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

What You Need to Know About Regional Steroid Injections and Alternatives

I see many patients eager to treat their painful joints with regional steroid injections. I urge them to weigh the risks and benefits carefully. Like all things in medicine, one size does not fit all, and alternatives to mainstream treatments are often safer and more effective in the long run.

Below, I’ll explain how regional steroid injections work, why doctors use them, why they’re not my first treatment choice, and what alternatives I recommend.

What Is a Regional Steroid Injection?

Corticosteroids, also called glucocorticoids, are injected directly into a specific affected area of the body to reduce local inflammation and relieve pain. Examples include shoulder and knee joints or the epidural space surrounding the nerves in the neck and back.

These injections’ effects are variable, ranging from no response to pain relief lasting from a few weeks to a few months.

Why Doctors Administer Steroid Injections

Administering a glucocorticoid regionally (as opposed to orally or injecting it into the bloodstream) exposes only a small part of the body to the drug and reduces, but does not eliminate, the risk of system-wide side effects. However, even local side effects are possible.

The most common side effects that can occur at the injection site include:

• Hypopigmentation (loss of pigmentation)
• Joint infection because of reduced immune function
• Worsening of the adjacent bone’s integrity
• Atrophy (weakening of tendons, ligaments, and muscle in the region)

Can Local Steroid Injections Affect the Entire Body?

Yes, depending on the individual and the amount and type of glucocorticoid injected.

Glucocorticoids are a double-edged sword. They relieve pain, but they have a long list of detrimental side effects throughout the body. These include:

• Osteoporosis
• Glaucoma
• Elevated blood sugar
• Anxiety
• Insomnia
• Immune suppression
• Cataracts
• Obesity
• Diabetes
• Hypertension

These side effects could occur in the short term or long term, depending on the amount of drug injected and the exposure duration. The fewer glucocorticoids you expose your body to, the better.

Some demographics are at a higher risk of experiencing these side effects, including:

• Children — steroids can stunt growth
• People with osteoporosis — steroids can exacerbate the disease
• Women who are pregnant or breastfeeding — drugs can pass to the fetus
• Athletes — steroids injected near tendons or ligaments can increase the risk of rupture
• People with diabetes — steroids can cause sudden, extreme blood sugar spikes
• People with compromised immune systems — steroids can further compromise the immune response
• People prone to neuropsychiatric side effects (i.e., anxiety) — steroids can produce an acute anxiety response

There’s a movement afoot within the medical community to reformulate glucocorticoids so that they absorb more slowly. This would have two benefits:

1. It keeps the drug in the joint longer, extending its effects (inflammation reduction and pain control).
2. It’s a lower dosage, providing longer-lasting effects with less drug absorbed into the body.

Are There Alternatives to Steroid Injections?

Steroid injections are a Faustian bargain.

If you’re unfamiliar with the reference, Dr. Faustus is a character from a medieval German play. In the play, he trades his soul to the devil for unlimited knowledge.

Steroid injections may not be as malicious as the devil himself, but the trade for pain-free joints is risky.

If the risks aren’t worth it to you, you have a wide range of alternative solutions to choose from. I recommend the following:

• Topical NSAIDs (including diclofenac)
• Non-pharmacological remedies
  • Resting the joint
  • Physical therapy
  • Massage
  • Chiropractic care
  • Acupuncture

Today’s Takeaways

I’m not a fan of steroid injections. They present a considerable amount of risk for the benefit they offer. Alternative treatments may provide benefits with far less risk.

Talk with your doctor, consider the risks, and explore all the options before choosing a safe route to healing.

by Barry Rotman, MD

How Long Does Blood Pressure Medicine Take to Work?

Patients with hypertension often ask, “How long does blood pressure medicine take to work?”

It depends. Most blood pressure medications take a few long weeks to reach their full effect — but there are steps you can take to lower your blood pressure in the meantime.

How High Blood Pressure Affects the Body

To understand how blood pressure medication works, you first need to understand what causes hypertension (high blood pressure).

Think of your blood vessels as an old-fashioned mechanical watch — one with dozens of interconnected gears and springs. When a single part malfunctions, the disruption spreads to other parts of the system, and the watch eventually stops working.

Repairing that one part triggers a chain reaction throughout the entire system, and the watch works better than it did before.

For a deeper exploration of blood pressure and its effect on the body, check out my blog post: A Physician’s Experience With High Blood Pressure.

How Long Does Blood Pressure Medicine Take to Work?

There are four common categories of blood pressure medication, but they all work within similar time frames. The initial effect occurs within hours but doesn’t reach its full effect for two to four weeks.

The following table describes the four common types of blood pressure medication, their mechanisms of action, and common side effects. The medication your doctor prescribes depends on your individual characteristics and risk factors:

How to Improve Your Medication’s Effectiveness

When your blood pressure is high, you want to lower it as quickly as possible. Making healthy lifestyle changes can boost your medication’s performance and reduce your blood pressure before your medication takes full effect.

Important: Lifestyle changes are not a replacement for professional help. If you have high blood pressure, you NEED to work with your doctor to lower it. Take your prescribed medication and follow your doctor’s advice.

While you’re doing that and waiting two to four weeks for your medication to reach its full effect, you can also (with your doctor’s approval!) make the following changes at home:

Reduce or Eliminate Unhealthy Foods and Substances

Some foods, drinks, and substances are notorious for elevating blood pressure. These include nicotine and alcohol.

Caffeine may be beneficial for some, but it can harm individuals with hypertension. While studies are still in progress, it’s best to reduce or eliminate your caffeine intake if your blood pressure is high.

Although sodium is necessary, excess salt is not. In the United States, virtually everything packaged, canned, frozen, processed, or served in a restaurant contains too much salt for someone with high blood pressure. Avoid excess salt by cooking fresh food at home or looking for foods with low sodium.

Adopt DASH

DASH (Dietary Approach to Stop Hypertension) is a diet clinically demonstrated to lower blood pressure. The diet includes fresh fruits, vegetables, whole grains, lean protein, and low-fat dairy.

Exercise

Exercise is the closest thing we have to magic. Studies show that exercise, specifically strength training, for a minimum of 150 minutes per week can improve blood pressure independently of weight loss.

Weight Loss

While not everyone with high blood pressure needs to lose weight, many do. Losing just 5–10% of your body mass can profoundly impact your blood pressure if you’re overweight.

Losing weight when necessary can also improve other factors that contribute to high blood pressure, like sleep quality.

Sleep

Getting enough quality sleep is essential to maintaining healthy blood pressure. Stress and sleep deprivation combined aggravate hypertension in dangerous ways. Do your best to get enough rest.

(If you aren’t getting enough sleep and need help figuring out why and how to improve your sleep quality, reach out today to discuss your options.)

Stress Reduction

We all know stress is the enemy of good health, but it’s especially insidious toward blood pressure.

Tackling your stress doesn’t have to be a chore. It can be as simple as reducing certain environmental noises with noise-canceling headphones or a white noise machine or meditating for a few minutes before hitting the hay. Spending time in nature has also been shown to reduce stress.

There are many ways to modify your environment and your lifestyle to reduce stress — you just need to find those that are most effective for you.

Today’s Takeaways

Now that we’ve answered the question, “How long does blood pressure medicine take to work?” and explored other ways of lowering blood pressure, the ball is in your court.

Follow your physician’s advice, take your medication as prescribed, and remember that there’s more to lowering blood pressure than taking a pill.

by Barry Rotman, MD

What Do Studies Show About the Relationship Between Stress and Memory?

Can you remember a stressful experience you had years ago with amazing clarity, but not what you had for dinner last night?

There’s a scientific reason!

Stress exposure directly impacts memory formation and retrieval. Sometimes, that’s helpful, and other times, not so much.

So, what do studies show about the relationship between stress and memory?

What Do Studies Show About the Relationship Between Stress and Memory?

Many studies explore how stress affects memory encoding and retrieval. The literature can appear contradictory.

To provide better clarity, I’ll break this topic down into three sections:

• How the timing of stress exposure affects memory formation and retrieval
• The body’s cortisol response
• Individual variation

How Does the Timing of Stress Exposure Affect Memory Formation and Retrieval?

We categorize stress into two groups: acute stress and chronic stress. Each triggers unique physiologic responses.

During acute stress (stress that occurs over the course of minutes or hours), memory is enhanced. According to the current theory, because your body’s cortisol levels spike during stress, brief spurts of cortisol enhance memory function.

This makes sense from an evolutionary perspective. Consider what caused stress in cavemen (stumbling upon a lion’s den, for example) and why it was important to remember that information (so they could avoid that den in the future).

Chronic stress (ongoing stress over days, weeks, months, or longer) is different. When endured at high levels over time, cortisol becomes a neurotoxin. Although it’s our own hormone, it can damage vital parts of the brain, including the hippocampus, the region responsible for memory formation and processing.

To put things simply, acute stress helps both memory encoding and retrieval, and chronic stress hurts both memory encoding and retrieval.

How Does the Body’s Cortisol Response Influence Memory?

The memory formation and retrieval process is multi-layered, leaving many opportunities for individual variations.

The first layer is our hormonal stress response. This includes the hypothalamic-pituitary-adrenal axis, which determines how much cortisol the body secretes.

The second layer is how our brains function, including the size of different parts of the brain, which varies tremendously. These size variations determine how the hormonal stress response signal reaches the brain and how strong it is when it gets there.

The third and final layer is individual traits and personal history. For example, someone who’s been clinically diagnosed with anxiety or depression has a cortisol response that’s more highly attuned to their memory. Also, someone who has a history of trauma or PTSD has a more intense stress response, which also impacts their memory.

These three layers combined create the potential for tremendous variation in the relationship between stress and memory. This means that the same stress level can impact each person differently.

Physiological Presentations of Stress Depend on the Individual More Than the External Stressor

It’s easy to believe that a high-stress situation, such as a shootout with the police, would trigger a more severe biological response than a lower-stress situation, like watching a horror movie. However, that’s not always the case.

An individual’s stress response depends on the physiological variations I explored above. Take a man with PTSD, for instance. Watching “Saving Private Ryan” may trigger flashbacks and an elevated heart rate, but if his wife suffers a sudden heart attack beside him, he may remain calm, cool, and collected as he administers life-saving care and calls for help.

In other words, the factor that most influences the way stress presents is not the external trigger of the stress — it’s the person experiencing the stress.

This makes studying stress’s effects on memory challenging.

How to Mitigate Stress’s Negative Effects on Memory

Regardless of your individual variations, you can limit and improve stress’s effect on your memory by making healthy lifestyle choices.

I’ll sound like a broken record, but here are the best ways to help reduce stress and maintain or improve your memory formation and retrieval:

• Exercise regularly
• Consume a healthy diet
• Avoid unhealthy substances
• Get proper sleep
• Socialize

Here’s why these recommendations are vital:

Exercise

Studies demonstrate that exercise reduces stress and improves cognitive function.

“Neuroplasticity” refers to the brain’s ability to change through growth and reorganization. We used to think that young people’s brains would create new connections between neurons, and those connections would mature as they became young adults and remain the same for life.

Now, we’re realizing this isn’t the case.

Given the right conditions, we may be able to create new neural pathways throughout our lives. One condition is exercise, a method for improving hippocampal function. Since the hippocampus is intimately involved in memory function, there is evidence that exercise can help improve memory.

Diet

Diet choices, including consuming healthy fats, can also improve memory.

Omega-3 fatty acids, found in fatty fish, flax seed, oil, and nuts, are an excellent source of healthy fats. Monounsaturated fats like olive, avocado, and various nut oils are also great.

Interestingly, fiber is also associated with improved memory function. We’ve come to understand that our gut microbiome affects almost every aspect of our health and that there’s a gut-brain connection. So, eating a bowl of oatmeal for breakfast might just help you ace that exam.

Unhealthy Substances

In case you needed another reason to avoid substances like nicotine and alcohol, studies demonstrate that they hurt memory formation and retrieval.

Caffeine, however, is not detrimental to memory. But using caffeine to compensate for poor sleep habits is like smacking a Band-Aid on top of a gaping wound.

Sleep

I’m always talking about the importance of sleep. Sleep is highly associated with memory function and stress reduction, which also improves memory.

So, try improving your sleep hygiene. It’ll improve your alertness more than that second pot of coffee.

Socialization

Decreased socialization and loneliness correlate with stress and an increased risk for dementia and impaired memory. Social interactions can help.

Therapy, such as cognitive behavioral therapy, can also reduce stress and improve memory function. So can mindfulness meditation.

Regarding Physical or Mental Illness

If you’ve been diagnosed with anxiety, depression, PTSD, or other mental or physical illnesses, talk with your doctor or seek other medical attention before making any changes to your routine, especially if you take medications.

Today’s Takeaways

We began this post by asking, “What do studies show about the relationship between stress and memory?” We’ve covered that and more:

• How stress can affect your memory
• How stress can affect your body
• How to address stress in a healthy way

If you need help managing your stress or have concerns about your memory function, reach out today. We’re here to help.

by Barry Rotman, MD

How to Safely Find Your Blood Sugar Balance

Sugar can cause all sorts of bad health outcomes, from cavities to diabetes to cardiovascular issues. But when we say “sugar balance,” what exactly do we mean?

There are two definitions:

1. ACEVA created a popular supplement called “Sugar Balance” and marketed it to diabetics. In 2021, ACEVA received a warning letter from the FDA to cease unsubstantiated medical claims, as Sugar Balance didn’t meet the FDA’s requirements for diabetes treatments. Supplements like this are dangerous and misleading.
2. The “sugar balance” we’re discussing in this post is the balance of glucose in your blood. This is not a DIY topic. If you experience elevated blood sugar, consult your doctor — he or she will come up with an individualized treatment plan.

Let’s explore sugars (natural and added) and how to achieve a healthy sugar balance.

What’s the Difference Between Natural Sugars and “Added” Sugars?

Natural sugars are sugars naturally found in foods. They’re ingested in complete foods with protein, fiber, etc., digested slowly, and converted into glucose by your body.

Added sugars are a part of food processing and are often high-fructose sugars derived from corn syrup. They’re added for taste, not nutrition.

Your body absorbs these sugars rapidly, leading to “sugar rise, sugar crash” cycles. The rapid rise, especially because of fructose, is associated with excess caloric deposition in the liver as fat, which can cause non-alcoholic fatty liver disease.

Since these calories aren’t associated with other nutrition, we call them “empty calories.”

Where Does Sugar “Hide”?

Sometimes, sugar hides in plain sight. Even foods we think of as “healthy” hide empty calories.

There are four calories in every gram of added sugar. Consider the following sugar amounts:

• Flavored yogurt: Up to 32 g in 6 oz
• Instant oatmeal: 10 to 15 g per packet
• Peanut or almond butter: 6 g per two tablespoons
• Granola bar: 8 to 10 g
• Canned fruit: Up to 26 g per cup
• Protein bar: Up to 22 g

Read those nutrition labels and pay attention to what you eat.

How to Achieve a Healthy Sugar Balance

How can you achieve a healthy blood sugar balance? Can (and should) you do more than just cut sweets from your diet?

A healthy fasting blood glucose range is between 70 mg/dl and 99 mg/dl. You can keep your blood glucose in this range by:

• Getting enough sleep
• Consuming a healthy diet
• Exercising regularly
• Reducing stress

These methods will help whether you currently have health complications or not. However, if you’re diabetic or at risk for developing diabetes, continuous glucose monitoring can also be extremely beneficial. Discuss your options with your doctor before starting a new treatment plan.

Sugar Is Not Your Friend

Consistently elevated serum glucose is associated with a host of poor health outcomes, including:

• Myocardial infarctions
• Cancer
• Stroke
• Pre-diabetes and diabetes
  • Diabetic neuropathy
  • Blindness
  • Kidney disease
  • Diabetic retinopathy
  • Glaucoma

And more. Consuming excess sugar can shorten your lifespan and healthspan, especially if you already have health conditions like diabetes that require careful monitoring. Avoid these consequences by avoiding added sugar and maintaining a healthy sugar balance.

If you’d like guidance from a trusted expert, reach out to Banner Peak Health. Our team of physicians is excited to help you live your longest, healthiest life.

by Barry Rotman, MD

Night Sweats: Understanding the Causes and How to Stay Cool

Do you often wake up in the middle of the night sweating, throwing the blankets off, turning up your fan, unable to find relief? Do you get up in the morning exhausted, asking, “Why do I get so hot when I sleep?”

You’re not alone.

Fourteen percent of American adults say they always feel too hot when they sleep, and another 43% say they “occasionally” do. What causes all this overheating? What can you do about it?

How Your Body Regulates Its Temperature During Sleep

Our circadian rhythm dictates the timing of almost all our biological processes, including sleep, digestion, and temperature regulation.

If our circadian rhythm deviates from its norm, we may feel too hot or cold while we sleep.

Common Contributing Factors

Several factors can throw our circadian rhythm out of whack.

We (humans) are inefficient from a metabolic perspective. We’re analogous to an incandescent lightbulb — about 75% of our energy intake from ingested calories goes toward heat generation rather than motion or growth.

Thus, anything that increases our metabolism generates excess heat. Common factors include:

• Evening exercise (within four hours of bedtime), which jump-starts our metabolism
• Some medications
• Infections with low-grade fevers
• Certain cancers
• Hormonal conditions, including:
  • Menopause, which reduces estrogen levels
  • The luteal phase of the menstrual cycle, which can increase the body’s temperature by around 0.3°F (0.7℃)
  • Pregnancy, which increases progesterone levels
  • Hyperthyroidism

Although some factors are unavoidable, you can strive to increase your sleep comfort. We’ll explore some methods for cooling down at night. However, if your symptoms persist, you should contact your doctor for an exploration of the underlying cause.

Creating the Optimal Sleeping Environment

Our circadian rhythm includes a drop in core temperature of up to 1.8°F over the course of the night. Excess heat can interfere with this process and hamper our sleep. Follow these suggestions to stay more comfortable at night:

• Set your thermostat between 60°F and 67°F
• Use light bedding, such as cotton, linen, or bamboo — all materials with good ventilation
• Wear lightweight pajamas
• Reduce your stress:
  • Exercise earlier in the day
  • Spend time outside
  • Meditate
  • Avoid caffeine and alcohol
  • Regularly connect with friends and family

Today’s Takeaways

If you’re struggling to answer the question, “Why do I get so hot when I sleep?” practice the tips in this post and see if you can find relief.

Here’s a quick summary:

Determine why you’re overheating:

• Exercising too late?
• Side effect of a medication?
• Do you have an infection or a fever?
• Do you have a hormonal imbalance?

Try these tips to find relief:

• Set your thermostat between 60℉ and 67℉
• Use lightweight bedding, such as cotton, linen, or bamboo
• Wear lightweight pajamas
• Reduce your stress:
  • Exercise earlier in the day
  • Spend time outside
  • Meditate
  • Avoid caffeine and alcohol
  • Regularly connect with friends and family

If none of those help, ask your physician about other solutions.

Remember, healthy sleep is crucial to overall wellness. Don’t underestimate its importance, and don’t procrastinate getting help.

We at Banner Peak Health are happy to help optimize your sleep. Contact us today to discuss solutions.

by Barry Rotman, MD