Beer has long played a role in the social life of many Australians. Moderate consumption of beer can have positive health effects for some people and diabetes does not always prevent the moderate consumption of alcohol. However, if you do have diabetes, it is important that you discuss your consumption of alcohol with your General Practitioner or Endocrinologuist, beacause diabetes may impact how alcohol affects you, and the amount you can safely consume.
What is Diabetes
Diabetes is a condition in which the body has difficulty controlling the level of glucose (sugar) in the blood. With diabetes, either insufficient insulin is produced by the body or the insulin does not work effectively. Insulin is a hormone produced by the pancreas, which acts to move glucose from the blood into cells where it is used for energy. As a result, it builds up in the blood, causing symptoms that include lack of energy, increased thirst and urination and possibly weight loss.
There are two main types of diabetes:
Type 1 or Insulin dependent diabetes mellitus (IDDM)
This usually occurs early in life (before thirty years of age), and is life-threatening if left untreated. People with Type 1 diabetes stop producing insulin altogether. Treatment involves daily injections of insulin along with regular meals and snacks, and regular physical activity.
Type 2 or Non-insulin dependent diabetes mellitus (NIDDM)
This usually occurs later in life, from 45 years onwards. People with Type 2 diabetes still produce insulin but for a number of reasons they are less sensitive to it. Type 2 diabetes is treated by changes in lifestyle such as introducing a healthy eating plan and participating in regular physical activity. Tablets may also be prescribed to stimulate insulin production, or to help the insulin work more effectively.
Alcohol and Diabetes
There are many sources of advice on this issue. The extract below is taken from a New South Wales Health Department publication:
"Under normal circumstances people with diabetes can enjoy a moderate alcohol intake and still maintain good glycaemic control. The same precautions regarding the use of alcohol that apply to the general population apply to people with diabetes. Alcohol may cause hypoglycaemia or may mask the symptoms of hypoglycaemia from the other causes. Chronic alcohol intake may impair glycaemic control, may aggravate hypertriglyceridaemia, and is also a risk factor for neuropathy."
The following additional advice was provided:
"Moderate drinking is defined as 2 (women) to 4 (men) drinks per day. When you drink alcohol, eat some carbohydrate food (see Principle 4). If reducing alcohol intake is difficult, seek guidance."
"Principle 4: Include mostly carbohydrate and fibre foods. Slowly absorbed carbohydrate foods generally produce a lower glycaemic response than other carbohydrate foods. Slowly absorbed carbohydrate foods include most vegetables, fruits, legumes, wholegrain breads and low fat dairy products."
Improving Diabetes Care and Outcomes, NSW Health Department, State Health Publication, No. (PHD) 970140.
Furthermore, Diabetes Australia advise that:
- If you are overweight, have poor blood glucose control, high triglycerides, high blood pressure or other complications of diabetes (such as eye, kidney or nerve damage) you may be advised to drink less or not to drink alcohol at all.
- If you are taking insulin or certain blood glucose lowering tablets, you are at risk of alcohol related hypoglycaemia. Not only have studies shown that alcohol may decrease awareness of hypoglycaemia resulting in delayed treatment, but people may mistake you for being drunk and therefore not assist you. The hypoglycaemia may also be difficult to treat.
- Wearing diabetes identification and making your friends aware that you have diabetes may also help to reduce the risks of misinterpreting the symptoms of hypoglycaemia.
Choosing a Beer
Australian beers are all produced from malted barley, with sugar syrups being used in many cases as an additional ingredient. During the initial processing the starch from the malted barley is broken down into a mixture of simple sugars and longer chain (complex) carbohydrate.
In the next step, fermentation, almost all simple sugars are converted by the yeast into alcohol and carbon dioxide. The amount of carbohydrate in the final beer does vary but in most beers it is largely the complex carbohydrate which the yeast cannot use (approximately 2 grams per 100mL) and a smaller amount of simple sugars (generally less than 1gram per 100mL).
Australian beers cover a spectrum of alcohol contents, with most in the range 2.5 to 5% alcohol by volume. Bearing in mind the guidelines above, and standard drink being 10 grams of alcohol, moderate drinking with a full strength beer (4.5 to 5% alc/vol) would be 2 to 3 small (eg. 375mL) bottles or cans per day for a man, and half of that quantity for a woman. There are some products, once termed "diet beers", in the full-strength range which have less carbohydrate and almost no simple sugars.
These are correspondingly lower in energy content and are useful for that reason. Similarly reduced alcohol or light beers are lower in energy because of the lower alcohol content. They often contain amounts of carbohydrate and simple sugars similar to full-strength beer as to provide fullness and flavour to the product. From a weight control viewpoint, the beer styles above provide some advantages.
However, from a diabetes perspective, low alcohol beers may be a better choice than low carbohydrate beer, because not only is the energy content lower but the consumption of alcohol with little or no carbohydrate can increase the risk of hypoglycaemia.
The final decision of whether to drink and what to drink lies with you. It remains essential that, if you wish to include beer in your diet, you consult your doctor. With certain diabetes medications, drinking increases the risk of hypoglycaemia.
Please note: This information is provided as a general guide only. It is not a susbstitute for advice obtained from your General practitioner. Foster's advises that people with diabetes who wish to drink beer should consult their General Practitioner before doing so.