April is a time for showers, taxes, and the Boston Marathon. It’s also Alcohol Awareness Month. Given this, I thought it would be appropriate to review a few facts about alcohol and how people with diabetes may be affected by its use.
1. Alcohol is not carbohydrate, protein, or fat. Most of us know that calories come from the three main nutrients (called macronutrients) in the food that we eat: carbohydrate (carb), protein, and fat. Carb and protein contain 4 calories per gram, while fat contains 9 calories per gram. These nutrients are also called essential nutrients because we must take them in from food and they serve vital roles in the body.
So where does alcohol fall into the mix? Alcohol isn’t an essential nutrient, nor, as I’ve mentioned, is it classified as carb, protein, or fat. But it does contain calories — 7 calories per gram, to be exact. If you’re watching your weight, you need to keep an eye on how much alcohol you drink. Additionally, alcohol contains little, if any, vitamins and minerals, unlike carb, protein, and fat foods. Technically, alcohol is considered to be a drug, as it can have potentially harmful effects.
2. Alcohol is metabolized, or processed, by the liver. If you drink alcohol, your body kicks into gear to metabolize it because, unlike carb, protein, and fat, the body has no way to store alcohol. Once the alcohol hits your stomach, about 20% of it is absorbed into the bloodstream, and the rest enters your intestines where it’s digested. A small amount is excreted through the urine, sweat, skin, and your breath. The liver is a key organ for alcohol metabolism; it detoxifies alcohol through a process called oxidation, oxidizing alcohol at a rate of about 1/4 to 1/3 of an ounce per hour.
3. Alcohol can lower blood sugar levels. You might already be aware of this, but it’s worth repeating, especially if you take insulin or diabetes pills that lower blood sugar levels, like sulfonylureas, for example. (If you take metformin, it’s unlikely that alcohol will cause hypoglycemia). Why does this happen? It goes back to the liver: The liver sees alcohol as a “poison,” and its task is to eliminate it. The liver is a remarkable organ, but it’s not a great multitasker. If it’s busy dealing with alcohol, it’s not able to focus too well on blood sugar levels, and as a result, low blood sugar can occur. If you choose to drink alcohol, lower your risk of lows by always eating a carb food when you drink. Sometimes, drinking alcohol can lead to high blood sugar, especially if a person drinks a lot and/or if they drink alcoholic beverages that contain a lot of carb, such as some beers, dessert wines, and cocktails.
4. Moderation is the key. Health professionals sometimes talk in vague terms — for example, “in moderation.” What does that mean? When it comes to alcohol, moderation means drinking no more than two drinks per day if you’re male, and no more than one drink per day if you’re female. A “drink” refers to 5 ounces of wine, 12 ounces of beer, or 1 1/2 ounces of hard liquor, such as vodka or rum. And, to be on the safe side, if you have any diabetes complications such as neuropathy or kidney disease, or if you take medications, talk with your doctor about whether it’s safe for you to drink alcohol.
5. Beware other effects of alcohol. Alcohol can impact more than just your blood sugar. It can raise blood pressure and triglyceride (blood fat) levels; it can also trigger your appetite, causing you to eat more and — guess what? — gain weight! Of course, alcohol can impair your judgment and lead to safety issues, especially if you’re driving. Alcohol can also take a toll on the liver, leading initially to inflammation and eventually, cirrhosis, which can be fatal. Women need to be careful about how much alcohol they consume, too, because two or more alcoholic beverages per day can increase the risk of invasive breast cancer by 41%.
6. Alcohol can affect sleep quality. We’ve all seen or have heard about people who have a bit too much to drink and “pass out” or fall into what appears to be a deep sleep. However, while a glass of wine may leave you feeling sleepy, the quality of your sleep can be negatively impacted by alcohol. Alcohol interferes with REM (rapid eye movement) sleep, which is a restorative type of sleep. As a result, you can end up feeling groggy and unable to concentrate the next day. Drinking alcohol can also trigger sleep apnea, as it can suppress normal breathing.
7. Alcohol has some positive effects, too. Drinking alcohol isn’t necessarily a “bad” thing to do. In fact, imbibing now and then can bring some health benefits. For example, alcohol has a blood-thinning effect, which may reduce the risk of ischemic stroke (a stroke caused by a blood clot). Also, studies show that drinking alcohol can lower the risk of having a heart attack, getting peripheral arterial disease, and dying from all types of cardiac problems.
So, should you drink alcohol or not? That’s a question that you should ask your health-care team. Most people with diabetes can safely drink alcohol, but it’s really best to talk it over with your doctor. Also, be extra diligent about checking your blood sugars when you drink alcohol to learn how it affects your diabetes control.
Editor’s note: Test your knowledge of diabetes and alcohol by trying your hand at our interactive quiz!
Why isn’t there a generic version of insulin? Bookmark DiabetesSelfManagement.com and tune in tomorrow to read Martha Zimmer’s theory!