[00:00:00.000] - Dr Lemanne

I found an article published in 2023 by two Polish toxicologists in Krakau, Poland, and they say, In women, breast cancer includes over half of all tumors caused by alcohol. You have found your way to the Lemanne Gordon podcast where Docs Talk Shop. Happy eavesdropping. I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:00:33.340] - Dr Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:37.140] - Dr Lemanne

We've been in practice a long time.

[00:00:38.290] - Dr Gordon

A very long time.

[00:00:41.130] - Dr Lemanne

We learn so much talking to each other.

[00:00:42.850] - Dr Gordon

We do. What if we let people listen in? In this episode, Dr. Lemanne and I discuss the delights of two popular beverages, coffee and alcohol. You'll learn about coffee's many health benefits, including decreases in the risk of breast cancer and colon cancer, dementia, bone and muscle loss, and much more. We also talk about why tea doesn't quite measure up to coffee in the cancer realm, and whether decaffeinated coffee or caffeine pills might also get the job done. Hint, not quite. And we go from there to the economic reasons behind the institution of the twice daily coffee break in American industry. We also discuss a recent study suggesting that maybe alcohol is all bad. Dr. Lemanne comes up with a long list of cancers related to alcohol intake, such as pancreatic cancer, breast cancer, colon cancer, and even melanoma. And I push back against this with evidence from a study that demonstrates a correlation evaluation between alcohol and improved cognitive health, get this, when moderate amounts of alcohol were compared to either abstinence or heavy drinking. We also ask each other exactly what is moderate drinking. We take a look at rates of breast cancer in migrants from countries where there were low rates of breast cancer who then moved to countries with high rates of breast cancer.

[00:02:28.210] - Dr Gordon

And as a bonus, we talk how iodized salt is practically useless for providing iodine, how using mouthwash can interfere with beneficial nutrient processing by the microbiome, oral and gut, and how mouthwashes containing alcohol in particular, such as classic Listerine, have been suspected to cause cancer. Please join us.

[00:02:58.600] - Dr Lemanne

Deborah, you said you wanted to talk about drink this week.

[00:03:01.520] - Dr Gordon

I do want to talk about drink because I'm very curious what you have to say for it in your area of clinical expertise, because I find it confusing the data and I have some ideas about why that might be, but I was hoping to really just get clarity and the downright truth from you.

[00:03:21.950] - Dr Lemanne

Well, I'm happy to provide. And just to be really clear, we're talking about coffee, right?

[00:03:26.760] - Dr Gordon

We are talking about coffee and my understanding, alcohol.

[00:03:31.440] - Dr Lemanne

Oh, drink and alcohol. Okay, we can talk about that. I love to talk about alcohol.

[00:03:36.520] - Dr Gordon

Okay. So we each came in here thinking we were focusing more on one aspect of drink than another, morning or evening. And I was thinking we were more going to do the evening alcohol drink. That's a good way to divide it. Yeah. I like that. And that's probably as it should be, morning and evening, but it is morning. So let's start with coffee. What's your fascination?

[00:03:59.410] - Dr Lemanne

We can start with coffee, but I'm just pulling your leg. I do know we're talking about alcohol today. Although when you emailed me this morning and said, look at this article about coffee, I thought, yes. You know, coffee is my favorite herbal treatment for cancer.

[00:04:22.370] - Dr Gordon

What?

[00:04:24.890] - Dr Lemanne

Now, I'm still pulling your leg a bit. Now, coffee is not a treatment for cancer, but coffee has been associated, coffee drinking, with decreased risk of cancer and also improved survival in certain cancers, not all cancers, but in some common cancers like colon cancer. And possibly breast cancer as well.

[00:04:47.320] - Dr Gordon

Can you break it down for me? In all the studies about everything that I've read related to coffee, they differentiate zero, low, moderate, high coffee consumption. Exactly.

[00:05:00.290] - Dr Lemanne

So there's a dose-response relationship.

[00:05:02.720] - Dr Gordon

And how does this play out?

[00:05:04.160] - Dr Lemanne

Up to about four or five cups a day. There seems to be increasing benefit to coffee drinking in many cancer situations, both in the prevention and in the survival realm after a diagnosis. So yeah, I think that coffee is a magical thing. You know it's associated with economic development?

[00:05:25.230] - Dr Gordon

Yeah.

[00:05:26.230] - Dr Lemanne

So when cultures apparently their hands on caffeine, for instance, the British Empire and tea, during that toll era from 1700 to the 1900s, when the British Empire was ascendant, the world's superpower, the British economy went straight up and they drank a lot of tea. It was implanted into their culture to have tea time a couple of times a day. And they also worked harder with that. And of course, they also began to have coffee, too.

[00:05:59.890] - Dr Gordon

Yes, but didn't it also coincide with sugar? Because a lot of Brits put way too much sugar in their tea.

[00:06:10.580] - Dr Lemanne

I don't think anybody's taken the sugar out and looked at those two things separately, but that's an interesting point. I would agree that sugar certainly was ascendant during that time. But do you know how coffee has affected the United States economic culture? No. Well, there was not always a coffee break. In the United States. So the first coffee break came about in a necktie factory in Denver, Colorado, during World War II. So the men who worked in this necktie factory were all sent off to war, and the factory was manned, and I'm using that word on purpose, by what the factory owner called elderly women. I don't know how old these people were, but anyway, he thought they were elderly and they were lacking in energy. And one of the women asked if she could drink coffee. I believe this is how the story goes, although I'm not 100% sure, so people should look this up to get the actual facts straight. But let me tell it this way because I think it makes a good story. One of the women asked if she could have coffee. And so she began having a little break so she could make and drink her coffee in the afternoon.

[00:07:21.000] - Dr Lemanne

Some of the other women did that. And the owner of the necktie factory found that after these elderly women had their coffee breaks, their productivity doubled. They made twice as many neckties, and they were better neckties, higher quality. So he instituted a mandatory coffee break twice a day in this factory, and they did well. And apparently, the coffee break spread after that. But there are books on such things if people are interested looking at the effect of coffee and the association of coffee drinking on a country's economy, apparently, the more caffeine the people in a certain country or economy use the better that economy does, which is really pretty interesting.

[00:08:05.750] - Dr Gordon

That is really interesting. And that was a unique situation in which he was able to do a good clinical experiment. And In fact- The factory owner? The factory owner, because they were not allowed to drink coffee during the day, and then they were allowed, and then they were mandated to drink coffee. So he had several variables that he could actually, he probably didn't write it down, but observe. And one of the comments I was going to make about both alcohol, about alcohol, and it may not relate so much to coffee. Okay, this is a really long, circuitous introduction to me asking you, when you say that coffee enhances survival or cancer, recovery, and survival, has that actually been clinically tested in clinical trials, or is this observational, which is really pretty much what all our That's what alcohol research is?

[00:09:01.100] - Dr Lemanne

So I did not say that coffee enhances survival, but I did say that it's associated.

[00:09:06.880] - Dr Gordon

Associated, okay.

[00:09:08.110] - Dr Lemanne

With improvement in survival. So these are association studies we are not doing. No one is doing interventional trials with placebos, decaffeinated coffee, and you don't know which one you've gotten, and we see how long you live. No one's done that. No one will ever do that. But the best kinds of studies that we can do in a situation this in an intake of non pharmaceutical is just to do some observational studies. And the observational studies show that there is probably a difference. And the difference seems to extend up to about three, four, five cups a day more than that, and you don't see any more improvement, but there is a dose response up to that level. So there's an asymptote at three, four, five cups a day, which is about, I think, 600 to milligrams of caffeine a day. And decaffeinated coffee seems not to be as powerful or maybe not to have any effect at all in a lot of studies. So it's the caffeine and the coffee together that seems to be causing the association.

[00:10:16.940] - Dr Gordon

Interesting now when we're talking about... So coffee has an impact on brain health, and I almost wonder, and I'm going to have to dig out this study, because they do make a differentiation between coffee... So coffee... I know what this was. Coffee consumption has a protective effect against cognitive decline, but caffeine, and I think they didn't do coffee with and without caffeine. I think they did coffee versus other forms of caffeine. So people who would take isolated caffeine did not slow their cognitive decline relative to people who... So there's people who have neither, people who caffeine, they ended up in the same boat with a generally accepted rate of cognitive decline. And those who had low to moderate coffee ingestion had slower decline and less beta amyloid. So that is actually a measurable, and it's still a correlation because I don't think this was an intervention. And again, when you When you get up to six or more cups a day, you start seeing brain shrinkage and an increased dementia risk.

[00:11:38.510] - Dr Lemanne

Well, that's really interesting. It makes me think of a couple of things. So first one about the brain shrinkage with more coffee, that's probably reverse causation. So people who feel their brain is shrinking, and you probably can't feel when that's starting to happen, are going to really pound back the coffee to try to get some of that activity back.

[00:11:58.400] - Dr Gordon

So this is the unhealthy User bias.

[00:12:00.940] - Dr Lemanne

Exactly. Exactly. Or reverse causation. And the other thing that what you're saying makes me think about is that there are a suite of chemicals that are related to caffeine in coffee. So you're getting a lot of caffeine type chemicals as well as your dose of caffeine. So you're getting more when you actually drink coffee than if you take an isolated caffeine pill. So a caffeine pill might, say, contain 50 milligrams of caffeine. I'm making that up. But a A cup of coffee may contain 50 milligrams of caffeine and another 100 milligrams of caffeine-like chemicals that give you a caffeine response that are stimulating. So you're getting a bigger dose of something when you're actually drinking a cup of coffee when the caffeine is being held constant, the caffeine content is being held.

[00:12:48.220] - Dr Gordon

Content is being held. And I think the researchers and the scientists who tout coffee for cognitive benefit would bend over backwards to differentiate the nutritional value of coffee itself. I remember reading a long time ago, and I'm going to have to find this, and that the greatest source of antioxidants in the American diet is from coffee.

[00:13:13.650] - Dr Lemanne

Yeah, I think that's a really wonderful factoid, and I've seen that, too. And yeah, it's probably one of the few things, plant-based concentrates that people eat, regularly.

[00:13:28.870] - Dr Gordon

Yes.

[00:13:30.000] - Dr Lemanne

It also increases activity. So when someone drinks a cup of coffee, they're physically more active afterwards, which, of course, is salutatory. We want activity. It's good for us. Our brains, our hearts, our bones. You sent me something this morning. Tell our listeners about that article.

[00:13:49.700] - Dr Gordon

I thought that was just fascinating. Yes, this is really fascinating. And since I just came across it this morning, I think... And it looks very legible. So we're going to put the link to it and people can read it to get perhaps more detail than we're going to extract in this brief overview of it. But that there is an association, so this was not interventional, but looking at a population, those who had more coffee, more caffeine, decaffed coffee or more caffeine. So I think in this case, they're saying decaff would work as well, which would be the polyphenols in coffee, were associated with greater accumulation of muscle mass.

[00:14:29.070] - Dr Lemanne

Yeah. So it How do you get muscle mass? You have to use your muscles.

[00:14:32.000] - Dr Gordon

You have to use your muscles. But decaffed coffee seems to work in this study as well because they differentiate between coffee and caffedated coffee. So I think there's something more complex. So I think that's brilliant that, yes, of course, that is true. What do I do before I went for my hike this morning, Dawn? Yes, Deborah.

[00:14:53.240] - Dr Lemanne

Deborah is for our listeners. Deborah, I just dragged myself out of bed and tried to get dressed brush my teeth and comb my hair before I get to this meeting so we can do this podcast. And Deborah has organized her day and done her dishes and eaten breakfast and gone for a walk and taken the dog with her. And I'm still the one who's late.

[00:15:16.390] - Dr Gordon

Right. So I go up about a mile and a quarter into the hills. It's my bone building exercise. But I intentionally- Do you drink coffee before that? I consume a double shot Espresso drink, which an Espresso is a little bit lower in caffeine than coffee, contrary to many popular impressions. But you take two of them. I take a double shot and I time it. So I'm drinking it as I'm driving up to the trailhead.

[00:15:41.200] - Dr Lemanne

Now, where are you getting this double shot?

[00:15:43.360] - Dr Gordon

From my Espresso maker.

[00:15:44.720] - Dr Lemanne

You have your own Espresso.

[00:15:45.970] - Dr Gordon

We finally bit the bullet, and I think we've saved more than twice the cost of the little machine because now I don't get coffee out as much. But it presses caffeine Espresso for us. It's the entry-level Espresso maker.

[00:16:03.590] - Dr Lemanne

You mean there's less caffeine?

[00:16:05.050] - Dr Gordon

No, the caffeine is just as good and it fuels my hike. And so, yes, I do- How much caffeine in a single shot, in a single Espresso shot. Well, I know that a single shot of Espresso has less about two-thirds the caffeine in it that a cup of coffee does. I think a cup of coffee has 100 milligrams of caffeine. Is that right?

[00:16:27.060] - Dr Lemanne

I think 100, 120 if it's dripping.

[00:16:29.010] - Dr Gordon

Yeah, and it's It's less than that with Espresso. And of course, it's less than that, again, myth-busting, in dark roasts of coffee. They have less caffeine in them.

[00:16:39.110] - Dr Lemanne

Than the medium roast.

[00:16:39.980] - Dr Gordon

Than the medium roast. So ours is a dark roast, so it's a little lower, but I get two shots. So I'm getting like a cup and a half of coffee, but less volume of water because it's somewhere between a cappuccino and macchiatto, something like that. So I'm I don't fill up my bladder before I go on my hike. That's always very inconvenient.

[00:17:03.870] - Dr Lemanne

Oh, that is inconvenient. And so you've really got this figured out in a very scientific way.

[00:17:11.670] - Dr Gordon

Well, you know that my focus is really in my practice are cognitive decline and bone loss, because I think both areas, the conventional wisdom, fall short of optimal. And you're not going to replace bone unless you're going to focus on on sarcopenia. So if coffee consumption can reduce sarcopenia, I have a new reason for recommending it.

[00:17:38.200] - Dr Lemanne

Well, you know, caffeine, I believe a certain blood level of caffeine will disqualify you from the Olympics. You can have too much. And it's considered a banned substance, at least in the past. I'd have to look and see if that's still the case. But I remember the day when athletes could be tested for caffeine content in their blood and having an excessive level could disqualify them. So caffeine is known to be a stimulant for physical activity and exercise.

[00:18:12.130] - Dr Gordon

And athletes do use it. That's got to be part of it. You're right. I think from this study, which I'll read in greater detail and try and answer the question, but I'm getting the impression from the lead intro in this study that decaffeinated coffee offers a benefit as well.

[00:18:29.560] - Dr Lemanne

And And- What about tea? Well, they say- For dementia and brain health. It has caffeine.

[00:18:37.270] - Dr Gordon

I think the caffeine and tea, depending on... Lipton may not have as much benefit as a complex mushroom, ruibas, herbal tea from the health food store. But so I think in general, a lot of varieties of tea have a polyphenol content as well.

[00:18:57.760] - Dr Lemanne

Yeah. Studies comparing in oncology, comparing tea to coffee, find a stronger anti-cancer association with coffee. Then with tea. Then with tea. Although people, you know.

[00:19:10.050] - Dr Gordon

Think tea is the health food.

[00:19:10.940] - Dr Lemanne

Think of tea and health food in the same sentence. But I try to impress upon patients, think of coffee, put the coffee in that sentence as well, and it may have a little bit more bang.

[00:19:21.030] - Dr Gordon

So pertinent to our discussion that we may or may not get around to on alcohol, can you be more specific? Or is the data there to tell us which kinds of cancer it might be helpful in preventing and whether or not that's the same as which kinds of cancer it might be associated with an enhanced recovery?

[00:19:44.350] - Dr Lemanne

So we're talking about coffee or alcohol? Coffee right now. So which kinds of cancer coffee might be useful? Exactly. The two that I'm aware of with some evidence is our breast cancer and colorectal cancer. There may be others But I'm not willing to say as much about that. And I think that the way that coffee may, if it does have an effect on cancer risk and survival, it's probably mediated through our microbiome. So coffee has a really strong effect on bile production. It increases bile production right away. So drinking coffee flushes out the liver and the gall bladder and flushes that bile from the liver and gall bladder into the colon and moves It moves things along because it relieves constipation. And I think that may have a very large effect on the microbiome. And people will use coffee enomas. You know, coffee enomas used to be in the Merck manual as a standard medical treatment.

[00:20:47.900] - Dr Gordon

I think they've been extracted from. They've been enimized from. You know, coffee, the other thing I thought, this is what I thought you were going to say, particularly with those two cancers, is that coffee intake may be beneficial for the prevention or the treatment of insulin resistance and type 2 diabetes, which I think of as insulin resistance as contributory to those two types of cancer?

[00:21:18.900] - Dr Lemanne

Well, certainly if coffee increases activity, we know that exercise is associated with improved survival for both breast cancer and colorectal cancer. And also for prevention prevention of those. So if coffee increases physical activity and it makes it easier for people to exercise, I certainly would raise my hand. I probably don't go to the gym really very often without having a nice big cup of coffee first. If coffee works to increase physical activity and effort at the gym or at your workout or your walk, certainly that would be a way to mediate improved cancer survival or cancer prevention.

[00:21:58.820] - Dr Gordon

Interesting.

[00:21:59.400] - Dr Lemanne

It also helps with weight control. And all of those, of course, are interlaced in ways that just can't be extricated with insulin resistance. So weight, exercise, insulin resistance, all of those things, you can't extract those from cancer risk and dementia risk.

[00:22:19.710] - Dr Gordon

So I have always thought that it was coffee stimulant activity that enhanced bowel movements, so that it helped with constipation So it's interesting what you say about bile because there are some genetic variants that are really pretty common that tend to lead to sluggish bile flow. So one of the pieces of advice I give people to try if they're constipated, and I know they have this genetic variant, is to add some bile, which you can get in supplement form in a variety of different- Are we talking about Tudka?

[00:23:00.820] - Dr Lemanne

T-u-d-c-a, Tauroerso-deoxycholic Acid, which is basically Oxbile?

[00:23:07.460] - Dr Gordon

I knew that was familiar, but I just say, go to the Health the food store that you like and pick out the bile. No, I'm not specific because there are others ones that are bile and bile cofactors that are made by different manufacturers. But if it helps, if they have this genetic variant, they tend to make thickened bile.

[00:23:32.070] - Dr Lemanne

How do you know if you have this genetic variant? Is that in one of the tests that you like to use?

[00:23:37.980] - Dr Gordon

Yes. So it's in 23andMe. And it's in any more elaborate test than that. And it's called the P-E-M-T gene. 7946 is its little RS number. And if you have one or two variants, you are deficient in healthy bile production, and you You are... One of the jobs of the liver... I'm going to get to liver, Dawn. All right.

[00:24:07.080] - Dr Lemanne

7296?

[00:24:10.000] - Dr Gordon

7948.

[00:24:11.720] - Dr Lemanne

79?

[00:24:12.190] - Dr Gordon

Oh, now I am going to- We'll put that in our show notes. We're going to correct that. And I'll tell you which is the letter that's the variant. So the liver has so many jobs. We could do a whole conversation just about the liver. But one of its jobs is to synthesize colonize choline. And choline is beneficial both for the health of the liver and correlates with choline for acetylcholine levels in the brain. So people who have the variants of the PEMT gene may need help with their bio flow, but they may also really be some... There are a few brain supplements that are common... They're not really common knowledge, they're folk wisdom. Oh, my mother took this supplement, and if everybody took that, there would be no dementia. Well, if this supplement your mother took was related to Coleine and it helped her tremendously, she probably has two variants in this PEMT gene.

[00:25:14.250] - Dr Lemanne

Are we talking about Coleine helping with constipation?

[00:25:17.780] - Dr Gordon

No, it helps more with liver health and it helps with brain health. The variant gives you thick bile. Anyway, this is a long way around making these connections that, aha, it's what coffee's role in in constipation is making your bile more liquid and less thick and making it more effective. So I would bet that the people who have the PEMT variant respond better. Their bowels respond more in a lively fashion to coffee than people. Anyway, it was a long way around of thinking, it's bile that coffee activates. I didn't know that.

[00:26:06.300] - Dr Lemanne

Very interesting. So do supplements like Cytocoline, CDP Coline, are those useful in people with constipation? No, they are- Or do you wash that down with your coffee?

[00:26:19.770] - Dr Gordon

No, because I think the coffee is going to do the job of what Coline would do in the liver. But if you have that variant, you have trouble having an acetylcholine in your brain. And Those are the people who have these miraculous cognitive boosts from taking cytocoline or CDP choline. They're the ones who have the PEMT variant and need help getting coline in their brain. And then for their bowels, we can just tell them to have a good cup of coffee, evidently. Or they could take dietary coline in the form of a food we both like, egg yokes, and a food that maybe only one of us really likes, which is liver.

[00:26:59.200] - Dr Lemanne

Well, I still haven't your liver. You're going to give me that next time I come to your house. I'm inviting myself over for a liver feast. Just a bite or two. Just, I'll leave after 10 minutes.

[00:27:11.260] - Dr Gordon

I don't like this week's batch so well. So We'll hold off on that till the next batch.

[00:27:16.920] - Dr Lemanne

I have a whole little ice cube tray filled with chicken liver ground up in the... But it says on this ice cube tray in the freezer, it says, For cat.

[00:27:27.930] - Dr Gordon

Lucky cat. You know this paradigm where a little bit is better than none, moderate amount might even be better than a little bit, but too much is hazardous, which applies to alcohol, certainly does apply to coffee and the brain. So really, really high coffee consumption, not so good. They have shrinking of their brains. And this paradigm of little, moderate a lot being very different is certainly true with alcohol as well.

[00:28:05.910] - Dr Lemanne

Yeah, I think there's some... In the last month or so, there's been some real news about a study that found that no level of alcohol was good for you. It was always detrimental, even in small amounts. Now, I think that that is... And it made the news because that's such an unpopular assertion. Almost nobody wants to that there's no level of alcohol that's safe. It's all bad. And so I think people work very hard to try to refute that.

[00:28:38.450] - Dr Gordon

Do you know what outcomes they looked at? Because I I really came across something a little different that surprised me this morning. But it was- Tell us about that. So it was specifically for the brain that having a low amount of alcohol really can... I would agree with everything you've said up to this point, and the work I did expecting that it was going to relate to the brain as well. But there's actually some evidence that a lot of alcohol is really bad for your brain. It makes you be one deficient, and it gives you alcohol. Terrible things. But several studies have found that a little bit of alcohol, and for a woman that's no more than four ounces at a time, and it can be daily or doesn't have to be daily, and men can have about twice that much, that there might be a decreased risk of cognitive impairment.

[00:29:52.830] - Dr Lemanne

Yeah. So I think the answer is not here yet, but I'll read you what The Lancet Public Health has published, and this was recently, and they said, and this is I'm quoting from Lancet Public Health, Evidence does not indicate the existence of a particular threshold at which the carcinogenic effects of alcohol start to manifest in the human body. As such, no safe amount of alcohol consumption for cancers and health can be established. Alcohol consumers should be objectively informed about the risks cancer and other health conditions associated with alcohol consumption. So that's a pretty clear statement saying that there's no safe level, according to the World Health Organization, Published in January 2023.

[00:30:46.950] - Dr Gordon

So what they're talking about, I would believe- They're talking about cancer risks. They're talking about cancer, but I think there are plenty of studies that say this is also true for cardiovascular disease and diabetes and all-cause mortality. But in 2020, JAMA published an observational study, so this is only association, which may be healthy user bias, of 20,000 people, middle-aged, observed over nine years. It's a U-shaped curve that the risk of cognitive decline was at its lowest in those who drank low to moderate drinking over this nine-year period of the study. In that cognitive performance was worse at lower levels of drinking, that is abstention, and higher levels of drinking, which is what a lot of people would say qualifies as social drinking. So what's really acceptable is, they said less than eight drinks per week for women and less than 15 for men, and that's pretty conventional. And I typically recommend less than that because I don't want my cognitive patients to get cardiovascular disease, diabetes or cancer either. So if there's a benefit for alcohol, it's at a very low level. But that is what this observational study in 2020 found to be worth considering.

[00:32:16.370] - Dr Gordon

Yeah.

[00:32:17.620] - Dr Lemanne

And I do think that's worth considering and worth looking into. One could argue, so tell me what you think of this. One could argue that alcohol improves social activity. Maybe it's the social activity, and maybe it's the social activity without the alcohol.

[00:32:31.000] - Dr Gordon

Absolutely.

[00:32:32.080] - Dr Lemanne

And certainly, social activity can be engaged in without alcohol, and that may require more brain power. So it may also provide something. And certainly eight drinks a week. Eight drinks a week is going to vastly increase the risk of breast cancer.

[00:32:50.750] - Dr Gordon

Right.

[00:32:51.110] - Dr Lemanne

So I recommend- Eight drinks a week is... I have an article here that I confess I prepared for your talk because I have to. I have to get ready. So I found an article published in 2023 by two Polish toxicologists in Krakow, Poland. And they say, quote, in women, Breast cancer includes over half of all tumors caused by alcohol. And they also say, and this is, I think, really important, and I think you're you're going to tell me, yes, of course. They say, quote, individuals differ in their ability to metabolize ethanol through genetic differences in alcohol dehydrogenes. And these genetic features may play an important role in alcoholic breast tumor agenesis or carcinogenesis.

[00:33:47.570] - Dr Gordon

Interestingly.

[00:33:48.260] - Dr Lemanne

So you may inherit an ability to process alcohol that may increase or decrease your risk of developing cancer from the alcohol.

[00:33:56.770] - Dr Gordon

Yes, that is very interesting. I have learned this from you over the years about alcohol, and that's the strongest cancer risk that runs through my family. So I do try to keep... I'm under eight drinks. If I drink eight drinks a week, I can't drink more than one full drink and not be heavily intoxicated. So it's really good that I've taken your general advice because I'm one of those people who probably has lousy alcohol dehydrogenase levels. I'm a cheap drunk. And so people who are cheap drunks or concerned about their brain health or their breast cancer health probably should limit themselves to what would be considered a half drink, not every day a week, less than that, down to zero drinks of alcohol a week.

[00:34:48.410] - Dr Lemanne

And recently, since this news has come out, this news study, I have actually told my patients point blank, it's better if you don't drink at all. If you have cancer, especially breast cancer, but any cancer, you may really, if you can, if it's not a problem for you, and if it is a problem for you, treat it as a problem and try to solve it. If you can, don't drink. And I used to not say that. I used to say, you can have a little bit. But I'm not so confident making that recommendation anymore. I'm more willing to say, no, let it go.

[00:35:29.210] - Dr Gordon

So just point blank question, does that differ in your risk for hormone receptor positive or triple negative? Does it vary at all the different kinds of breast cancer?

[00:35:43.760] - Dr Lemanne

I don't know. And it certainly varies with premenopausal versus postmenopausal. So premenopausal women with certain alcohol dehydrogenase enzyme variants are at much higher risk of breast cancer. And premenopausal breast cancer, meaning your breast cancer is diagnosed before you get to menopause, is more dangerous than postmenopausal breast cancer. You're more likely to die if you get breast cancer before you hit menopause.

[00:36:12.320] - Dr Gordon

Absolutely. That's very interesting because isn't it true that postmenopausal women who use hormone replacement therapy, in other words, trying to slightly mimic their premenopausal heyday of youth have less breast cancer risk than postmenopausal women who don't use hormone replacement therapy?

[00:36:36.240] - Dr Lemanne

We will have to see. I mean, really, the bioidentical hormone replacement paradigm is pretty new. So I think we'll have to let things run for 20, 30 years and see what we see in those groups, in that group. So I think that's going to be really interesting. You asked me the list I think you asked me, did you ask me the list of cancers that are related to alcohol?

[00:37:04.460] - Dr Gordon

To alcohol.

[00:37:05.070] - Dr Lemanne

And you just put- You gave us the number one.

[00:37:07.630] - Dr Gordon

So breast cancer.

[00:37:09.840] - Dr Lemanne

I'm going to list them. Breast cancer, colorectal cancer, pancreatic cancer, where there's a clear dose-response relationship, liver cancer, head and neck cancers, which include throat cancer, tongue cancer, larynx or voice box cancer, tonsil cancers, are closely associated, especially in combination with cigarettes smoking. And also with human papillomavirus exposure, esophageal cancer, stomach cancer, and melanoma. So all of these we know are, or there's some signal that alcohol can be a problem.

[00:37:45.820] - Dr Gordon

Right. And those are all different. I think of, oh, there's the insulin resistant cancers, there's the smoking cancers. Melanoma doesn't fall into any of those categories, really.

[00:37:57.210] - Dr Lemanne

So we think there's a direct toxic effect of the alcohol cell through the alcohol dehydrogenase enzyme, which makes, I think, acid aldehyde, which can damage the DNA in both your human nuclear cell DNA and also the mitochondrial DNA. And So that's probably the mechanism besides effects on hormones, effects on alcohol drinkers are generally heavier. So there's excess weight. There's effects on nutrient absorption. If you damage your intestine, which alcohol does temporarily, you may have a problem with... You mentioned thiamin, other nutrients, nutrient absorption can be damaged. And you can also potentiate the damage from other toxins like tobacco, which we've also mentioned. So there are a lot of ways that alcohol interacts with a person's life and intake and lifestyle to damage the DNA and cause cancer.

[00:38:56.350] - Dr Gordon

Not to mention disruption of sleep.

[00:38:59.160] - Dr Lemanne

Oh, that's Which I don't want to forget about.

[00:39:02.640] - Dr Gordon

But I want to ask you, so I'm pretend dream on, Deborah dream. But it's how I'm a 35-year-old woman, and I have another 10 or 15, 20 years maybe before menopause. And I do like to drink a little bit. Dr. Lemanne, if I wanted to be conscientious and be as healthy as I could, but I do like to drink occasionally, is there any way I can tell before I get cancer that I'm putting myself more risk than somebody else? Or that I'm putting myself... What level of increased risk am I putting myself at by drinking alcohol, me individually? Is there any way to know anything about that?

[00:39:41.500] - Dr Lemanne

Yeah, that's a really good question, and I don't know the answer to that. I would say that it would be interesting, interesting, not definitive, but interesting to go ahead and check your particular enzyme variant, ADH enzyme variant. The the article that I mentioned above by the Polish toxicologist, toxicologists, do list the variants, I believe. And I'll put a link to that article in our show notes. So you might work with your doctor to see if you can test to see which variant you have.

[00:40:18.280] - Dr Gordon

Does the fact that I get flush cheeks immediately that I consume half a glass of alcohol say something about my enzyme activity?

[00:40:25.700] - Dr Lemanne

Yes, it does. And so you might look up and see how that enzyme activity relates to the risk of cancer, if that's known. But that particular genotype is distinguishable.

[00:40:40.110] - Dr Gordon

Yes. You mentioned Poland. So I think so many of these things that we're saying about how much alcohol you're drinking and how much coffee you're drinking, and there are trade offs, and you have to manage the rest of your life as well. And let's go on and talk about sleep. But Poland, there was an observational study, a long time ago about breast cancer, which is the cancer I've looked into the most before I even met you because of my family history, that in Poland, women have very low risk of breast cancer compared to the United States. And when they move to the United States, there's a great split between those who continue to eat homemade Polish sauerkraut and those who don't... Sauerkraut or cabbage, just plain cabbage or sauerkraut. The The ones who continue with their Polish habits, keep the Polish level of breast cancer risk, and the ones who completely switch to an American diet, which is way more than just losing a lot of cabbage and sauerkraut, develop the American breast cancer risk.

[00:41:45.240] - Dr Lemanne

That's really interesting. And that's consistent across many, many immigrant cultures. So Japanese women who move from Japan, which has a very low rate of breast cancer to the United States and who take up the United United States lifestyle over a couple of generations, their risk of breast cancer moves straight up to a general American level. So, yes, we don't understand that completely. These are older studies looking at immigration and dietary habits. It may be the diet. It may be something completely other. We don't know. But the fact that the diet was kept in the Polish study is really helpful.

[00:42:27.940] - Dr Gordon

Which I think of as being the cruciferous vegetables which influence the metabolism, the metabolic pathways of estrogen elimination, whether it's metabolized into a 2-hydroxy or 16-hydroxy metabolite, but Studies along those lines, particularly, have not really panned out, though I still do give them some nod of attention.

[00:42:52.510] - Dr Lemanne

Well, in Japan, I'm trying to think there's a lot of soy and seafood and seaweed There's three things. The soy in particular, and you'll be able to talk a lot more about this than I can. The soy does also have some effect on estrogen metabolism.

[00:43:14.700] - Dr Gordon

And doesn't iodine, which you get from seaweed, reduce breast cancer risk?

[00:43:19.380] - Dr Lemanne

Is it- Well, iodine has a direct effect on thyroid metabolism, of course. And in Japan, the iodine intake is huge. So sometimes I'll I'll supplement some of my patients with supplemental iodine if they have breast cancer and some thyroid issues, but very gingerly. So I'll give them a supplement that contains 1,000 micrograms, not milligrams, but micrograms. A microgram is one-thousandth of a milligram. So very low dose. It's one microgram is one milligram for the arithmetic fans there. And I believe the dietary intake in Japan, just without any supplementation, is 50 milligrams a day.

[00:44:01.130] - Dr Gordon

Huge. Oh, that is huge.

[00:44:02.710] - Dr Lemanne

It's a whole bottle of iodine pills every day.

[00:44:06.310] - Dr Gordon

I think that's toxic.

[00:44:07.840] - Dr Lemanne

It's not toxic. I'm going to jump in. Japan has the best longevity of any nation in the world.

[00:44:17.150] - Dr Gordon

Okay. Now I'll have to look into this because I have some knowledge from some distant part of my brain, which I'm not going to find while we're speaking about evidently erroneous concepts that too much iodine is toxic.

[00:44:30.750] - Dr Lemanne

Well, too much, sure. But apparently 50 milligrams isn't too much.

[00:44:35.000] - Dr Gordon

I think of that as being a lot. I particularly select when I recommend a multivitamin. There's only a few I recommend. And one of the components should be And I like to include not your dose, but about 150 micrograms of iodine a day for people who are no longer eating iodine salt.

[00:44:54.100] - Dr Lemanne

Well, iodine salt. Oh, boy. I'm going to get up on the soapbox here. Did you know that the iodine and iodine salt evaporates away in three to six weeks? So if you have a box of iodine salt around, which I remember when I was a kid, we'd have one around for a year or two. Take a long time to go through that. There's no iodine in there. It's all gone in the first three to six weeks after it's produced.

[00:45:20.680] - Dr Gordon

But what is still in there? Do you know what else is in iodine salt? Yeah, dextrose.

[00:45:24.570] - Dr Lemanne

Yeah, sugar to make it flow. When it rains, it pours. There was one brand that used to say that. I won't mention the brand.

[00:45:31.920] - Dr Gordon

I think we're both old enough to remember that. Yes, but okay, so alcohol- So iodine salt, no good. Yes, no good on iodine salt. Get your iodine in your supplements one way or another, or seaweed, eating seaweed.

[00:45:47.290] - Dr Lemanne

Of course, then you can't measure how much you're getting, but you're probably getting a nice- Yeah, but you can get it in a lab test.

[00:45:52.980] - Dr Gordon

You do a random urine for iodine and it gives you a range. And I have liked the lower range, but now I'm going to do some research to see if I need to adjust that and forget about worrying about the upper range. Because definitely insufficient iodine is definitely a risk factor for low thyroid levels that you can normalize without having to take a prescription.

[00:46:17.530] - Dr Lemanne

That's a really good point. And you want to have the building blocks because what iodine is for our listeners, iodine is incorporated into the protein, the amino acid part of thyroid hormone. And so to make a thyroid hormone, you have to have tyrosine, which is an amino acid, and you have to have a molecule of iodine. And they are put together to make L-thyroxine or T4. And so if you don't have the iodine- Or the tyrosine. Or the tyrosine, you cannot make thyroid hormone, and you're going to feel ill. You're not going to get it.

[00:46:53.730] - Dr Gordon

So, yeah, there are a few people who they've avoided a thyroid prescription by replacing those microtions. Yeah, absolutely.

[00:46:59.520] - Dr Lemanne

It's good to try that first. And thyroid abnormality, thyroid illness, either too much or too little, hyperthyroid or hypothyroidism, is associated with breast cancer risk. And they go together. It's a chicken and egg thing for us right now. We don't know how They fit together, but people who get one often get the other.

[00:47:18.520] - Dr Gordon

I did a talk once on thyroid for a group of paleo-oriented doctors, and I was amazed, and I don't I actually remember that finding, but musculoskeletal injury, high blood pressure. And I myself, the first time I was told I had high blood pressure by a cardiologist, I said, That's ridiculous. I'm too healthy to have high blood pressure. And at that fact, at that time, replenishing my loss, my insufficient thyroid hormone, did eradicate my high blood pressure for about 10 years. But thyroid has its hands in everything in our bodies. Oh, yeah.

[00:48:02.160] - Dr Lemanne

Yeah. Yeah, you want your thyroid to be really, really healthy and want those numbers to be really harmonious.

[00:48:08.980] - Dr Gordon

We touched on, and so I just want to touch back there a little bit about... So alcohol causing adverse effects, being associated with increased risk of various chronic diseases, not to a huge extent if you're a moderate drinker, but at any intake slightly increases that. But as you just pointed out, if you need that for some other benefit, that perhaps might be its sole benefit for you. But it is a trade-off. So if you really love a little tiny glass of wine every day and you say, But I'm carrying 10 extra pounds, that's not good for my heart or my diabetes or cancer risk. I'm going to drop those 10 pounds, Doc, but I want to keep my four ounces. That's great.

[00:48:59.030] - Dr Lemanne

You know who this reminds me of? Who? It reminds me of Elizabeth Kubler-Ross. Remember Elizabeth Kubler-Ross? Yes. And the stages of dying? Yes. And one of the stages was bargaining.

[00:49:09.220] - Dr Gordon

Yes. But I think it's important that it's I'm suggesting, and that was why I asked that question about detecting your personal level of threshold, because you have to make yourself honest. You can say, Oh, I can handle a little 25 % cardiovascular risk. Well, run your cardiovascular numbers through the cardiac risk calculator and see if you really are happy with that transformation of your risk from 10% to 15% over the next years, because it really is true. And you are in charge of more than just your alcohol consumption. And perhaps you can figure out, if I exercise way more than I am, but as much as I should, well, that'll help my health in all those ways. Yes, you'd reduce your risk even further if you didn't drink. And then there's the sleep because alcohol interferes with sleep. What's your experience with alcohol and sleep?

[00:50:10.540] - Dr Lemanne

My personal experience?

[00:50:11.920] - Dr Gordon

Yes.

[00:50:12.710] - Dr Lemanne

I have not drunk alcohol enough to really understand how it affects my sleep. So I might have four or five drinks a year, and they might be half drinks. And I've never been drunk, not once in my entire life. So I am not the right person to ask. But I have been thinking about that, what does alcohol do for people? And in the exam room, people will say, well, it helps me sleep. But alcohol, I understand. And from my reading that alcohol destroys sleep architecture. It's a sedative, not a sleep inducer. Exactly. So you're not getting real sleep. Your brain is not being refreshed, your body is not being refreshed, your immune system is not being refreshed. You're just being sedated for a while. And when you wake up, the work of repairing everything that should be repaired during sleep still has to be done. You still owe that to your body if you've gone to sleep. And that's not just alcohol, that's any sedative. So Benadryl, benzodiazapines, anything that sedates you interferes with your actual ability to sleep.

[00:51:22.940] - Dr Gordon

And I think you can see that we were talking about sleep trackers. I don't remember if that was in discussions here or aside, that one of the things you said was that, so I have a sleep tracker, you have a sleep tracker. Mine tells me how much rem sleep I got and tells me what my heart rate variability is. And you were pointing out the other day that on your days of fasting, your heart rate variability goes through the roof, which is a good thing for those who haven't been familiar with this. But alcohol reduces both rem sleep and heart rate variability. Oh, okay. And your sleep is more fragmented, which is a common complaint of older people.

[00:52:04.880] - Dr Lemanne

And now I think I- You mean they wake up frequently in the night? Yeah.

[00:52:07.870] - Dr Gordon

But there is a huge difference in personal threshold. So somebody's sleep could be excellent without alcohol and really look pretty good with one drink. And it's the timing of the drink.

[00:52:26.940] - Dr Lemanne

So if they're going to drink, drink at lunch, not at supper?

[00:52:29.910] - Dr Gordon

Unless they have to go back and work in the afternoon. But for most people, if you're drinking between your half drink, four days a week, no more, between five and six in the evening, make yourself honest. Look at If you're sleep tracking that night. No, five to six is still late. And if it affects your sleep, then that's a trade-off that nobody really wants to lose the quality of their sleep because it can affect all these other things that we're talking about, right? It affects brain health from my point of view. Does it affect cancer risk to mess up with your sleep?

[00:53:07.700] - Dr Lemanne

Absolutely. Yeah. In fact, I tell people, if there was one thing you could do, and nobody ever asks me this, if somebody were to ask, what can I do to make sure that I get cancer? The answer is make sure that your sleep is disrupted. No one ever asks that. But if the sleep is not in good shape, there's nothing else you can do. You can do all the chemo, all the beautiful dietary exercise interventions, all of those things. The patient is not going to get well. But it doesn't mean- It has to be in place.

[00:53:38.480] - Dr Gordon

To recover from cancer. To recover from cancer. To recover, not necessarily to prevent cancer.

[00:53:43.130] - Dr Lemanne

Actually, Yes. So if you live in Denmark and you get breast cancer and you've worked as a nurse or a flight attendant, you get a pension for an occupation-induced illness because of this shift work, the night time work.

[00:53:58.390] - Dr Gordon

But I guess my point- Which is considered a carcinogenic. Carcinogenic. And I would say that, again, there's a huge difference in personal thresholds for how much alcohol disrupts your sleep and for how much sleep disruption puts you at increased health risks. Not everybody who's a night worker in Denmark gets... Everyone who works as a night worker should get a surplus on their pay because it is hard on your health in so many ways, but not all of them will get cancer.

[00:54:31.410] - Dr Lemanne

No, but when you think about it, 50 % of us get cancer.

[00:54:34.650] - Dr Gordon

50 % of us?

[00:54:35.840] - Dr Lemanne

And we're not even all of us night workers. So yes, it's two out of three men and one out of two women. So it's a little higher in men. So 50% of women get cancer. 67% of men during their lifetime, are diagnosed with some form of cancer.

[00:54:52.430] - Dr Gordon

So that is most of us. Yeah, you're right. Is that different mostly for men having more because of prostate cancer Do they get other cancers more as well?

[00:55:01.860] - Dr Lemanne

They get other cancers as well. And it may... Men are larger, so larger the body size, women or men, taller, wider, either one, they're higher the risk of cancer because there's a difference in growth hormones. So It's my opinion that the difference, the gender difference in cancer risk may be related to body size. But yeah, there's certainly some clear connections between cancer are in sleep. Tell me if you get this a lot, so I'll ask a patient about their alcohol intake, and they'll say, well, yeah, I have a few drinks a week, but it's only wine.

[00:55:41.580] - Dr Gordon

As if wine were a type of health food and didn't count as alcohol.

[00:55:47.600] - Dr Lemanne

But the studies show that really wine isn't healthy. It's not healthy. And wine counts as alcohol. And the amount of wine is five fluid ounces of wine, 12 ounces of beer, or 1.5 ounces of spirits or liquor. All of those contain about half an ounce of alcohol, ethanol, which is the chemical term for what we're talking about alcohol, drinking alcohol. And that amount of alcohol is the amount that's used in these studies to determine what a drink is. So a glass of wine counts. It's not healthy just because it's wine. And it's no better than drinking... Five ounces of wine is no better than drinking a can of beer or having a 1.5, a large shot of whiskey. Having a shot of alcohol. Of whiskey. And then there's mouth Did you know that mouthwash has been rather loosely, I think, but it's been linked to cancer of the mouth, specifically. So alcohol-based mouthwash, like classic glycerine. It Increased use is associated with increased risk of cancer of the mouth. I'm not sure how much we can put that into practice. It may be that people who use mouthwash like Listerine. I think that they're covering up their alcohol breath from spending lunch at the bar.

[00:57:22.570] - Dr Gordon

No, I think it just... So I recommend that people have in their medicine cabinet a jar, a bottle, whatever you call it, of something like Listerine, because you said that, or any of those other commercial brands, and that they never use it unless they are fending off some dire upper respiratory illness that they think they've been exposed to or are beginning to get, and then And you can gargle with it and spit it out for about two or three days, and then they should lock it up under lock and key and never use it again because it definitely reduces the vitality of your oral microbiome, which is good if it's COVID trying to take hold in your oral microbiome and your nasal pharenx, your oral nasal conjunction microbiome.

[00:58:08.790] - Dr Lemanne

Well, I have good news, Deborah. What's that? So I think the study is looking at the COVID levels in the nasal pharynx with alcohol gargling used scope, which does not contain alcohol.

[00:58:21.640] - Dr Gordon

Interesting.

[00:58:22.280] - Dr Lemanne

So there are brands, and Listerine makes alcohol free brand versions, too. But the classic Listerine, that brown stuff that makes your eyes water. The alcohol free versions of mouthwash are not associated. It's the alcohol.

[00:58:37.530] - Dr Gordon

That is associated, okay.

[00:58:39.680] - Dr Lemanne

In the mouthwash, yeah.

[00:58:40.500] - Dr Gordon

But another effect, though, of those mouthwashes, and I wonder if this is true for scope or not. Well, if it takes down COVID, it still must affect the microbiome. One of the things our microbiome does is feed our gut microbiome. And you have talked about that with the bacterium that we can find in our mouths that can to colon cancer. Reference some earlier podcast episode when we talked about fusibacterium.

[00:59:07.340] - Dr Lemanne

Yes, fusibacterium, nucleotum, very closely associated, particularly two strains, very closely associated with colon cancer.

[00:59:13.670] - Dr Gordon

Yes. And there are certain oral strands in the microbiome that when they're exposed to nitrates in food, and the nitrates that are more found in vegetables than are found in smoked meats, but beets or leafy and you chew it up and expose to the microbiome, they make nitrates that your body can swallow. And if your microbiome in your body and your genetics look on you favorably, you'll make the right amount of nitric oxide that will be helpful for your vascular endothelial health to reduce inflammation.

[00:59:54.190] - Dr Lemanne

Yes. And if you use mouthwash before you eat your beets, that will not... You beets will not be turned into nitric oxide. Yes, so don't do that. Yes. Don't gargle before you eat beets.

[01:00:06.640] - Dr Gordon

I think we've talked about 37 topics this morning. What do you think?

[01:00:10.820] - Dr Lemanne

We've covered a lot.

[01:00:14.320] - Dr Gordon

It's pretty interesting. And my brain is swimming. And I've got a list of seven things I need to go home and look up.

[01:00:22.410] - Dr Lemanne

We'll put some links in the show notes for people who are interested in our references and in going deeper. And into this topic, which is absolutely an ocean.

[01:00:33.480] - Dr Gordon

Exactly. We're asking you to drink in in one small episode.

[01:00:38.180] - Dr Lemanne

And that's the title of this episode, Drink? Drink. It's always so good to talk to you, Dawn.

[01:00:44.690] - Dr Gordon

Good to talk to you, Dawn. Thanks for today. Bye-bye.

[01:00:46.850] - Dr Lemanne

Bye-bye.

[01:00:49.330] - Dr Gordon

You have been listening to the Lemanne Gordon podcast, where Docs Talk Shop.

[01:00:55.100] - Dr Lemanne

For podcast transcripts, episode notes and links, and more, please visit the podcast website at docs talkshop.

[01:01:03.850] - Dr Gordon

Com. Happy eves dropping.

[01:01:14.430] - Dr Lemanne

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[01:01:31.340] - Dr Gordon

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[01:01:43.430] - Dr Lemanne

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[01:01:57.860] - Dr Gordon

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[01:02:04.710] - Dr Lemanne

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[01:02:22.400] - Dr Gordon

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