Is Any Amount of Alcohol Okay for Your Health?

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Research is growing every day about the health risks of drinking. From heart health to cancer to damaging the immune system and sleep quality, even small amounts of drinking may be harmful. Medical toxicologist, Ryan Marino, MD, explains alcohol’s impact and whether any level of consumption is a healthy choice.

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Macie Jepson
Abstaining from alcohol has a moment when dry January rolls around every year, and now we’re hearing a lot about Sober October as well. The topic comes up among my friends, probably yours too. It comes up at work. It’s all over social media. In fact, I’m pretty sure the whole idea was born from social media. And we get expert advice about giving our bodies a break from alcohol from just about anybody.

Pete Kenworthy
Yeah. A lot of that advice focuses on giving our liver a break. And that makes sense. I’ve actually had a couple of friends die from what I believe was drinking too much. Maybe organ failure. I don’t know the medical part behind it, but it got us to thinking, can we do long-term damage to other parts of our body? Now, common sense tells us the answer is yes, but how so? And what does that mean for our long-term health? Hi, I’m Pete Kenworthy.

Macie Jepson
And I’m Macie Jepson, and this is The Science of Health. So many questions here and today we are leaning on Dr. Ryan Marino for the answers. He’s a medical toxicologist at University Hospitals in Cleveland. He specializes in addiction, also emergency medicine. Thank you for joining us today.

Ryan Marino, MD
Yeah. I’m glad to be here.

Macie Jepson
Now, your title tells us that you’ve seen a lot on the job, likely at the acute end of our actions, the consequences for our actions. So for this conversation, we’re going to focus on the long-term medical effects of alcohol consumption, but I feel like we really have to start from the beginning. So what physiologically happens when alcohol is metabolized, when it goes through our bodies?

Ryan Marino, MD
So alcohol has pretty wide ranging effects on almost every organ system in the body. And something that has been coming out more and more in recent years is kind of that it has toxic effects on almost every tissue and cell line in your body. So the main things, I mean, I think in terms of consuming some alcohol, having one drink, one glass of wine, that kind of thing, it first gets absorbed and alcohol is absorbed very quickly where it then gets into your bloodstream and goes to your brain primarily where you get kind of the effects ranging from maybe feeling a little relaxed to all the way to intoxicated, but it is metabolized in the liver. It gets broken down and then cleared from the body, but it kind of touches everything else along the way just because it is going through your entire bloodstream.

Pete Kenworthy
My guess is there are variables that matter. Alcohol doesn’t impact everyone the same way. So what are those variables? Like do things like your weight, your gender, your age, do all those things come into play when in terms of the impact that alcohol has?

Ryan Marino, MD
Yeah. I mean all the things that you just brought up from weight to gender to even your body composition, age, how hydrated you are, your nutritional status, all of those things can play a role.

Pete Kenworthy
So let’s go through them kind of one at a time. If your weight is lower, you feel the effects of alcohol more quickly. This is common knowledge, right? Because you have less tissue to absorb alcohol. Is that it?

Ryan Marino, MD
Yeah. If you think of alcohol, I mean, as a weight-based drug basically, one glass of wine is going to affect a smaller person more than a bigger person.

Pete Kenworthy
And so that’s why it affects women more quickly than men because averages are, women are generally smaller than men?

Ryan Marino, MD
That’s actually one of the reasons. There’s also differences in kind of the water content throughout the body in women and men as well.

Pete Kenworthy
And how about age? Because as you get older, are you at a higher risk of more detrimental impacts from alcohol?

Ryan Marino, MD
Yes. More likely to have kind of adverse effects from alcohol, probably the more we age.

Pete Kenworthy
So you talked about alcohol going to our brains. It changes our mood. It changes our behavior, but what is it doing specifically to our brain and what is the harmful side of that?

Ryan Marino, MD
Yeah. So alcohol has a number of effects and the main reason that people feel kind of relaxed and disinhibited and can even end up intoxicated is because it acts on your GABA receptors. And so if you think of GABA as being kind of the primary neurotransmitter that causes like relaxation, like benzodiazepines are a medication that would do the same kind of thing. Alcohol also acts on glutamate, which is the body’s main excitatory neurotransmitter. And so it blocks that and so kind of doubles up the effect. And so over time, I mean, your body, if you are drinking frequently every day, your body gets used to this and will kind of change the amount of these receptors and neurotransmitters that it’s making. And so if you take the alcohol away, you may be kind of functioning at a more excited neurologic state. And the pathologic or disease form of this would be alcohol withdrawal. But that also is the reason why people who drink regularly can get things like high blood pressure and can get mood changes and other psychiatric and psychologic features from this as well.

Pete Kenworthy
Are there physical damages that occur in the brain though?

Ryan Marino, MD
Yes. Alcohol itself, I mean, can cause damage to every cell and tissue. The effects that you feel in the short term and the kind of long-term changes aside, your brain can actually shrink over time from a lot of alcohol consumption. And the alcohol itself can cause brain damage, especially in like large overdoses, I guess I would say, consuming, binge drinking, that kind of thing.

Macie Jepson
You mentioned changes your cells and your tissues. Is that why we hear and read in the headlines that excessive alcohol consumption can lead to cancer?

Ryan Marino, MD
So that is the main reason. I mean, if you think of, I’m trying to think of a good example here, like rubbing alcohol is a form of alcohol, but if that touches any like open skin or say you got it on your mouth or something, that is very painful just because the kind of composition of alcohol is damaging to those cells in your mouth, your mucus membranes. And so when you drink alcohol, there is some sort of damage being done and that’s why oropharyngeal, the head and neck, esophageal cancers and stuff can be associated as well. But it seems like kind of almost every form of cancer may be affected by alcohol in some way. We’re seeing colon, breast, all of these other different forms that aren’t just from the direct contact with alcohol.

Macie Jepson
We’re going to continue to talk about the different parts of the body, but I want to also touch on something you just said that I feel like this is a good time to talk about the elephant in the room. You talked about binge drinking. You talked about excessive drinking. In your experience on the front lines, do we have a problem in America?

Ryan Marino, MD
Yeah. There is a lot of alcohol consumption here and it seems like especially since the pandemic, the amount of kind of heavy drinking, not necessarily binge drinking but binge drinking as well as heavy chronic drinking seems to have gone up. And I don’t know that anyone has a good answer for why this is happening, but if you think of kind of American culture has always been kind of work hard, play hard, like the weekend warrior mindset. And I think we have a very strong hold from our alcohol industry on marketing and different kind of cultural events as well. So it kind of makes sense that this is happening, but it does seem to be a uniquely American phenomenon in a lot of ways.

Macie Jepson
And what are you seeing as a physician? Are they coming through the emergency room? Are they coming to you for an appointment and saying, what have I done? What does that look like?

Ryan Marino, MD
It can be a lot of different ways people can come in saying, I have kind of lost control of my drinking and I want help with it. And we’re seeing a lot of that. I mean people are like, I just didn’t know how it got to this point where I’m now drinking all the time. But also seeing a lot of the effects of people having these binge episodes especially, I mean, can have very immediate health effects. And then the long-term effects take probably more decades to really cause things like the severe liver damage, but certainly still seeing that all the time as well.

Pete Kenworthy
Before we get on to the, you mentioned liver damage and we’re going to go on to some other body parts, too, but while we’re here talking about drinking, and my guess is everybody’s got their own definition of the things you’re talking about, right? Drinking too much. My definition of that is different than your definition of that, but there’s a clinical definition of that is my guess, that what is really too much, right? We’ve heard a lot. One glass of red wine a day is fine. That’s kind of what we’ve heard. So people then interpret that as well, two’s not bad then or one liquor drink. Or people start making their own assumptions about alcohol. And we were going to kind of reserve this for the end, but it seems like this is the time to talk about it. What is okay? What from a clinical standpoint is okay or is the answer none?

Ryan Marino, MD
Yeah, that’s a great question because this has been changing so much in recent years and most recently, I believe the CDC has said that one drink or fewer per day for women and two drinks or fewer per day for men is okay. And they define that as one glass of wine being five ounces, one beer being 5% and 12 ounces and one shot of hard liquor. But in the kind of long term, that little snapshot of one day also doesn’t apply to, it doesn’t mean that drinking every day is okay. And more and more, as more data comes out, that very clearly shows that any amount of alcohol is detrimental. It seems like the recommendation is moving towards no amount is actually considered safe. And so it’s not like that one glass of wine at dinner is going to give you cancer per se. It’s just that there is no amount that is without any risk. And so minimizing it like dry January, I mean, if you can go 31 days without drinking, that’s great. And if you’re someone who drinks every night, maybe if you can go every other night or something, any little change is going to make a big difference.

Macie Jepson
Let’s continue with our trip kind of through the body and kidneys. It makes sense to me. So please explain that. Lungs surprised me. How does drinking affect that?

Ryan Marino, MD
Well, so interestingly enough, one of the ways that alcohol leaves your body is you actually breathe it out through the surfaces of your lungs. And so that’s something that comes up for me more often when people drink the toxic alcohols that I have to worry about getting them some sort of antidote or something because if we block other routes of metabolism, that’s the only way they can get it out is by breathing it out. But for regular alcohol, that is one of the ways and because it is just traveling through your bloodstream, it ends up getting to anywhere that blood is reaching.

Pete Kenworthy
And the other way it gets out has to do with the kidney, right?

Ryan Marino, MD
I mean clearing the metabolites of alcohol and even alcohol itself, I mean, comes out in your urine. You can test if someone has been recently drinking because there’ll be alcohol in their urine. But that’s where it all ends up being filtered out.

Pete Kenworthy
And kidney disease can result from that.

Ryan Marino, MD
Mm-hmm.

Pete Kenworthy
So when you think about drinking anything, not just alcohol, and you actually already mentioned this a little bit ago, the liquid goes in your throat, your esophagus, then your stomach, all those things. You mentioned oral cancers coming from alcohol, but throat, esophagus, stomach, these all can be impacted by alcohol as well?

Ryan Marino, MD
Yeah. In recent years I think rates of those cancers have been going up and there’s certainly other reasons that people can get those, but we’ve seen, I mean, smoking has gone down in the past few decades and with drinking going up, it kind of makes sense that those would be coming back up again.

Pete Kenworthy
So the liver is the one we hear about the most. Can you tell us what happens there? I mentioned at the beginning of the podcast a couple of my friends have passed away and at least one of them I’m pretty sure was “organ failure.” So I assume that’s the liver. What happens there? Why does it fail? How much does it take for something like that to happen?

Ryan Marino, MD
So the liver is the primary source or site of alcohol metabolism. And so to get the alcohol out of your body, it goes into the liver. The liver kind of uses it actually for energy and so metabolizes alcohol into various products. And the liver without alcohol present is usually going to be metabolizing fatty acids, which is a very important part of your kind of metabolism. And so for people who are drinking chronically, and this would be every day and really kind of all the time having alcohol always in their system, the liver completely changes its primary source of metabolism from fatty acids to alcohol. And so when it stops metabolizing those fatty acids, it then starts storing fat. And so people start getting fatty liver. And this is very inflammatory to the liver itself, leads to scarring down the road. And that eventually leads to, I mean, the scars kind of take out the functionality of the liver and so you can get full-blown liver failure, but this is usually something that will take decades to develop and really requires kind of pretty prolonged and heavy use. And so even for people who like I’m sure everyone knows that one person either in their family or friends or someone who drinks a lot, probably way too much and does so for many years and has no issues, it seems to only affect like a smaller number of these people, but there’s no way to predict that risk. And so even though I know someone who drank for 90 years and never developed liver failure, it doesn’t mean that I would ever want to take that risk myself.

Macie Jepson
So cirrhosis is what we hear about and it seems to be the scariest, but at the same time, the liver regenerates. Isn’t it one of the most regenerating organs in our body?

Ryan Marino, MD
Yeah.

Macie Jepson
So how does that work?

Ryan Marino, MD
The liver has pretty incredible powers of regeneration, can recover from a lot of insults, I mean. We even hear now about how you can donate a lobe of your liver to someone and you can grow them a whole new liver for transplantation. Cirrhosis, the term is for the amount of scarring and damage to the liver from alcohol that is considered irreversible. And so there is kind of a point where it’s too much to recover from. And that isn’t to say that there isn’t any hope or cirrhosis is the end of the road because if you are diagnosed with cirrhosis or someone you know is, there are plenty of things you can do to slow the progression to stop any further damage. But the road to cirrhosis is also very long. And so that fatty liver, the steatosis, the scarring, the fibrosis, those things can be identified earlier and those you can recover from a lot of the time. And especially as soon as you stop drinking, the fatty liver and that kind of stuff can start to resolve. The liver can regenerate and go back to functioning the way it wants to.

Macie Jepson
So to be clear, there are a lot of steps along the way towards cirrhosis. Your one month off in January isn’t going to reverse that, but we really want to inform people with the facts because on social media in January they’re talking about that one week your body looks like this. In week two it feels like this. Break it down for us.

Ryan Marino, MD
Yeah. That is always tricky because I mean people can have great effects and can start to see benefits right away. And I don’t want to say that you shouldn’t hope for that or you can’t have that, but when I hear that week one, your sleep will be better, week two, your skin will look fresher, all that stuff. I mean it’s really hard then for people who don’t get those results right away. And to just remember that the changes happening in your body are definitely happening even if your sleep maybe isn’t fixed right away, if your skin isn’t changing that kind of thing. On the inside, I mean the livers can go back to metabolizing the fats that it wants to and not storing them. And those kind of cellular level changes, all of that, your different organs can start healing themselves, that kind of thing.

Pete Kenworthy
Can everything in the body start healing itself to some extent? And I realize there’s a lot of subjectivity here. It depends on how much you drank and for how long, but if we’re talking about those people who are drinking every day or maybe drinking a handful of times a week, more than the average person, and they’ve done some damage to some parts of their body, can all those parts recover?

Ryan Marino, MD
For the most part, yeah. I mean there’s definitely some degrees of damage that can be irreversible. And so I mean the liver isn’t the only one. You can get enough damage to your heart and the heart muscle that may not be able to recover. But stopping is the best chance at any improvement. And I think one good example that we didn’t touch on that’s worth bringing up is the pancreas. And so pancreatitis, which is a horrible, painful condition, people have bad abdominal pain and vomiting is primarily caused by alcohol. That’s the number one cause. But as soon as people stop drinking, that inflammation immediately starts to resolve. And on the flip side, we see that I mean, if people go back to drinking, you can immediately have recurrence of that. So it is good to remember that on the inside things are healing and can get back to kind of their baseline state even if you don’t necessarily see the changes on the outside.

Macie Jepson
And going back to drinking, that’s what I often think about. You’ve given yourself a break, your body’s ticking along, maybe healing itself a little bit, and then come February or whenever you decide to jump right back in, it’s got to be a shock to the body. That can’t be good, right?

Ryan Marino, MD
I think though, I mean any amount of that kind of time off and healing is good and it seems like at least in terms of dry January, but when I’m talking to people who are just trying to quit drinking for other reasons or trying to cut back on their drinking, having that time away from alcohol beyond just letting your body kind of reset. And it also will help if you feel like you’re drinking a lot because you’ve developed tolerance, that tolerance can go away. And so if you started drinking again, you hopefully wouldn’t need to drink as much, but it allows people time to consider their relationship with alcohol. And so a lot of times, I mean people are drinking just because it’s something to do because we’ve associated with so many events, but other times people may be drinking because they’re having trouble sleeping, dealing with anxiety, stress, that kind of thing. And so having time without the alcohol on board to deal with whatever that is and kind of think about why you were drinking in the first place, seems to, at least in my anecdotal experience, help people if they do start drinking again or not completely stop in terms of reevaluating how much or why they’re drinking in the first place.

Macie Jepson
You mentioned better sleep, not necessarily the case with alcohol. So can we talk about some other effects of quitting for a while? I read libido. I mean that should be enough right there to make some people want to stop drinking.

Ryan Marino, MD
Yeah, I mean, these all are, I would want to put a caveat on that they are potential benefits, but people might not see them right away or might not see the same benefits as everyone else. And sleep I think is a great one because this is one that comes up in social media posts, especially with dry January. It’s like my first week I had endless energy. My second week I slept like a baby, that kind of thing. And for people who have like problem drinking or have been drinking for a very long time, we actually see a lot of disorders in kind of sleep. And those can actually be worse when people stop drinking. So alcohol itself is bad for your sleep because it disrupts your REM cycles. And so even though it may help people fall asleep, it may help people get a full night’s sleep, they’re not getting the same kind of quality sleep, and so your sleep will improve when you take the alcohol out of the picture.

But for a lot of people who really have been struggling with issues with alcohol, their sleep might be even worse after they stop drinking. And that is hard to kind of talk people through, especially when it comes to comparing yourself to these fantastic results that you see in a TikTok video because it will get better eventually. But yeah, your blood pressure can go down almost immediately. Even just reducing the amount you drink can start lowering your blood pressure. Libido can return and can improve for people who have been drinking for a long time, but again, in the short term may actually be even worse. So it is hard to kind of coach people through that when they’re expecting great results and not seeing them. But there’s a great chance that people could see those results right away.

Macie Jepson
But it could be a long-term commitment for some people to really, a commitment to pull away from alcohol significantly.

Ryan Marino, MD
And to undo a lot of these kind of changes in the body, especially if someone has been drinking for a very long time, it may take more than just a month. It may take months, three to five months even, to see some of those changes.

Pete Kenworthy
My guess is, I was going to ask you what the first signs are of alcohol damage to your body, but my guess is if you see the signs, it’s too late?

Ryan Marino, MD
It’s not that it’s too late, but it is one of those things where for the most part, there isn’t going to be any sort of outward sign. So I, I feel like I keep saying the same phrase where we probably all know someone, but I’m sure everybody knows that person who drinks way more than seems healthy and doesn’t have any sort of outward signs. They’re not unhealthy seeming. They’re not sick. They’re not having trouble with their job, their life, that kind of thing. But yeah, it can be kind of a later thing. It can be more of a masked illness, so to speak, or a hidden illness. But in terms of things to watch for, I mean, I think high blood is one of the earlier things that develops, that kind of thing. Mood disorders as well.

Macie Jepson
If you’re looking for jaundice, that’s probably a little late.

Ryan Marino, MD
Yeah.

Pete Kenworthy
Can you tie a bow on this and with advice really for everyone, right? People who haven’t started drinking or maybe early drinkers, people who’ve been drinking for 20 years, people who’ve been drinking for 50 years, what should all those people know that maybe people don’t know? We know alcohol can have long-term impact, certainly on your liver. We just went through a bunch of other body parts, but what’s the takeaway about alcohol? It’s not pure evil, but it’s not pure joy either.

Ryan Marino, MD
In terms of kind of takeaway points, it’s never too late or too little to try to reduce the amount that you’re drinking. So I mean, if you can cut back one drink or stop for one month or completely stop, all of those things are going to have some sort of health benefit. And even if you are someone who has cirrhosis stopping drinking, it’s still not too late for that. There still is a benefit. I think in terms of the other takeaway on kind a flip side is that, I mean, I remember for the past few decades just hearing health benefits from red wine. It’s great to have one drink a day, that kind of thing. And really within the past couple of years we’ve seen the complete opposite of that is true. And there is very good data that shows that just any amount of alcohol is going to have some potential for harm. And so it’s not that you should be scared and cut out the glass of wine with dinner or getting beers with your friends, but just remembering that there is no amount that is going to be good for you per se.

Pete Kenworthy
Dr. Ryan Marino, toxicologist and addiction specialist from University Hospitals in Cleveland, thanks so much for joining us.

Ryan Marino, MD
Yeah. Thanks for having me.