Transcription
Well, welcome to this talk, and welcome back to Professor David Nutt. Professor, thank you for coming back.
Absolute pleasure, John. Looking forward to it. Now, you more than me, but when I was 18, I started seeing the destructive effects of alcohol. Uh, I saw people die when I was 18 from alcohol-related illness as a first-year student psychiatric nurse. And uh, a few years after that, I was foolish enough to start drinking myself. I've now stopped. Um, but alcohol is like a huge, a huge global issue really, I think. Um, and and and you are a psychiatrist. You're an addiction specialist. Um, and I know you have a particular interest. It could be said, uh, disdain perhaps for alcohol. Do tell us how you got interested basically.
Well, you've—my story is rather similar to yours. Um, I be—before I went to university, what I wanted to do was to drink, but the pubs were quite good at excluding, excluding under-18-year-olds. Then my very first day at, at university, um, there were nine students, um, in my college, down in college Cambridge doing medicine, and we do what groups of students do when they went out on the first night—we went to the local pub and we had a few pints. After three pints, I was—yeah, I was a pretty—I felt I'd asked enough because I, I hadn't really drunk before. But then we went back to college, and because we had to be in by 10:30 because they closed the gates and uh, you needed special written permission to stay out after 10:30, we went back inside. Someone got out a couple of bottles of wine. People started drinking. I didn't. I sat around chatting, and then a couple of hours later, one of the students started crying and wailing and saying, you know, he wanted to die. He was so miserable and so happy. And and I, I thought, "Wow, he's going to commit suicide." And I said, "Should we call an ambulance?" And and one of the other guys who knew him from school, he said, "No, he's always like this when he's drunk." And I, and that, that shook me up in two ways. Firstly, because, you know, really, he shouldn't have been drinking at all. He only just made it old enough to. And secondly, wow, you know, the power of alcohol to turn someone from—actually what turned out to be quite a successful career as a doctor, you know, blighted, I have to say, in his case, by alcohol, but he still made it—and turning from a, from, you know, an A-grade student to, to someone who was actually wanting to die. I thought, "Wow, this is—wow, this is fascinating. Alcohol changes the brain very powerfully." And and of course, then, you know, when I became qualified a few years later as a doctor, every day you, you would see someone who was damaged from alcohol. You know, half the orthopedic wards are occupied by people who've had accidents under alcohol. On our nurses' station where the doctors aren't allowed on A&E where we make up the drugs, there's normally a few bottles of confiscated alcohol—bottles of vodka and things. I mean, I mean, alcohol is just like everywhere. It's ubiquitous. Um, you know, one of the regrets in my life is, is, is making light of it, joking about it, you know, as people do. You know, just this following on with my cultural norms rather than thinking about it objectively. It's, it really is a powerful drug. And we talked about that tragic case there, that, you know, what you might call ordinary people can also be dramatically affected by alcohol. It's, it's a powerful drug, and uh, what I'd like to know is how is alcohol actually working in the brain.
Well, before I just tell you that, which I obviously want to do, I'll just tell you a statistic which I think a lot of people don't really understand. Um, alcohol globally kills over 3 million people a year. That is more than the total of all—apart from tobacco—all other drugs put together. Yeah. And and so yes, all of the drugs that people take for the buzz, for the fun. Yes. Whether it's opioids, cocaine, amphetamines, whatever.
Cannabis. Yeah. Cannabis. Yeah. I mean, overall, alcohol—it's at least three times more than all other drugs put together. So there, that just tells you it's a massive problem. It also, of course, it tells you that people like to drink because no one's forced to drink. So people choose to do it without properly understanding the harms, and and you know, the reasons for that we can talk about in a minute. But, but to answer your specific question—what happens when you drink? It depends a lot on whether you're an seasoned drinker or a naive drinker. You know, if you do an experiment on a, a baby or a child and you just put your—dip your, your finger, say, into, you know, into a whiskey or vodka and put it on their tongue, they will—it's very aversive. No. In fact, people, people say, you know, I like alcohol. So, you don't—you've probably never ever drunk neat alcohol. All the alcohol we drink is flavored, to take away those, you know, that those bitter, sour, toxic effects on the tongue. So, so but over time, of course, people who become experienced drinkers get to know that the taste is associated in a few minutes with the pleasure. So eventually, people who as a child would spit out a, a 50-pound bottle of, you know, a mouthful of a 50-pound bottle of carrot, when, when they get to our age, they savor it because they've become so sophisticated and acquired, you know, the relationship between the taste and the effect that they, they now revere it rather than find it aversive. So, so for, for people who drink regularly, the, the smell and and the flavor are immediately begin to recreate in the brain the experience—the desired experience—and then over—and then as it slows—slows down your gullet. Of course, actually with spirits that's even more of an interesting aspect because there's—for people who drink relatively neat scotch—there's that burning sensation in the back of the throat, which actually is, for many people, a good sign. They look—they like that—that makes them feel warm and flushed, and and the alcohol then crackles down into the stomach, gets absorbed into the bloodstream, goes through the portal vein into the liver, and it gets broken down—part of it gets broken down to acetaldehyde, but some of it doesn't, and what doesn't gets back into the systemic circulation, gets into the brain. And so within about 5 to 10 minutes, alcohol has gone from your mouth to your brain. And there it begins to do what most people drink for, which is relax you and and calm you down and take away particularly social anxiety. The anxiety that we all have in social situations, which of course is, you know, where most people drink. Most people drink in social groups to, to avoid anxiety.
Well, many don't. I've certainly—I don't know how cathartic people want this session to be, but you know, I've, I've drank on my own purely for the effect on the brain—purely for the—
Yes. And that's—I have to say that's—thanks for saying—mentioning it because—but one of the, the points I make in, in, in my book is that solitary drinking misses most of the value of alcohol. Yeah, you can—you drink by yourself to get basically numbed or to relax—but then get numbed. But it's, it's a dangerous thing to do, and you probably realize that yourself in time and stop.
Yeah, I've realized that, and mentioned your book there, David. Uh, *Drink*? Drink? Drink? Yeah. Um, it's—I mean, your many years of experience comes through in this book. Uh, but it's eminently readable. I think it was only about seven quid, eight quid from Amazon or something. So, yeah, I think I think this book's for two—for two types of people to be quite honest. I think it's for people that drink, so they can understand more about what alcohol is doing. And I also think probably even more importantly, the other group that this book is useful for is those that don't drink. Read this before you start. Because in medicine, we have a special word for that. It's called informed consent. Yes. Special two words. So read this and then decide if you want to stop, start drinking or not. Uh, my advice would unequivocally be if you haven't started drinking, whatever you do, do not, do not start if you haven't started already. But if you do that, that adds a lot of layman's context.
Um, thank you. Yeah. Can I just say the book is—the book is designed—is—you can—there's thousands of books on the wonders of alcohol and hundreds of books on the dangers of alcohol and the value of sobriety. And this—I just try to tell the truth. For some people, alcohol is very dangerous. 15–20% of drinkers will end up becoming dependent. Yeah, we can predict some of them. I mean, point is, if if your father was an alcoholic, you're more vulnerable, and your brothers and sisters, as it runs in the family. So, it's clearly a genetic aspect. So if you're vulnerable, if you—if you—if the only time you can relax and socialize is when you're drinking, wow, then you've—you know, you're at high risk of becoming dependent because socialization is something you do all the time. So, so be aware, try to work out why you drink. And my—one of my key tips is only ever drink a drink that you can reflect back—gave you some benefit because if it's not giving you benefits, it's harming you. I think there's a lot of psychology here as well.
Well, I mean the whole psychology of addiction, but the stimulus-response whole thing. You mean—you know, you go into a bar, you maybe order a pint of real ale or whatever it—whatever your tipple is, and you sort of sit there and you look at it and you know the effects almost starting before you've taken the first sip, isn't it?
Oh, definitely. Definitely. I mean, when you see that, you know, when you see adverts for booze, that's why I wish—I wish we would ban adverts for booze. I start, you know, on a warm day, you know, you see a beer with a, you know, bit of conversation—I'm salivating before.
Yeah. Absolutely. Yeah. Yeah. It—you—you become really very strongly conditioned to alcohol.
Absolutely. Yeah. And then there's always an excuse. Oh, it's a hot summer's day. I need a drink to cool me down. Oh. Oh, it's a cold winter's night. I can't go out. I might as well have a drink by the fire. Woke me up. You know, it's—
Yes. I'm reminded—you and me will remember this, but a great film called *Ice Cold in Alex*.
Oh boy. Yes, indeed. Where John Mills—he hacks through the desert for days on end with a—with a—what's that called anyway? I remember I fancied her for years. The nurse in that video—in that film—Jean Sim—Jean Sims—and you know, they hack through—
Yeah. They hack through the desert. They fight off the germs. Then he pours the lager, and he runs his finger up the side of the glass, and he looks at the lager and just—
But I can relate to that. I can now. I'm already—I, I can taste it. Worth waiting for.
Yeah. Yeah. I can remember the film. I can tell. Yeah. Yeah. Yeah. Uh, just as an interesting aside, that was about the eighth take on that film—on that fact. So when he actually—when that sip was actually taken, he was already pretty, pretty far gone apparently. It was the eighth take. Nice work if you can get it.
More of a real ale man myself, but you know, same here.
Yeah. Yeah. But they didn't carry very well—it was difficult to get real ale into Egypt. It, it was probably quite tricky.
Yeah. What, what about the, the harms that alcohol—and before we do that, just give, give us a bit of the, the geeky stuff—the, the neurotransmitters—the GABA, the dopamine, the glutamate, the endorphins—to, to name a few random transmitters in no particular order—
Well, I think you've summed them up rather well—you obviously read—
Yeah, I've read the book—alcohol has a—has a stepwise interaction with the brain, and and the, the first effect is to enhance the activity of this neurotransmitter called GABA. Now, GABA is not a transmitter that many people have heard about. So it's GABA first. Gamma-aminobutyric acid. Yes. But it's a hugely important because it's the brain—it's the off switch of the brain. It's the calming neurotransmitter. It dampens down brain function.
Is that where the benzodiazepines work? The Valium, Librium type drugs?
Yes, they work on, on, on the GABA receptor. They work on subtypes of the GABA receptor. It's—I won't go into the complexity of the system because it is very complex, but the reality is that things that calm you down tend to enhance GABA, right? And and uh, and that's—most people drink because—certainly in social situations, we're a bit—we're a bit socially anxious. I mean, humans, I like to say this, humans are actually a really social, um, species. I mean, we love to go to parties, but we're not very good at being social because we're always anxious when we go—meet strangers—strange—and even when we meet our family that we haven't seen for a while, you know, we're always—there was that tension—and I think that's evolutionarily helpful. I mean, being slightly cautious of strains probably is protective, but it doesn't help you get to know them. And alcohol, that first drink or so enhances GABA, relaxes you, particularly in those parts of the brain which you need to, to relax in order to socialize. And that's great. And if, if we just stopped at that, then we'd be happy. But for many people, we can't stop. And and when you start to increase the dose, you begin to engage other transmitters. You begin to release dopamine, right? And that's where people start to get activated. They get louder. They may get a bit competitive. They may get a bit aggressive. Uh, and when—and the thing about dopamine is it's a moreish transmitter. You release dopamine, you like it. It's—cocaine, amphetamine do that, but then as a levels four, you want more. So, so dopamine is one of the transmitters which gets you addicted to alcohol. Yeah. And and for me, it's the trigger dose as well. The amount of times I've said, "Oh, I'll have a pint." And of course, you end up having more than a pint.
Yes. And that is partly dopamine. And it's—but also there's an interaction interestingly between dopamine and endorphins. Okay. And they work together to, to basically encourage your brain to say—I, I need some more. I want some more—to—to chip away at the resistance.
Oh, yeah. And you—we know that if you—for instance, if you block the endorphin system—there was a medicine out there called naltrexone. You block the endorphin system. It reduces to some extent that people's going from a couple of drinks to a binge because because that seems to have an endorphin drive. I mean, I tend to associate endorphins with, uh, morphine, opiates—is that—is that—
Well, that's exactly the problem—same transmitter. Yes. So what morphine does, morphine mimics and exaggerates the effect of endorphins, whereas alcohol releases endorphins, but but they both—in the end, they—there's still this propensity. Endorphins have a—are painkillers in the brain, but they also have a motivational role, and they also have some role in, in addictive behaviors, and addiction to alcohol is one of their roles. So this is a real biochemical, neurobiological drug that alcohol is having. It's taken systemically. It goes through this blood-brain barrier and gets deep into your, into your brain.
What—what causes the—a lot of people ask me this. Does alcohol increase sexual appetite or does it just inhibit—
Well, Shakespeare put it brilliantly. Inhibitions. Yeah, it just inhibits you. He said—"Yeah, he disinhibited"—It worsens to the effect that alcohol increases the desire but messes with, with the function.
Yeah. Yeah. Yeah. And I would—I wouldn't—I wouldn't count on that.
Especially—especially for young people watching.
No. Well, unfortunat—I mean, it's, it's actually alcoholism is a very common cause of, um, basically, uh, impotence.
Yeah. Yeah. Eventually. Yeah. Yeah. So what harmful effect does alcohol have on the body? I mean, you know, I, I once met—I once met a man, and he said, uh, John, I like to drink. Tell me how I can drink as much as possible without harming myself. Interesting the way sometimes this mentality works. But, but you know, what—what are the main harms that alcohol has on the body? Probably thinking more—I mean, obviously you can get drunk and fall down the stairs. I mean, I—I mean, there's a common diagnosis in, in A&E. I'm sure you have it in psychiatry. It's called PFO.
Um, remind me. PFO. Uh, uh, let's—Well, it's a family show. So let, let's say—Pedestrian fell over. Fell over. Um, quite—is he a PFO? Go and see to the PFO in cubicle 3. Appalling when you think about it, but it is. But it's hugely important. Yes. Because alcohol is probably the only drug that we can image the brains of people who drink and show their damage by alcohol. Other—even, even drugs like cocaine don't produce objective changes in brain—in brain function that alcohol does. Alcohol shrinks the brain, but it also damages the brain. But part of the damage, particularly in men, is due to that kind of violence, accidents, fights, traffic crashes, etc.—brain—brain injury occasioned by being drunk. Um, so if—so that's the first thing I suppose to say—if you want to avoid harming your brain when you're drinking, don't stand up because falling over is a problem.
Well, yeah—yes—yeah—um, but, but on a, on a more serious note—alcohol—there's almost no organ system in the body that alcohol doesn't harm, and you kind of know that. I mean, everyone knows, you know, when you have a cut, you, you put an alcohol spray, you know, to kill the bugs. Well, if it's killing bugs, and bugs have pretty tough capsules, it's going to kill nerves—neurons—and it's going to kill other, other cells in your body. And that's what it does. Alcohol and and the metabolite acetaldehyde, they're, they're both relatively toxic. So, wherever the alcohol gets, it starts to irritate. It irritates the mouth, and it's associated with increased levels of, of mouth cancer, particularly in smokers because the two—alcohol and tobacco—you know, have an aggregate effect. It's associated with esophageal cancer because it burns as it goes down. It's associated with stomach cancer and stomach ulcers. Uh, it's strongly associated obviously with liver cirrhosis. People don't often—don't realize though—one of—more people die of alcohol-related hypertension and stroke than cirrhosis. It's one of the few preventable causes of hypertension in heavy, heavy drinkers. It causes cardiomyopathy. The heart just swells and becomes not very functional, and then of course it, it damages the brain and it shrinks the brain and kills neurons, and it's a major—It's, it's again one of the few preventable causes of dementia. Yeah. And and the peripheral nerves can be damaged as well, can't they?
Very much so. But yes, of course, that—when people become alcohol-dependent, they often become vitamin deficient. They get—they lose sensation in their, um, in their toes and their ankles, and they get tingling. Yeah. They get peripheral neuropathy, which aggravates—you know, they trip over as well and cut themselves and that. Yeah. So a question—I get—a question I get—sorry—a question I get asked really quite often is—is it true alcohol kills brain cells?
So alcohol is killing brain cells directly. Yes, it is. It, it's killing brain cells by—turning strangely—by turning off another neurotransmitter we didn't get to, which is called glutamate.
Oh, right. Yeah. And and here's the paradox. So when you get rid of it, when you start to forget, when you start to get alcohol-related amnesia, that's because alcohol blocks the glutamate receptor in the brain. Now, the glutamate receptor is the receptor in the brain that keeps you awake and alert. And that's why, you know, in the old days, people used to use alcohol as an anesthetic because it dampens down the on switch of the brain, the glutamate switch. So it, it impairs your memory. So even if you could feel the pain, you didn't remember it. Now, the problem is glutamate is essential to your brain function. Your brain knows when it's being impaired, when the glutamate is being blocked. So it compensates, and it compensates by making more glutamate receptors to try to offset the effect of alcohol. And the brain's good at doing that. Turns on more receptors. And that's one of the reasons why people can drink a hell of an amount over, over a night and not be—not be anaesthetized or—pouring over—because the brain—compensating. But when they stop drinking, the alcohol levels in the brain fall faster than the brain can readjust its glutamate receptors. And that's why you get a hangover. And there's also this recently named but long-known phenomenon called anxiety. People are very anxious when they're coming out of an alcohol, um, binge. Yeah. And that's because there's too much glutamate in the brain, and we know that glutamate kills neurons. Too much glutamate kills neurons. And that's why you have GABA in your brain to make sure the glutamate isn't overactive and and killing neurons. But there are situations where you have too much glutamate, like in epilepsy, where you—you—we know neurons die. And the same is true for alcohol withdrawal. It's—a withdrawal of alcohol that is really toxic to neurons.
So alcohol is going to suppress glutamate. The brain makes more glutamate to compensate.
Correct. The alcohol goes away from the brain because the liver metabolizes it, but the, the brain is still overcompensating and producing more glutamate, which makes you feel basically terrified.
Correct. Anxious—fits. People have fits in their alcohol withdrawal. Uh, also it turns on the sympathetic nervous system. So you get—his heart pounding and your blood pressure is surging.
Yes. The glutamate stimulates the sympathetic nervous system—of the fight or flight.
It does. It—Yes. It drives—it drives the sympathetic nervous system in the brain, and that then goes into the periphery and makes the heart beat and the blood pressure go up essentially. Yeah. And that's—what I mean—some people get even abnormal rhythms of the heart after drinking.
Is that a glutamate effect?
That's a great question. Now, I suspect it is one of—I mean, you, you're probably aware there's been a lot of interest in the last few years in, in cardiac and particularly atrial arrhythmias—atrial fibrillation. There's a lot of talk about it. A lot of—a lot of people are on anticoagulant medication for the fibrillation. A lot of that is due to too much drinking. I think, you know, my recommendation is anyone who's fibrillating—cut your drinking down—and that's not well known. Most people don't know that.
Um, yes, absolutely. And it—same with hypertension. If you've got—if your blood pressure is up before you go on meds, cut your blood pressure, cut your alcohol down. And you—there's quite good data that, you know, giving up drinking will dramatically reduce your, your blood pressure by maybe 10 to 15 millimeters systolic. That's a lot. And as well as that, of course, there's the calorific component because—absolutely—you know, weight is very—blood pressure and weight are quite tightly escalated—it's been—it's—we used to think it was old, you know, men that were drinking and putting on weight through, through alcohol, but in fact, we now know it's actually young women—a lot of them—you know, are getting half their calories through alcohol, and often they're compensating by eating even less so then they, which aggravates, you know, their problems—and—you know, alcohol is not a good food source.
Why do people eat kebabs on the way home from the pub? Because normally you wouldn't consider eating a kebab. It's unconscionable. But after a few pints, it seems like quite a good idea.
Yeah. Yes. It's, it's a really interesting question that I've reflected a great deal on in my life. You find yourself eating things you don't—wouldn't want to eat.
Yeah. I think it's—I don't know the answer to that. It's partly disinhibition, you know, taking away your restraint. Uh, there—I mean, one of the tips that, uh, I think a very powerful tip, um, in relation to, to weight loss is that people on a diet shouldn't drink because alcohol definitely dissolves the resolve not to eat. You know, it's, it's very—
Yeah. You, you've got the calories from the alcohol, and then the calories from—then they think—oh, I don't see any reason not to—well, pudding or whatever it is. No—alcohol—it's—alcohol dissolves self-control. I think we, we can all say that—and whether that self-control is directed at what you say to people or what you eat. So if you—if you're on a diet, don't drink till you've got to the weight you want to get to. So that's partly—so it's partly a brain effect. Alcohol—taking—
Away the the will to restrain, but it probably affects appetite as well. I mean, we know that the alcohol changes the metabolism of glycogen in the liver, and it probably it puts you into a slightly hypoglycemic state, which also then triggers the desire to eat. So it's a sort of vicious circle really.
I've looked after a lot of people with quite severe mental health disorders; not as many as you, but and a lot of them drink, and you know, there was always the debate: is this someone with schizophrenia who drinks, or is it someone who drinks—you know—which is cause and effect? Um, I mean, it's a ludicrous question, but in mental health, let me put it, let's put it this way: in do people drink who have mental health disorders drink by self-medicating? Yeah, that is actually the much more common route, right? Strange. This is very strange, but more people become alcoholic because in in the te in the late 20s, early 30s, 40s drinking to deal with stress. Yeah. Than are alcoholic from the the ones who are in the teens who were drinking because they for the hell of it. Yeah. Medication is a primary driver. And that's so important because if you can work out why they're drinking and then use processes to deal with the anxiety or the depression or the drama, you can really cut down on the drinking.
I mean, I've certainly drank for both reasons. I've drank for positive reasons because it's fun, especially with your mates and, you know, but I've also drank for negative reasons. Um, you know, when you've been in a job for 20, 25 years and it's not going very well, you've got a lot of you got a lot of uh stake on the table there really. It's quite quite or or a marriage, a relationship situation. It it's it's very very understandable. But I think the thing is, um, the reason we have people like you is to avoid people like me self-medicating. You you're able to prescribe much more appropriate treat.
That is true. I think but alcohol is a very cunning drug. I mean, because it is does work when you you know if when life is tough, alcohol can dampen down the stress. It can numb you. It can take away a lot of even quite severe trauma. We know military veterans can numb the memories that they can't cope with with alcohol. But the problem is because of this daily cycle where the alcohol numbs and the brain overcompensates and makes it worse. It's like a ratchet effect. Every time you are suppressing things, they're coming back worse. You know, they're getting energy from the brain adaptations. So in the end, you end up having the problem that your problems got worse and you're also alcohol dependent, which in itself is a major trauma. I mean, people once you've dependent on alcohol, you make a lot of bad decisions in life, and that then aggravates your your your stress levels. Yeah.
But the temptation's always there because you know you take that drink and you know that within five or 10 minutes the world's a better place. That instant gratification it you know you know if you prescribe anti-depressants, you know I'm going to be hanging around for a month waiting to feel better.
That is true. Not not talking about psychedelics, but but um that is also true. But but but but with uh with alcohol, you know, just bang, oh f oh actually actually it's not so bad after all. But of course, the next day, the way I I think about this is is with alcohol, you're borrowing happiness from the next day.
That's a very interesting analogy. I like that. Yeah. And you pay you pay it back with interest. You you do. Absolutely. Especially that next morning.
Can I just make another point? I just going to, you know, since we're trying to educate people, if you are suffering a lot of anxiety in the morning after drinking the night before and you're shaky and anxious and worried about going to work, do not ever drink to cope with that. We call that relief drinking, and it is the slippery slope. Once you start drinking so that you can function after a night of drinking, you are essentially you're an alcoholic. Yeah. And again, we've seen this really quite commonly. Certainly, I've seen a lot of colleagues drinking at at lunchtime. So that's Yes. Yes.
So this this anxious feeling you get uh after well the reason I I had to well I'm not saying I completely stopped drinking but more or less stopped, maybe have a blip every few months now, but um was as I've got older um the drinking a relatively small amount will actually give me quite a bad hangover and and this anxiety. Um, well, is it is it some some is it old age metabolism? Is it have I just become more sensible or is there a biochemical change that means I can't metabolize it properly anymore?
No, you've become more s it's interesting. You've become more sensible, and I and that's uh what and what you what you've observed is really something that I've observed too. As as you drink less, you become more vulnerable to what you drink. And and and of course, and again, you know, this is the paradox of alcohol. Well, you know, I can I know if I just have a large glass of wine at night, it will affect my sleep. I absolutely can tell you, you know, a glass of wine and I will wake up half an hour earlier, two glasses of wine, I'll wake up. It absolutely predictable. I wake up at 3:00 in the morning being anxious.
There you go. Exactly. Yeah, before you know you were you you were sort of desensit the system was desensitized. Now your system is back to normal and and slightly more reactive so that you you experience the com. So you don't need so much to get you drunk by the way, but but on the other hand that the less even though you drink less you still have the more adaptation of the brain because your brain is is not completely tolerant.
So if someone's been drinking heavily for a period of time, they'll get a physical withdrawal or abstinence syndrome, the shakes, the DTS, the delirium treatments. Um is is that a separate phenomena from a hangover or is there an overlap between the two?
Yeah, again really interesting question. So it's there's definitely an overlap in in the sense that um hangovers preede delirium. But delirium is a state where you your brain becomes so overactive that uh well it starts to make things up. Basically, it's a state of uh hyper hyperglutamate activity, too little GABA activity, too much strangely too much dopamine activity. Um, and that's probably because the glutamate system is pushing the dopamine system because it's dopamine is also a stress response system as well as a pleasure system. And then when you get pumping out too much dopamine, you begin to um get paranoid and and delirium is that's what it is. Delirium is a state where uh your consciousness is impaired and you become very very suspicious. You see things, you hear things that aren't there. You you know you see classical hallucinations like spiders and elephants and that and snakes and actually snakes. Yeah.
And delirium tremends is is a medical emergency. People people have seizures and they die in delirium tremendous. You've got to treat it really very actively. If people people with severe you know people who are very alcohol dependent they should go through what we would you know a medically controlled withdrawal where they're given drugs like benzodizopines to dampen down the excitability so they don't go through a worsening and which then leads to once they start having seizures or delirium it's very hard to reverse. Yeah, we normally give in A&E we give patients Librium, the chlorioipin oxide, and it it does seem to work remarkably well. Oh, it's been a revolution actually. Um, yeah, because you can get basically it's very safe. You know, you give people, especially people who are tolerant to alcohol, they're tolerant to benzo. So, you can give them, you know, usually a big dose 60 100 milligrams of cordos of oxide and then that sits around in their body for a few days. So it it sort of covers them through that period of um of alcohol withdrawal. I mean, sometimes they need a top up but usually it's one big dose and then little you know descending topups.
If you were on a remote island in the out he alcoholic friend was going into withdrawal and you couldn't get to a doctor for the next few days, would it be safer to actually give them a drink so that they could detoxify under medical supervision?
Yeah, it probably would. I mean, but you would have it would have to be that you gave them the drink rather than that they took it themselves. We used to, John, you might remember I don't know you, you might you're a bit younger than me, but when I first started in medicine, we would occasionally give people introvenous alcohol to deal to help them deal with things like withdrawal. It was available as a medicine. I never g I never gave that. I think I seem to remember it as an antidote for drinking antifreeze. Oh, right. Yeah. Okay. That I forgotten about that. Yeah. What we used to do was we when I was a psychiatrist, we gave him hem and of course it was a drink. You poured it out. Yeah. And the alcoholics used to really savor it and and then and then the nicker bottle go out and drink hemine and alcohol together and get totally plastered. That was Yeah. I mean, there was hope that he would be uh essentially um the methadone for alcohol. Yeah. But it didn't really work. It didn't it wasn't I didn't know because it w it was well it didn't have the right methadone has one great advantage. You just need to take it once a day. Yeah. If you had a if you had a once a day he everin that you you know that people would just take and it would last that long then in in a way chlorize epoxide liium is like that. Yeah. Yeah. I mean and just occasionally we you know we would use it on a regular daily basis to help people stop drinking. But the problem is that they can always drink on top.
Got so much reminiscing from the old psychiatric days. But remember we changed it from the drink into the we called it the duck eggs, the yellow capsules. So you didn't have the uh That's right. That's right. You know the tribes say I'll give him his duck eggs. You know that that was that was the hem and um really serious question. um per conceptually pregnancy if we do men first of all um I mean if men smoke before they facilitate a conception that can damage the chromosomes in the sperm and lead to dilitterarious effects in the in the child that's subsequently born even cancers I mean is that the same with alcohol or can men just carry on me merrily drinking while trying to conceive.
I I'm not sure it affects the the genome, but it certainly affects um the sperm production, I think. And uh Oh, does it? So, I think it it's it impedes fertility in men to some extent. Yeah. And what what about women drinking round about conception and in pregnancy? It's not ideal, but I want to I want to qualify this and and this is important and yes a lot of women become very very anxious because they discovered they were they got pregnant because they were and they were drunk when they got pregnant. Yeah. And then you know there are people who would say well you know you damage your baby and the answer is I think if if you don't carry on drinking when you're pregnant you probably haven't damaged your baby. Yeah but there are a small proportion of women who drink he who cannot stop or don't care and they can drink and then that that first trimester heavy drinking the first trimester is has a really delterious effect on the fetus. Yeah. So ideally once soon as you know you're pregnant you you stop drinking and ideally when you're intending to get pregnant you don't drink heavily you know you maybe just a glass of wine a day or no more because we don't know exactly what the threshold is and it's it's probable that there's some effect at low levels but it's the very high levels that are the real problem and and people don't realize it fetal alcohol syndrome is is causes more um developmental problems than than down syndrome and fragile X put together. So it's it is the most common cause of developmental problems, learning disabilities in kids and and many of the kids end up being in homes all their lives because the behavior is so disrupted by the alcohol brain damage.
So part of the fetal alcohol syndrome is that the physical architecture of the child's brain is distorted. It is and it's um in the same way as that you know their face looks different and their hearts may be different but the yeah they their brain it's works in a very different and it's it's almost like they're in overdrive. Many of them have really severe hyperactivity. They they're sort of relentlessly active. They can't sit still. they it's like extreme ADHD and it's probably got something to do with well the brains are smaller and I think just so we're now understanding that one of the the brain is obviously a really complicated organ but one of the sort of key principles is that the frontal cortex controls the rest of the brain generally. Yeah. And if your frontal cortex is damaged like from a road traffic accident or too much drinking you it's harder to control your behavior. And these kids are born without with with less ability to to regulate their their their behaviors, their activities. And and they they sometimes just can never learn to to to you know to sit in class, to read a book, you know, they're just they're just in a well they're brain damaged essentially. That's my simplistic way to think about it that the frontal cortex, the frontal loes of the brain are sort of controlling the lower if you like animal parts of the brain.
It's the Phineas Gage story, isn't it? The guy who um Oh, yes. Well, tell people. Yeah, tell tell your audience about that because that is an remarkable story. Oh, Phineas Gage the time. It was actually quite early. I think it was about 1830s, was he? And he he was in the 1800s. Yeah. In America. Yeah. And he he was packing he had a bar and he was packing in the dynamite. Yep. and the bar blew out and it went in there and out there and everyone assumed he would die but he didn't. He got better but he became he changed to I think he was a late preacher like like Clark Kent the mildmannered reporter and he became a a bit of a lad around town by all accounts and uh drinking womanizing and because the control part of his brain had been damaged.
Exactly. Exactly. And that's very similar to what we see with people who have frontal injury. You know, motorbike cyclist coming off, smashing the front of the head, horse riders. Yeah. And these kids and of course we saw the same in dementia, frontal dementia that often is associated FTD. Yeah. Yeah. Behavioral disturbance much more than memory disturbance. Yeah. In the old days, those old psychiatric boys called that Pix disease. It's now called frontto temple. Yes. Dementia.
I can see I'm tweaking some of your distant memory circuits here, David. I do remember I remember learning about Pix and Yeah. Yeah. Horrible disease though. My brother got fronttoal dementia. It's a in a sense it's a bit funny because the disinhibition is like uh you know so ludicrous you know but um sadly it the lack of Yeah. The lack of insight. Yes. The sort of it's it is like putting them you going back to being really a baby, isn't it? It really is impulsive. You see something, you want it, you take it. Someone someone else just like, "What's mine? Why shouldn't Why shouldn't I have it?" You know? Yeah. Yeah.
Now, I started drinking when I was about 19 or 20. About 19. So, yeah. 19 to 20 I started drinking really. Would I have done myself more home harm if I'd started drinking five years earlier? Almost. One of the One of the strange kind of laws of drinking which applies across the western world anyway is that people start drinking on average about 5 years before they're allowed to buy and they become alcoholic. They become dependent on average two to three years before they're allowed to buy. So So the the median age for becoming alcohol dependent in Britain is about 15. Kids start drinking from about 12. And uh we know that 15 half of 15 year olds both men and women girls and boys are drunk at least once a month. Half of 15y olds are drunk once a month at least. And that's been the same for the last 35 40 years. And and so the answer is for some of them quite a lot of harm has already been done by the time they get to drinking age because dependence is a hu you know dependence on alcohol is a massive problem because it's there everywhere. It's easy to get you got advertisements all the time encourage you to drink. So it's a really difficult dependence to escape from because there is no escape. There's no way you can go where alcohol isn't present. It's just everywhere.
Absolutely. is ubiquitous. Now, I know you've got another meeting shortly, David. So, um is there any minutes? No, no, no. Are you okay? Right. Yeah. Yeah. No, I got to I've got some Yeah, I can go up to near an hour. Yeah. Yeah. Um quality of life is is so much worse when you drink, isn't it? Um sleep, nutrition, work, creativity. I mean, yeah. What what would you say about alcohol's effect on the quality of life?
Well, I would say uh if you drink within the current recommended guidelines to less than 14 units a week and you don't take all those units in one go, yeah, uh you're probably all right. But once you beyond those limits, you are likely to discover that you're uh impairing your life, your quality of life in some way. And the thing is, you won't know until you cut down. And that's why it's worth doing the experiment to find out whether you actually really need the alcohol, whether it is improving your life or whether you're just drinking because that's out of bad habit. Let me give you an amazing statistic that the um Nick Sheron was professor of hepatology at Southampton University and he was he's a sort of Britain's expert on alcohol in the liver and he would monitor people coming in with alcoholic liver disease into his clinic and a third of them didn't meet any criteria of being alcoholic. They said well you know they they weren't they weren't classic alcoholics. They weren't getting drunk. They weren't having fights. They weren't having severe withdrawal. They were just drinking a bottle of wine a night with their partners. They were middle- class people just drinking what what you know, we just drink like the French do, but we're pickling our livers over 10, 20 years. You know, the French get cerosis. So do we. Yeah. No, I've I've seen cerosis in people that wouldn't consider I mean, there's other factors, but alcohol is a big one. and uh people that just consider themselves social drinkers. Yeah. Yeah, that's right. Yes. You um so a third of cerosis occurring are basically non-alcoholics. Yeah. People who don't Yeah, that's right. You see never be diagnosed. A GP would never pick it up, you know, unless you say, "How much do you actually drink?" And they would probably just say half a bottle. So So I mean I mean then if you double it as you should. Yeah. I mean, I I'm I'm not an alcoholic. Alcoholics are people that live in the streets and they drink they drink bottles of cider out of brown out of brown paper packets on the on the park bench and they're sick and they haven't got any teeth and they're you know, they go to hospital all the time. you know the ability to rationalize and that is of course the um the message some people are down there the points whereas we're perpetuate it doesn't you know nice comfortable middle class people like us we doesn't matter how much we drink we'll never suffer but of course that's not true no can't possibly be a problem there's this wonderful study the it's called the the it's the Westminster study the study of looking at civil servants saying it's a very clear relationship between how much you drink and how small your brain is. The the people that drink more have smaller brains, you know, over the course of, you know, a course of 20, 30 years.
The White Hall study, it's called, and double your drinking, you know, doubles the shrinkage of your brain. It's pretty clear. I I always taught my students to work out units. So, you know, a unit of alcohol being 10 ms. Yeah. and you know how how many units are in various drinks and working out as a percentage and things and and the amount of intelligent young people that were genuinely I'I'd say probably about maybe 10 10 15 20% of a class were genuinely shocked by how much they drank in the past few weeks. They actually didn't realize. No. And that's a huge I mean I'm glad you do that because you most people do most people don't want to know the truth about their drinking. You know they we're you know one of the strengths of humans is we minimize things but in the end you know that's to our detriment. And I one of the tips I give to to people is that there are one of there are five variables that you really should know for yourself. You know, you should know your weight and you probably know your waist circumference, your blood pressure, your cholesterol, and your drinking. And with all those, you should almost certainly be trying to reduce them all.
That sounds like pretty good pretty good advice. Um, is if you drink, you excrete more vitamin B and vitamin C. So if someone's drinking regularly, should they take vitamin supplements or is that just a No, you should. Absolutely. You should I mean out of vit yes and particularly well we know that heavy drinkers when when you're getting to the point where alcohol is the dominant energy source, you would you're going to be seriously B1 deficient and probably B12 deficient. And that can lead people into a terrible situation. a severe neurological illness called vernicus enkephylopathy where your brain is actually parts of your brain particularly the memory circuit is dying because it doesn't have enough vitamin B1 so it's it's a medical emergency and we we should actually be put why don't we put B1 into drinks because the drinks indust they don't they think it might change the taste I'm not sure it would but they just they don't even want to admit that drinking is the main cause of vericus so it is And this is a historic problem. You know, we've known this for well, I think Vernica was about 1890. So, it's not, you know, but we've consistently refuse to bite the bullet and help people not get vericas by adding vitamin B1s to to drinks or or to food stuffs even. Yeah. So, so when when you drink basically you're weing out your fat sol your water soluble vitamins. That's the problem. Yeah. and and you're also the the inflammation in the gut that alcohol causes reduces the ability for you to absorb them even if you take them. So you got to give people best of all to give them injections if once they're in that state. And of course we do this very very regularly in the healthcare situation. In the I think now it's called Pabrinex. In the in the in the old days it was called um Pentravite. Preventrovite. Yes. But now we put a but now we put it in a 100 mil bag and drip it in and it's a nice yellow color. And uh Yeah. But we it's really important but it's not always done you know it's not always done. Yeah it certainly should be.
Now what is it about human beings that like to leave reality for a short period of time from time to time? Is this some intrinsic defect that we have? Because people have been using abusing various psychotropic compounds. Well no Noah planted a vineyard as soon as he came out the ark. It seemed to be one of his priorities. And uh I'm sure people were having the odd tipple well before that as well. Um yes, what is it that we seem to need something? Yeah, it's um I think it's there are two aspects to it. I think I mean the first is that because we've got such big brains uh and we've got this huge expansion of our frontal cortex. The frontal cortex is where we think about the future. Yeah. For most of us, thinking about the future is stressful. And and so, you know, you do and if you're doing that day in day out, you know, you you know, you'll get tense and you and alcohol is a is a phenomenal relaxer. It's just like I used to think of it sometimes as a as a as a as a safety raft. You could just go on and float on
For have a few hours off. It is. It is. And I think I want to, you know, you know, alcohol; my book is not about alcohol being good or bad. It's about there is no moralizing in this at all. Thank you. It's scientific. And yes, and but the other aspect of alcohol which we've briefly touched on also is is it is a pro-social drug. You know, it is it is the most social of all drugs. Most of us um have met partners through social lubrication with alcohol, and that's a good thing because if we didn't, I mean, you know, then we wouldn't probably be in relationships. So so it's it is definitely a social drug, and there are there are anthropologists and paleontologists who think things like Stonehenge were built to bring people together. There were places where there were great celebrations, particularly of beer drinking, in order to to for tribes to make peace, but also to make new mates, to sort of spread the gene pool. So so alcohol has a a very special place in human society in terms of facilitating social interaction. It's absolutely true. So it's good as well as bad. Right.
Last question I'm going to ask you: Is alcoholism a a disease? Well, alcohol dependence for some people is once it get once you're dependent, yeah, your brain has changed, and therefore it's it's a disease in the same way as alcohol cerosis is a disease. It's a it's your body has changed as a result of the of of your drinking. The propensity to become independent is also in a way it's a sort of prodome of a disease, but is is obviously it's not inevitable, and there you know there are people who have got high risks of becoming alcoholic now you you know boys whose dads are alcoholic; if they don't drink at all, then they you know they won't become alcoholic, so it's not inevitable, but but once you start, for some people it's easier to the slope becomes is steeper for some people than others. M. The reason I asked that I was disappointed. Uh, but when I retired from academia I did some clinical work again, and amongst doctors and nurses I did find a lot of judgmentalism about alcoholism. You know you know to to me it is it is a disease problem, and you know I I have uh empathy with the alcoholic the same as I do with an appendicitis. It's um absolutely. Yeah. I mean a society that not only allows advertising but also makes a lot of money from the tax on alcohol and then surprise surprise surprise some people use the drug, you know, it's um it's double standards. Yeah. Yeah.
Now let's get on to your new invention. If only there was an alternative to have you got one, John? Oh, I've got several. Yeah. So you kindly sent me some this. Now I have no commercial interest in this at all. The reason I'm doing this, David, is is I consider the bakus to be quite a wild raving animal that goes around tearing people apart. You know, alcohol is a real problem. And and that's what I want to uh to that's why I'm highlighting this. But but you you've invented this stuff. So there's the red for relaxation. And uh this smells like nothing I've ever smelt before. And I add that one with a ginger beer, I think. Then then there's the yellow uh which the gold we call it, John, the gold. Gold. The gold. The gold. Yes. Of course. Yeah. It's our procco equivalent. Is that the summer citrusy drink? Yeah. Yeah. I'm not so sure about the black. I've only tried that once. But um my son my son and my wife both really like them. So on a small sample size. Um so what the heck is this stuff, David? Well, the drinks you're talking about are called centia. They're centia red, black, and gold. They're three different flavors, but also have slightly different ingredients, but the core of them all are herbs that enhance the effects of GABA in the brain. So, centa is designed to mimic a drink of alcohol. And and I must say, I was amazed. I I drank this and I felt like I'd had a double gin, but there's no alcohol at all in it. Zero alcohol. Absolutely. It's just herbs which we've known historically from Chinese medicine, iovertic medicine and also interestingly historic British herbal drinks which have been designed and used for centuries to relax people, and that's what we want to achieve. We want to give people a drink which can relax them like alcohol relaxes them but without turning on the dopamine the endorphins without blocking the glutamate. So this is a a drink which targets just GABA.
Now, if if if these drinks artificially stimulate GABA, surely that's going to reduce the amount of GABA that my body produces like like a benzoazipene. Or am I wrong about that? No, it's a really important question, and it's one that's, you know, we get asked a lot, and we've obviously thought a huge amount about it, and the way we minimize that is this. We minimize it firstly by the herbs in centia; you cannot get drunk on you know even if you we we recommend 25 mil units; we recommend no more than 100 100 meals a day because that fits within the recommended daily allowance for the herbs, but even if you were to drink a whole bottle you wouldn't get drunk, so the compensation in your brain wouldn't really kick in because you're not messing with your brain that much, and the other way we mitigate um sort of development of tolerance is because it doesn't hang around as long as alcohol, and so there's less time for the brain. There's less need for the brain to to adapt, and there's less time for the brain to adapt. So we're generally not s I we haven't had anyone report to us that they for instance get disrupted sleep in the mornings like you would if you were getting tolerance to alcohol. But, you know, if you take I mean, I'm not saying it's the same as benzoazipines, but if you take benzoazipines regularly, then you stop. Your anxiety will be worse than it was to begin with because you're altering the GABA. I mean, yeah. Is is that are you fairly happy that that's not a risk here? Well, firstly, it doesn't work on the same sites as the benzo. That's the first thing. And and the second is that we do know uh from there are there are benzo which are only used in anesthesia where you don't get tolerance because if you just knock someone out for 10 15 minutes you know the brain doesn't adapt. The ones that if you know if you're taking something like daopam or chordiz epoxide for for five six years your brain will adapt. um the long half-life ones cause more adaptation because the brain is always they're always sitting on the receptors, but we're deliberately avoiding we're minimizing the time that we're changing the GABA system, and as I say Centia doesn't work through those um mechanisms anyway.
I mean if if if I took I took this and um first of all you get some effect virtually straight away; I must say it's a very similar to alcohol effect pleasant so it presumably must going through the mouth somehow because you know within seconds I could feel some some sort of well yeah that's right; I mean it's there are quite it's quite a lot of herbs in there; I mean some people some people think they love the taste some people are not so sure, but this definitely stimulates both the your sense of smell and your sense of taste, and those nerves feed straight in to your brain centers where you gauge liking and appetite. So yeah so you're beginning it's like turning on was the same. It was the same circuit as you turn on if you were um you know sipping your first sip of your favorite um your favorite ale, but you could still drive home. Well, we say this, we say if you're feeling changed and you could be quite relaxed on Centia, then you shouldn't drive. You know, if you're if your mental state is not as acute as it should be for driving, you shouldn't. But but we're pretty confident the effect will wear off a lot faster than if you got to the same level of um relaxation with alcohol. Yeah. I mean I mean I must say I found the taste extraordinarily it's unlike anything I've tasted before but in a very positive way. My wife absolutely loves which one does she like? Uh she likes the red one. Yeah. My son quite like Yeah. My son quite like the yellow one. The gold one. Sorry. Yeah. Gold one. Yeah. So it's people people vary, and that's one of the reasons we've got these very different drinks because people some people say I hate the black and other say I love the black, and it depends on whether you like spicy things you want to be you know you know you want to or whether you like relaxing things, so the red's for relaxation sitting down with your wife over a over a meal or you know and then the the gold's for when you know your son and all his friends come around for a you know afternoon party. Yeah. And and the black, well, we the black you can use, you know, people. The black goes very well with things like Coke or um or ginger ale. It's a spicy activating drink. But all they all relax you. I mean, they they do. It's it's it's quite extraordinary. Um but it took a long time to get there, John. It took That's about six years of research. But you and your wife in the kitchen jiggling around with different herbal preparations. No, I was doing it with with some some science sciency friends who work with us. No, it really is. Uh, personally, I think the taste is fantastic. I mean, I I can't keep I'm sniffing this. It It smells like walking into a So, so sometimes in Asia, you get like shops where they sell herbs and spices and all sorts of stuff. Exactly. Absolutely. That's what it smells like. It's Yeah. We've had Indians say, "Wow, this is I remember drinking this when I, you know, this is what I used my granny used to give me this when I was a kid when I you know, it's almost medicinal." So it it use and of course it uses herbs which have have positive effects, and people remember positive effects.
Is it potentially addictive? I don't think so. I mean I I'll say that for two reasons, John. I'll say that for two. The first is you know we um I don't think you can get intoxicated enough. And the second is and perhaps this is a more important thing. You know, many people have said to us, well, uh, I'm an ex-alcoholic. Should I drink it? And we say, well, we certainly couldn't recommend it. Um, but you know, if you do choose, let us know. And many of them have said, I chose, I did, and actually I enjoyed it, but it didn't bring back any alcohol craving because it isn't it's not like alcohol craving is through something more deeper than GABA. through glutamate or dopamine or endorphins. So this is gabber. It's not endorphins. It's not dopamine. It's not glutamate. Correct. Correct. Yeah. Cuz I must say if I if I drink a double gin, which I don't really do anymore, but if I did, I think, oh, I'll just have another. Yes. But with this, I didn't. Uh, exactly. I didn't. I thought, "Oh, that that's quite nice." And then it wore off after about oh well I think I think I must say this black one this seems to work slowly, but I could feel this for about three hours maybe four three and a half hours the this one the gold seemed to work really quickly but not last as long; I mean it's probably just me, but well it's probably is just partly the aromomas too and the the the and the taste and black is a spicier taste, and I think you know for some people you know that isn't what they're used to drink getting in a drink. But, you know, the idea that you could go out on a social occasion and have this as an alternative to alcohol is I think it's a really good idea. Um, over time with mass production, well, it's relatively expensive at the moment. Now, you only need 25 ms at a time, so it lasts for a while. Do you think do you think with mass production it will get because there's no there's no doubt in my mind this is going to catch on. Well, I hope so. What the way forward is it get cheaper? Well, it'll get different, Sean. and it'll get different in two interesting ways. So, if you're interested, at the end of this month, we will have available a beer and a stout, alcohol-free beer, alcohol-free stout that has in it the ingredients that give you the effect. We're calling it Gabir. And uh and if you'd like, I'll send I'll send you Yeah, please do. Yeah. So that'll be a lot cheaper. And then the next way, the other approach we're working on is to is to make it in a can so people can have a pre-made can. You know, you would have maybe the red and tonic, and that'll bring the price down so people won't have to have a bottle sitting there. They can just buy a can. So to I mean, you know, with not drinking, you know, I'll maybe go out for a meal or, you know, go to wither spoons or something and, you know, Yeah. Okay. You can have some juice and a tonic and some water, but it's not quite the same as a drink. Whereas this is much more this is much more like a drink. Um well it is a drink, and we call it I mean I you know much as I don't want to be uh remembering what Tony Blair said but it is the third way. You can see on the bottle they got three dots. So it's it's not alcohol and it's not alcohol non-alcoholic. It's functional. It's the it's a functional alcohol-free functional drink. And and we think people should well we know people want it. We think people should be allowed to get it, and we we personally would we're thinking of starting a a kind of campaign to it would be nice if any social events which are put on by government funded you know local authority funded um councils and that any taxpayer funding we think they should it should be a regulation that this is available because because a lot of people don't won't go to those events if they because they don't want the alcohol and that's all that's served. So we, you know, we think people should have a right to choose non-alcoholic. Yeah. But functional drinks. No. You know, sometimes you walking down, you think, I could just go into that pub for for fish and chips or something, but I I I don't want to drink with alcohol in it just now. I don't want to drink with sugar in it just now, and I don't want to drink with artificial sweeteners in it just now. Yes. Where was What's this beer called? Gabir. Gabir. I'm going to send you a bottle. Don't worry. I'm salivating. It sounds great. Well, can you have to send a couple cuz my son will want one as well. But I will definitely I'll send you It's interesting. My wife's had a few, but uh the last we haven't drank much, but uh after a couple last night, she said, "Oh, just have another one of those." Well, I'll tell her you can tell her what I do, which is in the week I just drink Centia, right? And at the weekend I might have a glass of open a bottle of wine and have a have a glass on a Saturday and a glass on a Sunday. But I but in the weekends I find centia is perfectly adequate. Relaxes you improves your sleep. No hangover and um and also it's got fewer calories than alcohol too. Yeah. Yeah. Yeah. Interesting. Right. So the way forward there are way forwards but people will always want some kind of escape. I don't think I think to deny that is is is precisely John. Precisely. The idea that you can you why would you want to live your life without relaxing if there was a a safe alternative? It makes no sense at all. Absolutely.
Can you buy it in local shops? I've never seen it. You you mates kindly sent me these samples. So um yeah it's um for for technically it's actually quite difficult to sell things in shops because you need so we sell we we tried that we actually tried to and sell it in bars and things but you need a huge sales force. We're a tiny little company. we've just said. So now we it's just basically it's all online because that that's the only way we can afford to survive if you know at some point we would like to get it into shops when it's become more more popular. But at present you know it's really word of mouth, and actually you know that's one of the nice things about talking to you because I know you've got a lot of listeners. Uh well um I I have some amazing people on on the channel. That's I don't think people will listen to me but for some strange reason world leading professors come on the channel and and and uh in all due modesty you're one of them. So professor thank you so much for coming on, Sean. Great as always to talk to you and always let me know how you get on with the gabir. All right. I will. I look forward to and I might have one of these tonight as well. Thank you. Fantastic. Thank you.