Diabetes Diet

Alcohol Is Especially Challenging for Diabetes

The apparent benefits of moderate drinking have gone up in smoke. Especially for those of us who have diabetes, any amount of alcohol presents special challenges.

get drunk

The liquor industry continues to claim that moderate drinking of alcohol may reduce the risk of heart disease. But those supposed benefits are now evaporating especially for people with diabetes.

Governments around the world are unwilling to take on the formidable economic power of the international alcohol industry, writes Health Policy Professor Mike Daube in his recent BMJ editorial, “Alcohol’s evaporating health benefits.”

Even Older Women May Not Benefit from Alcohol

Any health benefits from alcohol is at best a moderate one that is limited to women aged 65 or more — and even then may have been exaggerated, suggests recent research published in BMJ, formerly the British Medical Journal. The apparent benefit to older women “is likely to be explained by selection bias,” Professor Daube writes.

Through analyses based on the Health Survey for England, a team of British and Australian researchers explored the association between alcohol consumption and mortality in different age groups to find out how much alcohol that people of different ages can safely drink. The full-text of the study is online.

Doubts that a “J-shaped Curve” Exists

The new study in BMJ redoubles the doubt that a “J-shaped curve” exists. This is what researchers called the apparent puzzle that moderate consumption seemed a bit better than abstinence, while heavy consumption is clearly much worse. Several previous studies, including these summarized below, challenge the apparent benefit of moderate drinking:

1. A 2007 review article “To Drink or Not to Drink? That Is the Question,” in Circulation, the journal of the American Heart Association, emphasized that no large, prospective, randomized trials — the gold standard of medical research — has ever tested the hypothesis that for alcohol consumption the U-shaped or J-shaped curve is real. The existing observational and epidemiological studies can show only correlation, which does not imply causation.

2. Two years ago a critical analysis in the journal Addiction, “Alcohol—a universal preventive agent?” concluded that “The evidence for the harmful effects of alcohol is undoubtedly stronger than the evidence for beneficial effects.”

3. A 2013 study in the International Journal of Epidemiology of 380,000 European adults followed up for an average 13 years found that the seemingly J-shape curve is “difficult to establish due to the possibility of selection bias and competing risks related to diseases occurring later in life.”

The Challenges of Alcohol When We Have Diabetes

These recent studies indicate that even in moderate amounts alcohol can be challenging for most people. But people with diabetes face special challenges when they drink it.

The real problem with alcohol for people with diabetes is that the way our bodies metabolize it. Normally it is our stomachs that metabolize our food, but our liver metabolizes alcohol and fructose. We already put far too much stress on our liver when we consume fructose, as I have emphasized in several articles here.

“When you drink an alcoholic beverage, the alcohol moves quickly into the bloodstream without being metabolized in your stomach,” an article on the Mayo Clinic website says. “Within five minutes of having a drink, there’s enough alcohol in your bloodstream to measure. Alcohol is metabolized by the liver.”

This article continues, noting that drinking alcohol can cause dangerously low blood sugar for people on insulin or a sulfonylurea “because your liver has to work to remove the alcohol from your blood instead of its main job to regulate your blood sugar.” Possibly even more challenging for people with diabetes is that the symptoms of too much alcohol and low blood sugar can be so similar that other people might confuse hypoglycemia for drunkenness with serious consequences.

Empty Stomach, Empty Calories

Some people with diabetes think that drinking on an empty stomach is a good thing because it can reduce blood sugar. But, as Dr. Richard K. Bernstein writes in Dr. Bernstein’s Diabetes Solution, “It does this by partially paralyzing the liver and thereby inhibiting gluconeogenesis so that it can’t convert enough protein from the meal into glucose.”

Like fructose, alcohol is a toxin that has empty calories. Beer and sweet wine also contain carbohydrates that can make it harder for us to manage our blood sugar level. It now appears that alcohol doesn’t benefit anyone, certainly not those of us who have diabetes.

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

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  • Stan July 1, 2015 at 11:34 am

    I just read this aricle, and reader comments: ‘Alcohol Is Especially Challenging for Diabetes’.
    I am type 2 since 2002, with typical a1c’s 5.6-6.1. Carefully controlled by what I eat/don’t eat. About 4 years ago I discovered that when I had a shot of booze (scotch, tequila, vodka) my blood sugar dropped about 25 pts during the 90 minutes afterwards. Consistently. So, when I am about to eat a meal with some bad carbs in it, I will have a shot during the early part of the meal. Post prandial testing has proven my point.

    • David Mendosa July 1, 2015 at 2:20 pm

      Frankly, I think this is a terrible strategy, Stan. The alcohol is putting a huge stress on your liver, which is why your level drops when you drink it. Liver disease is, of course, one of the most common and serious complications of diabetes. My wife, Catherine, who had diabetes died from liver failure 9 years ago.

  • mordigess July 1, 2015 at 3:07 am

    you don’t mention wine. I believe the ADA still recommends a glass of dry red a day for type !. there is no sugar in dry wine and its benefits are widely known. I have had Type I for 56 years and have been drinking dry wine for many years with no adverse affect on my control. mordi.

  • Lee Hunnicutt, Jr. June 30, 2015 at 6:04 pm

    David,

    I have been drinking about a pint of dry red wine every night for about three years. It takes me about four hours t drink it. I have been following a modified Atkins diet and only eat complex carbs and protein, nothing white, except for cauliflower. I drink the wine because it is suppose to help with mental acuity (which I think has helped) and it has Resveratrol. My HbA1C is 5.6. I have never taken any anti-diabetic drugs.

    When I was diagnosed with diabetes I lost 35 pounds and started a strict diet. I am a fanatic and it has paid off.

    Should I knock off the wine?

    Thanks,

    Lee

    • David Mendosa June 30, 2015 at 8:32 pm

      Normally, I would say to knock off the wine, Lee. But in your case what I am thinking is that if it ain’t broken, don’t fix it.

  • Ergo June 22, 2015 at 5:50 am

    David

    Interesting article. As you may recall, I discovered that alcohol has a depressive effect on blood glucose levels a few months ago and use it successfully every so often, mostly on weekends, if I depart from my low/ultra low carb diet.

    Last night was a good example. I attended a party and for the first time since being diagnosed in December with Type 2, I let myself go and had 2/3 portions of ice cream, chocolate etc. At the same time, to counter the sugar intake, I had 5 double whiskeys (single malt of course). This morning my blood was an acceptable 6.4.

    Clearly, it would be irresponsible to cheat as above too often, not least, because of the calories.

    But, my life has changed substantially since December (for the better BTW, as I am more healthy now) and I now follow a fairly strict low/ ultra low carb diet nearly all the time. However, it is important to me to know that I can cheat every once in a while but to do so in such a way that will not spike my BG too much. Those taking insulin will increase their dose if they expect to ingest more carbs. But, I do not take insulin and the 4 or 5 times I have used alcohol in the past few months to counteract the effects of sugar, it has worked every time, for me.

    Last night aside (which should be saved for rare special occasions only), it seems to me reasonable to incorporate a glass of dry red wine with your meal, perhaps 3/4 times a week to allow a small departure from an otherwise low/ ultra low carb diet.

  • Diane June 14, 2015 at 9:19 am

    Thanks David. I’ll read the study carefully.

    Just saying that I’ve seen this with a lot of things. Cigarette smoking, candy bar eating, you name it. I’m not going to bother looking up all the junk I’ve seen on this subject but here is a compendium:

    http://www.livescience.com/15115-5-health-benefits-smoking-disease.html

    That’s what I mean about focusing on a minute metabolic advantage, while ignoring the big picture. I don’t doubt that nicotine has some very interesting benefits, but studies highlighting these are the essence of distortion. Same with alcohol, and white sugar, etc.

    My remarks are not directed towards those who, like Alan, work a small amount of alcohol into a healthy lifestyle. But I don’t think there is ever a healthy amount of smoking!

  • Alan Shanley June 13, 2015 at 10:25 pm

    David, I’ve read the detail. I’ve also read a lot of other research on the subject which supports the other side of the case.

    As you know I follow a carefully managed way of eating for my blood glucose levels. Alcohol can also be properly managed. I have never had a low as a consequence of alcohol because I never drink to the point of inebriation and I am also careful of the carbs in beer or mixed drinks.

    I note that most of the studies you referenced were unable to be definitive and said more study is needed – or even disagreed with the premise. For example: “The observational data collected thus far appear consistent that light to moderate alcohol has a cardiovascular benefit even when corrected for confounding factors, and 0.5 to 1 drink per day appears protective. ”

    Based on the earlier papers and my own experience I’ll continue to consume approximately half a bottle a day of dry red wine (not every day 🙂 ) and the occasional beer or spirits.

    I also have no complications yet; I was diagnosed type 2 in 2002.

    • David Mendosa June 14, 2015 at 7:18 am

      This certainly is a controversial area, Alan. And of course they say that more studies are needed. I don’t see a study very often that omits those words; editors probably require them. But to me at least a part of the bottom line is that alcohol is empty calories and carbs, just like sucrose and fructose (I have other considerations, as I have indicated, based on my spiritual practice to avoid drugs that can cause heedlessness). I also think that all the earlier studies that show a U-shaped (or actually J-shaped) curve indicating that a little alcohol can be better for us than none are based on observational studies that have not taken into account the residual confounders.

  • Diane June 13, 2015 at 5:49 pm

    I’ve always been skeptical of the benefits of alcohol. I think what the researchers do is focus on some trivial metabolic byproduct of alcohol consumption and blow that out of proportion, while ignoring the big picture.