Jillian Woodruff, MD (00:00)
Have you ever had one completely ordinary glass of wine at dinner and woken up the next morning thinking, excuse me, who replaced my body overnight? Because suddenly the headache is bigger, your sleep was terrible. Maybe your heart was racing at three in the morning. You're puffy. gosh, so puffy. You're anxious and the bounce back you used to count on is just gone.
Dr. Ade Akindipe, DNP (00:24)
Yeah, actually gone, missing. You know, there is no forwarding address. And women tell us this all the time. You know, they'll say, I've used to I used to be able to drink two drinks, stay out late, and get up the next morning and go working out, go to work and take care of everyone. And now if I have one glass of wine, I need to be able to recover.
Jillian Woodruff, MD (00:45)
Yes, yes. And so when for so many women, that change seems to show up at exactly the same time. Their periods may get unpredictable, their sleep is a bit fragile, their hot flashes start, their body starts to change, like more weight around the midsection. Hormones are basically saying we're no longer following the previous itinerary.
Dr. Ade Akindipe, DNP (01:08)
Yep, that's right. And today we are talking about alcohol in perimenopause and menopause, why it can suddenly hit differently and why the bounce back disappears, what hormones really have to do with all that, and what happens with sleep, mood, your weight, your gut, your bladder, and overall your long-term health.
Jillian Woodruff, MD (01:29)
Yeah, so everything. Everything. And we'll bust
Dr. Ade Akindipe, DNP (01:32)
Pretty much.
Jillian Woodruff, MD (01:32)
a few midlife myths along the way, including the idea that red wine is practically a vitamin. You know you've heard it. You know you've thought it.
Dr. Ade Akindipe, DNP (01:43)
Somebody's auntie's about to be upset about
Dr. Ade Akindipe, DNP (01:45)
this.
Jillian Woodruff, MD (01:45)
And you know, because hot flashes and night sweats are sometimes part of the reason women may want to reach for that glass of wine in the first
Dr. Ade Akindipe, DNP (01:53)
Mm-hmm.
Jillian Woodruff, MD (01:54)
place, right? You know, they may have anxiety that's been increasing, and so they think that glass of wine is going to be helping them. So we're gonna talk about the vasomotor symptoms, so those hot flashes and night sweats that are coming.
Jillian Woodruff, MD (02:08)
during perimenopause and menopause and why maybe the alcohol is not the best thing to grab for to help you.
Dr. Ade Akindipe, DNP (02:17)
Yeah, and this is not a bashing episode for people who drink. it's not an anti-alcohol episode. So just so you know, this is just a little bit more information and helping you make better decisions.
Jillian Woodruff, MD (02:29)
That's right, no shame, no judgment, there are no gold stars for abstinence.
Dr. Ade Akindipe, DNP (02:35)
Yeah, just information because midlife is really a bad time to keep using your twenty year twenty-eight year old strategy for
Jillian Woodruff, MD (02:42)
Yeah.
Dr. Ade Akindipe, DNP (02:43)
right now. So we're actually
Jillian Woodruff, MD (02:45)
Yeah, I think
Jillian Woodruff, MD (02:46)
the 20 and the 28 were probably different strategies, right? Like
Dr. Ade Akindipe, DNP (02:49)
Ha ha.
Jillian Woodruff, MD (02:50)
I don't know if we had a strategy at 20 and maybe we're trying to start one at twenty-eight.
Dr. Ade Akindipe, DNP (02:54)
I did not have a strategy and we just went with the flow.
Dr. Ade Akindipe, DNP (03:53)
So yeah, and we actually had a very funny example of this on our trip. You know, we had a podcast planning trip some time ago. Remember that?
Jillian Woodruff, MD (04:01)
Yes, Hawaii.
Dr. Ade Akindipe, DNP (04:03)
people he Yeah. Well, it it
Jillian Woodruff, MD (04:04)
It sounds wilder than it was, you know.
Dr. Ade Akindipe, DNP (04:08)
definitely wasn't that wild. I mean, we were there. People hear two girlfriends go on the Hawaii trip and they're like, yeah, they're they're partying, cocktails, staying out late dancing. Mm-mm. What did we do?
Jillian Woodruff, MD (04:17)
No. Well, we were
Jillian Woodruff, MD (04:18)
in bed early. we did a lot of reading. I thought that was pretty exciting. I don't think we
Dr. Ade Akindipe, DNP (04:22)
Yeah, we did. We were focused.
Jillian Woodruff, MD (04:24)
were drinking at all. It was like a peak
Dr. Ade Akindipe, DNP (04:26)
No, I don't know what
Jillian Woodruff, MD (04:27)
midlife rebellion.
Dr. Ade Akindipe, DNP (04:28)
Well, I don't really remember drinking, but maybe that's I don't know. Usually I don't do because
Jillian Woodruff, MD (04:31)
I don't think so.
Dr. Ade Akindipe, DNP (04:33)
I don't think we did. Yeah. And we were like, this is amazing. This is wonderful.
Jillian Woodruff, MD (04:36)
Yeah.
Dr. Ade Akindipe, DNP (04:36)
We had time. Nobody needs anything from us. We had books. We have a bed and we said goodnight. And that was it. And honestly, I think that says something about this stage of life because you start realizing, you know, that feeling good the next day.
Dr. Ade Akindipe, DNP (04:51)
is very appealing. I mean I like to go to bed, wake up feeling refreshed.
Jillian Woodruff, MD (04:56)
Very underrated.
Dr. Ade Akindipe, DNP (04:58)
Mm-hmm. Mm-hmm. And one of us even decided this year I'm going to stop drinking altogether.
Jillian Woodruff, MD (05:03)
will protect her identity. It lasted about a month. so technically I would classify that as an experiment.
Dr. Ade Akindipe, DNP (05:10)
Experiment. Hmm. Okay. Well, here's the interesting part. It wasn't some dramatic failure where she went right back to regular drinking. Now it's literally maybe a glass of wine every month or so. And I don't I don't, you know, I think that's that
Jillian Woodruff, MD (05:24)
Yeah.
Dr. Ade Akindipe, DNP (05:24)
is such a better way to think about this. It doesn't have to be I drink or I don't drink. Sometimes you you just change the baseline. You pay attention to how you feel and you realize, you know, actually I don't really want this that often anymore.
Dr. Ade Akindipe, DNP (05:39)
And that's okay.
Jillian Woodruff, MD (05:40)
That should be our theme for today. Recalibration, not perfection.
Dr. Ade Akindipe, DNP (05:44)
Absolutely.
Jillian Woodruff, MD (05:45)
I think we should start with probably estrogen. You know, we
Dr. Ade Akindipe, DNP (05:49)
Your favorite.
Jillian Woodruff, MD (05:50)
love to talk about it. Yes. The hormonal transition matters. We do need to be precise. In your 20s, when you didn't have that strategy, and in your 30s, when you had a different strategy, estrogen is not actually steady, right? So we're talking about how in perimenopause our hormones get wild and fluctuate.
Jillian Woodruff, MD (06:10)
But they're never steady. They always fluctuate. It's just the amount of fluctuation may change. So it rises and falls throughout your menstrual cycle when you're in your 20s and 30s. But in perimenopause, that ovarian function becomes unpredictable. And so estrogen can swing dramatically high, dramatically low, and those fluctuations are unpredictable, like we said. And so
Jillian Woodruff, MD (06:36)
Gosh, perimenopause is just not nice. It's not like this slow fade. There's a lot of turbulence.
Dr. Ade Akindipe, DNP (06:43)
Which is why a lot of women describe it the way they, you know, they actually feel. It's like I was fine and then suddenly I wasn't. Mm-hmm.
Jillian Woodruff, MD (06:51)
Yeah, it's like a roller coaster. Mm-hmm.
Jillian Woodruff, MD (06:54)
Yep. And estrogen affects so many systems outside of reproduction. We know that we have estrogen receptors all throughout our body, in our brain, in our blood vessels, in our bones, in our metabolic system. it controls temperature, our sleep, our mood, all the things are affected by estrogen. And alcohol can interact with several of those same systems.
Dr. Ade Akindipe, DNP (07:18)
Yeah, there's actual real evidence on this. You know, there was a controlled study back in the nineties that found that alcohol raised circulating estrogen, estradiol, by about 22% in post-menopausal women on estrogen therapy. And a bigger one, even more recently, 2020 2024, acute drinking and even more regular moderate drinking is linked to higher estradiol levels. So
Dr. Ade Akindipe, DNP (07:44)
The relationship between estrogen and alcohol is real. It's just genuinely complicated because you're also having, you know, that up and down, like Dr. Jill just mentioned. So estrogen seems to influence drinking patterns, not just the other way around. So if you already have if it's increasing circulating levels of estrogen, you can imagine how that can cause a lot of it can really mess with perimenopauses. Again, it's the zone of chaos. So you're adding more to it.
Jillian Woodruff, MD (08:11)
Yes. Yes, I I like that explanation, the zone of chaos. And that's exactly why I wouldn't say your estrogen dropped, therefore your liver suddenly stopped
Dr. Ade Akindipe, DNP (08:20)
Mm.
Jillian Woodruff, MD (08:21)
metabolizing ac alcohol, because that is just like way too simple to describe what's actually happening and what the research shows.
Dr. Ade Akindipe, DNP (08:28)
Mm-hmm.
Dr. Ade Akindipe, DNP (08:30)
Absolutely agree. So hormones are part of the story, but not the whole thing, right? So and I think that distinction really matters clinically. It's not just a disclaimer there. because if we tell every woman it's just your estrogen, she stops looking at her sleep, her medications, her genetics, her body composition, all the other levers she can actually work with. We're not, you know, we're oversimplifying it and
Dr. Ade Akindipe, DNP (08:56)
It's not very empowering, so
Jillian Woodruff, MD (08:57)
I loved coming to your office last week and doing my body composition. I don't know. It took me so long to do. I think a part of me was a bit nervous to do it, to know the truth. It's like, can I handle it? I don't know. But yeah, it was really cool. Yeah. Thank you. Thank
Dr. Ade Akindipe, DNP (09:07)
And it wasn't bad. You did good. Imagine if we now stuck with it. You already have a good body composition. You have nothing to worry about.
Jillian Woodruff, MD (09:17)
you. But it's good to see like where you are and what you can
Dr. Ade Akindipe, DNP (09:21)
Mm-hmm.
Jillian Woodruff, MD (09:21)
do to improve it. And as we talked to you about alcohol.
Jillian Woodruff, MD (09:25)
I think what you can see with your body composition will explain so many things about how
Dr. Ade Akindipe, DNP (09:30)
Yeah.
Jillian Woodruff, MD (09:30)
alcohol and how we tolerate it changes as we age. So we'll talk more about it. But I thank you for letting me come over there and do that.
Dr. Ade Akindipe, DNP (09:38)
Absolutely. Any time.
Jillian Woodruff, MD (09:40)
yes. Well, the current evidence does not let us say that fluctuating estrogen directly shuts down your alcohol dehydrogenase. And it's an enzyme, I'll tell you more about it. so
Jillian Woodruff, MD (09:51)
Alcohol dehydrogenase, that enzyme that breaks down alcohol, is not the whole reason why you suddenly cannot tolerate alcohol as you used to. So, all of those things that she just mentioned, the aging of our body, the body changes your total body water, the way your liver efficiency changes, and how it metabolizes alcohol and medications that can change both your liver or change how
Jillian Woodruff, MD (10:18)
You change the function of your liver or change the way your liver needs to work to metabolize that medication, thus you can't metabolize other things, or vice versa. The sleep in your genetics is also a part of this. The way your nervous system changes, all of these things overlap with the menopause transition. And together, that can absolutely create the experience women describe as alcohol suddenly hits me differently.
Jillian Woodruff, MD (10:43)
I just don't tolerate it like I used to, and I just don't feel good after I drink.
Dr. Ade Akindipe, DNP (10:47)
Yeah, I mean it's really important because women know we we know our bodies, we can tell when something's changed. But, you know, again, when body composition and all those little o other things also are changing with biology and you're having that transition, it's good to kind of know the connection and know that, wow, this is the reason why I can't have maybe three drinks anymore. Maybe you just do one, maybe a few times a week. So
Jillian Woodruff, MD (11:12)
Right, well I can't or why I shouldn't, you know. Right.
Dr. Ade Akindipe, DNP (11:15)
Mm-hmm, mm-hmm.
Jillian Woodruff, MD (11:16)
I agree so much with that. And I just mentioned alcohol dehydrogenase. So let's talk enzymes. Alcohol dehydrogenase is an enzyme. this is where the actual chemistry happens, and so let's walk through it. Alcohol dehydrogenase, for short, we may say ADH. It's one of the major enzymes that begins to break down ethanol.
Jillian Woodruff, MD (11:39)
In your liver and your stomach before alcohol even reaches the bloodstream. So it's broken down before alcohol can get to the bloodstream. ADH breaks down into a compound called acetaldehyde. And how much ADH activity you have varies quite a bit person to person based on your age, your genetic sex, and all those other things. So.
Dr. Ade Akindipe, DNP (12:01)
And acetal aldehy ac acetaldehyde, that word. Tongue twister. Acetaldehyde. Is the toxic one. And that's the part
Jillian Woodruff, MD (12:04)
Yeah. Say it three times. Yeah.
Dr. Ade Akindipe, DNP (12:10)
that actually makes you feel awful. Mm-hmm.
Jillian Woodruff, MD (12:12)
That's true. That's true.
Jillian Woodruff, MD (12:14)
It's responsible for a lot of the unpleasant effects we associate with drinking. So the flushing, the headache that people may have afterwards, the nausea. The enzyme that clears it out is aldehyde dehydrogenase. And so that's mainly ALDH2. And that converts acetaldehyde into acetate that the body can process further.
Jillian Woodruff, MD (12:39)
And there are real genetic differences here too. Some people carry ALDH2 variants that make that clearance much less efficient, leading to more flushing or you know, a heart racing or nausea, like more intense nausea. And sometimes, after even a pretty small amount of alcohol, they may have these. I'm sure we've, you know, heard about this in the past. They may not have named that exact, you know.
Jillian Woodruff, MD (13:06)
the ALDH2, they may have just said alcohol dehydrogenates and some people don't have that gene to process alcohol. This is what they're talking about. And so some people have more flushing of their skin. You may see them getting red. And there are and there's genetics involved in this.
Dr. Ade Akindipe, DNP (13:22)
Yeah, so when somebody says my friend and I drink the exact same amount and she feels completely different than I do, then that can literally be biology, not willpower thing.
Jillian Woodruff, MD (13:33)
Yeah, exactly. And I do want to be careful. The research on sex differences in gastric ADH, so the the ADH activity that's in your stomach s hasn't always been consistent from study to study, you know. So this is what's saying, hey, do women metabolize alcohol differently than men? The the research is a little, you know, different because it depends on so many different things.
Jillian Woodruff, MD (13:59)
The important part is that inconsistency isn't really telling us the effect is imaginary. A lot comes down to age in how the studies were actually run. But what we can say confidently is that women tend to reach higher blood alcohol concentrations than men after the same exposure. So it affects women differently and maybe more intensely than it does men. And there are two reasons for that working together.
Jillian Woodruff, MD (14:26)
The first is largely because women generally have less total body water. And then the second is aging. And so as we age, the differences, it it may become difficult for both women and men to process alcohol due to the aging part, but the differences between the sexes early on, like l when you're less than 50, is most likely due to the total body water content.
Dr. Ade Akindipe, DNP (14:53)
Yeah, real enzymes, real genetics, and real variability between people, just not one clean menopause switch that flips it all off at once. So that first reason you just noted is is probably one of my favorites because it's so simple once you hear it. So alcohol distributes through your body water. If you have less water available to dilute the alcohol, the concentration in your blood can be higher. women generally have less total body water than men.
Dr. Ade Akindipe, DNP (15:21)
At the same body weight. So often around 50 to 50 percent versus 60 to 65% for men. So and that can again, that can vary from person to person. So when we do body compositions in the clinic, that's one of the ways we're able to track how how women are doing, especially when they're trying to shift their body composition. You can actually see what's happening month to month with with their with the water weight.
Dr. Ade Akindipe, DNP (15:45)
So as we age, body composition often shifts. Less lean tissue like muscle. If we are, if we aren't actively preserving it through strength training and adequate protein intake, and often a greater proportion of body fat starts to settle, especially around the belly area. So it's really important to keep that in mind. I'll also say, too, if you're on a a weight loss journey and you're using GLP1s, that's one of the things that commonly
Dr. Ade Akindipe, DNP (16:12)
tends to be an issue. You know, if you women in perimenopause specifically, menopause, once that you start having that decline, you do start to see that stiff, rigid belly fat that doesn't want to go anywhere. And if you're someone that drinks alcohol, it will raise your blood sugars, right? So it'll make it even more difficult. So often women are so used to maybe they're drinking a lot more. They were drinking a lot more and that's difficult for them. Sometimes you might need to
Dr. Ade Akindipe, DNP (16:37)
If it's something that's been part of your life for a really long time, it can be difficult. So the GLP one can help. I've seen that. But it can also make it difficult when you're used to it. So you might have some withdrawal symptoms. Anyway, I digress a little bit, but I'm saying that because if you are someone who drinks quite a bit, that might be something worth looking at because if your body composition isn't shifting in the right way, that might be the cause of that.
Dr. Ade Akindipe, DNP (17:03)
I figured I s mention that since we're talking about
Jillian Woodruff, MD (17:03)
Very interesting.
Dr. Ade Akindipe, DNP (17:04)
body composition. Yeah.
Jillian Woodruff, MD (17:05)
How often are are you checking people's body composition from month to month? How often do you check for someone who's on a weight loss journey?
Dr. Ade Akindipe, DNP (17:11)
Yeah, I recommend I recommend month to
Dr. Ade Akindipe, DNP (17:14)
month, especially the for to monitor visceral fat, because if we're not seeing a shift in visceral fat month to month, then we're we're not really moving fat. Sometimes you'll see the muscle decline. Because what I find too with is with GLP1s, you you what people tend to get more sluggish because it can cause you to eat less. So you're more sluggish, you're not moving as much as you should. So you may lose muscle, but you may actually not.
Dr. Ade Akindipe, DNP (17:39)
lose visceral fat. So it it's really important if you're on that body composition should be moderate. And if you're especially if you're if you drink alcohol.
Jillian Woodruff, MD (17:48)
And I just want to say, like visceral fat, the fat around your organs.
Dr. Ade Akindipe, DNP (17:52)
That, yep, yep, exactly. That's
Dr. Ade Akindipe, DNP (17:54)
that deep seated fat around the organs. And if you have had belly fat for a long time, it can be difficult to lose. So it's it's really important to get with someone when when you when you're looking at that. And and labs too, checking to make sure that you don't have fatty liver, which can happen when you're if you're if you do drink plenty of alcohol.
Jillian Woodruff, MD (18:13)
I know you do continuous glucose monitoring, you know, when they're wearing
Dr. Ade Akindipe, DNP (18:16)
Mm-hmm.
Jillian Woodruff, MD (18:16)
their glucose monitor. Are you seeing changes between like when people are drinking alcohol? Are we seeing higher blood sugar when they're drinking alcohol, even if they're not drinking like a fruity cocktail?
Dr. Ade Akindipe, DNP (18:28)
that's an excellent question.
Dr. Ade Akindipe, DNP (18:30)
Actually, it depends on the person. There are some people where it really doesn't spike too much. And there are some some people it just depends on on them. If you're insulin resistant, then absolutely you'll see those, you know, spikes 200 plus and it'll stay up there. But I have some people who drink and it doesn't bot it doesn't budge. It it's really, I mean, it is a sugar, but the which is why I highly recommend wearing it. You would be surprised what you'll find.
Dr. Ade Akindipe, DNP (18:56)
If you wear it for a couple of weeks, I'm sure you've tried it as well. But yeah, it'll keep you honest.
Jillian Woodruff, MD (19:01)
Yes.
Jillian Woodruff, MD (19:02)
Yeah, no, it's really interesting how some things can affect your blood sugar where they wouldn't with another person.
Dr. Ade Akindipe, DNP (19:07)
Mm-hmm.
Jillian Woodruff, MD (19:08)
And I guess that's what we're saying here with alcohol too, is that it affects each of us differently and it affects, you know, women and men differently, and it affects you differently based off of age too, genetics, all
Dr. Ade Akindipe, DNP (19:20)
Yeah.
Jillian Woodruff, MD (19:21)
of these things. So when you're talking about total body water, the same glass of wine, maybe going into a smaller pool.
Jillian Woodruff, MD (19:27)
Of body water than it used to as women age. Mm-hmm.
Dr. Ade Akindipe, DNP (19:30)
Yeah. Absolutely.
Dr. Ade Akindipe, DNP (19:32)
Same amount of alcohol, smaller distribution volume, potentially higher concentration too, right? So that glass
Jillian Woodruff, MD (19:37)
That's true.
Dr. Ade Akindipe, DNP (19:38)
of wine at forty five may literally not behave like the glass of wine y that at thirty. So
Jillian Woodruff, MD (19:44)
Yeah,
Jillian Woodruff, MD (19:44)
yeah. And on top of that, the reduced gastric ADH. I'm just coming back to that, alcohol dehydrogenase. So that enzyme in your stomach that comes from aging leads to less first pass metabolism. And we've talked about first pass metabolism when we talk about our hormones. especially, you know, if you're taking a hormone by mouth, right? You're going to be metabolized first in the liver, first pass metabolism. So this is.
Jillian Woodruff, MD (20:11)
In the stomach, you have this enzyme where you're going to break down that alcohol after you drink it. And so there's a larger share of what a woman drinks, a larger share of what the woman drinks actually will make it into her bloodstream. So if you have less of the gastric ADH, there's less metabolism and breaking down of the alcohol. When it's not broken down in the stomach, it can be.
Jillian Woodruff, MD (20:36)
Absorbed into the bloodstream. So there's going be more absorbed into the bloodstream. And then what what do you think happens when there's more absorbed into the bloodstream? There's more effects from that. And so the body composition changes, come along with age. An older person, female or male, will hit a higher peak blood alcohol level from the very same drink than they would have decades earlier. So that is very interesting too, is that your blood
Jillian Woodruff, MD (21:04)
alcohol level even from what you may think is a small amount of alcohol, but it's going to behave differently in you when you're older versus when you were younger. So you have to be pretty careful with that. Biology
Dr. Ade Akindipe, DNP (21:19)
So rude. It's just not fair. What happens with age?
Jillian Woodruff, MD (21:24)
has no HR department.
Dr. Ade Akindipe, DNP (21:26)
No, not at
Dr. Ade Akindipe, DNP (21:27)
all. And this is actually one of the more actionable pieces in this whole episode. It's part of why we keep coming back to strength training and back to protein on this show because it's important it is super important. Preserving lean muscle mass literally helps preserve that water pool as well.
Jillian Woodruff, MD (21:47)
Mm-hmm. Yep.
Dr. Ade Akindipe, DNP (21:48)
Well, I
Dr. Ade Akindipe, DNP (21:48)
think the bounce back is bigger than alcohol metabolism, right? Because when we say I used to bounce back, what did bouncing back actually require? You had to metabolize the alcohol, you had to rehydrate, you had to drink water, right? Your brain had to recover, your sleep had to restore you, and you had to wake up with enough metabolic and emotional reserve to function again. So
Dr. Ade Akindipe, DNP (22:14)
That's what that means then and but then it it might just look a little bit different now.
Jillian Woodruff, MD (22:18)
Exactly. Perimenopause destabilizes several of those things at the same time. So sleep is already more vulnerable. Hot flashes are waking you up. Mood more reactive. Maybe that's the kinder way to say what happens to your mood in perimenopause. You're just more reactive. your body composition changing. We talked about that. You may be taking medications that you weren't taking at 30. Your liver may not.
Jillian Woodruff, MD (22:43)
process alcohol exactly the same way when it did when you were younger. So the alcohol is is not occurring. You're not drinking in isolation from all these other things, right? It's landing on a completely different physiologic landscape.
Dr. Ade Akindipe, DNP (22:58)
Mm. Yeah, you mentioned medication. That is such a huge thing too. I think prescription medications, even some supplements, you know, sometimes we want to supplement to different things and maybe they're metabolized through the liver. It's just always really good to kind of just double check to make sure things are not interacting with each other and with alcohol on top of that. So and that is why the woman who says two drinks suddenly feels like four isn't necessarily imagining things. It's just
Dr. Ade Akindipe, DNP (23:23)
All the things we mentioned, medications, you know, body transitioning can all really impact women and but in all differ different ways. So okay, we have to do it. Yeah.
Jillian Woodruff, MD (23:31)
You know, I wanna I wanna
Jillian Woodruff, MD (23:33)
add because I don't know that we like clearly said it, but I know, you know, when we are giving, we're prescribing people hormone therapy, you know, we do hormone replacement therapy. And I notice that when your liver is not functioning at its best, you know, you're you're not metabolizing your hormones in the best way either, right? So aside from alcohol, you may or may not drink, but
Jillian Woodruff, MD (23:57)
If your liver is not functioning efficiently, then even when you're having these hormones replaced, or let's say you're trying to you're holding on to the hormones you have in perimenopause, if your liver isn't functioning at its best, then you're not breaking down these hormones and using the active component and excreting the toxins from your body in the best way either. So
Jillian Woodruff, MD (24:21)
We are always, and I know you do this too, but like we think about, okay, what supplements can we do or what other medications are putting a huge strain on our liver, you know, to try to figure out, okay, how can we optimize our liver function so we can metabolize either the hormones your body makes or the hormones we're giving you, we're prescribing you. So if you're doing alcohol, we know that alcohol takes a huge amount of work to break down.
Jillian Woodruff, MD (24:48)
And to get
Dr. Ade Akindipe, DNP (24:48)
Mm.
Jillian Woodruff, MD (24:48)
these toxins out. And the liver is doing that work. And so let's say you have a great liver and the liver is churning along, but you're drinking this alcohol and it's doing the work that it just has to do to break that down. What do you think is left for it to do with hormones, either the ones you produce or the ones we give you? You're not probably gonna break them down in the best way or utilize them and get the toxins out if it's working so hard for something else.
Jillian Woodruff, MD (25:16)
And so that's kind of
Dr. Ade Akindipe, DNP (25:16)
Yeah.
Jillian Woodruff, MD (25:16)
the same with medications, right? If you have medications that take a huge amount of work from the liver, it affects these other things. And these are just these are invisible things that we don't see, you know? It's not like we're
Dr. Ade Akindipe, DNP (25:28)
Yeah, absolutely agree.
Jillian Woodruff, MD (25:30)
seeing blood work that's telling us. I mean, there is blood work, but when the blood work changes, that means, you know, there's some real issues, damage to the liver, right?
Dr. Ade Akindipe, DNP (25:39)
Yeah.
Jillian Woodruff, MD (25:40)
They these are things that we don't see. There's not a blood work that says, your liver's working too hard on this other thing. So
Dr. Ade Akindipe, DNP (25:46)
Yeah, absolutely
Dr. Ade Akindipe, DNP (25:47)
agree with all of that. Yeah. Thank you for adding that part. okay, now we've come to myth busting. we have to do this.
Jillian Woodruff, MD (25:54)
Hmm. Yeah.
Dr. Ade Akindipe, DNP (25:56)
let's go for it.
Jillian Woodruff, MD (25:57)
Okay. Let's do it. What are we gonna talk about?
Dr. Ade Akindipe, DNP (26:01)
we have to talk about a midlife myth that I hear often. Red wine is heart healthy.
Jillian Woodruff, MD (26:07)
Yes. This has had an amazing public relations campaign. For years, people heard about antioxidants like resveratrol and there's other polyphenols that you know people have heard about. These are antioxidants, they're good for us. And there are observational studies suggesting that moderate wine drinkers had better cardiovascular outcomes. The concentrations of resveratrol.
Jillian Woodruff, MD (26:30)
in wine are far below those producing effects in experimental models that are in those studies. And clinical trials of resveratrol have shown very little effect on cardiovascular disease. So I think you know sometimes you like grasp onto things that you want to believe because you're like, yes, this could be helpful because there's this little thing in here. But if it's not even enough to do anything, then I don't know if we can say that this is heart healthy.
Jillian Woodruff, MD (26:55)
The studies are also hard to interpret because moderate drinkers, and it's moderate, that's not a small amount, right? Moderate drinkers can differ from non-drinkers in many other ways, right? Their diets are different, their income may be different, their exercise, the amount of exercise they get, their access to healthcare, so many things can be different. So it's really difficult to compare these two groups of people. So current cardiovascular guidance does not recommend that someone
Jillian Woodruff, MD (27:24)
Start drinking alcohol or start drinking red wine to protect their heart. In the most recent, which was 2025, I think, American Heart Association, they had a scientific statement that explicitly states that these newer analyses have challenged the idea that any level of alcohol consumption has positive health effects. I think that's huge to say. That's huge to say, no level.
Dr. Ade Akindipe, DNP (27:48)
So s
Dr. Ade Akindipe, DNP (27:51)
so in other words, if you don't drink now, please do not start because you think your cardiologist will, you know, forgot to prescribe you or Merlot or something. So this is no, this that's
Jillian Woodruff, MD (28:01)
Yeah.
Dr. Ade Akindipe, DNP (28:02)
not. Mm-mm.
Jillian Woodruff, MD (28:03)
Correct, correct.
Jillian Woodruff, MD (28:05)
And alcohol's potential effects on blood pressure, atrial fibrillation, your triglycerides, your your liver health, and your sleep, and cancer risks are part of the complete picture when you're talking about your health.
Jillian Woodruff, MD (28:20)
So our job is not to scare women. Our job is to share facts so that women can make informed decisions. So I hope that's what we are doing. And so I hope we're just sharing the facts. And I hate this like scare tactic of, my God, we can't do anything. Everything's going to hurt you. So that is not true. But the facts are with alcohol, it is considered a group one carcinogen. And that's the same category.
Jillian Woodruff, MD (28:45)
Category as tobacco. So carcinogen is something that increases cancer risk. And so there's group one, highest level, just like tobacco in in cigarettes, the highest level of evidence from the International Agency for Research on Cancer. That's what they use to describe alcohol. And alcohol is causally linked to several cancers, including breast cancer. So sometimes we talk about risk and how risk goes up, but it's not that.
Jillian Woodruff, MD (29:12)
You are causing something, but they have a causal association between alcohol and breast cancer. That's what has been uncovered.
Dr. Ade Akindipe, DNP (29:21)
Yeah, and the cancer risk comes primarily from the alcohol itself, the ethanol, that's the alcohol, in red wine, white wine, beer, cocktails. It doesn't matter how it comes, you know, if it comes in a beautiful stamped glass, that's not what really matters. The research shows that even around one drink per day is associated with a modest increase in breast cancer risk compared with not drinking.
Dr. Ade Akindipe, DNP (29:46)
Roughly in the range of about five to fifteen percent higher, depending on the study. Again, this is not a scare tactic to say don't drink. It's really just looking at, you know, the evidence and what your risk factor is. And of course, if you know your breast cancer risk, if you have a family history of breast cancer, these are just some information to kind of help you make that decision on, you know.
Dr. Ade Akindipe, DNP (30:08)
If if you are not a drinker and you wanted to start or maybe you wanted to cut back, these are some things that you can consider, based on your own family or genetic history.
Jillian Woodruff, MD (30:18)
Yeah, that's important to consider that. The f your family history, your genetic history. Absolutely. Yeah. And researchers
Dr. Ade Akindipe, DNP (30:22)
Mm-hmm. Yeah.
Jillian Woodruff, MD (30:25)
haven't found a clear safe threshold for women below which there's no added risk. So that's, you know, important to know. We just haven't found like that one glass
Dr. Ade Akindipe, DNP (30:33)
Yeah, that's really important. Mm-hmm.
Jillian Woodruff, MD (30:36)
is okay. You know, the they haven't found any safe threshold.
Dr. Ade Akindipe, DNP (30:40)
Yeah. And I think women deserve to know that without anyone turning it into a shame, you may hear that information and say, I still want a glass of wine occasionally. And that's okay. That's fine.
Jillian Woodruff, MD (30:52)
Yeah, exactly. Informed consent applies to lifestyle choices too. Absolutely. Yeah.
Dr. Ade Akindipe, DNP (30:58)
Sure. All right. Hot flashes, night sweats, and the wine that started the fire. Let's talk about what one of the most
Jillian Woodruff, MD (31:03)
Ha ha yes.
Dr. Ade Akindipe, DNP (31:06)
obvious connections, alcohol and hot flashes. You know, alcohol is a vasodilator. So we can talk a bit more about how that can intensify these symptoms.
Jillian Woodruff, MD (31:16)
Yeah, okay. Yeah, it's a vasodilator. It widens or dilates blood vessels near the skin, which can contribute to that warm, flush sensation. And vasomotor symptoms and menopause come from changes in your brain's thermoregulatory system as estrogen signaling changes. So it comes from that withdrawal from of estrogen. And so alcohol is not technically causing.
Jillian Woodruff, MD (31:43)
menopause although it can it can how should I say this is maybe a whole a different program about aging of your ovaries so let's leave that out like alcohol doesn't directly cause menopause but for some women alcohol clearly acts as a trigger or amplifier but I would say there are two different you know alcohol vasodilation in the skin leading to that flushing sensation
Jillian Woodruff, MD (32:08)
and intensifies the the way that you recover and also the symptoms that you have from drinking either at that time or afterwards because of changes in your gastric ADH so changes in the enzyme that breaks it down so you're making less of it and also changes in your body composition and all of those things. Menopause, you have estrogen fluctuating
Jillian Woodruff, MD (32:33)
Or you have estrogen in perimenopause, it fluctuates. In menopause, there's low estrogen levels. And so that withdrawal affects your brain's receptors and that thermoregulatory system. There's not a real level of estrogen, though. So that's very interesting. People say, How much do I need? You know, I have I have some numbers based off of.
Jillian Woodruff, MD (32:56)
what our goals are, right? But there's not like, okay, this is the number where you're not gonna have hot flashes or night sweats. That's kind very different for for everyone. Mm-hmm.
Dr. Ade Akindipe, DNP (33:07)
So wait, hold on. Early I said alcohol can actually raise estradiol a bit. So if estrogen is going up, shouldn't that calm things down, not set off a hot flash?
Jillian Woodruff, MD (33:16)
A great catch, you know that answer. Yeah, yeah, that's true. Yes, you did talk about that study where what did you say? There were there is a study where they had they were looking at people drinking versus those who don't, and the ones who were drinking had higher estradiol levels slightly, however, actually, no, I don't think it was slight. I think it was it may have been more than slight, but the difference was is those were.
Jillian Woodruff, MD (33:42)
Comparing people who are on exogenous, they were taking estrogen versus those who weren't. So for those who were taking estrogen, like estrogen therapy, their levels increased over what they were over when they weren't taking it. So I mean that is interesting, but it wasn't a study looking at people who were n like in general, people who didn't take any hormones. It wasn't comparing people who didn't take hormones.
Jillian Woodruff, MD (34:10)
who drink versus not drink. They were comparing people who took hormones who drink or didn't drink. Does that make sense? Did I say that correctly?
Dr. Ade Akindipe, DNP (34:18)
Sure. So it's not a contradiction then. It's just two different systems. alcohol can bump estradiol a little in one context and separately trigger a flush or a hot flash through a completely different pathway. Neither one is canceling each other out.
Jillian Woodruff, MD (34:33)
Yeah, exactly. Because you're gonna have those effects from drinking and the vasodilation effects leading to that flushing sensation and can cause some of those other symptoms, whether you have alcohol or you don't have alcohol, even if your
Dr. Ade Akindipe, DNP (34:48)
And
Jillian Woodruff, MD (34:48)
estradiol level is greater, right?
Dr. Ade Akindipe, DNP (34:50)
And women can know their drink too. I can have a tequila and be okay and but red wine, maybe not, or if I have a drink after eight, I am changing pajamas at two in the morning.
Jillian Woodruff, MD (35:01)
Yeah, you're having that night sweat. Yes. Individual individual responses may vary. Yes.
Dr. Ade Akindipe, DNP (35:06)
Yes.
Jillian Woodruff, MD (35:07)
And this is where tracking your own symptoms can be more useful than someone else's list of rules.
Dr. Ade Akindipe, DNP (35:13)
So you need to have really sounds like we just need to ask ourselves, you know, what did I drink? How much? What time did I eat? You know, how did I sleep? Did I have night sweats? So if you're tracking it, these are some of the questions you should be asking. How did I feel the next morning? So basically, you just need to become a scientist of your own happy hour. So
Jillian Woodruff, MD (35:31)
You like it.
Dr. Ade Akindipe, DNP (35:33)
you know, we also hear women say, wine suddenly makes me flush, my nose gets stuffy.
Dr. Ade Akindipe, DNP (35:38)
I get itchy, I get a pounding
Jillian Woodruff, MD (35:40)
Right.
Dr. Ade Akindipe, DNP (35:40)
headache. did I develop an allergy?
Jillian Woodruff, MD (35:43)
Yeah, maybe, but not necessarily. wine and other fermented beverages, they contain histamine. And alcohol can also interfere with histamine breakdown in some people. sulfites, yeah. I think you know people have probably heard a lot about sulfites and how some people are looking for wine that doesn't have sulfites, right?
Jillian Woodruff, MD (36:03)
The asulfides can trigger symptoms in susceptible individuals as well, particularly those with respiratory symptoms, like you know, people who are asthmatic. but we have to be careful with the menopause explanation here. There are a lot of claims online that fluctuating estrogen automatically causes this DAO deficiency and suddenly creates a histamine intolerance in menopause. And that relationship isn't established.
Jillian Woodruff, MD (36:28)
like strongly enough for us to prevent present it as fact. But there there is a lot of emerging research about histamine issues in perimenopause and and menopause and and also with a lot of autoimmune issues that women start to have in midlife. I don't know if you've been noticing that as well.
Dr. Ade Akindipe, DNP (36:46)
No, actually I have not been noticing that. but it it does make sense that if you are a drinker and you let's say you had red wine, for example, and you suddenly feel miserable, you should really believe your body because you know, your body really is trying to send you signals. so you don't necessarily need to diagnose yourself, but tracking your symptoms like we mentioned before. you know, there might be menopause, histamine intolerance. I do know, not in the setting of alcohol, but I do notice women.
Dr. Ade Akindipe, DNP (37:12)
Start noticing things things like itchy ears, drier skin. I know some women actually had like a dry patch. It was just, it's unilateral just on one side, and it was itchy. Somehow, you know, it just kind of disappeared. So just some interesting things that happen with all these hormonal changes and perimetopause can really look different in in different women. And maybe alcohol are just one of those things that can trigger or make things kind of go haywire in the body too. So
Dr. Ade Akindipe, DNP (37:40)
If you're having things like flushing, hives, wheezing, swelling, you know, feeling faint or even palpitations, that's also another one of those symptoms too. And it definitely needs to be evaluated.
Jillian Woodruff, MD (37:52)
Right.
Jillian Woodruff, MD (37:52)
And different types of alcohol can affect people differently. The core ingredient is the same, so the ethanol is the same, but darker drinks like whiskey or bourbon tend to have more of something that's called congeners. And those are like the flavor and color byproducts that are left over from fermenting and aging. And the more congeners the alcohol has, the rougher the hangover tends to be.
Jillian Woodruff, MD (38:18)
And so this is why maybe a night of drinking whiskey can hit you harder than a night of vodka. And even if the same amount of alcohol is there. And then wine brings something different to the table because usually that's due to that histamine. And so people can feel that flush feeling, they can feel stuffy, they can have more of a headache after they drink a glass of red wine. And then even bubbles.
Jillian Woodruff, MD (38:43)
make a difference. So if you're drinking champagne or beer or you know, a vodka with vodka with some sort of soda, right? Vodka soda or something. The carbonation helps the alcohol hit your bloodstream faster. And I say help, right? We don't actually want that for our health. Maybe some people do for some of the things they feel when they're drinking alcohol. But yes, those those little bubbles can affect
Jillian Woodruff, MD (39:10)
the way that alcohol is broken down and eliminated.
Dr. Ade Akindipe, DNP (39:13)
Yes, and can we talk about portion size for a second? Because you know, a restaurant
Jillian Woodruff, MD (39:16)
No.
Dr. Ade Akindipe, DNP (39:17)
margarita, the size of a fishbowl, is not one drink, right? That is easily
Jillian Woodruff, MD (39:21)
Yeah, that could be a problem.
Dr. Ade Akindipe, DNP (39:23)
like what two or three dressed up as one. So,
Jillian Woodruff, MD (39:26)
Yeah, yeah.
Dr. Ade Akindipe, DNP (39:28)
you know, a glass, a glass is not a serving is not a serving size. A standard drink is 12 ounces of regular beer or five ounces of wine or
Dr. Ade Akindipe, DNP (39:39)
one point five ounces of distilled spirits. And most restaurants' pores and almost all home pours are a lot bigger than that. So that's something worth noting there. So
Jillian Woodruff, MD (39:49)
Yeah, of course. At a restaurant if they give you this standard size, you're gonna be like, Why where's the rest of my wine, right?
Dr. Ade Akindipe, DNP (39:55)
Mm-hmm. Why?
Jillian Woodruff, MD (39:56)
You want like that full pour, which is really an over pour, I guess.
Dr. Ade Akindipe, DNP (39:59)
Mm-hmm.
Dr. Ade Akindipe, DNP (40:01)
It's an overpour, which is why I cannot do it. So I cannot.
Jillian Woodruff, MD (40:03)
Yeah.
Dr. Ade Akindipe, DNP (40:04)
So but we have to talk about why alcohol is such a tempting trap in perimenopause, because you know, these symptoms are real, right? The exhaustion, if you're not sleeping very well, or you know, if you're really stressed out and you really have been maybe you just turn to it as a way to wind down and try to get to sleep at night, or you're stressed from work. you know, alcohol can make you feel sleepy.
Dr. Ade Akindipe, DNP (40:27)
Right.
Jillian Woodruff, MD (40:27)
Yeah, it can, but sedation is not the same thing as restorative sleep.
Dr. Ade Akindipe, DNP (40:32)
Mm-hmm.
Jillian Woodruff, MD (40:32)
And so we do have to keep that in mind. We want to get that deep restorative sleep. There was a recent systematic review and meta-analysis where they're comparing many different studies that showed even relatively low alcohol doses can disrupt your REM sleep. And higher doses
Jillian Woodruff, MD (40:52)
of alcohol can shorten the time it takes to fall asleep, which is why people may like it, right? You fall asleep quicker, but the sleep architecture is disrupted. So overall, not good. Maybe you think it's good at the beginning, but it does not end up being good for your sleep.
Dr. Ade Akindipe, DNP (41:09)
Yeah, that's so that explains the classic, you know, hey, I was able to get to sleep, but then, you know, three o'clock in the morning, your eyes open, your brain is
Jillian Woodruff, MD (41:17)
No.
Dr. Ade Akindipe, DNP (41:18)
online, you're scrolling again and you know, why did I say that? Why wh why did I say that thing in twenty fourteen? You know, you're kinda go rewinding things in your mind. You've been through that. So that's exactly why. Yeah.
Jillian Woodruff, MD (41:27)
Yes. Yes,
Jillian Woodruff, MD (41:29)
if perimenopause already made your sleep lighter and more fragmented because of, you know, night sweats you may be experien experiencing because of your hormonal changes, then alcohol is just another disrupted layer on top.
Dr. Ade Akindipe, DNP (41:44)
Absolutely. So then you wake up exhausted, your cravings are much louder, exercise is less appealing, you know, your stress tolerance is also lower. and you're reaching for caffeine all day, and then that evening you're thinking, I just need something to take the edge off. That's a real
Jillian Woodruff, MD (42:00)
And the loop starts again.
Dr. Ade Akindipe, DNP (42:02)
yep, all over again. Okay, let's talk about this other thing called hangxiety. hangxiety.
Jillian Woodruff, MD (42:08)
Anxiety. Anxiety.
Jillian Woodruff, MD (42:12)
That's a good one.
Dr. Ade Akindipe, DNP (42:13)
I think it's
Dr. Ade Akindipe, DNP (42:13)
so underdiscussed though, because some women aren't just tired the day after drinking. They feel this dread, racing thoughts, low grade panic, and they are replaying the night, right? They feel emotionally fragile. What's up with that?
Jillian Woodruff, MD (42:29)
Yeah, well, you know, alcohol acutely changes inhibitory and excitatory signaling in our brain, right? Things that speed us up and slow us down. And so as alcohol wears off, the nervous system can rebound toward greater arousal. So being anxiety and restlessness and poor sleep and irritability, and these are all things we may already have in perimenopause and menopause.
Jillian Woodruff, MD (42:57)
So these are exacerbated after heavy drinking. And so if you're already in the stage of life when your sleep and mood are less predictable, that rebound can feel so much more intense.
Dr. Ade Akindipe, DNP (43:09)
Absolutely, which is another moment where I want women to stop moralizing their biology, right? If you consistently
Jillian Woodruff, MD (43:15)
Hmm.
Dr. Ade Akindipe, DNP (43:15)
feel anxious or low after drinking, so that's that's a signal, that's a sign information you don't need to prove you can tolerate it. And I think I was kind of guilty of this before. I was like, Well, I can I can take that drink. No, I can't.
Jillian Woodruff, MD (43:31)
Yeah.
Dr. Ade Akindipe, DNP (43:31)
I cannot. So okay.
Dr. Ade Akindipe, DNP (43:33)
what about weight? Because this is where everyone wants one villain to blame, right? It's menopause, it's cortisol, it's wine, it's carbs. But we also know midlife body composition is multifactorial, right? So menopause itself is associated with changes in fat distribution. We talked a little bit about that earlier, particularly in the midsection, that deep-seated visceral fat in the belly.
Dr. Ade Akindipe, DNP (44:01)
And associate that's as associated with lower estrogen. So aging is also associated with loss of lean muscle mass. We that we're trying to, you know, proactively, you know, stay. You want you want that muscle to stay. And alcohol alcohol can make that environment harder. So it provides calories without much fullness, right? So it can actually increase your appetite. you know, it lowers the inhibition.
Dr. Ade Akindipe, DNP (44:26)
So you'll feel more hungry, especially the next day, if you're not sleeping well too. And the food choices you actually make after two cocktails may be the food choices you plan before dinner. May not be the food choices. Yeah, exactly. Mm-hmm. Mm-hmm. It may not be. Mm-hmm.
Jillian Woodruff, MD (44:37)
May not be. Yeah. I was like, that's what you may not be. Absolutely. I right, because
Jillian Woodruff, MD (44:44)
we're thinking about alcohol. Some of the reasons you may like alcohol, it lowers inhibition. So if you're nervous
Dr. Ade Akindipe, DNP (44:51)
Mm-hmm.
Jillian Woodruff, MD (44:51)
about something, you know, if people are going to perform or something, maybe that's something that they would do to like, you know, go ask that person out. I don't know, I'll take a shot. I don't
Dr. Ade Akindipe, DNP (45:01)
Yeah.
Jillian Woodruff, MD (45:02)
know.
Jillian Woodruff, MD (45:02)
So it could, so yeah, you lower inhibition in one way, but it's gonna lower it in other ways too, where, you know, before you were able to like say, you know, I shouldn't have that or I shouldn't eat at this time, lower inhibition is lower inhibition, meaning I'm just gonna say yes to things you probably shouldn't, you know.
Dr. Ade Akindipe, DNP (45:21)
More food.
Jillian Woodruff, MD (45:22)
Yes, yes. And you know, sleep disruption also matters because poor sleep can affect appetite regulation, right?
Jillian Woodruff, MD (45:30)
It also affects your insulin sensitivity. it also, you know, poor sleep in the morning. Sometimes if people aren't sleeping well in the evenings or overnight, or they have like sleep apnea that disrupts their sleep. Oftentimes I'm seeing these women have higher fasting blood sugar levels. I'm sure you are very accustomed to seeing that. And so it's not always, hey, what did you eat?
Jillian Woodruff, MD (45:52)
It could be what did you do before you went to bed? What did you eat before you went to bed? How did you sleep overnight? Did you have that recovery sleep? If you didn't, it's going to show up in the morning. There's always a tell for that kind of thing. Yep.
Dr. Ade Akindipe, DNP (46:05)
There was definitely,
Dr. Ade Akindipe, DNP (46:06)
definitely as a tell. I mean, yeah, you definitely see those blood sugar spiking the day the day after that and your fasting blood sugars will be much higher too, especially if you're already struggling with your blood sugar. So Okay, now we're moving to two things women don't connect to alcohol.
Dr. Ade Akindipe, DNP (46:21)
If you have ever woken up and or if you've ever come to me and and I'm I'm asking you these questions and I'm like, hey, well how many times do you go to bed and I'm asking all these questions? This is probably why. So first one we're gonna talk about is bladder and I'm sure you see this a lot. Bladder, waking up in the middle the night.
Jillian Woodruff, MD (46:36)
Yes, yes. and you know, often doesn't have to do with with alcohol. but alcohol can increase urine production. You know, you're always, you know, running to the bathroom at, you know, if you're at a club or something, the bathroom lines are so long because it increases urine production and can worsen urinary urgency. So that feeling of having to get to the bathroom and having to get there quickly, like having the urge.
Jillian Woodruff, MD (47:02)
That is increased with people after they've consumed alcohol. And at the same time, perimenopause and menopausal women may be developing genitourinary changes from lower estrogen. And we call this genitourinary syndrome of menopause. So they may be developing this, having urgency, having frequency. If you have low estrogen, your bladder is usually irritable like other parts of you.
Jillian Woodruff, MD (47:26)
But it's irritable, so it's spasms, and then you have this feeling like you have to pee. And so it's not, and we we think, is that a urinary tract infection? Not necessarily, although you can have you could have that, but usually it's just the squeezing and the irritability of your bladder. so these things are exacerbated with alcohol, recurrent urinary symptoms, dryness, discomfort, some all of those things happen with alcohol.
Dr. Ade Akindipe, DNP (47:51)
So the woman saying, Why am I suddenly peeing constantly after two glasses of wine may have more than one thing actually stacking together and working against her. Mm-hmm.
Jillian Woodruff, MD (48:00)
Exactly. Yeah. Second medications. We kind of talked about this, but midlife is often the decade when your medication list gets longer. And so you may be on sleep medications thinking, if I just, you know, take this medicine to help me, I can sleep better, which we should probably talk about that some more, about the different sleep medications, what they actually do. or you may be on antibod antidepressants. many people are on blood pressure medications.
Jillian Woodruff, MD (48:26)
Maybe on pain medications, anxiety, diabetes, the list goes on and on. And so alcohol can interfere and interact with mini medications.
Dr. Ade Akindipe, DNP (48:35)
Absolutely. So if your tolerance changed right after you started a new medication, that's something worth noting. And you don't wanna just assume your hormones are the only explanation.
Jillian Woodruff, MD (48:44)
Yeah. So you may want to talk to your pharmacist, your prescriber, especially if you're taking sedating medications, you know, combining them with alcohol can be quite dangerous.
Dr. Ade Akindipe, DNP (48:55)
Absolutely. okay, let's talk about gut health now. I love talking about gut health,
Jillian Woodruff, MD (49:00)
Yeah.
Dr. Ade Akindipe, DNP (49:00)
but the internet loves gut health maybe a little too much. I find a lot of things on the internet about gut health. Some of it are true, not so much true. So let's let's explore that a little
Jillian Woodruff, MD (49:09)
Yeah.
Dr. Ade Akindipe, DNP (49:10)
bit.
Jillian Woodruff, MD (49:10)
Well everything is apparently the microbiome now.
Dr. Ade Akindipe, DNP (49:12)
If you have a bad mood, it's a microbiome bloating. Microbiome well, your Wi Fi went out. So this is also an emerging area of
Jillian Woodruff, MD (49:18)
Microbiome.
Dr. Ade Akindipe, DNP (49:21)
research too. So there's a lot of information out there. we're learning more about the relationship between estrogen and the gut. I actually have been reading a lot about this, the gut microbiome inflammation, alcohol, but we don't have all the answers yet.
Jillian Woodruff, MD (49:36)
Yeah, we have good evidence that repeated or heavier alcohol exposure can disrupt that gut barrier, right? And affect the microbiome.
Dr. Ade Akindipe, DNP (49:44)
Mm-hmm.
Jillian Woodruff, MD (49:46)
And what I think is still emerging is exactly how the menopause transition changes that microbiome. I I feel pretty clear in you know how estrogen fits into that and the lowering estrogen changes your microbiome. I mean, it does in the vagina, your microbiome definitely.
Jillian Woodruff, MD (50:03)
changes with lower estrogen and your even your your odor, your vaginal odor and your body odor changes with lower estrogen. And I believe that's due to the microbiome.
Dr. Ade Akindipe, DNP (50:16)
Yeah.
Dr. Ade Akindipe, DNP (50:17)
And you know, we don't need to do all of this gut testing and you don't need a lot of I mean, you could certainly do that, but if you do notice alcohol causing reflux bloating, you know, some still changes,
Jillian Woodruff, MD (50:28)
Hmm.
Dr. Ade Akindipe, DNP (50:31)
or you just feel like just awful, then this is something that really matters and maybe this is time to kind of look at that connection between alcohol and your symptoms and and do something about that.
Jillian Woodruff, MD (50:40)
Definitely persistent GI symptoms. So blood in the stool, changes in your stool,
Dr. Ade Akindipe, DNP (50:45)
Mm-hmm.
Jillian Woodruff, MD (50:46)
unexplained weight loss, abdominal pain. You know, these things shouldn't be dismissed or just said this is menopause or or this is leaky gut. You right? We talk about leaky gut a lot, and we can't assume that everything is is leaky gut. We need to get evaluated. But I certainly think that, you know, alcohol, and I think it would depend.
Jillian Woodruff, MD (51:06)
And would you agree that the amount of, you know, alcohol you drink will affect your your microbiome and then that microbiome can lead to some of these changes.
Dr. Ade Akindipe, DNP (51:17)
Sure. For I mean, definitely. I mean, we just talked about how alcohol can be a toxin, right? The ethanol in there. So if it's messing up with the if it's causing inflammatory response in the gut, it'll definitely change what's growing in the gut. So all the, you know, bacteria, the good ones that's supposed to kind of keep your your gut healthy, it may actually cause overgrowth of other things that should not be
Dr. Ade Akindipe, DNP (51:41)
overgrowing there. Maybe they live there normally, but now they're taking over. So it causes a lot of issues. So but for basic gut support, we come back to things that are not as sexy but remarkably effective things like fiber. I have to have my fiber every day, every single day. So fiber if you're not taking it getting it in your food, a scoop of a really good source fiber is always great. A diverse range of plants
Dr. Ade Akindipe, DNP (52:09)
Foods, if you've got healthy, wonderfully fresh plant food, you are lucky. Eat them. Adequate protein,
Jillian Woodruff, MD (52:15)
Yes.
Dr. Ade Akindipe, DNP (52:16)
hydration, movement. Movement definitely helps gut health, sleep, fermented foods. If you can tolerate them, absolutely. And then less exposure to things that clearly irritate your system. Like if alcohol is doing that, that's something you need to eliminate. So.
Jillian Woodruff, MD (52:30)
Yeah, that's true. Yeah, that's that's very true.
Dr. Ade Akindipe, DNP (52:33)
Yeah. All right. Now we're getting down to rapid fire myth busting. Myth number one. If I can hold my liquor, alcohol isn't affecting me as much. Not have to worry about it.
Jillian Woodruff, MD (52:46)
False, false, false.
Jillian Woodruff, MD (52:48)
Tolerance describes how intoxicated you feel at a given exposure. It does not mean your liver, your blood pressure, your heart, your brain, or your cancer risk is somehow protected. Myth number two for you. Wine is healthier than liquor because it's natural.
Dr. Ade Akindipe, DNP (53:08)
Yeah, your liver does not care which
Dr. Ade Akindipe, DNP (53:10)
one does not care about the you know the charcuterie board. Ethanol is ethanol. Alcohol is alcohol. I think that one's pretty clear.
Jillian Woodruff, MD (53:16)
Mm-hmm. Yes.
Dr. Ade Akindipe, DNP (53:19)
myth number three. This one's for you. alcohol helps my insomnia because it knocks me out.
Jillian Woodruff, MD (53:24)
Falling asleep faster is not the same as sleeping better. Alcohol can disrupt your rim sleep and fragment your night. Okay,
Dr. Ade Akindipe, DNP (53:34)
Mm. Definitely true.
Jillian Woodruff, MD (53:35)
myth number four. If I start hormone therapy, I'll be able to drink like I did at 30 again.
Dr. Ade Akindipe, DNP (53:41)
No, hormone therapy is not a hangover antidote. It just just doesn't work that way. It just doesn't.
Jillian Woodruff, MD (53:49)
Nope.
Dr. Ade Akindipe, DNP (53:50)
myth number five. If hormone therapy isn't right for me, I just have to live with hot flashes. Oof.
Jillian Woodruff, MD (53:56)
Absolutely false. And this one matters. Yeah, absolutely false. Nope, nope, nope. There are other things
Dr. Ade Akindipe, DNP (54:00)
No, absolutely not.
Jillian Woodruff, MD (54:02)
that you can do. And you know, I don't know if we've done a program talking about non-hormonal treatments for hot flashes. It may be the time. Well, not right this moment, but it may be the time. Yes.
Dr. Ade Akindipe, DNP (54:11)
I don't think we've we've gone deep dive yet. I don't think so. It just might be. This is gonna be over two hours if we can
Dr. Ade Akindipe, DNP (54:20)
if we delve into that.
Jillian Woodruff, MD (54:22)
Let
Jillian Woodruff, MD (54:22)
us know if that's something you want to hear about in the future
Dr. Ade Akindipe, DNP (54:24)
Mm.
Jillian Woodruff, MD (54:25)
so that we can bring that to you.
Dr. Ade Akindipe, DNP (54:27)
Yes, absolutely. All right. We want to give everybody something practical. Okay. And we're not gonna have you detox or do a cleanse or punish you. But
Jillian Woodruff, MD (54:36)
Yeah.
Dr. Ade Akindipe, DNP (54:36)
for 14 days, try this experiment two weeks for two weeks. Try to eliminate alcohol or reduce it enough that you can actually compare how you feel. And I really mean this because I actually had a client that was working on trying to, you know, fix a lot of other things, but
Dr. Ade Akindipe, DNP (54:54)
This one was specifically really hard for her because she just was used to alcohol around her. And that's one of the first things she actually mentioned was just feeling better. That can be her energy levels, especially certain times of the day in the morning. So, you know, track how you feel, track your sleep, your hot flashes and night sweats. you know, again, like how you feel in the morning, mood, your anxiety.
Dr. Ade Akindipe, DNP (55:16)
And your appetite, like like we talked about before, this is something that can really stimulate your, you know, your consumption of food too.
Jillian Woodruff, MD (55:24)
Yeah, and you may decide to drink again. So if you do, then you want to notice what happens. So, you know, not really emotionally, but physiologically. So did you sleep differently when you started drinking again? Did you feel like your heart racing, those palpitations? Did you wake up hot? Did you wake up a lot? did you feel anxious the next day? How did your appetite change? So, like a lot of things to track, you know? So this actually
Jillian Woodruff, MD (55:51)
This is actually what I like about the attempt that one of us made to quit alcohol completely. It lasted a month.
Dr. Ade Akindipe, DNP (55:59)
We weren't
Dr. Ade Akindipe, DNP (55:59)
gonna give it away, but it looks like you probably did. Well
Jillian Woodruff, MD (56:02)
Because
Jillian Woodruff, MD (56:04)
I wanted to cheat. I wanted to say what happened. Well, you know, yes. The long term result, I think, is just that alcohol became extremely occasional because I just didn't feel good. It's kind of the same thing that happened with steak. It's like you drink steak, it's not broken down in the same way for me. And so I just don't feel good, you know, that night. My body, I feel like, has to work harder to break it down, to break down.
Jillian Woodruff, MD (56:28)
Beef. And so
Dr. Ade Akindipe, DNP (56:29)
Mm.
Jillian Woodruff, MD (56:29)
probably the same thing with alcohol. It was working harder.
Dr. Ade Akindipe, DNP (56:31)
Yeah.
Jillian Woodruff, MD (56:32)
And so I just didn't like that feeling. And so it's not as fun if you're like, you know, why am I going to have this drink and I'm going to feel awful later? You
Dr. Ade Akindipe, DNP (56:39)
Yeah.
Jillian Woodruff, MD (56:40)
know, so that's kind of where that came from. So it would be interesting just to compare how do you cause you may not notice any change when you go off of it. But then when you go back on, you notice. And I see the same thing with people who are on hormone therapy and then they take a break for for whatever reason.
Jillian Woodruff, MD (56:56)
And a lot of people will come back and say, you know, I didn't know that I was feeling good until I stopped and I was no longer feeling that way. So it
Dr. Ade Akindipe, DNP (57:03)
Until it stopped. Yeah.
Jillian Woodruff, MD (57:06)
could be the same thing. Yeah. We just get used to feeling the way we feel. Mm-hmm.
Dr. Ade Akindipe, DNP (57:08)
Exactly. So you don't have to, yeah.
Dr. Ade Akindipe, DNP (57:13)
Absolutely. You don't have to create an identity around it. You just are figuring out really what works for your body now. and you if you do drink, don't drink on an empty stomach. know what a standard drink actually looks like, slow down, hydrate, alternate with water or a zero-proof option.
Dr. Ade Akindipe, DNP (57:32)
and maybe that's something I started doing now too is doing the mocktails. And I've I mean not that I was really a big drinker to begin with, but if I'm out socializing and I just kinda want that taste of just something that's very similar, mocktails are great. And maybe stopping drinking earlier in the evening instead of having an alcohol right before bed too might be a a a good solution.
Jillian Woodruff, MD (57:51)
Yeah, I think that is exactly right. You mentioned the social situation. So you just want to know why am I drinking it? It is, is it because you love the wine? Great. Is it because you're socializing? You know, that's fine too.
Dr. Ade Akindipe, DNP (58:05)
Yeah.
Jillian Woodruff, MD (58:06)
because you can't fall asleep without it, maybe that deserves another conversation. are you using it to manage anxiety? That may need another, a different conversation, right? so.
Jillian Woodruff, MD (58:17)
figuring out why you're doing it and then if that reason, if you're doing it for a reason that actually is not going to be helping you, right?
Dr. Ade Akindipe, DNP (58:26)
Absolutely. so here's a listener question. If I stop drinking, will my hot flashes disappear?
Jillian Woodruff, MD (58:32)
You know, they might improve if alcohol is one of your triggers, but hot flashes
Dr. Ade Akindipe, DNP (58:36)
Mm-hmm.
Jillian Woodruff, MD (58:37)
are fundamentally driven by menopause related changes in thermoregulation. So in those estrogen receptors in your brain. So if you're having frequent and disruptive vasomotor symptoms, you deserve actual treatment, not simply a list of things you're forbidden to consume.
Jillian Woodruff, MD (58:55)
So can we retire the version of menopause care that is basically no coffee, no wine, no spicy food, wear layers and good luck?
Dr. Ade Akindipe, DNP (59:02)
Absolutely. Please. Please. All
Jillian Woodruff, MD (59:04)
Yeah.
Dr. Ade Akindipe, DNP (59:07)
right. midlife is really asking us to renegotiate a lot of things that we just like
Jillian Woodruff, MD (59:11)
Mm.
Dr. Ade Akindipe, DNP (59:12)
we just talked about, right? Sleep, how we train, how we eat, how we recover, stress, and sometimes how we drink.
Jillian Woodruff, MD (59:19)
Yeah. Well losing your bounce back, it's not a character flaw. It's not necessarily one single hormone or one enzyme. It's your body giving you new information during a very real physiologic transition.
Dr. Ade Akindipe, DNP (59:34)
Yeah, your old rules may simply not apply anymore and that can actually be freeing. So you don't have to keep proving that you can still do what you did at twenty-eight.
Jillian Woodruff, MD (59:43)
Yeah, you can decide that sleeping well feels better. There's nothing wrong with that. And that not having a hot flash at two in the morning feels better. And that you prefer to wake up clear headed. Well, you hope so. You hope to wake up clear headed. And you know, maybe one glass every once in a while is enough. And or and and you can decide that you still want to enjoy a drink sometimes and you're going to do it. That's fine.
Dr. Ade Akindipe, DNP (01:00:06)
Yeah, yeah.
Dr. Ade Akindipe, DNP (01:00:07)
Yeah, that girls trip to Hawaii really taught us a lot. You know, it's like, yeah, we weren't partying like we were twenty-eight. You know, you can still have a girls' trip and the wildest thing we do is stay up reading past our bedtime, and that's fine too.
Jillian Woodruff, MD (01:00:19)
Yeah. Did I say I partied at
Jillian Woodruff, MD (01:00:21)
twenty eight? How do you know? I don't know.
Dr. Ade Akindipe, DNP (01:00:23)
I don't know. Well we'll leave that for another time. You
Dr. Ade Akindipe, DNP (01:00:27)
know what? It was fantastic. We had so much fun.
Jillian Woodruff, MD (01:00:29)
Ten out of ten.
Dr. Ade Akindipe, DNP (01:00:30)
Yep. So our challenge this week is simple. Pay attention. Does alcohol make your sleep worse? Your hot flashes louder? Your stomach unhappier? Your bladder more irritated? Your cravings stronger. Is your anxiety worse the next morning?
Dr. Ade Akindipe, DNP (01:00:47)
If those answers say yes, then experiment with less, not because you failed at drinking, but because you learned something about yourself.
Jillian Woodruff, MD (01:00:55)
Yes, and if hot flashes or night sweats are driving you toward that evening glass of wine, remember you have options. Hormone therapy is highly effective for many women. And
Dr. Ade Akindipe, DNP (01:01:06)
Uh-huh.
Jillian Woodruff, MD (01:01:06)
if hormone therapy is not appropriate or not desired, there are multiple evidence-based non-hormonal treatments. So you don't have to white knuckle your way through menopause and you don't have to grab alcohol to treat it. Because it's not really treating it.
Dr. Ade Akindipe, DNP (01:01:21)
No, it's not. Yes. maybe the most midlife thing we can say right now is that you don't have to keep doing just doing something just because it used to work for you.
Jillian Woodruff, MD (01:01:31)
Yes, your body changed, so update the plan.
Dr. Ade Akindipe, DNP (01:01:34)
That's right. Because thriving at forty and beyond sometimes looks a lot less like bouncing back.
Jillian Woodruff, MD (01:01:39)
my gosh, yes. And a lot more like
Dr. Ade Akindipe, DNP (01:01:40)
Ha ha.
Jillian Woodruff, MD (01:01:41)
finally knowing what you don't need to recover from.
Dr. Ade Akindipe, DNP (01:01:45)
And that's your power move.
Jillian Woodruff, MD (01:01:46)
Yes. Okay, I think that's all we have for today. And thank you so much for listening to us on the Modern Midlife Collective. And please share with us what you want us to cover next and review us. Please go to www.modernmidlife collective dot com or email us. The email address is connect at modern midlife collective dot com. And we'd love to hear from you.
Jillian Woodruff, MD (01:02:14)
Thank you for
Dr. Ade Akindipe, DNP (01:02:14)
Bye.
Jillian Woodruff, MD (01:02:14)
listening. Bye.