We have personal glycemic responses, so understanding how alcohol impacts your blood sugar can inform your choices
Our relationship with alcohol is complex. While drinking is a big part of so many social and celebratory events, most of us know that too much alcohol isn’t so great for our health. Aside from addiction concerns, alcohol is linked to cancer, heart disease, obesity, and more. Plus, heavy drinking is associated with an increased risk<sup>1</sup> of developed type 2 diabetes.
The way alcohol impacts our blood sugar is equally complex. How much you drink, what type of beverage you have, and even what food you eat while drinking all impact how alcohol is processed by your body. Fundamentally, the body treats alcohol like a toxin and will prioritize breaking it down before anything else, which impacts all other aspects of your normal metabolism.
Since we all have individual glycemic responses to food and drinks, understanding how alcohol impacts your blood sugar can help you make the right choices for your health. This article will cover the relationship between alcohol and blood sugar dysregulation, plus examine how drinking impacts weight loss.
First, let’s start with what happens in your body after you drink. A small amount of alcohol is absorbed in your stomach, but most occurs in your small intestine<sup>2</sup>. Once absorbed, alcohol moves to your liver, where it is processed with the help of specialized enzymes that break it down into smaller metabolites to remove it from the body.
While most alcohol metabolism happens in the liver, some happens in other parts of your body, including the pancreas. And how well you metabolize alcohol has a genetic component<sup>3</sup>, so some people can do it more efficiently or quickly than others.
Generally, alcohol will lower your blood sugar because it interferes with carbohydrate metabolism. This is true for people with or without diabetes.
Your liver helps regulate blood sugar by releasing stored glucose into your bloodstream when you need an energy source.
It does this in two ways:
1. Gluconeogenesis<sup>4</sup>: The liver makes glucose from non-carbohydrate substances like amino acids
2. Glycogenolysis<sup>5</sup>: Stored glucose is broken down and released into your blood.
Alcohol inhibits these processes because your liver prioritizes metabolizing the alcohol<sup>6</sup> before anything else. As a result, your blood sugar drops. In fact, gluconeogenesis can drop by almost half after four drinks<sup>7</sup>.
Interestingly, alcohol can also temporarily increase insulin sensitivity<sup>8</sup>, which can also lower blood sugar as the body pulls more glucose out of the blood.
Several studies on light to moderate drinking for people with diabetes found that even with temporary lows, blood sugar regulation isn’t significantly impacted<sup>9</sup> overall. And interestingly, some research suggests that because alcohol can temporarily increase insulin sensitivity, it may help people with blood sugar dysregulation<sup>10</sup>.
A piece of sprouted bread made with a lot of fiber will affect your blood sugar differently than a piece of processed white bread. The same goes for your drink choices. Not all alcohol will do the same thing in your body, so the type of alcoholic beverage you choose can have varying impacts on your blood sugar.
While it’s true that alcohol can lead to lower blood sugar, certain types of alcohol can be secret sugar-bombs because of added mixers, simple syrups, or juice.
Dark or craft beers also tend to be higher in carbohydrates than other alcoholic drinks. So drinking too many of these drinks can also increase your blood sugar because of the excess sugar and carbs.
As mentioned above, alcohol may positively impact insulin sensitivity, which could help lower post-meal glucose. One study on healthy adults found that drinking alcohol with a meal leads to a lower glucose response<sup>11</sup> than drinking water.
But since there are healthier ways to improve your blood sugar response, this study doesn’t necessarily mean you should start drinking with all your meals.
Drinking on an empty stomach is not recommended for anyone with or without diabetes. Food helps slow down the absorption of alcohol, so you’re less likely to overdo it. Drinking alcohol in a fasted state also puts you more at risk for hypoglycemia (as you will learn below).
It can take up to 90 minutes for your liver to process each glass of alcohol, but the effects can last up to 12 hours<sup>12</sup> after you’ve had your last drink. Knock back more than one drink and it can add up quickly.
Since many people tend to drink at the end of the day, this means right when you lie down to sleep, your glucose can drop for some time (and normal metabolism is impacted), depending on how much you had to drink.
Many studies that look at blood sugar responses after drinking focus on people with diabetes, but even otherwise healthy people without diabetes can experience low blood sugar.
However, while it can be serious for people with diabetes who end up with dangerously low blood sugar (hypoglycemia), healthy people who drink light to moderate amounts of alcohol likely won’t see significant impacts on their blood sugar.
One caveat is if you are fasting or follow a ketogenic diet. You may experience hypoglycemia because you don’t have stored glucose. Keto, for example, relies on gluconeogenesis for the small amounts of glucose the body still needs. While the liver is busy removing alcohol from the body, your blood sugar drops because you aren’t producing glucose and you have no glucose reserves to tap into.
A healthy blood sugar response means your blood sugar remains in a tight window without many highs and lows. High variability in blood glucose<sup>13</sup>, or bouncing between highs and lows, is also a health concern. So, even if you don’t necessarily have dangerous lows, you want to determine your individual response to alcohol before deciding how it impacts your health.
The health risks increase if you are a heavy drinker. Heavy drinking can lead to liver damage, impacting insulin production and secretion and how well your cells respond to signals from insulin.
Research suggests that chronic drinkers can develop insulin resistance<sup>14</sup> because it interrupts insulin signaling and causes beta-cell damage. Beta-cells are found in your pancreas and are responsible for insulin secretion.
Women with a history of binge drinking<sup>15</sup> (or more than four drinks in two hours) may also be at higher risk for high blood sugar.
One study found that women who drank more and participated in binge drinking were more likely to have high blood sugar<sup>16</sup> regardless of how much they weighed or if they had other health concerns like smoking or hypertension. Interestingly, the same results weren’t seen for men who only had associations with high blood sugar and BMI or blood pressure. However, men in the study had higher glucose levels and alcoholic intake than women overall.
If you’re trying to lose weight, the general recommendation is to abstain or limit how much alcohol you drink. The research on alcohol and weight loss is mixed, but alcohol can make it more challenging to lose weight for several reasons:
<ul role="list"><li>When you drink, you lose inhibitions<sup>17</sup> and may find yourself reaching for another drink, even if you only meant to have one. You’re also more likely to choose foods and snacks you don’t normally eat.</li><li>The extra calories from drinks<sup>18</sup> can add up quickly, especially if it’s a mixed drink. There are seven calories per gram of alcohol. So if you end the week with a few margaritas at happy hour and share a bottle of wine with a friend on Saturday night, you’ve added close to 800 extra calories (and possibly more depending on what’s mixed into your drink).</li><li>If your goal for weight loss is to optimize your health, alcohol has no nutritive value<sup>19</sup>, so it adds minimal benefit to your diet. </li><li>Since your body prioritizes alcohol metabolism over everything else, fat breakdown is also interrupted<sup>20</sup>. You may be taking in more calories while pausing your body’s natural ability to burn fat. </li><li>Excess drinking can decrease your motivation. You may feel too tired and lethargic after a night of drinking to participate in the activities that support weight loss, like exercise or prepping a healthy meal.</li></ul>
Ideally, drinking when you want to lose weight would be limited to special occasions like birthdays or a fun night out. That said, unless you’ve made the personal choice to abstain from alcohol, you’ll likely find yourself in situations where you want to drink.
Consider these drink choices if you are trying to lose weight:
<ul role="list"><li>Red wine: A better drink choice with health associations such as longevity and fighting inflammation, a glass of red wine has 125 calories in a five-ounce pour<sup>21</sup>.</li><li>Liquor: Hard alcohol like vodka, gin, or tequila can be low-calorie choices. Just avoid mixing with a sweetened mixer. A shot of hard liquor generally has 120 calories per 1.5 ounces<sup>22</sup> (about the size of a shot glass), making it a lower-calorie option. Try drinking on the rocks or add plain seltzer water.</li><li>Light beer: Beer drinkers watching their weight may want to stick to lighter beers because darker beers are much higher in calories. Light beer generally has 100 to 120 calories per 12 ounces<sup>23</sup>.</li></ul>
If you plan to have a few drinks, make sure you eat a meal that includes protein and fat to slow alcohol absorption, and plan to drink water throughout the night.
Drinking alcohol can temporarily lower your blood sugar.
While light to moderate drinking may not make a huge difference for some people, the variability this adds to your overall blood sugar balance depends on your individual response.
If you are trying to lose weight, alcohol could sabotage your efforts. Moderate amounts of lower-calorie drinks are a better choice if you do choose to drink.
It’s also important to note that you can respond differently to alcohol on different days depending on stress levels, physical activity, diet during the day, and how much you slept the night before. So monitoring your personal blood sugar response to alcohol can give you significant clues when it comes to your metabolic health.
Each glass of alcohol can take 60 to 90 minutes for the body to metabolize. For example, if you have three drinks, it can take three to four-and-a-half hours to digest. However, the effects of alcohol on your blood sugar can last for up to 12 hours after you drink.
Alcohol can raise your blood sugar depending on how much you drink and what you have to drink. Even though alcohol can lead to lower glucose, if you have a drink with a lot of sugar, the extra carbs can raise your blood sugar.
Alcohol can cause hypoglycemia in people with impaired glucose response. People with diabetes are especially at risk, but even people who follow very low-carb diets could be impacted because it interrupts the body’s normal endogenous glucose production.
Quitting drinking alcohol may lower blood sugar if you usually choose drinks that are higher in carbs. People who drink craft beers or mixed drinks could have higher blood sugar responses because these are higher in carbs, so if you stop drinking, your body won’t get the flood of extra glucose. Also, heavy drinkers can have an impaired insulin response, so quitting may help reduce insulin resistance.