Feb 04, 2008

Diabetes and Alcohol: Do the Two Mix? (Part 3)

Amy Campbell

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.

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