Dr. Amy Nett: So this is a great question. I think of alcohol as being a problem when there is more of a psychological aspect or a psychological dependence. So I don’t look at an absolute number of drinks as indicating a problem because, like you’re suggesting, some people are tipsy, if not drunk, on half a glass or a full glass of wine, whereas other people barely feel tipsy at three to four drinks. So it depends on the person’s size, genetic predisposition to alcohol metabolism, that sort of thing.
So, you know, in medical school, one of the things they teach us, the CAGE questionnaire, C-A-G-E. That’s something that you can use for some guidance and the CAGE questionnaire, so these are four questions, C-A-G-E. So C is cut down, the question is, “Have you ever felt you should cut down on your drinking?” A is annoyed, so, “Have people annoyed you by criticizing your drinking?” G is guilty, “Have you ever felt bad or guilty about your drinking?” And the E is eye-opener, “Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover, i.e., an eye opener?” So those are four questions that you can ask, and generally, if a patient answers “yes” to two or more of those questions, then alcohol is considered to be a problem. So you can see by looking at those questions it’s more of a psychological issue. The other thing you can do, we ask all of our patients to do 30 days on a strict Paleo reset diet, which includes no alcohol. If patients tell me, “No way. I can’t do that,” “I’m not going to do that,” “It’s not an option,” or “I tried and I have withdrawal,” those are all potential indications that alcohol is a problem. If somebody is having two drinks a day, so let’s say, they’re having 12 to 14 drinks per week, and you say, “Hey, can you cut those out?” and they say, “No problem,” cut them out 30 days, no withdrawal symptoms, have no problem doing it, then I’m going to more reluctant to say that that’s alcoholism. It might that they’re drinking too much alcohol than I would recommend. I think 12 to 14 drinks probably is too much both from a calorie perspective when we know that alcohol does affect that HPA axis, it affects the gut, etc.
So there are different ways to look at alcohol. Alcoholism, I think, more has to do with the psychological aspects around it rather than an absolute number of drinks. So hopefully, that helps and you know, you can always Google “CAGE questions” if you want to have those questions handy because again, it’s more about the person’s relationship to alcohol really than it is about the absolute number of drinks, but it’s a really good question and we have a lot of patients that may not be alcoholics. But a lot of people too will then put that into food and you’ll start seeing orthorexia where there are sort of unhealthy relationships to even eating healthy. So it’s good to just be aware of people’s relationships to these different things.