A Glass Too Much for the Brain

00:00:03: Welcome to the Brain Health Mission Podcast, exploring how science, policy and everyday choices shape the health of your brain

00:00:10: and what you can do

00:00:11: to protect

00:00:12: it.

00:00:14: Hello,

00:00:15: and welcome back to the Brain Health Mission Podcast, where we explore the science, strategies and the stories behind brain health in neurology.

00:00:23: I'm your host, Dr Janna Midlfart Hof, neurologist and board member of the European Academy of Neurology.

00:00:31: In today's episode we dive into the theme alcohol and brain health.

00:00:36: We will explore how our drinking habits affect not just our brains but also other organs such as the liver and what strategies exist to reduce the harm.

00:00:47: I'm joined today by two wonderful guests, Professor Frank Murray from the European Association for the Study of the Liver and Catherine Paradis from WHO Europe.

00:00:59: Welcome to both of you.

00:01:00: Thank you.

00:01:01: Thank

00:01:01: you.

00:01:02: Nice to have you here, Catherine and Frank.

00:01:05: Before we go into the theme of the podcast, let us start with some quick introduction.

00:01:12: Catherine, could you start?

00:01:13: Who are you?

00:01:15: Hi, good morning.

00:01:17: Maybe it's afternoon when you're listening to this, but my name is Catherine Parasi.

00:01:21: I'm currently a technical officer within the alcohol unit at the World Health Organization.

00:01:29: European office.

00:01:31: I've been here for two years, but I've been in the alcohol research business, I would say for almost a quarter of a century, originally from Canada, where I led multiple projects, including Canada's guidance on alcohol and health, the most recent guidelines that were released in twenty twenty three.

00:01:54: So that's me.

00:01:54: That

00:01:56: was nice.

00:01:57: Frank, you are the next one out.

00:02:01: Good morning and good morning listeners.

00:02:03: So I'm Frank Murray.

00:02:04: I am a gastroenterologist and hepatologist based in Dublin.

00:02:08: I trained in Ireland the UK and the US and I've been looking after liver patients for many years about.

00:02:18: Fifteen years ago my wife said to me when I came home in the evening and expressed my disappointment and sadness that seems many people sick and died from alcohol.

00:02:25: She's a public health doctor and she said Frank you should really get involved in.

00:02:28: Reducing alcohol consumption.

00:02:30: that's the only effective way reducing harm.

00:02:31: so i listened to my wife eventually as she was quite correct and i've been involved in advocacy and lobbying around trying to reduce alcohol harms in ireland and and literally in europe.

00:02:43: Thank you both.

00:02:44: wonderful to have you here and very wise to listen to your wife frank.

00:02:49: Catherine first of all could you briefly introduce the european alcohols health alliance.

00:02:55: How did it start?

00:02:56: Why do we need an alliance targeted specifically against alcohol?

00:03:00: And what are the main goals?

00:03:03: Sure, I can do that, but I'll do that with Frank also, but let me start.

00:03:08: So my job here at WHO is primarily to set up health networks that will help us to translate all the evidence we have into action.

00:03:20: The reason behind that is that we have tons of data, tons of evidence about the impact of alcohol on health, on society, on the economies of our society.

00:03:32: That's not the problem.

00:03:33: The problem that we have is making that evidence available to the greater number and making translated into policies.

00:03:44: Therefore, we tell you, you know what?

00:03:45: We need to create a united public health community.

00:03:48: We need to have allies that will work with us, work with researchers, and that will transmit this evidence.

00:03:55: And of course, a very powerful and credible voice is the one of health professionals and medical doctors.

00:04:02: So we had this idea of setting up an alliance of all health professional organizations that could come together and, you know, wear their white jackets and say, you know what, there is actually a lot of evidence.

00:04:15: We see it and we need you to act upon it.

00:04:19: So at the invitation of Bezel, and that was really serene.

00:04:25: I'm sure I'm a massacre that word, but anyway, you know what I mean.

00:04:28: It was by accident.

00:04:29: And I was invited to easel, to conference, to speak about alcohol.

00:04:34: And I decided that I would use that as an opportunity to make a call to action, to set up an alliance of health professionals.

00:04:43: So I went there, and I did that, and Frank was there.

00:04:48: Yes, we've been wanting to do this and I think I need to pass it on to Frank there to tell the rest of the story.

00:04:55: Do that Frank.

00:04:56: Thank you, Catherine.

00:04:57: So yes, that's really what happened.

00:05:01: While Catherine and WHO, WHO and Everdaction had been thinking about forming an alliance and have formed other alliances of various other, of youth and the like, in easel we had been busy.

00:05:13: to A, developing an alcohol policy for your organization.

00:05:17: Because most patients who die from liver disease actually die from alcohol by far the majority.

00:05:23: And yet, we've no effective treatments for it in the main or very few effective treatments for it.

00:05:29: And we had a deep sense of frustration in relation to that.

00:05:32: And so EASL put together a group to develop policy, which we did and published in twenty twenty three.

00:05:39: And it's largely based on WHO best buys.

00:05:43: WHO have developed a tremendous resource of effective actions for reducing alcohol harms.

00:05:51: And as a follow-up to that, one of the key things that we felt was important was to establish an alliance because when you look at who determines public health in relation to alcohol, who is that, do you think?

00:06:04: It's the industry.

00:06:06: So what we felt was we needed to make the medical voice Louder and more coherent and to bring together the various clinical organizations mainly medical but not just medical.

00:06:15: we also have organized other organizations as well to bring them together with a view to articulating what the problem is.

00:06:23: first of all because the problem is horrendous which we see and you see in urology also but we see it particularly in our in liver disease and oncology and cardiology and emergency medicine.

00:06:33: So to bring people together so that they could explain the tragedy.

00:06:38: for the individual and for their families and for the people around them in relation to the health harms associated with alcohol.

00:06:44: So with WHO, EASL has been working really hard to establish this alliance.

00:06:48: We've signed up more than twenty-two organizations now, including your own, to come together to articulate what the problem is, what the evidence-based solutions are, and to call on policymakers and politicians to look carefully at those and to consider implementing them urgently.

00:07:07: Because every day we wait, more and more people are harmed and die.

00:07:12: You already said a little about that, both of you.

00:07:16: But why should we focus on alcohol?

00:07:19: There are so many risk factors for disease.

00:07:21: But why do you think that it's necessary for us in Europe today to focus on alcohol as a risk factor for disease?

00:07:29: Maybe you could start, Frank.

00:07:32: It's a great question.

00:07:32: And you know, the first thing I'd say in relation to alcohol, Janne, is there's a lot of cognitive dissonance around.

00:07:38: because many of us consume alcohol and we see it causing tremendous harms in our daily clinical work.

00:07:45: And yet we felt powerless to manage to change that environment as Catherine has already said.

00:07:52: So when we go to work, I think we often have a sense of frustration and futility about trying to reduce alcohol harms in terms of reducing consumption.

00:08:02: And we tend to focus on the individual patient, which is... what we're supposed to do, of course, the professionals, but I think we also do need to have a number of us who are very determined and dedicated in relation to reducing alcohol

00:08:14: harms.

00:08:15: So just to put big figures on it, about eight hundred thousand people die in the European region per year as a result of alcohol.

00:08:22: That's an astonishing figure, one in twenty deaths.

00:08:26: Isn't it?

00:08:26: It's shocking and the burden is high in both men and women, but it's much higher in men because men consume so much more alcohol than women.

00:08:34: They consume in both countries about three times more alcohol than women.

00:08:39: If you look at the average European man and in the greater European region, they consume just over thirty standard drinks a week.

00:08:45: That's equivalent to about four to five bottles of wine a week.

00:08:50: or equivalent to beer.

00:08:51: Now, that's an enormous burden of alcohol, which is a toxic substance.

00:08:55: And that's what the average man consumes.

00:08:57: And if you put that kind of number into the global burden of disease, life expectancy tables for life expectancy in patients consuming alcohol, the average European man is probably losing about four years of life.

00:09:11: Four years of life.

00:09:12: In fact, that's the difference in many countries between life expectancy in men and women.

00:09:18: So, you know, when we talk about health equity and social justice, there's a tremendous social justice argument for reducing that burden of harm in both men and women, but particularly in men where the burdens are so high.

00:09:31: So, in addition to the health harms, which are terrible, and we'll discuss what other organs are affected later, there's also, as Canadians refer to, social harms, families neglected and damaged, there are the social justice costs and the justice system prisons, all of that policing.

00:09:48: And then there are the harms to children, which are dreadful.

00:09:51: So they categorize in my view in three types.

00:09:54: First is fetal spectrum disorder.

00:09:58: Secondly, parental alcohol misuse with adverse childhood experiences for children.

00:10:04: And third, the early alcohol.

00:10:06: consumption and drunkenness.

00:10:07: So there are some of the harms.

00:10:09: that that's a top-level view of it and I'll pass it over to Catherine if I can for her thoughts.

00:10:14: Yes, I'd want to add.

00:10:16: I think you know your question is why is it a public health issue?

00:10:21: but I would argue that it's much more than a public health issue.

00:10:24: It's become much more than that because Frank talked about the number of death and the years of life loss referring to morbidity and mortality.

00:10:34: This costs a lot of money to our societies.

00:10:37: And as we are entering and experience this very strange era where, you know, the global order is being redefined, we hear governments looking everywhere for money or competitiveness in Europe for defense.

00:10:52: It's not my place to say whether that's a good decision or not.

00:10:56: But what I do know is that there's tons of money that would be available.

00:11:01: to governments if they would just implement some small tweaks in the policy environment that would prevent so many people from entering hospitals because of alcohol.

00:11:13: Let's just think about emergency departments where day after day after day a significant proportions of admissions are caused by alcohol whether that is because they're belly is full of blood because of a liver disease, or whether it is because they got into a fight, or they fell down the stairs and broke their leg, or they've been the victim of domestic violence, but our emergency departments are full of those cases.

00:11:39: An ambulance pulling up that costs money, and that consultation costs money, and intubation costs money, and so on and so on.

00:11:47: big chunk of money that could be redistributed to more pressing issues at the moment, because the reality, and I'm going to steal one of my favorite lines from Frank here, but the reality is that at the moment, the revenues that are being made out of alcohol, the profits are privatized and the costs are socialized.

00:12:08: And so it's more than a public health issue.

00:12:11: It's a societal issue.

00:12:15: That's very interesting.

00:12:16: And also what you said about the life expectancy, Frank, that was quite scary, wasn't it?

00:12:20: That there are

00:12:22: so many years perhaps to be saved.

00:12:26: Yes.

00:12:27: I mean, it's shocking when you think about that.

00:12:29: And just to emphasize, I mean, I think if you just think about the whole panoply of health harms, other harms, and the cost of cats because we're in this outline, it's the product, it's the luxury we can't afford really truthfully.

00:12:43: And would you also say, Frank, that this is a factor that we can influence on an individual basis, whereas, for instance, climate change and so on are very important factors for disease as well.

00:12:54: But it's so complicated to work on them, whereas here we can target it more, like Catherine also says.

00:13:04: Yeah, oh for certain.

00:13:05: I think that's that's absolutely correct.

00:13:06: Yeah But there's two things we can do.

00:13:08: first of all I think all of us everybody listening to this all of us participating here today We should reflect on how much we drink and everybody in my view should reduce their alcohol consumption.

00:13:18: that would be would be a very important thing.

00:13:20: but the second thing is WHO have driven very hard there that there are evidence-based policies to reduce alcohol harms as a national level and the key to that is reducing per capita alcohol consumption.

00:13:36: That's the key step.

00:13:38: All of their policies funnel into that.

00:13:41: And those evidence-based policies are hanging in the air in most countries, not implemented.

00:13:46: That's the point of Ever Action Project that Katrina's been involved in, and that's the point of setting up the European Alcohol Health Alliance is to try to advocate.

00:13:55: for the implementation of these policies across Europe and individual countries, and that's why we're together working.

00:14:03: That is great, and it's great to have you here.

00:14:05: We are a European podcast, and of course the listeners might be interested in, are there any differences across Europe in drinking pattern, in disease pattern, linked to alcoholism?

00:14:18: Is there something you could share with us, either Frank perhaps or Catherine?

00:14:24: Sure.

00:14:25: Of course, there are different drinking patterns across Europe.

00:14:29: I think there are two things to think about in terms of alcohol consumption.

00:14:31: The first is the volume that per capita consumption in countries per year.

00:14:36: And then the second thing is the frequency of bad drinking, which is a particularly harmful form of drinking in terms of the adverse outcomes of that event itself.

00:14:43: So that's one of the reasons why younger men, for instance, have such bad outcomes associated with alcohol because of particularly heavy episodic drinking or bad drinking.

00:14:53: So what's been very interesting, I think, to look at it in recent years across Europe is the fact that there are countries where there are very unhealthy patterns of alcohol consumption, very harmful patterns of alcohol consumption, particularly some of the countries in Eastern Europe, many of which have taken steps to reduce that.

00:15:11: And then there are countries like Southern Europe where it tends to be low levels of alcohol on a regular basis rather than binge drinking.

00:15:18: They have a different output.

00:15:20: And then Northern Europe, where we live, where there's so much binge drinking.

00:15:24: And it's worth just, I just might discuss a couple of countries, because I think they're particularly useful to think about.

00:15:29: The first is France.

00:15:30: So France had a hue, was one of the highest alcohol-consuming countries about thirty years ago.

00:15:36: And they reduced that through a number of steps, including the Law of Van, which restricted greatly advertising of alcohol.

00:15:42: And they now consume about half of what they drank at thirty years ago.

00:15:46: Now, they still are very heavy alcohol consumers per capita, but much better than they previously were.

00:15:51: Likewise, in Italy, Italy had a very high rate of alcohol consumption and alcohol-related harms.

00:15:59: And through what they call the Italian paradox, they've reduced their alcohol consumption through many steps by about a third.

00:16:06: And they've seen substantial reduction, for instance.

00:16:10: mortality deaths due to liver disease and they're really worth looking at.

00:16:16: In northern Europe and several countries in northern Europe, particularly Scotland, Wales and Ireland, there has been an introduction of various measures including minimum unit price and those countries have all seen a benefit from the introduction of minimum unit price and evidence-based policy supported wholeheartedly by WHO.

00:16:35: And then I think a country to really look at it because we might pick this up after I finish is Lithuania, which was one of the heaviest drinking countries in Europe.

00:16:45: And in fact, when they joined the EU, their tax structure had to change and consumption went really high.

00:16:50: And they realized it got a problem.

00:16:52: And they have implemented several public health measures, all the common sense measures that WHO has been supporting for many years and talking about for many years and miraculously.

00:17:04: I'll call some just follow.

00:17:05: significantly and there has been an associated reduction in a number of parameters.

00:17:10: one of them is attendances at the emergency department cardiac events events related to the event of drinking.

00:17:17: you know people dying from suicide and accidents road traffic collisions and the like.

00:17:22: so.

00:17:23: Literally is a great example to me of country that's done fantastically well at reducing alcohol consumption in an evidence-based way.

00:17:30: Before I pass out the country, because I know she's going to want to talk about that, people, if you listen to the alcohol industry, people often who are in various industries in these countries, they'll say, alcohol is part of our culture.

00:17:41: It's an important part of how we are, of who we are.

00:17:44: Actually, there's a grain of truth in that.

00:17:47: But that's not what sells alcohol.

00:17:49: What sells alcohol is advertising and marketing.

00:17:51: You know, these countries have seen huge increases in over decades, over generations in alcohol consumption, not because their culture has changed, but because the availability, the affordability and the advertising of alcohol have all driven that.

00:18:04: i'll pass on to kathleen.

00:18:05: i think i'm sure she's got some comment.

00:18:06: yeah so i have some numbers uh that i can share with the audience.

00:18:11: so um in terms of of run numbers so when we are looking at the alcohol per capita consumption across the EU so Sorry, I don't have Norwegian data, but I have Swedish one, which are close enough.

00:18:24: So for the EU, the average alcohol consumption is eleven liters per year.

00:18:31: And how much does that represent?

00:18:33: Because here we're talking about pure alcohol.

00:18:35: Well, that would be thirty-seven bottles of spirits or one hundred twenty-two bottles of wine.

00:18:42: or six hundred sixty seven cans of beers in average.

00:18:46: This is what eleven liters of alcohol represent.

00:18:50: Now of course that's an average and what we see across the EU is that the country with the lowest per capita consumption is Greece at seven point one liter and the highest one is Romania at seventeen liters at the moment.

00:19:06: And that to me is so interesting to see also because just last week I was at the European Society of Immersion emergency medicine congress and we had a boot over there and emergency doctors would stop by and I would ask them in their view you know in their practice which proportions of emergency department admissions were related to alcohol?

00:19:27: and the numbers I got varied between thirty percent and eighty percent and not surprisingly the person who gave me an eighty percent was from Romania.

00:19:37: And, you know, we see that here with seventeen leaders.

00:19:41: What's interesting, as Frank was saying also, is that when we are at WHO, we track this per capita consumption.

00:19:47: We track it over time.

00:19:49: And what we've been paying A lot of attention to present it as an example is those countries who have been able to decrease by more than ten percent the alcohol per capita consumption over the last years.

00:20:05: And Lithuania is one of those countries with, unfortunately, you know, had won the gold medal of the country with the highest per capita consumption.

00:20:15: But now with implementing Smart policies have been able to show right away some results in decreasing.

00:20:26: What you say is so true.

00:20:28: This is not only a health issue.

00:20:31: It's also a cultural issue.

00:20:32: It's also a battle against myths.

00:20:35: You were talking about France, France in Norway and in Scandinavian countries.

00:20:39: We long ago, in a long time, talked about the French paradox.

00:20:44: that the French, they lived so long and so healthy even though they drank wine and that even misled us to adopt the same drinking pattern in our country.

00:20:53: So we would see Norwegians drinking in the week as well as in the weekends, combining the worst of the worst.

00:21:00: I mean, regular alcohol consumption on the work.

00:21:04: And then days, and then combining that with binge drinking in the weekends.

00:21:07: And Norwegian doctors have been complaining a lot about that.

00:21:10: So that was a so-called French paradox.

00:21:12: And we know that the French paradox is not the paradox it seems.

00:21:15: It has to do with other factors such as diet.

00:21:18: And they have definitely decreased their alcohol consumption.

00:21:22: Catherine and Frank, we have to see that wine is often associated with a good life, celavi.

00:21:30: And as you say, there are religious myths and so on, but there are also a lot of myths about alcohol itself.

00:21:38: Probably you've heard that wine is more healthy than spirits, that you have to have a good glass of wine in order to enjoy a good meal and so on.

00:21:50: What do you think about?

00:21:51: And how do you combat, for instance, a method that is better to drink a little every day than to binge drink?

00:21:59: Is that true?

00:22:00: Are there any comments on that?

00:22:01: Yeah, let me jump on that one first.

00:22:02: There's

00:22:02: a paper that I love that was written a while ago.

00:22:03: I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it was, I think it.

00:22:17: And it's this idea that people can take a drink of wine every day.

00:22:22: And, you know, just go on their life with having seven drinks per week.

00:22:27: When we look at data, that daily light drinker does not exist.

00:22:33: And there's a very good reason to that, because the main reason why people drink, it's because, you know, it gives them that little... tipsy feeling, you know, of reducing stress and calming you and feeling better and more talkative and so on and so on.

00:22:52: But alcohol is also a drug for which tolerance builds so quickly and so fast.

00:22:58: And so what happens when you start drinking one glass every day is that arrives Friday and Saturday and you would like to have that tipsy feeling that you associate with the weekend.

00:23:12: Well, then

00:23:13: you don't need a drink anymore.

00:23:14: then you need two or you need three to have that feeling.

00:23:18: And you build that tolerance.

00:23:19: And suddenly, you know, your daily drinking moves from one to two and your weekend increases and increases.

00:23:26: We did a study in Canada a few years ago.

00:23:29: I led one where we looked at that.

00:23:31: And I mean, the risk of someone getting intoxicated increased, I think it was, it's a while ago, I think it was a nineteen ninety four paper, sorry, a century ago, but it was a person's risk of getting drunk increased.

00:23:44: sevenfold if you know for each day that they were drinking during the week.

00:23:50: So there's really a myth first of all about the daily light drinker.

00:23:55: Then when it comes to whether you take beer or wine or spirits, quite frankly, I couldn't care less because on that the evidence is so clear.

00:24:02: I mean, it is the ethanol that causes harm.

00:24:06: It has nothing to do in which format or color or container that you disguise it.

00:24:12: ethanol is the carcinogen substance here.

00:24:16: It's the one that leads people to become more violent or more aggressive.

00:24:24: It is the ethanol that is causing all of that.

00:24:28: No, you cannot hide behind a bottle of wine to justify your drinking, that is for sure.

00:24:34: Frank, I'll pass it on to you then.

00:24:38: Thank you.

00:24:39: Alcohol is harmful no matter which way you get it and there's no safe level of alcohol consumption according to the WHO and I think they're entirely correct in relation to that.

00:24:48: Paradox of reduced, particularly ischemic heart disease associated with this low alcohol consumption, that benefit is overwhelmed by the harmful effects of alcohol in terms of cancer and incidents and accidents so that there is no benefit.

00:25:03: There is no beneficial effect, health beneficial effect of consuming alcohol.

00:25:07: People should not, in my view, drink for the benefit of their health and that people should be aware that even at low levels, alcohol consumption is harmful.

00:25:18: Now, it's worth making a comment.

00:25:20: You asked about different drinks.

00:25:21: I mean, the alcohol industry has been furiously developing products to appeal to different age groups.

00:25:28: So they make drinks that are sweeter for younger people.

00:25:30: They make all kinds of other drinks.

00:25:32: Spirits, in my view, have the harm or extra harm of.

00:25:36: you can drink an awful lot, consume an awful lot of alcohol very quickly with spirits.

00:25:40: So that's a next.

00:25:42: harm from it and I think keeping away from substantial amounts of spirits is a very good idea.

00:25:48: If you were to ask me what I think about how we should consume alcohol, I'm not in favor of prohibition or trying to eliminate alcohol, but I am in favor of us all trying to reduce our alcohol consumption and in changing it from being what you were outlining there, Jana, a daily occurrence, you know, by drinking every day to make it a treat.

00:26:07: Occasionally we consume alcohol as a treat because we know how harmful and how dangerous it is.

00:26:12: I would argue that we should think a bit of a little bit like driving or using using the road.

00:26:17: So we know the tobacco is quite different.

00:26:19: Everybody wants to get rid of tobacco.

00:26:20: There's no upside to tobacco.

00:26:22: But we want to continue to consume alcohol in small quantities, I'd argue.

00:26:26: And we want to continue to use the road.

00:26:28: So we've lots of.

00:26:28: we've lots of conditions, you know, we've lots of restrictions on how we behave on the road.

00:26:33: Speed limits, traffic lights, motorways, all kinds of things are put in place.

00:26:37: Seat belts.

00:26:38: to reduce our harms from using the world.

00:26:41: And I think likewise, we need to put in place evidence-based measures to reduce our harms with using alcohol.

00:26:47: And if I can make a final point that I see in my clinical practice a lot, because I see a lot of patients who drink very harmfully and have had harms from alcohol.

00:26:55: And when I see patients who drink a lot of alcohol and I ask them to cut down or cut out, and they come back, those who've cut out, I'd regularly ask them, how do they feel now?

00:27:04: How is their life now compared to when they consumed alcohol?

00:27:08: And nineteen out of twenty tell me they feel much better overall.

00:27:12: They sleep better, less anxious, less depressed.

00:27:16: And I'd also, I think, people around them are happier.

00:27:21: They're easier to live with because they're not consuming alcohol.

00:27:24: So besides the health benefits of alcohol, there are huge quality of life benefits for the person who's consuming heavily and for the people around them.

00:27:34: I'd like to follow it.

00:27:36: To follow up on that, the audience here is likely to be physicians and clinicians that see patient in their office.

00:27:44: And regarding that myth of a drink a day keeps the doctor away.

00:27:49: You know, that myth is associated with a so-called protective effect for cardiovascular disease.

00:27:57: But one thing that people need to be reminded all the time is that when you take a class of alcohol, you cannot directed to the organ of your choice.

00:28:08: That is absolutely impossible.

00:28:10: So once when someone is telling me... or I drink from my heart, or really, and you're able to make sure that it avoids your breast and that you don't develop breast cancer, and you're sure that you're able to avoid it impacting your brain and so on, it's not possible.

00:28:27: So I'm always very critical of this approach of talking about alcohol in terms of specific disease also.

00:28:34: We should not lose sight of the bigger picture that it is health and well-being in general that we are talking.

00:28:40: And speaking of that well-being, to comment on Frank's last part about patients doing better.

00:28:48: You know, when WHO and other public health organizations have started to relay that message, that less is better, a lot of people are upset about it.

00:28:58: Oh, here you are with the bad news again, you know, and we cannot do anything anymore, and you're taking the fun away from us.

00:29:05: I see no, you know what?

00:29:06: This message at Lessons Better is actually a very good news because what we're telling you is that if you're looking to feel better, sleep better, have more energy, be more patient,

00:29:20: we have a very

00:29:21: quick fix for you.

00:29:23: just reduce your alcohol use and immediately you're going to be feeling all of these things and feeling better.

00:29:30: So the message that we have is a bloody good news, you know?

00:29:34: It really

00:29:35: is.

00:29:36: And it's instant.

00:29:38: And it's also instant for government.

00:29:40: And I'm going back to what we talked at the beginning, but it's the same thing with policy.

00:29:44: And this is what we've seen in Lithuania.

00:29:46: You know, government saying, well, I don't want to implement alcohol policies because I'm not going to be reelected, you know, and people are just going to see that I'm taking away stuff from them.

00:29:55: But actually what we've been seeing in Lithuania is that almost instantly after introducing a policy, the benefits were seen in society.

00:30:05: It didn't take a whole political cycle.

00:30:07: It was a matter of months before we started seeing reduced number of people entering the emergency rooms, that there were less cases of cardiovascular disease being admitted to the hospital on a Monday after they decided to reduce the number of hours of cell of alcohol during the weekend.

00:30:27: And right now, the Lithuanian are feeling rather positive about the whole alcohol policy.

00:30:34: There's a good news for built individuals and government with this message that less is better.

00:30:41: Less is better.

00:30:42: That's a very good clue actually.

00:30:44: And I like your analogy, Frank, about the road.

00:30:48: I think that's a good one, because abolition is... not probably a good strategy.

00:30:54: because you say Catherine and you are quite right that there are so much opposition.

00:31:00: People come in here telling you what to do and so on.

00:31:03: Less is better is good.

00:31:04: I usually use the term that alcohol is like potato chips.

00:31:09: We all know that potato chips is not good for you.

00:31:12: You shouldn't do that on a regular basis.

00:31:14: But to share with friends on very special occasions, like Manchester United playing Leeds or whatever, might be... good thing for you also socially, but that is cherish those few moments.

00:31:27: That is what I think is a good approach and what you definitely also say.

00:31:33: But there are groups that should not be exposed to alcohol at anytime.

00:31:41: And for instance pregnant women and as a neurologist and also being concerned about the young brain, the time of our lives when our brains are evolving very quickly and when the juvenile brain is very vulnerable.

00:31:57: We also know that if you are introduced at an early age for alcohol, the chance of becoming addicted is so much higher than if you can postpone the debut.

00:32:07: So, Catherine.

00:32:09: a little challenge to you.

00:32:10: How could the WHO

00:32:12: help

00:32:13: us, I say physicians, but also to the listeners who are working in different fields of the society to make sure that these groups are protected and that the information seeps through, that pregnant women should not drink, that young people should avoid getting in contact with alcohol as long as possible and so on.

00:32:39: So one way that we've been doing that recently with a lot of success, and again, that's part of this big trend that we receive from the European Commission, the evid action trend, you know, transforming evidence into action.

00:32:51: We knew that public communication was important and we wanted to do something about it, but we wanted to do it in an innovative way.

00:32:59: And I'm not the communication officer and my colleague, Alexandra, could give you all sorts of details about this, but here's... what I want to share with all of you is that we've been taking a different approach where instead of telling people what to do and what are the guidelines, we launched this campaign called Redefine Alcohol and where we are leading people to think differently about alcohol to reflect upon it in line with what I said previously of People sharing their happy stories related to reducing alcohol.

00:33:36: We've been working.

00:33:37: We are working as I'm speaking two floors below me.

00:33:41: It's a big communication Congress right now with influencers.

00:33:46: We've been working a lot with influencers.

00:33:48: There's there's a big sober curious movement and those cool and young people and sharing all of the benefits of not drinking.

00:34:00: and Because what we know also is that very often, you know, we live in this Alkogenic culture where we were led to believe that you cannot have fun without alcohol, but very often all you need is to experience a sober moment, experience a moment where you don't drink and where, my goodness.

00:34:22: you do have fun, you know, and building from that.

00:34:26: So we are really trying to use, you know, we said there's a lot of the alcohol industry has definitely tapped social media in terms of advertising and marketing, but we're also trying to do it and use the influencer movement to our advantage.

00:34:43: This is the approach, I'm personalizing here, the approach that WHO has been taking now of allowing people to reading their views about alcohol and giving them some chance of experiencing a more sober life.

00:35:03: and again that does not necessarily mean abstinence.

00:35:07: it means.

00:35:08: reducing.

00:35:08: It means alternating between alcoholic drinks and mocktails when you're at an event.

00:35:15: It's choosing one day of the week or two days and moving up with the number of days of the week that you decide not to drink.

00:35:22: Key things, really following up with what you've both been saying.

00:35:25: I mean, we know what the steps are that are effective to reduce per capita alcohol consumption, average consumption in a country.

00:35:32: And they're really the three A's.

00:35:34: Affordability, in other words, price.

00:35:37: Advertising and marketing.

00:35:39: and availability.

00:35:40: And you know, tapping into the measures around those three are incredibly effective.

00:35:44: There's a huge body of evidence.

00:35:46: Evidence-based practice would suggest that we should go down those tracks to reduce availability, to reduce affordability by increasing cost, and to reduce and control advertising and marketing, particularly to younger people.

00:36:00: As both of you have said already, the harm to the developing brain is key.

00:36:05: And you know, the alcohol industry, it's worth calling it out.

00:36:08: The alcohol industry is our opponent in relation to this.

00:36:11: It's a David and Goliath battle.

00:36:13: They're an absolutely huge powerful and well-funded industry, and we're very small economically in comparison.

00:36:19: But what we have on our side is that when we articulate what the problems are and the solutions are, we don't have conflict of interest.

00:36:26: And as people involved in healthcare, we've got credibility.

00:36:30: But what we haven't done is made our voices.

00:36:33: heard to leverage that credibility and that lack of conflict of interest.

00:36:38: And I think that's what we're trying to do in the Alliance.

00:36:40: That's what are the association between the various organizations, medical organizations and WHO is trying to do.

00:36:48: And it's funny, you know, when you think about price, like in Ireland, we've introduced minimum unit price, but still alcohol is quite inexpensive.

00:36:55: And I saw a patient this week who drinks a bottle of wine a day.

00:36:59: And I was saying to him, you know, that's so harmful and where do you buy it?

00:37:02: And and taking, taking steps because in fact I think the first thing to do if you want to reduce your alcohol consumption is to reduce your purchasing.

00:37:09: You know, if you don't buy it, you can't drink it.

00:37:11: So I was saying to him, you know, would you think about, you know, he was saying he buys it when it goes to the supermarket with their, himself and his wife with their weekly shop.

00:37:20: And he was saying, you know, he said, it's so inexpensive.

00:37:22: It's so cheap to buy a bottle of wine.

00:37:24: And that's it.

00:37:25: It's everywhere.

00:37:26: Everywhere sells wide at Ireland, you know, all the petrol stations, all the small shops, all the medium-sized shops, all the big shops.

00:37:33: It's everywhere.

00:37:34: It's availability is excessive.

00:37:37: And it's cheap relative to what people earn.

00:37:40: If it costs three times the amount or twice, the amount of fifty percent more, people would spend less.

00:37:46: So, and the interesting thing to get back to what Catherine said at the start.

00:37:49: Catherine said alcohol is unaffordable in society.

00:37:54: WHO have calculated that Two and a half percent of GDP in high income countries, such as the ones that we're all from here, my goodness.

00:38:02: Two and a half percent of the GDP is spent on dealing with the downstream harmful consequence of alcohol.

00:38:08: That's an astonishing sum of money.

00:38:10: And in no countries are the alcohol industry paying that contribution in terms of excise duty or taxes or the economic benefits that they may have to society.

00:38:21: So we need to think about bringing the alcohol industry bringing them to account for the harms that they're doing.

00:38:29: Because what they're doing, they're selling a myth, and we're seeing the lie of that myth as we work in hospitals, as you see patients with harm from alcohol and neurology, as we see in liver disease, as cardiologists see, and the emergency medicine, doctor see, and the psychiatrists and all those.

00:38:45: So, you know, and that's without talking about the dreadful social costs and justice costs and all those dreadful things that happen as a consequence of alcohol.

00:38:54: So, you know, I would argue that we need to be really pushing together.

00:38:59: And we're delighted that your Society, the European Association of Neurologies has joined the Alliance.

00:39:05: I think it's really, really important.

00:39:07: And it's important that we hear the voice of neurologists describing the harms that you see from alcohol, as well as the liver doctors and the cancer doctors and so on and so forth.

00:39:17: That's

00:39:18: true.

00:39:19: Time is running.

00:39:20: But these very good words, I just wanted to say... to ask you one thing, because there will be listeners here who think, okay, maybe I should do something about my alcohol consumption.

00:39:30: And if somebody of you ask that question to yourself, we have already had some success with this podcast, I think.

00:39:38: But give us some practical advice.

00:39:41: What should a person do if she or he is sitting there and thinking, maybe I should do something about it, or maybe I should talk to my wife or to my husband or to my children.

00:39:53: Why January?

00:39:54: Is that a good thing?

00:39:56: Is it a good thing to look at the more weekly consumption?

00:40:00: Frank, what do you advise your patients when they come?

00:40:03: Or what do you advise your relations to do?

00:40:07: Oh, my friends, yeah.

00:40:10: Can

00:40:10: I start over here?

00:40:12: I want to put my Canadian hat and my hat of the Co-Chair develop Canada's guidance on alcohol and health.

00:40:19: You know, most countries who develop drinking guidelines usually come up with a numerical limit.

00:40:24: You know, do not drink more than this or that per day or per week and so on.

00:40:29: And they set up like this, yeah, this quantitative limit.

00:40:32: And when we developed the most recent guidelines in Canada in twenty twenty three, I think we took a very innovative approach, which was definitely influenced by, you know, those guidelines were developed during COVID.

00:40:46: Everyone was exposed to all of those red lights and yellow lights and green lights and so on.

00:40:51: And so we decided to develop a continuum of risk.

00:40:55: And what we did is that through all sorts of modeling analysis and so on.

00:41:00: And I will not go into the details of that.

00:41:02: But we came with this continuum of risk where we've been able to say to people, less is better.

00:41:07: That is definitely the key.

00:41:09: Less is better.

00:41:10: And if you take two drinks or less per week, your risk of harm, is low.

00:41:17: Your chance of premature death is one in a thousand.

00:41:21: If you take between two and six drinks per week, your risk of premature death increases.

00:41:28: And at six drinks, you hit the mark of one in a hundred chance of premature death.

00:41:34: And after six drinks per week, the risk increases exponentially.

00:41:40: really disrisk curves indicates, really illustrate the less is better.

00:41:45: And with that comes the message that any reduction in alcohol use will be beneficial.

00:41:52: So my message to people, if anyone listening is like, okay, maybe I should reduce,

00:41:57: create

00:41:58: and start small.

00:41:59: Just, you know, you're taking eight drinks per week and you're thinking about going down.

00:42:05: let's start by seven and see how you feel and six and go on like that.

00:42:10: and what is pretty cool.

00:42:11: so discontinuum of risk is that

00:42:14: the

00:42:14: heaviest drinkers because it's exponential the heaviest drinkers is the one that are going to see the greatest benefit in reducing.

00:42:22: so you know Many people like Frank's have clients that are up at forty and fifty drinks per week.

00:42:27: Well, if they go down from fifty to forty, that's wonderful.

00:42:31: Let's start there.

00:42:32: Let's see that and see how they feel.

00:42:34: As Frank mentioned, they're probably going to see a lot of benefits and then you bring them down a little bit.

00:42:39: I think like physicians have been doing for years with tobacco, you know, where people were taking two packs a week and you were trying to get them down to one pack per week and so on.

00:42:48: So it's about those little changes.

00:42:51: Less is better.

00:42:52: Any reduction will be beneficial.

00:42:54: So you do not need to aim for two drinks per week right away.

00:42:58: Go step by step.

00:43:00: Just reduce.

00:43:01: Just consider reducing.

00:43:04: Step by step.

00:43:04: That's a very good position, Catherine.

00:43:07: And from you, Frank, finally.

00:43:10: I agree with you and I think the Canadian guidelines are the best guidelines actually in terms of alcohol consumption and I recommend people to look at them and there's a very good infographic with them.

00:43:18: that is, I think, very enlightening and I think I encourage patients to look at it.

00:43:23: I think that it's a great idea to cut down alcohol.

00:43:25: If people are drinking very heavily, I would take a slightly different view.

00:43:28: I'd say, you know, people are in terrible trouble.

00:43:30: First of all, there are certain categories of people who shouldn't drink, people who are pregnant or thinking of getting.

00:43:35: uh pregnant people have got other significant illness and people with advanced liver disease in fact or any significant liver disease should not consume alcohol at all.

00:43:43: It's from a health point of view and I agree with Catherine exactly about about.

00:43:48: About reducing.

00:43:48: if people drinking really heavily i would suggest them that they don't stop drinking straight away because of the risk of getting delirium treatments or the dts or withdrawal syndrome and i would suggest that they cut down maybe every three or four days by substantial amount to try and get it down to a decent level.

00:44:04: You know a less harmful level and also we would encourage them to take time to protect their brain.

00:44:09: to get back to yourselves again and i. do say, I say to patients too, that when I see patients, I say, if you reduce your alcohol consumption, I guarantee you feel better at nineteen times out of ten.

00:44:20: And that's absolutely correct.

00:44:21: And I go back to what I said earlier on, a lot of people say the first thing to do if you're drinking heavily is to realize you've got a problem.

00:44:27: And that may be true, actually.

00:44:30: But I think the first thing to do if you want to reduce your alcohol consumption is to reduce your buying.

00:44:34: You know, buying it is where is the real issue.

00:44:38: So reduce your purchasing of alcohol.

00:44:41: So think about it in the supermarket or the store where you buy it.

00:44:45: And if I may add, giving the audience that you're speaking to, when it comes to young people, to teenagers, I think the message here is delay, delay, delay, delay as much as you can.

00:44:59: And, you know, I hold a PhD in sociology, so I'm not going to masquerade myself as a neurologist here today, but What I do know, and I think we can all relate to that, we remember our heartbreak so vividly.

00:45:15: And we remember by heart all the lyrics of those songs we loved when we were fourteen, fifteen years old.

00:45:21: And today, you know, I probably won't even remember this conversation in two hours.

00:45:27: But what I heard when I was fourteen, fifteen, sixteen, oh my goodness, I remember forever.

00:45:34: And it's because of the plasticity of the brain at that age, you know, of the developing brain.

00:45:39: And the same thing goes for alcohol.

00:45:41: If you start using alcohol during those defining years, we have all the data that shows that, you know, when you do use alcohol at that age, your risk of.

00:45:54: experienced harms later in life or developing alcohol use disorder increases as well.

00:45:59: because these are defining moments, you know, when you create those paths in your brain that you will want to use again and again.

00:46:06: So delay, delay, delay as much as you can would be my message to young people.

00:46:14: I couldn't agree more.

00:46:16: Well, people do sum it up.

00:46:17: This was a very nice session.

00:46:19: I learned a lot.

00:46:21: very many interesting reflections and interesting figures.

00:46:25: I'm going to take them with me and I think the listeners had an interesting time too.

00:46:29: To sum it up, we learned that less is better, but that for some groups such as pregnant women and for young people, no is better, that you should try to avoid getting in contact with alcohol when you are young as much as possible and to sort of delay the debut.

00:46:49: We also learned that availability, the three A's that you were saying, Frank, are important for our consumption.

00:46:57: And it's like the potato chips.

00:47:00: If you don't buy it, then you don't have it in your cupboard, then you don't eat it.

00:47:05: You don't sit in front of the telly and then go to the shop to get chocolate.

00:47:10: If you don't have the chocolate in the house, if you don't have the wine or the beer, then you don't drink it.

00:47:14: Availability is a keyword here.

00:47:17: as is the price, and that can also be targeted in a more structural way by governments and also on an EU level.

00:47:25: We have also learned that the myths about alcohol are myths, and they are also mainly created by people who are interested in selling us alcohol, so they shouldn't be taken too seriously, as also Catherine reflected upon.

00:47:42: And finally, that this is something we all could do something about that would make our brain health better, but also the general health in general, the public health and also for our bodies without the brain.

00:47:58: So both for the brain, the rest of the body, including the limb.

00:48:02: Yes, alcohol is good for you.

00:48:05: Any final remarks from you?

00:48:07: Did I get that right?

00:48:10: Yes.

00:48:10: Thank you very much.

00:48:13: Thank you very much.

00:48:15: Thank you very much for inviting us.

00:48:18: I was so much fun.

00:48:19: I learned a lot and people do what they say, less is better

00:48:25: and

00:48:26: think about it every week, but also consider that October and January are good months for doing something about it.

00:48:36: Thank you very much for being here and thank you again.

00:48:41: to our listeners also for joining us on the Brain Health Mission podcast.

00:48:45: And if you enjoyed this episode, please follow us on your preferred podcast platform.

00:48:51: Share it with your network.

00:48:52: Stay tuned for more conversations on brain health.

00:48:55: Would you say something, Frank, before we close

00:48:59: up?

00:49:01: Yes, I think two things.

00:49:02: The first is that I think we should all reflect on how much alcohol we consume and all of us, I think, should reduce our alcohol consumption to a level that's really guided by those Canadian guidelines.

00:49:13: I think that's really important.

00:49:14: And the second I'd call on clinicians particularly and everybody listening to this to advocate for.

00:49:21: by public health measures for health measures at a national level to reduce alcohol harms.

00:49:25: They're incredibly inexpensive to implement and very effective and evidence-based.

00:49:32: Thank you very much and goodbye.

00:49:39: You've been listening to the Brain Health Mission podcast where science meets action for a healthier brain.

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00:49:51: For more tools, tips and expert insights, head to brainhealthmission.org.

00:49:55: That's brainhealthmission.org.

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00:50:02: Until next time, take care of your brain.

00:50:05: It's the only one you've got.