Just a Drop of Common Sense
After you are diagnosed with diabetes, you might find yourself learning quite a bit about your diet. Much of this involves making decisions about how best to eat and drink to achieve good outcomes and avoid problems with your therapy. While some rules are fairly obvious and based on solid science, for others, far less evidence is available. One such example is drinking alcohol.
Let's face it: Alcohol is a potent drug that can have a profound, and often negative, impact on users. Still, more than 120 million people in the United States drink alcohol on a regular basis, and many of them have diabetes. When I was diagnosed with type 1 diabetes 30 years ago, many doctors, including my own physician, believed that people with diabetes should not drink alcohol. The prevailing wisdom was that alcohol could impair your judgment, make it difficult to sense the onset of hypoglycemia, and inhibit self-management. While there wasn't much experimental evidence supporting these assertions, it was the party line of the time.
Today, however, increasing evidence suggests that moderate consumption has many beneficial effects for people with diabetes. In a comprehensive review of several studies on the effect of alcohol use by people with diabetes, the data show that both not drinking at all and drinking heavily (i.e., more than three drinks per day) have more deleterious effects on health status than does moderate consumption. Indeed, moderate alcohol intake (i.e., one to three drinks per day) is associated with decreased incidence of coronary heart disease, a major killer of people with type 2 diabetes; improved lipids; and, potentially, reduction of inflammatory response, which is increasingly linked to the risk of cardiovascular disease events.
Limited research also suggests that alcohol is not associated with adverse outcomes when using sulfonylureas or thiazolidinediones. Moderate consumption was found to have no acute effects on glycemic control in type 2 diabetes. In type 1, it may in fact cause hypoglycemia the following morning, and the usual symptoms of hypoglycemia may be masked and impair the counter-regulatory responses to insulin-induced hypoglycemia. This suggests that people with type 1 need to consider diet regulation when they drink and make sure they are monitoring their blood glucose.
While moderate consumption of alcohol may have some positive benefits for those who already drink, the science does not support adding alcohol to your diet if you don't currently do so. But if you have diabetes and you do drink, it's important to discuss this with your health team. Make them aware that drinking alcohol is part of your lifestyle and that you want to continue to do so in a responsible fashion. A dietitian can show you how to enjoy a glass of wine or beer with your meals without adding excessive calories.
Optimal control of diabetes is not only about attaining good metabolic numbers, but achieving a lifestyle that is comfortable and rewarding while you do so. You can, with a little thought, drink a glass of fine wine with your meal and by doing so benefit your health—and your enjoyment of life.