บทถอดความฉบับเต็มของ Decoding Alcohol with Dr. David Dodick

toxins that are generated from the trillions of organisms in the gut can leak into the blood, and that can affect both the barrier that separates the blood from the brain, allowing inflammation or molecules to. 00:07:25 Speaker 5: Get into the brain that shouldn't. 00:07:27 Speaker 4: Be there, but it also drives and activates another cell in the brain called the microglia. Microglia are there as a defense mechanism. They're inflammatory cells that are supposed to fight invaders, but when chronically turned on, they actually continue to release molecules of inflammation that damage brain tissue. So this constant state of neuroinflammation, which is one of the main drivers of neurodegeneration and neurodegenerational course, is ultimately what causes things like dementia and Alzheimer's disease. 00:08:06 Speaker 5: But also this. 00:08:08 Speaker 4: Reduction in energy supply. It's very damaging to the brain. 00:08:13 Speaker 5: The other thing that. 00:08:14 Speaker 4: The alcohol does is it kind of strips the insulation off of those fiber optic cables, so it slows down and it disrupts the flow of. 00:08:24 Speaker 5: Information in the brain. 00:08:26 Speaker 4: So at a cellular level, there's a lot of damage being done to the brain, both from inflammation, which again drives up the need for more energy, while at the same time you're starving the brain of both the nutrients that it needs to make energy and its ability to drive energy production that drives the function of each cell in the brain. 00:08:49 Speaker 3: Do you think that when you drink the night before, one or two drinks, that that changes your cognitive ability that energy change or blood flow change in the brain. Is it impactful immediately after a couple of drinks, like the next morning, do you see people's cognitive abilities change? 00:09:07 Speaker 4: Yeah, no question about it for a variety of reasons, not least what I just mentioned. But the other thing that alcoholol does is it disrupts sleep. So you know the so called nightcap that people take to relax to maybe get to sleep sooner. It may work, But what it does is it really disrupts the architecture if you sleep. So what do I mean by that? Well, there are two important times during sleep that the brain uses to consolidate memory, which is rem sleep and deep sleep. Deep sleep also flushes out the brain of the proteins and toxins that build up during the day. It's kind of the waste management of the brain, if you will. So here you have alcohol, that's it's disrupting waste management. You can't flush things out that need to be flushed out, and you're not allowing enough rem sleep to occur when emotional regulation and memory consolidation is both as supposed to occur. The other thing that alcohol does is it activates the sympathetic nervous system, and so you might notice when you're the next morning, if you wear a wearable, that your heart variability drops, and that's because the sympathetic nervous system is activated. The

other thing that alcohol does is when you drink alcohol, you get sleepy, and you get sleepy and get sedated a bit because it promotes the most inhibitory chemical or transmitter in their brain called gabba. 00:10:44 Speaker 5: What it also does is it reduces. 00:10:48 Speaker 4: The excitable nerroor transmitter called glutamate. And so the next day, think about what happens. You've disrupted your sleep and you get this sort of anxiety, if you will, where the brain sort of revolts and produces more glutamate, which is an excitatory neuro transmitter, which may make you more anxious and more vigilant. So that hangover or anxiety and the brain fog that you experience the next day is a direct result of alcohol's effect on the brain and on sleep architecture, which, again, if you don't sleep well, you don't think well the next day. So even though you think you're getting sleep, if you've changed your sleep architecture, the way you feel the next day is going to be dramatically impacted. 00:11:40 Speaker 3: Can you unpack a little bit about the risk of cancer with alcohol use, which cancers are increased and why that would be? 00:11:50 Speaker 4: Yeah, this is a this is a big one. You know, everybody knows visually, they understand that when you pop a cigarette and that whatever is in that goes into your lungs, that that can cause lung cancer. 00:12:04 Speaker 5: People get that, but. 00:12:06 Speaker 4: People don't And I was one of them who really never understood the found effect that alcohol can have on your risk of cancer. 00:12:16 Speaker 5: So how does it do that? 00:12:19 Speaker 4: Well, in addition to everything I talked about at the cellular level that alcohol does, it also acts like a wrench in your DNA and it's sort of tears it open or tears it apart a little bit. And you know, every day we're having a little DNA damage that occurs, and we have mechanisms that repair that damage. Alcohol not only acts as a wrench on the DNA and damages it, but it actually prevents its repair. When that happens, cells are more prone to become cancerous. I think the other thing alcohol does is it creates the milieu or the environment one of inflammation that allows cancer cells to grow, expand spread. The other thing alcohol does is, you know, when you think about our immune system, immunos senesceence where the aging immune system is. 00:13:20 Speaker 5: The reason why. 00:13:20 Speaker 4: For example, cancer is more common as we age and infections become more severe as we age. Our immune system just likes the rest of our body ages. Alcohol accelerates that aging. I'll give you an example. There's a cell called a natural killer cell. They're kind of like immune soldiers, and alcohol damages those natural killer cells. So at the same time as it's sort of breaking up the DNA, injuring the DNA, impairing its ability to repair itself, reducing the immune surveillance those immune soldiers that normally take it out, it's a sort of perfect storm that allows cancer cells to actually emerge, grow, expand, and develop into a tumor. So for those reasons, just like asbestos, tobacco, and other type one carcinogens, alcohol is a Grade wander type one carcinogen. Some governments like Ireland and Canada have recognized that and those of you who might have heard the Surgeon General last year talked about putting warning labels on alcohol, not just for expecting mothers not to be drinking, but also the fact that it increases the risk of cancer. 00:14:42 Speaker 3: When I first started oncology, the guidance was that one drink a day for women was acceptable. And now I think they've really come out and said that no amount of alcohol is safe for women when it comes to breast cancer risk, and that takes us into midlife women. You know, a lot of patients will ask me if alcohol is bad for my total body health and overall well being? Can I drink at all? What if I enjoy a glass of wine at night to unwind? Can I drink any drinks? Is there any amount of alcohol that I can drink that's safe. 00:15:11 Speaker 5: Yeah, that's a good question. 00:15:13 Speaker 4: I mean, it really is how much kindling, if you will, to which alcohol is a sort of a gas that ignites a fire. Let me, let me, let me explain what I mean by that. 00:15:29 Speaker 5: When you combine. 00:15:30 Speaker 4: Genetic risk with other lifestyle risks. For example, your diet's not great, your sleep is poor, you're not moving, you're not exercising, you're not managing your vascular risk. 00:15:44 Speaker 5: Factors the way they need to be managed, like. 00:15:47 Speaker 4: Blood sugar insulin sensitivity Lvl eight bl b, your blood pressure is not optimally managed. So when you have all of these modifiable risk factors that aren't well controlled, then adding any alcohol to that is just like adding fuel to a kindling fire. 00:16:11 Speaker 3: Right. 00:16:11 Speaker 4: But if you are in every other way looking after yourself, right, and you're modifying those vascular risk factors, and you're exercising and you're not smoking, and you're socially connected and you're cognitively active, if you're doing all those things right, and you're sleeping and you're taking your sleep seriously and you eat a predominantly plant based diet with fiber, if you're doing all of those things, is a glass of wine with dinner occasionally? 00:16:46 Speaker 5: Is that like a no? 00:16:47 Speaker 4: No? Does everybody who drinks a cocktail or has an occasional glass of wine going to develop dementia? No? But it certainly depletes that cognitive reserve. And if you're genetically at risk and you're not managing those other modifiable risk factors, then it's the fuel to the fire, so to speak. And in women in particular, you know oncologists right now are kind of treating alcohol in women who are at risk for breast cancer as a no no, you know, one drink per day appears to increase the risk of breast cancer by up to ten percent. I guess the one other thing I will say is, in

addition to damaging DNA, there's something called the epigeno or epigenetics. So we're born with, you know, our genetics, but the genes that are active at any one time changes over the course of your life, and it changes primarily in response to your environment and your lifestyle. So you can turn genes on and you can turn genes off. So one of the things that alcohol does is it turns off genes that are responsible for immune surveillance immune health, and it turns on genes that can promote the development of cancer, something we call onca genes. So I don't want the listeners to be, you know, overwhelmed by all of this, except to know that there's no doubt that alcohol is not only a neurotoxin but a carcinogen. And science has figured out and continues to figure out all the mechanisms by which it does that. And by the way, you know, as a neurologist, and as a preventive neurologist, I'm not the alcohol police. I'm more like a brain health coach where I can sit down with the patient and have this kind of discussion with that. So am I an absolutist where I would say that you know, one should never touch alcohol. No, but there are some people who never should touch alcohol, and I hope I've described who that person is versus the person who enjoys an occasional glass of wine with dinner, which at this point in time, I will say it's okay, so long as they're managing everything else in their life that protects their brain. 00:19:11 Speaker 3: Coming up after the break, doctor Dotick and I dive deeper into the science and discuss genetics, dopamine, and alcohol's effect on midlife women during perimenopause and menopause. Will be right back. Are there genetic tests for alcohol metabolism that you can tell genetically that somebody may be at more risk from alcohol use than another person? 00:19:48 Speaker 4: You know, I don't do genetic testing for alcohol, but you know there is something called a polygenic risk core where where there may be hundreds of different genes that increase the risk of alcohol use disorder, and so sometimes it's good to be aware of that. There are pharmacogenomic tests that w can do to determine the way in which you metabolize certain medications that some people go on that actually curbs your appetite for alcohol. Let's say the GLP one antagonist, for example, the ozepic ozepics in the moonjarro Those actually curb appetite for alcohol. Then there's something called alcohol dehydrogenase, which is the principal enzyme that breaks down alcohol into acid aldehyde. Women actually have less of it, so they don't metabolize alcohol as well. But for people who might have had a variant in the acid aldehyde dehydrogenase G that may affect your propensity to drink. 00:20:55 Speaker 5: I'll give you an example. 00:20:57 Speaker 4: Some people rapidly produce acid aldehyde and they don't feel well, They get flushed, they get nauseated. Just alcohol makes them feel bad, so they don't drink. There are others people who can so called drink people under the table, and they have a high tolerance for alcohol, so they may have to have three drinks or four drinks to feel the buzz that someone with different metabolism feels after one drink. 00:21:22 Speaker 5: That's actually dangerous. 00:21:24 Speaker 4: Those people who can drink others under the table consume more alcohol, and that neurotoxin is having an effect even when you're not feeling the buzz. And remember that the liver can only metabolize one drink per hour. 00:21:43 Speaker 5: That's the kind of metabolism it has. 00:21:45 Speaker 4: So the more you drink, and the more rapid you drink, the more you know. Basically, the alcohol just keeps circulating and keeps bathing your brain while it's waiting for the liver to be freed up so that the enzymes can metabolize it. So combine that with if you're one of those people who, because of genes, can drink someone under the table, you're really bathing your brain in a very toxic soup, even though you may not be feeling the buzz or feeling intoxicated. 00:22:20 Speaker 5: When you do drink. 00:22:22 Speaker 4: So if you're going to drink, and if you're going to have more than one drink, boy, you're better spread it out. 00:22:29 Speaker 3: So let's talk midlife women, dopamine, perimenopause, hormonal fluctuations, and vulnerability to alcohol. In my reading of the research in literature, currently alcohol use is dropping amongst younger populations except midlife women. Estrogen fluctuations are occurring which impact the brain. They impact the brain, energetics, blood flow to the brain, amyloid in tao right at midlife? Are women more vulnerable to alcohol problems in midlife in terms of the impact of alcohol as a neurotoxin? And the second part to this question is dopamine have anything to do with it? Because as estrogen levels fluctuate, opamine goes down. Are women seeking more alcohol maybe in this time of their lives or our lives? Perhaps I should say because of dopamine. Do you see any link there? 00:23:23 Speaker 4: Yeah, you know, it's the very population on which alcohol can have the most profound effect, or midlife women, I believe because of that. You know, profound fluctuation and estrogen that occurs around the perimenopause and the menopause. And I'm talking to a world expert right now, so I'm feeling rather conspicuous. But you know what happens in the perimenopause and the menopausal state. If you look at you know, sometimes that gets distributed differently around the abdomen and viscera. Sleep gets disrupted. Yes, you have symptoms like hot flashes and nice sweats, changes in bone density occur brain fock. You know, women are experiencing brain fog during that period of time. And when you think about the effect of alcohol on sleep, which we talked about, we didn't talk about its effect on bone, but alcohol actually activates what we call osteoclass, which break down bone and inhibit osteoblasts. 00:24:28 Speaker 5: Which form new bone. 00:24:29 Speaker 4: They also

affect the way the liver activates vitamin D and affects the way the kidney regulates calcium, so it can have a profound effect on bone density. We've already talked about brain fog and the effect that it can have on women's brain, not the least of which estrogen is neuroprotected, and so you've lost a hormone that was protecting the brain and now you're trying to make up with alcohol to correct that sort of dopamine gap. You mentioned dopamine, and I just talked about the fact that you know, as estrogen drops, the dopamine drops, that rewards circuit is not as active, and alcohol of tends to make up that gap, at least temporarily. You know the other thing that alcohol does is, you know, for women who are prone or at risk or breast cancer. Alcohol can actually increase levels of estrogen and other hormones which are associated with hormone receptive positive breast cancer. So that's the reason why. Of course, on colleges, as you mentioned, are are kind of becoming a binary decision for women. 00:25:39 Speaker 5: Where if they're at risk, they're told not to drink. You know, women during midlife are. 00:25:47 Speaker 4: Trying to nurture and raise a family well at the same time, trying to grow and build a career at the same time, also trying to care be a caregiver for aging parents. So this thirty five to sixty five age range is very unique. It's kind of a there being sandwiched between caring for children, caring from aging parents, and trying to nurture and grow their own careers. And this wine culture we're marketing heavily targets this demographic braining alcohol is kind of a reward or a coping mechanism for all of the invisible. 00:26:28 Speaker 5: Labor that women perform. 00:26:30 Speaker 4: It's really harmful. So, you know, I would say that in many ways, the metabolic, the brain, the cardiac issues that women face during this midlife are all exacerbated by alcohol, and so the most vulnerable population which are women during midlife are actually probably the population that shouldn't be consuming alcohol or consuming it at a very modest level. 00:27:09 Speaker 3: The issue that I find that I get asked the most and I find the most problematic is women will say to me, it's closure to my day. I sit down, I put my feet up, I have a glass of wine. For me, it was a glass of bourbon or a shot of bourbon. Or how do you respond to that when people say I need some closure, I need something to wind down. How do you coach somebody or what do you recommend to a woman to replace that glass of Chardonnay or that shot of Kentucky bourbon. 00:27:43 Speaker 4: The tough one because everybody has different social circumstances, different family circumstances. 00:27:50 Speaker 5: But I think, you. 00:27:51 Speaker 4: Know, women tend not to delegate, and they certainly tend not to divine. They tend to take all of the responsibility on themselves, and I think they need time to focus on themselves and do something positive, good and healthy for themselves. And whether that's for these thirty to forty five minutes, I'm actually going to get into a song. I'm going to take a hot bath, I'm going to exercise. I'm going to do something positive and good for myself and with awareness of if they were aware of what they're doing to their bodies, and the fact that you know, when they take the edge off, if you will, with that. 00:28:31 Speaker 5: Glass of wine or that glass of. 00:28:32 Speaker 4: Bourbon in the evening, it disrupts their sleep. It may actually promote hot flashes night sweats, It may actually promote brain fog the next day. 00:28:43 Speaker 5: So it's a biological. 00:28:44 Speaker 4: Thief actually, and it is short term gain for long term pain. And I think many of the anxiety that I talked about. You know, alcohol has a profound effect on mood as well. 00:28:59 Speaker 5: Part of the area of the brain. One of the areas of the. 00:29:01 Speaker 4: Brain that alcohol effects causes what we call anhedonia, or a lack of pleasure. So the very things that people used to take pleasure and they don't get to much pleasure out of anymore. So, given the effect on moved and anxiety and sleep and cognitive function or brain flock, coupled with the fact that it increases blood pressure as a negative effect on the heart and cardiovascular disease is still a primary cause of morbidity and mortality in women. Bone health insulin sensitivity. All of these things are compounded by the effects of alcohol. 00:29:43 Speaker 5: So I think if. 00:29:44 Speaker 4: Women, especially during midlife, had greater awareness of the profound effect of alcohol at a multi organ level and the very issues that they're dealing with for which they take a glass of alcohol, which is which may be stress or anxiety, it actually makes it worse over time. I don't want to oversimplify things, and I don't want to be accused of not being sensitive sense to everybody's life circumstances, but it actually will exacerbate some of the very symptoms for which you're actually taking that glass. 00:30:18 Speaker 5: Of wine or bourbon at night. 00:30:20 Speaker 3: Let's just talk very briefly about exercise at night. I was always under the belief that you should not exercise before you go to bed because it jacks up your nervous system and can get you rubbed up. And indeed that's kind of like not true and kind of the opposite, right, So for me, I replaced my evening bourbon with core work, or with push ups, or with taking a long walk. Does exercise disrupt sleep or can it help us to get better sleep? And we can substitute maybe a glass of alcohol for a little bit of core work, a little bit of setups or a long walk. 00:30:53 Speaker 4: Actually, oh, one hundred percent. I mean I think you know, I exercise mostly in the evening actually, and it actually has improved my sleep considerably. You know, my sleep scores now are much better than they used to be, just simply by not getting up early in the morning. I mean some people, everybody's schedule

in calendar is different. 00:31:15 Speaker 5: But for me to get up at four. 00:31:17 Speaker 4: Thirty or five o'clock in the morning and to get a workout in before work, I used to feel good doing it, But I feel better if I'm exercising in the evening and my sleep is actually better in the evening now. I don't mean like exercising at ten o'clock at night and then trying to go to bed at eleven, but I mean exercising in the evening before dinner that actually will have a better effect on your insolent sensitivity, on your metabolism, and on your ability to sleep then perhaps exercising it at other times of the day. But yeah, for women who are struggling, particularly midlife, with some of the perimenopausal symptoms, including sleep, exercise is the best prescription that I can write and is the most important prescription for people to fill, especially women during that midlife I love to hear that. 00:32:15 Speaker 3: Coming up, doctor Dodeck talks about the field of preventive neurology and the ways in which we can protect the brain and other organs before symptoms appear. 00:32:24 Speaker 1: More in a minute, Welcome back to the show. 00:32:41 Speaker 3: When I first came to Atria, I had a daily meeting every morning with doctor Dodeck, and I quickly realized I had to be really on my game at these meetings. So another reason I actually quit drinking almost completely was because of those daily meetings. I realized that my mind wasn't as sharp as it could be if I had had a drink at the night before. Looking back now, it seems so obvious. I wanted doctor Doda to really unpack for us all the ways that alcohol impact our health, including his own specialty, preventive neurology. Let's talk a little bit about the emerging field and exciting emerging field of preventive neurology. Can you tell us a little bit about what preventive neurology is, the research around alcohol and dementia prevention, and how alcohol use counseling is being utilized as part of the preventive neurology programs in order to prevent dementia. 00:33:40 Speaker 4: So preventive neurology is really a proactive shift in medicine and in neurology in particular. So what I mean by that is, instead of waiting to treat a stroke or to treat someone's dementia or memory loss after it occurs, neurologists now are looking at the lifestyle insults, like alcohol being one of them that accumulates over decades. In fact, there was a rather significant publication from the Lancet Commission published in the Lancet and there have been three versions of this on dementia prevention. And what they did was they looked at how much dementia could be prevented if you optimized, in other words, reduced or eliminated these risk factors that are modifiable, and it turned out that about forty five percent or almost half of all dementia could be prevented if you optimized or modified those risk factors. And alcohol is a profound risk factor. It's kind of a monotonic risk factor. In other words, there's no amount of alcohol that's actually safe for the brain. Unfortunately, because as we talked about earlier, it's a neurotoxin. Obviously there's a dose response, so that the more that you drink, the more damage that can occur. And in those who have serious issues alcohol use disorders or alcoholism, you can have alcohol really to dementia. So it can directly cause dementia as opposed to increasing the risk or other types of dementia like Alzheimer's disease. You know, I talked about what alcohol can do to the brain at the cellular level. The other thing that it does is it actually activates one of the enzymes in the brain that produces amyloid. Not only that, but those who drink, you know, eight or more drinks per week have actually been shown to have increased levels of TOWL in the brain. And amyloid and TOW are two proteins that aggregate or clump and accumulate in the brain, and we believe those are the two major protein insults that gives rise to Alzheimer's disease and other types of dementia. They also increase the levels of TOW and amyloid in the brain. And based on what I said about sleep, reduce your ability to flush out at night during deep sleep, so you can see that alcohol has sort of a multidimensional and multi pronged effect on the brain that you can see why it's now a modifiable risk factor for dementia and the way you know, neurologists are looking at preventive neurology now, it's all about cognitive reserve. You know, think about your bank account. Each time you make a withdrawal, you deplete the reserve in your bank account. 00:36:40 Speaker 5: You think about the brain the same way. 00:36:42 Speaker 4: Each time you insult the brain, you reduce that cognitive preserve because it's about what kind of cognitive independence and cognitive longevity can I have when of them in my seventies, eighties, and nineties, if I live that long. I actually believe that the most devastating neurological diseases like stroke and dementia are largely preventable. 00:37:05 Speaker 5: In addition to all. 00:37:06 Speaker 4: The other things that women are at risk for at a significant higher risk than men, Alzheimer's disease is another one, and especially women in midlife. If you knew that the risk is two to three times of a woman developing Alzheimer's disease than men, which is true, and you knew that alcoholism, neurotoxin potentiates that risk. 00:37:34 Speaker 5: This is where precision medicine comes into things. 00:37:36 Speaker 4: So, doctor Poynter, if we do whole genome sequencing here at Atria, as you know, if I have a young woman, and I have plenty of young women right now in the practice who have a genetic risk for Alzheimer's disease and a family history, so they have one or two copies of this risk gene called apo E four. For a woman who has two copies of apo E four or even one copy of APOLI four, who have that genetic risk and who aren'toly optimized, I would say no amount of alcohol is safe. And so there is an example of someone who

I would say no. The decision here is binary, no alcohol zero if you don't want to deplete quite rapidly that cognitive reserve. So I think that's where precision medicine comes in. To say that nobody should actually have any alcohol is an overgeneralization that medicine is moving away from. We're getting into precision medicine now. And so if I have a molecular phenotype of a patient and I know what their insulin sensitivity is, and I know what their blood pressure is, and I know what their LDL is, and I know what their hemoglobinating one sees. I know how metabolically healthy or unhealthy they are. I know what their risk for cancer is. I know what the risk for Alzheimer's disease is. I know what their risk for heart diseases. Because we're assessing that. Then to throw alcohol on those embers, I would say it's a binary decision. 00:39:21 Speaker 5: And the answer to that is no. 00:39:22 Speaker 4: If you have someone who has a neuroprotectivegy for example, and there are plenty of them who are metabolically optimized, could that person have an occasional glass of wine with dinner. Yes, yes, it's a neurotoxin, but it's. 00:39:40 Speaker 5: The body into which you put it. 00:39:43 Speaker 4: How much is that person at risks for some of the detrimental consequences that alcohol can amplify. That's really the magic. That's where medicine is going. It's all about precision prevention, and that's the nuanced conversation that we're able to have with patients now, given our ability to test and to risk stratify, to identify people who are at that elevated risk. My conversation with that person that young thirty two year old woman who has two copies of AIGHTO E four is very different than the young woman, thirty two year old woman who has no copies of a bo E four and is metabolically Christine and doing all the things like bragging about her sleep score, exercising right, eating a plant based diet, a Mediterranean diet. My conversation about alcohol is going to be very different with those two people, despite the fact that they're both thirty two year old women or forty two year old women or shifty two year old women. 00:40:43 Speaker 3: So taking it away from one recommendation into a highly personalized recommendation, absolutely, can we undo the damage that's done. 00:40:51 Speaker 5: The answer is yes and no. 00:40:54 Speaker 4: On the on the positive side, if you stopped drinking, assuming you're in other ways healthy, it actually has been shown that if you stop drinking, that gray matter that cortex, the sort of skin of the apples, so to speak, starts to increase some volume. We know that even low amounts of alcohol will shrink the gray matter, but we've also seen that gray matter expands when you stop drinking. We also know that you remember I talked about the insulation that stripped off the fiber optic cabling the wiring in the brain. We know that that can repair itself as well. So yes, if you stop drinking and you start looking after your body by focusing on nutrition, exercise, sleep, you'll start to clear out and flush out some of that accumulated protein. 00:41:45 Speaker 5: That's collective. Of course. When I said yes and no. 00:41:48 Speaker 4: I mean no insofar as if you continue, like I talked about a dose response, the more you drink and the longer you drink, some of the damage is not repairable. But the good news is that if you stop drinking, you start to see the beneficial effects of that almost immediately, and then over time there's repair. 00:42:10 Speaker 5: There's repair that can occur. 00:42:11 Speaker 4: And we also know that the brain, even into older age, is a very plastic organ and if you do all of the things that we do in our brain health program to optimize the health of the brain and to optim we can actually optimize I think copative function over time. I mean we've actually seen in our practice where not only does cortical thickness and the volume of the gray matter and cortex expand over time, but sometimes the hippocanphi, which are these two little memory organs, and the temporal lobes of the brain that are responsible. They're like the save button on your computer, right, They store memories. They put it into your hard drive, and now you have that memory, those start to enlarge and work better as well. You know, Look, if I could go back and tell my eighteen or twenty five year old self what I know now, I probably would have done things differently on many different levels. 00:43:08 Speaker 5: I wouldn't have been eating, you know, the fast food that I'm light have eaten. 00:43:11 Speaker 4: I wouldn't have been having the beer or any alcohol, or it would have been certainly in very much moderation. 00:43:20 Speaker 5: But I can't do that now. 00:43:23 Speaker 4: But what I do know is that if you look after the brain, regardless of what age you were, you can improve that cognitive reserve over time and mitigate against any sort of withdrawal continuing to withdraw on that reserve, because if you don't, then you're going to get into trouble over time. 00:43:43 Speaker 3: Doctor Dodick, thank you so much for today. You've been a wealth of knowledge, and I know we're going to get a lot of actionable points for our listeners. I so appreciate it. We also appreciate it. 00:43:53 Speaker 5: Oh it's my pleasure. Thank you so much for having me. 00:43:56 Speaker 3: After this interview wrapped, I kept replaying doctor Dodick's words in my mind that alcohol is a biological thief. Sure, alcohol might make you feel better in the moment, and I know for a lot of people it can be helpful. Social situations are simply a habit that's formed over many years. Honestly, it still feels new for me to go to a party and not have a bourbon in my hand. But when I think about the havoc it's wreaking on my health. Plus the fact that I'm just not going to really feel well the next day, I'm reminded why I stopped. I can't afford to have a day where I don't feel so great. Cutting back on alcohol may help improve your sleep, protect your brain, and mitigate your long term health risk. But I understand that cutting drinking entirely might seem really unappealing to some people listening right now, even knowing all the health risk. When I was researching for this episode, I spoke with an academic who has studied alcohol and human behavior. She told me about participants in her studies, often women in midlife, who reported drinking wine at night. Did this help take the edge off or is a way to connect with their partner. I get that, I really do. But I hope that this this conversation has given you more context about the impact alcohol has on your overall health and maybe even some new strategies for ways to reframe your relationship with alcohol. Maybe you take a long walk with your partner, or maybe you even just exercise after work to close out your day. It's okay to let go of old rituals. This will make space for new habits and new routines. Coming up, on the next episode of Decoding Women's Health, I'll be answering some of our listeners really great intelligent questions about my favorite topic, hormones and midlife women's health. Which BHRT is most effective transdermal creams, gels or vagil cream's inserts or oral pills? 00:45:59 Speaker 2: Okay, first, before we get into it, can you explain or define be HRT? 00:46:04 Speaker 3: And if you like this podcast, please consider leaving us a review wherever you're listening now it helps new people find the show. 00:46:12 Speaker 1: Thanks so much. 00:46:14 Speaker 3: Decoding Women's Health is a production of Pushkin Industries and the Atria Health and Research Institute. This episode was produced by Rebecca Lee Douglas. It was edited by Amy Gaines McQuaid, mastering by Sarah Burguare. Our associate producer is Sonya Gerwit. Our executive producer is Alexandra Garreton. Our theme song was composed by Hannes Brown. Concept creative development and fact checking by Shavon O'Connor. A special thanks to Alan Tish, David Saltzman, Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagdorn, Owen Miller, Jordan McMillan, and Greta Cohne. 00:46:55 Speaker 1: If you have a. 00:46:55 Speaker 3: Question about women's health in midlife, leave us a voicemail at four FO five two O one three three eight five, or send us a message at Decodingwomen's Health at pushkin dot FM. I'm doctor Elizabeth Pointer and thanks for listening. Until next time.