Barry Rotman, MD

Normal Oxygen Saturation by Age: Measuring and Monitoring

We all want to know we’re healthy and aging well. But what does oxygen saturation tell us about our health? What is oxygen saturation? Is there a normal oxygen saturation by age? Is it a good metric to track and gauge our health against?

Pulse oximetry is a tool worth understanding, and it’s essential to only use it in conjunction with qualified healthcare.

What Is Oxygen Saturation?

Our metabolism uses oxygen, which makes up 21% of our air, to produce energy. Oxygen saturation is the percentage of oxygen bound to the hemoglobin (a protein in red blood cells) in our blood.

However, the process is complicated.

Imagine a city (the body) where various construction sites (tissues) need lumber (oxygen) to function. Trucks (hemoglobin) go to the lumberyard (lungs) to pick up their cargo. They follow this system:

1. Trucks (hemoglobin) arrive at the lumberyard (lungs) empty.
2. Workers (alveoli: tiny air sacs in the lungs) load lumber (oxygen) onto the trucks.
3. Each truck can carry four pieces of lumber (each hemoglobin binds four oxygen molecules).
4. Fully loaded trucks leave the lumberyard (lungs) and enter the highway system (bloodstream).
5. The highway has a central hub (the heart) directing traffic to different parts of the city (body).
6. Trucks (hemoglobin) travel along various roads (blood vessels) to reach construction sites (tissues).
7. The trucks (hemoglobin) turn bright red when loaded with lumber (oxygen).
8. At each site, workers unload (release) the needed lumber (oxygen) for use (absorption into cells).
9. Empty trucks return to the lumberyard (lungs) to pick up more cargo (hemoglobin returns to the lungs).
10. When empty or carrying less lumber (oxygen), the trucks (hemoglobin) appear darker, with a bluish tint.

This cycle continues, ensuring a constant lumber (oxygen) supply to all construction sites (tissues) in the city (body).

How to Measure Oxygen Saturation

We measure oxygen saturation in two ways: blood testing and pulse oximetry. While drawing arterial blood for lab tests is accurate, it’s painful and inconvenient.

Pulse oximetry is non-invasive. It measures the color change of the hemoglobin to determine oxygen saturation. Blood with ample oxygen is reddish, while blood with depleted oxygen is more purple. Additionally, it measures your pulse rate — the quantity of hemoglobin that moves through your skin every time your heart contracts.

How Accurate Are Pulse Oximeters?

Source: Mockup Graphics via Unsplash

Pulse oximeters come in medical and over-the-counter (OTC) grades.

We don’t know the accuracy of OTC-grade devices because they aren’t FDA-approved. FDA medical-grade pulse oximeters are more accurate (±2–4% for oxygen saturation in the 90–100% saturation range). However, these devices become less accurate when oxygen saturation falls below 90%.

In addition to the inherent error source from the devices themselves, common use errors include:

• Too much ambient light
• Inadequate wait time between measurements
• Insufficient perfusion
• A cold finger or poor finger placement
• Nail polish on the measured finger

A pulse oximeter’s ability to detect the color of hemoglobin can be influenced by skin color. Darker skin containing more melanin absorbs more light and can produce falsely high readings.

An example occurred during the pandemic when many relied on pulse oximeters to triage medical emergencies. Tragically, people with darker skin were less likely to have their low oxygen levels show up on pulse oximeters.

As a result, during the height of the pandemic, this demographic probably suffered during triage decisions in the Emergency Department, being sent home when their true oxygen levels were lower than displayed on a pulse oximeter. This was an inexcusable ethical lapse by the medical community.

Use Cases for Pulse Oximeters

The best use case for this device isn’t a single measurement, but looking at an individual’s changes over time.

During the pandemic, we gave anyone who tested positive for COVID an OTC pulse oximeter and instructed them to monitor their oxygen saturation. Rather than looking for “normal oxygen saturation by age,” we looked for change in individuals.

For example, if a person’s pulse oxygenation looked like this: 94, 94, 94, 89 — we knew we had a problem.

Now, we recommend these devices for a very narrow set of conditions. When a member has a lung infection or lung impairment, such as an emphysema flare, pneumonia, or severe COVID, we use a pulse oximeter to monitor the illness over time, trying to detect a worsening.

Is There a Normal Oxygen Saturation by Age?

Technically, yes, there are age-related changes to oxygen saturation. Children, young adults, and middle-aged people usually have between 97% and 100% oxygen saturation. Once a person reaches 70 or older, their number will be closer to 93–97%.

However, as mentioned, even the higher-quality FDA-approved pulse oximeters are only accurate to ±2–4%. Any difference due to aging is less than the device’s accuracy. So, you can’t accurately measure change due to aging by measuring a single person.

Today’s Takeaways

Pulse oximeters are an important technology, but they’re only helpful for monitoring individual changes over time.

They’re prone to inaccuracy and are often used incorrectly. The device can create more anxiety than it alleviates. It’s not a valuable instrument at home, independent of consulting a doctor.

If you’re concerned about your oxygen saturation compared to the normal oxygen saturation by age, visit your healthcare physician and use a pulse oximeter in conjunction with their advice.

by Barry Rotman, MD

How Long Does Melatonin Stay in Your System?

Can’t sleep? Do you finally get to sleep but can’t stay asleep? You’re not alone.

Millions of people experience sleep disruption, insomnia, or some form of sleep disorder. They take sleeping pills and supplements in the hopes of solving their sleepless nights, only to find themselves more exhausted.

What about melatonin? It’s all natural, right? It must be better than Benadryl! But how much should you take? And how long does melatonin stay in your system?

These are important questions to ask before taking any medication or supplement, and we’ve got the answers.

What Is Melatonin?

First discovered in 1958, melatonin is a hormone manufactured by a part of the brain called the pineal gland. Here’s how the process works:

1. We have special non-image receptors in the back of our retinas that perceive light and darkness.
2. As these receptors detect darkness, they send a signal to the brain region called the suprachiasmatic nucleus.
3. The suprachiasmatic nucleus triggers the pineal gland to secrete melatonin.

Melatonin is the “hormone of darkness.” It helps to synchronize our circadian rhythm (i.e., internal clock) with the light and darkness of the world around us.

Melatonin as a Supplement

Since melatonin is a crucial hormone for normal biological function, its use as a supplement has become popular in recent years for various reasons.

The global market value for melatonin supplements in 2022 was $2.15 billion, projected to increase to $8.64 billion by 2032.

The literature on the efficacy of melatonin supplements varies. Some studies show benefits, and others show none. The key component to consider is the root cause of insomnia.

For example, melatonin can be helpful for people with delayed sleep phase disorder (aka “night owls”) because it’s a circadian rhythm issue — tied to when your body makes melatonin.

If we think of your sleep as a house, we want to investigate the reasons for the cracks in the walls rather than simply painting over them.

Most prescription medications are like paint: They cover the cracks but don’t repair them. We want to find and fix the root cause of the damage.

Causes for insomnia can include medication side effects, unresolved pain, associated mental health challenges (e.g., anxiety, depression, PTSD), substances (e.g., nicotine, alcohol, caffeine), and more. A sleeping pill doesn’t address any of these.

Who Might Melatonin Be Helpful For?

Since it’s a natural hormone, melatonin naturally affects our circadian rhythm, helping to correct circadian rhythm disorders.

Here are some examples of people for whom melatonin can be helpful:

• Night owls can use melatonin to adjust their sleep habits and improve insomnia.
  • There is both individual and age-related variability among night owls. Teenagers are naturally night owls due to hormonal changes during that life stage.
• People experiencing jet lag can use melatonin to recover faster.
• Studies have shown that melatonin can improve sleep disorders associated with Parkinson’s and Alzheimer’s. Both have reduced melatonin production as a part of the disease.

What if You’re Not in One of Those Categories?

The literature supporting the use of melatonin supplements is slim. However, it’s a remarkably safe compound — much safer than prescription (e.g., Ambien or Lunesta) or OTC sleeping aids (e.g., Benadryl, aka diphenhydramine).

When we look at the risk vs. benefit ratio, the benefits far outweigh the risks. That said, there are some potential side effects to be aware of. These include:

• Daytime sleepiness
• Change of mood
• GI disturbance
• Nightmares
• Headache
• Dizziness
• Nausea

Remember that the FDA doesn’t regulate supplements. So, if you want to try melatonin as a supplement, be aware and informed.

A study from 2017 found that the content of melatonin measured in the products varied dramatically (between -83% to +478%) from the amount listed on the package labels.

How Long Does Melatonin Stay in Your System?

Like many medical questions, the answer to “How long does melatonin stay in your system?” is “It depends.”

According to one small study, melatonin remained in the subjects’ systems for an average of five hours. However, at higher doses (>50pg/ml), it took as many as 10 hours to leave the bloodstream completely. At 10 hours, the dose may extend into post-awakening hours and affect other activities.

However, as we mentioned, there are very few studies on melatonin, and this study, although controlled and randomized, had only 56 participants. We need more larger studies to learn definitive answers about melatonin and its effects and applications.

Melatonin Use Cases and Recommendations

Currently, the most common use cases for melatonin supplements are:

Delayed Phase Sleep Disorder

People with insomnia have a difficult time falling asleep. For them, we suggest an extended-release supplement four hours prior to the desired bedtime.

This mirrors the physiology of our endogenous hormone, melatonin, inducing sleep. It builds slowly over time and signals a natural bedtime.

Additionally, we recommend blue light-blocking glasses. This is because blue light signals our body to suppress melatonin. Tip: Blue light-blocking glasses must be amber-colored. If the lenses are clear, they aren’t strong enough to block all blue light.

We suggest wearing the glasses two hours before bedtime and not removing them until you close your eyes. People in this group include:

• Teens
• Night owls
• People with anxiety
• People with fibromyalgia

Preterminal Insomnia

These people wake up in the middle of the night and have trouble staying asleep. The best way to use melatonin to treat this form of insomnia is to absorb it as quickly as possible.

I recommend low-dose, 1mg lozenges — break one in half or quarters. You really only need a small fraction of the 1mg.

Keep the broken lozenges at your bedside so you can stay in darkness and relax until it kicks in. It may take up to 20 minutes, but the benefit is that it won’t cause daytime sedation. The people most often affected by preterminal insomnia are:

• People with anxiety
• People with jetlag

Melatonin Supplement Recommendations

For most people, less is more. We suggest a dose of between 600 micrograms (mcgs) and one milligram (mg) for most people taking a melatonin supplement. Patients with Parkinson’s or Alzheimer’s may benefit from a higher dosage, 5–10 mgs, to compensate for their bodies impaired ability to make melatonin.

We recommend these two brands* of melatonin supplements:

• Short-acting: Source Naturals Sleep Science® Melatonin
• Time-release: Life Extension Melatonin Six Hour Time Released Vegetarian, 300 MCG

*Not affiliated or sponsored

Since the literature on this topic comes up short, I base these recommendations on my decades of personal and professional experience.

Today’s Takeaways

• Before taking any sleep supplement or medication, determine the root cause of your sleep disorder.
• If you need a supplement to help with sleep, melatonin is safer than many alternatives.
• If you use melatonin, decide whether you need a fast-acting or slow-release formula. This depends on your use case.
• How long does melatonin stay in your system? It depends. The average is around five hours, but it can be up to 10, so tread carefully and remember that less is more.

If you have questions about melatonin or sleep medicine, reach out anytime. We’re here to help!

by Barry Rotman, MD

How Long Does It Take to See Weight Loss?

We’ve used scales to measure mass for thousands of years, but humans aren’t composed of homogeneous densities like gold or wheat. We have various components, including three that comprise most of our mass: fluids, fat, and muscle.

Today, our technology, including DEXA and bioelectrical impedance analysis (InBody), can break down a person’s weight into those three components.

Despite the advances in weight measurement technology, we still face the question, “How long does it take to see weight loss?” As with so many other questions in healthcare, the answer is, “It depends.”

Level 1: Fluid Loss

The largest percentage of our body mass — 50% to 60% — is water containing minerals and electrolytes.

Sodium is the mineral we have in the greatest quantity. Our bodies closely regulate sodium concentration, as our cells can only survive slight variations.

The recommended daily amount of ingested sodium chloride is less than 2,300 milligrams (mg). However, the average American diet contains over 3,400 mg of sodium chloride daily. That’s 70% more sodium than is helpful for the human body.

How does this happen?

Processed foods contain a lot of added sodium, whether in a can, a box, frozen, or otherwise prepared. Foods processed in any way have too much salt.

Your body will always seek equilibrium — a balance between excess salt and water to flush it out. Increased sodium intake leads to increased excretion by the kidneys, assuming your body is healthy. There are disease states, such as heart and kidney diseases, that prevent the body from excreting excess salt, leading to progressive swelling and edema.

In these cases, the body can’t maintain equilibrium, and water and salt continue to increase in volume within the body, which leads to an increased risk of poor health outcomes.

Let’s return to the question, “How long does it take to see weight loss?” This first level pertains to rapid weight loss, usually during the first week of a diet. Here’s why.

During the first few days of a diet, you probably fast and eat less, or at least eat less processed food (less salt). Your body has an easier time finding equilibrium and purging excess fluid. So, the first few days, when you lose a couple of pounds (lbs) a day, that weight loss results from losing fluid — not losing fat.

Level 2: Fat Loss

After the initial fluid loss during the first week or so, your body shifts into a different type of weight loss.

Here’s where we’ll use some math to explain the time frame for how fat loss works and how it doesn’t. Don’t worry; it’s not as much about counting calories as you think.

We’ll say a pound of fat represents about 3,500 kilocalories of energy. To lose a pound of fat, you’ll need to burn an additional 3,500 calories daily, consume 3,500 fewer calories daily, or some combination. This is why the weight loss you experience in the first week isn’t fat loss.

For example, to lose two pounds of fat (spend 7,000 calories) in one day, you’d have to not only walk for 14 hours straight (spend 500 calories per hour) but also not eat anything at all. The math doesn’t add up. Thus, those two pounds had to be fluid loss.

Here’s an example of how to lose fat sustainably:

Sustainable Fat Loss

Gradual weight loss is much more reasonable and healthier. Think 0.5–2 pounds per week. It may not seem like enough, but it can add up over time (e.g., a year).

The caloric deficit translates to between 1,750 and 7,000 calories per week or 250 to 1,000 calories daily. For example, can you give up a couple of cookies every day or walk a bit longer?

Those small changes mean big results over 52 weeks! Consuming two hundred fewer calories daily and burning 300 calories daily by walking creates a 3,500-calorie deficit per week multiplied by 52 weeks, which equals 52 pounds! You can lose this by making those two small changes in your daily routine.

How to Lose It Faster

But we want results now, right? Well, here are the problems with weight loss:

• We can’t control where our weight loss happens in our bodies. Unfortunately, we can’t point to our stubborn belly fat and impose our will upon it to disappear first.
• We can’t control the fat loss ratio. Muscles metabolize just as easily as fat, but it’s not healthy for us to lose muscle mass, so we must be careful about how we lose weight.

(Undesirable) Level 3: Muscle Loss

Muscles help determine our basal metabolic rate, which is how many calories we burn daily by simply being alive — heart beating, lungs breathing, blood circulating, etc. They also help us maintain a caloric balance.

When we lose weight, we lower our basal metabolic rate by losing muscle mass. However, this makes it harder to continue making weight loss progress.

If you lose enough muscle, your endocrine system thinks you’re starving. It puts your body into survival mode, making it harder for you to lose weight.

We want to avoid reducing our basal metabolic rate because 90% of our glucose is distributed in muscle. Maintaining muscle mass is essential for good glucose homeostasis and reducing insulin resistance.

For these reasons, when we guide someone through a diet, we focus on what’s happening to their muscle mass. 

As we age, our hormones, lifestyles, and protein intake make it more challenging to maintain muscle mass. Normal muscle mass loss carries the risk of sarcopenia.

To age successfully, reduce your risk of falling, and maintain optimal insulin resistance, preserve good muscle mass.

The New Era of Rapid Weight Loss and Beyond: Our Approach

If you spend down your muscle mass through dieting, it makes it that much harder to regain it as you age. In traditional calorie-restricted diets, people tend to lose 75% of that mass as fat and 25% as muscle.

With new technology such as GLP-1 medications (e.g., Wegovy, Ozempic, Mounjaro), people often lose weight more rapidly than 0.5 to 2 pounds per week. We’re also seeing a change in the distribution of weight loss. It’s not uncommon for people on GLP-1s to lose 60% fat and 40% muscle mass, which is potentially dangerous.

Firstly, we measure your weight every time we see you — not just annually. If you’re taking a GLP-1 medication, we must closely monitor your fat, fluid, and muscle mass.

Also, in conjunction with our patients’ calorie restriction, we ask them to eat more protein. It can be challenging because we ask them to eat less overall but add more protein to their restricted diet, but it’s essential.

When necessary, we also have our patients work with nutritionists. We’re laser-focused on this.

Food is our fuel. Calories don’t just make you fat. They allow you to move. You need enough fuel to stimulate movement to maintain muscle mass.

Along with nutrition specialists, we refer patients to fitness instructors to help with strength training and customized programs to preserve muscle mass. Exercise is a must for a long, quality healthspan.

Today’s Takeaways: How Long Does It Take to See Weight Loss?

Understanding our bodies’ three main components (fluids, fat, and muscle):

• Helps us appreciate the risks and benefits of losing weight at different tempos.
• Explains why people lose weight rapidly through fluid loss as they reduce their sodium intake.
• Provides insights into how fat loss differs and is best maintained with a more gradual approach.
• Demonstrates how crucial muscle mass is to our overall health and how easy it is to lose if we’re not careful during our weight loss journeys.

Focus on protein intake, strength training, and healthy weight loss monitoring to answer “how long does it take to see weight loss” for yourself. And if you need a helping hand, we’re a phone call away.

by Barry Rotman, MD

Rise and Shine: How to Wake Yourself Up

My patients often tell me, “I’m having trouble waking up in the morning.” They want help feeling less fatigued and more energized.

As adults, we’ve experienced tens of thousands of sleep-wake cycles, yet we haven’t mastered it. If you’ve read anything I’ve written, you know sleep hygiene is a passion of mine. It’s vital to our health, and far too few of us enjoy enough good nights of sleep. I want to change that.

Today, I’m discussing how to wake yourself up without lingering fatigue. 

The Two Determinants of the Sleep-Wake Cycle

Two concepts work together to create our sleep-wake cycle: sleep homeostasis and circadian rhythm.

Sleep Homeostasis

Analogous to sand falling through an hourglass, the sand is the chemical adenosine. From the moment we wake up, adenosine begins to pile up. The more adenosine we have, the more it suppresses our body’s ability to remain awake.

Fun fact: Caffeine blocks adenosine receptors in the brain. This means caffeine masks the signal of fatigue from our brain that the adenosine triggers. The hourglass is still filling up — our brain just can’t “see” it until the caffeine wears off.

Circadian Rhythm

I’ve written quite a bit about the circadian rhythm.

It’s controlled by our suprachiasmatic nucleus, our internal, intrinsic, 24-hour biochemical clock that synchronizes with the outside world. Neurons connect our retinas to the suprachiasmatic nucleus, and our hormones tell us to be awake during the day and asleep at night.

For example, when the sun sets, less light reaches the eye. This reduction in light causes the suprachiasmatic nucleus to signal more melatonin, which creates sleepiness and causes the body to fall asleep.

Conversely, even through closed eyelids at sunrise, we perceive more light, suppressing melatonin and reversing hormonal changes, such as increasing cortisol and body temperature. That’s how we wake up.

These systems work in tandem.

How to Wake Yourself Up Better

Now that you understand how you fall asleep and wake up, it’s time to learn how to wake yourself up better to feel refreshed.

You must adhere to your natural sleep cycle. But how can you do that, especially in today’s busy world?

Get Enough Sleep

Returning to our hourglass analogy, start with an empty hourglass. Your hourglass fills itself with fatigue throughout the day and empties itself each night, so ensure that you empty that hourglass completely every night. Do that by getting enough sleep to reset your homeostasis.

Studies show that the average adult needs between seven and nine hours of sleep per night. Children and teens need more sleep than adults in order to remain healthy.

Follow Your Circadian Rhythm

Synchronize your circadian rhythm and hormones rather than fight against them. There are two chronotypes:

• Night owls: People whose circadian rhythm is longer than 24 hours and whose energy peaks later in the day.
• Morning sparrows: People whose circadian rhythm is shorter than 24 hours and whose energy peaks early in the day. 

By identifying your chronotype, you can live in sync with your hormones and enjoy the benefits, such as better focus, sleep, and energy.

Use Light to Sync Your Internal Clock

First morning light cues our internal clocks to wake up and start the day. It has to do with the spectrum of morning light.

We can use this knowledge to our advantage when traveling to reduce jet lag or reset our circadian rhythms anytime we need. Simply avoid wearing sunglasses first thing in the morning and enjoy the morning light.

To bring the same spectrum indoors, try TUO light bulbs, which use the same light as morning sunlight. I highly recommend them.

Avoid Chemical Hangovers

We’re all familiar with alcoholic hangovers, but other chemicals can produce unpleasant effects the morning after, too.

Various OTC medications cause drowsiness as a side effect, including Tylenol PM and Advil PM. These medications contain diphenhydramine, which stays in the body longer than the duration of your sleep and can lead to a strong chemical hangover. Be cognizant of these side effects and talk to your doctor if they become worrisome.

Many prescription medicines have similar side effects, so review potential side effect information with your doctor or pharmacist.

Beware the Alarm Clock

Our sleep cycles through light sleep, deep sleep, and REM sleep about every 90 minutes. We call this sleep architecture. If you wake up during deep sleep or REM sleep because your alarm clock goes off, that’s an unnatural time in your sleep cycle, so you’re more likely to wake up groggy and exhausted.

If possible, wake up naturally rather than with an alarm clock.

Today’s Takeaways

You asked how to wake yourself up with less fatigue, and now you have five tactics to improve your sleep and boost your energy in the morning, no coffee required. They’re easier said than done, but nothing worth doing is easy.

Improving your health, quality of life, and energy are worth the effort. If you have questions, reach out to us. We’re here to help.

by Barry Rotman, MD

What Is the Normal Blood Pressure? Well, It’s Complicated…

We all want normal blood pressure. But what is the normal blood pressure for you? It’s a more complicated question than it seems.

Blood pressure is crucial to overall health, but how do we learn what our normal is, and how do we monitor it once we do?

What Is the “Normal” Blood Pressure?

The chart below reflects the American Heart Association’s parameters for “normal blood pressure.” However, those parameters are more complicated than they appear.

The numbers corresponding to “normal” in the chart are the blood pressure goals for healthy adults, not the results for the average American adult. The average blood pressure isn’t desirable from a health perspective because nearly half of American adults are hypertensive.

The “normal blood pressure” target has also changed significantly in the nearly four decades I’ve been in medicine. “Normal” blood pressure was defined as under 160 systolic in the 1980s, according to the SHEP study. The American Heart Association and the American College of Cardiology updated those guidelines to 140 systolic in 2014.

How Your Blood Pressure Measurement Changes

Medical guidelines recommend that adult blood pressure be lower than 120 or over 70, based on the SPRINT study. But even this recommendation isn’t straightforward. Many factors influence your measured blood pressure from minute to minute, and they compound like Russian nesting dolls.

For example, the study that determined the latest “normal blood pressure” did so by averaging the blood pressures of healthy adults taken every five minutes as the participants were calm and at rest without a doctor’s presence. Compare those conditions with the conditions under which you typically have your blood pressure taken — immediately after sitting down in an anxiety-inducing doctor’s office — and you can see why your blood pressure may not measure up to the standard.

Physiological Variations

Blood pressure changes constantly, like the weather, because of physiological variations, including body position, exercise, stress level, etc. Measuring it accurately requires a standard of conditions seldom met in daily life.

Sampling Errors

Blood pressure measurements also vary because of sampling errors. For instance, taking your blood pressure immediately after rushing into your doctor’s office after facing frustrating traffic is a bad idea. The measurement will probably be high and inaccurate.

Equipment and Technique Errors

Finally, errors stem from misused equipment and misapplied technique.

Common mistakes include using wrist cuffs. These measure blood pressure at the radial artery, which differs significantly from the brachial artery (the artery in your upper arm). Comparing the numbers from a wrist cuff to those in a chart meant for an arm cuff yields inaccurate results.

Another common mistake is positioning the arm lower than the heart. This position creates additional pressure in the artery and throws the measurement off. Having the wrong-sized cuff also leads to inaccurate measurements.

Getting an Accurate Blood Pressure Reading

How can you get an accurate blood pressure measurement? Be an educated consumer. 

The SPRINT study taught us that the most accurate blood pressure measurement is taken at home, not at the doctor’s office. We need to be calm and comfortable.

That said, the simple task of determining blood pressure is not a simple task.

Understanding your blood pressure as an average or trend rather than a single measurement or number is important. Be familiar with your body and have conversations with your doctor about what is the normal blood pressure for you. Staying informed and engaged is the best way to stay healthy.

by Barry Rotman, MD

Alcohol and Your Brain: The Long-Term Impact on Thinking and Memory

We’ve all had too much to drink and regretted that decision. But what are the long-term effects of alcohol on the brain? Can you mitigate those effects?

What Is Alcohol Brain Fog?

Alcohol brain fog is any cognitive difficulty you experience during or after ingesting alcohol. Those may be difficulties with focus, memory, coordination, concentration, or judgment.

It’s a broad definition, so we’ll divide it into three categories of effects: immediate, day after, and long-term.

Alcohol’s Acute Effects on the Brain

Acute ingestion of alcohol (aka being drunk) has all sorts of consequences because of direct chemical effects on the brain, including:

• Mood swings
• Balance impairment
• Dysarthria
• Poor judgment
• Impaired coordination
• Impaired reflexes
• Memory
• Impaired cognitive function

If the amount of alcohol in your bloodstream reaches toxic levels, you can overdose, which can be fatal. High alcohol concentrations can cause loss of consciousness, temperature dysregulation, impaired breathing, and heart failure.

Acute alcohol ingestion also has a high mortality risk because of direct toxicity and associated behaviors. For example, drunk people are much more likely to die because of falls, motor vehicle accidents, and fights. In 2022, 32% of all driving fatalities were a result of alcohol-impaired driving.

Sex and alcohol don’t always pair well, either. Of the 25% of women who have been victims of sexual assault (a conservative estimate), half of those cases involved alcohol consumption by the perpetrator, the victim, or both.

Why Does Alcohol Consumption Lead to Bad Decisions?

Alcohol increases the sedative effects of the neurotransmitter GABA (gamma-aminobutyric acid), which blocks certain signals from the central nervous system. It also dulls the excitatory neurotransmitter glutamate, which plays a key role in learning, memory, sleep, and mood.

Alcohol also enhances dopamine, leading to the euphoria associated with alcohol consumption.

Finally, alcohol disrupts communication between the brain’s neurons, which causes more global side effects like loss of balance, memory, speech, and judgment.

The Next-Day Effects of Alcohol on the Brain

The day after you drink, you may experience a hangover, among other symptoms.

Alcohol is a diuretic, meaning it causes fluid loss in the body. It makes you thirsty, dehydrated, and susceptible to electrolyte imbalance. Unless you correct the problem, you’ll likely experience weakness, headache, dizziness, and cognitive impairment.

Alcohol can also interfere with the production and metabolism of glucose, leading to low blood sugar, fatigue, and mood and cognitive changes.

It can also disrupt sleep — a separate pathway for cognitive impairment. If drinking too much ruins your sleep, you may wake up with a double dose of brain fog.

Even after a single day of drinking, you may experience a mini-withdrawal effect. You may feel restlessness and anxiety associated with levels of alcohol in the brain.

Long-Term Effects of Alcohol on the Brain

Alcohol is a neurotoxin. That means that after enough exposure, it shrinks both individual neurons and the entire brain. When particular regions of the brain, such as the hippocampus, are chronically exposed to alcohol, memory, mood, behavior, and cognition suffer.

When you ingest enough alcohol over time, it interferes with the absorption of the B vitamin thiamine because your body uses the thiamine to metabolize alcohol. This leads to Wernicke-Korsakoff syndrome, which is associated with mental confusion, memory, and eye movement disorder.

Chronic alcohol use leads to alcohol use disorder, which is associated with cravings and withdrawal symptoms. Alcohol use disorder can exacerbate underlying concomitant depression and anxiety.

Perhaps most distressing, alcohol use in children and young adults can arrest or impair the completion of brain development and can lead to long-term brain impairment. This remains true even after they stop ingesting alcohol.

How Can We Minimize Alcohol’s Effects?

Or, more specifically, how can we minimize alcohol’s effects relative to the three time spans we discussed above (immediate, next-day, and long-term)?

Immediate

Be cautious about your consumption rate. We consider the “standard drink” to be 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of distilled spirits per hour. However, every pour is highly variable.

There’s also variability in individual susceptibilities. Women tend to weigh less than men and are enzymatically prone to not processing alcohol as quickly. Therefore, they’re more likely to feel the acute effects of alcohol sooner.

Food slows alcohol absorption. Staying hydrated also helps mitigate adverse effects.

As for other side effects of drinking, like poor judgment, it’s best to plan ahead. Don’t drink yourself into oblivion. Take an Uber home. Make sure you’re with people you trust. Don’t let alcohol lead you anywhere unsafe.

Next-Day

Eating and drinking will help with a hangover. Electrolytes are best. Coffee or tea can also help in moderation.

Expect your sleep to be impaired, so sleep in or take a nap if you can.

Long-Term

There’s no safe way to be a chronic heavy drinker. The best thing to do is seek help.

Today’s Takeaways

Alcohol can be enjoyed in moderation, and there are ways to mitigate the effects of overindulging. However, excessive drinking is dangerous, especially for young people.

If you need help cutting alcohol out of your life, we’re here to help and would be happy to talk. Schedule an appointment today.

by Barry Rotman, MD