Over the last two weeks, we’ve been taking a closer look at alcohol. Several of you have submitted great questions and comments about alcohol, too. The use of alcohol among people with diabetes often stirs up controversy: There are those who feel that people with diabetes shouldn’t drink at all, while others remain on the fence and believe it’s OK to have alcohol once in a while.
It’s important to point out that there are no hard and fast rules when it comes to drinking alcohol. That’s why I repeatedly state that it’s important to have this discussion with your health-care provider, as the “rules” can vary from person to person.
But, assuming that you’ve gotten the green light from your provider to carefully and safely enjoy alcohol on occasion, how do you fit it into your meal plan? How much can you drink? And what are the best choices? Let’s go through these questions one by one.
Fitting alcohol into your meal plan
Alcohol is unlike carbohydrate, protein, and fat. However, alcohol is metabolized, or handled, by the body in a manner similar to fat. This means that calories from alcohol can easily be stored as fat unless you burn them off. Alcohol contains 7 calories per gram; fat contains 9 calories per gram, and carb and protein contain 4 calories per gram. So alcohol is a prime source of calories. If you’re trying to lose or maintain your weight, you need to think about this carefully. An occasional glass of wine isn’t a problem. But if you tend to have a glass of wine every night, you need to consider that 4 ounces of wine contains about 90 calories. Over time, this can add up. You may want to cut out 90 calories somewhere else in your meal plan to balance things out and avoid that spare tire around your waist.
Remember, too, that alcohol may lead to low blood glucose in people taking insulin with a meal or those taking a sulfonylurea drug, such as glipizide, glyburide, or glimepiride. If you take any of these types of medicines, be sure to eat a carbohydrate-containing food, such as bread, pasta, rice, or fruit, with your alcohol. If you need to shave calories from somewhere else in your meal plan, you may want to think about cutting out some fat, such as margarine, oil, or salad dressing, for example.
How much to drink?
To best answer this question, it helps to know serving sizes of common alcoholic beverages. All of these are considered a serving: 5 ounces of red or white wine; 12 ounces of beer; 1½ ounces (a shot glass) of distilled spirits (such as vodka, rum, or whiskey).
Men are “allowed” more alcohol than women because men can process alcohol more efficiently. Therefore, if and when you choose to drink, the guideline for men is no more than two servings of alcohol per day; for women, no more than one serving.
Best choices
Things can be as murky as a mudslide when it comes to deciding what to drink. The “best” choices, though, are those that don’t contain too many calories or carbs: dry white or red wine or champagne; light beer; or distilled spirits. Fruity drinks, such as piña coladas, daiquiris, and margaritas contain fruit juices and therefore contain more calories and carbs. In fact, 4 ounces of a strawberry daiquiri can contain 200 calories and 30 grams of carb or more. And many people don’t stop at just one! Stouts and ales (think Guinness or Sam Adams lager) approach 200 calories per 12-ounce bottle. More of a gin and tonic or rum and coke lover? Go for diet tonic water and diet soda as your mixers. If you drink alcoholic beverages that contain a significant amount of carbohydrate, talk to your dietitian or health-care provider about how to fit these into your eating plan safely.
What about nonalcoholic beer and wine? Because these beverages contain little, if any, alcohol, you may actually need to count them as carbohydrate choices in your meal plan. Many nonalcoholic beers contain close to 15 grams of carb (equal to 1 slice of bread or 1 small piece of fruit).
In summary, there’s a lot to think about when it comes to alcohol. For some people, the safest and smartest approach to take is to not drink any alcohol. For others, the goal is to learn how to fit alcohol into your diabetes treatment plan safely—ask your health-care team if you’re not sure.
There is solid scientific evidence that judicious amounts of alcohol may indeed prolong life, reduce cardiovascular deaths, and reduce the incidence of dementia.
Women with a personal or family history of breast cancer would be well-advised to consider total abstention from alcohol since several published studies link breast cancer with alcohol intake.
-Steve Parker, M.D.
Posted by Steve Parker | Feb 14, 2008 at 6:32 pmmy drink of choice vodka soda just a splash
Posted by keithy02 | Feb 15, 2008 at 7:12 amof cranberry very low carb
keith mcclelland
I agree of that the two mix together because According of many researchers drug rehabilitation is an umbrella term for process of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The obvious intent is to enable the patient to cease their previous level of abuse, for the sake of avoiding its legal, social, and physical consequences, especially in extreme abuse because every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism.
______________
Rey
This is a comprehensive addiction portal focusing on topics of alcohol and drug abuse. http://www.alcoholaddiction.org
Posted by reywahp | May 13, 2008 at 9:54 amI take Glipizide(10) and Gemfibrozil(600mg) 1/2 hr before meals and Metformin (500mg)during.
Occasionally, prior, I drank (3-4 x a week) I like 1 or 2 vodka rocks before or after eating (don’t drink during meals unless I have a glass of wine. Definitely, love a friday vodka (TGIF).
Any advice other than quitting altogether?
PS: I do exercise moderately and watch my carbs. I am a small to med eater 6′3″, 200 lbs.
Posted by Bob | Sep 25, 2009 at 9:35 pmHi Bob,
In general, most people with diabetes can safely drink alcohol, but it always is worth a discussion with your physician. Two possible concerns are first, the glipizide — this is a sulfonylurea, which can lead to hypoglycemia, especially with alcohol; the second is your gemfibrozil, which can cause dizziness and blurred vision. These symptoms may be exacerbated with alcohol, and it’s advised to not drink alcohol when taking this medicine. However, hypoglycemia can be prevented when drinking alcohol by always eating a source of carbohydrate when drinking and by limiting alcohol intake to no more than two servings per day. Also, careful blood glucose monitoring is helpful. I’d suggest asking your physician about the safety of drinking alcohol while taking gemfibrozil, though.
Posted by acampbell | Sep 28, 2009 at 11:31 amType II slowly drifting into Type I. On Lantus and off the Glip. and Met.. Glad to be off of both! Any changes with alcohol use that I need to
consider and….
Enjoy a mixed drink once or twice a week. What would be the best combination. Volka & diet, Rum & diet, Blended & diet or is there no difference as we are just dealing with calories/carbs?
Do some alcohol’s affect the liver differently? Once the liver has finish processing the alcohol will it have a greater tendency to dump
more sugar into your system at a later time due to type and amount consumed?
Yes I will be discussing w/my Endo..
Would like your imput too.
Posted by Elmi | Feb 06, 2010 at 4:09 pmHi Elmi,
Having an alcoholic beverage once or twice a week is unlikely to have much of an impact on your blood glucose levels. It’s possible that if your gluocse is on the low side and you haven’t eaten when you do have a drink, you may be at risk for hypoglycemia. But in general, one drink usually doesn’t lead to hypoglycemia. Also, there’s not much of a difference between vodka, rum, or other distilled spirits in terms of their effect on glucose. (What you MIX with alcohol can have an effect if it contains carbohydrate, though). I’m not aware that the liver handles various types of alcohol differently, and I have not heard that the liver will compensate at a later time by releasing more glucose. That perhaps could happen if you went low and then the liver released glucose to compensate. (The liver would not be able to release glucose if its glycogen stores are depleted, as can happen in the case of alcoholism or someone who is malnourished, for example). But, these are good questions that perhaps your endocrinologist can answer for you.
Posted by acampbell | Feb 09, 2010 at 9:02 amAppreciate the info. Find myself angry at this time as I find myself now drifting farther onto the type 1. How do you count carbs on alcohol (believe you do) and what is the carb count on said personality enhancements (rum, etc…)? Do understand that it is very important to mix beverages with food and never without. I admire and wonder how individuals survive socially when one is raised in a beveraged enhanced family setting. A setting where people do take it responsibly and watch over each and every individual. Yet are not afraid to kick up their heels and dance to the beat. Appreciate all advice and guidelines.
Working through the muck!
Posted by Elmi | Mar 10, 2010 at 2:06 amHi Elmi,
If you’re drinking a glass of wine or beer, or perhaps a rum and Diet Coke beverage, for example, you wouldn’t count the carbohydrate in these drinks — mostly because there are very few carbohydrates anyway. In fact, rum has no carbohydrate. Don’t forget that alcohol can have a blood glucose-lowering effect, too. Certainly, some alcoholic beverages do contain a significant amount of carbohydrate, mostly from added ingredients, such as fruit juice, sugar, etc. And if you take premeal insulin, it may be necessary to take a little insulin to “cover” the carbohydrate in these drinks. It’s always best to err on the side of caution, however. If, for example, a beverage contains 15 grams of carbohydrate and a person usually takes 2 units of insulin to cover those carbohydrate, he might instead try taking just one unit. For someone with Type 2 diabetes not on insulin, the best advice is to stick with lower-carbohydrate alcoholic drinks and if calories are a concern, count alcohol as fat servings. As always, it’s important to check your glucose to see how alcohol affects you.
Posted by acampbell | Mar 12, 2010 at 9:03 am