How to drink safely... Diabetes Australia

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How to drink safely

Here’s to your health!
Australia has a well-deserved reputation for producing premium quality wines and beers at a very affordable price. We also have a reputation for drinking large quantities of the alcohol that we produce. Per head of population, Australia is ranked 19th in the world in terms of consumption of pure alcohol (7.6 Litres per person per year) (source: 1,2).

Over three-quarters of all Australians report that they drink alcohol. When they do drink, more than half report that they drink at levels that may pose a short-term risk to their health (eg, accidents, injury), and nearly 2 out of 5 people drink at levels that may pose a risk to their long-term health (eg weight gain, high blood pressure, strokes and cancers of the pharynx, oesophagus, colorectal, liver and breast) (1,2,3).

Alcohol is the fourth macro-nutrient, providing 29 kJ of energy per gram, second only to fats (37 kJ/g) (2). It has been estimated that alcohol provides at least 4.8% of the average daily energy intake for Australian men (18.5 g of alcohol/day) and 2.6% for women (7.3 g of alcohol/day) (4).

The prevalence of overweight and obesity continues to rise in Australia and is strongly linked to the development of type 2 Diabetes and other "lifestyle" related conditions (2,5). Alcohol has been linked to overweight/obesity through addition of "empty" kilojoules to the overall diet, and through alcohols’ appetite stimulating effects and subsequent increase in energy consumption from other food sources (2). Alcohol also displaces fat and carbohydrate oxidation (2), leading to increased fat deposition (2).

Moderate amounts of alcohol consumed with food by people with type 1 or type 2 diabetes has no acute effect on blood glucose or insulin levels6. Regular moderate alcohol consumption may in fact be of benefit to people with diabetes because it may increase insulin sensitivity, HDL cholesterol levels, and probably reduces platelet aggregation, with the net effect of reducing the risk of cardiovascular-disease (2,3).

However, excessive alcohol consumption may pose additional risks for people with diabetes including increasing the risk of hypoglycaemia if using insulin or oral hypoglycaemic agents (e.g. sulphonylureas), exacerbation of diabetic neuropathy, and increased insulin resistance (3).

Total abstention should be advised for women during pregnancy and for people with other medical problems such as pancreatitis, advanced neuropathy, severe hypertriglyceridemia, or alcohol abuse (6).

Hypoglycaemia and alcohol
People with diabetes who use insulin or oral hypoglycaemic agents should be advised to eat some carbohydrate containing foods (such as low fat cracker biscuits, bread, or fruit/fruit juice) to prevent hypoglycaemia from occurring.

If they are at a party and low fat carbohydrate snacks are not available, they should be advised to have ordinary chips, crackers, pastries, or biscuits – avoiding a hypo is more important in the short term than watching their fat intake! If no carbohydrate food is available, a non-diet soft drink will provide carbohydrates.

What kinds of alcoholic beverages are best for people with diabetes?
The cardioprotective effects of alcohol do not appear to be determined by the type of alcoholic beverage consumed (6). Therefore regular or low alcohol beers, red or white wine, or spirits are all suitable choices.

It is not necessary for people with diabetes to drink low carbohydrate varieties, as most regular varieties do not contain significant quantities of carbohydrate anyway. On average, regular beer contains 5g (or 1 teaspoon); low alcohol beer contains 4g; wine contains 1g; and spirits contain less than 1g of carbohydrate per standard drink.

How much is safe?
Research indicates that in general, the level of alcohol consumption associated with the least risk for people with diabetes is the same as that for the general population (6). The new Dietary Guidelines for Australian Adults have lowered the recommendations for Australians in general, in order to address the growing prevalence of overweight and obesity (2).

Therefore it is now recommended that Australian men should aim to drink no more than 2 standard drinks on any day, women no more than 1, and both men and women should aim to have at least two alcohol free days each week (2,3).

A standard drink contains 10 grams (12.5 mL) of pure alcohol (3). The following volumes are equal to one standard drink: 100 mL wine, 285 mL regular beer, 375 mL low-alcohol beer, 30 mL spirits.

Safe Drinking Tips for people with diabetes:
1. Make sure you eat enough carbohydrate to avoid hypos.
2. Try and count the number of drinks that you have. (The more drinks you have above the recommended level, the greater the risk of harm.)
3. Alternate between alcoholic and non-alcoholic drinks
4. Let someone at the party know that you have diabetes.
5. Wear some form of diabetes identification.

Conclusion
The key message for most people with diabetes is, if they choose to drink, do so in moderation and preferably with food, and to consider the kilojoules as an addition to the regular food/meal plan (6).

References:
1. Healey J. Issues in Society: Alcohol Use. The Spinney Press, 2002.
2. National Health and Medical Research Council. Dietary Guidelines for Australian Adults. Commonwealth of Australia, 2003.
3. National Health and Medical Research Council. Australian Alcohol Guidelines. Commonwealth of Australia, 2001.
4. Australian Bureau of Statistics. National Nutrition Survey: nutrient intake and physical measurements, 1995. Canberra: ABS, 1998.
5. Diabesity and Associated Disorders in Australia 2000. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). International Diabetes Institute, Melbourne, 2001.
6. American Diabetes Association: Evidence based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 25:202–212, 2002.