Doctor’s Q & A2021-05-08T19:58:27+02:00

Doctor’s Q & A

Our members are able to send us any alcohol related medical questions which we pass straight on to our Tribe Sober doctor. We then publish the questions and answers (anonymously) in case any other members have similar concerns.




How long, after abstaining from alcohol, can I be affected by PAWS.


Dear M

PAWS stands for post acute withdrawal syndrome. It is caused , to put it simply, by the brain complaining about the lack of its supply of alcohol . It typically starts after about a month and can last for about a year depending on the individual. Symptoms are often of a depressive or irritable nature and often occur in cycles more a less a month apart.

Another problem is the sugar aspect. Alcohol contains massive amounts of sugar. A lot of us develop a sweet tooth after abstaining. If we don’t give in to the sugar craving we can develop keto flu, which consists of flu like symptoms. To counteract that, a salty snack often works wonders.

Hope this helps

Best wishes

Dr Judy

Blood Tests


Hi Dr Judy
I’m not sure where you are based, but I was wondering whether you do consultations or have GPs that you could refer to in the northern suburbs of Cape Town.
I recently stopped drinking and want to have some blood tests done to see how bad the damage is (I know I already have increased MCV), and then monitor it over time. Would also be good to get some supplements if needed.


Congratulations on your sobriety. You have made a wise decision and joined the best tribe. I’m situated in Gauteng and don’t know the northern suburbs GPs. However, I would recommend that you contact your nearest rehab centre (for substance abuse). They have GPs that they refer their clients to which are knowledgeable about what to look for and can give advice.

I can recommend Harmony rehab centre. It’s not situated in the northern suburbs but they may know of someone close to you. It is my experience that everyone reacts differently to alcohol and that we all have our vulnerable areas. For some it may be the liver. For others the pancreas or brain. And then there’s the increased risk for cancers. The reason for this is that alcohol causes extreme inflammation which damages our bodies. Therefore, it’s a good idea to have a check up. Let me know if I can be of further assistance.

Dr Judy.


Liver Health


I am afraid that my liver is already damaged beyond repair … I am 65 and have drunk heavily all my life. Have I left it too late and how can you test for this? Thanks


I’m so pleased that you’ve become aware of the possible damage you may have done due to your drinking. And it’s never too late to stop.

Alcohol gets broken down by the liver to acetaldehyde which is extremely inflammatory. This is what damages the liver. However, only about 15% of heavy drinkers develop cirrhosis of the liver. This is thought to be due to our genetics. Some people are better at metabolising the alcohol than others. Fatty liver is very common in heavy drinkers. This can be reversed when one stops drinking, usually within a few months.

There are various tests that can be done to determine the damage done. Liver function tests are not very accurate and are usually only abnormal in end stage liver disease. There is a newish test called carbohydrate deficient transferrin which can demonstrate damage.  A better estimation is ultrasound of the liver. It can show the development of a fatty liver and cirrhosis. The big centers are able to determine the stiffness of the liver which demonstrates the level of inflammation.

The golden standard of liver function is a liver biopsy. It is not without its risks however and the before mentioned is usually adequate to make a diagnosis.

Hope this is useful. Let me know if I can be of further assistance

Best wishes,

Dr Judy.


Liver Supplements or Not?


Hello Dr. Judy. My local pharmacist is recommending a product from Standard Process called Livaplex for liver health through recovery. I wondered if you were familiar/thought it a good idea? I’m not familiar with anything on the ingredients list: A-F Betafood®, Hepatrophin PMG®, Betacol®, Spanish Black Radish, Chezyn®, and Antronex®.

I’m trying to give my body what she needs after decades of way too much wine and I am trying to sort out what would be positive in addition to healthy nutrition. Thank you!


I wish to start by explaining what happens when we drink alcohol. 

The alcohol gets broken down by an enzyme in the liver to acetaldehyde. This is a highly toxic substance which causes a lot of inflammation to our tissues as well as being a carcinogen (can cause cancer). Another enzyme breaks the acetaldehyde to acetone which is then secreted by the body. 

The inflammatory action of acetaldehyde is what damages our bodies and causes the typical lesions of alcohol abuse. In the liver it first causes fatty liver as seen in pate de fois gras (force fed geese). However, in the case of us heavy drinkers I don’t think many of us have a funnel thrust down our throats and the booze poured into our gullets. Further damage causes alcoholic hepatitis and then cirrhosis of the liver. 

What happens when we stop drinking? The body has the most amazing ability to heal itself. As long as we don’t have cirrhosis the liver can repair itself within weeks. To help this process it is important to eat well (no preservatives, colorant’s, processed foods, etc). Also keep yourself hydrated and rest a lot. In my opinion supplements are nice to have but not necessary.

That is except for Vitamin D. Most of us are deficient in vitamin D. It’s very important to our immune system in warding off infections and preventing cancer. As long as we are eating preferably  organic foods , as far as I’m concerned the other supplements aren’t needed

Hope this is of use,

Dr Judy.

I Want to Stop my Daily Bottle of Wine


Dear Dr Judy

I have joined today as a Tribe Sober member. I have been drinking about a litre of wine every night for the past year. I am fully functional and hold down a demanding job, but I feel that it is taking its toll on me physically (I am 60) and I want to give it up.

I acknowledge that I have an addiction. I have read that stopping suddenly is not advisable as withdrawal symptoms can be severe, and so I am looking for a tapering programme or guidelines for creating my own. Would you be able to point me towards some resources or otherwise suggest how I can go about this?

Kind regards


Congratulations on joining our Tribe . It’s extremely difficult if not impossible to stop drinking on your own. One needs the collective experience and support of the members to be successful. Unfortunately, it is also almost impossible to wean oneself off the booze. Alcohol stimulates certain brain receptors. If you try weaning yourself, the brain demands you drink more and you are back at square one.

So cold turkey is the only option. If you are worried about side effects there are multiple centers that could help you with the initial few days. The first 10 days are usually the worst. Or else go and see your GP who can recommend supplements to assist you.

Good luck with the journey. I can also recommend Janet’s workshop. And let me know if you need more information.

Dr Judy


Recovery from a Binge


I have a client and I want to suggest something for him to support his liver. He has had a month-long alcohol binge and is feeling ambivalent. He will be looking at joining Tribe Sober. What can I suggest to him please?


Hi. Regarding recovery from a binge, the most important medication is replenishment of lost nutrients, especially thiamine (vitamin B1) and vitamin B12.

If the patient is very bad this can be given intravenously or intramuscular (at the pharmacy).  Proper hydration and nutrition (preferably plant-based) will also be beneficial.

Hope this helps.

Best wishes,

Dr Judy

Quitting Alcohol and Medication


Hi Judy, I have a brother in the Eastern Cape who is a heavy drinker and I believe he just quit. Sounds like he having severe symptoms and needs medication.

I assume you don’t do telephonic consultations and prescribing meds? Sounds like they are disenchanted with their local GP. Are you at all aware of rehab in the area of Port Alfred? I wonder if rehabs do outpatient management?


Hi! I am sorry to hear your brother is struggling. Alcohol withdrawal is a potential medical emergency. Is there not a hospital nearby?

I would suggest he goes to the local ER for an assessment and treatment. Often the patient just needs an IV infusion of vitamins and a sedative for the anxiety which often accompanies withdrawal.

It would be irresponsible of me to treat over the phone in this situation. Good luck and let me know how it goes.

Best wishes,

Dr Judy.

Pain in Ankle Veins


I would like to know what causes what feels like a very sharp pain around my ankle veins – like a circulation issue? Vitamin B helps but what is the cause? If I have had wine, this will happen very acutely (but not only then) with increased muscle spasms, which I am very prone to. No, I am not magnesium deficient.



Thanks for your inquiry.

Alcohol abuse leads to a shortage of various nutritional substances due to a decreased absorption rate. The most important ones are thiamine (vitamin B1), folate, niacin, vitamin B6 and B12. This affects the nerves to cause the following symptoms: numbness, tingling and burning, a prickly sensation in the limbs, spasms and cramps in the legs and muscle weakness. It can also cause urinary incontinence, constipation and diarrhoea.

Luckily, abstaining from alcohol and treating the nutritional deficiencies will usually cure the problem as long as the damage is not too severe.

I hope this helps.

Dr Judy.


Liver Damage


Dear Doctor

I recently had some tests done, as I thought the reason for my massive weight gain was maybe a liver issue … Turned out that eating too much was the main reason.

One of the tests is S-g-GLUTAMYL TRANSFERASE where my result is 75 IU/L. What does this even mean? My GP just said to cut back on the wine, but I would like to know what is considered a normal count and if “cutting back” not really actually means – QUITTING completely?

I will really appreciate your response.


Your gamma glutamyl transferase is about double the normal value. However, this is a rather non-specific test and there are various reasons that it could be elevated.

I would recommend that you go for a new test on the market called carbohydrate deficient transferrin (CDT) which is specific for alcohol-induced liver damage. It’s quite scary how relatively little alcohol (more than 1 1/2 bottles of wine a week) can damage the liver.

Please let me know if I can be of further assistance .

Best wishes,

Dr Judy

What About My Liver?


Hi Dr Judy,

Last week I joined Tribe Sober as I am desperate to stop drinking. I have been a binge drinker since I was about 17. I am now 37. During these years, I stopped for 6 months in my early 20s, and most recently in 2018/2019 when I was pregnant. Once my son was born, I slowly started again but before I knew it I was drinking more that I have in the last 5 years.

A few days before I joined Tribe Sober, my body was feeling so beaten up. I couldn’t eat, it was painful to swallow food and it wouldn’t go down. I was nauseous all the time, shaking, had cold sweats, and muscle and stomach pain. I just figured it was a bad hangover every day. What scared me though, was that I developed little skin blotches on my stomach, back and thighs.

So my question is: could this be a sign of liver damage and should it be checked out? I have been sober for 5 days now. All the above symptoms, except the blotching, have subsided. Also, besides stopping the alcohol and eating a healthy plant-based diet, is there anything else that I can do take to speed up the healing process?

Your advice would be greatly appreciated. Xx



Congratulations on giving up the booze. It is such a dangerous drug and it damages all our organs, especially the liver, as the liver has to break down the alcohol.
The best way to check for liver damage is to go for a liver stiffness test. Most big centers offer them now. Ask your GP where you could get this. Liver function tests are not accurate and only become abnormal at end stage liver disease.
The pancreas is another organ that becomes damaged, especially with binge drinking. Some of your symptoms can be explained by this. However, severe abdominal pain is the main symptom of pancreatitis.
The skin blotches sounds like an allergic response to me. Hopefully that will subside with time.
I hope this helps. Please let me know if you have any questions or concerns.
Best wishes,
Dr Judy

Losing Brain Power


Hi Dr Judy

I wonder if you can advise. I used to be smart – MENSA smart – and have for the last few years lived in a “dwaal” where I have had memory blanks. I used to forget about what happened in meetings at work, what was agreed, what had been discussed, etc.

And I only drank at night. Black outs and not remembering the night before was the norm. But as I say, I used to forget many things that had happened in the day as well.

I have not been drinking since mid-March and was kind of hoping that the brain-fade would have improved. However, today I can’t remember what I did on Friday and what we might have discussed in meetings. While the black spots are not as frequent, they are still happening. Will they improve or have I damaged my brain (it was once my best asset) forever?




How old are you? Alcohol does affect the brain and it can take a long time to recover. However, there are other conditions that can also affect your brain.

My advice to you is to consult a neurologist so that he or she can try and rule out these conditions and give you peace of mind.

Best wishes,

Dr Judy.

Stopping Alcohol Intake Abruptly


Good morning Doctor,

I am 66 and have been drinking heavily since I was 18. I lately have started hand tremors and decided to stop totally. I have not drank for the last 2 nights and already feel reduced tremors. Is it safe to stop abruptly?
And I feel better.


Well done on giving up the booze! The first  month is pretty hairy. The most scary complication is delirium tremens. This typically happens around the 3rd day after the last drink, but can occur up to day 10. The symptoms are sudden confusion, seizures, fever and high blood pressure.

This is a medical emergency and you have to warn your loved ones to immediately take you to the nearest emergency unit. If you escape this, general supportive guidelines often suffice. Keep yourself well hydrated and well fed. Your body is used to lots of sugar so give in to the sugar cravings, as long as you are not diabetic. Try to avoid stressful situations and be gentle on yourself.

Hope this helps. Good Luck.

Dr Judy

Gut Flora and IBS


Hi Doc

I’ve had something of a candida overgrowth for a long long time now. I take probiotics daily now and seem to be happiest on the Probiflora Junior (2 a day). I suffer with a spastic colon (since teen years) but was able to ignore that until recently, as the red wine seemed to help void the colon.

I removed alcohol from 17 March for 38 days and suffered terribly with IBS, like I haven’t felt it for years. I cut out bread (although have the occasional wheat product) and now try to avoid all grain fiber and also have increased veg fiber daily intake.

Today is 15 days free of alcohol and although I was a little more prepared for it than last time, I’d really like some advice on getting the gut flora balanced, and some info on how these two are related. I find the Probiflora helps as long as I don’t skip a day, but even without skipping, I still get a little discharge despite the probiotics.

Funnily enough, I had some de-alcoholised wine last night (two small glasses) and that was a massive catalyst for a painful reaction over the course of the evening. Pain as there was bloating, which was trying to move I guess, but couldn’t move. I am sleeping a lot better – I was seriously sleep deprived. I used to wake up sometimes at 12am and be awake the whole night. Lack of sleep is like instant IBS for me, I have to be extra careful of what I eat the next day if I did not sleep enough or well.

I guess my body is just in a mess and will stabilise eventually, but my brain keeps going to thoughts of polyps blocking my intestines. Also, I think I have increased sugar/chocolate intake, which may be feeding the harmful bacteria?

Any thoughts or advice for this situation would be greatly appreciated.





This sounds like a much more complicated condition than can be overcome with changing diet and not drinking. Your first port of call should be your GP who will arrange a colonoscopy and blood work to firstly rule out any underlying physical problem.

Polyps are easy to deal with nowadays and are often zapped during the colonoscopy. If it is Candida at the root of things, it requires months of a very restricted diet and specific medication. Worry will also add to the cocktail. My advice would be to not try and treat this yourself. Rule out medical problems, this will then help with the anxiety and only then start to tackle diet, if cost allows, with a good dietician.



Want to Stop Drinking then Moderate


Hi there, I’ve just joined Tribe Sober. I am planning to give up drinking completely for 3 months and then try and moderate. Is Nalttexone available in South Africa, or something similar?

I’m also suffering from huge huge anxiety and panic attacks in which I believe I’m going to die – which I believe are being heightened when I drink more than two glasses of wine a night. Is there anything you can recommend I take? I am also sometimes having suicidal thoughts, which then make me feel guilty.


Answer :

The medications available to prevent you from drinking are:

  1. Disulfiram (antabuse): blocks one of the enzymes that would break down the alcohol in your body. The effect of it is that the effects of a hangover are felt immediately after alcohol is consumed.
  2. Acamprostrate (Campral): mainly used for the maintenance of abstinence. It stabilises the chemicals signaling in the brain that would be disrupted by alcohol withdrawal. It is essentially an anti-craving drug.
  3. Naltrexone (Revia): designed to reduce/suppress the cravings for alcohol and opiate drugs.

All the above drugs need to be prescribed by a doctor, and their effects must be monitored by your doctor. The dose prescribed will be dependent on the assessment made by the doctor.

Anxiety or panic  attacks can be caused by many things and seem to be exacerbated by the alcohol. Having suicidal thoughts is possibly exacerbated by the alcohol. Given the severity of your symptoms and the presence of suicidal thoughts, a doctor’s consultation is recommended to try identify the reason for your anxiety and, where necessary, give you medication. The suicidal thoughts also need to be investigated and managed by a doctor.

Not Drinking Wine But Crave Sugar


Dear Doc

I have not been drinking and have an intense sugar craving, particularly late afternoon and into the evening. I would guess its my body used to the sugar from a glass of wine?

I want to stop the sugar and carb intake and craving – would it be best to go cold turkey or have a block of dark chocolate? I do exercise and am active throughout the day but I feel tired / lethargic in the afternoons – maybe a natural ‘pick me up’ would help ?

I also have a history of diabetes in the family and had gestational diabetes a few years ago, so I have to be really strict with myself to hopefully prevent getting diabetes one day.

Any assistance please!


Alcohol stimulates the release of a neurotransmitter (dopamine). Dopamine is a chemical which has a feel good effect on people. Sugar also has the same effect of releasing dopamine, thus leaving you feeling good. When you stop drinking alcohol, sugar cravings may increase as you seek the feel good effect that alcohol used to give you.

There are healthier ways to get a dopamine “fix”. Some ideas include exercise, yoga, good quality sleep or massages. You may want to try some of these. Stopping your sugar intake cold turkey or slowly decreasing will depend on your self-will. You may want to cut it down and eat sugary feed on the weekend. Having dark chocolate as an alternative could also help with the cravings.

Korsakoff Syndrome, Early Onset Dementia Through Alcohol


I need your advice and hope that you have an answer, (no pressure). My husband and I have an old friend who has Korsakoff Syndrome, early onset dementia through alcohol.

He has had two short Clinic detoxes in the past 3 or 4 years and a long residential rehab this year, and has been sober since April after derailing prior. He was having several weekly one on one therapy and analysis sessions, plus group sessions, during the rehab – but the facility was suspect, both financially and professionally.

He used to live alone but now lives with 24 hour housekeepers/carers, who we call his PA’s. Short-term memory is very impacted and he doesn’t, or can’t, really participate in the various social activities available. When he came out of the rehab facility, he was feeling strong and determined (or so he said) about not drinking again. He is a former specialized wine guide and was a real fundi, I might add.

He is now grappling with the reality of his life and seriously thinking about drinking wine again. We don’t know any therapist, although we hope to make an arrangement through his psychiatrist, who will hopefully be seeing him early October.

I was wondering whether you had any ideas of how we can help him with some professional conversation to keep him on the right path? I have told him about my sobriety, but, being an old friend, I am possibly too close to him for him to take real notice of what I am saying. His memory issues bring an added facet to it.’


Dear J

Your friend is very lucky to have you as a friend, that already is wonderful. It is very encouraging that he has been off alcohol since April. We all know it is imperative that he stays off it. I am sure he is getting adequate medical treatment, with B vitamins, and treating any underlying mood disorders.
The socialization and making new friends in a new environment is difficult for all of us, let alone when you are battling this demon. There is no doubt that connecting with others is what ultimately makes life have meaning. I have two suggestions that are non-medical and that might be sustainable. The routine and stability are very important, also any intervention must be sustainable, please keep it in mind. I make these suggestions with not much knowledge regarding the sustainability.
I would suggest that you get an Occupational therapist involved who is involved with rehab around dementia. There are private facilities, but the facilities at the academic hospitals, as well as the academic psychiatric hospital, will be great. They evaluate your lifestyle and help with tasks for daily living as well as physical activities … crafts etc. They are an enormous value-add.
The other suggestion is a companion animal. This will need to fit in with any rules of where he lives. There is so much data to support the improvement in quality of life. It gives us meaning, relieves boredom and it gives us opportunity to be compassionate.
My best wishes to you and your friend.

Weight Loss in Sobriety


Dear Doc,

I stopped drinking 2 years ago. For the first year I maintained my weight because I was banting. In the second year I fell off the banting wagon. On 17th March I also stopped smoking. I will be 60 in September.

So I am now very overweight – I am short, 1.55m, so a small amount of weight gain makes a big difference in how I look and feel. I am trying to practice “self-care” and not beat myself up about it – one thing at a time. But I would like to now get the sugar addiction under control rather than “diet” – which I know will then have a positive effect on my weight.

I am taking Sally Anne Creed products, the collagen and glutamine, to assist with this. I am also on Cilift and blood pressure tablets (a hereditary problem, not health / weight related.) I know I need to exercise more, but have been through the gym addiction before and don’t want to go there again. I have tried yoga but did not enjoy that class. Winter is coming so it is important I find something that really gets me excited to pursue it. Any advice on the way forward for me?


Dear S

Once we stop consuming alcohol, there are a number of changes that happen to us. They are wonderful to experience but can be daunting none the less. Unfortunately the demons we were running away from, and numb with alcohol, remain, and the stark realities of our lives remain the same.

Although stopping alcohol might be the biggest investment in yourself that you could ever make, this does not mean it is easy or that all other areas of your life will miraculously be corrected. Weight fluctuations remain one of life’s biggest struggles. The fact that billions of dollars are generated in the weight loss industry is testimony to that.

As you are aware, there are many factors regarding weight gain/loss, but I do believe that if we look at it with our new fresh set of eyes, we can achieve a lot.

Wine and alcohol are packed with sugars and as much as alcohol is highly addictive, sugar is also a highly physically addictive substance. Our sugar metabolism is an incredible regulatory system in our bodies to starve us from dying of hunger. But unfortunately, this also backfires on us if we begin at a base of high sugar intake. Insulin is a hormone that our bodies secrete to regulate our blood sugar. As soon as our blood sugar increases, our bodies release insulin to help bring down the level of sugar in our blood.

Unfortunately, this sugar gets taken into our cells and, if not used, it is stored as fat. Once our blood sugar drops, we develop “cravings” and we turn into the parent who will eat their child’s packet of sweets they were saving to take to school. How do we fix this regulatory system that seems to have gone haywire? We go back to basics: three healthy low caloric meals a day.

This is like painting the background on a canvas. The colour you want to paint it does not matter, as long as it is painted with the acrylic of healthy caloric intake three times a day. To Bant or not to Bant? That is indeed the question of our era. I prefer a pragmatic approach of low carbohydrates – and if I do consume them, I do it in the wholegrain state.

Blue, yellow, green, any colour you want, but the entire canvas must be painted – not one morning a week and then two dinners a week and 16 lunches that are cheat meals. The background will look like our two year old selves got hold of this painting. Initially it will look like that, but the wonder is that we get to wake up every morning and repaint the background till we get it right one day. And then, just as with the wine, two days … and before we know it, we have a beautiful background of a blue sky. Evenly painted right into every corner.

The uneven painted patches are: skipping meals, caving into our sugar craving, high caloric meals with high fat content. Sugary drinks are the easiest place to stop. Then other sources of external refined sugars. And before you know it, a month has passed and the tiny packet of Smarties goes to school because you did not notice it.

Exercise! It is simple – we must expend more energy than we consume, and then the pounds will melt away and we will become our own inner goddess, otherwise known as Kate Moss….! Exercise is wonderful and it gives us the same “fix” as the sugars. It gives us a Dopamine rush, but without the nasty hangover … other than some stiff body parts.

I understand the “gym addiction” and I think that starting a practice of being mindful and kind and caring is amazing. Listen to your body getting back to moderate exercises such as walking the dog consistently, practicing yoga regularly, or maybe finding a group that hikes over weekends. These are alternatives to pumping iron.

My approach is a health-orientated mindset, with activities that build you up, rather than act as another punitive measure. In recovery, there is so much guilt to deal with – and making food and weight another one, is just setting yourself up to fail. Hiking, swimming in the open water, rock climbing are all outdoor activities that make us focus on health rather than weight.

I have found the wonder in what my body is able to do, rather than what it looks like. Try to praise it for being strong, rather than looking like Kate Moss … or not. I am not suggesting that a too relaxed approach will make the kilo’s melt …. I wish. I do however believe that this is a journey of a thousand steps, and that recovery is a whole body process.

In short:

  1. Be kind and patient with yourself.
  2. Follow a consistent eating plan that is low in calories, but that you are able to enjoy and incorporate as a lifestyle.
  3. Exercise is your friend but see that there are beautiful outdoor activities that are also exercise with far less stress associated with it.
  4. Be consistent in your efforts.

Good luck and be kind to yourself.


Tired Since Quit Drinking


Hi Doc,

I’ve recently given up alcohol. I used to drink a lot of beer and wine every day (6 beers and a bottle of wine daily!) Having stopped, I find myself being incredibly tired in the afternoons. I presume it’s from a lack of carbs and sugar from the lack of wine and beer! Is there something I can do to help this? Low GI diet ? Please help.


Dear J

Thanks for your question and congratulations on your resolve. I completely concur with Janet’s reply and I think we underestimate the cumulative effect that long-term alcohol has on our bodies. Alcohol is stored in our fat stores until our liver can metabolise it. Because it is metabolised in a linear curve, you might feel the effects for longer than you thought. You may think that all the sobriety literature is just a new hippie cult!

Initially you might feel worse and want to go back to your old habits. Stick with it, it does get better. Fatigue is difficult and supplements might be able to help. I often suggest a good combination of B vitamins, Magnesium and Calcium supplements. These however are supportive and are not wonder drugs.

Blood sugar fluctuations can lead to a great deal of fatigue, especially a late afternoon slump, which might be the blood sugar dropping. You will find that you develop sugar cravings. Generally we say go with them in early sobriety as you have so much to deal with.

The more your blood sugar fluctuates, the more tired you will be, and it can just be a new bad habit that forms. A good balanced diet with three meals and two snacks per day should help to stabilise your blood sugar. Get as much help as you can get, prepare a healthy snack that you can eat on the go, even pack a little cooler box with healthy snacks that you eat well in advance of your slump.

I would consider consulting a dietician. Understand what will motivate you, and go for it. If you function well with a coach or trainer, consider all the help you can get. There are also wonderful electronic apps to assist you.

One of the most important factors to consider is why we got into the habit of consuming large amounts of alcohol in the first place. Very often it is a way to self-medicate. Underlying depression and anxiety disorders are very common and this could be part of the fatigue. My suggestion is to speak to your GP, and even a psychologist, to have this evaluated and, if needed, medicated.

There is no shame in using medication for a mood disorder – it is no different from taking blood pressure medication. We need to be kind and let go of shame during this time. There are other practices such as mindfulness and meditation that assist with altering our moods and reduce anxiety. With the help of neuroplasticity we slowly teach our brains new pathways and new ways to react to our environment.

Your body is on a wonderful new path and it takes a while to learn to listen to what our bodies need as the numbing effect of the alcohol wear off. There are so many exciting new techniques and methods (mindfulness) to learn how to control our anxiety, anger, fear, and depression.

I can strongly suggest looking into some meditation techniques. Exercise, although you do not feel like it when you are that tired, will in the long run assist with introducing feel good hormones Dopamine and Serotonin, but also boost you to not feel so tired.

This is an adjustment period, stick with it, be curious about problems you encounter and not judgmental. You will find this journey far more than just stopping those couple of glasses of wine, but a beautiful new life.


Do I Have a Drinking Problem?


Dear Doc

My question may seem a bit strange, but perhaps I am just looking for confirmation that I may have a problem. I am a 50 year old female. I can easily drink at least 3/4 of a bottle of wine a night, sometimes finishing the bottle.

Other alcohol does not “bother” me, but if I have wine in the fridge I “need” to drink it. We have whiskey, rum, etc but that does not affect me. Also I can never just have one glass of wine. If I have one it always leads to more. I also find that when I wake up in the morning I am adamant that I am not going to drink that evening, but by the time I get home from work I look for excuses to have a glass of wine always saying that “tomorrow I won’t have any”.

Is it possible to be addicted to wine? I have joined Tribe Sober and am going to try to do 30 days alcohol-free, but it is quite a depressing thought. Today is my first day. I also find that I tend to take Adcodol’s (up to 3 per day) which tends to relax me at work or if I feel a bit uptight. Could I also be addicted to Adcodol? Am I causing myself harm by drinking as I do and by taking the Adcodol’s?

I have been trying to lose weight also for some time now. I need to lose between 8 and 10 kg. Could the wine be contributing to my weight?


The absolute volumes of alcohol that one should consume varies from regulatory authority and country. The US guidelines are not more than 3 per night for women and not more than 7 per week. That is roughly 1 1/2 bottle of wine per week.

You are exceeding this amount , but what seems to distress you is the drive to drink and the thought of giving it up seems daunting. It is completely possible to have formed some sort of dependency on alcohol. Yearning for one form of alcohol and rebuffing your less favourite drink is a story many people will tell you.

This is a complex condition with the first step being realising there is a problem. My approach is more to try and find a solution rather than labeling yourself and using it as another way to punish yourself. As a society we have a very ingrained alcohol culture – we fall into this trap and before we know it, we are stuck.

The Adcodol has an ingredient called Codeiene Phosphate which is addictive. I think you might be self-medicating a mood disorder with significant anxiety. Stopping the alcohol and the Codeine will help but you must address your anxiety. Your healthcare practitioner(GP) must screen you too to see if you do not also suffer from depression. These can be treated with medication taken under the care of a professional.

You must also discuss the way to go off the medication and the wine, as you might initially feel more anxious while the wine is leaving your body. As soon as the medication and the alcohol is out of your system, you will see a significant improvement in your mood, as well as your anxiety.

Alcohol contains large amounts of sugar that messes with our insulin levels and is also empty calories that can add to weight gain. Alcohol also increases appetite to manage the slump in the morning after consuming alcohol. The decreased inhibition that happens while consuming alcohol also makes us eat more.

I would not focus on the weight loss initially. My approach would be to see your GP, discuss going off the alcohol and the Adcodol, and use any medication that they might deem appropriate. Take it one day at a time, nurture yourself and focus on healthy foods, not weight loss.

You have taken the first step in the right direction. Enjoy this journey.

Dr M (Tribe Sober Doctor).


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