How To Manage The Effects of Alcohol with Dr. Kristen Holmes and Dr. Greg Grosicki

0:00 Whether people like it or not, alcohol just is not very good for you.

0:04 There is this uh, you know, perception of an invisible cost of drinking, or that if I'm not necessarily feeling bad the next day, that uh it's not having any consequences, and you know, the consequences are there. Just one drink more than usual is your personal average increasing resting heart rate by two to three beats per minute and reducing heart rate variability by four to five milliseconds.

0:25 That scales with every drink that you have. On days people drank alcohol, if they did more exercise during the day, the consequences of drinking were exaggerated. Essentially, what we're seeing with alcohol and exercise. So the lesson learned was it very counter to the college days where I'd be like, well, gonna go to a party tonight.

0:45 Better make sure I work it off before I go. That was actually not what we found is gonna lead to the best outcome.

0:51 Dr. Greg, how's it going?

0:53 Dr. Kristen, it's going well. How are you?

0:56 I'm good. We're gonna talk about uh what are your favorite topics?

1:00 Alcohol.

1:01 Yeah. I mean, you like to study it, but you also like to drink it.

1:04 I do enjoy it. Let's not let's be honest here. I enjoy a good IPA. It's one of the best things about being in Boston.

1:09 I know, I know. Yeah, you you come out, you you you live down in South Carolina, so when you come up here, you're you know, you kind of let it let loose a little bit. Uh every now and then. Every now and again. Yeah. Although I, you know, I'm always pushing you pretty hard, so not a lot of time to imbibe.

1:24 Imbibe. It is true. We're gonna talk about what alcohol really does to the body.

1:29 Yeah.

1:30 For whether people like it or not, um alcohol just is not very good for you. Let's just set the stage because we're gonna talk about our own data. We've got two really great papers that shows alcohol in kind of two different lights. Um but I'd love for you to back up and just talk about some of the external evidence that's been emerging over the course of the last, you know, few years that give us um, I think a perspective that we've been able to validate in our own data.

1:58 Yeah. So alcohol is an interesting one. People have been consuming alcohol since 7000 BC. So people have been consuming alcohol for as long as time. And it is also one of the, if not the most, psychoactive substances consumed by humans. Yeah. Just explain what psychoactive is. Psychoactive, it's having effects on the brain.

2:21 Right. And so if you were to look at an image of the brain while drinking alcohol, what would what would you see?

2:30 Yeah, it's lots of activity. Lots of activity, and it depends on you know when you're drinking it, and then there's a time.

2:36 So different regions of the brain are lighting up. Yep. If you can imagine that they're like firing up.

2:42 And there's very different acute and then chronic responses. So one of the things anybody who's consumed alcohol knows is that generally shortly after you consume it, you get this feeling of lower inhibition. Um, your acetylcholine goes up and brings you this feeling of uh, you know, being relaxed and and good.

3:02 But then, you know, the next morning you wake up after consuming some alcohol and your anxiety's up and you tend to feel a little depressed because you have very different acute responses and then the next morning. Yeah.

3:13 So it kind of swings the pendulum almost. Yeah. And and you're and that's essentially what a hangover is, is the pendulum swinging in the other direction. Yeah. Is that fair to say?

3:24 Yeah. And it's interesting that despite the pendulum swinging in that other direction, people continue to drink it, right? More than 50% of people.

3:32 But the reinforced the bad behavior being reinforced. Exactly.

3:35 Uh waking up and feeling poorly, having a headache, people continue to drink it. And as a matter of fact, over 50%, somewhere around 55 to 60% of people in the United States report having consumed alcohol in the last 30 to 60 days. So people are drinking alcohol pretty commonly, and it's not an uncommon thing to do.

3:52 What about the data that suggests people are drinking less?

3:56 Yeah, that that's an interesting one. So when you look at science, generally operates a little bit more slowly than some polls and such. But uh a recent study that was published in 2024 used data from national surveys, the now national alcohol surveys.

4:13 Is this moral? Yeah, I believe so. I believe so.

4:16 So they looked at data again from yeah, 1978 all the way to 2020. So that's kind of one of the more recent data points we have in the literature. And it actually shows that people are actually drinking, you know, if anything, maybe slightly more. And there are variations by demographic age and sex, particularly with older individuals.

4:33 For whatever reason, it seems like they actually might be drinking a little bit more than they were, and younger individuals drinking a little bit less. We know during COVID, people were drinking more. There are more recent polls, the Gallup polls show that uh that fact I gave that around 55 to 60% of people report having out consumed alcohol recently.

4:51 It's actually come down a little bit over the past three years from 62 to 60 to 55. But those data aren't published, and there's probably some bias in people taking those surveys. So what's actually happening with alcohol trends, kind of anyone's guess, but we do know that a lot of people are consuming it.

5:06 And just because people are purchasing more non-alcoholic beer for site, doesn't mean they're actually not also purchasing alcoholics. Right. Right. That is what a fallacy is that, Greg.

5:21 For sure. Well, yeah, the yeah, it uh logical fallacy, right? Where and people cite that all the time. Oh, NA sales are way up.

5:28 Right.

5:28 But who is buying NA? It's active, like if you look at the demographic buying NA beers is the get demographic who drinks beer. It's you know, because people are eating more cookies doesn't mean they're not eating ice cream as well.

5:40 Yeah. You listed off some of the, I guess, cost of drinking, you know, the hangover. Um, what else is maybe h happening physiologically that you know is is is one of the reasons why it's alcohols emerging as even at moderate levels, it's probably not so good for us.

5:58 Yeah. So from the perspective of a physiologist, alcohol is particularly interesting to study, in my opinion. Um physiologists love to study what happens to the body when it's stressed. So uh during exercise or following some sort of mental stressor, alcohol is unique in that it's one of the only substances that is both fat soluble and water-soluble, meaning it can dissolve in both fat and water.

6:26 So, why does that matter in the body? Because it can make it into all cells and tissues of the body, which ultimately means that it's going to have consequences for all the cells and the tissues of the body.

6:38 I think just pause there for a second, because that's that's that's kind of wild.

6:42 Yeah. Yeah. For sure.

6:44 Because if you think about any other substance you put in your body, is there any other substance that can permeate the cell in the same way that alcohol can?

6:53 There probably are. I can't I can't say I'm privy necessarily to what those may be. Um and because someone spot checked me, I'll not give an answer. But but it is unique in that way. Most things are not. Right. I I I feel confident in saying that.

7:06 Yeah, I think that's fair. Um I don't actually know the answer to the question. Oftentimes I'll ask a question and I do know the answer, but um people can leave it in the show notes.

7:14 People can leave it in the show notes and tell us just how wrong it is. Yeah. But because of that, again, it's having these consequences in in all the cells and tissues of the body. So the brain, the liver, the stomach, circulation, increasing inflammation, uh, et cetera, and and leading to these harmful consequences.

7:32 So that's why it's interesting to study from a perspective of stress.

7:35 It's cool because you know, when you joined a year ago, a year and a half, almost two years ago now, uh, it one of the first projects you took on was the alcohol project. You know, you're like, all right, let's like really dig in here. Cause what were some of the open questions that you're like, you know what, we don't know the answer to these questions.

7:51 And we have literally the only data set in the world that can tell us the answer. Yeah.

7:56 Talk to that. And I I think my interest in studying alcohol came from that of a physiologist who's interested in stress. But it also comes from just telling people that I work at Whoop.

8:06 Yeah.

8:07 Because anybody who knows what Whoop is, which is an increasing number of people, and has used Woop, when you tell them you work there, they'll generally give you some anecdote. Oh, uh, you know, I had Whoop or I used Whoop. But the thing I heard more than anything is Whoop got me to stop drinking as much.

8:26 Yeah. It's just a common theme. And when you talk to people about it, it happens. And I'm sure there are a number of fitness trackers who this is a consequence of people purchasing and seeing their data. But after continually hearing that, it's hard not to think about well, why is that the case? Why is it that when people buy a wearable device, they stop drinking as much?

8:49 Anyone who uses Whoop knows that since we're continuously monitoring your biometrics and behaviors, and alcohol being one of the most commonly journaled uh items on Whoop, it has a colossal impact on recovery, uh, tremendously reduces people's recovery. And you can't continue to drink alcohol without immediately realizing the cost that it's having on your recovery.

9:16 You drink alcohol and your resting heart rate goes up, even just one drink more. Yeah. Just one drink more than usual is your personal average increasing resting heart rate by two to three beats per minute and reducing heart rate variability by four to five milliseconds. And that scales with every drink that you have.

9:40 And so if you have three or four drinks, which maybe doesn't seem excessive, and you wake up the next day and your heart rate variability is literally half of what it typically is, that is um something that you immediately realize. And it's it you're you know, now seeing objectively in your data the consequences of your behavior.

10:03 Now people might say, well, maybe it's it's just poor sleep because I drank, but I also slept bad. So does maybe just disambiguate kind of the interaction that's happening there.

10:14 Yeah. I I think first what's interesting there is a lot of people drink because it helps them fall to sleep. Yeah. Right. But it's very clear in the greater scientific literature and also in our data that alcohol is not a sleep aid. That yes, it may help you fall to sleep. But on average, in our study, there's again a dose response between the more you drank and the less sleep you got.

10:39 And people are not only sleeping less in terms of duration, but the quality of that sleep is down. It's more fragmented, they're waking up more during the night, and they're having less restorative, deep, and REM sleep. And so that's having consequences for them as well.

10:54 Let's just talk real quick about the study that was published in April. Yep.

10:59 And plus digital health.

11:01 Yep. Um, let's just talk about the what the what the hypothesis was and just, you know, kind of what we were looking for in that study and you know, what we're kind of what did we control for in terms of the key covariates. Just maybe just walk through that structure.

11:17 Yeah. And so it's not lost on most people or anyone who uses a whoop that when they drink, their resting heart rate goes up, their heart rate variability goes down, and their sleep becomes shorter and more fragmented. Publishing that is not necessarily groundbreaking, and there are tons of laboratory studies where they've given people alcohol or exposed them to ethanol, and we see these cardiovascular consequences.

11:41 But one of the unique things about our data set is that it's probably larger than really any human being has access to. In this study, we studied over 20,000 individuals, over 5 million nights of data. And when we uh identified these individuals, and I'm going to say individuals, but I think very important to point out, we're not looking at anyone individually of our members, right?

12:04 These are all de-identified random strings of numbers. But when we studied this 20,000 uh user cohort from our Whoop database, and they're 5 million nights, we were able to get at questions that have not been asked or answered yet in the scientific literature that I think are important and that they provide people actionable insights around.

12:26 There was a finished study, and I'd be remiss not to talk about it, that studied, I think it was about 4,000 individuals and it was about 12,000 nights, and it looked at their acute responses to alcohol. And it also looked, like we did, at how people respond differently by age and sex. Although I'll caveat it with saying they uh this group only looked at the first three hours of sleep, which I think makes sense because by those three hours being up, a lot of the alcohol has left the body, but it didn't look at the rest of sleep, which I think misses some important findings that we actually did.

12:59 Because I think the when the architecture in the front end of your sleep changes, that is invariably going to shift the architecture in the back end of your sleep, which is not a trivial scenario for the body.

13:09 Yeah. For sure. And so they looked at this finished group that they published it in the Journal of Medical Internet Research, which is a parent journal of where we published it, which is JMIR, M Health, and UHealth. And they just asked the question how do responses to alcohol differ by dose, which we've already talked about, and then age and sex.

13:28 We followed up on that, also wanting to know dose. And when members report alcohol report drinking alcohol in the Whoop journal, they report how many drinks they had. They also report um timing. Timing. And for any of our members who don't report the number, uh, the volume and the timing for alcohol or for any of our other behaviors in the journal, I would highly encourage you to do it.

13:51 We've recently updated uh our app, right?

13:54 This year, yeah.

13:55 So it actually provides really nice insights around volume and timing and how that relates to your recovery. And I think that's a great ad by Woop.

14:03 So good. So good.

14:04 I'd just like to start with that.

14:05 Yeah, I love it.

14:05 In and this was so we we had 20,000 members and we pulled their entire year of data. So we're looking at repeated exposures to drinking. Each individual had, you know, 300 plus nights of data, a very, very rich data set. And we wanted to follow up on that question. What is the relationship between how much alcohol consumed and what happened in their biometrics and their behaviors?

14:26 We didn't ask just about sleep, but novelly, we asked about, well, is alcohol having an impact on what they do the next day with physical activity? Because that answers more than just, okay, what is the effects of alcohol on your biometrics that night? But it brings it more into a cyclical consequences of you drinking alcohol.

14:45 We know that your biometrics that night matter, but what does your sleep look like? And then is there any lasting impact the next day when the feelings of being hung over theoretically may be gone? So we said, okay, what are the effects of alcohol on resting heart rate and heart rate variability, sleep duration that night, and then next day physical activity?

15:04 And we asked, and how do those effects differ by age? And so when we pulled those 20,000 individuals, we strategically pulled them so that we had younger, middle-aged, and older adults, as well as by biological sex. And we pulled an equal distribution of males and females. And then taking it one step forward, we wanted to ask what are the consequences of different lifestyle behaviors on the biometric and behavioral responses to alcohol specifically.

15:35 Anyone who, you know, has consumed a large quantity of alcohol kind of knows the, you know, the old adage that you can sleep off a hangover. And so that was a question we wanted to address. If you sleep more after a night of drinking, do you wake up with better metrics? Okay, do you do more activity the next day?

15:54 We also asked, and this was a little more novel, what about the activity that you do the day before you drink? So if it's Saturday and I know I'm going to a party, is it good for me to do more activity before I go to that party and imbibe or less? And then we looked at hydration. A number of our members are very good about logging whether or not they hydrated.

16:15 And this could have been before they were drinking, it could have been after. We can't really tell for sure. Um, but we looked at are there any associations between journaling, hydration, and the effects that that alcohol had? And so those are the research questions.

16:28 Um of those questions, and I I think we would have the same answer to what was the most surprising finding?

16:36 The most surprising, there's two. I'm gonna have to go with two. Okay, okay. Okay. So uh as you said, um, I I do enjoy a good IPA. And I've realized now that I'm almost 40, uh, I can't enjoy as many IPAs as I did when I was 20 and back in college. And so going into the study, I hypothesized that older individuals would show exaggerated responses, greater increases in resting heart rate, greater reductions in HRV, greater impact on their sleep, lower next day activity than younger individuals after drinking.

17:11 And I couldn't have been more wrong. And we can go into more of that if you like.

17:15 But I think that was not really interesting because I find this I find this when we think about the vagal tank theory, right? This is where it comes into play, right? When older individuals have less movement in their heart rate variability. Yep. Younger individuals have more movement in their variability and in their eight in their in their heart rate variability.

17:37 And that flexibility actually creates a good sign. It's a good sign. And so the the more the more egregious your deviation, the insults after drinking, actually the healthier your autonomic nervous system.

17:54 That's very likely. I thought you had a conversation with someone on LinkedIn about this, actually.

17:58 I did. Yeah, yeah.

17:59 They were like, man, when I drink, my metrics go nuts. And he was like, but I'm a little bit older. And you're like, that's actually a good thing.

18:04unknown I know.

18:05 I know. I loved chiming in on that one because I I well, this is I think it's you know, there's this is um more of a newer exploration of that, you know, it's is I don't think it's talked about a lot, which I think is hopefully fascinating for the people who are listening or watching. You know, that you want to maintain, you want to preserve as much variability in your heart rate variability as possible, right?

18:24 Like, so in in a lot of that is a path to that, of course, is to limit the amount of drinking, right? But understanding that as you age and and you don't see that same effect from alcohol doesn't mean like you're positively adapting to you. You're immune to it. Oh, I'm fine. So maybe just take take that thread and go where you want to go, and then we can talk about your second point that surprised you.

18:47 Yeah, it's kind of a learning I've had since working at working at Whoop, to be honest with you. It's not something that I had ever really thought about before, but we see it repeatedly with all different types of things and how people respond to exercise and how they respond to a night of drinking. And even in a recent paper we have in review, uh, how they respond to seasonal variation in temperature and photo period.

19:09 Right.

19:09 The older adults, and particularly older adults, uh, even more exemplified, older adults who are less healthy. So even if we take two different older adults and we have older adults who don't do as much physical activity and have a higher BMI, which is less desirable, compared to older adults who do more physical activity and have a lower BMI, the more healthy older adult phenotype will respond more to a given stressor than the less healthy older adult.

19:38 That is, they have more variation to that stressor than individuals who are low fit by the markers you just indicated. Yeah.

19:48 Yeah. And this ultimately, I guess, shouldn't be that surprising given laboratories studies showing blunted, and I'm going to call this cardiovascular reactivity in less healthy individuals. So people who have diabetes or overweight or different cardiovascular diseases don't show the same cardiovascular reactivity to stress.

20:09 And in a lab, we do things like blow up a blood pressure cuff on someone's arm as they're trying to squeeze a hand grip dynamometer or dunk their hands in a bucket of ice water and look at how your heart rate and blood pressure respond to that stress. And uh in a lab, people who are less healthy don't respond as much.

20:25 And we're seeing the same thing, but in the real world with how people respond to alcohol, which I think is really cool.

20:31 It is cool. And I think one of the reasons why people decrease their alcohol consumption so much on whoop is that you become as when you become healthier, you're gonna be that one drink is gonna impact you more the healthier you become, right? Is kind of what we're saying.

20:48 Likely, yeah. Yeah. There's probably a bit of uh some nuance around age and yeah, like a desensitization to alcohol.

20:53 Yeah.

20:54 And we actually showed that. The people who in the paper, this is actually in the supplementary material, but people who drank more frequently uh did exhibit blunted responses to drinking. Less variation across all of their metrics. Because their body uh increases the enzymes in the liver that help to process alcohol as a result of their chronic alcohol consumption, which is not necessarily a good thing.

21:16 Okay. All right. Second thing that was surprised you know.

21:18 So that was number one.

21:19 Yeah.

21:20 Um number two was the physical activity finding. And I I was working, you know, we published this paper with a couple of academic colleagues, and one of my uh Yeah, I wanted to call them out real quick.

21:31 Um we've got Austin Robinson, we've got Michael Journer joyner, Jason Carter, and Jeremy Bogalia.

21:38 Yeah, yeah. So pretty rock star crew.

21:39 It's such a rock star crew. And then of course our whoop our regulars colleagues.

21:43 Yeah. And you know, Austin and I were like kind of Austin and I are really good friends, and so we were like texting back and forth about it. We're like, man, I don't really know if we want to like get across a public health message that if you do more exercise on a day you drink, it's like worse for.

22:00 For your metrics. And so we were even like wondering how to write that in the paper.

22:04 We kind of saw this amplifying effect of exercise. Totally. You know, when you're engaging in naughty behaviors, like exercise doesn't like cancel it out. No. And that's what we saw with alcohol.

22:12 Trevor Burrus, Jr.: And it makes sense from a physiological perspective. And so to be very clear about what we found, on days people drank alcohol, if they did more exercise during the day, the uh consequences of drinking were exaggerated. Right.

22:27 Which makes sense physiologically.

22:30 Yeah. Yeah. Yeah. Because they're both stressors, right? And we said we're studying stress.

22:35 That's why the cold water immersion data is really interesting. We look at super high fit people who are working out four or more times per week. Cold plunging three or more times per week is not adaptive. Like you we see like a same sort of thing, like in a decrease in an impairment in resting physiology over the course of that seven-day period toward the back end when people are engaging in again, you don't need all the stress on your body, right?

23:01 In the end if you're already stressing it. Yeah.

23:03 You know, that's what that serves us. Potential data showing p differences across the cycle and by menopause status in females, too? Yes. And maybe that's not the same thing.

23:13 It's it's a little bit different. But um but but mechanistically, it's it's similar. You know, in and I think, you know, I think the bottom line, when you're laying stress on top of stress, it's gonna take more for you to recover from it. And that's essentially what we're seeing with alcohol and exercise.

23:29 So the lesson is stressors.

23:31 Was it very counter to the college days where I'd be like, well, gonna go to a party tonight. Better make sure I work it off before I go. That was actually not what we found is gonna lead to the best outcomes. Instead, if you're gonna uh stress the body at night with a few drinks, it might be better to uh lay off the exercise a little bit.

23:48 Maybe do a more memory. Lesson.

23:49 Right, right. So I think it's it's still exercise, but maybe do like a zone two or something. Something that's actually recovery promoting, but still feels like exercise.

23:57 And probably keep it equal to or lower than your habitual. Yeah. Right. Because that's really what we're doing. I think that's good advice. Yeah. Because you compared it to people's person mean. Right. And when they did more than their usual and drank, their metrics got worse and their so whatever it means to you, that's the value of whoop.

24:12 You have your own baseline, you know what your kind of average workload is.

24:16 Maybe hit the strain target, but let's not exceed it on days for drinking.

24:20 Great call. Yes. And we know following strain coach is a good thing for most folks. Yep. Yeah.

24:26 Associated with improvements for sure.

24:27 That's right. And we have published those data.

24:30 Yeah.

24:31 Which is great. You don't adapt to drink, you don't become better at drinking, essentially. You might get better at drinking, but your body is not getting better at adapting necessarily.

24:40 Your body's showing even less of a response.

24:42 And less of a response, which is a bad thing. Right. Yeah. And then exercise has an amplifying effect when drinking alcohol. Yep. A negative one, that is. Yep. Okay. Um, let's talk about women and young. And we kind of we hinted at the older folks and just a blunted. Let's kind of talk more about the women specifically and and both young men and young women.

25:06 Yeah. So one of the beauties of the scale of the data set we had is that we were able to actually our findings contradicted the observations from the Finnish group in JMIR. That's right. That's right. So we actually showed no sex difference and cardiovascular response to alcohol. Kind of more in line with the existing literature on even giving males and females acute alcohol administration in a lab.

25:31 But then even if you look at long-term data on males and females uh drinking throughout the lifespan, which of uh which group is the same amount of drinks going to have more detrimental consequences? It's females. And our data showed our results were exactly in line with these observations. I can't remember.

25:50 Did we look at naturally cycling versus hormonal birth control? We didn't separate that out. No, it's okay. We can maybe go back into that data set and maybe look at that. It would be interesting because I think my hypothesis would be that women who are um have a natural cycle have more egregious responses to alcohol, alcohol, will have a more acute response to alcohol consumption, whereas um women on hormonal birth control might have a less of a response.

26:15 It would be interesting to see because I because I think what happens, you know, when you're naturally cycling, of course, like your body is is essentially wired to, you know, any toxin you're putting in your body is a threat to re you know, to reproducing, right? So to reproduction. And you're whether you want to have a baby or not, like that's what your body is like wired to do.

26:36 So when you're introducing toxins, it's gonna have a more acute response because it's like, oh no, like we have created a not a safe environment, you know, and if this persists, we need to shut things down.

26:48 Yeah, right.

26:48 Because we don't want to bring a baby to the world in a in a toxic environment, right? So so it's interesting biologically, yeah, you know, that you've got this kind of happening in the background, which makes sense why we would uh absolutely hypothesize that there are sex differences, you know.

27:03 Yeah. My thought goes now to the study we published with Andy Galpin looking at the sex, looking at uh hormonal birth control and the gut microbiome and exercise training. Anyway, exactly, yeah.

27:14 Also a really interesting feasibility kind of study, you know. That that obviously is very early, you know, that it's a small sample and it's um, you know, kind of uh uh you know, pilot in nature, but um, but really interesting, and we can maybe just say very quickly what the essentially the findings were observed.

27:31 We observed associations between the use of hormonal birth control and changes in the gut microbiome that could be uh less desirable.

27:38 Yeah, unfavorable.

27:40 Potentially. But again, associations n equals 12, not high highly powered. Small data set, yeah.

27:45 Yeah, but but interesting because I, you know, there's the the gut biome is hugely impactful and and alcohol impacts the gut biome. Alcohol impacts the gut biome. Massively, right? Which is gonna, which is why I think one of the primary reasons we see all of these negative consequences, right? Yeah.

28:00 The hops are not uh improving my gut microbiome.

28:03 It's not helping the biome. No, yeah. Okay, anything else? What about what about young kids? Because we we talked about, you know, younger kids inherently have, generally speaking, better resting physiology than than older folks. You'd imagine that they're just more robust to alcohol, but that's actually not what we see.

28:20 Yeah. So the younger adults and females showed the most exaggerated responses. So of all the groups in the study, uh, the younger females showed the greatest increases in resting heart rate, the greatest reductions in HRV, the biggest consequences on their sleep and next day activity we talked about, and we didn't actually say is that on nights people drank the day after they tended to do less activity.

28:43 And so there is this like yes, feedback loop where alcohol is having detrimental consequences on future.

28:49 Next day activity, yeah.

28:50 Yeah. And so in females, young females in particular, those effects were most pronounced. Probably doesn't come necessarily as a surprise. I will say we did control for both body mass index as well as body weight, and those findings persisted. When you look at the literature, things like uh slower, uh, lower first pass gastric metabolism of alcohol, meaning that when alcohol goes through the stomach, it's not being degraded as quickly in females as males, might explain that, as well as um the fact that when that alcohol then is moving into circulation, females have a, in general, lower blood volume.

29:31 And so uh blood alcohol content is going up. So it's not overly surprising that we saw greater implications for females and males, but we did. Yeah. And then we talked about the age response, a greater impact of the drinking on resting heart rate, heart rate variability, sleep, and next day activity in our younger individuals compared to our older individuals.

29:53 And it was even dose response where I went younger, middle aged, and then older.

29:57 Yeah. The fastest way to blunt your future response would be to drink alcohol. Is that a what would you say? Yes or no?

30:04 Uh for I mean, it's definitely gonna have an impact on the future response, yeah.

30:08 But we have not been able to quantify what that impact necessarily would be.

30:11 No, yeah, but that's we gotta look at longitudinal change for that.

30:16 We'll be able to answer it eventually.

30:17 It would be cool looking at how people respond to alcohol before and after dry January or something like that, right?

30:22 Yeah, yeah.

30:23 Predict greater responses after dry January.

30:26 So what about so should folks they go out, they drink? How much should they oversleep the next day?

30:37 Yeah, we didn't necessarily look at uh like what the optimal sleep was. We know that on nights people drank, they tended to sleep less. And we observed uh data directly in support of that notion we talked about before, which is sleeping off a hangover. And a lot of this makes biological sense, right?

30:58 And if you consider that Whoop is measuring our metrics, resting heart rate and heart rate availability throughout the night, the longer you sleep, probably the higher quality sleep you're getting, because you're getting sleep where that alcohol has worn off, essentially worn off or left the system. Yeah.

31:14 And so your metrics are getting closer and to a more stable baseline. And so what we observed again was just that the more people sleep after night of drinking, the less detrimental the night of drinking was on their on their resting heart rate and heart rate variability, as well as the more, and this is what what I think is really cool, because when you look at sleep and resting heart rate and heart availability on WHOOP, they're all measured under the same time period.

31:41 So kind of like we were talking about, there's this endogeneity problem where if you drink more, or if you drink and then you sleep more, you're measuring sleep where there's less alcohol in your system. Yeah.

31:52 But what was cool endogeny is just confounding kind of variables. Yeah. Yeah.

31:57 Measuring resting heart rate and HRV while sleep is occurring. Right, right. Yeah. But what isn't occurring during that sleep is how much activity you're doing that day. And we actually showed that the more, so again, the more you slept, the better your metrics. And also the more you slept, the more activity you were likely to do that day.

32:16 Right.

32:17 And so that's a pretty cool example, I think, of using behavior to combat the effects of alcohol, right? Where you're, you know, essentially poisoning yourself with alcohol, you're sleeping longer, and you're probably feeling better when you wake up for that sleep. And as a result, you're being more physically active that day.

32:33 Yep. Which I think is pretty neat.

32:35 It's really neat, yeah. Um, so just maybe a quick hypothetical that I I I feel like I think if I were listening, I would maybe ask this question. So if if I am really concerned about tonight's sleep, I just want to get back on track. Oversleeping a lot could potentially impact my biological sleep the following night.

33:00 Yep. Yeah. So it's it's there's a little bit of a pull. Maybe a cafe. Yeah, just like being aware. You don't want to sleep probably until noon. Yep. That's unless you plan to not go to bed until 2 a.m., right? But just understand like if it's a Saturday night and Sunday, Monday you got to get up for work and you wake up Sunday morning and you've slept until 1 p.m., now all of a sudden you're in a vicious cycle.

33:23 So just understanding, like, all right, I I still want to protect my biological sleep. How much sleep can I, how much extent sleep extension can I engage in without compromising my biological sleep? I think that might be worth the calculus. Like, yeah, and even if your sleep is maybe, let's say your sleep is a little bit shorter, maybe an hour nap before noon, right?

33:46 It's a weekend. You kind of have that luxury, right? And then you wake up, you work out, or whatever, and you kind of get into your routine. So you want to extend sleep. The data tell us that. We can't tell you exactly how much to extend sleep, but that's why having your own personal physio longitudinal physiological data, you can figure this out for yourself.

34:04 But that that is a calculus to keep in mind. So you don't get in this vicious cycle, and now Monday morning is gonna be horrible.

34:10 Yeah. And I think that I think you didn't bring it up unintentionally. That our number is a really good number to keep in mind, right? When we look at sleep regularity or sleep consistency, which we know is our favorite thing to discuss, and we'll avoid getting into too uh exorbitant discussions of that.

34:26 There's a great podcast with you and Emily discussing sleep. Yeah, yeah. We go deep. Um, we know that sleep tip for sleep regularity and sleep consistency, it's recommended that you go to bed and wake up within 30-minute windows of one another, approximately on each side. And so with that in mind, we also know that people whose sleep wake windows are roughly less than an hour apart, they live longer lives.

34:48 Right. And so if you are indeed in extending your sleep after a night of drinking, I think setting the alarm for an hour later than usual makes a lot of sense.

34:55 Yeah, yeah. And oftentimes people, you're just gonna wake up, right? If you are in a, if you're used to waking up at 6 30 a.m. every single day and you have a late night, you're probably gonna wake up at 6 30 a.m. Like your body's just naturally gonna pop up. And, you know, if that's the case and you just feel really awake and then you're just kind of lying in bed awake, just get up and then take the nap.

35:17 Yep. You know, that that's a great strategy. Uh, you know, athletes do it all the time with just short sleep. It's super effective. Um, it lets you stay on track, it protects your biological sleep, but also helps you through the afternoon so you're not falling asleep at 7 p.m. Because you don't want that either.

35:32 Yeah. Right? Like you so thinking through this is worth it if Monday matters to you.

35:37 Yeah, you need the sufficient sleep pressure when you're going to sleep. Exactly, right.

35:40 You need to build that sleep pressure. So caffeine, naps, falling asleep at 7 p.m. Yeah. On the couch, watching it.

35:46 Three coffees a day after drinking.

35:48 Three coffees is not the time for a successful future. Right, exactly. And I, you know, uh once in a blue moon is fine, right? But that's just not the that's not the pattern you want to get yourself into if if you care about your performance and health. Definitely. If you're gonna drink tonight, what's the smartest thing that you can do if you were to name just two things?

36:07 I'm probably gonna cheat and go with three.

36:09 Okay.

36:10 I wish I could be an older male because then I wouldn't respond to it at all. No, I'm just kidding. One, I'd probably avoid excessively straining myself during the day.

36:21 Um so a slightly below strain coach.

36:24 Yep. Another one we found, and we didn't talk about this yet, but I think it's it was kind of like a funny finding.

36:30 Yeah.

36:30 Most people aren't drinking beers at like 8 or 9 or 10 a.m. or but some people are like, you know, bloody merry.

36:35 Yeah.

36:36 And it turns out, and perhaps it's not surprising, that drinking earlier in the day is associated with less nefarious consequences at night.

36:43 Day drinking is an absolute strategy.

36:46 If you want to assuming you stop, if you want to protect your resting physiology, your recovery next day, that's but I will say, even in the paper we found, and I I'm I'm not sure what the exact number was, but it was something like the difference between having a drink if you're going to sleep at nine o'clock between before dinner versus after dinner.

37:05 It is good for two beats per minute and I think three milliseconds in each, or I mean that's the big that's a thing. So if you're coming home from work and you're gonna have a drink, maybe get it before dinner rather than after getting the kids to bed.

37:16unknown Yeah.

37:16 5 p.m.

37:17 Could be instead of nine p.m. Yeah. Yeah. If you're looking to try to protect your sleep as much as you can. So I thought that was kind of a neat finding, right? I love it. Okay, that's two. So you got three. I'll give it to you. We're uh avoiding excess of strain, drinking earlier in the day, um, and then you know, trying to extend my sleep as much as possible.

37:36 Okay. Making sure I get a good beverage too.

37:39 Yes, yes. All right. We have another paper. So this is a separate paper. And, you know, given you know, all the anecdotal evidence that we have, like of people like viewing their data, like seeing this like crazy, you know, shift in their recovery and just their resting physiology and their sleep, they're like, wow, okay, I definitely drink, I've definitely I come onto Whoop and I drink less.

38:03 We wanted to have a look at those data, what's actually happening? So why don't you talk through the other study that we had that we published also in April, um, looking at 70 the 72 weeks after you get onto WHOOP, what happens to your alcohol consumption?

38:20 Yeah. And so I think we set the stage initially talking about the ubiquity of drinking. We already talked about trends in drinking. Uh they may be going up, they may be going down, probably staying relatively stable at the population level. But one of the things is clear, evidence from the World Health Organization stating directly that alcohol is a group one carcinogen, which doesn't mean that it may or it might.

38:48 It means it does cause cancer. Other uh recommendations from the FDA saying that the best amount of alcohol is not one or two or three drinks a night. It's none. And that's how much you should be drinking. And I think most people know that by now. Right. But there's a difference in hearing those things and acting on them.

39:09 And it's very easy to go home and have because people have been doing it for years, one drink a night, two drinks a night. And I'm not saying by any means that having one or two drinks a night is necessarily going to kill you. There's other things that are group one carcinogens that people do regularly that aren't necessarily killing you.

39:31 I I think red meat might be on there, to be honest with you. And people still eat cheeseburgers, yeah. Right. Yeah. So I'm not saying you have to give up all alcohol by any means. But people know that drinking is probably not good for you. It's not. And yet they still do it. But in this question, we kind of went back to that anecdote that when I was talking to people about whoop.

39:53 What's the one thing, you know, oh, I work for whoop. Oh, I have a whoop and I've had it for two years, and I actually have to stop drinking because of it. And why is that? And I think there's a big difference between the person who is or is not seeing every day the consequences of their actions. And when we look at the behavior change literature, things like uh weight loss or blood pressure, frequency of measure is a key predictor of change.

40:21 People who wake up every day and weigh themselves or measure their blood pressure.

40:27 And that's what we see in our blood pressure data.

40:28 Exactly.

40:29 And our frequency and our and our body weight data.

40:31 And the tobacco data. And the tobacco data. It's a it's a it's a continual trend. And this isn't surprising. Like if I am trying to lose weight and I get on the scale every day and see that my weight is not changing or going up, I can't help but think about that when I open the refrigerator or when I go shopping, because it's etched in my memory.

40:51 And the same thing happens with people with alcohol when they get on whoop. We talked about in the last study the consequences of alcohol on whoop data. It's probably the biggest predictor of a red recovery on whoop. And so when you wake up for a year or two years of being on Whoop and you see continually the trend in your data that the, like for me personally, I know that if I have some alcohol, I am not waking up in the green the next day.

41:19 I'm probably red or maybe yellow. And people see that, and it's it's obvious to them. And so all it has to do is start with, you know, maybe one night, and people can go in and set goals, and they do on the platform. Oh, I'm just gonna not have alcohol one night. And they wake up and they see a green recovery.

41:38 And I'm like, oh, and it becomes addictive. Yeah. And it becomes easier to drop something that was previously addictive that's like you from that green store. Right. I enjoyed, you know, having my drink. But you know what I enjoy more is actually the fact that I'm getting 20 minutes more sleep and that my sleep efficiency is 5% higher.

41:54 And that my response is.

41:55 I'm getting a higher strain because I'm moving more.

41:58 My health span is moving in the right direction. And that's a positive feedback loop in and of itself.

42:02 Right.

42:03 And so in this study, we actually studied 30,000 members on WHOOP stratified by uh biological sex. So 15,000 males, 15,000 females, uh over 72 weeks on WHOOP. So we didn't do it three months, we didn't do it six months. We wanted to know if there was long-term and stable behavior change to people who reported alcohol on Whoop.

42:28 And 72 weeks more than gets us there. Yeah, it's almost a year and a half of data. So it's a lot of data. Now, was it their first day on WHOOP, 72 weeks after?

42:39 Yeah.

42:39 Yep. I think that's important to note because I want to come back to that.

42:42 Yes.

42:42 Yeah.

42:43 Yep. And they had to specifically report yes or no to alcohol in the journal. It wasn't like we said, oh, days they didn't report, they didn't have alcohol. Right. Like, no, days they didn't report, we didn't consider. Right. It was like, did you or did you not have alcohol? Right. And so yes, there could have been reporting bias.

43:00 So we looked at the days that they reported no alcohol versus alcohol.

43:04 Right. And there could be reporting bias, right? If I must say that's like an obvious limitation. Right.

43:09 Which we obviously call out in the discussion.

43:12 For sure. But over time we see a progressive reduction in the frequency at which people were drinking. And it ended up being something like 25%. People on a given day, 72 weeks after joining Whoop, are 25% less likely to have a drink than when they joined. And that's pretty interesting from the perspective of a behavior that is so commonly on Whoop.

43:38 And I think to your earlier point, behavior change is very hard, right? Like it's it's hard because we have access. You know, if you have resources, you have access to alcohol, right? You have access to food. Like you, you know, you have access to, you know, if you're trying to lose weight, for example, well, it's tough because you have access to food 247, right?

43:54 If you've got resources, you've got access. And it's the same with alcohol. So you have to really Evoke some discipline and some willpower, you know, and and I think that's where I think that's what's exciting, despite some of the limitations in terms of us knowing exactly why people decreased their alcohol consumption.

44:14 There is a really compelling pattern of decreasing alcohol consumption. And I think we know just from our own experiences, when we have a drink close to bedtime, it impacts our resting physiology in negative ways. And we see that we get that feedback loop and it changes our behavior.

44:30 Yeah.

44:30 And I will say, you know, for folks listening, you know, who are like, oh, well, we don't know why they came on to Whoop in the first place. If you started tracking, you know, their data when they came on in day one and you looked 72 weeks out, maybe they got on because they specifically wanted to quit drinking.

44:46 Well, great. You know, I mean, people see that as a limitation because we we can't obviously, we don't know what people's motivations are. But I think from my perspective, if you are struggling with substance use, you're struggling with managing your weight, you want to lose weight, and you are motivated to make change, whoop is an unbelievable companion.

45:05 Yep. Right. Like if you want to lower your blood pressure, whoop is an unbelievable companion, right? And that's in just having visibility into how your body is responding and adapting to inputs is one of the most incredible sources of insight we can have have as humans in modern society. Because modern society does not make any of this easy.

45:26 We are not wired for modern times. As a result, we need a strategy, right? And that's what Whoop gives you is a little bit of a strategy. And so for any of those people pushed back on data, like, okay, go live on the savannah, great. And you probably don't need it. But in modern society, we do.

45:46 Yeah. And to that point, um, it is very possible that some people were like, hey, um, you know, I am trying to get off alcohol, so I'm gonna buy Whoop, and I'm gonna change my life. And so one of the things we actually looked at, thanks to uh Reviewer 2, uh asked a comment about, well, because they knew they must have known Whoop.

46:05 Yeah. They said, um, well, what about like goal setting? Did you look at goal setting? And so we actually went back into the data and it was something around, I think maybe a quarter to a third of the 30,000 people we studied did go into the app and set a goal to reduce their alcohol consumption.

46:20 Okay, so we we have that's right, we have a little bit of motivation.

46:22 But we also looked at people who didn't do that. And what was even more interesting is both groups had a reduction in alcohol consumption. And the reduction was fairly similar. But as a matter of fact, the reduction was a slightest bit greater than the people who didn't even set a goal, which means people are probably reducing their alcohol without having the and it could be that they just didn't go into the app and set the goal.

46:49 I'm not gonna say that.

46:50 Right, right.

46:50 But I think just again, the visibility. You have a drink, you wake up, and it just smacks you in the face that you had a drink last night. It's on it, you know, you do it look at that for 500 consecutive days, and eventually you're probably gonna make a change. Yeah. If you keep touching a hot stove, eventually it's gonna burn you.

47:07 Right, right.

47:08 And I think people see that in their data and change their behavior.

47:11 And what's cool, like you said earlier, we see this across tobacco use, we see this across marijuana use, we see this with blood pressure and weight management. So it's exciting.

47:21 Yeah.

47:22 Yeah. It's certainly uh because behavior change is hard.

47:24 Yeah. And we need tools to help us.

47:27 Yeah. And I think a lot of people, when they think about wearable technology, and I was having a colleague, a conversation with a a colleague in academia about this. Is they were reading the alcohol and tobacco studies, and he said, you know what, now I get it. He's like, you know, my um my wife and my kids like have uh wearable devices.

47:49 And I've never really like understood what the goal of them is. But he's like, and now I see it, that it actually does provide this catalyst for behavior change. Yep. And I think a lot of people don't really realize that. They don't really understand like what's like, oh, well, uh, you know, Cristiano Ronaldo wears it because it helps him with his soccer, or Tate Pagaccio wears it because it helps him win the Tour de France.

48:12 Right.

48:12 But that the average Joe can wear it to figure out that when they sleep more consistently, they play better soccer or that they do better on their exams.

48:22 Or they're just a better dad or mom, like partner.

48:26 Exactly. Yeah. And so I think that is kind of a bit of a reframe of like showing, and again, not definitive because all of this is associations. We need to do uh prospective, right, robust longitudinal studies, and those are coming. But we have to start somewhere. I think this these are really some of the first studies to come out showing that these wearable devices can be a catalyst for meaningful behavior change.

48:52 Yeah, and I think, you know, this is a a big shout out to product and to the algorithm development that, you know, it is people pay attention to these these numbers, you know, and and I think that is exciting, you know, and and there's always a lot of work to do there. Um, because again, humans are complex and life is dynamic, um, and there are people have a lot of constraints.

49:15 But I think at the end of the day, you know, we say this all the time, like you, you know, you you it's very hard to to manage what you're you're not you don't see and and you're not measuring, right? And and I think it that's really the story here, you know, is is you see and you you change. Right. Um and you know, an alcohol is is a great example and a bad example in that it's just so acute that it's hard to not pay attention to it, you know, and and some of the other behaviors, and I think this maps onto what you say, what you said, Greg, in in terms of just like kind of mindset, but some of these other behaviors are a little bit more subtle.

49:48 It's not quite as obvious, right? That irregular sleep wake time is like impacting me, uh my sleep quality hugely, right? Or is impacting my heart variability hugely. Like it, you know, these are smaller effects, but I think I think what's important to note is that when we don't pay attention to some of the smaller effects, they compound over time.

50:11 And what happens, and and this is where, you know, when I think about just myself as a professional and the mom, you know, I'm not Ronaldo and I'm not Pat Mahomes, and I'm not, you know, Caitlin Clark and Sue Bird, I'm not those people, right? But I don't want to adapt to a lower level of functioning mentally, physically, emotionally, and spiritually, right?

50:30 So just understanding where I'm at and paying attention actually to some of the more subtle stuff, right? The alcohol, that's pretty obvious at this point, right? But it's some of the other subtle, like more subtle shifts, right? That if I can counteract those subtle shifts, then um effectively preventing that slow insidious decline that we accept as we age.

50:54 We don't we don't have to accept that, right? We have visibility into it, right? And and to me, that's that's the beauty of this data is that we can counteract, you know, we can, we can, you know, with our our behaviors and and thus basically stop this potential decline, right? Or or uh delay it or mitigate it, right?

51:15 So I think visibility, you know, into the data across a number of different behaviors can be wildly helpful.

51:21 Yeah. And even though the shifts are subtle, like half a beat per, you know, we have the paper interview right now about sleeping with dogs, cats, and kids in your bed.

51:29 Right.

51:30 And one of the things we get is like, oh, if someone sleeps with a dog in the bed, they get a little more sleep, but their heart rate's a little bit lower. So what do you make of that? It's like, well, like, yeah, maybe like a half beat per minute or one beat per minute decrease or increase in your resting heart rate isn't clinically meaningful.

51:45 Right. But what if you take sleeping with a dog and combine that with curtains like blackout curtains and a colder room? And then all of a sudden you've got one beat per minute. You're no, you're borrowing from different places, one beat per minute here, one beat per minute there. Right. And all of a sudden you've created an environment where you can optimize your your life, right?

52:04 And unlike sunscreen, it does compound in in a way like you can't add up, oh, put 15 on and 30 and get 45. It doesn't work that way. I know, just is gonna hang with me, but yeah. Um, but you can add up these little increments, you know, and and uh and yeah, and and it and it it does add up. For sure.

52:25 Yeah. Is there anything you want to leave our listeners with? We covered a lot.

52:30 We have covered a lot. Yeah. I would just say, you know, we're not here to like demonize alcohol or anyone's choices. No. But that there is this uh, you know, perception of an invisible cost of drinking, or that if I'm not necessarily feeling bad the next day, that uh it's not having any consequences and um you know the consequences are there.

52:51 And so I think if anything, uh it can help, you know, whoop can help teach to moderation in that regard.

52:59 And have a strategy, right? Like let's not wing it, right? Yep.

53:02 Yeah, at least know at least know what it's doing.

53:04 At least know. Yep. Well, thank you so much, Greg. As always, uh you are amazing. Wealth of knowledge.

53:10 Thank you, Kristen.