# What Alcohol Actually Does to Your Gut Lining | Dr Wil Bulsiewicz

An episode of [Live Well Be Well with Sarah Ann Macklin | Health, Lifestyle, Nutrition](https://invisiblenetwork.ai/podcast/1508380100), 5 Jun 2026, 11 min.

Audio: https://anchor.fm/s/1033d1554/podcast/play/120548655/https%3A%2F%2Fd3ctxlq1ktw2nl.cloudfront.net%2Fstaging%2F2026-4-26%2Fe9d79410-b2a2-c8ab-7489-1313f662e9ff.mp3

Is one glass of red wine a day actually good for your gut? In this conversation, I dig into why the idea of “moderate drinking” being beneficial became popular, and how newer analyses suggest that earlier cardiovascular findings may have been influenced by confounding factors like diet, exercise, and affluence. Will Bulsiewicz in conversation with Sarah Ann Listen to the full episode here. Watch the full episode on YouTube here. *** This episode is sponsored by: NOWATCH: The compassionate health tracker Connecting body and mind with unique stress recovery insights so you can live fully today15% off with code LWBW15 at https://nowatch.com/ DIOME: Rest deeper. Stay grounded.Rested is available now and Grounded lands later this month.👉 Get 20% off with code SARAH20 at DIOME.CO *** The Great British Veg OutHow to support your gut, energy, and hormones by eating more — not less. 👉 https://sarahmacklin.substack.com/p/the-great-british-veg-outReset Your HealthIf your body feels off after stress, travel, or burnout — this is where to start. 👉 https://sarahmacklin.substack.com/s/reset-your-health-in-30-days 👉 Practical beats perfect.Here’s a free 5-recipe PDF I use to support energy and stress during busy weeks.https://sarahannmacklin.com/5_free_recipes 👉 If this resonates, you can join the thousands who readThe Compassionate Cure each week.https://sarahmacklin.substack.com/ *** Let’s be friends! 📷 Instagram: https://www.instagram.com/sarahannmacklin/ 📹 Subscribe: http://www.youtube.com/@livewellbewellsarah 🐦 Twitter: https://x.com/SarahAnnMacklin 📱 TikTok: https://www.tiktok.com/@livewellbewellpodcast💌 Newsletter: https://sarahmacklin.substack.com/

## Transcript

[0:02] This is a Beware moment, the most replayed moments from my
[0:05] latest conversation. It's a glimpse into the wider
[0:08] episode, which you can find LinkedIn the show notes below.
[0:12] Because sometimes one small moment is enough to reconnect to
[0:16] living well and being well. There's been many experts over
[0:24] the last five years that have come onto the show.
[0:25] And also when I've gone to the Royal College of Physicians and
[0:28] listened to different conversations, people have cited
[0:32] that, you know, one glass of red wine a day is fine for your gut
[0:36] microbiome. It's got, you know, polyphenols
[0:38] in it. So it's not actually that bad.
[0:40] And there's always been, you know, a bit of indiscrepancy on
[0:43] whether people believe that or they don't.
[0:46] I think one thing that we can all agree on is that social
[0:48] drinking, if it brings you a little bit of joint connection,
[0:51] that's undeniable. But when we're actually just
[0:54] isolating it now, taking all of that part out, just isolating it
[0:57] to like the gut lining and inflammation and exactly what's
[1:00] going on in the body. It was really interesting to
[1:03] hear that your own views have kind of changed a lot as well
[1:06] understanding on alcohol and you kind of mentioned that you don't
[1:09] believe alcohol to actually have any health benefit from a recent
[1:13] study that you that you looked at whilst you were writing this
[1:15] book. Can you explain a little bit
[1:17] about how the conversation has shifted from the original 2011
[1:22] systematic review, which which is where this will really stem
[1:25] from showing that moderate drinkers had a lower risk of
[1:28] cardiovascular disease, which is why I think this whole
[1:30] conversation started to now to what you've recently discovered
[1:34] and why your views on this are, are quite strong when it
[1:37] literally just comes directly to the gut microbiome.
[1:40] First of all, let me say I totally agree with you that when
[1:43] you are making the choice to go out and be social, if you choose
[1:47] to consume alcohol, like I don't think you should feel horribly
[1:49] bad about that. I also don't think that you
[1:51] should like make it a weekly pattern that every Friday and
[1:54] Saturday night you're going to go and get smashed.
[1:56] Have you met anyone British? Yeah I have.
[2:00] I know how y'all like to enjoy your pub on a Friday on a Friday
[2:04] after. Work.
[2:04] It's like busy at 11 AM. Yeah, yes, no, I understand.
[2:10] I understand. So I mean, look, the social, the
[2:12] social aspect I think is, is relevant because we do have a
[2:16] loneliness issue at the same time.
[2:19] So we need to find ways to be connected with one another.
[2:22] So that being said, really what we're discussing here is like,
[2:26] if you, if this was not for social purposes, if you were
[2:29] sitting at home by yourself, should you be consuming alcohol
[2:33] on a regular basis? And this original study, these
[2:37] are, these are population based studies.
[2:38] They're epidemiology studies where you're trying to like
[2:42] understand a risk factor for a specific condition.
[2:47] And when they examine alcohol, what they discover is that
[2:50] actually the people who consumed A moderate amount of alcohol, so
[2:53] like 1 to 2 drinks per day, they actually had lower risk than the
[2:58] people who were zero drinks, and they had lower risk than the
[3:02] people who were excessively consuming alcohol.
[3:05] So it sort of led to this idea that there's this sweet spot
[3:09] where you should be 1 to 2 drinks per day, and that's what
[3:12] you should target. And that was just the
[3:14] cardiovascular disease, right? Nothing else.
[3:16] It was just cardiovascular disease that study was showing.
[3:19] From my right I believe it was for cardiovascular disease, but
[3:21] I I I have it here. I have to dig into more detail.
[3:25] You too. Underlined.
[3:28] Perfect. Thank you.
[3:29] Thank you. So anyway, the, the issue with
[3:34] this, and I, just to be clear, I'm actually a big believer in
[3:37] epidemiology studies. I, I studied at the University
[3:40] of North Carolina, which is the #2 School of Public Health in
[3:42] America on this particular topic.
[3:44] I have a master's of clinical investigation.
[3:47] But the, the problem that exists is that you can have
[3:50] confounding, which basically means that there's stuff that's
[3:54] impacting the result that has nothing to do with alcohol and
[3:57] heart disease. There's other factors.
[4:00] So do people who drink wine, do they tend to be more affluent?
[4:04] Yes. Do people who drink wine, do
[4:06] they tend to be people who live a healthier lifestyle and have a
[4:09] healthier diet? Yes.
[4:10] Do they also tend to be people who exercise more often?
[4:12] Yes. Could those things impact heart
[4:14] disease 100%, and can we account for all of that in a study?
[4:18] No, you can't. That's the problem.
[4:21] You can have this like leftover element that you haven't fully
[4:24] addressed. And so there have been more
[4:28] recent studies in the last five years that have called this
[4:31] entire discovery into question because when they do more
[4:35] thorough analysis of these confounding factors, they
[4:41] actually discover that it goes that there is no advantage
[4:44] relative to 0. So then it leads me to, OK, well
[4:50] what is the impact on the gut microbiome?
[4:53] And what we know with 100% total clarity is that heavy drinkers
[4:57] definitely don't have a healthy gut microbiome.
[5:00] In fact, what I've found is that in order to develop alcoholic
[5:03] liver disease, things like cirrhosis or alcoholic
[5:06] hepatitis, it's actually a required step that the
[5:10] microbiome basically collapses. So in order to get to the
[5:14] disease, you actually need to ruin your gut and then you will
[5:17] develop these alcoholic liver diseases.
[5:20] OK, so but what about like this idea of one to two drinks?
[5:25] What does that mean in the gut microbiome?
[5:27] Well, there was this study that sort of changed my perspective
[5:30] on it, where they took a group of people and they, they had
[5:35] them consume alcohol consumption to like at the point of
[5:39] intoxication, where if they had, in the States at least, if they
[5:45] had a sobriety test, they would fail.
[5:49] And like you couldn't drive, you would, you would get pulled over
[5:51] and get a ticket. So, and they measured 2 things
[5:57] every 30 minutes. They would measure their blood
[6:01] alcohol level and they would measure what's called their
[6:05] lipopolysaccharide level. What's that?
[6:08] Now, lipopolysaccharide is a toxin that lives on the surface
[6:15] of bacteria like E coli, and these are bacteria that are
[6:19] inside your intestines. They're in your gut, and the
[6:23] purpose of your gut barrier is to keep them in your gut.
[6:29] And when the gut barrier gets weak, we call that increase
[6:32] intestinal permeability, but many people call it leaky gut.
[6:35] I don't have a problem with that because the leaky gut allows
[6:40] these bacteria to sneak across and then you can actually detect
[6:44] them in the blood. So these inflammatory bacteria
[6:47] are now present in your bloodstream.
[6:49] They weren't supposed to be there.
[6:52] And So what they discovered was that the, and for people who are
[7:00] not watching on YouTube, you may want to flip over because
[7:05] basically I'm going to show with my hands that they had this
[7:08] graph of like how the blood alcohol level went up after they
[7:14] started drinking. And you could have superimposed
[7:20] the lipopolysaccharide level because it was a mirror image.
[7:23] Like it was basically like you could just carbon copy it right
[7:27] over the top of it. Basically the lipopolysaccharide
[7:31] levels matched what was happening with the blood
[7:34] alcohol. There was this weird moment and
[7:37] I can't explain why this happened, but the blood alcohol
[7:41] level went down and then it kind of blipped up a little bit.
[7:43] It kind of went back up. Guess what the
[7:46] lipopolysaccharide did? It went down and then it blipped
[7:48] up. It copied.
[7:50] And then the last thing is that the lipopolysaccharide level
[7:55] didn't get back to 0, not 0, but didn't get back to normal until
[8:00] the alcohol level was literally 0.
[8:03] So to be clear, the study wasn't on one or two drinks, but I
[8:11] think that the take away from the study for me the fact that
[8:14] there was such 1 to 1 matching of alcohol level in the blood
[8:19] and lipopolysaccharide and that the lipo and that the
[8:22] lipopolysaccharide needed a 0 alcohol level to get back to
[8:26] normal. That to me was sufficient
[8:29] evidence for me to say I don't think there's any advantage to 1
[8:33] to 2 drinks because even that small amount is enough to impact
[8:37] your blood alcohol level and potentially cause leaky gut and
[8:41] that creates inflammation. Wow.
[8:42] How many people do you think are walking around with leaky gut?
[8:44] I have no idea because I think we hear this terminology a lot.
[8:47] And I'm guessing if we are a a nation full of drinkers, I
[8:51] think, you know, we probably drink more than anyone else.
[8:53] When I'm in America, I don't tend to drink as much, but that
[8:57] might be in certain places. What do you think kind of the
[9:01] relationship is between leaky gut and alcohol consumption?
[9:04] The relationship between leaky gut and alcohol consumption I,
[9:06] I, you know, based upon what I'm seeing, it's, it's leading me to
[9:09] believe that alcohol is directly responsible for creating leaky
[9:12] gut. And so, you know, you, if you
[9:16] have, if you have 1/2 of a drink and you feel nothing, then I
[9:23] don't, It's hard for me to argue that that's a disastrous thing.
[9:26] But when you drink and then you feel it, and I would argue that
[9:30] most people even 1 drink, you feel something.
[9:34] That's why you're having it. There's also a big connection to
[9:36] alcohol on the liver obviously as well, and that's a big
[9:39] connection with the liver and the microbiome. 100% these
[9:42] things are completely interconnected and even even the
[9:46] ways in which we manifest a hangover, we have blamed this
[9:54] one particular molecule called acetaldehyde.
[9:57] But actually, if you dig into this in more detail, I'm totally
[10:01] convinced that hangovers are related to basically the damage
[10:05] that we have caused to our microbiome with alcohol.
[10:10] Thank you for listening to this Be Well moment.
[10:12] If it resonated, the full conversation is LinkedIn, the
[10:15] show notes, and I hope it gave you a small pause to take a
[10:19] moment for you and to reconnect to living well and being well.
[10:23] If you loved it, please do leave a review, follow the show or
[10:26] share this maybe with someone you love.

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