Drinking and Diabetes Don’t Mix

Compared with some other stuff we put in our mouths, the trouble with alcohol might not seem to be a big deal for most of us who have diabetes. We all know, of course, that even a little alcohol can mean big trouble for those of us who can’t handle alcohol in moderation.

More than 30 percent of adult Americans have “experienced alcohol use disorders during their lifetimes,” according to a 2007 study in JAMA Psychiatry. That study also found that 17.8 percent have alcohol abuse problems and that 12.5 are alcohol dependent.

Our genes are responsible for about half of the risk for alcoholism, according to the National Institute on Alcohol Abuse and Alcoholism. The other half is our environment, which includes our friends.

If you were sure from your experience that you can handle a little alcohol and if you were a middle-aged or older man who didn’t have diabetes, a little alcohol might actually be good for you. That’s because the response of some people to different amounts of alcohol seems to be quite unusual. It’s not something that could be plotted on a straight line. Researchers call it a U-shaped or J-shaped curve, where among middle-aged and older men, abstinence seems to be a little worse than moderate consumption, while heavy consumption is much worse.

Many studies seem to indicate that moderate drinkers live longer. They describe this relationship as one between moderate alcohol use and total mortality. But like a lot of medical science, we still don’t know for sure.

One big problem is that “these studies have all been observational and epidemiological in nature,” according to the definitive review article, “To Drink or Not to Drink? That Is the Question,” in Circulation, the journal of the American Heart Association. After all these years, not a single large, prospective, randomized trial — the gold standard of medical research — has ever tested the hypothesis that for alcohol consumption the U-shaped or J-shaped curve is real. Observational and epidemiological studies can show only correlation, which does not imply causation. All scientists and statisticians know that a correlation between two variables does not necessarily imply that one causes the other.

But even these studies of correlation might give pause to young men and to women of all ages.

An epidemiological study of 17,279 men did show a U-shaped or J-shaped curve for men between 35 and 64. But for men between 25 and 34 the relationship was linear — the risk went up in a straight line from 0 to 8 drinks per day.

Another epidemiological study, this one in The New England Journal of Medicine, might concern a woman of any age. It found that, “The rate of death from breast cancer was 30 percent higher among women reporting at least one drink daily than among nondrinkers.”

But even if, like me, you are a middle-aged or older man, you might want to stop drinking alcohol if you have diabetes. Keep in mind that alcohol has a bunch of calories. It’s 6.93 calories per gram, compared to 4 calories per gram for carbohydrates, according to the U.S. Department of Agriculture.

This rule of thumb varies, of course, depending on what it is that you drink, whether it’s hard liquor (distilled spirits), wine, beer, or liqueur. And within these broad categories you can find even greater variation. For example, you can find how many calories and grams of carbohydrates many different domestic and imported beers have in this table.

If you have diabetes, which I can assume you do if you’ve stayed the course of this article so far, you know that it’s the carbs that will raise your blood glucose level. While hard liquor and most table wines don’t contain carbs, they can contribute calories to your diet. Dessert wines and many liqueurs have carbs, and beer has the most of any alcohol.

Why drink then? Just like sugar, alcohol seems to be essentially nothing but a source of empty calories. That’s particularly true for those of us who need to control our blood sugar levels as well as our weight.

This article is based on an earlier version of my article published by HealthCentral.