Sober Day #35- Sleep vs. The Attractiveness of Alcohol

Yesterday was the first time in a number of weeks that I felt a yearning for alcohol.  Specifically, I wanted the rosy-hued lenses supplied by about 2 glasses of wine.  I wanted that feeling of remembering all I had to do, all the commitments coming due-  and not really caring.  That feeling of being in a protected place where nothing bad could touch me, where nothing demanding really mattered.

WTF?  I said to myself.  Why now?  What's going on here?  I remain committed to doing these 100 days without alcohol, but found myself thinking longingly to Feb 2014 when the 100 days will be up-  wouldn't a nice glass of dry sherry taste good, sitting by the fire and gazing at the snowy landscape outside?  Mmmmmm.

And then I saw a possible connection.  For most of my almost-5-weeks of abstinence, I've been sleeping a lot.  Seven hours at a minimum- sometimes 9, once even 10 hours!  This is in contrast to my former staying-up-late-having-one-more-glass-of-wine, with about 4 hours as my usual time in bed.

Sunday night I stayed up late finishing a fabulous book.  It was after 1 AM when I got in bed, and I was up as usual at 5:30, meaning just a few minutes more than 4 hours of sleep.  It was the first time since starting this challenge that I got so little sleep, and the first time since starting this challenge that alcohol seemed so attractive.

I am guessing there is a connection, that insufficient sleep decreases my psychic resilience, my ability to cope gracefully with daily life.  Therefore leading to more stress (even though I didn't overtly feel more stressed than usual).  And this, in turn, leading to feeling the need for relief in the form of alcohol.

Hmmmmmmm.

Perhaps a productive approach for me would be:  When alcohol is calling to me louder than usual, look carefully for what sources of stress might be in play.  And tackle the stressor directly, rather than seeking to quiet it temporarily with alcohol.

Sober Day #34- Christmas, Autocorrect and 21st Birthday!!

Wow, I'm 1/3 of the way to finishing my initial 100-day challenge.  It's hard for me to believe I could actually do this!  Although now I feel pretty confident of being able to finish the full 100 days-  even though those 100 days encompass holiday parties, Christmas and New Year's Eve.  Phew!

The good thing about this time of year, though, is the vast number of satisfying activities that don't necessarily require alcohol.  Trimming the tree?  On my agenda for today!  Finishing the match-making of friends and family with gifts they will love?  80% done!  Enjoying wrapping the presents, beginning stuffing stockings?  Next weekend, I think.

And great news!  Older daughter, who lives about an 8 hours drive away, will be coming home later this month for a few days, and will be here to celebrate her 21st birthday with us! (She is a December 22nd baby).  I texted her that Dad would take her out for a gin and tonic, but we'd stick to flavored seltzer water at home (she knows about and supports my participation in the 100 day challenge).  But Autocorrect changed my text to "Gun and Tonic"- and she allowed as how Gin was more enticing to her than Gun, lol!!  That app is full of giggles-  yesterday it also changed 'septoplasty' to 'sextuplets'-  a veritable comedian!!

And no wine in my life these days!  It does get a little easier.  But not Easy.  

Sober Day #33- Vitamin D deficiency and Alcohol Use Disorders

Vitamin D (the one we get from sun exposure on our skin) deficiency is wide-spread in the US, and its lack is associated with occurence and worsening of all sorts of chronic inflammatory diseases.  For example, if you plot the average vitamin D levels on a US map, levels get lower and lower as you go further north- which makes sense if you consider the sun exposure and intensity increases as you head south.  The decreasing levels as you head further north correlate with increasing ER visits for asthma. 

This study finds that lower vitamin D levels are associated with more alcohol-use problems in an Asian population.  It's not much of a stretch to guess that the same pattern occurs in the US.  The association, of course, does not prove or disprove causality.  Does low vitamin D predispose to alcohol overuse?  Or does alcohol overuse cause vitamin D deficiency?  Or is there even a direct connection between the two, or might they be totally independent variables?  

What action to take while waiting for more data to answer these questions?  I suggest that each of us should check our serum vitamin D levels, a simple blood test.  If we are indeed low, taking enough vitamin D to bring our levels at least halfway up the range of normal levels (i.e., at least 50-60 nmol/L) will have all sorts of health benefits, and might make (this is a stretch, not fact) early sobriety easier.  (More to come in future posts about other baseline blood and other testing that might be useful in early sobriety).

Abstract

BACKGROUND:

Mounting evidence suggests that deficiency of vitamin D may be associated with major health problems, including alcohol-use disorders (AUD) and major depression (MD). This study aimed to identify the vitamin D status of Nepalese inpatients with an AUD. We explored socio-demographic and alcohol-use related correlates and the relationship between vitamin D deficiency and comorbid MD.

METHODS:

A cross-sectional study was conducted on AUD inpatients (N=174) at eight alcohol/drug treatment centres around Kathmandu. Structured questionnaires were administered to assess the socio-demographic and alcohol-use parameters and to establish DSM-IV diagnoses of AUD and MD. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25(OH)D) concentration of <50nmol/L.

RESULTS:

The prevalence of vitamin D deficiency was 64%. Higher age, having a stable job or business, shorter time since last alcohol intake and winter serum samples were related to having lower 25(OH)D levels. Several features of AUD severity were associated with low vitamin D levels: guilt about drinking, using alcohol as eye-opener, and history of relapse after alcohol treatment (p≤0.03). Patients with a comorbid major depression, in particular secondarily depressed cases, were less likely to have vitamin D deficiency (X(2)=6.8; p=0.01).

CONCLUSIONS:

This study confirms high rates of vitamin D deficiency in alcohol treatment sample and shows a positive association between vitamin D deficiency and severity of alcohol-use disorders. Competing risk and other confounders may help explain the vitamin D status among patients with alcohol-use disorders and comorbid major depression.

Neupane SP, Lien L, Hilberg T, Bramness JG.  Vitamin D deficiency in alcohol-use disorders and its relationship to comorbid major depression: A cross-sectional study of inpatients in Nepal.  Drug Alcohol Depend. 2013;133:480-5.

Sober Day #32- First Holiday/Vacation without Wine

Today it is official!  Thanksgiving without wine, and a week's vacation in New Orleans without wine.  Truly a Milestone for me.

These are the things I did to help ensure my No Wine success this week:

(1)  As soon as we arrived, I stocked up on flavored seltzer water and diet soft drinks.
(2)  I permitted myself food treats this week that I usually steer clear of- my usual diet is No grain, No sugar- and this week I had some of both.
(3)  I arranged distractions of Non-Wine things I enjoy:  crossword puzzles, jigsaw puzzle, new embroidery threat, a quilt that was done except for hand-stitching the binding, a large stash of magazines and a few new books, etc
(4)  I enlisted the help of a few trusted folks- DH, one sister, my nephews- to help distract attention from me if there were questions about my not drinking.  DH was kind enough to refrain from ordering any alcohol when we ate out.
(5)  I took my kindle with me to social gatherings, and occasionally excused myself for a few minutes of Reorientation by Book.
(6)  I invented the Detail Game:  When I feel disoriented or regretful about no wine, I refocus on my surroundings.  I challenge myself to notice at least 10 details that I haven't seen before.  This turns out to be fascinating:  from cracks in the ceiling (a la Madeline in Paris?) to a carved wooden edge to the table I'd never noticed, to a column of caged oyster shells at the restaurant-  this approach seems to add a richness and grounding.

What do you do to help set yourself up for No Alcohol Success?

Sober Day #31- Eating to support Sobriety

Being a somewhat insatiably curious person, I find myself wondering about how we in early sobriety can use nutrition to support ourselves, how food and supplements might hasten our return to vibrant health.  And there is a ton of information available, as my initial google searches have identified.

On the other hand, as a scientifically-trained physician, I am highly skeptical of unattributed blanket claims.  Things like:  Eat more vegetables, Never eat xxx, always eat a lot of yyyy- grab my attention in a bad sort of way.

So I have given myself a new task:  Developing a health assessment useful for establishing a health baseline on quitting alcohol, and coming up with evidence-based recommendations for food and supplements.

Evidence-based means that I can show you (a) specific article(s) from peer-reviewed medical journals that provide good evidence to support that recommendation.  It is the opposite of the 'snatched from thin air' recommendations found proliferating on the web.

As soon as I figure out how to do it, I will make a separate page summarizing these ideas, with references back to each specific post detailing the scientific evidence for this particular recommendation.

My Thanksgiving, BTW, was alcohol-free and pretty awesome.  This was my first major holiday without alcohol, and it went pretty smoothly.  Thank goodness I have a relatively drama-free family, so I didn't have to cope with the massive drinking around me or other major crazinesses that many of our community had to face, and I am grateful for that!!

Sober Day #30- Happy Thanksgiving!! The Visit

Last night a dear friend I hadn't seen in a while visited us in our rental house here in New Orleans.  Our typical evenings together are usually sharing wine while catching up on news.   I texted her about my 100 day challenge- expecting that she wouldn't drink when we got together.  Yet when I texted her yesterday about what she'd like to snack on, she replied:  white wine and I eat almost anything.

Well, I thought, I can handle this.  I asked DH if he would please buy a bottle of white wine, open and pour it for her, and handle pouring refills so I didn't have to handle the wine bottle at all.  And so he did.

Observation #1:  Friend is a devout Catholic.  She mentioned how another friend of hers was also doing a 100 day no-alcohol challenge- for a special novena or something (please forgive, I'm sure I have the religious terminology wrong).  And friend approached my challenge like it was no big deal, like it wouldn't be any harder for me than, say, giving up sweets for Lent.  And I actually found this very refreshing.  Since it was no big deal in her mind, it made it easier for me to say to myself:  This is no big deal, you are just choosing not to drink wine tonight.  It turned out to be very refreshing NOT to have a moral/judgmental component attached to my actions.

Observation #2:  I bought a big jigsaw puzzle for us to work on as we talked, as distraction for me.  This worked well.  And as we sat at the DR table doing the puzzle, I had the same great time I always have with her, complete with lots and lots of belly laughs.  I will admit we also had a ton of great food to nibble on, which helped me feel not-deprived (back to my usual low-carb eating after this week in New Orleans!!!).  And not-drinking was not nearly as hard as I feared it might be.

The things I keep learning about sobriety, they continue to surprise me!

Happy Thanksgiving and Many Blessing for the coming year!

Sober Day #29- Bone Density Improvement after Quitting Drinking!

As a, ahem, mature female, I do think about my bone density.  I want to keep it strong and normal to support a healthy active life as I age.  My weight-lifting, pilates, yoga, TRX, cardio, etc, certainly help-  but I also know chronic alcohol overuse has an adverse affect on bone density.  Therefore I was very happy to come across the following article.  What I have reprinted here is the article's abstract.  The full reference is at the bottom of the post, for anyone who wishes to review the original article in it's entirety.  It is available at www.pubmed.com as a free full text article.  I have highlighted the bits that are the most relevant!  

AIMS:

The aims of this study were to assess bone mineral density (BMD) and content (BMC), osteocalcin, serum telopeptide, PTH and vitamin D in alcoholics, and to determine if a 6-month period of abstinence leads to changes in these parameters.

METHODS:

Serum osteocalcin, insulin-like growth factor 1 (IGF-1), telopeptide (40 patients) and 1,25 dihydroxyvitamin D, were measured in 28 controls and 77 alcoholic patients, 48 of whom were evaluated again 6 months later. All patients underwent whole-body assessment of BMD by a Hologic QDR-2000 (Waltham, MA, USA) bone densitometer, at the beginning of the study and 6 months later.

RESULTS:

Patients showed higher serum telopeptide levels **(0.59 +/- 0.40 versus 0.19 +/- 0.10 nmol/100 ml, P < 0.001), lower IGF-1 [median = 49, interquartile range (IQR) = 31-121 ng/ml versus 135, IQR = 116-237 ng/ml, P < 0.001], vitamin D [26.5, IQR = 17.0-37.8 pg/ml versus 82.4 (IQR = 60.9-107.4 pg/ml, P < 0.001] and osteocalcin (2.1, IQR = 1.1-3.6 ng/ml versus 6.65, IQR = 4.9-8.8 ng/ml, P < 0.001) than those in controls. Patients also showed lower BMD values, Z- and T-scores at many levels of the skeleton and reduced total BMC. After 6 months, those who continued drinking showed a loss of bone mass, whereas those who abstained showed either no change or increase, differences being especially marked at pelvis, right arm and total BMD and BMC. Simultaneously, abstainers showed a significant increase in osteocalcin (versus a decrease among those who continued drinking). Serum telopeptide increased in both groups.

CONCLUSION:

Ethanol consumption leads to osteopenia, and decreased serum osteocalcin, which improve with abstinence, whereas those who continue drinking show a worsening of both parameters.

Full Reference: 

Alvisa-Negrín J, González-Reimers E, Santolaria-Fernández F, García-Valdecasas-Campelo E, Valls MR, Pelazas-González R, Durán-Castellón MC, de Los Angeles Gómez-Rodríguez M.   Osteopenia in alcoholics: effect of alcohol abstinence. Alcohol Alcohol. 2009;44:468-75.