Ep. 35 - LiveWell Talk On...Alcohol
Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital
Guest: Matt Rocca, ACADC, program manager, St. Luke's Chemical Dependency, and Mary Beth Peiffer, RD, CSO, LD, CDE, oncology dietitian, Helen G. Nassif Community Cancer Center
Dr. Arnold: This is LiveWell Talk On…Alcohol. I'm Dr. Dustin Arnold, chief medical officer at Unity Point Health-St. Luke's Hospital. Alcohol is a significant part of our culture. From a glass of champagne and a toast, to grabbing a beer with friends after work. It can be very positive in social settings, but for some people, one consumed in excess can lead to a disability and disease. To discuss this today with me is Matt Rocca, program manager at St. Luke's Chemical Dependency and Mary Beth Peiffer oncology dietician at Helen G. Nassif Community Cancer Center, welcome. I mean alcohol is a big part of our culture. Going back to antiquity, I mean this is nothing that's new and it's there. We tried as a society to prohibit it. That didn't work out very well. And so we need to be aware of the risks and the benefits. Alcohol, obviously there's the dependency. Some people can drink and not have any problems and moderation is not a big deal. Others aren't as fortunate and can lead to significant disability. I'd like to cover both the disability from that as well as some of the nutritional aspects of it as well and some of the other comorbid conditions that we see with alcohol. Matt, I'll start with you. What is moderation when it comes to alcohol consumption?
Matt Rocca: Sure. Moderation is a concept that we hear about and as you identify, there's certainly individuals that are more capable. Maybe don't have a family history or background of addiction and are able to consume alcohol in smaller amounts where there isn't any problems. Certainly by the time to get to walking in the door and an office like ours, something has happened. So those are the individuals that we certainly give a little bit more attention to and try to figure out and understand and help. Are the ones that it's gone beyond being able to demonstrate to themselves and to family members that it's not causing problems. It's very common for individuals to really get focused on amounts, whereas we try to focus on problems. So the amounts really can vary for some people though it can work. But once those problems do start to show up, that's where we're hoping we might be able to make some contact with them.
Dr. Arnold: In that same line, Mary Beth let's say. I'm consuming alcohol in excess or moderation, quotation marks, but I'm not having problems. I don't have any disruption in my life. What's considered moderation from a dietary standpoint?
Mary Beth Peiffer: Well, from a dietary standpoint, moderation recommendations from the American Cancer Society are two drinks a day for men and one for women. And a 12 ounce beer is considered one serving, a one and a half ounce alcohol shot, I guess you would call it, is equivalent to one serving. And wine, it's about five ounces, is considered a serving. And kind of where we see nutritional problems is those calories that people get from alcohol replace something else nutritionally. That they really need like protein or a variety of other nutrients so the risk for malnutrition is pretty high for those people that do drink in excess.
Dr. Arnold: And that's where we get the term empty calories, that there's really no nutritional benefit. You know, it's funny you say that once a day, one drink a day. I've seen many patients over the years and you'll say how much do you drink? I have one drink a day. Okay. Well during my residency, Tonya and I lived in this building with all of these retired women and we would meet them Sunday afternoons in someone's apartment for beverages and they would have a tumbler that was 16 ounces and I was just thinking myself all the time. Yeah I bet they tell their doctor, "Oh, I have one a day". So it's good to put that quantitate, that amount on there and understand that five ounces is not a lot.
Mary Beth Peiffer: No, it's not. And the supersize containers that alcohol comes in these days, you know, I don't even know all the names for some of them that can it be equivalent to seven to 11 drinks. So I think it was the boxes of wine that go in the refrigerator. It's 33 servings of the five ounces. And I thought, wow! And I think awareness is the first step in understanding. Alcohol for some people, moderation works. But for other people and what we're finding with cancer prevention that, there's a definite link even for occasional alcohol use, increasing cancer risk in seven different types of cancer. Primarily the digestive system from the head I'm down to the colon and with women breast cancer.
Dr. Arnold: Now, is there a difference between hard alcohol liquor as opposed to beer or is it a risk of all of them?
Mary Beth Peiffer: It's the amount of alcohol per drink and I think it's 10 milliliters of alcohol is considered an average drink. So that's what all three of those things I mentioned earlier all have. In terms of alcohol content.
Dr. Arnold: Matt, do you see with chemical dependency, do you see a lot of people with health problems from alcohol? You know, I don't know if my patient sampling is biased because the ones that are in the hospital obviously have liver problems and pain concerns. So to me, I think every person has that problem, but what do you see?
Matt Rocca: Yeah. So absolutely the health problems we'll see will be the only mental health issues that we deal with but the physical health issues. A lot of times really do center on nutritional habits. So even with our moderate severe cases in the outpatient setting, the nutritional choices and decisions that they make lessen or worsen that we'll see that commonly with alcohol. Then the more severe cases, the ones that we are coming up to see the hospital in, they've gotten to the point where, as you're familiar with, they're replacing their meals with alcohol over long periods of time. So if you're doing that as you know, for two weeks or two months now we're talking about the body needs nutrients and fluids to rehydrate and that gets real serious because those are admissions. What were coming up in, those are very serious. So we seem kind of at two different levels with the relationship that the negative influence that alcohol can have on nutrition. An outpatient setting, still serious. But even more so on those inpatient patients we see.
Dr. Arnold: Do you see the age of people drinking more now than they'd perhaps in the past in your specialties?
Matt Rocca: I mean, I know that like the state of Iowa certainly collects that kind of data. For the patients that we see, we serve adults only. But we know that there's some data out there that certainly supports that not only with other substances but with alcohol, that there's more kids that are experimenting, there's more kids that are coming to that conclusion that it's less risky than maybe it used to be or what I was told. So I would think that there's probably some good data out there that supports there's more going on.
Dr. Arnold: Much like vaping. I just don't think it's a good idea to push these flavored seltzer alcoholic beverages. And flavored beers, etc. etc., because you're just making it more palatable, perhaps to younger, younger people. Is there an age where I should quit drinking alcohol? I mean, do you recommend that later in life, Mary Beth, to stimulate appetite, etc. in cancer patients?
Mary Beth Peiffer: Yeah. When I was working in long-term care and we had older geriatric patients that had a problem with appetite, we sometimes did allow that and one of the requests that we got for recreation was a happy hour before the meals because of that. However, now that I'm working in oncology, I see that really any alcohol is probably not in the best interest of patients that are trying to prevent any significant disease, particularly cancer.
Dr. Arnold: So and falls in the elderly I imagine because I mean alcohol obviously impairs your balance. How long does it stay in your system, Matt, do you know?
Matt Rocca: Well and there's a lot of variables that can impact that. You know, with the length of time, you know, the law enforcement community really has to spend a lot of time, effort and energy trying to figure that sort of stuff out. But you know, certainly we're talking about male versus female. This same amounts, you know, are going to be metabolized differently and processed differently on a full stomach, on an empty stomach. So there's a number of different things that can influence that. So the average length, you know, I really couldn't tell you unless we're looking at real specific situation
Dr. Arnold: And I'm sure it's variable on people's metabolism. The amount of formic acid they can make, etc. etc., alcohol dehydrogenase or whatever it is that processes that in the liver. You mentioned the cancers; breast and gastrointestinal. What are some, you mentioned seven, what are some other ones that people should be wary of?
Mary Beth Peiffer: Obviously the liver cancer, which is where body processes alcohol. Any tissue in the body that is physically exposed to alcohol. And that's where I mentioned the head and neck. So mouth, we have a lot of head and neck cancers. When I first started in gynecology, we had about five head and neck patients at one time. We have 35 now and head and neck cancers is probably one of the worst cancers to have due to the treatment affects. And the good thing is it's very curable, but the bad thing is, it's a tough treatment. So it's liver, breast, I think I mentioned earlier, but colon, particularly in men, they're finding a higher relationship. And when we were talking about alcohol and nutrition that was talking about, the variability and men metabolize it more quickly than women. Due to the amount of muscle mass versus fat where women have more fat, it doesn't process it as quickly or efficiently. So for women, like I said, the breast cancer, colon cancer is another one. That we try to do our best to prevent that. The American Institute for Cancer Research recommends no alcohol at all, even small amounts. And that's a change from previous recommendations.
Dr. Arnold: Right. Because then you get it from the American Heart Association. The red wine and then, you know, which they actually find out it's probably the red grape. Which the Welch's people are obviously excited about. So it's actually they think it might be a tannin in the grape skin. And that's what the benefit is and it's not actually wine. But then people take that to drink the whole box of wine thinking they've just got extra, extra health prevention. And that's not the case. About liver cancer, that's kind of the classic internal medicine case. That it's the alcoholic that survived their alcoholism. It's been sober for 20 years. Really. Really. And then they present with liver cancer later in life. That's one that we've seen. And you always think about that when a recovered alcoholic or recovering alcoholic presents with a health problem later in life. Matt, back to the clientele that you and I deal with on this end of the spectrum or that end of the spectrum. I always say when an alcoholic shows up for medical care, look for something beyond their alcoholism because they wouldn't be there unless something was driving them there. You know, so look for the pneumonia, look for something else that might be going on. Don't just attribute it to their intoxication. I think you have to be vigilant about that.\
Matt Rocca: They can be very complex cases with a lot going on.
Dr. Arnold: You bet. We talked about the elderly population or preventing stuff. Matt, what's underage drinking? Obviously that doesn't sound like a good idea. So what are some problems that you see with that?
Matt Rocca: Well certainly anybody that presents to us with what we define as early onset is unfortunately a real indicator of there's probably going to be problems down the road. So we're talking with, we have an opportunity to speak with parents or with younger patients we'll see at the hospital. The longer that you can hold off on having any alcohol, the significantly greater chances you are to not have any problems at all with alcohol, the road in your life. So there's some good data out there that really supports that also. But then also, you know, that no different, we've talked about with any substance and some other substances specifically is when you're using them in that window of time where you're growing and maturing and developing the most, that is the riskiest time to be learning how to cope with issues by using substances. What it can impact on you even physically, which you know much better than I would. But that social component on using it as a coping skill when your mind and body are growing and developing the most during that five/six year window of time as an older teen and young adult. That's where we really see the risks and the problems start to show up and they can be prolonged over life with the earlier that you start, which is kind of common knowledge.
Dr. Arnold: My dad, who long passed away, but was a heavy drinker, he always would say "the bottle will not provide answers, but it makes the questions go away". And you know, that's so true that it really doesn't solve anything. It just delays the consequences of whatever is going on in your life. Mary Beth back to you from a nutritional standpoint or risk standpoint. Beer, wine, liquor, they're all risky. There's not a safe alcohol.
Mary Beth Peiffer: They're equivalent. Matt and I were talking a few minutes before we started about smoking and the impact of what a dangerous duo alcohol and smoking are. And this is what we've found in our work with cancer patients is that if they've got both of those things going on, your cancer risk increases almost seven fold by doing both of those things. So it's a pretty dramatic and like I said, I call it a dangerous duo. So you know, and we do have patients that totally quit drinking alcohol upon a cancer diagnosis. They are encouraged to totally see smoking and alcohol consumption and many do. And we of course always give them positive feedback that, you know, what a wonderful thing that is. But there are some people that the social aspects are so strong that their desire to stop is overwhelmed by the body.
Dr. Arnold: Well that's a good point to come back to Matt with. I mean we use the term recovering alcoholic and I think not from necessary that maybe someone that's a recovering alcoholic listening, but maybe people that might interact with them. That they should know that there's really not a safe amount of alcohol for that person to consume that they, well they're just going to be a glass of champagne at this toast or etc. etc. That they really should avoid that. And if they're a good friend, they'll take that into consideration prior to exposing them. Right. I mean you can't just...
Matt Rocca: Absolutely. The risks of having one drink for the alcoholic, you know, are tremendous compared to maybe the person sitting next to them that does not have that history at all or even a family history of it and can have that one drink and it totally, they react to it differently. You know, the common metaphor we use a lot of times is if you have an allergy to a bee sting when you're little, but you don't have a bee sting for 20 years, you're still allergic. If you still have a bee sting 20 down, you might have a reaction to that bee sting, which is similar to what we'll see with people.
Dr. Arnold: Well that's a great analogy, it really is. If we could give one, I'll let each in, we'll start with the Mary Beth. If you could give one thing that you could give advice to people about alcohol and what you see cancer and dietary, what would you tell them?
Mary Beth Peiffer: Well, I really have to say and encourage people not to drink at all if at all possible. And look for non-alcoholic substitutions. Things like crystal light teas particularly green tea we know has cancer fighting effects compared to even black tea. But looking for things that don't have the negative effects that come with alcohol. And that's why many groups recommendations is no alcohol at all if possible. And patients that come in often have B vitamin deficiencies. As you know, we do give them thiamine because we need to get that alcohol broken down. But we see malnutrition quite often if we have people that have been long-term drinkers and consistently drink.
Dr. Arnold: Yeah, severe malnutrition. A couple of years ago, oh it's been longer than that. I had a lady present with Wernicke-korsakoff. Of course with vitamin B deficiency to the point that, I mean she's still impaired but has recovered but still has disability from that, which is unfortunate because it's so preventable. You know a bowl breakfast cereal is going to replace most of those vitamins. Matt, how about, what advice would you give individuals regarding alcohol consumption?
Matt Rocca: Yup. We would say, you know, our message is always very clear. Nothing compares with the problems that alcohol has caused in our society. When you're looking at dollar amounts or health issues, like we're talking about today, you know, a lot of times we'll have people identify for the right reasons. Maybe if you want to look at tobacco and the problems that has caused. But for us, our message has always been the health problems that can be very situational or long-term. Associated with the developing a relationship with alcohol and using it can be very severe so we would encourage people to really think about that.
Dr. Arnold: And if, and if they do have trouble with that relationship, it's not a positive relationship. They should seek help shouldn't they?
Matt Rocca: Absolutely. We would say for a community our size, there's some great treatment options. You know, certainly we'd say, stop by and see us, have a conversation, talk with a counselor, and we could start that process with trying to determine how severe is the situation. And there's a number of different kinds of levels of severity, but we can help them walk through that.
Dr. Arnold: Yeah, absolutely. Why wait until rock bottom to get it right? You know you have a problem and listen to your loved one. It might be encouraging.
Matt Rocca: Sooner the better. Absolutely.
Dr. Arnold: Well, this is really great information. Thanks so much for taking the time to talk about this. Again, that was Matt Roca program manager at St. Luke's Chemical Dependency and Mary Beth Peiffer, oncology dietician at the Helen G. Nassif Community Cancer Center. If you have a topic you'd like to suggest for our TalkOn podcast, shoot us an email at firstname.lastname@example.org. We encourage you, tell your family, friends, neighbors, strangers about our podcast. Until next time, be well.