Effects of moderate alcohol on fasting insulin and insulin sensitivity (2002)(jamanetwork.com)
jamanetwork.com
Effects of moderate alcohol on fasting insulin and insulin sensitivity (2002)
https://jamanetwork.com/journals/jama/fullarticle/194914
29 comments
I am a 25+ year type 1 diabetic who shares this disease with my mother and brother. I can tell you with certainty whenever you have an increase in insulin sensitivity it has to do with an increase in serotonin in your blood. Anything that increases serotonin; alcohol, certain drugs, exercise, etc will increase insulin sensitivity. Serotonin not only modulates but also increases insulin effectiveness.
Whoa. This is a fascinating connection I've never heard of before! Thank you for sharing. Where can I learn more about this?
This would check out with the positive impact that anabolic steroids have on insulin sensitivity too, given literature showing that many of them are serotonergic (IE, nandrolone).
Never thought about this, that's an interesting idea.
Never thought about this, that's an interesting idea.
A more recent RCT with 220 participants with type 2 diabetes[1] concluded similar beneficial outcomes to alcohol consumption.
[1] https://www.acpjournals.org/doi/full/10.7326/M14-1650
[1] https://www.acpjournals.org/doi/full/10.7326/M14-1650
* in Postmenopausal Women, 2002
the title should be changed
I would highly recommend everyone try a constant glucose monitor at least once in their life. I couldn't believe how much even small amounts of alcohol messed up my insulin/glucose into the next day.
the title should be changed
I would highly recommend everyone try a constant glucose monitor at least once in their life. I couldn't believe how much even small amounts of alcohol messed up my insulin/glucose into the next day.
I am pre-diabetic and I very well might be diabetic. My A1C is right at the border so I was able to convince my GP to give me a prescription for a CGM.
It’s very interesting and helpful in keeping my blood sugar levels. I’ve been on carb-restriction diet for about a year and it unfortunately hasn’t had any impact on my insulin resistance. I had a “cheat week” recently and my body’s reaction to carbs was extremely disappointing so I guess low carb is what I’ll need to be on for the remainder of my life.
The thing I hate most about CGM like Freestyle Libre 2 is how they purposefully artificially limit the device to keep control over the user and to maximize their profits. I don’t have any data past 90 days, which I didn’t realize so I can’t see my data from before. There’s no reason to not store all my data and it infuriates me. The sensor is limited to 14 days which is also artificial so they are just maximizing their profits. I wish another manufacturer would come out with a cheaper priced one so that more people could benefit from it.
It’s very interesting and helpful in keeping my blood sugar levels. I’ve been on carb-restriction diet for about a year and it unfortunately hasn’t had any impact on my insulin resistance. I had a “cheat week” recently and my body’s reaction to carbs was extremely disappointing so I guess low carb is what I’ll need to be on for the remainder of my life.
The thing I hate most about CGM like Freestyle Libre 2 is how they purposefully artificially limit the device to keep control over the user and to maximize their profits. I don’t have any data past 90 days, which I didn’t realize so I can’t see my data from before. There’s no reason to not store all my data and it infuriates me. The sensor is limited to 14 days which is also artificial so they are just maximizing their profits. I wish another manufacturer would come out with a cheaper priced one so that more people could benefit from it.
Check out the "BluCon" from Ambrosia Systems. I just bought two.
Like other devices such as the MiaoMiao, it reads your Libre 2 sensor every five minutes and then sends that data over Bluetooth to an app on your phone.
Unlike many other such devices, you can get one model of BluCon that is also water-resistant, just like the Libre 2. It's also the same shape and size as the Libre 2, so that you can easily stack them one on top of the other. Of course, you'll want to put something over that to help ensure the whole stack doesn't accidentally get ripped off, and Ambrosia helpfully includes some stuff in the pack to do that.
I'm picking up my refill for the Libre 2 this afternoon, and then I'll get a chance to try my first BluCon.
The Libre 2 itself should last 14 days. But the BluCon will last much longer on it's CR2032 replaceable battery, and can be transferred from one Libre sensor to the next. See https://www.ambrosiasys.com/our-products/blucon/
Like other devices such as the MiaoMiao, it reads your Libre 2 sensor every five minutes and then sends that data over Bluetooth to an app on your phone.
Unlike many other such devices, you can get one model of BluCon that is also water-resistant, just like the Libre 2. It's also the same shape and size as the Libre 2, so that you can easily stack them one on top of the other. Of course, you'll want to put something over that to help ensure the whole stack doesn't accidentally get ripped off, and Ambrosia helpfully includes some stuff in the pack to do that.
I'm picking up my refill for the Libre 2 this afternoon, and then I'll get a chance to try my first BluCon.
The Libre 2 itself should last 14 days. But the BluCon will last much longer on it's CR2032 replaceable battery, and can be transferred from one Libre sensor to the next. See https://www.ambrosiasys.com/our-products/blucon/
Yea the official app is garbage. Or it was garbage the last time I even tried using it. It was more than a year ago and I'm still angry at it.
Not sure how well it works with the Libre 2 but check out Xdrip. It can upload your measurements too so you can share them with your doctor. I use the app to read my Libre 1 through a Miaomiao relay.
Not sure how well it works with the Libre 2 but check out Xdrip. It can upload your measurements too so you can share them with your doctor. I use the app to read my Libre 1 through a Miaomiao relay.
You don’t have to rely on M^2 (miaomiao) anymore with the Libre 2 since it has BT, You can use the xdrip4ios app directly. Unfortunately the test flight campaign is full (https://testflight.apple.com/join/6ZqKUGpm) so you can’t install the app anymore over the testflight App Store :(
There's a Libre 3 sensor that has been released in Europe which uses Bluetooth to connect directly to your phone. It's recently been approved for use by the FDA, but is not yet shipping here in the US.
Meanwhile, you can use the Ambrosia BluCon or other similar device to act as an intermediary.
Meanwhile, you can use the Ambrosia BluCon or other similar device to act as an intermediary.
Hi! For alternative sensor take a look at dexcom, haven’t used it myself but met other t1s with good experience, sensor life of dexcom is 10days so def a trade off.
By constant, do you mean continuous? How would you get this monitor, via your GP?
Yes, thank you!
I've gotten some directly from walmart.com in the past with no prescription. There're a lot of other options lately, like agelessrx.com, levelshealth.com, Veri, Nutrisense, January.ai.
It may give you some life changing insights. Oversimplified, high glucose spikes = shorter life. And it's not a simple issue of carb intake. Your behavior, personal biology and dietary environment (fat? fiber? protein? stress? food sequence?) yield huge variation.
If you decide to learn more about this subject, Peter Attia is a great (if involved) start:
https://peterattiamd.com/?s=insulin
Within a couple days I learned things like I was hypoglycemic during sleep, and my daily oat milk lattes were like eating candy (maltose), whereas an outrageous French dinner left me totally level (fiber/fat).
I've gotten some directly from walmart.com in the past with no prescription. There're a lot of other options lately, like agelessrx.com, levelshealth.com, Veri, Nutrisense, January.ai.
It may give you some life changing insights. Oversimplified, high glucose spikes = shorter life. And it's not a simple issue of carb intake. Your behavior, personal biology and dietary environment (fat? fiber? protein? stress? food sequence?) yield huge variation.
If you decide to learn more about this subject, Peter Attia is a great (if involved) start:
https://peterattiamd.com/?s=insulin
Within a couple days I learned things like I was hypoglycemic during sleep, and my daily oat milk lattes were like eating candy (maltose), whereas an outrageous French dinner left me totally level (fiber/fat).
Sugar metabolism is very interesting.
Sucrose is metabolized in a different pathway than fructose. Fructose is directly metabolized by the liver, which is why things like High Fructose Corn Syrup is devastating for your body. HFCS directly causes fatty liver disease because as the fructose is metabolized by the liver, that’s where the fat accumulated. Fatty liver disease causes things like cirrhosis of the liver which could cause cancer.
I used to drink 6 Cokes a day and my liver blood tests were so high (ALT and AST) that my GP was worried I had liver cancer. I got an ultrasound and I only had fatty liver disease but it was pretty severe. I was overweight but not obese as per BMI. That “scared me straight” and once I started to lose weight my ALT and AST responded instantly.
I have a CGM and when I have cheat days and have Cheetos and a Coke, my blood sugar levels still spike to almost 300 which is diabetic levels but drop back to normal pretty quickly. Food like Cheetos are very quickly turned into blood sugar unnaturally quickly which is why processed carbs are extremely terrible for you and a major cause of pre diabetes.
Sucrose is metabolized in a different pathway than fructose. Fructose is directly metabolized by the liver, which is why things like High Fructose Corn Syrup is devastating for your body. HFCS directly causes fatty liver disease because as the fructose is metabolized by the liver, that’s where the fat accumulated. Fatty liver disease causes things like cirrhosis of the liver which could cause cancer.
I used to drink 6 Cokes a day and my liver blood tests were so high (ALT and AST) that my GP was worried I had liver cancer. I got an ultrasound and I only had fatty liver disease but it was pretty severe. I was overweight but not obese as per BMI. That “scared me straight” and once I started to lose weight my ALT and AST responded instantly.
I have a CGM and when I have cheat days and have Cheetos and a Coke, my blood sugar levels still spike to almost 300 which is diabetic levels but drop back to normal pretty quickly. Food like Cheetos are very quickly turned into blood sugar unnaturally quickly which is why processed carbs are extremely terrible for you and a major cause of pre diabetes.
Do they have you on acarbose/metformin/berberine or something of that ilk?
No I prefer to tackle this naturally but will take it if I need to.
>Sucrose is metabolized in a different pathway than fructose. Fructose is directly metabolized by the liver, which is why things like High Fructose Corn Syrup is devastating for your body.
Source for this? Specifically, the part where HFCS is worse than regular sugar?
>The United States Food and Drug Administration states that it is not aware of evidence showing that HFCS is less safe than traditional sweeteners such as sucrose and honey.[5]
Source for this? Specifically, the part where HFCS is worse than regular sugar?
>The United States Food and Drug Administration states that it is not aware of evidence showing that HFCS is less safe than traditional sweeteners such as sucrose and honey.[5]
Not OP, and "worse" is relative, of course, but you may find these podcast episodes interesting:
https://peterattiamd.com/roblustig/
https://peterattiamd.com/rickjohnson/
https://peterattiamd.com/rickjohnson2/
https://peterattiamd.com/roblustig/
https://peterattiamd.com/rickjohnson/
https://peterattiamd.com/rickjohnson2/
Yes, please tell us more...
Freestyle Libre
What do you mean by messed up?
I'm not OP but have been on strict keto for >5 yrs. Every metabolism/lifestyle is different so, N=1 and I can only share my experiences with it. By design, a ketogenic diet greatly reduces and evens out glucose spikes as opposed to the Standard American Diet. Prior to keto I was obese and mostly ate a normal carb-heavy diet, except when I was trying to lose weight with a typical calorie-restricted diet.
Keeping my body in a constant ketogenic state has not only allowed me to be thin for the first time in my adult life, it also enables me to sense changes to my metabolism based on what I eat and when, especially my blood sugar. Now when I consume too much of the wrong mix foods I can feel the glycemic impact when my blood sugar spikes. There's a subtle "up" phase which feels quite artificial followed by a longer "down" phase. In more extreme cases the down phase extends through to the next day. I vividly remember the one time I consumed a significant amount of sugar all at once since being in keto. I was traveling with family and was in a place with a 'legendary' unique dessert and had a full portion of it. Within a couple hours I had a terrible, almost debilitating, migraine headache (which I never get normally). The headache persisted through most of the next day and I felt generally lethargic and hungover.
I suspect this sort of up / down flow was constant before keto but I had adapted to it and didn't perceive the effects. Now that my body is fully keto adapted, a previously 'normal' spike was disruptive like dropping a tray of dishes in a silent library. After losing all my excess weight over the first 8 months of keto, I realized that I loved the feeling of being in a ketogenic state. For me and my metabolism type, the benefits include sharper cognitive abilities and a much more even emotional balance. To me these benefits are easily worth the small effort to maintain keto. Obviously, radically changing diet is disruptive and difficult at first but it gets much easier after a few months and is now entirely on auto-pilot for me.
If I'd read what I wrote above prior to experiencing it myself it would have seemed weird and not something that would happen to me. That's how different and almost alien the physical, mental and emotional changes felt to me. I knew I was overweight but I had no idea how the tidal glycemic forces were impacting my internal state. I did keto as a temporary thing to lose weight. I would never have imagined I'd stay keto for a year, much less for the rest of my life - especially after being thin. But after I experienced such profound effects first-hand, going back was unimaginable. However, that's my experience and I clearly have a metabolism that's sensitive to glycemic loading, I just never knew it. Other metabolism types may have different results. I don't think there's really a way to know without trying it for a couple months. Prior to keto, I was overweight, had increasingly high A1C tests, was pre-diabetic and on statins - so those may be markers to look for. The long-term health issues from carrying excess weight along with the prospect of becoming a type 2 diabetic needing to inject insulin for life were also sufficient motivation to get off my ass and make dramatic changes.
Keeping my body in a constant ketogenic state has not only allowed me to be thin for the first time in my adult life, it also enables me to sense changes to my metabolism based on what I eat and when, especially my blood sugar. Now when I consume too much of the wrong mix foods I can feel the glycemic impact when my blood sugar spikes. There's a subtle "up" phase which feels quite artificial followed by a longer "down" phase. In more extreme cases the down phase extends through to the next day. I vividly remember the one time I consumed a significant amount of sugar all at once since being in keto. I was traveling with family and was in a place with a 'legendary' unique dessert and had a full portion of it. Within a couple hours I had a terrible, almost debilitating, migraine headache (which I never get normally). The headache persisted through most of the next day and I felt generally lethargic and hungover.
I suspect this sort of up / down flow was constant before keto but I had adapted to it and didn't perceive the effects. Now that my body is fully keto adapted, a previously 'normal' spike was disruptive like dropping a tray of dishes in a silent library. After losing all my excess weight over the first 8 months of keto, I realized that I loved the feeling of being in a ketogenic state. For me and my metabolism type, the benefits include sharper cognitive abilities and a much more even emotional balance. To me these benefits are easily worth the small effort to maintain keto. Obviously, radically changing diet is disruptive and difficult at first but it gets much easier after a few months and is now entirely on auto-pilot for me.
If I'd read what I wrote above prior to experiencing it myself it would have seemed weird and not something that would happen to me. That's how different and almost alien the physical, mental and emotional changes felt to me. I knew I was overweight but I had no idea how the tidal glycemic forces were impacting my internal state. I did keto as a temporary thing to lose weight. I would never have imagined I'd stay keto for a year, much less for the rest of my life - especially after being thin. But after I experienced such profound effects first-hand, going back was unimaginable. However, that's my experience and I clearly have a metabolism that's sensitive to glycemic loading, I just never knew it. Other metabolism types may have different results. I don't think there's really a way to know without trying it for a couple months. Prior to keto, I was overweight, had increasingly high A1C tests, was pre-diabetic and on statins - so those may be markers to look for. The long-term health issues from carrying excess weight along with the prospect of becoming a type 2 diabetic needing to inject insulin for life were also sufficient motivation to get off my ass and make dramatic changes.
I too enjoy the feelings of being on a low-carb/keto diet. I feel like my head is clearer and when I got on cheat weeks my hunger levels increase to incredible levels.
While on a low-carb diet I won’t eat until noon, have a soup and eggs, and then a regular low-carb dinner with maybe 1 cup of yogurt.
When I break my diet, I’m constantly and insatiably snacking all the time. The difference is stark and really eye opening.
I suspect your migraine is largely psychosomatic. At 5 years keto, any sugar you eat will be metabolized within hours and your blood sugar levels normalize. Having symptoms well into the next day doesn’t make physiological sense, but I understand where that comes from. I don’t get migraines but a deep sense of shame when my willpower decreases and I eat a delicious but unhealthy dessert.
While on a low-carb diet I won’t eat until noon, have a soup and eggs, and then a regular low-carb dinner with maybe 1 cup of yogurt.
When I break my diet, I’m constantly and insatiably snacking all the time. The difference is stark and really eye opening.
I suspect your migraine is largely psychosomatic. At 5 years keto, any sugar you eat will be metabolized within hours and your blood sugar levels normalize. Having symptoms well into the next day doesn’t make physiological sense, but I understand where that comes from. I don’t get migraines but a deep sense of shame when my willpower decreases and I eat a delicious but unhealthy dessert.
The severe headache the next day felt like what's called "keto flu" which is caused by an electrolyte imbalance. It's not really a flu but happens to many people when transitioning into keto if they don't take care to supplement electrolytes (primarily salt). The mechanism is well-understood. It happened to me when I first started keto because I foolishly ignored the warnings about supplementing electrolytes. The headaches and other keto flu symptoms usually start 24-36 hours after stopping carbs and can persist for a few days if not addressed with electrolytes.
I haven't needed to supplement electrolytes since my first month of keto because I'm fully keto adapted. I think the episode where I stupidly 'overdosed' on sugar my metabolism was no longer adapted to handle, pulled me fully out of keto and caused an electrolyte imbalance similar to what I experienced early in keto.
I haven't needed to supplement electrolytes since my first month of keto because I'm fully keto adapted. I think the episode where I stupidly 'overdosed' on sugar my metabolism was no longer adapted to handle, pulled me fully out of keto and caused an electrolyte imbalance similar to what I experienced early in keto.
This paper does not find that ingesting alcohol is beneficial for insulin sensitivity. It shows that ingesting alcohol is better for insulin sensitivity than ingesting sugar water.
> Women consumed either 15 g/d of alcohol (1 drink), 30 g/d of alcohol (2 drinks), or an isocaloric beverage (0 g/d alcohol) as part of a controlled diet in a randomized crossover design for 8 weeks per diet treatment. Each period was preceded by a 2- to 5-week washout period. Random allocation to treatment sequence and washout periods were used to eliminate carryover from previous treatment. All foods and beverages were prepared and supplied by the Center's Human Studies Facility. Menus were prepared to provide 54% of calories from carbohydrates or carbohydrates and alcohol, 32% from fat, and 14% from protein. Alcohol was supplied as ethanol (Everclear, Daniel Sherman Corp, St Louis, Mo) in orange juice (340 mL). Energy from alcohol was replaced with energy from carbohydrates (Polycose, Ross Products Division, Columbus, Ohio) and soft drinks
> Women consumed either 15 g/d of alcohol (1 drink), 30 g/d of alcohol (2 drinks), or an isocaloric beverage (0 g/d alcohol) as part of a controlled diet in a randomized crossover design for 8 weeks per diet treatment. Each period was preceded by a 2- to 5-week washout period. Random allocation to treatment sequence and washout periods were used to eliminate carryover from previous treatment. All foods and beverages were prepared and supplied by the Center's Human Studies Facility. Menus were prepared to provide 54% of calories from carbohydrates or carbohydrates and alcohol, 32% from fat, and 14% from protein. Alcohol was supplied as ethanol (Everclear, Daniel Sherman Corp, St Louis, Mo) in orange juice (340 mL). Energy from alcohol was replaced with energy from carbohydrates (Polycose, Ross Products Division, Columbus, Ohio) and soft drinks
You’d think there would be a plausible hormesis explanation for the benefits of moderate alcohol intake.
Lots of systems in the body work this way. Eg we grow our muscles by literally damaging them and having them grow back stronger.
Lots of systems in the body work this way. Eg we grow our muscles by literally damaging them and having them grow back stronger.
I have a totally made up theory given I know nothing. But perhaps alcohol cleans out the arteries because it makes built up fat break away from walls. It is a solvent after all.
Life is for the liver
It's worth saying that a more recent meta-analysis [1] concludes that there is a slight reduction of HbA1c (i.e. better long-term glycaemic control) but that the evidence is weak. As ever with medicine, you should now read a metric ton of disclaimers into this paragraph along the lines of the other harms that alcohol produces, and how the evidence is mixed and it is hard to produce decent trials to study it. With regards to (the very related) cardiovascular risk profile, this meta-analysis is also likely to be of interest. [2]
[1] https://diabetesjournals.org/care/article/38/4/723/37573/The... [2] https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....