How to Eat to Change How You Drink, page 7
A 2015 study showed a possible correlation between ghrelin and leptin levels in alcohol-dependent subjects contributing to alcohol cravings and urges to drink.6 This is particularly interesting to note, as ghrelin levels can be affected by maintaining a healthy weight, consumption of protein, more frequent meals, and even prioritizing sleep. Increasing muscle mass and decreasing fat mass can also play a role in balancing these two hunger hormones. The way your body releases and responds to ghrelin and leptin may be influenced by genetics, which may also contribute to how we respond to alcohol use behaviors, consumption of food, and management of healthy body weight.7 Ghrelin might even be the reason why up to 20 percent of people with gastric bypass surgery develop alcohol addiction.8 Other theories suggest that ghrelin might contribute to the development of a transfer addiction from food to another drug like alcohol.
What about Weight and Metabolism?
I would be remiss if I didn’t address the ways that alcohol can sabotage our metabolism and management of a healthy weight. Metabolism is how our body breaks down the food and beverages we consume into fuel, a process that includes several of the hormones that we’ve mentioned in this chapter, like ghrelin, leptin, insulin, cortisol, and the sex hormones.
Most existing health advice suggests that simply eliminating alcohol will lead to weight loss due to a reduction in caloric intake, but this is not always the case. Have you tried eliminating or cutting back on alcohol, expecting to see a rapid weight loss, only to find that the number on the scale won’t budge? We might think that the reduction in calories will do the trick, considering that a full bottle of wine (4 glasses) can contain anywhere from 600 to 800 calories. A 12-ounce Budweiser contains 145 calories, which means a six-pack contains about 870 calories. Let’s not forget that late-night, alcohol-inspired snacking. While it is true that alcoholic beverages pack a big caloric hit, there’s more at play than caloric intake. We also have to consider how the alcohol itself is metabolized in the body. Because alcohol takes priority metabolism over other compounds in the body, when we are drinking, the body uses alcohol as a source of fuel (rather than tapping into existing carbohydrates or fat tissue for fuel).
Challenges with weight management are especially common in long-term drinkers and those who have a higher overall intake of alcohol. Because alcohol causes shifts in hormonal balance and metabolism, it is quite common for weight to stay the same—at least until we can start to repair the body’s hormonal systems. Women may find it especially challenging to shed weight, while men often slim down more rapidly. This is due to the fact that women have more regular hormonal fluctuations, which can often be impacted by alcohol breakdown on a greater level.
For these reasons, I generally advise against intermittent fasting (IF) or other long fasts for those who are repairing the body from alcohol use. While IF has been shown to support weight loss in some, I find that for most people, blood sugar is too fragile to go long periods of time without eating. Often, fasting stretches can increase our level of cravings for sugar, carbs, and alcohol. I advise clients to wait until they are no longer experiencing cravings before attempting any type of fast for weight-loss purposes. Men typically see better results on IF protocols, whereas women have more sensitive hormonal systems that can be negatively impacted by long fasts.
SEX HORMONES, LIKE ESTROGEN AND TESTOSTERONE
We’ve just learned how alcohol interrupts our metabolism through more general means, but what about the regular fluctuations in sex hormones? We might immediately think of women’s cycles and changes throughout the course of their lives, but men, too, experience changes in hormone levels throughout their lifecycles as well. Let’s talk about each of them.
As of this writing, there isn’t any research concerning nonbinary or transgender individuals. For this reason, those who identify as such may need to pay more attention to their hormone levels and be mindful of how alcohol and hormone therapy may interact. If you are in the process of transitioning and are also changing your relationship with alcohol, work closely with your physician to ensure you’re getting the appropriate support and recommendations for your personal needs.
More on Female Hormones
Many of my female clients are surprised when I tell them that their hormonal imbalances may be the direct result of their drinking habits. While these two systems may seem unrelated, they are definitely correlated. As we learned in chapter 4, the liver metabolizes alcohol, but it also plays a key role in the development, metabolism, and excretion of hormones from the body. When our liver is overburdened by alcohol, hormones become a low priority.
Think of it this way: our reproductive hormone system is the only system that can be completely removed from the body while sustaining life. We cannot remove the respiratory system, the nervous system, or even the cardiovascular system. We can, however, remove the male or female reproductive organs and still survive. That means that when the body is in a state of stress or toxicity, it will often sacrifice the production or management of sex hormones to prioritize other life-threatening processes. In women, these alcohol-related hormone imbalances can contribute to a host of symptoms—from PMS and irregular periods to extreme menopause symptoms and infertility, and continuing to drink heavily can increase the risk of hormone-specific cancers, like breast cancer.9
Most of us have heard not to consume alcohol during pregnancy, but what about before conception? When it comes to reproduction and fertility, if you’re actively trying to conceive and having difficulty doing so, I advise you to reduce or eliminate your alcohol intake. A 2021 study showed that both moderate and heavy alcohol use was associated with a decreased probability of conception throughout different phases of the menstrual cycle.10 But alcohol doesn’t just affect a woman’s fertility. Another study from 202211 showed that increased alcohol consumption in men affected the quality of sperm, which has the potential to impact a baby’s health. As we will see in the next section, this is only one of the ways that alcohol affects male fertility and hormones.
More on Male Hormones
While men tend to experience fewer hormonal fluctuations on a regular basis, it doesn’t make them immune to the effects that alcohol can have on their hormonal systems. Oftentimes, men who drink regularly have increased activity in the aromatase pathway, where the body increases the conversion of testosterone to estrogen, yielding lower levels of testosterone and higher levels of estrogen.12 Low testosterone levels can yield loss of muscle mass, low mood, fatigue, irritability, loss of sex drive, and erectile dysfunction. These symptoms are not only frustrating to manage but can also increase the desire to use alcohol to cope.
Men also may experience changes in body mass as the result of lower testosterone coupled with elevated estrogen. This can manifest as an increase in abdominal fat, which we often call a “beer belly.” This fat distribution can set men up for increased risk of cardiovascular disease, fatty liver disease, and higher mortality. It can also be an indicator of higher fat distribution around the organs and the result of the poor movement of fats through the liver and lymphatic systems.13 Sure, drinking more beer will potentially contribute to increased fat mass, but this type of accumulation of fat can also happen as the result of other blood sugar imbalances, high sugar intake, or other liver dysfunction (which is why some men who don’t drink at all still have a “beer belly”).
CORTISOL: OUR BODY’S MAIN STRESS HORMONE
Stress hormones, namely cortisol, can contribute to imbalances in blood sugar, which can in turn lead to alcohol misuse and ongoing cravings for alcohol. Cortisol, also known as our “fight or flight” hormone, is released anytime we’re under extreme stress—if we’ve just been in an accident, or we’re running from danger, or even stressed out over an important meeting at work. When cortisol is released, it causes a surge of blood sugar that helps fuel our body to outrun our assailant or make our brain function at peak ability during that important meeting.
In order to create more glucose to spike our blood sugar, the body breaks protein down to produce glucose—our body’s main source of energy. When we’re under long-term stress and have elevated cortisol on a regular basis, the body continues to produce glucose, resulting in elevated or imbalanced blood sugar levels.14 Alcohol intake further contributes to these fluctuations, making our stress worse, and contributing to this detrimental cycle.
FOODS TO SUPPORT BLOOD SUGAR AND HORMONE BALANCE
Certain foods can be used strategically to help support blood sugar balance, hormone balance, and the stress response. We’ll touch briefly on these foods here and then discuss them further in chapter 8.
Protein. Protein is one of the key food groups to focus on when balancing blood sugar. Protein not only helps improve satiety but also helps keep us feeling full for longer. Protein should be incorporated at each meal and snack throughout the day and come from a variety of sources, like lean meats, seafood, eggs, dairy, nuts, seeds, beans, and legumes. Plant-based eaters must be especially mindful to consume enough protein throughout the day to keep their blood sugars balanced, as vegan and vegetarian protein sources contain lower total protein content.
Healthy fats. Healthy fats are key to the production of our sex hormones, which are derived from fats in the body, in addition to aiding in nutrient absorption and improving bowel regularity. Healthy fats are generally categorized as monounsaturated or polyunsaturated fats. These can be found in foods like avocado, olive oil, nuts, seeds, and others. When consuming animal-based sources of fat, quality is key. Wild-caught fish and grass-fed beef contain higher levels of omega-3 fats, which also support a healthy hormonal system.
Complex carbohydrates. Not all carbohydrate sources are equal. There are two main types of carbs: simple and complex. Simple carbohydrates are easily converted to sugar in the body and generally cause a sharp increase in blood sugar followed by a drop (the type of response we’re looking to avoid). Simple carbs are the refined carbs, like processed wheat flour, refined grains, and simple sugars found in sweets and baked goods. On the other hand, complex carbohydrates contain fiber that helps reduce their impact on blood sugar. Examples include fruits, vegetables, and whole grains like brown rice, farro, and others. Complex carbs should be the go-to choice when choosing carbs for your meals.
BLOOD SUGAR, HORMONES, AND YOUR DRINKING ARCHETYPE
Because of the biochemical differences in each of the drinking archetypes we learned about in chapter 3, there are different ways that our blood sugar and hormones may play a role in the reasons why we drink.
Our hunger response is generally triggered by low blood sugar, which can not only manifest as cravings for sugar and carbs to raise our blood sugar back to normal levels but can also manifest as cravings for alcohol. This is especially common in people who are regular drinkers and get regular “hits” to blood sugar from alcohol consumption. When your blood sugar dips, check in with yourself. Are you really in need of a drink or could it be possible that you’re hungry? Think about when you had your last meal. Was it more than 3 or 4 hours ago? Having something to eat can restore us to normal sugar levels.
Social Drinker. The social drinker’s blood sugar may be more triggered by having that first drink. As we discussed earlier in this chapter, the initial drink can set off a roller coaster of high and low blood sugars. In these cases, it may be helpful to avoid taking that first drink—so you avoid giving in and drinking more. If your goal is to cut back but not abstain entirely, try to stabilize your blood sugar before drinking by having something to eat; choose something high in protein and healthy carbs containing fiber. This may help you better manage your cravings before you begin drinking. You may even notice that the desire to drink goes away, making it much easier to stop the cycle.
Stress Drinker. Stress and changes in blood sugar can often precede cravings for alcohol. This may be because stress can cause a drop in blood sugar or an increased need for the body to fuel itself to support the looming stress. Because of this, shortly after a stressful event, the craving for alcohol may be insatiable. It’s that moment at the end of a long day when happy hour seems to be the best choice—like it’s the only thing that will help you unwind. As with the social drinker, a generous snack containing protein, fats, and complex carbs can help offset this craving. And because more cortisol can cause more cravings, it is also important to manage stress and reduce cortisol through other activities, like exercise or meditation—or whatever brings you joy.
Habitual Drinker. For the habitual drinker, we often see more frequent ups and downs in blood sugar throughout the day, whether alcohol is present or not. In this case, we must work to effectively manage blood sugar throughout the day, starting from when we first wake up. By setting up our meal timing and the components of our meals (protein, fat, and carbs), we can avoid the pitfalls of cravings that can strike at any time of the day when blood sugar drops.
There are so many ways alcohol affects hormones in the body, but blood sugar and certain parts of the endocrine system are important parts of a nutrition and food-based approach to changing alcohol behaviors. The foods we eat and the alcohol we drink also play a large role in our gut health. While blood sugar has more of an immediate impact on how we feel, ongoing drinking impacts our gut health in the long run. We’ll dive deeper into gut health in the next chapter and look at how alcohol impacts the gut microbiome.
WHAT TO REMEMBER
When it comes to alcohol use, we often believe we don’t have the willpower to say no, but this may have more to do with the effects alcohol has on many of the body’s systems. Making positive changes to better support blood sugar levels and the endocrine system can be a simple approach to reducing cravings for alcohol and sugar. Because these blood sugar imbalances can have lasting effects and can’t be repaired by simply skipping a few days of alcohol, those of us with a history of heavy alcohol use have an opportunity to better manage alcohol reduction or cessation, in addition to managing food behaviors and nutrition.
CHAPTER 6
The Gut and the Microbiome
All disease begins in the gut.
—Hippocrates
IT SEEMS LIKE EVERYONE IS TALKING ABOUT GUT HEALTH THESE DAYS, and rightfully so. Over the last several years, new research has pointed to the gut, and the health of our gut microbiome, as playing a key role in our health in ways that had never been understood.
You may be asking, What does drinking alcohol have to do with my gut? And while there may be some obvious ways that alcohol affects the gut, there’s a lot going on behind the scenes at the cellular level. We’ve probably all suffered the consequences of a night of excessive drinking—certainly, our bowels have. Maybe you’ve experienced diarrhea, constipation, uncomfortable bloating, or heartburn. Usually, a hangover brings some level of digestive dysregulation that can range from minor discomfort to total disarray of your digestion that can last for several days. You might even notice that certain types of alcohol seem to have a different impact.
In this chapter, we’re going to learn how alcohol affects your digestion and your microbiome (the delicate balance of bacteria in the gut), and the long-term effects that alcohol can have on your gut lining and immune system. We’re also going to talk about your digestion in a general sense as an indicator of your overall health.
Yes, we’re going to be talking about poop in this chapter. A lot.
A NOTE TO THOSE WITH A GI DIAGNOSIS
It’s very common to be diagnosed with a gastrointestinal concern—whether irritable bowel syndrome (IBS), Crohn’s disease, ulcerative colitis, or diverticulitis. With a digestive diagnosis, it’s important to consult with your doctor about how alcohol might play a role in your symptoms. It’s also very important to work with them before implementing any new protocols, like diet or supplementation.
THE GUT AND YOUR HEALTH
By the end of this chapter, my hope is that you not only feel more comfortable going to the bathroom but also talking about it. It can be extremely empowering to become besties with your bowels, because our #2 habits can tell us a ton about our health—the health of not only our gut but our whole body. Knowing more about what’s going on down there can help you learn more about pretty much all of the symptoms you may be experiencing.
In the past, gut health exclusively focused on the importance of digestion and regular bowel movements. However, over the last several years, there’s been research pointing to the importance of our gut health, and the impact it has on our overall health and feeling of wellness. The gut, often referred to as the “second brain,” communicates with the entire body and impacts nearly every aspect of our health. Everything from our cognitive and mental health to our hormones, immune system, skin, food cravings, alcohol cravings, and more is connected to our gut health.1
This is important whether you experience near-perfect digestion or are constantly battling constipation or urgent, uncomfortable bowel movements. There’s an opportunity to focus on the gut to address a range of issues, including:
• General fatigue
• Headaches or migraines
• Hormonal acne or regular breakouts
• Hormonal imbalances
• Eczema or psoriasis
• Frequent hives
• Joint pain or muscle aches
• Autoimmune diseases
• A weak immune system
• Seasonal allergies
