According to data from the period 1989–1991, alcohol is estimated to account for ~2.5% of adult energy intake in the U.S., compared to the previous ~5%, which was based on NHANES II data (1976–1980). It is unclear whether this change is due to reduced consumption or methodological differences in the assessment of alcohol intake. Approximately 67% of U.S. adults are reported to consume alcoholic beverages, while 33% report abstaining. People with diabetes undoubtedly fall into both of these categories.
The alcohol in distilled products (hard liquors), wine, and beer is ethanol (ethyl alcohol, C₂H₅OH). It is a by-product of the enzymatic fermentation of sugars by yeast. A drink or an alcoholic beverage is commonly defined as a 12-oz beer, a 5-oz glass of wine, or a 1.5-oz shot of distilled spirits. Each contains approximately 15 grams of alcohol. The cardioprotective effects of alcohol are not determined by the type of beverage. A summary of ecological, hypothesis-driven studies based on certain population groups concludes that all alcoholic beverages are associated with a reduced risk of coronary heart disease. Thus, many of the benefits are attributed to the alcohol itself rather than other ingredients of each beverage type.
The same precautions that apply to the general population regarding alcohol consumption also apply to individuals with diabetes. Abstinence is recommended for women during pregnancy and for people with medical conditions such as pancreatitis, advanced-stage neuropathy, severe hypertriglyceridemia, or a history of alcohol abuse. The "Dietary Guidelines for Americans" recommend no more than two drinks per day for adult men and no more than one drink per day for adult women.
After consuming equal amounts of alcohol, women have higher blood ethanol concentrations than men, even when body composition differences are accounted for. Compared to men, women have increased alcohol bioavailability, due to lower gastric metabolism and reduced gastric alcohol dehydrogenase activity. This may contribute to women’s increased sensitivity to the effects of alcohol.
Alcoholic beverages can have both hypo- and hyperglycemic effects in people with diabetes, depending on the amount of alcohol absorbed, whether it is consumed with or without food, and whether the consumption is chronic or excessive. Moderate to severe hypoglycemia, no hypoglycemia, and hyperglycemia have all been reported in individuals with diabetes following alcohol consumption. Absorbing moderate amounts of alcohol appears to blunt awareness of hypoglycemia in people with type 1 diabetes.
Moderate alcohol intake can enhance the glucose-lowering effects of exogenous insulin and some oral glucose-lowering agents. Although alcohol does not affect the rate or degree of plasma glucose decline, it seems to interfere with the glucose recovery phase by impairing hepatic gluconeogenesis. Alcohol-induced hypoglycemia is not corrected by glucagon administration, as it results from impaired gluconeogenesis and not excessive insulin secretion.
In individuals with type 1 and type 2 diabetes, consuming moderate amounts of alcohol with food or snacks has been shown to have no immediate effect on blood glucose or insulin levels. The risk of alcohol-induced hypoglycemia during fasting is moderate in people with type 2 diabetes and exists only if they are receiving insulin or insulin secretagogues.
Heavy or excessive alcohol consumption is one of the leading and preventable causes of death in the United States.
Diabetes Mellitus
There may be additional adverse effects of chronic alcohol use specifically for diabetic individuals. In people with type 2 diabetes, chronic alcohol intake (~45 g/day) worsens glucose metabolism in both the short and long term. Thus, metabolic control should be closely monitored when alcohol is an unavoidable part of the diabetic patient’s diet. Alcohol-induced effects are reversible after a three-day period of abstinence.
Epidemiological data in healthy non-diabetic individuals suggest that light to moderate alcohol consumption is associated with a reduced risk of developing type 2 diabetes, stroke, and increased insulin sensitivity, although this sensitivity may be diminished by overall adiposity. In diabetic adults, chronic consumption of small to moderate amounts of alcohol (5–15 g/day) is associated with reduced risk of coronary heart disease, possibly due to an associated increase in HDL cholesterol. Prospective long-term studies are needed to confirm these observations.
Increased capacity for lipoprotein synthesis
Alcohol intake increases lipoprotein synthesis capacity, especially for VLDL cholesterol. This increase is amplified in the presence of genetic predisposition, high-fat diets, and diabetes. However, increased lipoprotein synthesis may be more a result of chronic alcohol abuse, as one study showed that non-diabetic individuals with fasting hypertriglyceridemia who consumed the equivalent of two alcoholic drinks did not experience an immediate rise in triglycerides. This suggests that individuals with hypertriglyceridemia may be able to consume alcohol occasionally and cautiously.
Hypertension and stroke risk
A U- or J-shaped relationship appears to exist between alcohol consumption and blood pressure. Small to moderate amounts of alcohol do not raise blood pressure. However, there is a strong correlation between chronic alcohol abuse (>30–60 g/day) and increased blood pressure in both men and women. Each additional 10 g of alcohol intake above 30 g/day increases systolic blood pressure by an average of 1–2 mmHg and diastolic pressure by 1 mmHg. In addition to being a possible risk factor for hypertension, alcohol may also interfere with the effectiveness of antihypertensive therapy, which may in turn increase the risk of stroke.
Source: Mednutrition.gr
