After listening to Edward Slingerland’s audiobook, Drunk, and reviewing that a couple weeks ago, I was curious to learn more about the latest research on alcohol and health. David Nutt is on a mission to explain the most significant alcohol-related research findings from the last 50 years. What I enjoyed most about his pragmatic approach is that he explains the impact of ANY amount of alcohol consumption. This is about making informed decisions, not moral judgements. He clarifies the differences that various levels of alcohol consumption have on our mental health, sleep, hormones, fertility, and propensity toward addiction. The limit in much of Europe is .05, while it's .02 in at least four countries and .00 in four more. One explanation is that business interests have more influence on government in the US than in Europe. "Reducing the limit to 0.05 percent would reduce the accident risk by half, even though it wouldn’t halve the amount people can drink." And it is a very scary book. I thought I knew most facts about the dangers, but Nutt goes into great detail about how alcohol affects every part of the body, what's involved in hangovers, fetal alcohol syndrome, and the types of cancers related to its use. He explains the drugs used for treatment of alcoholics. It’s by far the most harmful food product in the grocery store. And that’s really saying something. Drink? holds the key to all the questions you want to know the answers to, covering mental health, sleep, hormones, fertility and addiction. It sheds light on what 'responsible drinking' truly means and equips us with the essential knowledge we all need to make rational, informed decisions about our consumption now and in the future.

Irrelevant to which part of the book some of his suggestions appeared, a few concerned me. Although one section is subtitled, "Hangover Cures: What's the Evidence," implying he's presenting information and not recommendations, since this is a self-help book, I might assume that most readers aren't processing the "What's the Evidence" portion of the heading and merely focusing on the promise of "Hangover Cures." He will illuminate our minds on what 'responsible drinking' truly means and equip us with the knowledge we need to make rational, informed decisions about our consumption now and in the future.I've never been in a bar or tavern, and I don't have a problem meeting plenty of good people. The crowd I'm around does not drink. I belong to a friendly church with social activities. Yes, I've taught Sunday School and many kids' programs, great experiences. I belong to a Christian writers' group. I have ministered on a jail team for 15 years as a volunteer assistant chaplain, as well, and had plenty of experiences with hundreds of alcoholics, all of whom started out as social drinkers. However, the evidence is pretty damning, even though alcohol is associated with blue zone diets and minor improvements in cardiovascular health drinking any amount of alcohol has more negative effects than positive. Two days in a row of drinking is extremely bad for you as your body doesn't have time to recover and you don't sleep well, it's a downward spiral. Avoid this if at all possible, and go light the second day if you decide to drink. From the mouth and gullet, the liquid moves to your stomach, where about 20% is absorbed through the stomach lining. The rest is absorbed once it reaches the small intestines, all of it ultimately ending up in your bloodstream. Food can act like a sponge and slow the alcohol’s absorption: if you are drinking on an empty stomach, the alcohol takes effect much faster. A few minutes after your first sip, once it gets to your bloodstream and into your brain, it starts to have an effect. You can die from alcohol poisoning, it is the leading cause of death in young people according to the WHO.

Nutt identifies alcohol as one of the most, if not the most harmful drug (legal or illegal) in common use. Alcohol is a huge dopamine stimulant, which is in part why it feels so good, and why we might crave it when stressed.

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Close to half of all people who commit suicide are intoxicated...you have a seven-times-increased risk for a suicide attempt soon after drinking alcohol, and this increases to 37 times after heavy use of alcohol." I've been reading about the dangers of alcohol multiple times, so this didn't really offer anything new. Occasional breaks from alcohol of 2-4 are very, very good for you as they establish the habit of not drinking, and tend to lower your drinking after you do drink again. It can take a few weeks to remove all effects of alcohol from your system and let your liver fully recover. Dehydration is common,” says Macey. “But alcohol can also irritate the stomach lining, potentially causing diarrhoea, vomiting and an imbalance of electrolytes including sodium, potassium and magnesium, which the body needs to function well. Together with blood vessels in the brain expanding, this can all cause a thumping headache.”

But sometimes he still spouts a factoid that he doesn't substantiate with a citation. I'd like to see the documentation of these assertions, Professor Nutt! In the US, an estimated 88,000 people (approxi- mately 62,000 men and 26,000 women) die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States, behind tobacco and poor diet and physical inactivity.The number of older people dependent on alcohol or who drink heavily has risen fast. It’s...also what happens when people retire and find themselves with disposable income and with more time to drink and no reason to put on the brakes." Retiring overseas is a risk factor. "The social life of the expat may be based around drinking, and booze is often cheaper too." Many patients with cirrhosis consider themselves social drinkers, though they tend to consume quite a bit. I worried this book would read like a medical text book or lecture on the evils of drink. Its does neither. You'll understand how your body & brain reacts to alcohol scientifically, & knowing that enables you to understand your subconscious behaviours & take control. Although one shouldn't expect 100% definitive guidelines, I'm bothered by some contradictions. At one point he says, ""...don't drink at all - because there are no health benefits" and "...no level of drinking is actually beneficial to health." However, one whole chapter (8) is about "The Social Benefits of Alcohol." Granted, health and social benefits are different, but he expounds in so many places how alcohol provides social benefits, which others can argue can positively affect health benefits. He concludes that "...But if you want the sociability benefits alcohol brings, it's a different story. In that case, you need to decide what risks you want to accept...." Teeter-totters go in both directions; he implies that the benefits of alcohol abstinence and social drinking have an inverse relationship, so one has to choose, to "balance out the pleasure you gain." Further into the book he says, "...that the amount of alcohol optimal to provide the protection ["partial protective effect on cardiovascular health - The Lancet"] appears to be very low - about one unit a day." So there are some health benefits; he just wants us to know "...that the benefit to the heart does not outweigh all the other risks of alcohol...." And remember the reference to alcoholic dementia above? Later in the book, he says, "...low levels of alcohol consumption - that is between one and ten drinks a week - reduced the risk of dementia. In fact, it appears that being teetotal may raise your risk of dementia...." He also includes "...a 2017 review [that] concluded that light to moderate drinking does reduce the risk of diabetes," and that report IS cited.

It seems really hard to have a good social life and not drink. It is such an accepted part of life. People don't really understand the effect it has on our bodies and our lives. Of course people do understand at the extreme of becoming an alcoholic, but short of that, what's the big deal? Everyone should educate themselves on why it could be a big deal, so we can all make better informed decisions around drinking, and this book is an excellent introduction to this. It is well establihed that heavy drinkers are less fertile. "It lowers libido and increases the likelihood of impotence." Chapters 1-5 are the "why" - chemistry and biology - and chapters 6-10 are the "how" - psychology and sociology. Never mix drinking with drugs. You are less likely to know what you're taking when you're drunk, and you don't know how it will mix.Alcohol affects the prefrontal cortex, which primarily governs cognitive control, impulse behaviour and the brain’s memory centre. This means that your judgment becomes impaired and movement is disrupted.