Today's guest is Dr. Joseph Mosquera, an integrative medical expert with extensive experience in general practice, who also happens to be Elara's dad. We cover various aspects of alcohol use, including alcohol use disorder, its impact on health, and approaches to moderation.
Dr. Mosquera begins by highlighting the significance of discussing alcohol, especially in the post-pandemic era where alcohol abuse and dependence have become prevalent issues. He emphasizes the importance of using the term "alcohol use disorder" instead of stigmatizing terms like "alcoholism" or "alcoholics."
A key topic discussed was the concept of moderation in alcohol consumption. Dr. Mosquera clarified that mild or social drinking does not significantly increase health risks, barring exceptions like pregnancy. However, people often underestimate their alcohol intake, which can lead to abuse and dependence. This leads to a discussion about what constitutes excessive drinking.
Elara and Dr. Mosquera explore the potential health impacts of regular drinking, like effects on the liver, gastrointestinal system, and mental health. We look at cultural differences in drinking habits, like the "French Paradox" and the practice of drinking wine in Mediterranean cultures. Dr. Mosquera shared personal anecdotes about his upbringing in Spain, illustrating cultural attitudes towards alcohol.
Next, we cover hangovers, their physiological basis, and ways to mitigate them. They discussed practical tips like hydration, anti-inflammatory medications, and specific foods to ease hangover symptoms. Elara shared her college experiences with hangovers and remedies like Pedialyte, highlighting the dangers of binge drinking.
We spend a fair amount of time on the risks of drinking during pregnancy and breastfeeding. Dr. Mosquera firmly advises against alcohol consumption during pregnancy due to the risk of fetal alcohol syndrome. For breastfeeding mothers, moderation was deemed acceptable, but caution is advised, especially regarding binge drinking.
Dr. Mosquera notes an increase in infertility rates linked to alcohol abuse. He emphasized the need for moderation and the potential long-term health risks, including increased cancer risk associated with excessive drinking.
Advice for replacing alcohol with healthier alternatives includes engaging in regular exercise, adopting good sleep patterns, and following a nutritious diet. He stressed the importance of an integrative health approach, tailored to individual lifestyles.
We'd be remiss if we didn't cover sugar intake in alcoholic beverages. Diana and Dr. Mosquera mention the often-overlooked high-caloric content in alcoholic drinks, particularly sugary cocktails and mixed drinks. They pointed out how these additional calories could contribute to health issues like obesity.
Listeners who might be concerned about their drinking habits can journal their consumption and seek help if necessary. Alcohol use disorder is treatable; it's important to recognize its severity and seeking appropriate help, which could range from behavioral therapy to more intensive medical interventions.
Finally, Dr. Mosquera underscores the importance of community and peer support in addressing alcohol use disorders. Listeners should reach out to friends and family members who might be struggling with alcohol dependency.
More:
Dr. Mosquera's Website: https://drmosquera.com/
Instagram: https://www.instagram.com/spontaneoushealing/
Announcer: Welcome to The Matcha Guardians podcast, brought to you by matcha.com. Here we focus on the biggest trending health topics of our time, featuring the greatest and upcoming wellness advocates. Now here are the Matcha Guardians, certified nutritionist, Diana Weil, and medical journalist, Elara Hadjipateras.
Diana Weil: Hello. Hello. Welcome to this week's episode. I am very excited about this topic and our guest. We are discussing alcohol today.
Elara Hadjipateras: Who better to have on the show to discuss alcohol than Dr. Mosquera, aka my dad? I think if you've tuned into any of our other podcasts, you might know that the way that Diana and I actually know each other is through our fathers’ friendship, so we thought it'd be great to bring him on to the podcast. He is an integrative medical expert. He has over 40 years of experience with his own general practice. Dad, if you want to just take it away. Just give us a little bit more in terms of why you're on this podcast today besides the fact that you're my dad and I forced you to do it, and why we thought that talking about alcohol would be a good topic.
Dr. Mosquera: Thank you. Thanks very much. Alcohol is a really important topic, especially post-pandemic and during the pandemic. It's a real prevalent issue in our healthcare system. Alcohol abuse is on the rise, alcohol dependence is on the rise, and we can talk about both of those, but it's a real issue in our society in terms of how we are approaching our conflicts and how we cope with conflict. We can talk a little about that and also talk about not calling it alcoholism or alcoholics. Those are improper terms. We need to use the term alcohol use disorder because the other two terms are really a little bit antagonizing and are not useful to solve the situation of alcoholic use disorder.
Elara: I think that one of the things I want to get across as far as the podcast is this is a judgment-free podcast. It's not about judging anyone for their alcohol use. It's about just providing clear information. What does the science say about how can we make more informed decisions about our alcohol intake?
Dr. Mosquera: Absolutely. Ultimately, with alcoholic use disorder, what really matters is your idea of moderation and balance in life. There is no evidence to show that mild or regular social drinking increases your health risks unless you're pregnant. That's the only exception. In general, we need to know or quantify how much we drink. And usually, we underestimate vastly the amount of alcohol we drink. That's where alcohol abuse and alcohol dependency comes in, so shoot away. Let's talk about it.
Diana: Okay. I'm going to jump off here. I'm going to call you Dr. Mosquera, even though I've known you since I was 10 years old. Dr. Mosquera, can you give us some numbers? You said about that a lot of people are greatly underestimating maybe how much they drink or what is problematic. Can we just start off with some numbers?
Dr. Mosquera: The numbers are astounding to say the least. About one in 12 men have severe alcohol use disorder, which means they need treatment. One in 25 women have it as well, but then the amount of alcohol abuse, meaning people that are just drinking excessively, and do not realize it and are not yet in those other two categories, is in the millions. I would say in my experience, you're talking about one out of every four to five people in general that have an issue with excessive alcohol use.
Elara: What would you say is excessive alcohol use? Is that like a per-day thing, a per-week thing?
Dr. Mosquera: Excessive alcohol abuse really has been defined now by the American Psychiatric Association. The way it's defined is in what's called a DSM-5 Manual. If you have more than two drinks a day and you do it every day, that's excessive. The understood criteria for safe drinking for an adult male is up to two glasses of beer or wine a day, and for women, one to one and a half depending on their body size. Once you start multiplying that and you do that every day, or you don't do it one day but then you have four or five drinks in a day, you're really entering into a danger zone, both for your health with all its ramifications and possibly getting into alcohol dependence syndrome.
Elara: What are the potential impacts for your health if say, you're just a daily drinker having one to two drinks a day?
Dr. Mosquera: Oh, the potential impacts for many people are the well-known hangover. It can affect your liver, your gastrointestinal system. It can affect your mental system vis-a-vis causing too many ups and downs, and people use it to treat from depression to their happiness, really. If you do it excessively, it can affect you. Your nervous system can suffer from it. It can numb your nervous system, it can affect your decision-making, of course. This is when you go above a certain level. The accepted level in most states is what's called 0.08%. To give you an idea, that 0.08% is equivalent to about over four to five drinks in a two to three-hour period. You do have to drink moderately or higher to really start getting some of the bad health issues.
Elara: Now, question, I've heard all these stories, particularly when Diana and I were just on a trip to Ireland, about people living well into their 90s, who would have one to two drinks a day, and they live to be 95. I guess my question to you is, is low to moderate drinking, say, a cocktail a night or one to two Guinnesses, is that going to be healthier than zero consumption at all of alcohol?
Dr. Mosquera: The answer to that is probably it lies within the cultural context of that drinking. For example, for the Irish, it works. For other cultures, it may not. A great example of this and one of the best studies of this was back in '91 in the New England Journal of Medicine, the most respected journal of medicine. There was an article called The French Paradox. The French Paradox was about how people in France generally enjoy their wine, a couple of glasses a day on the average, and they actually had lower levels of cholesterol and seemed to live very well and longer, but most importantly, living very well in terms of their health issues.
My answer is, depending on the cultural context and how you view alcohol as you were raised. For example, Elara, you know that I was raised on a farm in Spain where we made wine, and so to me, it was not a big issue of, gee, should I start drinking that? We were offered wine at the table when I was very young, ages eight and nine. I had a sip here and there with my parents. But it's considered a tonic when you're in certain cultures. In Spain and France, it's almost considered, if you give it to a teenager, a tonic. It's all within the whole cultural context. My short answer is, of course, drinking, once again, in moderation, in a cultural context that's comfortable for you is fine. There is no health issue to that.
Diana: Do you think that there's a difference health-wise from maybe drinking a glass of wine out with your family or your friends, having that social connection, versus coming home from a day of work and drinking wine by yourself? Do you think that that impacts health, and if so, how?
Dr. Mosquera: There's no question that that's an important distinction, Diana, that you bring up. When you're in a setting, a community setting with friends and socially and responsibly you have a drink or maximally two in that setting and you go home, it's part of the entire connection that you've enjoyed with each other. If you have to come home from the stress of a day and the first thing you do, instead of perhaps exercising, planning a healthy meal, if the first thing you do is grab a glass of wine, you're really beginning to treat your stress that way. And that's not a good way to begin treating stress. The ways of treating stress are to take care of yourself in terms of sleep patterns, exercise, lifestyle changes which do not include drinking alone as soon as you get home.
Elara: A question that just popped into my mind because I'm not usually a regular drinker. I don't tend to drink that much. I'm more of a social drinker, say, every other weekend, a glass of wine here and there. What do you think would be more detrimental to your health? Someone who's drinking every day, one to three drinks a day, or someone that maybe once every month or two binge drinks? They have one night where they go out and they have over eight cocktails and they black out and they have a horrible hangover for several days. They're vomiting. Is one worse for your health than the other?
Dr. Mosquera: That's a great question. The answer is clear and the evidence in healthcare is definitely clear. Binge drinking is dangerous. It is much more dangerous than having your daily drink in moderation. The reasons are multiple. One is binge drinking can get you into a lot of issues. We've heard a college of students who have actually died because they passed away on ingesting their own vomit. They pass out and sometimes they use other drugs with it. Binge drinking certainly has a lot of medical issues. This is what brings a lot of young people and adults in general into the emergency room, is the effects from binge drinking.
Diana: Can you walk us through, I was just thinking about hangovers and I know that for the majority of us, I had my college days where I was binge drinking. Thankfully, I don't do that anymore, but that is a reality for a lot of people. A hangover is something that does still happen in my life. What is a hangover? What is happening to our bodies when we drink? Sometimes if I drink wine, I feel like I have a worse hangover over champagne. What is the physiology of why do some liquors or alcohols give some people worse hangovers?
Dr. Mosquera: Your body is trying to detoxify because alcohol is a toxin. Ethanol is a toxin. Once again, it depends on the amount. Too much water can be a toxin. Too much of anything can really intoxify your body to the point where you can get sick. Alcohol, particularly when you go over the limit, particularly when there's binge drinking or dependency, at that point, your body is trying to come off of this toxicity by trying to detoxify, and those symptoms of detoxification are nervousness, headaches, sometimes your gastrointestinal system, you get very nauseous, you feel jittery, you're very angry at the world, and you don't understand why. Physiologically, your body goes into this withdrawal symptom.
In the more severe cases, people who actually have alcohol use disorder, you can actually get into anywhere from nervousness, trembling of your hands, to seizures, to having a severe, severe headache that won't go away. Many of these patients end up in the emergency room thinking that they're either having a stroke or something severe has happened to them, but in fact, they're detoxifying from what is a toxin.
Once again, I keep mentioning this, moderation is the key. As you're saying Diana, binge drinking has been on the rise, and particularly in college. I think these last few years with the pandemic, we're heading back to almost before prohibition, the Roaring '20s, except it's 2023, of drinking and just going out and there's a lot of excessive partying, and this does lead to a lot of these hangovers for sure.
Elara: Now, not to say that I'm going to go out and drink and end up with a hangover, but inevitably, right, things happen, you get a hangover, you have a few too many drinks. What is the scientific evidence behind ways that you can reduce a hangover? What can you do, right, before you drink? What can you do while you're drinking? What can you do after you're drinking? Something that I've always heard, and I don't know if this is folklore, for every drink you have, have a glass of water or take an Advil before bed. The next day, have greasy foods. Is there any truth to these myths around a hangover to maybe a cold shower?
Dr. Mosquera: Some of them for sure, Elara. For example, having water in between drinks is a tried-and-true idea. Trying to combine drinking your wine, your beer, with some food also helps slow down the absorption and the impact of the alcohol. Those are two prior to. There is some evidence that taking an anti-inflammatory medication, for those who are not allergic to the Motrins and Advils of life, before or when you come home if you've been drinking, it'll help the inflammation.
Because when you drink a lot, the hangover is part of this inflammatory response that goes on in your nervous system and your gastrointestinal system, and so an anti-inflammatory, albeit something like a Motrin or Advil can help. Also, the following day, having foods that are anti-inflammatory that you both have discussed in the past could also be helpful, and having a substantial breakfast, and that's why people tell you to have everything from eggs and hamburgers to french fries as soon as you get up in the morning. There's some truth to that and it's certainly a safe way to also approach it. Those are just a few of the ways, but there's a lot of different other ways as well.
Elara: In college, one of my favorite ways that my friends and I used to do, back in my binge drinking days, which are for the most part long behind me, we would have Pedialyte. I remember distinctly, it was this trade-off where we would chug Pedialyte at the end of the night and we'd wake up and have these sausage fingers. You talk about inflammation, so we'd have these thick fingers that our rings wouldn't even fit on and our toes would look chubby, but we'd generally feel better.
We'd go, we'd get a bagel versus the mornings when I would wake up and say I was dehydrated, I looked a bit drained, I looked a bit veiny. I wouldn't necessarily have breakfast, I couldn't keep anything down. I found that that helped a lot. Not only just have that glass of water in between drinks, but actually refueling your electrolytes, at least in my experience, was something that was very helpful. Then another thing I was interestingly reading the other day was how low-sugar fermented foods could be helpful to have the next day. Have you heard anything about that?
Dr. Mosquera: Yes. Thank you, Elara. First of all, I'm glad you didn't tell me these things when you were in college. I'm glad you're okay and we're finding out about this now. Notwithstanding, what you're saying about Pedialyte is a good idea. Pedialyte is used as a supplement, a Gatorade, but better in that it has essential minerals in it. It rehydrates you and certainly is helpful.
As far as what you're saying about eating, I would say, first of all, sugar should not be a strong part of your diet. Let's start with that, and certainly, the answer is not to have a lot of sugar in the morning. I would be totally against sugar in the morning for that. I would say a substantial protein meal, preferably with some vegetarian-based protein would be the way to go. You can have some carbohydrates there to help. That would be it, but I would certainly stay away from sugar. That would not be the answer.
Diana: Obviously, behavior change here is going to be the best bet. If someone is drinking too much, their best option is to reduce drinking. But if someone isn't going to do that, I'm curious what your opinion is on long-term things that someone could do to counteract the alcohol they're drinking, whether that's diet, exercise, meditation. Is there anything that we can counteract and do you think that you can fully counteract it or are you just balancing out the bad and the good?
Dr. Mosquera: It's definitely a treatable disorder for sure, Diana, and the way I would approach it, and once again, getting back to my integrative training with your dad, what we do first, you have to assess the severity. Is this an alcohol use disorder that's mild, moderate, or severe? The treatments are all very different for all three. That's determined by the scale of 11 criteria to see how many criteria you fit under.
For example, have you ever been arrested from drinking alcohol or have you ever shown up late for work? Is it affecting your relationships? Do you feel very nervous every morning when you get up? Do you feel the need to go and drink in the morning and on and on? We basically add these up and if it's 2 of these 11 criteria, we call that mild alcohol use disorder. If it's three to five, that's moderate alcohol disorder. Then over 5 of those 11 criteria, that's severe.
Each one has to be approached differently. For example, a mild alcohol use disorder can be addressed with some behavioral therapy, possibly cognitive behavioral therapy, possibly mindful therapy, exercise, and really an integrative program, a lifestyle, a recharge of your lifestyle, a revamping of the lifestyle. Really looking to that person's overall dietary habits, their sleep habits, their exercise habits, their peers, also, especially young people. So much peer pressure is there with young people to drink. All these things should be looked at and addressed.
Once you go into the moderate category, then there has to be stronger intervention. There has to be a physician, possibly a psychiatrist and a neurologist involved, and maybe even medication at that point. Then, of course, when you go to the severe level of alcohol use disorder, that really requires really addressing, it's been shown, for example, that when a severe alcoholic goes to an emergency room, if an intervention happens within that visit of a psychiatrist on staff or a psychologist on staff, and they go into, whether it be multiple programs with Alcoholics Anonymous and possibly an inpatient or intensive outpatient program, they do respond.
Alcoholism is like any other disease. It's not only preventable but it's treatable, and it depends on where on the spectrum you lie that determines the treatment. All three require an integrative approach though.
Elara: Now, this just brought a question to my mind. Does it depend on what alcohol you're drinking? Because there's these really funny legalities where in certain states, you have to go to a state liquor store to get any liquor, but you can still get wine and beer at say the bodega or the corner shop, which mentally implies maybe wine and beer is not as bad as vodka or brandy or rum. Is there any truth to that in terms of the alcohol that you're choosing to drink impacting your health in one maybe being worse than the other?
Dr. Mosquera: That's a great question. My answer is it's the amount of ethanol that your body metabolizes that eventually causes a level. Now, that being said, it takes someone-- I could be at a bar sitting on a beer for two hours. Generally, people that are doing shots of tequila or gin or the distilled drinks versus the non-distilled like wine or beer, there tends to be more abuse with them because it's repetitive and it tends to-- Nobody just sits on a shot for the whole night. They just keep drinking.
There is a distinction there, but ultimately, we get back to a level that most people consider intoxicating, which is 0.08% of alcohol measured in the blood. To get that, you really have to have five or more drinks in a two, three-hour period. Those drinks could be beers, wines, or also the distilled drinks, gin, the whiskeys, the bourbons, et cetera. It's all alcohol. It's how often you're taking it and they're both ethanol alcohol, which is toxic to the body ultimately. Getting back, I keep repeating the word but moderation is your answer.
Elara: Moderation. Sorry. One of the other words that just popped into my head is congeners and nitrates, et cetera, things like that. Are there any alcohols-- I know that they're all kind of equally bad, but are some going to give you a worse hangover than others? I've always heard that myth where when you mix different alcohols, you set yourself up for a really hard next day.
Dr. Mosquera: Sure, you do. People respond. Generally, people think that vodka is cleaner, now tequila is making a big comeback, but the way they're distilled, so many ingredients in them, especially we get, I start with wine, with the sulfite. Sulfites are terrible for a lot of people and cause a lot of side effect issues, regardless if you have one drink or four. There are wines that are available without sulfites that you may want to try but that is a significant medical issue with wine.
Beers, a lot of people have sensitivities and allergies to substances that are used in beer, particularly barley. You do want to make sure that you don't have sensitivities to these substances that are used to make beer. Some of the malts and et cetera, sometimes they tend to cause a lot of headaches. As far as the distilled, you have some that actually come from-- that are considered medicinal out there, some of these elderberry wine concoctions. Historically, some of these were considered tonics, health tonics, even going back 150, 200 years ago, in particular, after our Civil War.
People drank actually more heavily then than we do now because there wasn't running water and they just thought that a lot of these things were tonics and they kept just drinking away. It's a fine line between what is a tonic, a tonic being any drink that you have in a social setting that, in moderation, once again, and that you have one, maximal two, and you go home and you can carry on your night. Once you get past that threshold, then the body starts saying, "No más, no más. This is toxic for me."
Diana: Let's tap into the taboo for a second. You guys ready?
Elara: Yes. Hit us.
Diana: I'm going to get in trouble for this one. I know that this is especially important for both Elara and I. I'm going to preface this by saying that you are not giving advice here, but I want to hear the honest answer to, can you drink during pregnancy and what does that mean?
Dr. Mosquera: That is a clear 100% no-no. There is something called fetal alcohol syndrome, and it's been well-studied, well-documented. You should not, and especially toxic in the first developmental stages, in the first trimester and second trimester, which are the first six months. Fetal alcohol syndrome has been well-known to cause problems such as premature births, birth defects, early onset diabetes in the child. Fetal alcohol syndrome, when you hear the word syndrome, it just means there's a plethora of things that can happen. Murphy's Law kicks in, what can go wrong, will go wrong if you drink during pregnancy.
I should also mention, Diana, that it's important that there are some moms that are already out there heavily drinking prior to getting pregnant, and they have this thing in their mind, "Well, I'm just going to stop when I become pregnant." Not a good idea. The reason is your body, if you've developed a dependency disorder on alcohol, whether it be even on a social scale that you've been drinking heavily, you need to get some help with counseling to really understand it properly and to not only be healthy during your pregnancy but prior to your pregnancy as well as after, of course.
Diana: What do you think about having a very small glass of wine in your third trimester?
Dr. Mosquera: Well, this is something that's common in Europe and a lot of countries, and so far, the evidence isn't terrible on it, but I as a physician can't say it's a good idea. If someone were to have a glass of wine, and I'm sure they do in France, Italy, and Spain, it's something that I can't say you can't do it but you should not do it is my point. You should not do it.
Elara: Now, this then leads into the question of breastfeeding. A term that I've heard a lot is pump and dump. You've spent nine months not drinking, maybe after the birth you want to celebrate. You want to have a glass or two of champagne. What does this term, pump and dump, mean, and can you drink while you breastfeed? Is this something you can do? How would you do it safely if at all possible?
Dr. Mosquera: While breastfeeding, the evidence is, once again, we begin to this level of drinking, of moderation, that having a glass or up to two, women, one and a half, remember, should be the limit. Men too. But this, of course, applies to women, and so one and a half, and not on a consistent basis, but let's say three to four days a week, every other day should not be a problem, in my opinion. It should not be every day. It should be, as I mentioned, every other day, but that is not a big issue as far as it's, as you're saying, wine or really any type of whether it's distilled or undistilled is not an issue, and should not be harmful to breastfeeding at those small levels.
Elara: Say it's New Year's, I've given birth at the beginning of December. My baby is two, three weeks old. I decide to have two glasses of champagne. Should I be breastfeeding right after I've consumed two glasses of champagne, or should I possibly pump to dump and maybe use some frozen breast milk from several days before when alcohol wasn't in my system?
Dr. Mosquera: I think that's a good idea. I would endorse that, the pump-and-dump theory.
Diana: The pump and dump.
Dr. Mosquera: No, it's fine. That's a good idea. Once again, I just don't want that theory to be used as an excuse to get into that danger zone of drinking. You've been stressed. I'm concerned about the woman who has postpartum depression without knowing it in the first three to six months, who then excessively drinks to treat their postpartum depression which is not properly diagnosed as, in most cases, women don't find out until months after. It's something you have to be careful with and not use that, "Okay, I've been waiting for this and I'm going to have it."
You just have to use it in a good context of saying, "Okay, I'm going to treat myself today. Three days down the road, I'll have a drink meaningfully with my family, my husband." Certainly not by yourself. I wouldn't recommend that. You have to be careful of these disorders postpartum that making sure you're healthy, making sure you don't have any postpartum diabetes, postpartum thyroid problems. All these things come into play for each person.
Diana: What do you think about alcohol in terms of fertility, and not just for women, but for men as well?
Dr. Mosquera: There's a lot of evidence out there, Diana, that the infertility rates out there amongst both men and women are in some cases soaring very high. I think the normal rates in men were about 7% to 8%, and now they're in the teens, they're in the 10%, 12%, 13%. That's a lot. That's one out of every 10 men. That's 15 million men out there, and women likewise.
There is some evidence, certainly alcohol is a toxin. Once again, remember what we said earlier, it depends on the use of it. Is it moderate? Is it severe? Men usually don't become infertile as a result of having a drink or two and staying within those limits that are actually can be healthy, as we're saying in some countries, that's fine. However, once you get into drinking every day and you have those three to five or more than five drinks a day, I think then you're really contributing to infertility. It's showing nowadays in all the statistics.
Elara: Interesting. That just brought up another question I had in my head as far as looking at severe alcohol intake, looking at regular binge drinkers, I am not a regular drinker, as I said before. After about two to three drinks, I, within several hours, even before the night has ended, I start to feel hungover. I start to feel tired. I want to go home. I don't want to be out past 12:00.
I have other friends I've noticed, and tell me what the science is behind this, that when they have their first one or two drinks, they seem to feel energized. They seemed more alert than ever. Their mood skyrockets and they feel really good while they're drinking. For all intents and purposes, they feel like a better version of themselves and they're more able to socialize.
Dr. Mosquera: Yes, absolutely true. Absolutely true. A lot of people, depending on their underlying behaviors and personalities, it's clear that alcohol affects our inhibitory centers. It's disinhibitory so people act out and it really depends on their personality. Some people become very engaging and funny. Others sometimes just become withdrawn and just feel good and just sit down on a couch.
There's a great variation to how people react to alcohol because it does trigger those centers, those inhibitory centers. When it gets to be too much, however, it really makes decision-making in our cortex, in our brain difficult. Then we start slurring our decisions, we start slurring our speech, and then it becomes a big issue that creates ramifications from all the car accidents that we have to personal accidents people have when they're really under the influence of high alcohol content, so it varies.
Elara: Diana, we've spoken about this. There are different kinds of drunk you experience on different types of alcohol. Something that I can personally say from my own experience is that tequila tends to be a bit more uplifting. Maybe that's going to be the type of drink that's hypothetically going to make me want to dance. I'm a bit more brazen with my actions, with my words, versus drinking a lot of beer. I'm going to feel a little bit bloated. I'm going to feel heavy. Maybe rum makes me happy, but then gin makes me feel really sick. Why is that? Does this go back to those underlying allergy issues that you said people have?
Dr. Mosquera: No, but that's a really important and good issue that you're mentioning, Elara. The point is that sure, everything's metabolized in our system into ethanol alcohol, right? However, just like let's draw a parallel to marijuana, cannabis. Cannabis is not just THC. It's hundreds of other ingredients and THC. That's what sometimes distinguishes your cannabis experience, whether it's medicinal or recreational, from one type of cannabis to the other. The same applies for alcohol.
Your experience on alcohol from gin, tequila, vodka, beer, wine, or sake will vary tremendously. That's because many of these, the way they're distilled, they have these different ingredients and they may have 50 to 100 different ingredients that are distinctive to that particular gin or that particular tequila. In the case of, for example, tequila, now these tequilas are very popular. The colored tequilas, añejos, the old tequilas were actually the purest form tequilas. Your white tequila seems to be, if I were to say you drink a healthy one, I would say white tequila.
Less hangover, vodka has always had the reputation for a less of a hangover drink. Beer, as you said, tends to be a little bloating. All we have to do is see are middle-aged bellies in guys that drink beer. It really causes some issues but beer has less alcohol in it. We look for alcohol content, which we haven't spoken about, but your light beers have about 3.5% alcohol while your IPAs go up to 8%, 9%. Whereas wine will have anywhere from 10% to 15% alcohol. Then with your distilled, your gins, your vodkas, you're really then going to 40%, 60%, 80%.
Your rums-they have a higher kick of alcohol per volume for sure but they also have all these ingredients that make people become only rum drinkers or gin drinkers or vodka drinkers or beer drinkers because that's what they like. That's perfectly fine as long, once again, we get back to moderation.
Diana: One of the things that I address pretty much with everyone that I work with is sleep and how important sleep is. I hear from a lot of clients that having a glass of wine before bed helps them sleep better. I know that that's not true, but can you give us the dirty on alcohol and sleep and why maybe people think it does help them sleep, but it actually isn't?
Dr. Mosquera: Great question. I agree with you that the evidence is against that, that it doesn't help you. I think initially it does. When I say initially, alcohol is in your system for about a glass of wine will be in your system for approximately an hour and a half. Another drink may be there up to two hours. It depends. In that hour and a half to two hours, within 10 to 15 minutes of ingesting that, you tend to feel calmer, less inhibited, more likely to engage in what you want to do. At that point, you want to engage in sleeping, so fine you do. However, the evidence is clear that if you're not a good sleeper, now some people are just great sleepers. They go into the REM stage four sleep and you can't wait. They do great.
Diana: Those lucky bastards.
Dr. Mosquera: I know. Most people, what they do is two hours later, guess what? They're up and they can't understand it because then the inhibitory effect of alcohol has worn off and you go back to your erratic sleeping cycle. It's probably not a good idea unless you're a great sleeper to begin with.
Diana: One thing that I find is that if I drink two glasses of wine, I will wake up between 2:00 AM and 3:00 AM. Someone told me recently that that's because your blood sugar drops and that if you eat a snack, you'll be able to go back to sleep. I'm just curious, do you think that that's true? Does alcohol affect your blood sugar like that?
Dr. Mosquera: I think it's true, Diana. It's called the Somogyi effect and it's well known amongst diabetics who drink, whose blood sugar drops and then varies throughout the night after drinking, so it is true.
Diana: Okay, so someone's listening to this podcast and they're like maybe I do have a little bit of an issue. I don't feel like I'm an alcoholic. I don't feel like this is inhibiting my friendships, it's not affecting my work but I'm listening to Dr. Mosquera and maybe I'm drinking a little bit more than in moderation. What do they do? Do they talk to their primary care physician? That's kind of an uncomfortable conversation. What do you do if you say maybe I do feel like I'm drinking a little bit much or maybe my relationship with alcohol isn't super healthy?
Dr. Mosquera: Well, the first thing to do is you sort of quantify what you're drinking and add it up. People will be surprised when they add up how many liters of alcohol they drink a month. You look at what you've drank, and just journaling is a great idea. You journal that okay, these last two weeks, this is what I've drank. I drank three drinks one day, two drinks another day, five drinks another day. This is how I feel. Then based on that, where you fall on the spectrum of mild to moderate and severe use disorder, you do need to get help.
Early on that help should be in the form of some behavioral therapy with a psychologist who is familiar with alcohol use disorder, but the moderate and severe really needs more help, more intensive help with a practitioner. That practitioner should be an integrative practitioner. That practitioner should be maybe a team approach, for example, not only the doctor but combining with a nutritionist, a behavioral therapist, an exercise physiologist because it really is an integrative approach that you have to take and that really will help tremendously the person who has mild disorder after they've confronted and admitted to it.
I wanted to point out one thing that is a downer, if you will, about alcohol use and cancer. We do know that once you get into that moderate use of alcohol, once again, moderate being over two drinks a day consistently, your risk of cancer is long-term. This has been studied. There was a study of over 300,000 people and the evidence is clear that there's about 150 cancers out there that put you at higher risk. Some of them are well-known- esophageal cancer, oral cancers, stomach cancer, pancreatic cancer. All the digestive cancers are much higher. Of course, liver disease. We haven't talked about cirrhosis. These are life-threatening conditions in particular women.
My biggest concern and the biggest risk so far in statistics is breast cancer in women who drink. Breast cancer skyrockets in women who drink more than a couple of drinks a day. It increases by a huge percentage. If there is someone with a family history of breast cancer or has had breast cancer, that really should be a huge, huge red flag that at best, you should consider once in a while, having one or two drinks at a special occasion but you should not consistently drink. It really puts you at much higher risk and I want to emphasize that because it's the one cancer where the evidence is super clear. Although the other cancers, the gastrointestinal cancers happen with usually severe drinkers.
Now the good news is that in the mild area, the people stay in the mild area that have two of those criteria, they usually are not at a huge risk of increasing their cancer risk. This is really for people who are on the moderate to severe category. That's something really to keep in mind. I know it's a downer, but there are consequences to this as a toxin when we go after more than moderation.
Elara: Now, Dad, if you were going to give, let's just say two or three simple pieces of advice to someone who alcohol has played a huge part in their life, socially, emotionally, as far as stress reduction, what are some other things they can do to fill that void instead of drinking alcohol that maybe you've recommended to patients?
Dr. Mosquera: Well, my experience tells me that people who engage, and let's start with exercise as one of them. People who engage in routine exercise and get into an intensive routine, I think we have all seen and have had friends who've gone into things like running, cross-training, biking, just working out, really working out, they just feel so much better and they see how their sober state and their physical state is so much an improvement in their life and their lifestyle, so I think exercise. Once again, getting back to what Diana was saying, sleep patterns. Obtaining just a normal good sleep pattern is essential along with the exercise and they sort of go hand in hand.
Nutrition is extremely important. Nutrition is the foundation of how we feel as well. It's food as medicine, right? It's so important to really have a diet that is full of Mediterranean leafy greens, vegetables, fruits, and fish. Unlike the true vegetarians, I know Diana, you're a true vegetarian but having some fish as I think we'd call them pesco-vegetarians, is also not a bad idea. Having a diet that's good against inflammation, we've heard of this anti-inflammatory diet that Diana's dad, Dr. Weil, has made so famous, and that's really important as well.
Relaxation exercises, relaxation breathing exercises, yoga, learning how to deal with your mind and body in terms of settling down so you don't have to reach for that other drink is important. What I'm really describing, once again, getting back to that great word, integrative health and medicine that Diana's dad, Dr. Weil, really is the true pioneer of. An integrative approach is a lifestyle approach, and everybody's lifestyle requires a different approach, because in the context, the cultural context that they live in, if they live out in the country, in a city and their work, and their relationships. Everyone should have an individualized approach, but the common is that they should include and must include diet, exercise, and sleep, as simple as that sounds.
Diana: You've really driven home the point that alcohol is probably not the best for our health. We drink it in moderation. I am dying to know what is your go-to drink, Elara and Dr. Mosquera. You're going to go treat yourself with a cocktail or beverage, what are you going for?
Dr. Mosquera: It depends on the setting. I enjoy if I'm with my friends if I visit a bar, I am a Guinness fan, so I've always liked Guinness as a beer, and I just enjoy having one. I may go up to two on occasion, depending on how long I stay there. I would say in that setting, with friends at a bar, Guinness. If I go out to dinner, I try to look for either a good white wine in the form of a Chablis, a French burgundy, or in the red wine category, I'm prone to the wines that I know from Spain that I have from Rioja and Ribera del Duero wines.
These are great wines for me but I never go beyond two glasses at those settings, and I do it that day, but the next day I'm back exercising. I probably will not drink the next day. Just, it's so enjoyable to have that drink and just being in control of yourself, and making sure that those other factors of your lifestyle, sleeping well, eating well, your sense of community with, In my case, with my patients and family, are there, and that's so satisfying. If we develop those satisfactions, we don't have to-- Just drinks are not what we have to reach for. They should just be an addendum to good times in our life when we feel well with our friends and family in our outings.
Diana: Love that. E?
Elara: I love a Paloma, i.e. some quality tequila with some grapefruit soda, that I would find to be my favorite social outing drink. Like I said, I'm not much of a drinker in a home setting, anything like that, so I like a Paloma, and I also love one to two glasses of a really nice champagne.
Dr. Mosquera: Bubbly.
Elara: What about you?
Diana: Yes, you know that. [laughs] I used to be a big wine girl, but it has messed with my sleep to the point where I can't really drink it anymore, so I've moved over to cocktails and I think a good Mojito, or-- Elara, close your ear holes, a good Espresso Martini with some Decaf Espresso.
[laughter]
Elara: Did you mean Matcha Martini? Is that what I heard you say?
Diana: Exactly. A Matcha Martini.
Elara: I think it was Matcha Martini. That's like rocket fuel to me. You can't give me one or two of those. I also have issues with wine too. I have a history of migraines and have found red wines, and particularly Sangria, can really set me off in the wrong direction.
Dr. Mosquera: Sangria is so full of-- It's not only wine, it's so full of sugar. They throw piles of sugar in there along with the fruit, and of course, it's very tasty. It's very refreshing when you add the ice and everything, but it's just so full of sugar, and it's no surprise that people get headaches from Sangria.
Diana: Yes, the nutritionist in me needs to mention that you can drink alcohol in moderation of course, but to be mindful of your sugar intake in that a lot of these drinks I think that there's two parts here of drinking is that, there's the alcohol part, but then the sugar part, if you're drinking-
Dr. Mosquera: Absolutely.
Diana: -drinking these like the mojito that I love. [chuckles]
Dr. Mosquera: One of the things also we didn't speak of is the caloric intake. When you're thinking in your mind, watching your caloric intake, we are all, of course-- We can do this on another podcast, but obesity is just epidemic. We've tripled it in the last 15, 20 years here in the United States. People think, I'm just going to have a drink and a salad. No. If they have three or four drinks, especially your distilled drinks, you can go up to 200 calories per drink.
Now, normally a beer, a light beer is maybe 100, 110. A regular beer is 160 calories. You can do the math that once you go beyond, especially three to four or five drinks, you're up there in calories, close to 1,000 calories in addition to your meal. That's an important thing to keep in mind. All those calories are, of course, as you know, Diana, converted and metabolized, and depending on what kind of calories they are, good or bad, generally, they're bad because of the sugars that get broken down. You do have to be mindful of that, and that's another reason just to enjoy a drink or two socially and in moderation.
Elara: This also touches on my personal vendetta I have against mocktails. In one way, it's really refreshing to see mocktails on a menu. Pretend like you're drinking, but for me, it's just kind of unnecessarily loading up my body with all these sugars and syrups, and overpaying for said sugars and syrups. Currently, I'm pregnant, so my drink of choice tends to be a seltzer water with a spritz of lemon or orange. I find that to be perfect, or perhaps a Kombucha on occasion, but I'm not a fan of mocktails.
Diana: Which I think is a really good tip for anyone who maybe is listening to this and thinking, "Okay, I do want to cut out my alcohol, and how can I do that?" I think going for sparkling water, but making it fancy, putting it in a wine glass, adding a spritz of lemon, a lime, maybe even a little bit of juice or berries, make it fancy for yourself, but a really good sparkling water. Or even if you enjoy mocktails, I think that there are ways to treat yourself without the alcohol.
Diana: Absolutely.
Dr. Mosquera: No question. Good points.
Diana: Well, Joe, this has been amazing. Thank you so much for informing us. I definitely feel that moderation, that was my take-home key, of alcohol. That we should be drinking in moderation, I think important to look at your alcohol relationship, be really honest with yourself, reach out to someone if maybe this stood out to you of interest of thinking, maybe I do, maybe this is above and beyond moderation. We encourage you to reach out.
Dr. Mosquera: Thank you. A very good point you just mentioned about reaching out to friends. The statistics with the millions and millions of people are there. Drinking and alcohol use disorder is clearly, clearly on the rise. It's an addiction at high levels. If we know friends that are drinking, it's important to just approach them open-endedly and saying, "Hey, listen, there's ways to drink less. It's unhealthy for you," but it's really important to reach out to our friends and loved ones, because almost in every family, in every family there's the uncle with alcohol use disorder, there's the friend with alcohol use disorder. There's always a relative or a good friend.
It's really important for us to take this information that we're talking about, but spread the word, and always mention that there is treatment and health, and an integrative health approach is probably your best. There's a lot of options out there for people. I'm really concerned about the rates of alcohol use disorder that I'm seeing, and it's important for us to reach out to everyone to get them back on the right track.
Diana: Joe, where can people find you?
Dr. Mosquera: They can find me in a lot of places, especially in today's media. On Facebook at Dr. Mosquera, MD. I have recently begun a new site on Instagram @Spontaneous Healing, in a tribute to your dad, who is the true pioneer of integrative medicine. I'll be posting on there and also developing a podcast in coming weeks over a few months.
Diana: We'll have Dr. Mosquera's information below. If you want to reach out or you want to hear more about what he's doing and different topics that he's discussing, just check it out below.
Dr. Mosquera: Thank you.
Elara: Totally, dad. Well, it has been a pleasure having you on the podcast today. I know that we could probably go off in a thousand different directions in terms of topics that would fall under your umbrella expertise, but I think we'll leave that for some other episodes. If you as a listener have any ideas of topics you want us to cover with Dr. Dad, Dr. Mosquera, please comment below. Reach out and we'll try and get it on the schedule.
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