Ian: My whole identity was wrapped up in alcohol. I had never had sex sober. I'd never danced sober. I really never really socialized sober. So what did I do? I just trusted in the program. I started working with others. Jay: Our guest, Ian, was a heavy drinker for 30 years. He's here to share a candid story about getting sober. Today we're diving into the latest research on alcohol use and the risks it poses to our brain health. Allison: Welcome to Defy Dementia. The podcast for anyone who has a brain. Jay: Defy Dementia is all about living in ways that keep our brains healthy and reduce our risk of dementia. Because dementia is not dictated by our genes, genetics can play a role. But lifestyle risk factors like a lack of exercise, exposure to air pollution and diminished well-being can also play roles and can have a major impact on our dementia risk. Allison: According to the very best evidence that research has to offer, scientists are saying that if we make healthy changes to those lifestyle risk factors, we could reduce dementia cases worldwide by at least 45%. Jay: On the show today, alcohol use and dementia risk. We're sharing some sobering thoughts on why those who drink might want to reduce their consumption. I'm Jay Ingram. I'm a science journalist and broadcaster, and I've been speaking and writing about dementia for decades. Allison: And I'm Allison Sekuler, President and Chief Scientist at the Baycrest Academy for Research and Education, and at the Centre for Aging and Brain Health Innovation. Jay: Join us as we defy dementia because you're never too young or too old to take care of your brain. Allison: If you enjoy drinking wine, beer, or spirits, please don't hit that pause button. We're not on a mission today to take away that joy. Rather, we have solid up-to-date information on how alcohol use shapes dementia risk so that you can make up your own mind on how much risk you feel comfortable with. Jay: That's actually something I've done myself. I used to like beer and red wine, but I've cut down on both a lot. And that's because I was thinking about the health risks associated with alcohol use and dementia risk was part of my decision. Allison: And as for me, I've never really been much of a drinker. In fact, I was usually the designated driver at parties, but I'm drinking even less now than I did before because like you Jay, I've weighed those health risks that are linked to alcohol, both dementia risks and other health risks. Jay: So Allison, both of us are drinking less and we're not unique in that. Statistics Canada reported that by the end of March, 2024, alcohol sales to Canadians had declined 3.8% compared to the previous fiscal year. That's the biggest decline since the government started collecting alcohol use stats in 1949. But still, most people still drink alcohol about three quarters of all Canadians. And if you're in that group or know someone who is, this show is for you. Allison: So how do we reduce our alcohol intake and how much do we need to cut back to meaningfully lower the risk to our brain health? That's what we're going to be talking about today. Jay: But first, we're going to get the inside scoop on how alcohol affects our brains and our risk for dementia. Dr. Rachita Sumbria is an associate professor at the Chapman University School of Pharmacy and an associate scientist at the University of California Irvine. Early in her career, Dr. Sumbria explored ways to transport medications that treat Alzheimer's disease. The challenge was getting those drugs across the blood-brain barrier. Now she's also studying alcohol as a risk factor for Alzheimer's, specifically on the role that the liver might play in the development of the disease. Rachita Sumbria joins us from Irvine, California. Dr. Sumbria, thank you for helping us defy dementia. Dr Sumbria: Thank you, Jay. It's a pleasure being here today. Jay: Dr. Sumbria, what do we know about the direct effect of alcohol on brain cells and the brain? Dr Sumbria: I think that's a great question to get started with because most people, when they drink alcohol, really do it for the effects that it has on calming us down, relaxing us, making us feel really happy. And that happens mainly because alcohol affects these chemicals in the brain, and these chemicals are called neurotransmitters. So for example, alcohol may increase the release of dopamine, which makes you feel really happy and really excited, but that's all the good effect. But everyone knows there's the other side which results in toxicity and there's really no question about it, right? Long-term consumption of alcohol, binging of alcohol is known to be toxic, but what does it really do? What does it do to the brain? So it turns out that alcohol affects these cells in the brain called neurons, which are the fundamental cells that help communicate information throughout the brain. So what alcohol does is it has the ability to directly impact these neurons, cause their degeneration eventually resulting in neuronal loss, meaning those neurons just die. So that's why when you scan the brains of these people with alcohol use disorder, their brains appear smaller. And why does that happen? It's called brain atrophy. It happens because there's loss of neurons, and of course neuronal loss really lies at the center of dementia, but that's not the end or that's not everything that alcohol does. It also affects other cells in the brain. And the way our blood vessels in the brain are designed is that they're lined by this barrier called the blood-brain barrier. And as the name suggests, this blood-brain barrier is really in place to protect our brain because you don't want things in your blood circulation just getting across the blood and getting into the brain because you want to protect brain health. But alcohol has this toxic ability to damage that blood-brain barrier, damage this lining, which as you can imagine, will allow anything in your blood circulation to then get into the brain and it's not supposed to be there. And that can trigger this cascade, right? You can have neuroinflammation, which can further aggravate neuronal loss, neuronal cell death eventually make you more prone to dementia. Allison: So can you talk a little bit more about how that change to that blood-brain barrier? How does that increase dementia risk? Dr Sumbria: So, if you think of the blood-brain barrier serving as your main gatekeeper, protecting your brain, once you allow these external proteins, external cells to get into the brain, they start impacting the immune cells of the brain. And just to break it down, to simplify that, we all know we have white blood cells in our circulation which respond to infection is supposed to protect us. We have a different set of cells in the brain called the microglia, which are the immune cells of the brain. So once you have a flurry or this whole flood of things getting into the brain, the microglia get activated. Allison: Because they think there's an infection or something? Dr Sumbria: Yes, they get triggered, they get activated, and they start creating this significant pro-inflammatory environment, which is really harmful. It also promotes the buildup of this toxic protein called amyloid beta, which is found in the brains of these patients with Alzheimer's. And in turn, these microglia actually then because of this excessive over activation, they stop responding to stimuli because they've been activated so long, and that reduces their ability to eat up these toxic proteins. These toxic proteins just keep building up. And then you have the same effect on another protein called tau, which again starts building up in the brains of these patients with Alzheimer's disease. You have the blood-brain barrier breakdown, you have inflammation. So it's kind of a vicious cycle. And once that happens, it's really very difficult to fix that situation. And this is the information that we've gained from mostly animal studies because for ethical reasons, you can't tell a person to consume alcohol to study its effect. So most of this information is driven from what we've studied in rodents, but just a recent study this month showed that people who drink about eight drinks a week can also have a higher chance of accumulation of this tau protein in the brain. The human studies and the rodent studies are now kind of telling us the same thing that alcohol consumption is really impacting toxic protein buildup, which can then eventually increase your risk to dementia. Jay: Rachita, we mentioned earlier that you're looking into the role of the liver in dementia. So what can you tell us about that relationship? Liver and dementia? Dr Sumbria: So Alzheimer's disease was first reported more than a hundred years ago, and since then it's always considered, well, not always, but largely considered a brain-centric disease. But now literature is showing that there are other organs that are also involved in these brain changes in Alzheimer's disease, for example, the liver, which is the second largest organ in our body, is significantly implicated because of something called the liver-brain crosstalk. So the two organs communicate with each other that can impact Alzheimer's disease pathology. And this becomes highly significant when you talk about alcohol, right? Because when you think about alcohol intake or alcohol use disorder, the first organ that everyone thinks of is not the brain, really, they think of the liver. So liver has this ability to really clean up a lot of toxins and unwanted substances from our blood circulation. So if you have a situation where your liver is really damaged, for example, chronic alcohol use, the liver's ability to really clean out all these unwanted proteins or excessive proteins really declines because the liver is damaged. As a result of which these proteins, including the amyloid beta, will start building up in your blood circulation, which can drive its accumulation in the brain. And that perhaps contributes to the amyloid beta buildup that you see in brains of these patients with Alzheimer's disease. And this is an area we really got interested in. And because there was really no literature out there that was talking about liver-brain crosstalk in alcohol use and Alzheimer's. However, we're excited because in the last few years people have really started looking into this. This area has gained so much traction. And I think it becomes very important when you're talking about alcohol use just because of the impact that alcohol has on the liver. Allison: And if the liver can repair itself to some extent, if somebody cuts back on drinking, for example, does the liver start to repair itself? And how does that repair affect dementia risk? Dr Sumbria: I think that's a question that still requires us to look into because this area is so new. My hypothesis or my take on this would be that if you do cut down on any kind of factor that's damaging your liver, there may be a possibility of reversing that damage depending on the extent of the damage. Because we know from history, liver injury when it's on the last stages is very difficult to repair. So really, depending on what stage you are at, it may be reversible or may not be reversible. Allison: So Rachita, thank you so much for all of that great information, and thank you for helping us defy dementia. Dr Sumbria: Of course. It was a pleasure to be here. Thank you so much. Jay: Thank you. Allison: Dr. Rachita Sumbria is an associate professor at the Chapman University School of Pharmacy. She joined us from Irvine, California. Our next guest has been listening to Dr. Rachita Sumbria. Ian is a 52-year-old who has recovered from alcohol and drug addiction. He's been sober for almost 11 years, and he's been a sponsor to at least 30 other people in recovery in the same program that helped him. But there's a lot more to Ian's story than addiction. He's a husband and a father. He's also a successful television writer. And full disclosure, my co-host, Jay, has known him for more than two decades. But there's one more thing that you need to know about Ian. He's also a caregiver. Both of his parents are living with dementia, and as you'll hear, both were big-time drinkers. To protect their identities we're not using Ian's family name. Ian joins us from Toronto. Ian, thank you for helping us defy dementia. Ian: Thanks for having me, Allison. Allison: What struck you when you heard Dr. Sumbria? Ian: Well, it's interesting that the research on this is only just beginning. I knew that alcohol killed brain cells, but we have a lot of them. So it wasn't a big deterrent for me. But the link between the liver and the brain is really interesting, and how the liver filters out these precursors for Alzheimer's, but if the liver's damaged and it can't, and those can collect in the brain, which is fascinating and a little scary as well. Jay: So, Ian, tell us about your parents. How are they doing right now? Ian: Well, my mom is confined to a wheelchair and a bed. She sleeps most of the day. She's uncommunicative. I mean, sometimes you can get her to smile or to mumble. I hope she's still in there. It's hard to know. It's almost felt like you're mourning your parent as they're alive. And my father has lost capacity for his financial decisions. He's very forgetful. He falls a lot. He's very emotional. He's about five years behind my mother. They do have around the clock care at home. They can afford that, and my dad would never put my mother in a home. So they're comfortable, but it's sad. It's really sad. Jay: Ian, you've pointed out that as Dr. Sumbria said, research on this link between alcohol and dementia is really just getting going. But do you suspect that alcohol use played a role in your parent's dementia? Ian: Well, I do because very early on when my mother was diagnosed with Alzheimer's, the doctors said to stop drinking alcohol. And so that was a big red flag for me. That was the first signal to me that, okay, there must be something here if they're saying to stop the alcohol intake and my parents couldn't. That was their one luxury. My mom loved her chardonnay at the end of the day, and even as she progressed, we didn't want to take that away from her, although the amount got smaller and smaller. So I suspected very early on that this probably had an effect. I don't know if it was the cause, but it makes sense now looking back. Allison: Can you tell us a little bit about the role of alcohol in your family life? Ian: Yeah, as far back as I can remember, alcohol was the social lubricant for our family. Every meal, all holidays, all celebrations, it was alcohol and to the excess. There was a lot of bravado about how much one could drink. And I just realized recently that my parents never were honest with me about their feelings, about how they felt about me or my brothers, unless they were inebriated. That sincerity came out then, but it didn't feel sincere because it was alcohol induced. And of course they didn't remember the next day. So emotions weren't a big part. I mean, I think that carried over in how they raised us. And for me, alcohol became my identity. I never really felt like I belonged even in my own family, but alcohol would normalize me. So it was integral to who I was from a very young age. Allison: Yeah. I was going to ask from a very young age, when did it start to become part of who you were? Ian: I can remember stealing what we call jungle juice, which was a little bit of alcohol from the liquor cabinet from every bottle. So they didn't notice much was taken, and I was probably 10 or 11, and I went to a friend's house and I drank it all. And very soon after vomited and went home. And the next morning I felt terrible, but I wanted more. It felt like I had arrived, that I had found something that made me feel like I belonged, that I connected, that I was normal. Allison: So Ian at school, did alcohol play a big role there as well? Ian: Well, alcohol gave me an identity, right? So I could be the party guy, and I carried a knapsack around with not only alcohol, but mix and a lot of times ice and cups. Allison: Like a walking bar? Ian: Yeah, I was a walking bar, and we'd often, we had a club next door to our school that I belonged to, and I would take people over at nine in the morning and we would play pool and drink beer on my parents' account, which my dad still brings up as a funny anecdote that that's what kids do when they're 12 years old and they don't, they really don't. Jay: Ian, when we introduced you, we pointed out you're a successful television writer. I worked with you, I know that. But when I was working with you, what was going on with regards to alcohol with you? Ian: Yeah, alcohol pretty much destroyed everything in my life, relationships, bank accounts, you name it. But work was like the last bar. If I held a job, then I was still managing my life okay. I worked very hard, but I played very hard. So on a shoot, I would work all day, and then I would drink most of the night and wake up still drunk and go to work, probably reeking like alcohol. I remember one point I would do interviews over the phone from home and I'd be actively drinking and using drugs while interviewing famous scientists thinking that that was normal or okay, because I could manage it. And it was insane looking back, really. Allison: So what caused you eventually to stop drinking and get sober? Ian: Well, I knew I had an addictive personality, and I avoided cocaine for a long, long time, and then I found it and it destroyed me in less than five years. Using cocaine allows you to drink more alcohol. And one night I was in a lot of pain and I looked in the mirror and a voice said, "Ian, you're killing yourself." And the response was, "I don't care." And that scared me enough to call a rehab center. And they said, "Well, we're full up. We'll call you in a month." And my first thought was, "Yes, I have a month more to party." That is crazy. And sure enough, I did go to rehab, and that was almost 11 years ago. Jay: And when you went to rehab, were you able to stop drinking, and I'm assuming, doing drugs immediately? Ian: I was pretty broken when I went into rehab and they lock you in for 40 days, so you're forced to go dry. I slept a lot in that month and started to feel better. They force you to go do 12 step programs, and I had my own ideas of what the 12 step program was. I thought it was a God program, and it turns out it wasn't. I also thought I was very unique in my troubles as a child. I do have experiences of abuse, but it turns out that my story was very common. And so I started to feel connected. I started to feel like these people were just like me, and there was some growth in that, and they tell you to get a sponsor and do the steps. And I was desperate enough. I had tried therapy for 20, 30 years. I tried exercise, I tried all these things, and I was out of answers. And so I did what they said, and sure enough, it worked. I don't know exactly how it worked. I think I was just desperate enough and broken enough, and I'm very grateful that I found that program. Jay: How difficult was it to remain sober after, say, your initial 40 days? Ian: Looking back, it was hard to, my whole identity was wrapped up in alcohol. I had never had sex sober. I had never danced sober. I really never really socialized sober. So what did I do? I just trusted in the program. I started working with others, and I would go out and I remember I went to the Grateful Dead final concert in Chicago, and I was probably one of very few people that were sober in a crowd of 50,000 people. And I was nervous that I wasn't going to like the music, that maybe it was just going to sound like noise, but I ended up having a great time. And the thing about being present and not being numb by alcohol is that I started to feel connected. I started to have real feelings. I started to find my authentic self and kind of start to have a purpose in life, which was helping others. I do think now that being an addict and an alcoholic is one of my greatest assets as a human being because I can help others. And I've also been given a second lease in life. So no, it wasn't easy. It took a lot of work, and that's what the steps are for. They help you with that. Now the big thing is, what I learned was that alcohol and drugs weren't my problem. They were the solution to my problem. We always think if we can just get rid of the booze and drugs, then I'll be fine. Well, why was I using the booze and drugs? And that's what the steps help you discover and then gives you a toolkit for how to live. Allison: Yeah, amazing. This show, as you know, is really focused on alcohol use as a dementia risk. So to what extent is your dementia risk on your mind? Ian: Well, having agreed to do this program, it's more on my mind now. I considered doing the genetic tests, but then I realized, well, what is that going to give me necessarily? I think I've made the decision about now that I've stopped, I think that's a start. And I definitely am more social now than I was drinking, and I exercise and I eat well. So maybe the damage is already done, but at least I have an 11-year start of living healthier and making better choices, and hopefully that improves. So it's a concern, but there's not a whole lot I can do about it right now other than what I'm doing. Jay: And I think based on what we've heard over this series of episodes, we would reassure you that at least when it comes to genes, what you're doing now in terms of reducing your other risks probably can account for and maybe exceed any genetic risk. But Ian, is there one thing you would like our listeners to take away from your story? Ian: Yeah, I mean, if I used for 30 years of my life and couldn't live without alcohol and drugs and was able to go through a program and not need those things anymore in life, then anyone can. Like I never thought I'd be able to give up. When I went to rehab, I thought if I just get rid of the coke, I'd be fine. I could live on alcohol. And luckily, it gave me an opportunity to reflect on my life. But you have to want it, and you have to be absolutely brutally honest with yourself because no one's going to do it for you. You have to do the work, and you have to do it every day. And the great thing is, if you do it and you're able to help others, then you start to feel a sense of purpose and serenity, and you start to love yourself and you start to enjoy life, like truly enjoy life. So I encourage anyone to look for help. I'm available for help if you need it. And that's it. Allison: I just want to say first of all, Ian, congratulations on making it almost 11 years sober. It's a challenge for anyone, and especially after 30 years of using, it's tremendous what you've been able to do and the outlook that you have on life and the work that you've done to support others. Thank you so much for that. And thank you today for helping us to defy dementia. Jay: Yeah, thank you, Ian. Ian: Thanks for having me, and thank you for having this show. It means a lot. Allison: Ian is a father, husband, son, and a television show writer. He joined us from Toronto. Jay: Our next guest has been listening to Ian. Dr. Tim Naimi is a physician by training and director of the Canadian Institute for Substance Use Research at the University of Victoria. He is one of the authors of Canada's Guidance on Alcohol and Health. That's the federal government's advice to Canadians on alcohol consumption. He's also one of the main creators of the website, knowalcohol.ca, that's know as in K-N-O-W. And it's a really interesting tool that enables people to input their alcohol intake and then the website calculates their associated health risk in simple and vivid ways. And get this, it also calculates the lifelong financial cost of your alcohol intake too. Dr. Tim Naimi joins us from Victoria. Tim, thank you for helping us defy dementia. Tim: Thanks to you both for having me. Jay: Tim, what struck you about Ian's story? Tim: Well, first of all, I think there's a number of interesting points. The way that people sort of think of alcohol use disorder, alcoholism often is a genetic thing, but really, I think his story tells us a lot about what really matters more, which is that we're all a product of our environment, and I think that's really important. And the other thing, of course, is that he's raising these interesting connections with alcohol and dementia, and not just, I'm sure his concern about himself, but also with his parents. Allison: So Tim, earlier we heard Dr. Sumbria detail how alcohol affects the brain at an anatomical level. And I wonder if you can give us sort of a big picture how those brain changes can impact a person's cognitive health. Tim: Well, Allison, if you look at a graph and on one axis you say, okay, this is how much alcohol somebody has consumed in their lifetime. And then you look at scans of their brain, and you look at the degree of atrophy, which is to say that the amount that the brain has shrunk, more alcohol very much correlates with more brain shrinkage, so more alcohol, less brain. How about that? That's kind of simple. And we know from epidemiological studies that particularly excessive alcohol consumption is associated with dementia. In fact, youth or sort of teenagers who binge drink regularly or drink to the point of impairment regularly have more than a five times increased risk of developing dementia in later life. Allison: But is there any protective effects ever or benefits for alcohol when it comes to dementia risk? So for example, you might have heard red wine is good for you. Where does that fit into the story? Tim: Well, I think that's always an interesting thing. I think if there were a benefit, it's at very, very low levels. The major message in terms of cognitive health and dementia is that if you drink, less is better. That's rock solid. The bit about what's happening at the very lowest levels of consumption is controversial. There's also another new type of study called a Mendelian or Genetic Randomization Study, which finds no protection even at the lowest levels. So again, probably no protective effect, even at really low levels. But if there is, again, less is better, and alcohol is a major modifiable risk factor for dementia. Jay: Tim, I'd like to pick up on something that you said just a minute ago about people drinking a lot when they're young and how elevated their risk is. Let's say you drank a lot until you were 30 or 35 and then you quit. Is there a benefit to that? Tim: Well, that kind of stuff hasn't been studied, but let's put it this way, if you continue to drink at particularly high levels, things will continue to get worse. So yes, there is a benefit of stopping, I would say that unequivocally. I guess, but this also has a bit of a common sense element, as in one of my favorite expressions is, when you're in a hole, quit digging. So I think that's the idea there. If you have consumed a lot of alcohol in youth and in middle adulthood, there's undoubtedly been neurological damage that may not have yet manifested itself because as we get older, just in general, there's some of our cognitive functions decline, and then those deficits or those damages caused by alcohol will become manifest. I should mention, if we think about alcohol in the brain, it's such an important risk factor for things like traumatic brain injuries where people have injuries to their head for strokes, for seizures, and then things related to acute intoxication, alcohol withdrawal, depression, another thing. So alcohol being an important modifiable risk factor for dementia, but is also really has a big influence on lots of brain-related conditions. Jay: And as we've heard in the series, many of the things you just mentioned contribute to the risk of dementia as well. So if we look not just at an individual and how much they drink, but across the population, how important would you say alcohol use is as a risk for dementia? Tim: Well, I would say it's very important. There's been a number of studies done on that in France, in Canada. I think the Lancet Commission on Dementia was very influential. Allison: So just to be clear, again, looking at the population level, if someone has been drinking and reduces their amount of alcohol use, how does that affect dementia risk and does it improve cognitive health? Tim: Well, it does improve cognitive health. Most of the studies that have been done just look at the effects of the cumulative amount of alcohol that people consume and the risk of dementia. So I think there's a relatively limited number of studies about taking a bunch of people who are drinking heavily and then trying to get them to stop and see what happens. But when you stop, even if it's in middle age, you're going to be reducing that total amount. In terms of the brain sort of healing itself the way or maybe the liver can sometimes heal itself, that's a bit more controversial. But again, by reducing as much as possible one's total exposure to ethanol, you're reducing your chances. Allison: I think a lot of people out there may have heard Ian's story, and they may resonate with the fact that for people who have alcohol as part of their lives, it's often really, really difficult to go less. So what's the best way to reduce alcohol consumption? Tim: The short and simple answer is that the people with an alcohol use disorder may need professional help. But for the vast majority of people who drink alcohol or who drink alcohol in ways that increases their risk of dementia or other problems, the first thing you got to do is kind of be mindful about it. That's where I think Canada's Guidance on Alcohol and Health, we presented a range of consumption levels and try to engage people at all levels of consumption to think about their risks, because it's difficult to make behavior change unless you actually think about it. Then you have to sort of set a goal, and then you have to have a plan, because as my daughter's second grade teacher, what would she say? She'd say, "A goal without a plan is just a wish." So that was her famous quote, at least according to my daughter at the time. But anyway, many people, and we talk about this at dry January, the idea is not to think of this as deprivation, but try to substitute other activities, make a plan for maybe you'll spend a little less time with your drinking buddies and more time with other buddies and do different activities. Again, talking to friends and family, thinking about the reasons why, you know, the motivations to drink less, and some of those benefits. And I'm going to put in a shameless plug for our calculator, knowalcohol.ca, K-N-O-W alcohol.ca, where people can not only look at their health calories and financial costs of what they drink currently, but we also show them the benefits of drinking less. So for example, if I put in I'm drinking 16 drinks a week and I want to get down to the upper sort of moderate risk zone for Canada of six, I can see, for example, how much life expectancy I would save or minutes per drink not consumed. I can see my lifetimes savings, those sorts of things. Jay: So how do you approach that when you're talking about reducing alcohol consumption? Because so many people feel like they're being asked to stop something that they really enjoy. That's actually a really important part of their social lives. Tim: Yeah. And I think it's so important to acknowledge that there are a lot of reasons why people drink. A lot of people drink because, especially at low levels, they may feel pleasurable. As you suggest, a lot of people drink because it's a way to socialize for people, especially those who tend to be a bit anxious. People may do it just because their family did it, all these things. So I think, again, that's where the being mindful comes in. Our ask with the guidance, for example, is not telling people you have to get down to two drinks a week or six drinks a week, but it's actually our ask is situate yourself in terms of health and consider drinking less. It's not saying we understand that many people won't want to drink less or are comfortable with where they're at. So I think it's being factual, but also being understanding. Allison: It's the baby steps that we always talk about. Tim: The baby steps, yeah. Jay: Is there a number because from time to time you hear really no drinking is best, or you might hear, well, two drinks a week, which is when it was first suggested, seemed a bit shocking to some. But is there a number where you can be confident that your cognitive health will be maintained if not improved? Tim: Well, the Canada's Guidance on Alcohol and Health was primarily determined based on the risk of dying early from alcohol. So I would say if people can get down to the two per week. Again, this is sort of based on death, but it parallels the risk of dementia broadly, which is like, I think if you can get down to a couple of drinks a week, that would be lowest in terms of risk. But other than that, trying to keep it to a drink per day or less. And the other thing is patterning, because if even for people who get down to five or six drinks a week, and if they're having it all at one time, that's worse for brain health, most likely than consuming one drink five or six days a week. Allison: Tim, one of Defy Dementia's taglines is, you're never too young or too old to take care of your brain. And you mentioned younger folks a little bit earlier on, but what is it that young people need to know about alcohol use and dementia risk reduction even at that young age? Tim: Well, I mean, honestly, some of these studies that have come out more recently, I didn't realize the strong connection between basically getting drunk in youth and adolescence and later dementia. And usually kids are really smart and they value their brains, and a lot of them, quite honestly, may have had grandparents with dementia, and they've seen what that's like. And yeah, so I think it's about quality of life. It's interesting with younger people, I'm from the US, but both in US and Canada, we've seen this leveling off and actually declining alcohol consumption, which has really outpaced that among adults. And so that's kind of an interesting thing. There is, I think, a growing appreciation among some segments of youth and young adults, again, the crew that's interested in healthier lifestyle, are drinking less. And there's a lot of great low, we call it low and no alcohol products that taste pretty good. So I think there's interest in kind of the sober curious movement. So I think youth are okay. I think actually I'm more worried about their middle and older age adult counterparts. Allison: And it is interesting to see, it is really the youth that are driving, if you go to almost any fancy restaurant, you used to just get the cocktail list and now there's the cocktail list and an equally large non-alcoholic cocktail list. And I see people equally drinking, but more and more leaning toward the non-alcoholic because the options are there. Tim: Yeah, and I think one of the ways we talked about drinking less is if people are starting to think about drinking as a treat or a special thing on the weekend. So maybe they also can buy better stuff or make it more like a special occasion. But also, like you're saying, there's a lot of really good non-alcoholic beers now, and even some of the wines are quite good. Jay: Tim, this has been absolutely fascinating, lots to think about. Thank you very much for joining us on Defy Dementia. Tim: Thanks to you both for having me. Jay: Dr. Tim Naimi is director of the Canadian Institute for Substance Use Research at the University of Victoria, and he joined us from Victoria, British Columbia. Lots of interesting information there, Allison. What stood out for you? Allison: I think two things stood out for me. One was in the first part of our discussion today, that liver brain connection, I'd never really thought about it or knew very much about it, so I learned a lot about that today. That was really interesting. And then the other thing that really stood out for me was, how hard it is to stop drinking. I think that the message came out loud and clear, it's better to drink less or to drink not at all. But it's also really, really hard because alcohol is everywhere in our culture. And I thought it was really interesting when Tim was talking about how you really have to understand the why about why you drink so that you can understand how to reduce your drinking. Jay: Oh, I totally agree. Any really popular television series, and I could go back to Mad Men and up to the very recent White Lotus, and I don't think there's a scene in those programs where there isn't alcohol in some form. And then I recently holidayed with some of my kids and their partners, and we were in Mexico, and it was a lot of fun. And to take somebody of say, in their mid 30's aside and say, "You know, guys are having a lot of fun and there's alcohol everywhere, but did you know that..." You just, it's so unconvincing. And as Tim, I think mentioned, if you start thinking about teenagers, my kids are older than that, it's really, really difficult. Allison: Absolutely. We know reducing it is going to improve your life in lots of different ways. And I think that's the other thing that's important to keep in mind is that excessive alcohol use is a risk factor, not just for dementia, but for many, many other health issues. And so stopping drinking or reducing your drinking is going to be good for your health, but there's so much more research that needs to be done to really hammer down the details there. To find out more about how we can all boost brain health and reduce the risk of dementia or slow its progression, please visit us at defydementia.org. There you can check out other episodes of this podcast as well as our videos, infographics, and other resources. We also will have links there to Canada's Guidance on Alcohol and Health. And Tim Naimi's site, knowalcohol.ca. Again, that's know, K-N-O-W. Jay: Our podcast production team is Rosanne Aleong and Sylvain Dubroqua. Our writer and Chase producer is Ben Schaub. Production is by PodTechs. Music is by Steve Dodd. And our cover art is by Amanda Forbis and Wendy Tilby. Allison: We'd also like to thank the funders of this podcast, the Slate Family Foundation, as well as the Center for Aging and Brain Health Innovation and Baycrest. And we are very grateful for your support too. So please push that subscribe button for Defy Dementia wherever you get your pods. And don't forget to leave a like, a comment or maybe even a five star review. Jay: Next time on Defy Dementia, untreated vision loss. It's a new addition to the list of dementia risk factors. Not only does untreated vision loss add to our cognitive load when we try and read or scrutinize something, it also interacts with other dementia risk factors like physical activity and well-being. A fascinating topic. You won't believe your eyes or your ears. That's next time on Defy Dementia. I'm Jay Ingram. Allison: And I'm Allison Sekouler. Thank you for listening to Defy Dementia. And don't ever forget, you're never too young or too old to take care of your brain.