Updated 13th March 2023

Alcohol: Can it ever be healthy?

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    For many of us, it's a ritual to help us wind down after a long day, an excuse to catch up with friends, or a lubricant to an awkward social situation. Alcohol can be delicious, but our relationship with it is often complicated. 

    Good times with friends aren’t without sacrifice, and many of us feel the morning-after impact of a few too many drinks. For some people, alcohol can lead to addiction and even death. 

    What we want to know is, can alcohol ever be healthy? Is any amount of alcohol a sure path to an early grave, or could a glass of red wine be the best thing for your heart health?

    In this podcast, Jonathan speaks with Tim Spector — scientific co-founder at ZOE and one of the top 100 most cited scientists in the world — and Sarah Berry — one of the world's leading experts in human nutrition, with over 30 randomized human clinical trials to her name. Together, they take a good look at what the science says.

    If you want to uncover the right foods for your body, head to joinzoe.com/podcast and get 10% off your personalized nutrition program.


    Jonathan Wolf: [00:00:00] Welcome to ZOE science and nutrition, where world-leading scientists explain how their research can improve your health.

    For many of us, it's a ritual to help us wind down after a long day, an excuse to catch up with friends, or a lubricant to an awkward social situation. Alcohol can be delicious, but our relationship with it is often complicated. Good times with friends don't come for free. And many of us have felt the morning after impact of a few too many.

    For some people, alcohol can lead to addiction and even death. So is alcohol ever healthy? If you're like me, you're probably deeply confused. Is any amount of alcohol, a short path to an early grave, or a glass of red wine, the best thing for your heart health, you might have read both things in the same newspaper in the same week. In this episode, we look to the very latest science to find out answering questions [00:01:00] like which alcohol is best for your health, which drinks make you gain the most weight, and is alcohol killing off the good microbes in my gut, I'm joined by Tim Spector, my scientific co-founder at ZOE, and one of the top 100 most cited scientists in the world. And Dr. Sarah Berry, one of the world's leading experts in human nutrition with over 30 randomized human clinical trials to her name. 

    So I'm very excited to welcome you back to our podcast. Two of my very good friends. And since I know you both said, well, I can also say with some confidence that you're not just world-leading scientists, you can talk about our bodies and alcohol in the abstract, but I know that you both regularly like to do some personal experiments on the impact of wine at varying quantities. So there's plenty of personal expertise, Tim, your favorite tipple of choice. 

    Tim Spector: Wow. I have to say a beer, good quality red wine, really. And, my choice does vary. Depending on what I'm offered. An aged full-bodied red wine [00:02:00] a nice Barolo from Italy, a nice Chateau Margaux from, France, pre-wrapped from Spain. These are some of my favorites, but I like a drop of wine, and I also do drink other alcohols as well. So I try and keep my hand in all of them.

    Jonathan Wolf: That's good. Good to keep your hand in. And what's going on, Tim? When you're drinking red wine healthy or not healthy? 

    Tim Spector: Well, I've actually felt better about drinking red wine in the last 10 years. Since I discovered it has magic properties, make it different from most other alcohols in that it's still got a close connection with the fruit and the skin. of the grape because red wine, unlike a white one is left for a long time. The great skin is left in contact with the mixture. So all the good chemicals in the grape skin, which, mainly we're talking about polyphenols, which are this group of defense [00:03:00] chemicals used to be known as antioxidants. These leak into the liquid. And actually, then undergo the fermenting process of microbes multiplies. So you get over a hundred different types of polyphenol chemicals in your glass of wine, which we now know, we didn't know are actually very good for you. So it's starting to explain why red wine, these studies have consistently shown red wine to be different from other types of alcohol in terms of its health benefits, at least for the heart. And some people say that might explain the so-called French paradox. That was, I call about 30 years ago about why say the French had much fewer heart attacks and the Americans for three or four times fewer heart problems. , I think it's probably exaggerated to say it's all due to red wine, but that started this whole quest. As we discovered more about food and nutrition and really take a [00:04:00] scientific approach. We started to pick apart what it is in all these drinks. And it's these polyphenols, which are actually rocket fuel for your microbes. If you're drinking hundreds of days, polyphenols, despite the alcohol, regardless of the way of the alcohol, you're feeding your gut microbes further down the chain, and they're paying you back by helping your immune system and your heart and your metabolism in general. So I think that's, that's sort of what it is. The trick is to get the dose just right as always, that's something that we all struggle with. And of course, it's very individual. That's why this government approach across most countries saying there's a certain amount of units that men or women should have is all the same is always gonna be problematic because just like with food, your response to alcohol is highly personalized. And of course, some people can't drink it. 

    Jonathan Wolf: And tell us a bit about what's going on with the alcohol. So like in a sense, this is a great story, right? It's like as long as you've had [00:05:00] bacteria, fermented the grapes into wine, that's good. Then it wouldn't get in our guts. There are more bacteria. So it's even more good stuff that will sound great. Clearly, there's this other stuff going on with alcohol, which is, I guess what's balancing out the reason that you're not suggesting we should all drink a liter of red wine, every day. 

    Tim Spector: Yeah, that's right. The only reason we started to unpack this is that the studies have consistently said that people who drink a lot of alcohol are less healthy than people that drink a small amount of alcohol. And there's been some debate about teetotallers because they might be a strange group, but generally, there's been a curve that goes up with them, your health the more you drink, but consistently if had red wine showing reduced heart disease when you're drinking less than two glasses a day on average. So we think that alcohol on one hand is probably, in a large amount, it's definitely harmful to you, but it's small amounts. It might be okay. And that allows what else is in the drink to give you that benefit. So I think that [00:06:00] also sort of our current thinking of why we've got these rather confusing messages, but of course, what's really difficult is to work out what is the minimum amount you can drink? Get that right, for anyone person, whether it's a male or a female to be on your weight, your, whether you have Asian alcohol genes or you have European genes that they're better able to metabolize alcohol. And how does this relate to your gut microbes and how does it relate directly to your heart? And it's all starting to come into place now. So we did a study in my department a few years ago, where we looked at about five to 8,000 people across different countries in Europe and the US. And found that again, red wine was the only drink really that came out as being beneficial for your gut microbes. So all the others, the more alcohol you drank, actually the less healthy or gut health was looking like. So that was quite supportive, that the benefits are actually due to your gut microbes rather than [00:07:00] some direct effect of polyphenols on your heart. So the microbes seem to be quite key in this. Do you agree, Sarah?. 

    Sarah Berry: Yeah, I think there are also other benefits to alcohol in wine in addition to them, that microbiome, which I think again as you said, Tim, it's really difficult to pick apart. What's due to alcohol. What's due to the polyphenols, for example, in wine or beer. And there's been lots of interesting studies where, they will feed people, either red wine or white wine then de-alcoholized. So they take the alcohol out and feed the kind of good bits. So to say, oh, of the drink or we'll get spirits. And then they can look at all these different mechanisms. So aside from the microbiome that we know of is impacted by alcoholic things, so mechanisms that are involved in how our blood clots and how, our, blood sugar. is processed and how our blood lipids change. So whether we have increasing good cholesterol or bad cholesterol, and [00:08:00] also how our blood vessels function. So we often use a term called diencephalon function, which basically is a way of looking at how healthy the lining of our blood vessels is. And there's been actually quite a lot of short-term studies to look at. When you drink wine or you drink de-alcoholized wine or gin, or all other spirits, you know, versus a controlled drink like a sugar drink, what have the effects. And what we see is that with all alcohol. So regardless of whether it's got polyphenols in it, so even in spirits you actually see a long-term increase in good cholesterol, which we call our HDL cholesterol. , now that's up to a certain point.

    Jonathan Wolf: And Sarah, can you help to explain what's going on? So I'm having this alcohol it's presumably transferring into my bloodstream, I guess, in the same way as when I'm eating something. What's going on afterward. Why is that having these effects? 

    Sarah Berry: Yeah, so I think a really, a nice way to visualize it is to think of having a glass of wine with your dinner and what [00:09:00] happens when you're consuming your dinner and what happens when you then add the wine, you know, the glass of wine with it. So when you consume that mixed nutrient in a contained meal, and I know we've discussed this many times on previous chats that we've had, you have an ...

    Jonathan Wolf: That's just like a regular meal isn't Sarah. 

    Sarah Berry: Yep. So if you have a regular meal that has a balance of fat carbohydrate protein in the meal, you have increases in blood sugar and blood fat in the say, you know, two to six hours after consuming that meal. And this kind of kick-starts a cascade of quite unfavorable effects like oxidative stress and inflammation, and ultimately in the really short term, this can actually impact that very special lining of your blood vessels. I mentioned this endothelial lining. So we often think of this endothelial lining being like Teflon that nothing sticks to it if it's working properly, but it kind of gets rid of that nonstick that you have. So that in that kind of two to six hours after consuming a meal, you're then causing. this, very transient short short-term damage to your blood [00:10:00] vessels. Now, if you have red wine with your meal and there are studies that have actually shown this, you don't get that damage. You have real attenuations. So you have a reduction in your oxidative stress in your inflammatory markers, and you don't see this kind of damage, this Teflon lining of your blood vessels. And that happens really in the short term that happens in that six hours, which is a really favorable effect. Now that's been shown to have predominantly with wine with red wine. We also see it with beer as well because beer has polyphenols. And this is a mechanism that's slightly separate from the good mechanisms that Tim was talking about relating to the gut microbes. But what's important to remember. Swell is alcohol on its own alcohol, without any of these other polyphenolic substances over the long-term does actually improve your HDL cholesterol. Now, the doses we've mentioned are so, so important. So we have this J shape curve. And we see this with a lot of dietary exposures where you have very, very low [00:11:00] amounts. You actually increase the risk of certain diseases where moderate amounts, and this applies to alcohol. You have favorable effects on many diseases, but then once you get to higher amounts, the risk rapidly increases as the dose increases. 

    Jonathan Wolf: And what else is the alcohol doing? Sarah? So you've talked about potentially wine drinking, red wine. Actually, there might be some protective thing. Well, we all know if you drink too much, you fall over and you can't remember things. And like there's a lot of stuff going on there. So a little bit more about what's going on. And I guess, how does this tie into this rather complex idea, right? Which is, you're saying small amounts might be good, but large amounts are bad. It's unusual. We're more used to the idea. It's cake-like small amounts. Aren't really very good for you, but it's okay. Big amounts of bad, but you're saying actually there's a sort of strange emotion here compared to most of the things we talk about. 

    Sarah Berry: Yeah, I think that a way to think about it that is really what they are going to tip the scale in terms of the benefit of. Depending, obviously on what you're drinking, the benefit of the polyphenols that are in the drink versus the [00:12:00] unfavorable effects of the alcohol when it's at a high intake. So we know that as soon as you go above maybe one or two drinks a day in terms of the alcohol content, we know that it has unfavorable effects on lots of mechanisms, such as oxidative, stress, and inflammation. Now, if you're thinking of the kind of, you know, scales. Having that imbalance with the number of polyphenols that you're delivering, when you're at that level of about one or two units, say one or two drinks a day, then you're balancing out any of the negative effects of alcohol with the positive effects of some of these bioactive. So these polyphenolic compounds are in the drink, as soon as you increase your alcoholic buffer. Much of it never, or the safe level favorable level, then you're tipping the balance of the unfavorable effects of alcohol and not having enough at this counterbalancing effect. And that's, that's when it becomes a problem.

    Tim Spector: Sarah, most alcohols don't actually have many polyphenols. So anything that's distilled is basically put everything [00:13:00] removed. So I think people need to remember that. Although whiskey might smell as if it's got aromatic chemicals, it's got very little, few good things for your gut. It's all been distilled away. So the polyphenols originally there, and, you know, those plants that made it are long gone, and that same is true for vodka gin, et cetera. So I think we've got to look at the broad epidemiology does say that there is, you know, there's no such thing as a safe level. There isn't a certain cutoff. When you look at epidemiology, which slightly contradicts the short-term experimental studies. Lack of clarity around these low dose effects and whether you should be having, you know, I think it's worth reminding people what alcohols do have polyphenols in them. So... 

    Jonathan Wolf: Tell us, Tim, if we were going to say, I really want to drink tonight, right? What is the, it sounds like a fairly short list of things that are sort of positively approved for my microbes.

    Tim Spector: Yeah. I used to say red wine beats everything, but actually, I've found some [00:14:00] artisan ciders and for the US and English, cider is an alcoholic side similar to beer and these have actually high polyphenol levels. So I think we'll be seeing more of those coming through is sort of health drinks. If you like, then you drop down to things like rosé wine, white wine, and champagne. Proseccos et cetera. And about that level, you've got lager beers and you've got slightly more from traditional warm, British ales, and some Belgian beers also contain polyphenols and some yeasts. And I believe to have some beneficial properties, at least according to the Belgians, that is, but not everyone believes them. So. That's pretty much it, there's not much else really, that has much to feel microbes to munch on if you, like, I think that's part of the problem. So then it becomes more complicated about, you know, then you start talking about sugars and other things, which we might want to touch on later, but the menu is relatively limited, but most [00:15:00] people don't realize how much fewer polyphenols are in white wine compared to red wine. You've got to drink three times as much white wine as red wine to get the same benefits. So is not generally recommended. 

    Sarah Berry: That's why I drink white wine. That's my excuse, Tim. That you say I should drink three times as much. 

    Tim Spector: That's right. And you can, you can tell the polyphenol also, cause it gives you that funny taste or that sort of astringency on the tongue. And that astringency the way it sort of dries out your tongue is a sign that the tannins are in there and the more tannins that are their classic polyphenols. So it's an interesting way to. judge wines as well, which may probably vary quite a lot within them. No, one's really testing them yet sticking that on the label. But I think in the future, they probably will be.

    Jonathan Wolf: And I'm not a big drinker, so you've definitely convinced me that red wine is the place to go. And I like red wine, so that's fantastic, but I definitely feel a whole bunch of negative effects right after my second glass. And that's not about long-term health anymore. Right. That's actually. [00:16:00] I'm going to feel a hangover the next day, I may start to feel effects probably even within the next hour. Let's clear some negative stuff that's going on there. Can you sort of help to explain? Cause I guess that's this sort of key trade-off that you're talking about in addition to long-term health, which is very different. And I think why you're saying there's not necessarily any safe level, these things are quite personalized. What's going on here? 

    Tim Spector: Well, alcohol, is a neurotoxin really, and it gets broken down. At different speeds in different people. And you have these genes that generally metabolize it either faster or slower. So the speed at which it gets to you or affects your brain or your cognition depends on, Hey, how much you're used to it. And B also what genes you might've inherited. And my, it also involves your gut microbes and your individuality. So huge differences between people. And that's why one glass for you might be three glasses for Sarah. And just because metabolically that's, you're going to process them rather differently. So it's very hard to give rules. And [00:17:00] I think what you're describing Jonathan is quite common people saying as soon as it got by one glass, I get all these. side effects and I don't sleep well at night and, all these kinds of extra things, which that really a difficulty with alcohol it's, it's a really difficult drug in a way to get right. In terms of dose and timing. That's why everyone has their own story about what makes them feel good or bad. And so in general, I think the idea is, in general, we're probably, better off without alcohol, I believe overall, but if you are going to drink at a thing, pick something with red wine, which has some proven effect on the heart, or increasingly these apple-based drinks, they might do some good or you just drink it because you know, it helps your social life and makes life more interesting.

    Sarah Berry: And do you know why hangovers get worse with age? I know people talk anecdotally about that is it to do at the enzymes involved. 

    Tim Spector: There are masses of literature on hangovers. None of it conclusive in any way at all, [00:18:00] other than everyone blames everything else. for it. So there was this whole thing about blaming congeners and things like distilled brandies and things like this. And, but it's turning out to be much more complicated than that, but they just think they have done some microbiome experiments in mice, giving them hangovers and showing that you can actually prevent some hangovers or reduce the toxic effects of alcohol by giving them probiotics or poo transplants. So they've done a few human studies as well, showing that you can actually find a minute relating the microbes, help people recover more from alcohol, but I'm not sure anyone's yet advertised those yogurts for that specific purpose, but it shows it's complicated. And that probably what you eating the day before, what you've got in your stomach also, plays, an impact on how you're that two or three extra glasses is going to affect you the next morning, just like we're learning and personalized nutrition. You know, it's often outside the window, you're thinking about what influences your body and all these other kinds of ways. So [00:19:00] drink at a different time with your meal rather than on empty stomach later in the day, rather than at the end of the day, all have different effects on the body and the brain. 

    Sarah Berry: Now I came across a really interesting study a couple of weeks ago, that was looking at the amount of alcohol, I think, versus the way in which you're consuming it. So your drinking habits versus your drinking amount actually showed a really strong impact on your drinking habits. So, you know, what time of the day do you have it? Do you have it with the main meal versus actually the amount of alcohol? So going back, Tim, to what you said about all of the work that we're finding with the ZOE predicts studies, showing the importance of, you know, your dietary patterns as well.

    So how do you eat and the same holds true for the alcohol intake. 

    Jonathan Wolf: What was better, Sarah? 

    Sarah Berry: Having it with your meal, having it with the main meal of the day, the time of the day didn't seem to have a big impact, although they were looking at, I think if I remember correctly lunch versus dinner, I don't think there are many people that consume it, [00:20:00] hopefully for breakfast or with their breakfast. , not nowadays, although, many years ago they did. Having the same amount of alcohol with a meal versus without a meal has a significantly different impact on some of these health outcomes. 

    Tim Spector: And it's one of the few things where genes actually do make a difference. So when we did the, I predict studies, genes had little impact on most foods and their responses to them, but two sorts of exceptions to that one are how you deal with milk. Okay. The lactose gene and the other is the alcohol dehydrogenase gene, which through evolution has changed. Actually, Europeans have mutated to be able to break down alcohol faster. So it doesn't cause those toxic effects. And they're having some studies actually in students where they gave them all triple shot of vodka, monitored them over time, a, in a controlled experiment and huge differences between individuals in how they responded. To that standard dose of alcohol in terms of hangovers, et [00:21:00] Cetera. So I think there's a whole other industry there. If we wanted to go to personalizing your alcohol behavior, I'm not sure we should go there. 

    Jonathan Wolf: It's interesting. I, I think my university education has been a bit like a controlled experiment in alcohol consumption. You know, I came up. With almost no tolerance. By the time I was 22, I had really high tolerance, much higher tolerance than I've had subsequently. I now drink very little, but at that point, and this was, you know, I guess 25 years ago. And I think that students today drink less. It was a sort of central part of my experience. So I definitely remember that shift. We had a couple of like fantastic questions that came in on Instagram overnight when people heard we were doing this question and one of them, which I think fits right in here is we've talked about the health bits, but what about weight? Does alcohol make you gain weight and follow on to that? Isn't it killing your microbes? Cause it seems like it kills everything else. What's going on there.

    Sarah Berry: I'm happy to touch on the weight that Tim, but I'll give you the box to talk about. So again, with weight, just like we see where the association with [00:22:00] alcohol and cardiovascular disease type two diabetes, we see this similar J-shaped curve actually as well. Why that is, I'm not sure. You know, obviously, if you have excessive alcohol, you're consuming a lot of sugar, you're consuming a lot more calories in these empty calories. Why a moderate intake is associated potentially with a lower weight. , then no intake could be, you know, as a byproduct to some of these metabolic favorable effects from particularly from, alcohol as containing the polyphenols that Tim mentioned.

    Tim Spector: But in general, alcohol increases your blood sugar, doesn't it. On average, most conventional drinks will increase your blood sugar or not? Cause I definitely, in some of the twins, we did see responses. I had one particular energetic set of twins, identical twins who were party lovers, and did a Prosecco test where they both drank Prosecco at the same time with the glucose monitors on and any one of them was getting peaks. And the other one wasn't which upset the one who was. [00:23:00] 

    Sarah Berry: So the sugar and the drink will obviously cause an increase in blood sugar low. It's really different between different people. So some people actually eat the sugar in there, and this is because it interferes with the way that the liver produces. Glucose as well. So you might have some sugar coming in from what you're drinking, but you're having a disturbance in the production of sugar from the liver. Hence, why it's really valuable. Hence why one of the twins might have had an increase and one of them might not have, 

    Jonathan Wolf: I seem to remember text messaging me at around 10:00 PM one night while wearing a CGM. But do you remember this story? 

    Sarah Berry: I do the one and only time I've worn a CGM and was quite troubled why my blood sugar had dipped so dramatically after my X number of wine, which is actually white wine. Didn't have these nicer polyphenols then or a large amount. And I was really surprised that, had debt. So yeah, I have since slipped into it and for some people, I do get an increase. So some people actually impair insulin sensitivity, acutely. 

    Jonathan Wolf: So [00:24:00] this is one of those signs of very big personalized differences. Right? I think that was part of what we ended up talking a lot about, right. About trying to understand the impact on blood sugar, that it was. . We're not seeing a very consistent pattern across the whole population, 

    Sarah Berry: But also it depends on the outcome you'll have. And again, going back to thinking about the type of alcohol, we know that certain polyphenols, certain flavonols actually interfere with how glucose is absorbed. So if you have a high dose of flavanols. Oh, a high sugar drink. We know that you can reduce your postprandial glycaemic response. And there's been quite a few trials on this actually in our department. And they have looked at this, not with alcoholic drinks, but with non-alcoholic drinks, use giving different polyphenols. And so again, if you have red wine, you're less likely to have such a big increase in postprandial blood sugar after consuming that drink. 

    Tim Spector: I sometimes have zero alcohol, beers, non-alcoholic beers. I try and have, a day or two off alcohol during the week. And this really helps. And they've got really good recent if people I've tried them, [00:25:00] this particular German beer, it was, and I was wearing a CGM and found it actually gave me a considerable sugar peak, whereas the regular version of it with alcohol didn't. Can you explain that?

    Sarah Berry: I could guess that it's to do with the polyphenols. Although, you said they're quite low. We know that polyphenols like I said, interfere with the uptake of glucose in the intestine, the way it's absorbed into the bloodstream. So it's absorbed at a slower pace. So you don't have that short shot, you know, that the rapid rise and rapid drop.

    Tim Spector: It's just more sugar in the non-alcohol beer to make up. For the lack of alcohol. I have a feeling. Tend to do that. Alcohol is a very complex sort of flavor to try and mimic. And so I think they, they often add in other things to it. So it's just something to be aware of. 

    Sarah Berry: Yeah. I do know there have been quite a few studies where they've looked at beer and then they've looked at the same beer, but with the alcohol removed, so non-alcoholic beer and they've looked at the impact on some of the favorable effects that I talked about earlier, but to do with [00:26:00] the blood vessel function, to do lots of stress and inflammation, and they actually see the same effects between the ones with alcohol and the ones without now, whether they're matching exactly the sugar in the drink, I don't know. 

    Tim Spector: And I think we're going to see many more non-alcoholic or low alcoholic wines and beers in the future that are going to be getting better and better. And I think this is going to be a different conversation in a few years' time about the health benefits of some of these taking the best things of the fermenting process. But then at the end stage, just cutting out the alcohol. I think we're going to see much more of that. 

    Jonathan Wolf: And I guess what people have to be aware of, right. Is. These are still drinks that have sugars in them, or things will get turned into sugars. And that for people who have less good blood sugar control, which is most of us in the Western world, as we get older, that can have quite a big impact on those blood sugar spikes in the way that Sarah talked about earlier negative effects. So I guess there was this question about beer and presumably, so the quantity of beer and the quantity of sugar is one of [00:27:00] the things that are not true, Tim, if you're having your half a bottle of non-alcoholic beer, but rather different, if you're going to drink a large amount? 

    Sarah Berry: Yeah. If you're having 3 or 4 pints of beer in a single session, then that's a huge amount of sugar, you know, really refined sugar that you're getting. Such a huge hit in a single setting we know is bad for us. Plus that's more than the daily intake that you should be having as refined sugar. 

    Jonathan Wolf: And that ties into the white, presumably coming back to this question around like alcohol and. The polyphenols aren't completely magic. Right? So we've already said the beer is lower, but I think that's important, right? They'll always cause we have a lot of these discussions, right? That's your J shape again, is it Sarah? You're saying, okay, so in small quantities, this is good, but it doesn't mean I'm drinking magically my cider with super high polyphenols. I can go and drink pints and pints and pints and all that. I can indeed drink bottles of wine without expecting not only the health issues but the sort of weight issues that I guess, you know, we tend to associate with people who drink a great deal regularly. [00:28:00] 

    Sarah Berry: Yeah. And I think it's also important to mention that a lot of what I've been talking about, are mechanisms associated with cardiovascular disease type two diabetes, you know what we call metabolic diseases, but we need to be mindful that for certain kinds of cancers, there's strong evidence to show that even moderate intake of alcohol has an unfavorable effect. So particularly cancers of the gastrointestinal tract. For example, I wouldn't encourage people. Particularly people that have an increased risk of consuming anything above the moderate intake of alcohol. 

    Jonathan Wolf: You've talked about how personalized it is, what are the other life conditions or, or situations where actually sort of skipping alcohol altogether is important?

    Sarah Berry: So I think if you have hypertension, if you have high blood pressure, Then the flex point in that J-shaped curve is shifted a little bit. So that whilst one to two glasses a day might be okay for the majority of people. If you do have high blood pressure, then you should try and limit it a little bit further and have now there is still [00:29:00] shape curve for people that have high blood pressure, but it's a lot lower. So it's, instead of it being, you know, up to say 12. Units a week it's lower than that. So maybe a glass of wine every few days, for example, or say, if you have high blood lipids and particularly blood triglyceride levels, so this is slightly different too, to your cholesterol levels, but we know if you have high triglyceride levels that again, alcohol can actually make that little bit worse and that's because it increases the production of triglycerides from the liver. But it also impedes the breakdown of triglycerides from the fat that you consume in your meal when you consume meal. So you have it kind of a double whammy at both ends there. And so that's where you need to be a little bit more careful as well. 

    Jonathan Wolf: I had another great question from our members and it comes back to beer, right. Which is sort of in this middle ground, right. It's not truly terrible, not really great. And the question is how does fermentation of beer differ from kombucha. 'cause, you know, Tim, you're always telling us how fantastic kombucha is because of all this [00:30:00] fermentation and all of these bugs in a beer. That sounds like it's fermented as well. You know, put aside maybe if you drink too much, there's too much alcohol. Why is beer not as good as kombucha? 

    Tim Spector: It's a great question. I'm no beer fermenting expert, but I do make kombucha on a regular basis and you get your mother blob and you add brewed tea and you add lots of sugar to it and you wait 10 days, and the 30 different species of bug in there. Will change that tea the bitter tannins of tea into a very complex mixture of actual alcohol it's about half a, 1% alcohol, slightly sparkly. And, a little bit of a punch and these rich flavors in the seating acid, et cetera. And that's really all you do. It's extremely simple. Whereas a beer-making process involves artificial yeasts. , which you add to barley hops or these various grains, there are stages. You tend to sterilize it. So you don't have outer control [00:31:00] bacteria in there. So it's evolved in the process, but one ends up basically a sterile product. And the other one is actually a live product. The Belgians claim that some of the yeast is left in the bottom of the beer is actually still potentially live and just resting and therefore might have some biological properties. But I think that the jury is still out on that. 

    Jonathan Wolf: So that's very different from something with all of these live bacteria, some of which, you know, should make it through that really tough condition in your stomach and actually get into your gut. Is that ...?

    Tim Spector: That's right, I don't think we have to realize it. There's no hard evidence to be as good for you, despite some of the adverts.

    Jonathan Wolf: And presumably, you tend to drink smaller quantities of kombucha. You also don't tend to have as much of the sugar spike and everything that we're talking about with beers and those big downsides. 

    Tim Spector: Yeah. with most of the sugar is turned into either alcohol or these acetic acids or various other by-products. So most kombucha, if you make it yourself is not very sweet. Although some of the commercial varieties actually do add in other sugars. So you have to be a bit careful [00:32:00] on that. 

    Jonathan Wolf: Yes. I know that you're quite negative on a lot of kombuchas you can actually buy and the store has not been very different from the sort of sugary strengths that get terrible. 

    Tim Spector: But it's getting better and there's a huge variety. So you're going to remember, there is a small amount of alcohol in that. So, you know, some people do include kombucha and they're talking about alcohol less than 1%. 

    Jonathan Wolf: Another question we had was about organic and natural wine. So we've talked a lot about wine and how great it is in general processing too much is often something that reduces the quality of food. Any views on that?

    Tim Spector: The big movement in this and the last few years, both for natural wines and organic wines, and definitions vary in each country about exactly what that means. And there's still no universal standard in general, organic wines tend not to use any added chemicals and artificial ingredients and be very careful about what they're using, but at the extreme, end you've got natural wines, which [00:33:00] might be made without preservatives and also vineyards that might not be using fertilizers, for example, so very natural products. So the terms are used interchangeably, but they're generally. Based on the idea that if you worry about the vine itself and the land, it's a sustainable system, and therefore we should be supporting these as opposed to the mass market type wines and grapes, which just use masses of fertilizers sprayed with pesticides herbicides, and you get actually more product. So what they produce is smaller. And less of it, but higher quality. And increasingly a lot of people are preferring natural wines, organic wines across the original natural wines are still made in Georgia, where they have been put in the ground. And you just basically threw, you know, grapes in there with a bit of water closed the barrel, and waited six months, and then drank what happened after that.

    Jonathan Wolf: It's a bit like your kombucha, Tim?

    Tim Spector: Yeah, exactly. So, [00:34:00] and had all the bits in it and all the things. So, you know, that's the extreme example. So, I don't think there's any evidence yet for organic food is better for you. The evidence is really not there yet. Very hard to do the experiments, but in theory, yes, fewer chemicals, generally, a better less harmful filled, gut microbes, fewer things to upset them because like all foods, if there's less spraying with herbicides like glyphosate, and for example, we know that has an effect on your gut microbes. And so that is beneficial. So in theory, it's better, but we don't have any proof. 

    Jonathan Wolf: One of the reasons that we're talking about this today is that we spend a lot of time over the last few months during these updates to the ZOE scores, to score alcohol for the first time, having not done that with our previous releases, but we just didn't feel that we'd had enough data. And, and at this point, I know that we've just released it on a fundamentally non-personalized basis because you know, we're not yet comfortable with our ability to be accurate enough. Did we learn anything sort of, particularly interesting that we haven't covered? And I'm also interested in sort of the differences [00:35:00] between what we saw in the US and the UK, as we were comparing these two populations and how we can think about that for advice to any listener who's still hanging on at this point in the podcast.

    Sarah Berry: We've covered most of the points. I think the kind of things that we considered very carefully when we were implementing our alcohol scores was around this, habits that we talked about, how, how it's consumed. So the scores were a lot more favorable if the alcohol was consumed as part of a meal, because of the reasons that we discussed earlier and also the scores are hugely different depending on the type of alcohol consumed, as we've talked about throughout this podcast and then the dose. So the dose was key. , and I think it's really important to mention that I know I've been quite favorable over the last half an hour about the favorable effects of alcohol. It's really important to reiterate this. As soon as you go above this low to moderate intake of one to two. Small glasses of wine or beer a day. It has a very, detrimental effects on health, and [00:36:00] that's really important to note. And so that's been a really careful consideration for when we were developing the schools as well, to make sure that we're only insuring a favorable dose as well. And the frequency was part of our consideration. 

    Tim Spector: I've been lucky at testing myself with various alcohols. I don't seem to get much of a glucose spike. Whereas some people do so bear in mind, there is quite a bit of variability in how we respond. So it's always, and it might differ with different alcohols, which we're going to progressively get to in the ZOE app. But I don't think we've got all the data. We need to sort that out yet. And of course, remember things we haven't, done yet, I added in that we probably will be doing things like, ethnicity and other elements to alcohol could be quite big factors as well. That's important. So, but yeah, realizing that alcohol is part of, you know, our lifestyle as a food, you know, or is it something that, we see small amounts of [00:37:00] local drinking and long-lived populations. So in the blue zone countries, the little old ladies age 90 are still going down for their beer or their glass of wine, once a day. It may not be necessarily the alcohol that's keeping them alive, but it's the fact that having a social activity and interaction with their friends. And so there are a lot of confounding factors and alcohol that depend very much on the context in which you're eating it. But if you can enjoy a smaller amount. In a social context that improves your general wellbeing, then it can be very good for you regardless of the actual biological mechanisms. So context is also very important, you know, drinking on your own and binges, as opposed to meeting friends in a Mediterranean cafe. I think are very different. 

    Jonathan Wolf: I think that's a brilliant place to stop. I think we would all like to be in a Mediterranean cafe right now. So hopefully soon I've really enjoyed the conversation, I think has been very wide-ranging. It's good to know that the conclusion is red wines at the top white wine is just about accessible Sarah beer at a real pinch. [00:38:00] Everything else you know, think carefully. Thank you. Both of you, Tim and Sarah for joining me on today's ZOE science podcast. We hope that you liked the episode. If you did, please remember to leave us a review and subscribe. If you're interested in learning more about ZOE and the best foods and drinks for your body, you can head to join ZOE.com/podcast and get 10% off your purchase of the ZOE program as always.

    I'm your host Jonathan Wolf. The ZOE science podcast is supported by Sharon Feder and Kirstin K. here at ZOE. See you next time.

    This podcast was produced by Fascinate Productions.

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