One of the really bad effects of alcohol, but that's extremely well-documented, is the fact that alcohol, because of this toxicity of acetyl aldehyde and related pathways, can alter DNA methylation. It can alter gene expression. That can mean many things in different tissues, but it is associated with a significant increase in cancer risk, in particular, breast cancer, and in particular, because breast tissue is present in both males and females, but in women, it's especially vulnerable to some of the DNA methylation changes.

Well, breast cancer in women has a relationship to alcohol intake, and alcohol intake has a relationship to breast cancer in women. In fact, there has been proposed to be anywhere from four to 13% increase in risk of breast cancer for every 10 grams of alcohol consumed. How much is 10 grams?

Well, there we need to think a little bit about the variation in the amount of alcohol in different drinks across the world. Different countries serve different sized drinks and have different concentrations of alcohol in those drinks. So without going down too much of a rabbit hole and just giving you some good rules of thumb to work with, there've been studies of the percentage of alcohol included in different drinks and the sizes of different drinks that are served in different countries, and here's a kind of a patchwork of those findings.

In Japan, one beer, one glass of wine, or one shot of liquor as it's served there tends to include anywhere from seven to eight grams of alcohol. In the US, one beer, which generally is 12 ounces, if it's in a bottle, one glass of wine or a shot of liquor tends to include about 10 to 12 grams of alcohol.

And in Russia, one drink of the various sorts that I just described, typically will have as much as 24 grams of alcohol because of the differences in the concentration of alcohols and the sizes of drinks that are poured in these different countries, okay? Of course, there are other countries in the world, those countries are also vitally important, but those are the ones that extracted from the studies that I could find.

What does this mean? Well, what we're talking about is that for every 10 grams of alcohol consumed, so that's one beer in the US, maybe a little bit more than one beer in Japan, or basically a third of a drink in Russia, there's a four to 13% increase in risk of cancer.

That's pretty outrageous, right? And you might think, wait, how could it be that this stuff is even legal? Well, look, as I described before, it's a toxin. It's also a toxin that people enjoy the effects of. I mean, in the US, at least they tried prohibition. It certainly did lead.

Yes, did lead to a reduction in alcohol-induced health disorders, in particular cirrhosis of the liver. It also led to a lot of crime because it became a substance that a lot of people still wanted and that people were willing to break the law in order to provide, or I should say to sell and provide.

But the point is that the more alcohol people drink, the greater their increase of cancer, in particular breast cancer. And that's because of the fact that alcohol has these effects on cells that include changes in gene expression. And cancer, that is the growth of tumors, is a dysregulation in cell cycles, right?

A tumor is a aggregation or the proliferation. Aggregation is stuff sticking together, by the way. Proliferation is stuff duplicating. A proliferation and aggregation of cells that could be a glioma, is glial cells, glioma, brain tumor, right? It could be lymphoma, so within the lymph tissue, et cetera. The mutations that alcohol induces to cause this are wide ranging.

Some of those are starting to start to be understood. For those of you that are interested in cell biology, I'll just mention that the PD-1 pathway, again, this is super specialized and for the aficionados only. You don't need to know this. The PD-1 pathway seems to be upregulated. And, and we knew this from the discussion earlier, there's a downregulation in some of the anti-inflammatory molecules that help suppress this proliferation of cancers.

Nowadays, there's a lot of interest in the fact that the immune system is constantly combating cancers that exist in us all the time. You know, little tumors start growing and our immune system goes and gobbles them up. Little tumors start growing, the immune system senses inflammation, sends out these incredible cells, these killer B cells and T cells and beats them up.

Cancers proliferate and take hold and cause serious problems when the proliferation of cells exceeds the immune system's ability to gobble up and remove those cells. There are other mechanisms of regulating cancers, but that's one of the primary one. And alcohol hits it, again, it's a two-hit model. It increases tumor growth and it decreases the sorts of molecules that suppress and combat tumor growth.

So again, even low to moderate amounts of alcohol can be problematic for sake of cancers, in particular, breast cancers. Epidemiologists and health specialists love to try and compare different substances in terms of how bad they are. Rarely do they compare substances in terms of how good they are, but sometimes they do.

And what they'll sometimes tell you and what you can find in the literature is that ingesting 10 to 15 grams of alcohol a day, so that would be like one beer in the US, one glass of wine, is the same as smoking 10 cigarettes a day. Frankly, it's hard to make that direct relationship really stick because it's a question of how long people inhale, do they have a predisposition to a lung cancer, et cetera.

But even if that number is off by plus or minus two cigarettes, or even if that number would, the equivalent of one glass of wine equals one cigarette per day, I think there's general consensus now that nicotine consumed by vaping or by cigarette it's bad for us in terms of lung cancer and other forms of cancer.

And for some reason, I don't know why, because this knowledge about alcohol and cancer and these established relationships have been known since the late 1980s. The first kind of landmark paper on this was published in 1987. I can provide a link to that paper, it's actually quite interesting to read.

Well, the relationship is there and yet we don't often hear about it, right? In fact, before researching this episode, I had heard before that alcohol can increase cancer risk, but I wasn't aware of just how strong that relationship is. Because of the serious nature of what we're talking about and because I would hate to be confusing or misleading to anybody, I want to just emphasize that this statistic, that there is a four to 13%, depending on which study you look at, a four to 13% increase in the risk of cancer, in particular breast cancer, for every 10 grams of alcohol consumed, that's 10 grams per day.

So that's one drink per day. But I do want to emphasize that if that equates to seven drinks per week and all those seven drinks are being consumed on Friday and Saturday, it still averages to 10 grams per day. And I also want to emphasize that there are things that people can do to at least partially offset some of the negative effects of alcohol as it relates to predisposition to the formation of certain kinds of tumors and cancers.

I also want to be clear before I say it that doing the things I'm about to tell you is not a guarantee that you're not going to get cancer, nor is it a guarantee that alcohol is not going to lead to an increased predisposition for certain kinds of cancers.

And the two things are consumption of folate and other B vitamins, especially B12. You know, the consumption of folate and B12 has been shown to decrease cancer risk in people that ingest alcohol, but not completely offset it. Why that is isn't exactly clear. It probably has something to do with the relationship between folate and B12 and other B vitamins in gene regulation pathways that can lead to tumor growth.

At some point soon, we will get an expert in cancer biology and in particular in breast cancer biology on the program, and we can ask them about this. But I realize this is going to raise a number of questions and maybe even cause some of you to go out there and start taking folate and other B vitamins and B12.

Not incidentally, a lot of the reported hangover supplements and treatments include folate and B12. I don't know if they had the cancer literature in mind when they created those supplements and products. I doubt they did. Alcohol really does disrupt B vitamin pathways, both synthesis pathways and utilization pathways. So sometimes you'll hear, oh, you know, if you get your B vitamins, it helps you recover from hangover more quickly.

Again, the literature doesn't support that, but also again, there aren't a lot of studies, but more to the point as it relates to alcohol and the formation of tumors and cancers, it does appear that decreased folate and other B vitamins like B12 are partially responsible for the effect of alcohol and increasing cancer risk.

And it does appear that consuming adequate amounts of folate and B12 might, again, might partially, I really want to bold face and underline and highlight, partially offset some of that increased risk. (upbeat music) (upbeat music)