Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained in board certified to the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system, no longer focused on disease management for achieving optimal health and vitality. Join me as a interview-world-renowned expert offering you a step-by-step guide to proactively avoid disease and most importantly extend your health span. Dr. Shah here with another solo-sode that's me doing a solo episode for you, Gempat with information in a short time period that you can use practically starting today. Today's episode is called Dry January, Smarter Drinking and the Science of Cutting Back, even if you're not completely trying to quit your alcohol consumption. So a lot of people start the year thinking about their alcohol consumption and there's many people that make new year's Eve promises to stop drinking after that one night of parting. Sometimes it's a full-dry January, sometimes it's just having a quiet realization that alcohol isn't totally destroying their lives but it is degrading certain aspects of it. They're sleep, they're recovery, they're mornings and there's always an intent people have to cut back for the most part. So on today's solo-sode I want to walk through some practical tips that you can use to reduce your alcohol consumption and tools that you can use to make it sustainable. These are all science-backed, they're realistic for people who still want a social life and some of them are very easy to implement. So look, I realized that quitting alcohol completely might be hard for some people and some people can go cold turkey and do it well for the entire month and that's absolutely fantastic. For both groups of people whether you're going to completely quit alcohol for January or just even slow down your consumption, this episode is going to be really important because it's more about the sustainable change that we can use this month to jumpstart for the long term. This is not a lecture about why you should never drink again in the future. It's more about how you can reduce alcohol consumption and the long term to get physiological benefits. It's about understanding how alcohol actually interacts with your sleep, your metabolism and your reward circuitry and how small intentional changes can create disproportionate benefits in reduction of alcohol consumption. So let's talk about why alcohol feels fine until it doesn't. So the early harm from alcohol is nothing to do with cirrhosis or liver failure. The earliest effects are subtle but they accumulate over time and these are aspects of your health such as disrupting your sleep, creating higher blood pressure, impairing your recovery from stress and from even working out. And definitely we all notice this when we have an angle for worse next day cognitive performance. Many people notice that the recovery even after a few drinks changes dramatically as you age, that's why hangovers go from being one day to a week as you start aging. Many people notice that the cumulative effect of this causes our brain to not function as well the next day and this could even affect our sleep two or three nights in the future and you can trap this by using a wearable device like a whoop or an orring. The reason for this cumulative effect of alcohol on our brain is it impairs our detoxification systems also known as our microglia. It also impairs our circadian rhythms and our cortisol levels get out of control and finally even our mitochondria within our cells get impaired over time and this effect again is cumulative. Even our microbiome changes for the worse were sustained alcohol consumption and it becomes harder and harder to recover from the damage as the damage is done even on a daily basis so people that drink every day, their body never really gets a chance to catch up. This framing is supported by decades of sleep in alcohol research including large reviews in a journal called sleep medicine reviews done in 2013 by Ibramette at out and this article show that alcohol alter sleep architecture even at moderate dosages. So to me the real question really isn't do I think too much it's more is alcohol giving me more than is taking from my life is the social and the stress reduction benefits outweighed by the cumulative effects of long term damage to our cellular machinery and our cognition not to mention our gut and our liver. So here the 10 science based tools that you can use as you go through January. Let's start with number one stop drinking at least four hours before bedtime. I think this is the highest impact change that most people can make. Alcohol initially acts as a sedative and helps you get to sleep but then as it is metabolized it actually fragments your sleep it suppresses your REM and your deep sleep and it increases the number of times you awake in the second half of the night and then you can't get back to sleep again because your heart is racing. This effect has been consistently demonstrated in controlled sleep studies and summarized in huge reviews like the one called alcohol and sleep published in sleep medicine 2013. And that review researchers analyze decades of laboratory sleep studies where alcohol was given before bedtime and sleep was measured with a sleep study called polysomography. They found that while alcohol can shorten the time it takes to fall asleep it significantly suppress REM sleep early in the night and it caused sleep fragmentation frequent awakenings in lighter sleep in the second half of the night as the blood alcohol levels continue to fall. So in other words don't think alcohol improves your sleep at all. It just front loads a bunch of sedation to get you to sleep and then it disrupts almost every sleep stage throughout the night. This is why people wake up earlier they feel unrefash with their heart racing and they have worse next day fatigue and it just never feels like they got a good night's sleep. In addition consensus hangover research has shown that sleep disruption and bedtime timing directly influence your hangover severity. That's why stopping the alcohol four hours before bed often improves not just your sleep quality and your resting heart rate and your HRV. It actually improves your hangover symptoms the next day. You might even be able to eliminate your hangover symptoms by day drinking instead of night time drinking. So from a physiological standpoint earlier drinking is less harmful than late drinking this is assuming that the total intake is the same because it gives you that time to detox and separates the sleep cycle with time from the high blood alcohol levels. Tip number two slow your pace the metabolism of alcohol matters. So here's a fact that will make a big difference once you know it. Also metabolism follows what's called zero order kinetics meaning that it's cleared at a relatively fixed rate regardless of the concentration once enzymes are saturated. Classic liver metabolism reviews including one published in 2012 and clinics and liver disease show that the average adult metabolizes alcohol at seven grams of ethanol per hour. Now a standard drink has about 14 grams of ethanol. So it's important to know what does that number really mean 14 grams. Well that's about a can of beer. This is about five ounces of table wine. It's about two to three ounces of an upper tea for the core and one and a half ounces of brand new cognac or any other type of distilled spirit like gin, rum, tequila, vodka, whiskey. So there's not a lot at all and that 14 grams of alcohol will take you two hours to metabolize. So basically one drink two hours. That's why drinking faster can lead to accumulation. You get rising blood alcohol levels because you just can metabolize fast enough. You increase the amount you're intoxicated and this all adds up to all of the negative consequences that we talked about earlier like sleep disruption, cognitive decline, etc. Forensic studies have also been done. There was one published in 2010 that confirmed that the ethanol elimination rate is finite. So there's no one out there that can somehow magically increase the amount of metabolism that their liver can do with alcohol. And practically speaking, spacing your drinks 90 to 120 minutes apart is far more physiologically better than just one drink per hour advice. You want to give it a little bit more time based on these pharmacokinetics. Tip number three, pre-decide your limit based on this knowledge. So we know for sure that alcohol impairs executive function, which is the function of your brain that determines the decisions that you're making and your impulse control. The studies that have been done that showed a blood alcohol concentration even as low as .02%, which is about one drink for many people, shows that it declines your attention and your working memory by 5 to 10%. Now when you get up to .05 blood alcohol concentration, which is still below the driving limit in US, there's a 20 to 30% impairment in executive function like response and emission, risk assessment and short term memory, along with significantly reduced activity in the pre-fundro cortex of your brain and this is a minute show to an MRI studies. Now at .08% blood alcohol concentration, this is where you're not allowed to drive anymore. Memory formation, reaction time and impulse control is impaired by 30 to 50% or more. This is why you can't drive when you're drinking, but imagine what else it can do with making other bad decisions that night. Behavioral studies and addiction psychiatry research show that pre-commitment strategies reduce impulsive drinking for sure in most people. So a simple rule that works really well in practice is take the number of hours that you're going out, divide that by two and that's the maximum number of drinks you should have. So if you're going out for six hours, three drinks, that should be your max that you tell yourself. And that's how you're deciding this limit works. So let's talk about how we can use this practically. Let's see you're going out for dinner and your dinners are usually two hours long. Well, you definitely don't want to order a bottle of wine for yourself every going out for two hour dinner. You should limit yourself to one maximum two drinks during that two hour dinner. Hi, Dr. Shah here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells you see are like phones and they have limited cell phone battery. Poor sleep, stress, process foods, all of these things can drain that battery way faster than it should. So this is the reason why it partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth DNA protection. The clinical dose of CoQ-10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha-lipoc acid, all of these works synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IMA actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMA had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies. And they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should, unfortunately. You don't have to be one of them. Try IMA. I actually have a discount secured for you. If you go to Dr. Shaw.com slash IMA or go to IMAidHealth.com slash discount slash Dr. Shaw. And you can get 20% off with my discount code Dr. Shaw. You can also find the link below. Tip number four, substitute without opting out. So most people drink for the ritual of the drinking, the way the drink feels in your hand. For that feeling of social lubrication you get when you have a drink in your hand, you're talking to someone that you haven't talked to in a long time, we're meeting for the first time. This is called behavioral substitution and maintaining the cue and the routine while removing the alcohol is a well established harm or dusting strategy. So high quality non-alcoholic options make this sustainable by preserving that social signal without the physiological cost. Again, there are many companies out there that are now making alcohol substitutes. Kin is one of them, KIN and they make some incredible kin drinks that you can use and also mixed drinks substitutes. And another company I know of is called ritual. Look them up on the internet. And if you're the one throwing the party, quick trip, have the bartender that you're hiring, make up some mocktail options or replicate the alcoholic version of popular drinks. Even having a soda water with a lemon in it in a cocktail glass gives you the feeling and the look of drinking without the actual alcohol. Number five, drink with meals, not instead of them. So it should be obvious you that alcohol absorption is faster on an empty stomach. Nutrition and pharmacokinetic studies show that food particularly protein slows gasio tempting in ethanol absorption and it reduces peak blood alcohol levels. Protein is often emphasized not because it uniquely blocks alcohol over fats or carbs, but because it also increases that satiety signal and reduces overeating and over drinking, protein can also stabilize your blood sugar. It reduces that impulsivity drinking behavior indirectly and it helps people prevent post-alcohol high-boke lycemia. So protein plus alcohol is usually a good combination in my opinion over carbs with alcohol. Alcohol is metabolized primarily by an enzyme called alcohol dehydrogenase in your liver. Once that enzyme is saturated, which can happen at very low level, the ethanol is cleared at a fixed zero order rate. What does that mean? It means that it does not go any faster and there's not much that you can do. This rate of alcohol clearance is not helped by food, it's not helped by coffee. There's no supplements that have been found to help it consistently and in large studies or even hydration. Hydration can dilute the alcohol in your system, but it's not going to help you clear it any faster. So this enzyme activity is a limiting factor and does not matter how much additional help you try to give it, it's going to be really hard to clear any faster. This pattern is supported by studies showing that food intake, especially mixed meals, reduces the peak blood alcohol level and it slows your drinking behavior, but the alcohol is still metabolized at the same rate. In real life, people who drink with meals tend to drink more slowly and stop earlier, which matters more than most people realize. Tip number six, don't mix your alcohol with sugar. Mixed drinks are uniquely hard in the body because they combine alcohol with sugar. Alcohol temporarily shuts down the liver's ability to regulate your blood sugar, while sugary mixers cause rapid glucose spikes often followed by crashes of your blood sugar later on in the night. This blood sugar crash can wake you up in the middle of the night and severely disrupt your sleep. The third factor, especially fructose, which comes from fruit juices, is process and the liver just like alcohol. So when you combine the two, you increase the amount of stress on your liver and this leads to increase fat production and increase inflammation as well. Sweet drinks are also consumed much faster, which leads to higher blood alcohol concentrations without people realizing it. Bottom line, if you're going to drink, avoid the sugar. Straight spirits are better than mixed drinks. Vine or low sugar mixers are metabolically less harmful than the sweet cocktails. Number seven, consider a medication called Naltrexone as a targeted medical tool. So Naltrexone is a drug that works by blocking opioid receptors involved in alcohol's reward response. You probably heard about its use in people that are alcoholics, which is really important and increasingly being supported by evidence in the literature is that Naltrexone does not need to be taken daily and is being used more and more often for people who are not considered alcoholics by the traditional definition, but needs some help with control. A randomized trial and follow-up analysis that was published in the American Journal of Psychiatry supported targeted as needed dosing, taken in anticipation of higher risk situations as a study done by Anton et al. in 2022. So typical dosing used in studies like this are taking 25 to 50 milligrams, one to two hour before an anticipated drinking episode. So if you know you're going out for an edit parting and you know how this is going to probably end up, maybe asking your doctor for some PRN or as needed pills of Naltrexone could be very helpful. Some clinicians start this at 25 milligrams, assessing tolerance and CO work, and then you increase to the 50. What's incredibly important is that you definitely talk to a doctor and work with a doctor or a medical practitioner to help you consider this medication in your overall program. The approach has been shown to reduce cravings for more alcohol, binging intensity, and the loss of control once drinking starts. If blunting the reward signal when it matters the most, and people who lose control once they start may want to ask their doctors for this alternate way of taking this medication. Tip number eight, GLP1 medications like semi-glutide and tersepatide can be a powerful adjunct to minimizing alcohol intake. So GLP1 receptor agonist effect much more than just your hunger and your appetite. They also act on your dopamine pathways that are involved in reward and craving. A randomized clinical trial published in Gempsychiatry demonstrated that semi-glutide reduced alcohol craving and drinking outcomes in adults with alcohol use disorder. This was published in 2025 by Henderson. So while this is off-label use of semi-glutide, real world entrial data suggests that there's a meaningful signal there. So here's what you want to do. Realize that effects on alcohol cravings have been observed as standard metabolic dosages of these medications. So the typical starting dose of semi-glutide for example is 0.25 milligrams a week. Alcohol tolerance may decrease and intoxication can occur faster so you want to be careful. GI side effects are also dose dependent and they improve with slower titration of the medication. This is not a first lying treatment for alcoholism but it might have some secondary benefits for patients that are already using GLP1 for weight loss or for metabolic health. And I personally have observed many of my patients reduce their alcohol intake while on GLP1's when they're trying to lose fat or lose weight. So once again, talk to your doctor or your medical practitioner about the potential use of semi-glutide or tezepatide for reducing your alcohol intake. Number 9. Track the number of drinks that you're drinking per day. So there are many apps out there that have a tracker app that allow you to track any type of habit that you want to. You can track steps with them, you can track the number of glasses of water you drink a day, track the number of drinks that you're drinking per day. And you can then see on these apps how many are adding up per week per month and set yourself a limit. Lacking is data and data is what you need to make changes. There's nothing that changes without the collection of data. And for some people, this can work really, really well. Let me tell you a story of one of my patients who travels a lot and usually is out on business dinners almost every single night. And he was complaining about inability to lose visceral fat. He was complaining about really bad sleep and also sleep apnea. And when we asked about his alcohol usage, he actually had absolutely no idea. He thought it was a couple of drinks every single day. But then when he started to track with the habit tracking app, he was actually drinking somewhere between four to 10 drinks almost every night of the week. And once he had this realization over the course of a month, he was drinking over 200 servings of alcohol. Now a lot of times when we're tracking the number of drinks that we're drinking, we have to add even more because we know that when mixed drinks are often served to us as more than one serving in there, sometimes their restaurant will pour you almost two glasses of wine in your wine cup versus just one. So we know that there's some fudging that we have to do on the positive side, meaning adding more drinks. Now, having this realization can be a game-changing moment for some people. And it definitely was for this individual. Then we started to now trexel and therapy on him. And he was able to cut back down to about four to six drinks a week, a massive improvement, almost tenfold decrease in the amount he was drinking. He immediately started to lose all of his visceral fat. He started feeling so much better because he was sleeping better. It completely changed his life. So this could be a useful technique for some people. And finally, number ten, if you're a data-driven person and like to track your biomarkers, the perfect biomarker to track to continually assess the level of alcohol impact on your liver is G-G-T. G-G-T is a liver enzyme biomarker. And it consistently soars in the hepatology literature as being the most sensitive enzyme for ongoing alcohol use tracking. It rises way before the traditional biomarkers of liver health, AST or ALT rise. And it falls predictably within four to eight weeks of reduction or abstinence from alcohol. And this was shown in a study published in 2012 in clinics and liver disease by Cedar Bung. G-G-T will remain normal even in moderate drinkers. And I've seen some people with tremendous amounts of fatty liver disease and fibrosis of the liver with a normal AST, ALT. Those biomarkers are resistant to change with even severe disease developing. That's why trends in G-G-T are far more informative than single lab values. And this makes G-G-T a very practical biomarker that you can track for behavior change. We like to track G-G-T in our patients every quarter. And if it's rising, we know that the person has been drinking more than normal. Another test that you can ask for, and we do these at art clinics, is called the fibroscan of your liver. This also changes way before your liver enzymes change. And it's a scan that measures the amount of fat in your liver and the amount of fibrosis in your liver and gives you a score. And there's so many people that get this test done that are incredibly surprised by their results. If you're looking to get this test, ask your doctor for a fibroscan or come to one of our next health clinics and we can perform one for you. So in closing, we know there are a few reasons why dry January works. Structured abstinence challenges and removes ambiguity from your protocols. In fact, a review from Columbia Psychiatry highlights that time-limited alcohol cessation like a dry January often leads to fewer drinking days, not just in that month, but lower intake months and months later. Even when abstinence isn't maintained completely, people drink less over the course of the year. The short resets can produce long-term behavior change. Combining a dry January with true alcohol reduction planning, using some of the techniques that I gave you here can truly help you improve your health over the long term. Remember, you don't need perfection, but you do need an intentional design plan and strategies to reduce alcohol consumption over time. This could be a combination of better timing, slower pace, clear limits, smart substitutes, feedback from your own data, and medical tools when appropriate, like medications like GOP1 and Altrexone. That can be used temporarily until you develop habits and routines to manage your alcohol consumption without them. So for all of you that are practicing a dry January this month, congratulations. And even if you're not doing a dry January, but you're cutting back in January, it's a great time to do it. Using these techniques can definitely help. And I hope you can share this episode with someone that you know is doing a dry January or needs to reduce their consumption to benefit their long-term health. Thank you for listening. This is Dr. Shaw on the Extend Podcast. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today. Especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and is always important to seek their guidance.
