14

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Drinking booze while in ketosis: is it dangerous?

Asked on March 21, 2017
Created December 19, 2011 at 2:56 PM

Hey all. I was bumping around the paleo inter-webs and came across this little nugget on ketosis:

DO NOT DRINK ALCOHOL IF YOU ARE KETOTIC!

Alcohol is a powerful inhibitor of gluconeogenesis. In fact, it forces part of the gluconeogenic metabolic process into reverse. This means that if all the glucose in the blood is being derived from gluconeogenesis then the consumption of alcohol will inevitably cause the blood glucose level to fall. Worse still, the alcohol also stops ketone body production, thus leaving the brain entirely without fuel.

A person who is ketotic is 100% reliant on gluconeogenesis to maintain adequate levels of glucose in the blood. If, under these circumstances alcohol is taken, the person will become disorientated and might lose consciousness, not just from the alcohol, but from low blood sugar. Needless to say, this could be very dangerous, and even fatal.

Alcohol does not have these effects if the glycogen stores in the liver are normal. Under these circumstances the blood glucose level in the blood is maintained by the breakdown of liver glycogen, a process that is not influenced by alcohol. If a person becomes confused under these circumstances it is due simply to the pharmacological effects of the alcohol! - Link

Although I'm philosophically ketosis-agnostic, I do best on a lowish carb diet and most likely find myself in ketosis from time-to-time. I'm wondering what you think of this warning. Is the science sound? Should ketotic boozers eat a sweet potato before hitting the firewater this xmas?

7bf306ada57db47547e9da39a415edf6

(11214)

on November 20, 2012
at 04:41 PM

Being in ketosis is not dangerous. This constant yo-yoing dieting that you are doing is dangerous.

B3173217a49b5b0116078775a17eb21d

(11488)

on November 20, 2012
at 08:56 AM

Why would being diabetic make any difference? Diabetes is a disease of glucose intolerence, of high blood glucose, not of low blood glucose. Some diabetic medecine causes hypoglycemia, but in general diabetics are less prone to hypos that the rest of the population.

61f9349ad28e3c42d1cec58ba4825a7d

(10480)

on November 13, 2012
at 04:07 PM

Just because people who consume an otherwise Paleo diet sometimes consume alcohol doesn't mean that we consider alcohol to be Paleo. Just like the Jenny Craig eater who eats out at McDonald's doesn't think McDonald's is on the diet. They just do it anyway. It's a cheat for a reason.

Db4ad76f6f307a6f577e175710049172

(2297)

on December 20, 2011
at 08:04 AM

@Rose - Yea, I've learned the hard way that I should never get drunk on wine, I guess my body is a litte more forgiving than yours.

100fd85230060e754fc13394eee6d6f1

(18696)

on December 20, 2011
at 01:43 AM

I'm sorry, Evelyn. That's terrible.

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on December 19, 2011
at 10:29 PM

80% of medications are labeled "do not take with alcohol"; its the most used warning label in the dispensary :)

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 08:09 PM

Hi sage, those without robust livers I suppose? Who knows ... I've always had a high alcohol tolerance, and they say it's the metabolite that gives the buzz. Perhaps my liver is a bit slow all around??

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on December 19, 2011
at 07:37 PM

which "*some* on VL or ZC diets". i don't drink anymore, so i have never paid much attention to alcohol related information.

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 06:29 PM

True, sage, but extra especially so for *some* on VL or ZC diets.

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on December 19, 2011
at 06:25 PM

one should be careful with alcohol period

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 05:36 PM

See my comment below to Amber. I think it depends on the individual. The advice is rather alarmist, but one should be careful with alcohol when severely restricting carbs and being in ketosis. You still need some glucose, and your liver's the only thing that's going to make it for you!

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 05:25 PM

I would say "it depends" on the people in ketosis thing. When I was VLC my FBG's hovered around 70 so I guess I don't have a real strong liver for GNG and I suspect some issues I had with the diet the last time (circa 2004) I did it were related to this. A death in the family involved a few "forget to eat, have a few" moments in there as well, and the result was not good despite being very ketoadapted.

3aea514b680d01bfd7573d74517946a7

(11996)

on December 19, 2011
at 05:19 PM

Yes on the hard liquor. I tolerate tequila (! which I used to loathe) and vodka much better than red wine, which gives me terrible hangovers even after just one glass.

100fd85230060e754fc13394eee6d6f1

(18696)

on December 19, 2011
at 05:01 PM

So, it's true that alcohol interferes with GNG, but false that this causes people in dietary ketosis a problem, then.

A968087cc1dd66d480749c02e4619ef4

(20436)

on December 19, 2011
at 04:39 PM

Yes it is. It's one of the reasons diabetes meds warn "Do not take this with alcohol". The combination can easily lead to hypos.

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15 Answers

16
531db50c958cf4d5605ee0c5ae8a57be

on December 19, 2011
at 05:49 PM

Total horseshit. If this were the case, I'd be dead by now, 1000 times over.

7
E87e6799f0aa0a3f8f3072cbb3c1fe53

on December 19, 2011
at 03:26 PM

I really wouldn't worry about it unless you're diabetic. I can speak to my own experiences - I've been low-carb for the better part of a year, and drink heavily three nights a week. While one does get drunk faster on low-carb, I've never felt like my blood sugar was plummeting and putting me in any danger. n=1

In fact, one of the earliest low carb diet fads in the 1970s was the "Drinking Man's Diet" which advocated that as long as carbohydrate was restricted one could drink as much booze as desired.

Alcoholic Ketoacidosis is a real medical issue, but I'm under the impression that it only happens in cases of extreme alcoholism where someone does not eat anything except liquor for several days in a row. Maybe someone else can fill in the science on this.

B3173217a49b5b0116078775a17eb21d

(11488)

on November 20, 2012
at 08:56 AM

Why would being diabetic make any difference? Diabetes is a disease of glucose intolerence, of high blood glucose, not of low blood glucose. Some diabetic medecine causes hypoglycemia, but in general diabetics are less prone to hypos that the rest of the population.

6
100fd85230060e754fc13394eee6d6f1

(18696)

on December 19, 2011
at 04:59 PM

I used to drink a lot in ketosis. I don't think this is a real problem at all. I think someone has reasoned from mechanism without doing an actual test.

3
29b16e0aa40fcf804643a6fe7fc065be

on June 22, 2012
at 09:10 PM

I think its funny all the people who say they drink heavily 'regularly' while in ketosis dont realize theyre not in real ketosis due to the constant sugar being consumed in the alcohol. good job guys.

3
24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 03:19 PM

Tis true!

Apparently this is known (at least to some) amongst diabetics who will drink the night before taking a physical to lower FBG.

That said, most livers can probably multitask enough to keep BG from falling too too low even with quite a bit of booze.

A968087cc1dd66d480749c02e4619ef4

(20436)

on December 19, 2011
at 04:39 PM

Yes it is. It's one of the reasons diabetes meds warn "Do not take this with alcohol". The combination can easily lead to hypos.

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on December 19, 2011
at 10:29 PM

80% of medications are labeled "do not take with alcohol"; its the most used warning label in the dispensary :)

100fd85230060e754fc13394eee6d6f1

(18696)

on December 20, 2011
at 01:43 AM

I'm sorry, Evelyn. That's terrible.

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 05:25 PM

I would say "it depends" on the people in ketosis thing. When I was VLC my FBG's hovered around 70 so I guess I don't have a real strong liver for GNG and I suspect some issues I had with the diet the last time (circa 2004) I did it were related to this. A death in the family involved a few "forget to eat, have a few" moments in there as well, and the result was not good despite being very ketoadapted.

100fd85230060e754fc13394eee6d6f1

(18696)

on December 19, 2011
at 05:01 PM

So, it's true that alcohol interferes with GNG, but false that this causes people in dietary ketosis a problem, then.

2
Db4ad76f6f307a6f577e175710049172

on December 19, 2011
at 05:07 PM

It's true that ethanol (EtOH) consumption screws up gluconeogenesis, but it also screws up glycolysis too, since it dumps in a ton of Acetyl-CoA into your cell metabolism. Bascially your body is forced into metabolizing the EtOH first - which is good, since EtOH is a poison after all.

There's also Alcoholic Ketoacidosis, but I'd guess that is more of a problem with people who are not ketoadapted, and then find themselves in ketosis. The only problem with ketosis is when one's body freaks out, and produces more ketones than it needs.

Also, from my experience, drinking hard liquor (Jim Beam in my case), has always proven to be a good choice for me, as drinking beer, wine and mead tends to leave me with a hangover. Sugar consumption also tends to increase the severity of the hangover, where I like to think that it has something to do with my body being forced into keto for an entire night, and it still having to deal with carbs that I'm ingesting.

3aea514b680d01bfd7573d74517946a7

(11996)

on December 19, 2011
at 05:19 PM

Yes on the hard liquor. I tolerate tequila (! which I used to loathe) and vodka much better than red wine, which gives me terrible hangovers even after just one glass.

Db4ad76f6f307a6f577e175710049172

(2297)

on December 20, 2011
at 08:04 AM

@Rose - Yea, I've learned the hard way that I should never get drunk on wine, I guess my body is a litte more forgiving than yours.

1
0540564e76fbe62506946bc34e3c545f

on March 21, 2017
at 10:33 AM

 No.

To understand the interplay of ketosis and booze, consider the following.

 

First, the production of glucose depends on having enough NAD+, or an adequate NAD+/NADH ratio. The lower that ratio the more ketones will be produced.

 

Second, an enzyme called malate dehydrogenase allows your body to produce glucose without you eating any carbs. It does so by catalyzing the oxidation of malate by reducing NAD+. This reaction gives you oxaloacetate, the rate-limiting element in the production of glucose. When you’re on a ketogenic diet (or fasting) you rely on this reaction to meet your glucose needs. [Wiki ==> malate dehydrogenase]

 

Last but not least…being in a state of ketosis doesn’t make drinking dangerous per se, what makes alcohol ‘dangerous’ (in any metabolic state) is its inherent toxicity. The claims of ‘ketosis  + alcohol’ being likely fatal is a massive exaggeration. [study ref ==> Alcoholism and Its Relation to Hypoglycemia – An Overview]

 

TL;DR Enjoy your booze responsibly but don’t freak out if you drink whilst ketogenic.

 

Over at Break Nutrition they give more info on ketogenic and low-carb diets. They leave the hype at the door.

1
96440612cf0fcf366bf5ad8f776fca84

(19398)

on December 19, 2011
at 04:17 PM

I've done that, and have had zero issues. I'd expect to feel like death incarnate if it were true, as I'd have to rely on the ketones to keep my brain awake - and I know what it's like when I deplete my glucose stores and don't refuel since I work out while IF'ed.

It might be an issue for some, but I've not had any issues with it at all.

And the best part, I haven't had any hangovers even after 7-8 drinks in a particularly heavy night, since I gave up beer due to paleo. (though I usually drink less than 2 drinks a week). A few beers would give me splitting headaches the next day, though I could drink several pints of Guinness without issue. One Chimay would put me out like a light immediately. So it's the kind of drink, not so much the alcohol level in it too that counts.

These days, I can drink as much Tequila or scotch, or even wine as I want without side effects the next day as long as I eat plenty of meat and drink enough water, even while in ketosis. Just order some "soda water" inbetween every few drinks, and you should have no issues.

0
C19d4a6b8a56e526baf4acc911a9844c

(0)

on September 22, 2016
at 03:29 AM

I'm pretty sure I nearly killed myself. It could have just been the alcohol, but I was in keto and drinking a good bit and suddenly I developed intense neurologic symptoms. Dizziness, vertigo, mental confusion. It was getting worse and worse. I've stopped drinking, and this is just anecdotal so take it with a grain of salt but if you are going to drink and do heavy keto best to limit your intake. I did it for months with no issue. Then suddenly, I'm pretty sure I was dying as I've never felt so ill and bizarre in my life.

0
56999990fb532a71248d679f8d0e5090

on September 15, 2016
at 10:21 PM

This happened to me tonight. I have been keto adapted for 8 month .I rarely drink ,not sure how you can be in keto if you are a regular drinker. Anyway I hadn't eaten anything for 5 hrs ,and l had approx 300ml of red wine .when I do drink it is normally with a meal, this time I started to feel faint ,I felt better when I sat down but as soon as I started moving I felt awful I was pale  cold sweats and visual disturbances. I got some one to get me something to eat ,crisps and I soon was feeling better

0
773f968664c7d985c2f6c072a61328b1

on November 20, 2012
at 03:24 AM

I think that there is much validity to this statement. I inadvertently put myself in a state of ketosis and it has been a real struggle trying to balance my metabolic state again. I'm still in the midst of research and I am not a doctor, dietician or nutritionist.

I've been on a 'primal' diet for about 2 years with periods of 100% primal and periods of 100% paleo. I started the diet because I had to eliminate gluten out of my diet and had already eliminated dairy- then soon found that soy and yeast were bothersome as well- there in-lies the primal diet by default. I was still presenting a lot of GI distress symptoms even after eliminating grains, dairy, soy, yeast, alcohol and processed foods so I decided to do the 21-Day-Sugar Detox (mind you I am about 100 lbs so I needed to be very aware that I was eating enough calories which was extremely difficult to do). I ended up having to stop the detox in the middle of day 13. I simply couldn't function. And I lost too much weight.

So after starting to introduce sugar (fruit, some maple syrup etc) and some other carbs back into my diet like winter squash, I was feeling OK but I was underweight and needed more so I started to eat some certified GF oats here and there... then things got... 'weird.' After a couple of weeks I had a trip to Napa and after not drinking for months I wanted to prepare my body so I had a small glass of wine one night, another one a couple of days later and so on. Anyway after the trip I continued to have small amounts of alcohol but never did feel quite right and haven't ever since. I have brain-fog as if I am eating wheat, extremely dizzy, bouts of confusion, spaced out etc.

One night a few weeks ago I had a pretty normal 95% day of primal eating and had a couple glasses of white wine with dinner and then about an hour later had a martini- that I couldn't finish. I became shaky, weak, elevated heart rate - even though I wasn't hungry I ate a huge bowl of sweet potatoes and finally after about 20 minutes started to feel kind of normal again. I haven't really been able to drink normally since getting off the Sugar Detox...

I have since found out that I have two hernias so that explains a lot of GI issues that I have been trying to solve for over two years...perhaps it's effecting how my body processes alcohol too. I don't know. But I'm pretty convinced that being in a ketosis state was very dangerous for me and I'm still not sure I'm out of it despite the carbs I am eating now...

7bf306ada57db47547e9da39a415edf6

(11214)

on November 20, 2012
at 04:41 PM

Being in ketosis is not dangerous. This constant yo-yoing dieting that you are doing is dangerous.

0
72f0166900f9fe851436dd1369552770

on June 29, 2012
at 10:04 PM

So far every time I have a drink I gain at least 1 to 2 lbs back. I am staying under 20g of carbs but it never fails. I don't have the strips but I think I can tell when I am Letotic because I am full of energy and feel great. I have been doing this 3 weeks and lost 6 lbs but drank last night and gained 1 lb back.

0
Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on June 23, 2012
at 04:34 AM

Oy vey.

Bristlebeard is right -- ethyl alcohol is basically a poison. As such, the body wants to metabolize it and get rid of it as soon as possible. Because of this, drinking alcohol temporarily stops ketosis because instead of using fat for fuel, the body will use alcohol. Will it kill you? Eff no. BUT...please do be careful if you're diabetic or on any kind of medication. (The medication thing is less a sugar/keto issue than it is a liver detox thing. I just finished a biochem class where we covered the liver detox pathways -- trust me, you do NOT want to mess with alcohol and meds if the label specifically warns you not to drink. That warning is there because someone stupider than you already tried it and the result was b-a-d.)

Anyhooooo...

As with most things, if we're talking drinking a reasonable amount of booze, I don't think it's a huge issue. The main thing you should be concerned about when drinking while ketotic or just lower carb in general is that the alcohol will affect you faster and harder. You'll probably require far less alcohol to get the same buzz you did when your body was loaded up with glycogen. A glass of wine? A beer or two? Don't be skeer'd. An all-night bender? I'd think twice.

ETA: I disagree: "A person who is ketotic is 100% reliant on gluconeogenesis to maintain adequate levels of glucose in the blood."

People vary in the amount of CHO they can eat and still be ketotic. For some it's 20g, for some it's 50. If you're in that upper range, you are not "100% reliant on gluconeogenesis."

0
B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on December 19, 2011
at 04:47 PM

Dr. Poullis does not cite any studies to back up this claim. the other thing that caught my attention is that the article is targetted at people who "accidentally" go into ketosis post exercise and not people who are aclimatized to being in ketosis as their norm.

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 05:36 PM

See my comment below to Amber. I think it depends on the individual. The advice is rather alarmist, but one should be careful with alcohol when severely restricting carbs and being in ketosis. You still need some glucose, and your liver's the only thing that's going to make it for you!

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 06:29 PM

True, sage, but extra especially so for *some* on VL or ZC diets.

24df4e0d0e7ce98963d4641fae1a60e5

on December 19, 2011
at 08:09 PM

Hi sage, those without robust livers I suppose? Who knows ... I've always had a high alcohol tolerance, and they say it's the metabolite that gives the buzz. Perhaps my liver is a bit slow all around??

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on December 19, 2011
at 07:37 PM

which "*some* on VL or ZC diets". i don't drink anymore, so i have never paid much attention to alcohol related information.

B4e1fa6a8cf43d2b69d97a99dfca262c

(10255)

on December 19, 2011
at 06:25 PM

one should be careful with alcohol period

-1
28aa1b14dbbbd2c1ba7e95a4e1b01cd2

on November 13, 2012
at 11:35 AM

Never mind the effects it has on your brain, you paleo nuts need to consider the pressure you are placing on your liver and kidneys. Being in ketosis and alcohol lowers your blood sugar further. I assume you eat a paleo diet because you think you are looking after your health. Read the medical EVIDENCE and stop being so blinkered. Just for the record since when does a paleo diet include alcohol anyway??

33b431eaaaac19eceeae3fd33641b186

on April 05, 2015
at 08:30 PM

Medical evidence of the sort you mention Is not only inconclusive and far from covering the entire keto spectrum it is food industry leveraged. Also any studies are never going to be 100% accurate anyway as the scale of actual world population versus subjects tested actually dwarfs and renders lots of studies redundant however it's always a case if who can shout the loudest who gets heard....not always the most accurate. 

61f9349ad28e3c42d1cec58ba4825a7d

(10480)

on November 13, 2012
at 04:07 PM

Just because people who consume an otherwise Paleo diet sometimes consume alcohol doesn't mean that we consider alcohol to be Paleo. Just like the Jenny Craig eater who eats out at McDonald's doesn't think McDonald's is on the diet. They just do it anyway. It's a cheat for a reason.

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