Will health coaching work for me if I drink alcohol?

A nutritional anomaly

What do water, fat, protein, carbohydrates, vitamins, and minerals have in common?

Humans require them for life; they’re our six core dietary nutrients.

These nutrients are converted into energy in our bodies which helps us to move, think, breathe, build our muscles and bones, and achieve all of the chemical processes needed to keep us alive and thriving. Oxygen is a nutrient, too, though we don’t “eat” it.

And then, there’s an anomaly that gives us energy but doesn’t support life—at least not on the physical level. Cultures around the world are obsessed with it. Entire industries and art forms and economic structures are dedicated to it. It’s rich with beauty and allure and danger, with ecstasy and addiction, with history and innovation, with celebration and destruction. This enigmatic substance is alcohol—the “most widely consumed drug worldwide” according to the Journal of Applied Physiology, Nutrition, and Metabolism (1).

Is alcohol good for you?

You may recall the study that came out in 2001 claiming that people who drank moderate amounts of red wine had lower risk of coronary heart disease (2). Moderate wine drinkers everywhere could celebrate their good health choices! Then, in the early 2020’s, multiple studies concluded that there was actually no healthy amount of alcohol—it all does damage—and that the previous study had overlooked the fact that moderate drinkers were also moderate in other aspects of life, making good health choices across the board, and that some non-drinkers were former drinkers, which explained the apparent benefits (3). Alcohol was back off the menu.

However, there are also multiple studies indicating that low-to-moderate alcohol consumption not only reduces total mortality risk but also correlates with an improved quality of life relative to both teetotalers and heavy drinkers (4). With that in mind, becoming a moderate drinker should be a no-brainer—except for the fact that alcohol is a biological toxin that the body prioritizes detoxing immediately over the absorption of other available nutrients.

There’s no simple answer, and really curious thing is that we’re not the only animal that craves alcohol.

Cedar waxwings are known to consume fermented berries before a long migration (and unfortunately sometimes die by intoxicated window-crashes as a result). Swedish Elk get tipsy by eating rotten windfall apples. In the Caribbean, monkeys are known to steal alcoholic drinks out of open-air bars and get sh*tfaced on the regular(5). Researchers have even noticed that male fruit flies seek out alcohol after being rejected by a potential mate(6).

In the human world, alcohol is baked into culture, ritual, religion, and socialization in communities around the globe. Alcohol’s a medicine, it’s a sacrament, it’s a preservative for herbs and fruits and vegetables through the winter, and it’s long been used as an alternative to water when the local water was unfit to drink.

Alcohol can also damage your liver, lower your immune system’s capacity, increase the “bad” kind of body fat (the visceral kind), increase inflammation, and lead to very poor choices that sometimes involve violence or death.

So why this paradox? Why do love to play with this liquid fire?

Three reasons I believe humans are drawn to alcohol:

1. Food preservation is life

Alcohol is a ferment that can last a long, long time—in some cases indefinitely. We use it to preserve herbal medicine in the form of tinctures; to preserve the vitamins, minerals, phytonutrients, and calories of last year’s grain or fruit harvest; and to preserve other foods in their whole forms—think brandied figs or pears. Wildcrafted alcohol is a source of probiotics. Without alcohol, our ancestors likely would have perished from malnutrition during harsh winters or poor harvest years, and they would have had a smaller selection of medicine outside the season when the herbs were growing. Alcohol has been central to our survival since the dawn of agriculture. We know this deep in our bones.

We are drawn to the magic of alcohol and its ability to expand the seasons and span across time. I’m home-brewing Dandelion wine for the first time this year, something I’ve been dreaming of doing since I first heard the song lyrics,

“Dandelion wine will make you remember the first days of spring in the middle of December, oh Dandelion wine, Dandelion wine…”

over twenty years ago. (Major bonus points for anyone who can tell me the origins of that song…I lost the recording and Google has yielded nothing!).

This timeless feeling is even more dramatically illustrated in the film The Taste of Things when a bottle of champagne purchased from a 50-year-old shipwreck is shared at a special meal. It’s partly about the taste of the champagne, but it’s likely more about the feeling of connection across history—an adventure through the magic of fermentation preservation. This deep, long-term, survival and culture based relationship to alcohol has to be accounted for when we explore our dietary choices and impulses.

2. We require altered states

Humans crave altered states. Let’s be real—being in consensus reality all the time can get boring, and often painful! But it’s not that shallow; we actually require altered states to release old ways of thinking and form new neural networks. We do this through dance, theatre, lovemaking, fasting, making art, prayer, meditation, chanting mantras, skydiving, and countless other channels. We crave substances that take us into altered states and we form elaborate rituals around them, from the subtle (cacao) to the extreme (ayahuasca) and everything in between. Those who have worked closely with organic substances which induce altered states—myself included—would say that it’s not just a chemical reaction, but a direct interaction with the spirit of the plant or mushroom ingested that produces the change.

Science is now backing up this need to shift consciousness with research into flow states, serotonin receptors in the gut, and the re-wiring of neural networks. Alcohol is one way humans have long achieved altered states. Many religious and Shamanic practices from traditions around the world incorporate alcohol into their rites and rituals, from traditional Mongolian Shamanism to Jewish Passover to Bacchanalian Mystery Cults to Catholic Mass. Alcohol involved in ritual becomes sacred. The altered state that alcohol produces allows for a dissolution of the everyday self and easier access to a sense of oneness with the ritual and within the community involved.

We also require altered states for relief from pain, both emotional and physical. This works on a smaller scale, such as having a glass of red wine to reduce menstrual cramps, and on a larger scale as well. Ever seen a Civil War movie where a soldier downed an entire bottle of bourbon then chomped on a leather belt before an anesthetic-free, highly unsanitary amputation? You can bet he was grateful for the altered state and numbing the alcohol provided! And, probably, for the emotional numbing it provided after the trauma of battle and open air operation as well. And that, of course, is the rub. I’ll address alcohol as a numbing agent in more depth in a minute, but first let’s circle back to the third piece: community, another aspect of why our relationship with alcohol can get so dang complicated.

3. We associate alcohol with community

This is one reason why, when alcohol becomes a detriment to someone’s life, it can be so hard to quit drinking. Historically, every step of the life cycle of alcohol itself is rooted in community. Harvesting the foods to be preserved and fermented is an act of community. Preparing and processing the harvest is an act of community. Caring for the vessels full of elixir as they ferment is an act of community. Drinking the fruits of everyone’s labor is an act of community. How iconic is the image of people romantically stomping grapes together on a vineyard in Italy? Maybe you’ve even done that yourself! In Peru, a drink called chicha is traditionally made by the community chewing corn kernels together and spitting the masticated corn into a large vessel to ferment as one mash-up of everyone’s saliva and digestive enzymes. Nowadays you can buy a sugary, sanitized, non-alcoholic version of chicha at a corner market, but the origins are community fermentation. I can only imagine the collective immune system boost this practice imparts!

Besides its involvement in ritual, alcohol is served as a matter of course at parties, concerts, dinners, and brunches. Teenagers, who especially crave altered states, bond over sneaking alcohol into forbidden places. Adults relish sitting down with friends over a glass of wine.

It takes a concerted act of personal will and social bravery to say, “No, I’ll just have water,” because alcohol is part and parcel to the bonding experience—there’s a trust element to being in an altered state together and, paradoxically, a trust element to getting wasted with someone else who’s sober. To be intoxicated is to be vulnerable (even if it imparts an unwarranted level of confidence or bravado, often later regretted). But to be sober and enter an altered state, to let your guard down and play and act silly and vulnerable without liquid courage, is even more emotionally vulnerable because you’re present to feel it all. So alcohol is embedded in community, but community is not dependent upon alcohol—not matter how much we might be sold the opposite truth.

How this fits into health coaching

When people come to me for health coaching, nutritional, and herbal support, my primary job is to help them achieve their own health goals—not mine. I’m also responsible for providing scientifically accurate information, and for providing culturally appropriate guidance. Some cultures include alcohol in almost every social gathering, some involve it in ritual, and some forbid it entirely. I take note of signs of addiction, but I never push someone to take actions for which they’re not ready. Alcohol, then, can be tricky.

The elephant in the room

The elephant in the room when talking about alcohol is addiction—knowing when the line is crossed between a choice and a compulsion to drink. The American Society of Addiction Medicine defines addiction as, “…a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences (7).” From a process oriented perspective, I would describe it as trying to meet an unmet biological, emotional, psychological, or social need in a way over which a person feels they don’t have full control.

Most of us are addicted to something—sugar, doomscrolling, complaining, and shopping come to mind as oft-unacknowledged addictions—but alcohol gets special attention because the impacts of its abuse are so dramatic. It’s everywhere, it’s easy to access and hard to avoid, there’s tremendous social pressure for and acceptance of drinking to excess, and the results of misuse can be quickly lethal for both the drinker and those around them (note the Cedwar waxwings).

A balanced perspective

With that in mind, it’s really, really important that when someone comes into my office wanting to work on drinking habits, there be no shame. I'm not interested in telling someone what to do, I'm interested in helping them find out what's true and healthy for themselves. I know that drinking might be the only thing keeping someone from having to feel the full pain of childhood abuse, from having to descend into the depths of unprocessed grief, or from recognizing that they need to leave a job or relationship in which they feel trapped. I know that, biologically, the compulsion to drink might be coming from someone’s gut microbiome—literally the cravings their intestinal bacteria have—and that that’s not something you change with willpower but rather by changing other aspects of diet and lifestyle. And I know that everyone has their own process and their own timing; my job is not to put my timing onto them, but rather to help them come to their own deepest truth.

During the lockdown phase of the recent pandemic, alcohol sales skyrocketed. Many people—including myself—drank more than ever before. Clients came into my office describing drinking habits that were new and specific to the times. This was a coping strategy. The sense of isolation, lack of safety, and social unrest led to unmet needs. For some people, this led to an addictive pattern or reactivated an old addictive pattern—for most people it was a temporary way to feel less overwhelmed. Not the best choice for the liver, but a coping strategy nonetheless. I mostly just acknowledged the truth of this. If people wanted to work on their drinking habits, we worked on them. We worked on the impact of drinking to relationships and jobs and health and goals and dreams. But there’s something relieving in just being seen and not shamed for managing the hardness of life in whatever way we can, and it’s important not to jump to the idea of long-term addiction when a short-term coping strategy is present. Often when the stressor lifts, so does the habit, and the thing to do is focus on creating more helpful habits.

And that’s the crux of it: life is hard, and beautiful, and we’re all just doing the best we can. The academic research on alcohol yields mixed results. The lived experience of alcohol use runs the gamut from ecstasy to devastation. When someone seeks out coaching and nutritional support, they’ve already made the decision to try and make life-enhancing choices for themselves and my goal is to help them do that.

For some people, alcohol has never been part of that picture and never will be. For some people, alcohol is a beautiful cultural and medicinal ally with which they have a responsible relationship. For some, it’s complicated; they’re not addicted, but they’d like to drink less, or with more awareness. For some, alcohol conflicts with medications or other health conditions. And for some, alcohol is actively harming their health and their relationships in a way they can’t control, and they may be ready to explore that—or they may have other goals they want to address first.

In any case, my job is to help someone find their own way to feel whole, healthy, and aligned with their core values. If you’ve been considering health or nutrition coaching but you’ve been afraid that your relationship with alcohol would be a deterrent to that work, please know that I am—and any client-centered practitioner is—here to meet you where you are, to find out what makes you feel vibrant and alive, and to help you get to where you want to be—whether or not you drink.

Sources

1. https://cdnsciencepub.com/doi/abs/10.1139/H07-175
2. https://onlinelibrary.wiley.com/doi/10.1046/j.1523-5408.2000.00024.x
3. https://greenmedinfo.com/content/sobering-science-alcohols-true-health-costs-and-natural-strategies-longer-life
4. https://link.springer.com/article/10.1007/s11136-016-1229-2 (one example study of elderly participants in Spain showing increased activity and better perceived quality of life with moderate alcohol consumption)
5. https://www.bbc.co.uk/programmes/p00zd535
6. https://nautil.us/do-animals-get-drunk-306357/
7. https://www.asam.org/quality-care/definition-of-addiction