EPISODE 31 – ALCOHOL AND THE PERINATAL PERIOD

Since 7000 B.C in China, humans have been drinking alcohol! It’s been generally a socially and culturally accepted ‘crutch’ or tool to help us feel better or to celebrate with family and friends.

Some quick statistics from Australia;

• In 2016 Australians spent $666 billion on general living costs, $14.9 billion was on alcohol vs $1.6 billion on tea and coffee (https://moneysmart.gov.au/australian-spending-habits

• The ABS data released on 21.3.22; 1 in 4 Australians aged 18 years and over exceeded the Australian Alcohol Guidelines in 2020-21

• Men were more likely to exceed the Guidelines than women (33.6% vs 18.5%)

• Those living in Inner and Outer Regional and remote areas were more likely to exceed the Guidelines than those living in Major Cities.

What are we covering today?

• EFFECTS OF ALCOHOL, HOW IT WORKS (biochemistry, short-term & long-term effects, and what an alcohol emergency looks like)

• WHAT ARE THE NHMRC ALCOHOL GUIDELINES: National Health and Medical Research Council

• WHAT IS A STANDARD DRINK?

• ALCOHOL AND SLEEP RELATIONSHIP

• MEDICATION SAFETY AND INTERACTIONS (As a pharmacist, medication safety and drug interactions are hugely important topics with alcohol! Hearing or watching people combine seemingly ‘benign’ over the counter medications with alcohol is always a trigger point for me!

• PREGNANCY AND ALCOHOL

• BREASTFEEDING AND ALCOHOL

• MOTHERHOOD/PARENTHOOD AND ALCOHOL

• AMA; EMOTIONAL AND PHYSICAL

• WHAT TO DO IF YOU ARE CONCERNED WITH YOUR DRINKING OR A LOVED ONE?

In terms of my own experience, I have shared on a number of podcasts, how inflammatory alcohol is for me personally, and how much my body speaks to me to reduce, if not eliminate it from my lifestyle. My body tends to become swollen, inflamed in my fingers/face/legs and feet, as well as my tonsils always becoming inflamed, with it taking a good 5-7 days to return to ‘normal’.

I do however, enjoy the relaxation aspect that it brings me, which is why I have not been able to ‘cut it out’ completely from my menu! I do try to drink higher quality wines with fewer preservatives and trialling one ‘type’ at a time; but I still haven’t quite worked it out! My ‘Google’ research has suggested that red wines, vodka and gin are the least inflammatory; but haven’t worked out my secret recipe or solution here!

So, I bring up alcohol from a MENTAL HEALTH space and also from the PERINATAL period space, because it is quite a complex and intricate balance between understanding;

+ the biochemical impacts that it has on our system

+ as well as safely considering all the aspects that need to be thought of when drinking

So I wanted to launch into each topic in some detail to help SHINE THE LIGHT on one of the most commonly used substances across the globe!

1. EFFECTS OF ALCOHOL, HOW IT WORKS (biochemistry, short-term & long-term effects, and what an alcohol emergency looks like)

https://www.betterhealth.vic.gov.au

CNS depressant chemical; one of the oldest and most commonly used recreational drug. Slows down the processes in your brain and CNS, and can initially make you feel less inhibited and RELAXED.

However, your body can get ‘used to this’, so enter the ‘fight or flight’ mode without alcohol in your body or as it wears off, and it can create a vicious cycle of needing alcohol to FEEL relaxed, but not having it in your system creates this heightened CNS.

Tolerance can occur, which means that you need more alcohol to exert the same effect.; which puts you at a greater risk of alcohol dependence.

In terms of MENTAL HEALTH and the impact that alcohol can have, on the www.drinkaware.co.uk website, they have this statement;

‘if you drink more than the UK Chief medical officers low risk drinking guidelines, it can have a negative effect on your brain chemistry and lead to worse mental health.

It also states that ‘binge drinking is found to have more likely to have symptoms of depression, with people who reported regular hangovers as most at risk.’ (with binge drinking being more than 8 units of alcohol in a single session for men, or 6 for women in the UK).

It continues to state that cutting out alcohol completely for just 4 weeks makes a clear difference in how they feel.

Alcohol is a CNS depressant and works in the brain primarily by;

• Small amount of alcohol can stimulate GABA (the inhibitory neurotransmitter), which causes a relaxation effect, but heavy drinking can deplete GABA, causing increased tension and feelings of panic


• It impacts other neurotransmitter systems of GLUTAMATE, GLYCINE, ACETYLCHOLINE, SEROTONIN.


• The pleasurable effects occur due to the increased level of DOPAMINE and ENDOGENOOUS OPIOIDS in the reward pathway of the brain.


• All of these contribute to alcohol’s ‘’reinforcement related’’ adverse effects of; ADDICTION, DEPENDENCE and WITHDRAWAL

How much alcohol impacts the body will depend upon;

• How much you drink


• Your pattern of drinking


• The quality of alcohol you drink


• Body size and composition


• Age


• Drinking experience


• Genetics


• Nutritional status


• Metabolism


• Social factors

What are SHORT TERM effects?

• Lowered inhibitions


• Feeling of relaxation


• Inducer of sleep due to the drowsiness/sedation


• Interpersonal conflict


• Falls and accidents


• Altered behaviour; including risky or violent behaviour


• Hangover


• Alcohol poisoning

Alcohol triggers a number of reactions in the body;

-frequent urination and dehydration

-inflammatory response from your immune system

-irritation to the stomach lining by increasing gastric acid secretion (it can enhance complications with people with PUD or H. pylori)

-a drop in blood sugar

-expansion of blood vessels

-can cause liver damage; due to accumulation of fats in the liver as a result of alcohol metabolism. It can cause cell death within the liver

What are symptoms of a ‘Hangover’?

Hangover symptoms usually last up to 24 hours and resolve on their own;

• Thirst, headache, muscle aches, diarrhoea, nausea, fatigue, weakness, trembling or shaking, rapid heart rate, increased blood pressure, dry mouth and eyes, poor concentration, increased sensitivity to light and sound, feeling like the room is spinning or dizziness


• Anxiety, depression, irritability and mood disturbances


• Feeling jittery


• Poor, restless or less sleep

Hangovers tend to be worse if;

• Drink on empty stomach


• Use other drugs and smoking nicotine is known to make it worse


• Sleep poorly after drinking


• Drink dark coloured alcohol such as brandy, rum and whiskey

What is an ‘’ALCOHOL POISONING EMERGENCY’’?

This is a life-threatening emergency due to the number of organ systems involved with alcohol poisoning.

Call 000 if you notice any;

• Confusion


• Vomiting


• Seizures


• Slow breathing, less than 8 breaths per minute or irregular breathing (a gap of more than 10 seconds between breaths)


• Blue tinged or pale skin


• Hypothermia; low body temperature


• Difficulty remaining conscious


• Passing out/unconscious and can’t be woken

The AMOUNT of alcohol required to reach this poisoning will be DIFFERENT for everyone based on the above factors discussed. If in doubt, check it out!

What are LONG TERM EFFECTS?

The WHO indicates that alcohol contributes to more than 200 different diseases and injury types.

Some examples;

-road and other accidents

-mental health conditions; such as anxiety and depression; as well as interference with antidepressant medication

-domestic and public violence

-crime

-family breakdown and social dysfunction

-cardiovascular disease

-cancers

-overweight and obesity

-risk to unborn babies

-liver disease, long term cognitive impairment, self-harm

What are WITHDRAWAL SYMPTOMS?

• confusion, paranoia, anxiety, insomnia, agitation, tremors, fever, nausea, vomiting, seizures and hallucinations, delirium

1. WHAT ARE THE NHMRC ALCOHOL GUIDELINES: National Health and Medical Research Council

The lifetime risk from drinking alcohol increases the more you drink.

For healthy men and women, the guidelines are;

• Drinking no more than 10 standard drinks per week reduces the lifetime risk of harm from alcohol related disease or injury

• Drinking no more than 4 standard drinks of one day reduces the risk of alcohol related injury arising from that occasion

• Children under 18 years should not drink alcohol to reduce the risk of injury and harms to health

• Women who are pregnant; to prevent harm from alcohol to the unborn child, women who are pregnant or planning to become pregnant should not drink alcohol

• Wom