It has been a while since I wrote the Highbrow Paleo Guide To Binge Drinking and there has been an outpouring of positive reactions from many readers. People say that they have eliminated hangovers, that they feel well after a night of drinking when they might have otherwise had a rough day, and that they generally don’t see side effects from drinking like they used to. Others have had less success and this calls for some trouble-shooting. There have been general questions about what is essential and what is icing on the coconut flour paleo cake. Which are the core aspects of that enormous list of supplements and foods and which are redundant in combination with other supplements or foods? I will clarify my thoughts on the matter. I will also address some scientific tidbits and share new discoveries. This post will tie up some loose ends and right the ship for smooth sailing.
The core of the regimen is a handful (not literally, phew) of supplements and supplement types along with some foods and practices. Pantethine is hugely important for reducing the acetaldehyde accumulation from ethanol metabolism, and everyone except for those who will get significant facial flushing when drinking will benefit from it in this way.
To answer WCC Paul’s question about the specifics of facial flushing in response to alcohol: some people have a polymorphism where they only have one normal copy of the ALDH2 gene which codes for the enzyme acetaldehyde dehydrogenase (see the original post for the diagram), which metabolizes acetaldehyde to a safer molecule. One common copy and one mutated copy results in significantly impaired acetaldehyde dehydrogenase activity, whereas two common copies means better acetaldehyde metabolism (1). Since coenzyme A which is produced from pantethine must activate this enzyme to exert its effects on metabolism, it is like putting gas in a broken-down car to supply more coenzyme A from pantethine. No go. Pantethine has many benefits besides the aforementioned so this doesn’t mean that those who flush shouldn’t think about it anyway. Byron Richards has written a superb article about some of the benefits of supplementing with pantethine including better lipid metabolism, brain health and a reduction of fat accumulation in the liver(2).
It is estimated that this extreme facial flushing is mostly a phenomenon occurring in The Orient, to the tune of 50% of the population in some places. That is a significant percentage of the world. It is a smaller percentage of the readers of this blog but I suspect that we have enough East Asian readers to make this relevant. You will know who you are.
This is your face on acetaldehyde
Along with panetethine it is imperative that you maintain a nutritious diet and get extra Vitamin B1, Vitamin E, and Vitamin C on the day of drinking. These will protect the body from the stress of acetaldehyde. I favor getting these from food but an acute supplemental dosage if you haven’t been paying close attention to your diet will probably help.
Embarrassingly I unintentionally omitted Astaxanthin from the original article. Astaxanthin is a carotenoid and is responsible for the pinkness of salmon, shrimp and flamingos. It is one of my favorite antioxidants and definitely protects rodents from alcohol-induced liver injury (3). Its benefits for humans are quite impressive, and in placebo-controlled trials it can radically reduce oxidative stress and inflammation in most areas of the body(4). It appears to be an ideal nutrient for dealing with acetaldehyde toxicity and one that I recommend highly.
Flamingos know how to party
About using rat studies: I mentioned in the original post that it was useful to hazard a guess as to whether or not what protects rats can in similar ways protect humans, and I stand by it. This isn’t a precise protocol to begin with, it has to do with experimentation because all of us are in a different state with regards to our health. In assessing how we feel in our everyday lives and getting blood tests we can make adjustments as needed.
Rat studies aren’t a great reflection of what happens in humans all of the time, but when it comes to the ability of nutrients to protect an organism I think that the inference from rat to human is a lot more tenable than guessing what might kill a human because it kills a rat, as thousands upon thousands of studies on obese rats with metabolic syndrome spectrum diseases and disorders have suggested. Routinely rat studies are used by the unknowing to justify the notion that a particular food causes harm, when the conditions that the rats are living in are unnatural and don’t apply to healthy humans in the real world. Just adding additional basic nutrients to the diet and making rats exercise can alleviate many of the problems that a so-called “high fat”, “high sugar” or “alcoholic” diet and lifestyle can cause the little critters. It is for this reason that whenever I see rodents getting a disease from something or other I have to ask “what could we add to save these furry little guys?” and oftentimes there is much that can be done.
"Help me Astaxanthin, you're my only hope!"
But it is often correct to extrapolate to humans as long as we employ comparative anatomy, knowledge of the mechanisms and of the different possible contexts. Like I just suggested with Astaxanthin, when the mechanisms are the same in both humans and rats and when all reason points us to a conclusion, we should act on it. I suspect that increasing glutathione and other protective molecules in the liver will protect humans as it does rats, this is my experience, this is the experience of others, and I think I’m justified in believing it.
That being said, humans have to live for a very long time and rat studies often take place over the course of months. So we can’t infer that these things don’t cause great harm to humans in the long term because they don’t cause rodents to become diseased in the short term. Chronic toxicity can be mitigated for a time in some cases but over the long-term it can add up to a significant negative effect on the body. This is where I realize the limits of such a protocol but I still think that there is much merit in looking at damage reduction on the occasions we might over-indulge.
Back to the implementation of the protocol. Anti-inflammatory nutrients may be frivolous in some cases. If we are eating and living in a generally anti-inflammatory way we will be greatly protected from excessive systemic inflammation by default. However they can be a great boon for some people who are still fighting inflammation, and the nutrients that I selected are like an insurance policy, they protect rats quite well and the same mechanisms can be demonstrated to work in humans.
Combinations of anti-inflammatory nutrients may be synergistic or redundant. If you take curcumin you may not need ginger but some supplement companies feel that their supplements should contain both. If you take quercetin, you might not need resveratrol. I suspect that you only need one strong selective inhibitor of the COX enzymes prior to drinking. One of the options that I suggested in the original post will probably suffice. Save your money and buy the cutie at the bar a drink instead! Most of our anti-inflammatory potential should come from staying healthy with a good diet and lifestyle anyway.
The guide is meant to be an adjunct to good health and good diet. The healthier we are when we drink, the less it will affect us negatively. It is not just that we have more life to destroy but that the toxic effects are actually lessened when we are in good health. Although I mentioned it in the disclaimer, it needs repeating. For those who are in the process of getting healthy but aren’t quite there yet, the effects of alcohol are more dire than for the stunning examples of health that we see all around us in the health community. If you have intestinal dysbiosis, diabetes, are inflamed and have high levels of the most common clinical marker for chronic inflammation C-reactive protein (CRP, one of the most common markers for chronic inflammation) then alcohol is going to be more of a burden on your liver and body in general. The inability of the immune system to be controlled so that it heals and doesn’t hurt is vital to getting away with abusing one’s liver. A dysregulated immune response is what turns mild damage to hepatocytes into cirrhosis over the years. The level of CRP conducive to good health is generally recognized to be 1.0 mg/dl or lower. Many of us have a CRP level of 0.1 mg/dl and I doubt that anyone on the paleo diet or other healthy diets long term will have appreciable levels of chronic inflammation, but you should check to make sure.
You will want a liver enzymes test (measures liver health) and general metabolic panel if you are serious about boozing healthfully. It’s all up to the individual what they want to do, but I’m assuming that we’re all interested in health. Subjective assessments of health upon waking up and drinking some water after a night of drinking are good measures of adaptability to alcohol, but you can never be too safe.
Now for some trouble-shooting and further answers to questions about how to implement the protocol effectively:
Exercise: You should exercise some time in the day before drinking. You don’t have to exercise during drinking. Running away from a police officer after urinating on his car DOES count over the course of the days that will follow, but I would discourage that. We are degenerates, not jerks.
Glutathione-supporting supplements: Glutathione-generating nutrients are very useful but taking many of them might be redundant like with anti-inflammatory nutrients. Then again maybe not, I can’t give my definitive stance on that right now. N-acetylcysteine will directly generate it and is a top choice. Silymarin from milk thistle is a good choice for preserving glutathione status in the liver as well. Getting enough sulfur will allow you to synthesize more glutathione, and foods like whey, milk, and fruits and vegetables may be ideal for supplying or generating it (5). Green tea has also been shown to increase glutathione levels significantly(6). I can’t give any clear rules to follow here, but do look into ways to boost glutathione levels on a daily basis; it will help you greatly when you need it. Take the supplements days in advance of drinking. This is very important because we don’t want to be glutathione-depleted when we are drinking and take a few pills on the same day, hoping to increase our antioxidant status all at once. Glutathione is like money in the biological bank, build it, maintain it, and spend it as you see fit, but don’t try to spend what you don’t have. It takes a while to build up to highly protective levels.
Milk thistle/silymarin: try it alone before trying it with alcohol or other supplements. It can produce what I assume to be a detox reaction in some people, and then they go and blame the protocol for not working, but they end up feeling better when omitting the milk thistle. If you get a good response or no response to milk thistle then take it two weeks at a time, two weeks off, as well as prior to drinking. I think that there is wisdom in rotating herbs, because they can potentially have adverse side effects if used for prolonged periods. I can’t say for sure if milk thistle has chronic toxicity but there are some reports of it eventually impairing the liver’s ability to function properly. However there is no reason to think that it is harmful when used in moderation and at opportune times, indeed, the opposite is true.
New discoveries that weren’t included in the original article besides the ones already mentioned:
I mentioned in the original article that there were mechanisms by which alcohol harms the body other than oxidative stress and acetaldehyde toxicity, but assumed that my protocol would cover the rest because rats are usually in good health after these interventions. However alcohol can also lead to dysbiosis, an imbalance in populations of symbiotic and pernicious microorganisms in the gut. We disinfect wounds with it, marinade meat in it, and drinking it is like going nuclear on our gut flora. This isn’t necessarily a deal-breaker, because experiments show that the effect can be reversed with probiotics and prebiotics (7). Some lactobacillus strains and some fermentable fiber. Yeah yeah I know, more stuff to add to the pile of pills and foods, but this issue strikes me as uniquely important. Hopefully most people are getting a moderate amount of vegetable and fruit fiber and eating some probiotic-containing foods anyway and the point is moot. The researchers used prebiotic oats that feed gut bacteria, and lactobacillus GG to counteract the leaky gut from intestinal dysbiosis. Mmm! I’ll just add that to my rice flour, whey protein, high oleic sunflower oil and pile of pills. Oh wait, that’s not a joke I actually eat those things. Stabby is inadvertently on the lab rat diet, hold the Crisco!
Rat gut flora is different than human gut flora but I think the same principle probably applies. Maintain certain levels of certain beneficial bacteria. Stomach cramps and excessive flatulence in response to fibrous foods are good subjective asessments of the state of one’s gut flora.
There is a great deal of anecdotal evidence that a little bit of sodium bicarbonate (baking soda) helps to prevent a hangover. The mechanism is likely as Dr. Ray Peat suggests, carbon’s buffering of lactic acid buildup (8). Alcohol metabolism interferes with the breakdown of lactic acid, which can raise the pH of the cells and blood, causing inflammation and fibrosis as well as interfering with energy production. Having enough Co2 available to buffer it will help to offset this effect. It certainly helps athletes to perform better, however it might take a few weeks of taking it to see a benefit (9). Consider it! It can potentially impair the efficacy of stomach acid so be sure to take it during a non digestive period.
Finally, don’t forget to hydrate properly; not too much or too little. Alcohol is a fluid but also a diuretic and can be dehydrating. “Oh dear, did he just tell us to drink enough water?! What’s next, get to bed at a reasonable time? Duh!” While it may be obvious, it can be easy to forget. We may also benefit from electrolytes which are depleted by drinking. Coconut water or various electrolyte supplements will help us feel our best and rehydrate. Verily this is an extension and additional detail of the overarching theme we have been discussing: be well-nourished if you wish to drink in excess. One can find all sorts of essential and non-essential nutrients that can protect the body against alcohol and they are invaluable. Some more that I didn’t mention already are selenium and magnesium (10). Those are pretty basic to any healthy diet, but this further illustrates the benefit of being well nourished when drinking.
And there you have it. Another segment of The Highbrow Paleo Guide To Binge Drinking: complete! As always, share your stories, your personal favorite remedies, and share this article! This has truly been a team effort; I write these articles but can’t take all of the credit.