7 things you need to know about alcohol and the keto diet – Diet Doctor

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Clay started theketo dietin 2014 because he wanted to lose weight. And it worked. He took 70 lbs (32 kg) off his 6’1′ (185 cm) frame in six months. During that time he drank alcohol every day — straight vodka, or vodka mixed with diet coke, often until he blacked out. Still, the weight came off. He actually liked the fact that the ketogenic diet lowered his alcohol tolerance: he’d get drunk faster.

About six months into his keto journey, however, Clay knew alcohol was causing too much havoc in his life, harming his health and hurting people he loved. He had to stop drinking.

“I realized the way I ate and the way I consumed alcohol were very similar. Once I started, I couldn’t stop. It was hard for me to do anything in moderation,” says Clay, 28, who is in the military.

He has been sober now for 2.5 years and on the keto diet for three years (except for 8 weeks in boot camp). He feels wonderful, both because of his diet and his sobriety. He is a lean, muscular 185 lbs (84 kg) and feels fit, strong and clear-headed. He enjoys working out regularly. The cravings for both his trigger foods and for alcohol are gone. He sees the two as being very closely related. And he will never risk bringing up those cravings again.

“A few potato chips from time to time might not kick me out of ketosis, but it could very well awaken the cravings in me… so that saves me from taking the first bite. And I stay away from alcohol entirely. It is not worth taking a single sip, knowing where my mind goes when I drink.”

Alcohol consumption and the keto diet is a hot topic. Many people who want to shed pounds come to ketogenic eating and are delighted that, unlike many diets, alcohol isn’t strictly forbidden when going low carb, high fat. While it may slow weight loss for many people, the occasional glass of dry white or red wine, champagne, or even distilled liquor may be okay — as long as it has no sugar. For the best options, see our guide, Top 5 low-carb alcoholic drinks. 

In fact, back in 1964 a slim bestseller called The Drinking Man’s Diet, by Robert Cameron, was one of the first to tout a low-carb diet as a way — in that Mad Men era — to have one’s steak and martini, too. Cut out the sugar and carbs, Cameron said, and moderate alcohol was not a problem.

But is that true for everyone? Well, not exactly. The relationship between sugar, carbs and alcohol — and the caveats around smart consumption when on the ketogenic diet — are not as simple and straightforward as Cameron’s 1960s advice.

For this post, we researched the medical literature and sought input from an array of experts about alcohol and the low-carb, ketodiet. Here are 7 essential points to know:

1. Moderation is key

For those who have healthy livers, not much weight to lose, and no trouble stopping at one drink (for women) or two (for men), the occasional imbibing of a low-carb alcoholic drink is probably not going to cause any harm, and may even help with cardiovascular health and joie de vivre.1

Dr. Aseem Malholtra, in his bestselling book The Pioppi Diet 2, notes that a glass of wine at dinner among friends and family while eating a low-sugar, no-processed-food Mediterranean diet is part of the recipe for longevity and good health enjoyed by the people living in the Italian village of Pioppi.

Swedish diabetes researcher and medical specialist Dr. Fredrik Nyström, head of internal medicine at Linköping University, has studied dietary intake in various populations and has the same advice for generally healthy people: a daily glass of wine, combined with a low-carb diet, can be good for your health.

Nyström notes that alcohol is actually the fourth macronutrient after protein, fats and carbohydrates, and that in many nutrition studies its intake is often overlooked.3 In Mediterranean countries like Greece and Italy, alcohol makes up about 10 % of caloric intake and may partially contribute to the touted benefits of the Mediterranean diet, Nyström says. “Alcohol is found to lower blood pressure and to acutely lower blood glucose. These effects are very well proven. It tends to increase healthy HDL cholesterol and it lowered LDL cholesterol in one of the studies I conducted.”4

If [my patients] experience any weight stall, I recommend they stop the alcohol completely.

– Dr. Sarah Hallberg

Drinking alcohol, however, may slow weight loss for some. Dr. Sarah Hallberg advises her patients who are trying to lose weight and/or reverse diabetes to have a maximum 1 glass of wine for women and 2 for men, and not every day. “If they experience any weight stall, I recommend they stop the alcohol completely,” says Hallberg.5Both Dr. Jason Fung and Dr. Ted Naiman discourage any alcohol use among patients in their care who are still trying to lose weight, reverse diabetes or heal a fatty liver (see point 5). “I find alcohol is not conducive to steady weight loss,” says Fung.6Keto nutritionist Maria Emmerich notes that the reason alcohol slows weight loss is not because of its calories, but because it stops the body’s ability to utilize fat stores for energy.7The takeaway: small amounts of low-carb alcohol are fine, but if your weight loss stalls or you still have issues of metabolic health, consider abstaining, at least for now.

2. Moderate drinkers: fundamentally different?

Many studies have shown that alcohol consumption when graphed against mortality risk is a J-shaped curve. Abstainers have slightly higher mortality risks than moderate drinkers and heavy drinkers have the highest risks of all. (There has been debate about whether the teetotalers group includes former heavy drinkers now abstaining, hence the worse result. And as we have noted before, observational trials such as these do not prove cause and effect)8

In a 2007 New York Times article, Gary Taubes says he is suspicious of these sorts of epidemiological findings: “The question I always had about these studies was whether or not people who drink alcohol in moderation are just different than the teetotalers, who drink none, and the binge drinkers, who drink to excess. Maybe by looking at a glass or two of alcohol a day you’re selecting out for people who live their entire lives in moderation, people capable of living well without excess.”

The takeaway: Be honest with yourself. Can you easily stop at one or two drinks max? If you can’t, our experts say be very cautious with alcohol and consider abstaining. Dr. Naiman notes that at higher levels of consumption, alcohol may be toxic to multiple organ systems and is linked to hypertension, nerve damage, cancers and cognitive decline.9

3. Can’t easily stop? It’s your brain chemistry

Many people who have trouble moderating their eating or drinking may often beat themselves up. Clay describes his feelings of self-hatred for his once uncontrolled eating and drinking. But as Diet Doctor’s sugar-addiction expert Bitten Jonsson states, the inability to quell cravings and moderate one’s consumption — whether high-carb foods or alcohol — has less to do with willpower and more to do with the altered biochemistry of the brain.

“The brain chemistry that drives the addict to seek pleasure beyond the point of satiety is similar, whether the user favors Jack Daniels or Jack-in-the-Box,” says Dr. Vera Tarman, author of Food Junkies, a book that Jonsson recommends for all sugar addicts.

Dr. Robert Lustig agrees, noting that neuroscience and addiction research shows that the brain’s dopamine (reward system) pathway is the same whether it is sugar, alcohol, nicotine, cocaine…whatever.10 “All hedonic (pleasure-causing) substances and all hedonic behaviors work through the same dopamine pathway,” says Lustig, the best-selling author, anti-sugar advocate and pediatric endocrinologist. In his latest book The Hacking of the American Mind, Lustig describes how big businesses like the sugar industry, beer companies, processed food manufacturers — even social media apps and smart phones — knowingly exploit this dopamine pathway to drive profits and to keep us coming back for more, despite detriments to our health and wellness.

Even if you are able to successfully stop one addiction, addiction transfer, also called addiction-interaction disorder, is a well-known phenomenon. Jonsson notes that many sugar addicts may become alcoholics.11 Likewise, alcoholics who quit drinking may turn to sugar in an attempt to control cravings. Studies show that patients undergoing bariatric surgery, who can no longer overeat, have a 20 % higher rate of post operative problems with alcohol dependence.12

“When you are addicted to one substance and find yourself abstaining, your dopamine’s modus operandi is to find a substitute trigger,” says Lustig.

The takeaway: if you are doing the low-carb, keto diet to help deal with a disordered or addictive relationship to carbs or sugar, addiction transfer to alcohol may occur. Our experts recommend abstaining.

4. An adaptive trait that helped, now harms

Our innate dopamine reward system, which says “this is good, I want more” was likely a highly functional trait for survival in our primate and hunter-gather days, but our stone-age genes have not adapted to the modern world.13

The evolutionary theories of why our brain biochemistry may drive some to overeat or drink to excess are fascinating and varied, but most have to do with the ancient need to consume large amounts of high-calorie fruit and carbs in season in order to pack on fat to live off of during lean seasons and food shortages.14

In 2014 researchers in Florida sequenced human and primate genomes and worked backward to find the common ancestor 10 million years ago that first began to efficiently metabolize ethanol (fruit alcohol) found in fermenting fruit lying on the forest floor. A genetic mutation was found that linked to a time when primates were coming down out of trees, the earth was cooling off, and food sources were changing. Primates who had the mutation could eat the fermenting fruit on the ground in the limited time it was available, metabolize the ethanol 40 times more successfully, get the extra calories and thrive. The researchers hypothesized that hominid brains then evolved to link its pleasure pathways to alcohol consumption because it was associated with finding and consuming a key high-calorie food source in season.15

The takeaway: some people find more self-acceptance — and a better ability to understand and control their cravings — by knowing about a once-helpful ancient trait that in modern times is a liability. As Lady Gaga sings in her anthem to self acceptance: “Rejoice and love yourself today, ’cause baby you were born this way.” Since you can’t change your biology, avoid the trigger — alcohol — and prevent overconsumption.

5. Fatty liver? Lay off the booze until it heals

Non-alcoholic fatty liver disease (NAFLD) is a huge health epidemic, impacting increasing numbers worldwide — including 65 million people in the US alone.16 Research suggests that one of the major contributors is the overconsumption of fructose.17 Dr. Evelyne Bourdua-Roy wrote about how common NAFLD is among the patients in her GP practice — but also how reversible it is on a low-carb, low-fructose, high-fat, no-alcohol diet in her article How fat is your liver?

Fructose is alcohol without the buzz.

– Professor Robert Lustig

Dr. Lustig notes that unlike glucose, fructose and alcohol go straight to the liver, where they are metabolized almost exactly the same way. “Fructose is alcohol without the buzz,” says Lustig. Ethanol and fructose are metabolic cousins and when consumed in excess, both may promote fatty liver, leading to eventual liver fibrosis, scarring and potentially cirrhosis, liver failure and even liver cancer.18

Higher rates of non-alcoholic fatty liver disease (NAFLD) are very common in people with diabetes, obesity, and polycystic ovarian syndrome.19

On a scan, a fatty liver looks exactly the same, whether caused by chronic alcohol consumption or high-fructose intake in someone who has never touched a drink.20

The takeaway: Anyone with any fatty or fibrotic liver issues should avoid sugar, carbs and alcohol until the liver has healed. “If you have liver problems you should avoid alcohol under all circumstances,” says Lustig.

 

6. Lower tolerance, worse hangovers

Many people posting in forums and discussion groups about the ketogenic diet report that their alcohol tolerance is much lower, and their hangovers much worse on a low-carb diet.21 However, there isn’t much scientific research yet to explain why tolerance seems to be reduced, just theories, such as the liver being busy producing ketones or glucose, which might slow down its ability to process alcohol.

Additionally, a stomach full of carbs can slow down alcohol absorption.22 However, many people eat very few carbs on a keto diet. So be careful, because you may become intoxicated at lower levels of alcohol consumption. And make sure to never drink and drive. (Note: even if you have not drunk very much, ketones in your breath may make you blow over in a breathalyzer, as some case reports have noted.)23

More severe hangovers may possibly be the result of dehydration and electrolyte imbalances, although the precise mechanism responsible for hangovers has yet to be determined.24 Carbs hold onto water, whereas the ketogenic diet increases urination and fluid loss. Alternate water between any alcoholic drinks, and consider adding some salt and taking magnesium and potassium supplements.25 Read our electrolyte supplementation guide for further details.

Alcohol may potentially lower blood glucose because the liver is busy metabolizing the alcohol and unable to produce glucose through gluconeogenesis.26

Alcohol and its harms are much more potent on a ketogenic diet.

Here is another important caution: for those doing the keto diet and intermittent fasting, a sudden episode of heavy binge drinking could even predispose some individuals to the dangerous situation of alcoholic ketoacidosis, in which ketones are very high in the blood, but unlike diabetic ketoacidosis, blood glucose is normal or even dangerously low.27“Theoretically, there would be an increased risk of alcoholic ketoacidosis if binge drinking and fasting,” said Dr. Fung.

The takeway: Be careful. Alcohol and its harms are much more potent on a ketogenic diet. See point 1: Moderation is key.

7. The keto diet can reduce alcohol cravings and may even help curb alcoholism

Many people, like Clay, have found the keto diet greatly helped reduce their cravings for both sugar and alcohol and reduced their urge and need to drink. Discussion threads on the popular social media site Reddit have many posts from people who found adopting the ketogenic diet helped them lower their consumption or even kick their alcohol addiction.28

“Once you get past the carb addiction and become a fat burner, your body has that other fuel (fat) that it can use instead of carbs and ethanol, and because it’s so satiating, both the carb and ethanol cravings subside,” said “Rockithound” in a Reddit discussion.

Film director Tom Naughton, who made the documentary Fat Head, says that when he was a vegetarian he craved alcohol and had trouble stopping once he started drinking. He lost the craving and desire to drink when he went LCHF. “I thought I needed a 12-step program. Turns out I actually needed a medium-rare steak,” he says.29

A keto diet may potentially even help alcoholics detox. The US National Institute on Alcohol Abuse and Alcoholism (NIAA) in Bethesda, Maryland is currently in the recruiting stage for a new clinical trial to investigate the use of the ketogenic diet during detox for alcohol dependency. Principal investigator Corinde Wiers, PhD, notes that a number of studies and observations on brain energetics suggest that the ketogenic diet is a promising supplementary intervention for alcohol use disorders (AUD).30

The NIAAA team is now recruiting 50 initial subjects, male and female, who are dependent on alcohol and want to stop drinking. These people will be admitted for an all-expenses-paid residential treatment program for alcoholism for three weeks and randomized into the ketogenic diet or the standard American diet while undergoing otherwise normal detox therapy. Then after discharge, the patients will be followed for a year to assess drinking behaviour and relapses, if any.

The ketogenic diet could help you reduce your cravings for alcoholic drinks.

“We will test if the ketogenic diet has an effect on withdrawal symptoms, craving, alcohol cue-induced brain reactivity and sleep quality,” says Wiers. If it does, then the ketogenic diet could become part of the arsenal of therapy for alcoholics who want to quit, she says.

The takeaway: the ketogenic diet could help you reduce your cravings for alcoholic drinks, or even help you quit altogether.

Conclusion

In short, drink moderately and stop if weight loss stalls. Be careful how alcohol triggers your own cravings for overconsumption. Watch out for lower tolerance and other harmful effects of mixing alcohol with keto (especially if you have fatty liver disease), and potentially note the positive impact on cravings on keto. Finally, of course, never drink and drive.

For Clay, he is happy that more people are talking about the ketogenic diet and alcohol. “I wish I had known about it earlier.”

What has been your experience with alcohol and the keto diet? Tell us in the comments below. And if you want to know more about what alcoholic drinks are low-carb or keto, check out our low-carb alcohol guide.


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