Alcohol Harm Reduction Protocol

In the last post, I made the case for drinking alcohol, showing that you can drink small amounts of alcohol on a regular basis and be completely healthy. And there may even be benefits.

Today I’m going to tell you how to make alcohol safer and more enjoyable. There are thousands of harm reduction stacks for illicit drugs out there, but not very many about alcohol. So these are the things you can do that have the effect of rendering alcohol less harmful, and perhaps even helpful.

Before I begin, let’s understand why alcohol can be so bad for you. When we consume ethanol (which isn’t that toxic by itself), our liver metabolizes it into acetaldehyde (which is). Acetaldehyde is so toxic that we evolved an enzyme whose primary purpose is to turn dangerous acetaldehyde into the far more benign acetate. Most problems with alcohol occur when acetaldehyde builds up to dangerous levels, either because we drink too much in too short a time or because our acetaldehyde clearance is impaired. So when we’re talking about a harm reduction protocol for alcohol, we’re really talking about how to improve acetaldehyde clearance.

Here’s my Harm Reduction Protocol for Alcohol.

Respect alcohol as a drug (Set & Setting)

First of all, I respect alcohol as a drug. They used to call alcohol “spirit” because it could animate you with a new self. Some would even say an interloper. The Romans used to say in vino veritas, in wine, truth, suggesting that your true self comes out when you drink, or at least a version of you that is partially true.

Like other classic drugs, set and setting matter. It isn’t only psychedelics or weed where mindset and environment determine the experience. Alcohol is the same. You have to be in the right mindset, and you have to be drinking for the right reasons.

You drink to enhance the steak you’re about to cook. You drink to enjoy the company you’re with. You drink to celebrate something meaningful. What you shouldn’t do is drink to numb depression, to quiet anxiety, or to escape whatever is bothering you. The intention behind the drink creates a different physiological response. Drinking in celebration creates one type of metabolic and hormonal outcome, while drinking to forget creates another.

If you ran a randomized trial where both groups consumed the exact same amount of alcohol, but one group drank in a celebratory setting and the other group drank out of stress or sadness, the outcomes would be different. Different toxicity. Different hangover severity. Same dosage. Different result. The study’s never been done, but this is something I hold to be true.

There’s a large body of research showing that mindset and setting change the physiological effects of drugs. A psychologist named Siegel demonstrated this with a series of rat studies. When rats were conditioned to take a drug in a specific location again and again, two things happened. Exposure to the location triggered craving for the drug. And when the drug was taken in that familiar setting, tolerance increased, a form of compensatory adaptation. But when rats received that same dose in a different location, the drug didn’t just feel stronger. It was stronger. Later interviews with drug users who’d overdosed revealed that many overdoses don’t actually involve higher doses of the drug. Rather, they happen when someone takes their usual dose in an unfamiliar setting. An alleyway at 1 am instead of their bedroom at 10 pm. The body isn’t prepared for it. Compensatory adaptation no longer occurs.

If the toxic effects of heroin depend on set and setting, if the same dose of heroin in a new environment can trigger a fatal overdose, it’s likely that drinking alcohol in a different mental or physical environment can change the toxicity. We already know that drinking in a comfortable setting produces less intoxication than drinking in a new environment, showing that set and setting determine at least some of the physiological response to alcohol.

Takeaway: Have a good reason to be drinking. Drink to celebrate and enhance, not to forget and blunt.

Get a good workout in

Another massive factor is physical activity. And not just the overall long term physical fitness that comes with regular training, but also acute exercise. Those are all important parts of increasing your alcohol tolerance and safety level, but even getting a workout in a few hours before your first drink matters. Working out the day of drinking improves your liver’s ability to metabolize and detoxify the alcohol by boosting glutathione, the body’s primary tool for reducing acetaldehyde build-up.

While we don’t have clinical trials in humans showing that acute exercise directly protects against alcohol toxicity, we have several lines of evidence that suggest it’s probably the case:

Rat studies show that both exercise adaptation (training over long periods of time) and acute exercise (running on a treadmill for an hour) improves ethanol clearance. The fitter you were and the more recently you exercised, the faster you clear alcohol from your body. In rats, at least.

Among drinkers, those who exercise regularly have better liver, inflammation, and lipid biomarkers, including markers specifically related to alcohol metabolism.

Exercise elevates glutathione levels for several hours post-workout—the very same endogenous antioxidant system we use to detoxify alcohol.

I know that alcohol always treats me better if I’m active that same day (which is pretty much every day by default). The best part is that the type of exercise doesn’t really matter as long as it’s fairly intense. Steady state running, HIIT, and resistance training have all been shown to either improve ethanol clearance, reduce toxicity, or improve endogenous antioxidant status.

Takeaway: Maintain physical fitness and get a good workout in the day you drink.

Drink mineral-rich water as you drink

Always sip mineral-rich water when you drink. Anytime I have wine, I have a bottle of sparkling mineral water alongside. In the restaurants, it’s usually San Pellegrino. At home, typically Gerolsteiner (very high in calcium and magnesium) or Mountain Valley. You can also add water directly to your wine in a one-to-one or two-to-one ratio, which the Greeks and Romans often did. It was even standard practice at feasts and parties to mix the wine and water in a large ceramic vase called a column-krater.

The point is that getting mineral-rich water in as you drink is the traditional, time-tested, culturally-evolved method of drinking alcohol, so it makes sense not to mess with an established practice. While there’s no direct human evidence that hydration status improves acetaldehyde clearance, it does improves overall organ function, hepatic blood flow, and oxidative stress levels, all of which will affect liver clearance of toxins.

Other options include having some electrolyte-rich water, like a packet of LMNT in a bottle of water.

Takeaway: Stay hydrated with mineral water or electrolyte packets.

Drink with food

I always drink with food. One of the reasons alcohol can be beneficial is that it reduces the postprandial oxidation of a meal. If you have a glass of red wine with your steak or burger or whatever, the formation of pro-oxidant lipid oxidation products is reduced in your gut and any oxidized lipids in your blood are lower. Having food in your belly also slows your absorption of alcohol down so that it’s more of a smooth, gradual experience rather than a sudden flood of ethanol and, eventually, acetaldehyde that your cells may not be able to handle.

Takeaway: Wine tastes good with steak for a reason.

Eat some cheese

In the Iliad, there’s a scene at one of the feasts where they mix aged goat cheese directly into the wine.

This always stuck out to me. And of course, cheese is a classic pairing with wine of all kinds. It got me wondering: was there some physiological justification for this natural pairing?

Perhaps. In a series of in vitro experiments, researchers tested various foods for their effects on alcohol dehydrogenase (ADH, an enzyme that metabolizes ethanol into acetaldehyde) and acetaldehyde dehydrogenase (ALDH, the enzyme that metabolizes acetaldehyde into acetate). Cheddar cheese was one of the only foods that increased both ADH and ALDH activity. These experiments don’t prove that the same effect occurs in vivo (when a human eats the food), but they are suggestive. In general, eating dairy does improve glutathione status, so it’s conceivable that eating cheese can improve acetaldehyde clearance. We know for sure that whey isolate increases glutathione, as does raw milk.

Takeaway: Eat cheese with your wine. It probably pairs well for a reason.

Limit linoleic acid, favor saturated fats, and don’t go overboard on the fatty fish

There are studies in rats where it’s almost impossible to provoke liver toxicity with alcohol unless the diet is rich in linoleic acid (a polyunsaturated fat found most abundantly in seed oils). Meanwhile, saturated fats have been shown to be protective. A saturated fat like stearic acid, which is rich in dark chocolate, is highly protective of the liver in the context of alcohol. Coconut oil, which is rich in saturated medium chain triglycerides, is also liver protective. Even beef fat is protective.

In fact, studies show:

Coconut oil and stearic acid both reduce gut barrier perforation, endotoxemia, and oxidative stress in rats with alcohol-related liver injuries compared to corn oil (high in linoleic acid).

Beef fat protects against alcoholic liver disease. Rats fed ethanol combined with either tallow, lard, or corn oil were followed for 6 months. Only those eating beef were entirely protected against liver disease. Lard (higher in unsaturated fat) rats had moderate protection, while corn oil rats had no protection.

This is more of a long-term situation where your diet over the course of weeks, months, and years is more important for protecting against alcohol, but even making sure that your diet the day of is low in PUFA and rich in protective stearic acid will help.

Interestingly, animal studies using enormous doses of fish oil (about 15-20 grams human equivalent) find that long chain omega 3s can also exacerbate liver injury because they’re unstable. Normal amounts, like a piece of fish or a dozen oysters, are perfectly fine, partly because of the dose (low) and partly because they come packaged with protective nutrients like zinc, selenium, taurine, and magnesium. Just don’t overdo it, and don’t overdo the alcohol either. Excessive amounts of alcohol or fish fats will make alcohol more dangerous.

Takeaway: Avoid seed oils, limit linoleic acid, prioritize saturated and monounsaturated fats. Dark chocolate, coconut, olive oil. Don’t overdo fish fats either. 4 ounce salmon filet or a dozen oysters is the perfect amount.

Drink quality matters

Alcohol isn’t alcohol isn’t alcohol.

My experience ten years ago makes this clear: I noticed wine was ruining my sleep, so I stopped drinking altogether. My sleep normalized. After a year, I tried drinking natural dry-farmed wines. These were wines made with no pesticides or additives, no irrigation (just rain), very low human interference. They were higher in polyphenols and lower in alcohol. All in all, they were closer to the ancestral wines the ancients were drinking before modern methods were developed. I could drink the same amount, at the same time of day as before without ruining my sleep.

I highly recommend switching to “natural wines,” or, if you have trouble finding any, trying out a service like Dry Farm Wines. If you drink hard alcohol, spending at least $45 on a bottle will usually get you higher quality, cleaner stuff. Lalo Tequila is supposed to be good.

Takeaway: Quality over quantity. Drink the good stuff, but less of it. Natural wines are preferred.

Drink early for better sleep

Of course, the elephant in the room is the time of intake. When you consume alcohol might be the most important factor in reducing its toxic effects. As I said in the last article, the biggest reason why health people recommend against drinking alcohol is its effect on sleep. It absolutely kills sleep quality by inhibiting melatonin secretion and throwing off your rhythms at night.

But here’s the thing. All of the studies showing that alcohol interferes with sleep are night drinking studies. They give people alcohol at 8 p.m. or later and then track how they sleep. This makes sense because that’s the most common mode of alcohol intake and it makes conducting studies easier, but you aren’t running a study on twenty people. You can break the mold. You don’t have to drink the most common way. If you drink much earlier in the day or even early in the evening, your liver has enough time to process the alcohol before it can interfere with melatonin secretion and sleep onset. This will differ based on your genetics and other lifestyle factors, but a safe cutoff for alcohol intake is around 6 p.m. Try to have your last drink by six or maybe seven, and, assuming you’re only drinking low to moderate amounts, your liver will clear it in time for melatonin to commence.

I find that I can have a glass or two of wine with dinner at 6 or 7 without any sleep issues (no wake-ups, no grogginess in the morning). Your mileage may vary.

Takeaway: Drink during late afternoon or early evening. Give yourself enough to time to metabolize the alcohol and acetaldehyde before melatonin secretion begins in earnest (around 9 PM).

Okay, those are all the basic things I do, but what if you’re planning on drinking a little extra? Is there a detailed supplement stack and protocol for harm reduction in that situation?

Yes.

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