that you’re too busy going to the bathroom (kidding!)

The aim is to shift the cycle, because I know how it works! I am great at abstinence but once I have a sip, my filter and discernment reduces and I drink far more than I would like…and my body is telling me in SO many ways that I need to not do that…so I completely understand!

9. AMA; EMOTIONAL AND PHYSICAL

From an Ayurvedic perspective, the VIRYA, or the energy of alcohol is quite heating, so for a PITTA PRAKRUTI or VIKRUTI, it can enhance the FIRE aspect (this can explain anger and violence when drinking alcohol in some).

It also is considered to have a RAJASIC impact on the mind; which is this sense of agitation, erratic-ness (vs SATWIC which is calm, serene and poised; the ultimate aim in Ayurveda is to increase the SATWIC quality of our mind by our food, practices etc.)

In terms of emotional AMA, we don’t want to add guilt, shame or emotional toxins whilst drinking; as this can affect our body, mind and soul. If you drink it, then drink with the energy of joy, celebration and love, and don’t add more toxin load.

However, Ayurveda always reminds us of this principle of PRAGYA APARAHDA, which is the ‘mistaken intellect’. Meaning that once you know that say alcohol is not the best for your system, to remind ourselves of this so that we can make the better choice to reduce the harm of it within our body. It’s almost like if you know something is poisonous, then why keep ingesting it?

It is this ‘forgetting’ of our intellect, which is almost the ‘ROOT CAUSE’ of imbalance in our system.

What to do if you are concerned with your drinking or a loved one?

Given that alcohol can create a TOLERANCE and alcohol dependence can create a myriad of effects on a bio, psycho, social plane, there can be a rea; need for accessing HELP with alcohol use:

• Your GP is an EXCELLENT resource!

 

• Alcohol and Drug Foundation (1300 85 85 84)

https://adf.org.au/help-support (Alcohol and Drug Foundation)

 

• DirectLine 1800 888 236

 

• ADIS, Alcohol Drug information Service National Support Line 24/7 1800 250 015

 

• Visit https://drinkwise.org.au they have the contacts for:

 

Alcoholics Anonymous, Beyond Blue, Lifeline, Parentline, Family Drug Support Australia

 

As well as https://www.health.gov.au/topics/alcohol.alcohol-contacts

 

• https://www.nhmrc.gov.au/health-advice/alcohol

 

Important to know that there are support groups, medication to help with the withdrawal process and to help with addiction, counselling and other resources to help you all get through this time.

Recovery IS possible and seeking the support from a counsellor, support group and medical intervention perspective can ALL help get to the underlying cause as well as give the resources needed to get through the complexities that exist.

The MENTAL and PHYSICAL health relationship with alcohol use are undeniable, but observing;

+ HOW much you are drinking

+ WHY you are drinking

+ WHAT perhaps is it numbing or sedating for you

+ What EFFECT is it having on your body and HOW you feel, your mood, your physical health?

+ What impact is it having on your SLEEP?

+ What impact is it having on your relationships?

Just some food for thought questions, and the MINDFUL MOMENT for this week, is to sit with these questions as you drink alcohol and see what comes up for you.

xxx

Namita