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Wine Protects Against Diabetes?

Jun 11, 2016

Study suggests wine consumption offers greater protection against type 2 risk, compared with beer or other alcoholic beverages.

In a study published in Journal of Diabetes Investigation, researchers concluded that any amount of wine — with certain precautions — can have a positive effect for type 2 diabetes.

The pooled RRs for different alcoholic beverages indicated that all wine, beer or spirits consumption was associated with decreased risk of type 2 diabetes, according to the  researchers. “In spite of the similarity, there were still diversities among different types of alcoholic beverages.”

Wine consumption yielded a 15% reduced risk for type 2 diabetes, beer consumption yielded a slight decrease in the risk and spirit consumption yielded a slight reduction, although not significant. In an additional analysis for amount of consumption (low, 0-10 g/day; moderate, 10-20 g/day; high, > 20 g/day), any amount of wine was linked to a significant decreased risk for type 2 diabetes. Moderate beer consumption had a greater effect for reducing the risk for type 2 diabetes compared with the low consumption, but there was no decreased risk with beer consumption in the high category. There was a mild decreased risk for type 2 diabetes with low and moderate spirits consumption, whereas high consumption was linked to an increased risk. “The present meta-analysis demonstrates strong evidence that specific alcoholic beverages had different effects on reducing the risk of type 2 diabetes,” the researchers wrote. “Wine consumption was associated with a significant reduction [in] risk of type 2 diabetes, while beer or spirits consumption showed a slight decrease in the risk of type 2 diabetes. The study provides a new perspective to explore the association between alcohol consumption and type 2 diabetes. Previous meta-analyses identified an inverse association of total alcohol consumption with the risk of type 2 diabetes. The current study further explored the relationship between specific types of alcoholic beverage and the incidence of type 2 diabetes.

13 prospective studies were included in this meta-analysis, with 397,296 study participants and 20,641 cases of type 2 diabetes. Relative to no or rare alcohol consumption, wine consumption was associated with a significant reduction of the risk of type 2 diabetes, with the pooled RRs of 0.85, while beer or spirits consumption led to a slight trend of decreasing risk of type 2 diabetes (RR, 0.96, 0.95, respectively). Further dose-response analysis displayed a U-shaped relationship between all three alcohol types and type 2 diabetes. Additionally, the peak risk reduction emerged at 20-30 g/day for wine and beer, at 7-15 g/day for spirits, with a decrease of 20%, 9%, 5% respectively.

From the results it was concluded that, compared with beer or spirits, wine was associated with a more significant decreased risk of type 2 diabetes, indicating that wine may be more helpful for protection against type 2 diabetes than beer or spirits.

ALCOHOL CONSUMPTION AND DIABETES (From DIABETES SOLUTION, Richard K. Bernstein, MD, FACE, FACN, and FACCWS; Little, Brown and Company, 2011)

Alcohol can provide calories, or energy, without directly raising blood sugar, but if you’re an insulin-dependent person with diabetes, you need to be cautious about drinking. Ethyl alcohol, which is the active ingredient in hard liquor, beer, and wine, has no direct effect on blood sugar because the body does not convert it into glucose. In the case of distilled spirits and very dry wine, the alcohol generally isn’t accompanied by enough carbohydrate to directly affect blood sugar very much. For example, 100 proof gin has 83 calories per ounce. These extra calories can increase your weight slightly, but not your blood sugar. Different beers—ales, stouts, and lagers—can have varying amounts of carbohydrate and therefore may increase blood sugar by different amounts. Mixed drinks and dessert wines can be loaded with sugar, so they’re best avoided. Exceptions would be a dry martini or mixed drinks that can be made with a sugar-free mixer, such as sugar-free tonic water.

Ethyl alcohol, however, can indirectly lower the blood sugars of some people with diabetes if consumed at the time of a meal. It does this by partially paralyzing the liver and thereby inhibiting gluconeogenesis so that it can’t adequately convert much of the protein of the meal into glucose. For the average adult, this appears to be a significant effect with doses greater than 1.5 ounces of distilled spirits, or one standard shot glass. More than one glass of wine or several beers may have similar effect. If you have two 1.5-ounce servings of gin with a meal, your liver’s ability to convert protein into glucose may be severely impaired. If you’re insulin-dependent and your calculation of how much insulin you’ll require to cover a meal is based on, say, two hot dogs, and those hot dogs don’t get their usual partial conversion  to glucose, the insulin you’ve injected will take your blood sugar too low.

The problem of hypoglycemia itself is a relatively simple matter to correct—you just eat some glucose and your blood sugar will rise. But this gets you into the kind of messy jerking up and down of blood sugar that can cause problems. It’s best if one can avoid hypo and hyperglycemia (high blood sugar) entirely.

Another problem with alcohol and hypoglycemia is that if you consume much alcohol, you’ll have symptoms typical of both alcohol intoxication and hypoglycemia—light-headedness, confusion, and slurring of speech. The only way you’ll know the cause of your symptoms is if you’ve been monitoring your blood sugar throughout your meal. This is unlikely. So you could find yourself thinking you’ve consumed too much alcohol when in fact your problem is dangerously low blood sugar. In such a situation, it wouldn’t even occur to you to check your blood sugar. The first blood sugar meter was developed to help emergency room staffs tell the difference between unconscious alcoholics and unconscious diabetics. Don’t make yourself an unconscious diabetic. A simple oversight could turn fatal.

Many of the symptoms of alcohol intoxication mimic those of ketoacidosis, or the extreme high blood sugar, dehydration and ketone buildup in the body that can result in diabetic coma. The presence of ketones can cause a diabetic’s breath to have an aroma rather like that of someone who’s been consuming alcohol. If you don’t die of severe hypoglycemia, then you might easily die of embarrassment when you come to and your friends are aghast and terrified that the emergency squad had to be called to bring you around.

Normally, when challenged by low serum glucose, the liver produces glucose to maintain blood sugar levels. But when you drink alcohol, this protection can be compromised so it does a poor job of getting glucose into the bloodstream. This can lead to hypoglycemia, if you are drinking alcohol with or without a meal.

Hepatic breakdown of alcohol takes several hours. For that entire time, the risk of low blood sugar exists.  The more alcohol consumed, the greater the risk for severe hypoglycemia.

Practice Pearls:

  • A new study suggests that consuming wine protects against diabetes, when compared to other forms of alcohol.
  • The more alcohol consumed, the greater the risk for severe hypoglycemia.
  • More than 1.5 oz. of distilled spirits or one glass of wine can inhibit hepatic gluconeogenesis of meal protein. This can cause severe hypoglycemia in patients who take bolus insulin to cover meals.

See the table of Alcohol Volumes, Carbs, and Calories. This table lists popular alcoholic beverages and gives the average serving size, carbohydrate content, and number of calories.

Huang J, et al. J. Specific Types of Alcoholic Beverage Consumption and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Investig. 2016;doi:10.1111/jdi.12537. May 19, 2016

Diabetes Solution, 2011; Richard K. Bernstein, MD