Qualy #1 - What are Peter's thoughts on alcohol consumption and health?

**Peter Attia** (0:05)
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**SPEAKER_2** (1:05)
Alcohol, thoughts on consumption of alcohol. It's a little generic.

**Peter Attia** (1:09)
Okay, so I put this into a couple of categories. The first is just a purely physiologic, what is the effect of the molecule ethanol on the body? And just as I sort of talk about sugar or other things, it's really important to understand that ethanol is a toxin, but of course the dose makes the poison. Now, the thing that I think many people forget who are not in the world of toxicology is that there is a probability distribution that drives the impact of a toxin on a population. And there are gonna be some people at one end of the spectrum who are largely unimpacted by certain toxins, and there are gonna be others who are not.
So ethanol is no exception to that, just as Tylenol or pick your favorite poison could be. So, again, Tylenol meaning like, even though it's at low doses, very efficacious as an analgesic, at high enough doses, it's hepatotoxic. So start with position one. I'm not convinced that there is a single benefit to ethanol, the molecule, in the human body. So ethanol in its metabolic pathway and it's uniquely metabolized by the liver, one of the byproducts is something called aldehyde, which is a toxin. It really has two, and this is a bit of an oversimplification, but it has two effects. There's an effect on the liver and then there's an effect on the brain. The effect on the brain is what people drink alcohol for. It's the buzz. It's the CNS depression that also comes with some euphoria. So it's a bit of a paradox there because ethanol, its effect in the CNS is that of a GABA agonist, and GABA of course is a non-excitatory or depressing neurotransmitter. But I think as most people will understand, certainly ethanol can have an excitatory effect. So you've got this brain effect of alcohol, you've got this liver effect. The liver effect is very similar to that of sugar or fructose. They have very similar metabolic pathways, not identical, but also not surprising that they overlap given that fructose is fermented to make ethanol.
So from that standpoint, no benefit to ethanol, but again, different people tolerated to different amounts. As a general rule, each beverage, and I'm not talking the kind you pour yourself where they're a little longer, a little taller, but an ounce of distilled spirits is about 15 grams of ethanol. An appropriate maybe four ounce glass of wine is also about 15 grams of ethanol, as is a beer, kind of like 10 ounces, 12 ounces, again, depending on the alcohol content. So as a general rule of thumb, each drink is about 15 grams of ethanol.
One of the things, if a patient asks me this question that I'm thinking is, well, what's your liver function right now? And the best proxy we have for that is the ALT, one of the transaminases. And so when I see a patient that's walking around with an ALT that's already at the upper limit of what we consider normal by range today, which I do not consider normal, which is probably 42 on our lab, I consider below 20 normal. I'm always asking the question, do they have fatty liver right now? And if they do, is it more in response to ethanol or is it more in response to fructose?
That said, I have at least two patients that I've taken care of, either in the past or currently, who consume seemingly unbelievable quantities of ethanol, some of them averaging between eight and 12 drinks a day.