Keto Alcohol. What Are The Benefits?
I saw an ad on social media recently, espousing the wonders of keto alcohol. As someone with a lifelong history of searching for the holy grail of fun foods that don’t require me to change any dietary habits, I was stopped in my tracks. I thought - secretly, of course - that maybe this was one of those foods, like the time I was introduced to vodka mixed with vanilla diet cola. All the fun and flavour and less calories OH YEAH!
The women who had commented about the ad seemingly had a spiritual epiphany with this product, similar to my own.
We can drink more without putting on weight!
Less calories and we can still party!
We will still be in ketosis and won’t ruin our diet!
I will have to let (insert friend’s name here) know about this; she will be stoked!
I am paraphrasing, in case you weren’t sure.
I then put my practitioner/educator/cynical detective hats on. Hang on a minute! Whether it is regular alcohol, or keto alcohol, or unicorn tears-infused alcohol, it is still alcohol. Your body won’t treat it any differently just because #smashingitketostylehellyeah said so. (This isn’t a real Instagram handle, although goodness knows it took me a while to find one that hasn’t been used yet.)
It turns out that these ladies are not alone. There are dozens, if not hundreds, of handles, pages, ads, dedicated to promoting the alcoholic beverages that are keto friendly. (For those of you who aren’t aware, the ketogenic diet, or keto, is an eating plan that promotes low carbohydrate intake [less than 50g per day], a moderate amount of protein to avoid the body breaking down lean tissue for energy, and the remaining amount of energy as fats. It was originally developed in the 1920s to help paediatric epileptic patients who weren’t responding to medication and has manifested into a rapid weight loss fad. The glucose that we store in the liver and muscles is rapidly depleted [we can store enough for around 24 hours of regular activity], so the body looks for another source of fuel – in this case fat, as ketone bodies.
There are pros and cons to this way of eating. Most notably, perhaps, is compliance as one of the cons. It is a challenge to eat like this over the long term (I bet there are plenty of people disagreeing with me right now, so I should stipulate that doing it properly is that to which I am referring). There are also a range of health benefits and risks associated with this diet, however they will be discussed at another time. I have already digressed and it isn’t even 10.30am!
So, keto alcohol. What does this really mean and why are the kids loving it so much? Alcohol is what we can call a discretionary food, a sometimes food, a not-for-everyday-and-certainly-not-in-excess food. The National Health and Medical Research Council (NHMRC) recommends no more than 10 standard drinks a week, no more than four standard drinks on any one day for healthy adults, and none for pregnant and lactating women or children under the age of 18.
A standard drink is:
· 30ml spirit (note: creamy liqueurs will have a higher calorie content)
· 100ml wine, including sparkling
· 285ml full strength beer or cider
· 375ml mid strength beer
· 425ml light beer
These are not necessarily what we are served in restaurants or bars, either. A glass of restaurant wine is usually 150ml (and then there’s the home pour, right?), a pot/middy is 285ml (ok, this is standard), a schooner is 425ml and a pint is 570ml.
Alcohol contains 7 calories per gram, with a standard alcoholic drink containing anywhere between 70 calories (290kj) and 150 calories (1050kj), depending on the type of alcohol and the ingredients used to produce it. To give you some context, a nip of vodka is around 70 calories, while a can of full-strength beer is around 150 calories. That doesn’t change because it is keto, and that is before mixers. Reconsidering that Fluffy Duck? (287 calories, by the way.) Take a look at Drink Wise (https://drinkwise.org.au/standard-drinks-calculator/#) if you want to see more energy values attributed to alcohol.
A standard glass of dry wine contains approximately 2g of carbohydrates, while a dry martini contains 0g and a 335ml beer contains between 9 and 14g. If you consider that a “good” keto diet limits carbohydrate intake to 50g per day, you are going to reach for your favourite seltzer, Martini or vodka and soda before a Margarita, aren’t you? There are lists and recommendations aplenty on social media, declaring the best alcoholic bev-er-hages to consume whilst not deviating from maintaining ketosis and, weight loss, if that is your goal.
So…great! You can have your low carb cake and eat it too.
Except that you can’t.
The body has no real need for alcohol (it has no storage capacity for later use) and recognizes it as a toxin; all stops are put out to get it out of the body as soon as possible. When alcohol is metabolised, mostly in the liver and a small amount in the gut, it produces acetaldehyde and acetate, both of which are toxic to the body. From there, it is converted to a substance known as Acetyl Co-enzyme A, a key player in the energy production process.
The body typically takes energy from macronutrients (fats, protein, carbohydrates), all of which are also broken down and converted to Acetyl Co-enzyme A, then further fed into the citric acid cycle and electron transport chain to produce adenosine triphosphate, the currency of energy in our body. This is a very basic description of this process. Alcohol, however, also contains calories, therefore it too can provide energy as it is processed by the body.
Herein lies the irony: digestion is put to one side while alcohol is metabolised as quickly as possible to get it out of your body. What does the body do with the fats, protein and carbohydrates that are pushed to the back of the queue while alcohol is dealt with? In a nutshell, they are put on hold. In fact, one of the by-products of alcohol metabolism (nicotinamide adenine dinucleotide, or NADH) inhibits the effective processing of macronutrients, which can lead to hypoglycaemia (low blood sugar) and lactic acid build up (an excess leads to lactic acidosis, which is potentially life threatening). It also primes the body for storage of these nutrients as fats, if they are not used for energy. Where, you might ask? Usually in the liver (fatty liver disease) or in fat cells. As fat.
Alcohol also takes key nutrients out of our body, including B vitamins, vitamin C, vitamin D, magnesium, selenium, vitamin A and vitamin E. There are so many consequences that can be attributed to insufficiency and deficiency of these nutrients, including impacts on our mental health and stress response, immune health, energy production, antioxidant status and much more. This alone warrants its own discussion. While not everyone drinks to excess to the point of brain damage and psychosis (Wernicke-Korsakoff Syndrome), nor do they invoke cirrhosis of the liver, there is little doubt that there are other consequences to alcohol consumption, based alone on the alterations to our nutritional profile.
If you are someone who drinks larger amounts of alcohol regularly, the body sets up another pathway to process the excess – the microsomal ethanol–oxidizing system (MEOS) pathway, however this produces large amounts of oxidative stress, leading to cellular damage to the liver, gut and other tissues. While we can applaud the body for adapting to this extraordinary amount of toxicity, it is not a process that is beneficial, nor is it the physiological answer to excessive alcohol consumption.
The liver bares a fair bit of the brunt of the damaging effects of alcohol, including fatty liver, cirrhosis and cancer. But so does the gut. Alcohol creates an imbalance in the microbiome, the universe of bacteria that are responsible for our digestive, immune and endocrine health (our gut is the largest site of serotonin production, a neurotransmitter that promotes a feeling of well-being). Evidence also points to an imbalance of bacteria – or dysbiosis – as a contributing factor to overweight and obesity. Alcohol also negatively affects the protective mucosal barrier in our gut, allowing the ‘bad’ bacteria that is winning the numbers game to cross over a compromised gut lining and enter the bloodstream. All of this causes a massive amount of inflammation in our body and a range of follow-on effects.
Not only does alcohol interrupt our sleep cycle, the inflammation in the gut produced by alcohol has an impact on our capacity to rest adequately. Furthermore, disrupted and deprived sleep has been shown to affect our capacity to maintain or lose weight, adding fuel to the fire that keto alcohol is little more than marketing spin.
There is some suggestion that we absorb alcohol more slowly if we consume carbohydrates before drinking; I have also seen studies that suggest anything in your stomach - fats, protein or carbohydrates – will slow absorption. The understanding is that carbohydrates slow the absorption of alcohol and fructose, in particular, increases alcohol metabolism and, therefore, reduces its effects in the body. What foods contain fructose? There are many, but think of fruits that are extra sweet, such as pears, apples, mangoes, as well as honey. This is not an exhaustive list, by the way, nor does it mean that I am advocating mango daiquiris as a get-out-of-jail-free-card option. Alcohol is still alcohol.
Recent data also suggests that the risk of developing certain cancers increases proportionately with the amount of alcohol consumed on a daily basis. This includes the mouth, throat, nose and pharynx, rectum, colon and liver cancer. There is also evidence that shows alcohol increases oestrogen production in women, particularly perimenopausal women, increasing the risk of oestrogen-dependent cancers, especially breast cancer.
As well as all of these risks, there are also the financial and emotional effects of alcohol. My nephew works in a bottle shop while studying at university and has noticed an increase in customers with every Covid lockdown. He also reported that many people were sharing stories of the work they had lost whilst going through lockdown 4.0 here in Melbourne. There is absolutely no judgement here, however alcohol also acts as a central nervous system depressant and can impact dopamine levels in the brain (our reward neurotransmitter), potentially leading to low mood and dependence, further exacerbated by the depletion of some of the nutrients mentioned above.
So, keto alcohol may be low in sugar. That’s kinda where it ends. I have been an avid lover, over the years, of anything delicious that I could still have without any consequences (to my waistline, my real motivation) but these facts suggest that not only does keto alcohol – or any alcohol - fall short of this promise, it poses too many risks associated with its consumption to continue to party like its 1999. Moderation is the key here. I still have 1-2 drinks a week but I have found other ways to relax, socialise, have fun, speak my truth, sing and dance like nobody is around (hint: I sing and dance when nobody is around!)
I saw a quote recently by the fabulous David Bowie, something along the lines of “…ageing is an extraordinary process whereby you become the person you always should have been.” I felt like he was talking to me. Again. This happens for different people at different life stages; you wake up and decide to be the person you were meant to be, bringing everything to your life game.
As the person I am meant to be, I call out BS on keto alcohol. And on myself if I continue to believe that vodka and vanilla diet cola is the answer to everything good.
With love.
And a dash of soda.
Julie
Healthy. Human. Happy.
References
Alcohol Think Again (2021), What Is A Standard Drink?, https://alcoholthinkagain.com.au/alcohol-your-health/what-is-a-standard-drink/
Barve, S., Chen, S. Y., Kirpich, I., Watson, W. H., & Mcclain, C. (2017). Development, Prevention, and Treatment of Alcohol-Induced Organ Injury: The Role of Nutrition. Alcohol research : current reviews, 38(2), 289–302.
Batch, J. T., Lamsal, S. P., Adkins, M., Sultan, S., & Ramirez, M. N. (2020). Advantages and Disadvantages of the Ketogenic Diet: A Review Article. Cureus, 12(8), e9639. https://doi.org/10.7759/cureus.9639
Berg JM, Tymoczko JL, Stryer L. Biochemistry. 5th edition. New York: W H Freeman; 2002. Section 30.5, Ethanol Alters Energy Metabolism in the Liver. Available from: https://www.ncbi.nlm.nih.gov/books/NBK22524/
Bishehsari, F., Magno, E., Swanson, G., Desai, V., Voigt, R. M., Forsyth, C. B., & Keshavarzian, A. (2017). Alcohol and Gut-Derived Inflammation. Alcohol research : current reviews, 38(2), 163–171.
Cederbaum A. I. (2012). Alcohol metabolism. Clinics in liver disease, 16(4), 667–685. https://doi.org/10.1016/j.cld.2012.08.002
Cooper, C. B., Neufeld, E. V., Dolezal, B. A., & Martin, J. L. (2018). Sleep deprivation and obesity in adults: a brief narrative review. BMJ open sport & exercise medicine, 4(1), e000392. https://doi.org/10.1136/bmjsem-2018-000392
Drink Wise Australia (2021), Standard Drinks Calculator, https://drinkwise.org.au/standard-drinks-calculator/#
Hui Li, Erica Toth, Nathan J Cherrington, Alcohol Metabolism in the Progression of Human Nonalcoholic Steatohepatitis, Toxicological Sciences, Volume 164, Issue 2, August 2018, Pages 428–438, https://doi.org/10.1093/toxsci/kfy106
Liu, Y., Nguyen, N., & Colditz, G. A. (2015). Links between alcohol consumption and breast cancer: a look at the evidence. Women's health (London, England), 11(1), 65–77. https://doi.org/10.2217/whe.14.62
National Health and Medical Research Council (2021), Australian guidelines to reduce health risks from drinking alcohol, https://www.nhmrc.gov.au/health-advice/alcohol
Sarich, P., Canfell, K., Egger, S. et al. Alcohol consumption, drinking patterns and cancer incidence in an Australian cohort of 226,162 participants aged 45 years and over. Br J Cancer 124, 513–523 (2021). https://doi.org/10.1038/s41416-020-01101-2
Zakhari S. (2006). Overview: how is alcohol metabolized by the body?. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 29(4), 245–254.