What Alcohol Does to Your Body: Harvard’s Dr. Sarah Wakeman With the Medical Facts You Need to Know

KEYPOINTS

• 01

  Your cocktail contains the same molecule as rubbing alcohol

  Dr. Sarah Wakeman, senior medical director for substance use disorder at Mass General Brigham and associate professor at Harvard Medical School, explains that drinking alcohol is made by fermenting sugars or starches. It's the same molecule found in hand sanitizer, mouthwash and rubbing alcohol. Some of her patients with the most severe alcohol use disorder drink those products when they can't get alcohol, which shows the power of addiction.

• 02

  The 'red wine is healthy' research had a flaw

  Early studies compared moderate drinkers with non-drinkers, but many non-drinkers abstain because of chronic illness or past alcohol use disorder, which raises their mortality. Newer studies use infrequent drinkers as the comparison. Wakeman describes a large recent study of hundreds of thousands of people surveyed from the 1990s to the mid-2010s that controlled for lifestyle and chronic conditions. It found a slight mortality decrease for low-risk drinking, but not for cancer.

• 03

  Any amount of alcohol raises cancer risk

  Breast cancer is strongly associated with alcohol, possibly through hormone effects, which is still being researched; liver and gut cancers also make sense given alcohol's path through the body. Wakeman says this matters especially if you have a personal or family history of cancer. She won't frame drinking as health-promoting, though she notes zero-risk living would also mean never driving, skiing or eating bacon.

• 04

  Liver damage can reverse until it can't

  Heavy drinking inflames the liver, leading to fatty liver, which can reverse if you stop; the liver can regenerate even after 80% is removed. Past a threshold, scarring becomes cirrhosis. Wakeman now sees people in their early 30s with cirrhosis, sometimes dying during that hospital stay, when transplant is the only option. She cites a significant rise in alcohol-related liver failure from 2010 to 2020, especially among women and younger people, and roughly a 25% rise in alcohol-related deaths after COVID began.

• 05

  Alcohol dehydrates you by blocking a hormone, and harms your gut

  You pee more because alcohol makes your kidneys less sensitive to antidiuretic hormone, not because of the volume you drink. In the gut, it can make the intestinal wall more porous ('leaky gut') and alter the microbiome, as a high-fat, high-sugar Western diet can.

• 06

  Higher-risk drinking thresholds

  Per Wakeman, for women or anyone over 65, higher-risk drinking means more than about 10 ounces of hard alcohol or 35 ounces of wine per week. Above that, risks rise for dementia, liver and digestive problems. Mel notes home cocktails are often three shots poured in one 'glug,' and admits she's lied to her doctor about how much she drinks. Wakeman says she lies to her dentist about flossing and sees earning patients' trust as her job.

• 07

  The warning-sign checklist

  Wakeman asks: Are you drinking more than you intend? Have you tried to cut back and failed? Do you keep drinking despite worried loved ones, work problems, or worsening anxiety or health? Do you have cravings? Physical signs include tolerance (needing four drinks for the effect one or two used to give) and feeling sick when you stop. The core of alcohol use disorder: loss of control, compulsive use and use despite consequences.

• 08

  Alcohol quietly disrupts sleep, mood and menopause symptoms

  It helps you fall asleep faster but disrupts sleep architecture, so you may wake at 2 a.m. or feel unrested. It relaxes the valve that keeps stomach acid down, worsening heartburn. Because it dilates blood vessels, Wakeman says any amount can worsen hot flashes. Heavy use can cause a substance-induced mood disorder that looks like depression.

• 09

  Hangovers aren't mild withdrawal

  Wakeman says hangovers are now thought to come mainly from dehydration plus toxic byproducts, including other compounds in some drinks, which is why dark liquors tend to cause worse hangovers than clear ones. Over time the brain adapts to regular drinking by changing receptors, dopamine and stress hormones, which drives tolerance and leaves you shaky and anxious when you stop.

• 10

  Never mix alcohol with sedating anxiety medications

  Combining alcohol with benzodiazepines such as Xanax, Klonopin or Ativan can slow breathing, cause impairment sooner and risk overdose. Wakeman also notes that people drinking to ease anxiety or depression may be working against their own treatment.

• 11

  Alcohol use disorder is common and treatable

  Wakeman says about 15% of people will have alcohol use disorder at some point, and most will get well with care. It's a health condition like depression, diabetes or high blood pressure, not a moral or willpower failing. If someone isn't meeting their goals, she says the treatment isn't enough yet; the person isn't failing.