Letter for Happy Hour, April 21st, 2022
Can mocktails suitably replace the real stuff? Can we stop our antacids? Can we boldly grow old?
[ Alive : longevity and an ounce of prevention ]
In a previous letter I wrote about the conflicting pleasure and poison of drinking alcohol. I tried not to be judgmental, as I too enjoy a drink. But I did state the evolving consensus is clearly that the less alcohol we drink, the better. Since that time I have had multiple people tell me in the office that they have cut back their drinking, and one has chosen not to have another drink since reading that post. These letters sometimes have more influence than the hurried advice I dole out during packed, rapid fire visits… and for that I’m thankful that you are reading!
I had the pleasure of getting together with some family during Easter. In addition to drinking some wine, I got to try out some new non-alcoholic spirits. One tasted like gin. Another mixed into a complex citrus cocktail. And the last one tasted just like whiskey, with the bite coming from cayenne instead of ethanol. My favorite was the “gin” - made by a brand called Monday. I mixed it with tonic, and it went down smoothly, and with as much pleasure as Hendrick’s. Which got me thinking…
The burn we feel when drinking alcohol is not a good thing. It’s a damaging sort of warning our mucosal nerve endings are sending us… like when we rub alcohol in an open wound. Yet the calming, enjoyable, and disinhibiting effects of alcohol that soon follow condition our brains to associate that fire with pleasure instead of alarm. Mix in pleasing botanicals, hops, or notes of ripe fruit, and you’ve got a potent cue that relaxation is coming. Ethanol by itself is not a complex taste… just a burning sweet and bitter taste on the tongue. It has to be ginned up with flavor.
Yet I argue that these non-alcoholic spirits like Grove 42 - with its “sophisticated, bright, citrus blend of Mediterranean Orange, Lemon Peel, Lemongrass and Ginger with a dry finish” - might just work like a great placebo on our way to relaxing and feeling pleasure while drinking. I swear, the mocktail I drank tasted really good, and my brain was happy, like as if I were drinking the real stuff.
Placebos work at least 30% of the time. Studies have shown that even when we know we are getting a placebo, they still work 30% of the time.
Pavlov’s dogs, who were trained to salivate when they heard a bell announcing the coming of their food, were a famous example of how the brain can be conditioned. I’m only a prefrontal cortex above those dogs.
So I think it’s fair to say that I enjoyed these non-alcoholic spirits because they tasted like the real thing. My brain, like a dog’s, then associated the gin-like botanicals with a future buzz and prepared itself to chill. As I carried on with conversation, the placebo effect of sipping a mocktail enhanced the pleasure of good company. And when the night was done I was able to safely drive home and sleep well. And my mouth, esophagus, stomach, intestines, brain, nerves, and liver had less patching up to do than they would have had after 4 drinks.
I still enjoyed that single glass of wine though, too. But I’m stocking up on a few of these alternatives through Amazon if interested. Plus most of these spirits have no calories, if that’s important to your health goals:
[ Well : ideas and studies that promote better health ]
Speaking of less stress on the stomach from alcohol… some updated guidelines were released recently by the American Gastrointestinal Association about weaning off proton pump inhibitors. PPI’s are consistently among the top 10 medications prescribed, and people often stay on them for years and years. Think Prilosec, Nexium, and the like. According to the guidelines, doctors should consider stopping these meds much more frequently.
So why stop a medicine for heartburn, especially if it’s harmless? Well, no medicine can be considered completely harmless, and while these antacids are relatively safe, there has been some chatter about possible long term risks, especially in those taking these medications for decades. From a medical education piece published by the Mayo Clinic:
Although PPIs have had an encouraging safety profile, recent studies regarding the long-term use of PPI medications have noted potential adverse effects, including risk of fractures, pneumonia, Clostridium difficile diarrhea, hypomagnesemia, vitamin B12 deficiency, chronic kidney disease, and dementia.
The only definite indications for continuing these meds long term (greater than 8 weeks) include:
complicated gastroesophageal reflux disease (e.g., severe erosive esophagitis, peptic stricture)
Barrett’s esophagus
eosinophilic esophagitis
Zollinger-Ellison syndrome (a rare, tumor-related overproduction of acid)
stomach protection in high-risk users of nonsteroidal anti-inflammatory drugs
idiopathic pulmonary fibrosis.
Acid damage can bleed. Less acid = less bleeds. The guidelines caution that people at risk of gastrointestinal bleeding should not discontinue PPI’s. This includes patients on multiple blood thinners, or with prior GI bleeds.
Docs should warn their patients that if PPI’s are discontinued, a temporary rebound increase in acid production may occur for days or even weeks. This rebound heartburn often convinces people that they cannot stop taking PPI’s. But if this rebound can be managed in the short run by using another antacid like Pepcid, or even the PPI as needed, perhaps the med can still be discontinued successfully.
The guidelines are quick to note that PPI’s should not be discontinued because of the fear of developing an adverse effect. It’s more just that people are started on these meds, and are often left on them without further consideration of the indications for indefinite use.
Did I mention that reducing alcohol helps heartburn?
[ Human : resisting trends that diminish us ]
This is the bargain. If you want to grow older - and growing older is a privilege - then these pains and problems are what you have to accept as the price we pay.
A wise woman stated this to me on Tuesday. We were discussing the many ravages of age upon the body. I had seen people that day with a torn rotator cuff, a torn Achilles tendon, a torn ligament in the foot, torn meniscal cartilage in the knees, and a torn biceps. One of these tears was in my own body, and I was feeling rather sorry for myself.
Yet we cannot expect to accumulate years, stories, and a full life without a similar ledger of wear and tear. Some of that wear and tear can be excruciating. We don’t get much of a choice about how long we live, but the price of living is certain. Gravity, entropy, and chaos must be paid in full, with regular installments along the way.
But life is worth that pound of flesh paid.
Life is, indeed, totally worth it. 😊💕
We have Monday gin in our liquor cabinet right now, I haven’t tried the Monday whiskey yet. When I participate in Dry January I switch to sparkling water(Drinkmate style) and flavored balsamic vinegar, it worked like magic, different flavors for each night. As for the aches and pains of growing in my 60’s, firstly my knee replacement was one of the best decisions I’ve ever made. I had no idea the total systemic effect the chronic pain and inflammation was having on me, so if any of your reader are considering it, I’d say give it a go and do all your physical therapy diligently.