Hopefully you heard the Alcohol Free Life podcast with Psychiatrist Dr Anya Topiwala, Here is the transcript of that interview. I’d love your feedback and please do share the episode as widely as possible!
Researchers from Oxford Population Health have published results from a new genetic based analysis that suggests that alcohol directly accelerates ageing by damaging DNA in telomeres. And the findings are published in Molecular Psychiatry. Finally, something that tells it like it is, I’ve long said that ditching the booze is the best anti ageing secret ever. So it was great to interview Senior clinical researcher, Dr Anya Topiwala from Oxford population health who was the study lead. I started by asking her about these alcohol studies generally:
Anya: ‘Yes. Its my primary interest, I’m a Psychiatrist by background, so interested in the effect of drinking on the brain and memory function. And we’ve done quite a few studies such as you mentioned, where the narrative was always – ‘Yes. Okay, if you drink a lot of alcohol over long periods of time, that was bad, but you know, maybe a glass of red wine a day is good for your brain’ And actually, we haven’t found that at all across two or three studies now, where we’ve shown that even really quite small amounts of drinking, is associated with harmful brain volumes and worse memory decline. We’ve done a lot with brain imaging, which is actually more sensitive, you can pick up more subtle changes years before the memory symptoms start. We found that more drinking equates to literally smaller brain volumes. So smaller brain size. And actually the week before last, we published a showing that higher sort of drinking was associated with higher iron in the brain, which in turn is linked to Alzheimer’s. And we were seeing results are only seven units of drinking a week. So you know, after two large glasses of wine, we started to see effects.
Janey; I get so exhausted with the studies that seem to say that alcohol is good. is good for you, I read one recently that said, as long as you’re over 40, or some kind of absolute nonsense.
Anna : ‘Yeah, that was a study two weeks ago. You’re right. It was published in The Lancet. Very good journal! Yes, that’s right. Well, it didn’t look at actually brain outcomes and mental health outcomes, which is my primary focus. But I think that’s one of the reasons we’ve done this genetic analysis, because especially for more sort of moderate drinking levels. There are loads of other factors that are probably responsible, and I think causing these spurious protective effects. Yes, to give you an example, so the kind of people that drink moderately are better educated, probably. eat better, exercise more. Everything else in our lives is probably healthily apart from the drink. And all those factors mean that their brains are healthier, for instance.
They’re healthy despite the alcohol, they’ve lucked out?.
Anna: As I said, on all the imaging studies we’ve done it looks like it’s harmful. And like you mentioned at the beginning, we’ve all got what you call a selective bias. Yes, we see the one out of even 100 studies showing that the red wine glass of red wine is good for us. We’d love to believe it. But I just don’t think it’s borne out in research.
Janey; And of course, there was also a piece this week in the press about the effects of lockdown drinking, which was really shocking, actually. Just the fact that Off licences were all left out and the gyms closed. what did they think was gonna happen? That was really sad, actually, when they really look at the knock on effect of that.
Anya: And we haven’t captured it all yet. I’m sure.
Janey ; So just tell us a bit about your work
Anya: My more recent work has been very large samples using brain imaging and memory tests. And I’ve had a particular focus of interest on alcohol, because so many people drink, And like you say, the studies have been really conflicting. And this so called protective effect and thinking about, you know, what I know about alcohol and how it works, I just didn’t believe it. We know it’s a toxin, it literally kills brain cells, I just couldn’t quite believe there was a protective effect. And I thought, this is a sort of topic which merits further investigation with different methods, brain imaging genetics, like some of these more sophisticated methods to try and get to the bottom of it.
Janey: Well, I’m so glad you’ve done this work. And, and what’s really interesting about this one is that, its basically saying that the findings could implicate alcohol with age related diseases. So just tell us a bit about this particular study, So what what does it mean, if it’s a genetic based analysis?
Anya; We looked at the links between how much people were drinking, and the length of what you call telomeres. So as we grow and get older are, the cells in our body have to divide, and to do in that process of dividing, they have to copy the DNA. And each time the DNA is copied, it gets slightly shorter, just a quirk of the copying process. So the length of these telomeres gives you an idea of ageing, so this is like a marker of biological age. And as these things get shorter, you increase your risk for things like Alzheimer’s disease, heart disease, cancers. So the shorter they are the worse
Janey: Is it a bit like neuroplasticity of the brain? Can we kind of repair it? Or, or is it a case of once you’ve shortened it, that’s it?
Anya: So I can’t say for definite with the effect of drinking, but in babies or in foetuses, there’s a repair mechanism. But by adulthood, with most of our body cells, that repair mechanism is lost. So I can’t think of a way I’m aware of, in which day that could be repaired. The good news, though, of course, on the side note is that the liver until it gets too far gone is really good at repairing. So it’s never too late. And you’re you’re trying to reduce your risk of this stuff getting worse. The other thing that we found was the dose was important. So the more you drank, the worse it was. So even reducing what you’re drinking is probably going to benefit you somewhat.
Janey; So the telomere, it is this indicator of biological ageing. And once they’re too short, the cells can’t divide. I think I understand that.So in this in this analysis, how did you gather the participants, literally from a sort of Bank of DNA? Is that how it works?
Anya : The study is called the UK Biobank, which is a huge study of middle aged, UK, individual individuals from the UK. There’s a whole team and it’s not just me, that they’ve done all the hard work, I got the easy job. So we looked at just under 250,000 of these people who had telomere measurements on their bloods on a blood sample. and we also had information about their drinking, all sorts of other factors that we took into account and how much they exercise, what they ate, whether they smoked, or the health conditions to take into account. And so we did two types of analysis. We looked at how much they were drinking, and the telomere length. And then the other aspect was the genetic analysis. And the reason for that was what we were talking about earlier, because there are all these different factors. That could be different in drinkers versus non drinkers, that may be important. And it’s very difficult to take account of all of them.
We use the associations between genes that predispose you to drink more, and the telomere length, and that gets round some of these problems, some of these other factors. And so if you get an association, you can be more confident that it’s the alcohol causing the telomere shortening rather than something else that we haven’t taken account of.
Janey; tell me a bit more about these genes. Do they predispose you to drinking or what do you mean by that?
Anya; If you took a group of people, there are certain genes that mean that those people would drink more on average than other people if they have them. So to take an extreme example, if you think about Southeast Asians, there is a gene that predisposes people to have a flush reaction, if they drink alcohol, you may have seen them. So if they literally have a drink or two, they go red, they feel sweaty and unwell. So people who have that gene tend to drink less alcohol, because they don’t feel good. In Europeans, we don’t have that an extreme reaction, but there are a number of other genes that have smaller effects. That if you have them, you might be more likely to drink more or less.
Janey: I read in your study where you said the most influential genetic variant and. analysis was ADH1V and alcohol metabolism gene.
Anya: it’s just the name of the gene in Europeans that explains the most of drinking. it’s a gene that affects how we break down alcohol in our bodies. when you break down the component of alcohol that does the damage it probably is ethanol. And that gets broken down to this nasty chemical called acetaldehyde in the body, and then that gets broken down too. We don’t like it, it doesn’t make us feel good. And that gene affects the speed at which we metabolise the alcohol.
Janey ; So in other words, some people effectively break it down quicker than others and somehow that affects how much we drink. I don’t know if that means those people feel worse when they drink, Or maybe they get worse hangovers? Something that we don’t understand means that they may drink less, and I’m guessing it’s different in men and women as well, because about how our bodies are made up?.
Anya : So men and women, definitely metabolise alcohol differently. But as far as I understand, that’s more about how the ethanol gets distributed in our body, because women have more fats, so we get a higher level for the same amount of drinking. there certainly are differences between men and women.
Janey: Even as we talk about this, what’s laughable is why the hell would we do this to ourselves? Even just having this conversation about, oh, well, you might break down the poison slightly faster than I might, what about not having the poison? Anyways, just back on your study, tell us a little bit about what you found in the observational analysis, because I know you said that there was a significant association between the higher alcohol intake and the shorter telomere length. I read that you said, compared with drinking less than six units of alcohol a week, two large glasses of wine. It was associated between one and two years of age related change on telomere length. So does that mean over a couple of year period that the telomeres would shorten?
Anya; We can’t say how long would a period would be because we just had a snapshot of people’s drinking at one time point. So it’s difficult to say. But we were trying to estimate and give people an idea of how big the effect was. So, people that were drinking more than 17 units a week, had shorter telomeres than those that were drinking less than six units. And then the people that were drinking more, the effect was greater. And those who had a diagnosis of alcohol use disorder, so more severe end of the spectrum, the effect was even greater. So it seems to be the higher dose of alcohol, you have the worst with the T limit as I tried to estimate
Janey; So really, what this study is saying then is that even a small amount of alcohol consumption is going to effectively damage these telomeres, which could result in ageing more quickly, or – living less? That’s it in a nutshell, right?
Anya: That’s what we’re hypothesising, we’re suggesting that alcohol is shortening these things. And it’s putting you at risk of age related diseases like Alzheimer’s or cancer. what’s also interesting, was that most of the participants in the study were currently drinking, when they did the study. But 3% have never been drinkers and 4% had been drinkers in the past. We were actually quite shocked, because this is this is not a group from the population, that this is not your average, ie if we randomly selected 500,000 people from the street. This is a group of relatively healthy people, middle class educated because they signed up for a research study. So the first thing is that the rates of drinking were just so high, I was shocked. And actually, more than half the sample was drinking over what the current guidelines are. And so that’s another reason why perhaps some of these other studies have shown protective effects of moderate drinking. Because if you choose your reference group, ie if you’re comparing the ‘never’ drinkers or the non drinkers, and then you look at the moderate drinkers, there might be there’s something called a ‘quitter’ effect. So it may be that some of those people that don’t drink now, used to be extremely heavy drinkers. They had a problem, That’s why they stopped drinking. So therefore, they, they do worse on the other outcomes. And so it, it looks like moderate drinking is ‘good’. We wanted to distinguish people that had never drunk, and had previously drunk, and those who were drinking the different amounts currently. So that we could sort of try and tease out those effects.
Janey , I would be really interested to know whether someone in my position, for example, someone who did drink too much for many goddamn years, you know, before I’ve wised up. But now, obviously doesn’t drink at all. Whether I have managed to stop this in its tracks, as it were. I mean, I certainly feel better. And I certainly feel younger!
Anya : Well, it’s difficult to say that from this study, but certainly, from what I know, of the brain imaging studies, there is some evidence that in previously very heavy drinkers that you can reverse to some degree, the brain changes and the memory loss. So if you stop drinking, certainly, it’s not too late.
Janey ; Tell us anything else that you found that seems important?
Anya : I think I think just I’d emphasise that using the two different approaches, and having consistent results across them is much more persuasive. That it is the alcohol causing the damage and as we said, its really tricky to do these alcohol studies as there’s so many other factors to take into account. But Yes, we’re very pleased that we had consistency of resources. Its Convincing.
Janey I know it’s not your remit, it’s not your within your job title. But how can we get medical profession to take this on board? Because, anyone listening to this podcast will know that one of the things that I get so frustrated by is …feeling brave enough to say to a GP, …actually, just something I’m bit worried about my drinking, And the answer would always be well, how much you drinking? obviously I lie. I mean, obviously, everyone lies they know, you lie. So I’d say, Well, you know, Two or three glasses a night. And the answer would always be …’Well have an alcohol free day, sounds normal’. And I’d go off again, thinking, ‘Thank God for that’…back to – however many units a week, which is way over what anybody would recommend. And the reason is, as we all know, GP’s are drinking too, the majority of them, and, they don’t know what to do with you, if you are clearly alcohol dependent, then that’s different. They’re going to hopefully help you find alcohol services or rehabilitation. But if you are (the term we now use is a grey area drinker) you’re drinking way more than you should be drinking, they don’t know where to signpost. And as your study shows, this isn’t going to be good for you, this is not going to be good for the economy, or for the NHS or for anybody else.
So how can we get through to the medical profession?
Anya; It’s very difficult. I’m a consultant psychiatrist, as well. I think speaking about it more helps. I’m hoping that, our work and other work that is emerging is, we’re really going to be changing perception for good, not just the public, but for medical profession as well on GPS I hope. I’m hoping it’s changing, And I think a lot of these studies, citing a protective effect have not helped. I’m hoping that slowly, we’re changing the perception of medical professionals as well. I think it often gets missed, in at least my work in hospitals, we don’t ask enough about know if people were drinking.
Janey: I have a friend who was being treated for breast cancer, who was literally told, after news like that, you’re gonna want to go home and have a large glass of wine. You know, I know, they’re just trying to be kind, but it’s just such awful mixed messaging.
Anya Yes. Well, I think I think that links with cancer and other sort of illnesses are important, the public are not aware of the links between alcohol and cancer. I think I think we kind of are in our, in our gut, but we don’t want to believe it. And these constant studies that show it’s protective don’t help. It’s like you say, a wider societal issue, completely bound up in our culture, and you celebrate and commiserate drinking, don’t we? so it’s really tricky. It won’t be a quick change. But you know, it’s happened for smoking. You know, that was also seen as healthy to some in the medical profession. There’s been a C change, but it does take time. And a lot of studies are needed, I think showing the same thing, probably to start changing opinion on it.
Janey So that is interesting, then, in your work as a psychiatrist, then I mean, you must have seen the impact of alcohol.
Anya Oh, hugely, I mean, the huge amount of comorbidity between drinking and depression and other mental illnesses.
Janey it’s not talked about enough is it, that link between depression and anxiety and our mental illness. It’s just not talked about, it seems, if you if you talk about that, it’s seen as if you are trying to make light of mental illness, and that that’s not the case. The reality is that, no one’s saying that one thing directly causes the other, but it definitely exacerbates it.
Anya ; Hugely, I think it’s just beginning to be researched, that sort of overlap between the two conditions. And worryingly, at least in mental health services I’ve worked in it’s a barrier, drinking is a barrier to accessing mental health services, often if you’ve got a drinking problem, you’re excluded from mental health services, or you’re supposed to sort that out first.
Janey Even people within my community in the Sober Club have rocked up to a GP, with depression, anxiety, they’re given antidepressants, and they’re never asked about their drinking. The number of the clients that I’ve had, who have have issues with drinking, and they’re on antidepressants. I couldn’t believe it.
Anya That’s the concern, because they say you can’t you can’t just treat one or ignore the other. Because they’re so interlinked. You need to try and take a holistic approach. And, yes, manage both together. I mean, it’s just impossible to do one without the other.
Janey Well it is medicating on top of medicating! Well, I’m thrilled you’re doing this work. Well done. It’s lovely to have somebody like you who’s actually on it. So maybe there will be a change. Let’s have a chat in six months or a year, and maybe, some of these studies will have actually properly hit home.
I really appreciate it. It’s really great to chat to you. Thanks for being part of the podcast.
Anya Thanks very much.
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