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Does Alcohol Clash with Keto?

iStock-1184659496Despite its celebrated antioxidant content, the reality is, alcohol isn’t a health food. However, consuming alcohol is often a part of many people’s social lives and religious and cultural traditions. Abstaining completely would potentially be a dealbreaker if it were required in order to adopt a dietary or lifestyle change. So, where does alcohol fit into a keto diet? Can you drink and still reap the benefits of this very low-carb way of eating?

Safety first

Before getting into the details about alcohol on a keto diet, it’s best to start with some basic caveats regarding safety and alcohol tolerance. Alcohol tolerance is typically much lower when someone follows a keto diet compared to when they ate more carbohydrates. This means alcohol will affect them harder and more quickly than they may be accustomed to, and it will likely take less to result in a “buzz.”

Many keto dieters learn the hard way that it’s essential to pace themselves: when following a keto diet, drink slowly and don’t drink on an empty stomach. Alternating sips of alcohol with sips of water is a good way to slow things down. And of course, for anyone enjoying alcohol someplace other than at home, always have a plan for safe transportation.

Another issue to be aware of when consuming alcohol on a keto diet is the inhibition-lowering effect of alcohol. Someone who has no trouble avoiding high-carb foods in the absence of alcohol may find themselves tempted to reach for sugary or starchy food when drinking, especially if it’s in the context of a social setting where such foods are readily available, as opposed to at home, where the environment may be free of those temptations. Having higher carb foods once in a while isn’t a death knell for keto, but this can be a slippery slope. Some individuals can enjoy higher carb items once in a while with no negative repercussions, but for others, “once in a while” can inadvertently turn into a long-term slide back into a higher carb diet, ultimately resulting in weight regain or the recurrence of health problems that had previously been put into remission.

Metabolic effects of alcohol

Not everyone who adopts a ketogenic diet does it for the purpose of weight loss. It’s among the top reasons, though, so how does alcohol affect fat loss? The key thing to know is that even if someone opts for zero-carbohydrate alcohol and sugar-free mixers, zero-carb (or close to it) doesn’t mean zero calorie. When fat loss is the goal, total energy intake still matters, regardless of how low one’s carb intake is. (Overdoing total calories—especially from fat—is a common reason for slow or stalled weight loss on keto.) Whether following a keto diet—or any other way of eating—when fat loss is stalled or especially slow, liquid calories should be the first thing to ditch, including alcohol.

Beyond its impact on total energy intake, alcohol has other effects keto dieters should be aware of. Alcohol affects the body’s insulin response. This may not be as significant on a keto diet, but if alcohol is consumed in conjunction with carbohydrates, the body may need substantially more insulin in order to bring blood sugar back down. (Alcohol reduces the affinity of binding between insulin and its receptor.) This means that blood glucose might not be any higher than it would be without the alcohol, but that’s because the increased insulin secretion helped to control it. And it’s critical to understand that even when blood sugar is normal, chronically elevated insulin is a major driver of cardiometabolic dysfunction.

The way the body metabolizes alcohol also affects the production of fat. Specifically, it increases de novo lipogenesis in the liver. (This is the origin of fatty liver disease associated with alcohol, which can be made worse by combining excessive alcohol intake with a high-carb diet.) Not only does alcohol increase endogenous fatty acid synthesis, but it also suppresses fat oxidation, so it’s a double whammy for those looking to lose body fat. The body has no storage capacity for ethanol, so it must be oxidized immediately, unlike glucose, fatty acids, and to a small extent, protein. Ethanol takes “oxidative priority” over other fuel substrates – when the body is busy metabolizing ethanol, it’s not burning stored fat. (On the contrary, it may be creating more of it.)

Effect of alcohol on blood sugar and ketones

It’s not necessary for most people to measure their ketones (whether in blood, breath or urine), but those who choose to may see their ketones elevated after drinking alcohol, including into the next day. This isn’t automatically something to celebrate, though. Firstly, for the purpose of fat loss or reversing cardiometabolic illness, higher ketones don’t cause a keto diet to work better or more quickly. In the context of post-alcohol measuring, ketones may be higher than normal because the body isn’t fully oxidizing fat, and ketones are the byproduct of this incomplete oxidation. Plus, alcohol inhibits metabolism of fat, carbs, and ketones, so it’s possible the ketone level may be higher because ketones are building up in the bloodstream since they’re not being utilized as quickly.

An even more critical thing to be aware of when drinking alcohol on a keto diet is that alcohol decreases gluconeogenesis (GNG). With very little dietary carbohydrate coming in, people who eat keto rely on GNG to supply some of the glucose the body requires, so it’s important to be on the lookout for signs and symptoms of hypoglycemia. Additionally, alcohol slows the release of hepatic glucose, adding another layer that could contribute to lower blood sugar during and acutely after drinking.

What to drink on keto

With all of that being said, as mentioned earlier, alcohol may be a component of many people’s social and cultural life. So, for those who choose to continue consuming alcohol while on a keto diet, what are the most sensible choices?

Keep it simple: opt for alcohol and mixers that are zero-carb or close to it.

Distilled spirits: Most distilled spirits (vodka, rum, tequila, gin, bourbon, etc.) are zero-carb. The issue is what they’re mixed with. Fruit juice, sugary mixers, and sugar-sweetened sodas are off-limits, so it’s best to choose sugar-free mixers, diet colas, zero-calorie flavored sparkling waters, etc. Fresh-squeezed lemon or lime juice adds a nice touch for a negligible amount of carbohydrate.

Beer: Since regular beer can be thought of as “liquid bread,” it’s best avoided completely, or enjoyed only occasionally. There are many light or low-carb beers available now, most with just 2-5 grams of carbohydrate per 12-ounce bottle.

Wine: It’s not necessary to seek out “keto wine.” Wine companies are capitalizing on the popularity of keto and marketing their wines as especially keto-friendly, but apart from fortified dessert wines and obviously sweeter wines, most wine is very low-carb. People often assume red wine is drier than white, but both reds and whites can vary from bone-dry to sweet. The drier the wine, the less residual sugar is left after fermentation of the grape juice. A very dry wine may have just 2 grams residual sugar per liter—and an entire bottle of wine is just 750 mL, so the amount of sugar per glass is negligible. But again, very low sugar doesn’t mean very low calorie, so even dry wine can be a culprit in stalled weight loss on a keto diet.

Bottom line

Following a keto diet doesn’t mean saying goodbye to alcohol. However, regular consumption may interfere with weight loss or even cause weight gain, along with other unwanted metabolic effects. When including alcohol in a keto lifestyle, consume it safely, in a reasonable quantity and frequency, and avoid drinking on an empty stomach. Favor selections that low- or zero-carb, and if weight loss is slow or stalled or other health problems fail to improve, it’s best to abstain altogether.

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