Alcohol and your blood

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From bruises to blood donation, menstruation to mozzies, the first season of It Can’t Hurt To Ask focuses on blood.

Does alcohol make you turn red? How does a breathalyser work? How would you know if you’re drinking too much, and where can you get support?

In this episode, we learn all about how alcohol affects the body from Dr Jeremy Hayllar. He demonstrates how a breathalyser works, explains how alcohol affects your brain and memory and offers tips for people wanting to rethink how they drink. As the clinical director of the Alcohol and drug information service (Adis), he provides insight into alcohol dependence and the ways in which the service can help people to stop drinking.

Featured in this episode

Dr Jeremy Hayllar

Dr Jeremy Hayllar is the clinical director of Metro North’s Alcohol and drug information service, or Adis. He has worked in the role for 19 years, and says he still finds the work incredibly rewarding.

Episode resources

Alcohol and drug information service (Adis)

Adis is an anonymous, 24-hour, 7 day a week confidential support service for people in Queensland with alcohol and other drug concerns, their loved ones and health professionals.

You can call Adis at any time for counselling, information and advice – experienced counsellors are available to listen and give you options about the next steps.

You can get more information on the Adis website or call on 1800 177 833.

Australia’s Alcohol Guidelines

In this episode, Dr Hayllar talks about the Australian Alcohol Guidelines, which provide guidance about how much to drink to reduce the risk of harms caused by alcohol.

The Australian Alcohol Guidelines recommend:

  • healthy adults should drink no more than 10 standard drinks in a week, and no more than 4 standard drinks on any one day
  • people under 18, and women who are pregnant, planning a pregnancy, or breastfeeding shouldn't drink any alcohol.

You can find more information about the recommendations and tips to manage your relationship with alcohol on our Your Drinking web pages.

Transcript

Vox pops: What is a blackout?

How does a breathalyser work?

Why is our memory fuzzy when we drink?

Does alcohol actually make people turn red?

Narrator: Welcome to It Can’t Hurt To Ask, the podcast from Queensland Health exploring all your health questions, concerns and curiosities.

This season is all things ‘In My Blood’ and today, we’re learning about alcohol.

Hi, I’m Lauren and this episode was recorded on the lands of the Jagera and Turrbal people. I acknowledge the Traditional Custodians and pay my respects to the Elders past, present and emerging.

Remember, whatever you hear in our episodes is general information. Always speak to your doctor about your individual circumstances.

And a note for our listeners that today’s episode will include discussions about alcohol consumption and use. If these topics are difficult for you, take a break or skip this episode.

If you or a loved one are struggling with alcohol or drug use, reach out to our alcohol and drug support service, Adis for free and confidential support – we’ve added a link in the show notes.

Alright. Let’s get into it.

Drinking is a big part of Australian culture and is strongly connected to social situations. It’s rare to visit a restaurant or attend a gathering without seeing people drinking beer, wine or spirits.

Alcohol is the most commonly used drug in Australia. People use alcohol to socialise, kick back and relax after work, or let their hair down on the weekend.

Unfortunately, this all-too-common substance can cause harm to individuals, families and the broader community.

So why is alcohol so often associated with relaxation and celebration in Australia? And what does it actually do to our bodies? Let’s find out.

Dr Jeremy Hayllar: My name's Jeremy Hayllar and I'm the clinical director of the Alcohol and Drug Service, which forms part of Metro-North mental health.

Narrator: Located in Brisbane’s north, Dr Hayllar and the team provide a range of services for people who are seeking treatment due to their alcohol use. This includes outpatient and inpatient withdrawal management services, counselling and group therapy programs.

To understand the harms of alcohol, you first need to know what it does to your mind and body.

So, let’s dive in head-first. Or should I say, brain-first.

Dr Jeremy Hayllar: When we start drinking, we feel it going to our head quite quickly. We feel a bit dizzy, a bit intoxicated, is probably the word. And that's the stage where the alcohol is having effects on the brain. It acts on various neurotransmitters. It increases GABA, which is the main calming transmitter in the brain.

Narrator: Neurotransmitters are chemicals in your body that send messages between nerve cells, muscles and glands. These messages help you move your limbs, feel sensations, keep your heart beating and more.

As Dr Hayllar said, GABA – or Gamma-Aminobutyric Acid, for our neuroscience fans – creates a calming effect in the brain. Alcohol increases GABA, which reduces the ability of nerve cells to communicate with each other.

Alcohol also reduces glutamate, a neurotransmitter crucial for your memory and learning, which helps nerve cells pass messages along.  GABA and glutamate work like an ‘on’ and ‘off’ switch in the brain.

But, what happens when alcohol increases GABA and reduces glutamate?

Dr Jeremy Hayllar: Now the way that has its effect is it releases some of the frontal lobe controls on our behaviour.

So, we suddenly feel we can say things which we wouldn't normally say in company. If we're shy or anxious, we suddenly feel, wow, we can go out and face everyone. One common scenario is someone might start using alcohol to overcome their social anxiety, and as they continue to use, they become tolerant, they start drinking more, and over the course of many months or years, they become dependent.

So, what was initially a benefit for them because it reduce some of their concerns about being seen with others then becomes a problem in itself.

Narrator: But, what happens when a few drinks turns into a few too many?

Dr Jeremy Hayllar: If you drink even more than that, then you start losing coordination. Your memory is affected.

It might be losing your belongings, it might be getting assaulted or attacked, all sorts of things like that, which can happen when the alcohol really is reaching high level.

Narrator: And, the worse-case scenario …

Dr Jeremy Hayllar: So, if you carry on drinking after that, then you can cause coma and even death. And the example I sometimes use is, Amy Winehouse. She died a few years ago at the tender age of 27. So, she'd come out of rehab a few weeks earlier. And while things were going well, something bad happened. So, she reached for her chosen drink, which was vodka. She drank a bottle of vodka, and in that process she went into coma and died. So that kind of illustrates the loss of tolerance when you do a withdrawal and the acute effects of alcohol, which really can be very serious in large quantities,

Narrator: Is that what people mean when they talk about alcohol poisoning? The terms can be thrown around to describe someone who is really drunk, or sick from too much alcohol. What is it, exactly?

Dr Jeremy Hayllar: I think broadly you've got such a high level of alcohol in your blood that it's really turning off the normal functions of the brain so you become comatose because of poisoning and that may lead to death. So, alcohol poisoning really means you've lost consciousness and there are lesser levels which might manifest in a terrible hangover the next day.

Narrator: Speaking of hangovers…

Vox pops: When I was younger, I used to be able to just brush it off quite easily and sort of next day, you know, feel fine. However, yeah, as I've got older, they just, I just suffer from them now.

Dr Jeremy Hayllar: So, you know, when you talk to people who've had a big night out the next morning, they say they'll never drink again and they feel absolutely ghastly. And that is the hangover effect, which is a result both of other congeners, as they're called. So other factors in the drink and also the dehydration, which comes about when you do drink, you tend to pass more urine than is necessary or appropriate because of, again, alcohol's effects on the brain.

Narrator: And blackouts – alcohol-induced memory loss. What's happening in your brain when you can’t remember what happened the night before?

Vox pops: I don't love the waking up the next day and the feeling of not really being sure what you said or what you did. I think that's probably the worst experience or memory I have from like when I was younger and was drinking more. It's that feeling of, oh God, did I say something stupid?

Dr Jeremy Hayllar: Alcohol seems to be able to switch off the laying down of memories while one is intoxicated.

Narrator: Blackouts occur when alcohol temporarily blocks the transfer of memories in your brain from short to long-term storage. You'll be awake, but memories of events won't form, and they usually can't be recovered. It's as if the events never occurred…

Dr Jeremy Hayllar: It's actually one of the questions I ask patients when they come in to seek treatment, broadly withdrawal treatment. So do you have blackouts and, you know, most of the patients who've been drinking heavily, in other words, more than, say, eight or ten units a day over the long term will admit that they have blackouts.

So, they may not have a clear recollection of the events the night before. Often, they wake up on the couch at 3am. Because they're fallen asleep. They don't recall what happened in the events leading up to them falling asleep.

Narrator: Many of us drink alcohol. In fact, in Australia 1 in 3 people drink more than they should on a single occasion. This is commonly referred to as binge drinking – which is, drinking more than 4 standard drinks. The Australian alcohol guidelines recommend drinking no more than 4 standard drinks on any one day.

Vox pops: When I drink alcohol, it makes me feel relaxed, silly, more chatty, and more up for doing anything. As I drink more alcohol though, I start to feel really unsettled, really out of control, and like I don't have a handle on what's going on around me. The thing I hate most about when I drink alcohol is it really stops me from feeling in control of my emotions. I get quite teary, and sometimes I really lose control of my emotions.

Narrator: The possible short-term effects of drinking too much alcohol are clear: dizziness, poor balance, poor co-ordination, drowsiness, impaired judgement, headaches, nausea and vomiting, mood swings.

But, what are the long-term effects? If you’re a healthy adult, drinking more than 10 standard drinks a week can negatively impact physical and mental health over your lifetime.

We’re talking alcohol dependence, weight gain, increased risk of cancer and more.

In the medical world, high blood pressure is known as hypertension. If you have high blood pressure, you may not feel any symptoms, so it’s important to get your blood pressure checked. Drinking too much alcohol is one of the factors that increases your risk of having high blood pressure.

High blood pressure can have unwanted health effects on your heart, brain, kidneys and other organs.

Dr Jeremy Hayllar: So, hypertension contributes to heart disease. It may cause the heart to grow in in thickness. It provides a greater workload for the heart to undertake. It may cause damage to the kidneys because they're very sensitive to blood perfusion.

Narrator: Perfusion is the flow of blood or fluid to tissues and organs.

Dr Jeremy Hayllar: As you can imagine, if you've got very high blood pressure, you risk a vessel bursting, for example, in your brain, which can lead to stroke.

Narrator: A quick note: a stroke occurs when the blood supply to a part of your brain is suddenly reduced.

Dr Jeremy Hayllar: In addition, we should say thatif the liver has been damaged long term, then the blood clotting may be impaired because the liver is responsible for making many of the proteins that allow us to have a clot form when we are injured. So if that has happened and you have on top of that high blood pressure, then the risks of a stroke becoming really catastrophic are very significant.

Narrator: Stroke is a serious medical emergency, and one way to lower your risk is by reducing alcohol consumption, blood pressure and cholesterol.

Let’s explore how long-term alcohol consumption also impacts your blood and its ability to clot. This podcast series is all about blood, after all.

Dr Jeremy Hayllar: When you've been drinking for a long period, alcohol affects the liver, which makes the clotting factors. And so if you're not making clotting factors adequately, alcohol can cause the spleen to enlarge basically because of its effect on the liver. And that will cause the platelet count in the body to, in the bloodstream to reduce.

And when that happens, your blood is thin because it bleeds much more easily and much for much longer for any particular injury.

Narrator: And what about the effects of alcohol on the developing brain, in utero?

Dr Jeremy Hayllar: We're seeing cases across Australia of foetal alcohol spectrum disorder and this is damage to the developing child in utero which expresses itself in both physical and intellectual findings, which really are very serious and lead to people having to go into maybe care or maybe custody.

Alcohol has those negative effects both on the developing brain in utero and during youth and in adolescence. So, protecting young people from the effects of alcohol is really important. It reduces their risk of immediate harm and also their future risks of going on to develop alcohol dependence.

Narrator: Stroke, blood thinning, high blood pressure, liver damage, foetal alcohol spectrum disorder are all serious issues linked to excessive drinking

Over consumption of alcohol also plays a significant role in accidents, violence and crime.

The reality is, drinking alcohol is never completely safe.

The good news? By controlling your alcohol intake and drinking responsibly, you can avoid these harmful effects.

If you suspect you or someone you love has a drinking problem, knowing the warning signs and where to find support can also be helpful.

But, how do you measure your own risk, or know if you’re drinking too much?

One way is to familiarise yourself with the Australian Alcohol Guidelines, which outline what's considered 'safe' and 'unsafe' drinking.

Dr Jeremy Hayllar: You should have generally a maximum of two standard drinks each day, four in any single drinking occasion. And if you do the sums, then you will probably be having one or two alcohol free days as well. And that is for healthy adults without other issues that may make them more vulnerable to the effects of alcohol.

Narrator: No more than two standard drinks a day … does this surprise you?

Counting the number of standard drinks is an easy way to keep track of how much alcohol you’re drinking. But it can be hard to work out what a standard drink is when you’re out at a restaurant or bar.

Let’s go back to Dr Hayllar to learn more.

Dr Jeremy Hayllar: This really depends on the alcohol content of the beverage and the volume.So, we kind of say that a gold stubby is approximately one standard drink, that implies there is ten grams of alcohol in that container, if you like. If it's a heavy beer, then that's generally 1.4 or even 1.5 standard drinks in a heavy beer. Now, all alcoholic beverages have to have the alcohol content on the label.

So, when you buy a bottle of wine, it'll say seven, eight, eight and a half units in a 700 ml bottle. And spirits likewise are a measure of about 30 mls of the spirit typically contains about 40% alcohol, which will be about ten grams.

Vox pops: So like on a night out, usually if I'm just going down to the pub I may have sort of four or five schooners typically and then head home. Some evenings when I'm at home and I'm just relaxing or whatever I might have a couple in the evening time.

Narrator: If you’re drinking more than 10 standard drinks a week or more than 4 standard drinkson any one a day, that’s considered an unsafe level of drinking.

Dr Jeremy Hayllar: ehe first thing that I ask patients often is do you know what the current guidelines say? Because that is kind of setting a safe level of drinking. And of course, most of the patients who present for help are well, well over those guidelines.

Having said that, though, when people do develop an alcohol dependence, usually the best approach to manage that, having completed a withdrawal, is to aim for abstinence. The reason being, and this is another phrase I use with patients, is look, unfortunately you’ve lost your off switch, so as soon as you have one drink, the high likelihood is you’ll carry on drinking after that, whereas maybe your partner or your friends, they can have one or two drinks and that’s it, they stop, because they know they've had enough.

Narrator: Dr Hayllar and his team provide a range of treatments for people with moderate to severe substance use disorders.

Dr Jeremy Hayllar: There are a range of reasons that people present. One of the ways we look at alcohol addiction or dependence is one of the disorders we treat, is that it affects many domains of life. So, it may affect work, it may affect the home life, family, it may affect recreation, so you lose interest in other activities and more and more you focus on acquiring alcohol, drinking and recovering from the use.

Narrator: Social factors can also play a role. We know that men are twice as likely to drink at risky levels compared to women, with men in their 50s being the most likely group. Similarly, among women, those in their 50s are now more likely to drink at risky levels.

How do we define alcohol dependency?

Dr Jeremy Hayllar: A dependence is probably a preferable word just because addiction is often shortened to addict, which is stigmatising and unhelpful. So, patients may call themselves an addict. We try not to use that term.

So, when you're developing a dependence, really the substance on which you’re dependent becomes more and more important in your life. You neglect other activities which may be work, family, leisure activities, meeting your friends, and you become more and more focussed on acquiring and using the substance. You develop tolerance. So, to achieve that altered state, whereas one or two beers might have done it at the start, you now need five or six to achieve the same effect.

Narrator: You or someone you know might be drinking too much if they: have a strong urge to drink, can’t control how much they drink, drink while alone, or hide it from members of their household, or struggle with work or relationships.

If you suspect that you or someone you love has concerns about their drinking it can be helpful to know where to find support.

Dr Jeremy Hayllar: One service that I'd like to flag is the Adis. So that's the Alcohol Drug Information Service. And although that used to be its role, it's now very much more involved in counselling and support. So, there's a range of trained counsellors available 24 hours a day who will engage with someone phoning up saying they've got a problem and try and provide them with suitable resources to go to next.

Narrator: Adis 24/7 Alcohol and Drug Support is a great place to start. The service is available to friends and family, too.

Another important starting point for treatment is to talk to you doctor about how to control your alcohol use.

Stronger dependence may need different treatments to manage the effects of alcohol withdrawal. Dr Hayllar explains how the process works for his patients.

Dr Jeremy Hayllar: So, you can generally be seen within a day or two of your reaching out to Adis and we would then provide medicated support safely to get you through withdrawal.

And that process, having been assessed and seen by the addiction doctor, that process generally takes four or five days. We will usually do bloods, physical examination and then we support the withdrawal process with treatment that helps people sleep, deals with anxiety and stop some of those awful withdrawal feelings. And then at the end of that engagement, we then discuss with the patient whether there's any medications which may help them deal with cravings down the track to keep them on their new chosen path.

We see patients coming in who are often in big trouble, whether that's relationships, job, the law, whatever triggered that appearance, or maybe they're just worried about their own health. We watch them over a few days. We see them a week later and often they, they’ve really transformed themselves.

Now, I won't pretend that there aren't missteps along that path because we do see people often more than once. And as long as people learn from prior experience and try and apply that learning to their next attempt at withdrawal, then it hasn't been wasted.

Narrator: If you’re looking for more information about Adis, withdrawal treatment and other support, we’ve added links to the description of this episode.

Your blood carries the alcohol you’ve consumed around the body, and it’s measured as blood alcohol concentration – or BAC.

This is what people test for in roadside alcohol breath tests.

You must be below 0.05 per cent BAC to drive in Australia – although your legal BAC limit  could be less, depending on what type of license you have.

The limit shows us that it’s only takes a low level of alcohol in your blood to cause impairment, with driving we’re talking about impairment to your coordination and attention and your driving skills.

Let’s see how a blood alcohol meter works.

Dr Jeremy Hayllar: So, I brought a breath alcohol meter today to show you how it works. Now, I haven't been drinking, so if I don't get a zero result, then I'm in trouble. The machine takes a few seconds to switch on, and once it's ready, I will blow into it.

Right, that's a great relief. The reading was 0.00.

Narrator: But, how sensitive is the machine?

Dr Jeremy Hayllar: So, I've got a little bit of alcohol hand wash here, which tastes alright, not great, but I'm just going to put that in my mouth. Thank you very much. And I will do that again.

Narrator: Now, Dr Hayllar blows into the machine. And, the numbers are going up already.

Dr Jeremy Hayllar: So, we've reached .12. We've reached .15. We've reached .18. So, remember, the limit for driving is .05. So that kind of shows how sensitive this machine is. And although we drink large volumes, they're obviously diluted because they're going into our circulation, yet quite low concentrations can have a dramatic effect.

Narrator: And how is it actually picking up the alcohol?

Dr Jeremy Hayllar: It's picking that up, alcohol up in the air. Yes. So, as I breathe out, I blow that off my tongue. So, the final reading is 0.318. So, most people would be under the table at that level. I certainly would be. I'd be unconscious.

Narrator: In a hospital or another setting, you might get a blood test that would measure this.

Dr Jeremy Hayllar: You can measure blood alcohol in a blood test, although if someone can blow in the machine, then that's simpler and quicker.

Narrator: It generally takes the body about one hour to process one standard drink. However, two people can drink the same amount of alcohol and have different BACs.

Your blood alcohol levels can be influenced by your age, sex, body size, liver health, medications and how much you’ve eaten.

Dr Jeremy Hayllar: So, if you do drink on an empty stomach, then alcohol is very rapidly absorbed through the stomach lining, goes into the bloodstream and the effects will be felt within a few minutes. The effect of food is to slow that process down a bit and stop the peak developing so it's in some way protecting you from some of the effects. Though it wouldn't be a strategy I would recommend, better to have a less alcohol intake rather than to try and compensate with more food.

Narrator: We’ve done a deep dive into the harms of drinking alcohol.

Let’s focus now on some of the physical and mental health benefits of reducing your alcohol intake.

Vox pops: The main thing I do to avoid alcohol is to just not socialize in those sorts of settings. I like to go out for cups of tea, coffee and lunch with my friends. I like to go for walks with my friends or hang out with them and their kids. So I'm not really around a lot of settings that has alcohol as part of the social

Narrator: There are some key benefits to reducing or quitting alcohol Dr Hayllar sees in his patients.

Dr Jeremy Hayllar: They've actually got an appetite. They can enjoy breakfast and time with the family instead of coping with a severe headache and a hangover and just not feeling like doing anything.

So that's a big immediate benefit. They will also have a clearer memory. So, we've talked before about how alcohol affects the memory, so they'll remember stuff they've done. They'll get more done.

So, another effect I would say is on the mood. There was a study done on people going to a rehab in New Zealand with alcohol problems and of about 200 patients, I think nine out of ten were on anti-depressants.

If you have a heavy intake of alcohol, then it's very unlikely that anti-depressant tablets are going to make any difference. I use the analogy of a rock band in one ear against quiet piano music in the other ear.

When it's quiet, you can hear the piano. That's the anti-depressant. If you've got a rock band in this ear, then the piano music is just wiped out and you're not going to hear a thing. So, I think an improvement in mood and improvement in motivation, getting things done, getting praise from those around you, from family who say, Wow, you're different now. One patient the other day said to me that his partner had said, you are a different person when you're drink. I don't like being around you. Now, you've managed to stop that, you're back to your old self. And that's really welcome. So that sort of support and encouragement I think makes a big difference to patients staying with it because it's not easy, I wouldn't pretend it was easy. It's really quite challenging.

Narrator: You might be thinking: what can I do to reduce how much I drink? There are many simple changes you can make, like: organising a coffee catch up, instead of meeting at the pub, destressing during a walk, yoga or meditation, instead of reaching for a drink or having regular alcohol-free days. If you decide to drink you could: swap to a low-strength drink, set yourself a drink limit, or having a glass of water between drinks.

Dr Jeremy Hayllar: Space your drinks out. Don't drink alcohol because you're thirsty. Drink water because you're thirsty. If you feel that you're letting the side down by not having a drink, then you have a lemon, lime and bitters and you do something different. It doesn't have to be an alcoholic beverage. And if you are staying sober in a group, what you tend to find is that after an hour or two when everyone has been drinking steadily, there's really no meaningful exchange. People are just giggling and talking nonsense. And you really wonder if this was such a great thing to be doing. So, there are many benefits of staying sober.

Narrator: Before we finish, as always, we’ve got a few myths to bust from your submissions.

Vox pops: Does alcohol actually make people turn red?

Dr Jeremy Hayllar: When I was a medical student, I was taught there were 20 physical signs of someone with an alcohol use disorder. The ones we might see in the pub would be plethoric facies. So, a reddened face, that seems to be due to dilatation of the superficial vessels under the skin.

So, there's more blood flow there and people do look bright red. And if you've only ever looked at anyone who's been drinking, they typically get flushed. It can affect the hands. There could be changes in the hands, so red palms can commonly be seen.

Narrator: Thank you for listening to this episode of It Can’t Hurt To Ask. We’ve covered a lot, and some of it was quite heavy, so if this episode has brought up any feelings of distress, support is available – you can find resources in our episode description.

Thank you to Dr Hayllar for sharing his expertise with us.

New episodes drop every week.

If you enjoyed this episode, please rate or review it. Even better, share it with a friend, family member or colleague who you think would also enjoy this episode.

We’ll be back in your ears next week. And remember, it can’t hurt to ask.