Drinking and Diabetes

Enjoying a glass of wine or a cocktail is part of many peoples’ idea of a good time. For some, it is even a daily habit that according to many medical experts is beneficial for cardiovascular health. The so-called French paradox is based upon epidemiological observations that French people have a relatively low incidence of coronary heart disease (CHD), while having a diet relatively rich in saturated fats. There are two main possible explanations for this observation: Red wine and stress.

In France, the consumption of red wine is higher than in most other countries, and the components in the wine that seem to be important are alcohol, reservatrol, procyanidins, and polyphenols.  Several studies have shown that moderate alcohol consumption leads to positive changes such as:

• Raises high-density lipoprotein (HDL) cholesterol, the “good” cholesterol
• Reduces the formation of blood clots
• Helps prevent artery damage caused by high levels of low-density lipoprotein (LDL) cholesterol, the “bad” cholesterol
• Produces changes in blood pressure

The other main difference between French people and the rest of the world is the amount of stress they are under. There is clearly a correlation between stress and heart disease, and especially in women, events such as myocardial infarctions can be triggered by a stressful situation leading to vessel contractions and reduced blood flow. Perhaps the French are just not as stressed as the rest of us? They are well known for leading lifestyles that are relatively lower in stress when compared to the US and other cultures. They take long lunch breaks where they connect with friends and family, along with longer vacations in the summer. They have a controversial 35 hour work week. All of these result in a less stressed population.

So what about diabetes? People with diabetes have at least double the normal risk of developing heart disease, and in women with diabetes, that risk is more than 4 times higher than in non-diabetics. This is due to many factors, the constant assault on the vessels by higher than average levels of sugar, low blood sugar that can cause disruption of oxygen flow to the tissues, and the general state of oxidation that leads to higher LDL and triglycerides. In people with diabetes who have complications, the neuropathy and the kidney disease can also cause cardiac issues that are related to the nerve function and the metabolic and electrolyte imbalances in kidney disease. However, recommending alcohol to a person with diabetes is not as simple as one would think.

Alcohol is broken down by the liver, which is also the location for much of the body’s storage of glycogen. Glycogen is used for states of low food supply, when the blood sugar needs a boost, and energy levels are low. Only the liver glycogen can be utilized by the brain and the organs, while muscle glycogen is used by the muscles only. In a normal individual, glycogen storage in the liver is around 100 g, but in a diabetic, that level may be much lower due to chronic insulin deficiency. Even more importantly, in a normal individual, the hormone glucagon from the alpha cells in the pancreas, enables glycogen metabolism into glucose when the blood sugar is low, but in a person with diabetes, low glucose is normally associated with excessive insulin levels, which prevent glucagon from acting on the liver. This is why a person with diabetes can pass out when overusing insulin, or missing a meal, exercising too much, etc, since the normal compensatory mechanisms cannot be put in place.

When a person with diabetes drinks alcohol, the first thing that happens is that the blood sugar goes up, due to the sugar and calories in the drink. One should clearly avoid sugary mixers, fruit juices, and high calorie sodas, that only exacerbate the effects of alcohol on the blood sugar, and we have seen options out there that work nicely, such as Be-Mixed and using lemon/lime seltzer to get a nice flavor. Vodka has the lowest amount of calories and lowest sugar content of liquors, and red wine generally has lower sugar content than white wines and champagne.

Alcohol can also negatively impact blood sugar levels each time that it is consumed, regardless of the frequency of consumption, but this is especially dangerous in “new drinkers,” such as teenagers and college students who do not know their limits. Acute consumption may increase insulin secretion, due to the sugar in the beverage, and can cause low blood sugar (hypoglycemia), but it may also impair the hormonal response (glucagon release that triggers glycogen metabolism into glucose in the blood) that would normally rectify the low blood sugar. Drinking as little as 2 ounces of alcohol on an empty stomach can lead to very low blood sugar levels. The liver is no longer able to release glucose from the stored glycogen sometimes several hours after consuming alcohol, so one has to be aware of this effect even the morning after drinking.

The best way to handle alcohol as a diabetic is:

• Never to drink on an empty stomach
• Never to drink alcohol to satisfy your thirst, but keep water on the side and continue to have it available while you are drinking
• Never to consume alcoholic beverages during or after exercise
• Never to drink alcohol combined with sweet mixers

Being a recovering diabetic, I have learned how to deal with alcohol, and I have very specific approaches that I stick to. For me, food is essential with alcohol, otherwise I very quickly feel dizzy and the scary thing is that I do not know if it is due to a hypo or to the alcohol just impacting my brain. The types of alcohol that work for me are red wine and vodka, not necessarily in that order. When testing my blood sugar, those two tended to increase my blood sugar the least, upset my stomach the least and not give me head aches or other sequelae. I tend to have olives and some crackers with a dip made of avocado or chick peas together with my drink, and a normal dinner when I am having wine. Most restaurants and bars can accommodate this, and at home I always keep snacks for cocktails. As a matter of fact, my fridge is often more stocked with those kinds of foods than with meat, fish or chicken! I love tapas-style dining, and adding some smoked salmon, nuts and raw veggies, make this a whole meal…

With that brief lesson, we at Lyfebulb hope you can continue to enjoy alcohol in moderation and that if you are diabetic or close to someone with diabetes, you have learned a little something both about the benefits and the risks of drinking!