Alcohol: Can I Drink and Lose Weight? Should I Drink At All?
**DISCLAIMER** PHD is not exclusive of any dietary choice. Alcohol cessation is NOT required to participate. You likely can continue to drink alcohol and lose weight. You can look forward to alcohol as part of your maintenance plan. Everyone’s metabolism is unique and the PHD team is trained to work with you to determine your tolerance to alcohol and how it can fit into your lifestyle. Genetic differences also play a role as you will see below!
Alcohol consumption is socially accepted and alcohol is arguably the most commonly used addictive drug in American society. Alcohol use is documented far back into recorded history. Fueled by a nearly 2 billion-dollar US marketing effort it’s easy to see why in some social circles it feels like everyone drinks and for nearly any reason. However, a hard look at the statistics shows a different picture and the studies on the benefits and harms seem to be reported only in favor of studies demonstrating any possible benefit. The rarely reported studies on harms demonstrate some frightening statistics for overall health and also explain why alcohol consumption makes weight loss and weight maintenance a challenge. This blog will focus on the metabolic effect of alcohol, but this should not overshadow the overall risk and disturbing cancer associations, especially for women.
First the truth behind the statistics. While the National Institutes of Health (NIH) reports that 90% of the American population will drink at some point in their life only 50% reported drinking more than once a month in a 2016 survey. While half of the American adult population is a staggering number of people it also demonstrates that half of us are NOT drinking regularly. Despite this, US alcohol sales of over 220 Billion in 2016 demonstrate that consumption is common and likely on the rise.
The increase in frequency and suggestion that alcohol consumption is required to be a part of society presents a significant challenge for those actively trying to lose weight and maintain weight loss. To understand why we have to look at the basic metabolism of alcohol and how the body responds to consumption. At its very basic level alcohol (ethanol) is an energy source and a potent one. At 7 calories per gram it carries an energy density closer to dietary fat than carbohydrate or protein. It also packs a metabolic punch that derails all other efforts at energy metabolism until the alcohol is gone. This explains much of the significance of alcohol with weight loss and why drinking at any frequency and above moderation is associated with obesity in certain groups.
After consumption of any quantity of alcohol your body shifts all of its metabolic processing power to breaking down the ethanol. Your body views it as a poison and it is. Ethanol has been declared a carcinogen and once exposed to the liver alcohol dehydrogenase breaks the ethanol down to acetaldehyde which is an even more potent carcinogen. From there the body forms substrates for the citric acid cycle which creates energy and ends the assault on the metabolism. During and even after metabolism of ethanol is complete the metabolic effect persists. Studies have demonstrated that ethanol metabolism decreases the function of lipoprotein lipase (LPL) by 24% after ingestion and persists for hours. The effect is reduction in fat burning (oxidation) potentially for days. While the effect on fat metabolism is the biggest concern for weight loss and maintenance the breakdown of stored carbohydrate is also altered and can have negative effects on glucose metabolism. These effects play a role in altered hunger signals as blood glucose drops in response to consumption of alcohol. This is particularly important in diabetics and those with metabolic syndrome or insulin resistance (common in those struggling with weight).
The relationship of alcohol to hunger and food consumption is complex. Like sweetened sodas the caloric density of alcohol doesn’t seem to decrease the quantity of food eaten during an associated meal. The energy consumed does not seem to decrease perceived hunger and for some actually increases it. When alcohol is consumed with a meal there is no measurable change in satiety. One study comparing alcohol consumption to water demonstrated degradation of the leptin axis in those that consumed alcohol. Leptin levels are frequently altered in those struggling with obesity and play an important role in hunger and satiety signaling. Another publication pointed toward central mechanisms including GABAergic, opioid and serotonergic receptor responses to ethanol that could explain increased hunger associated with alcohol consumption. These mechanisms are consistent with all addictive substances and people at risk for addictive behavior will have a higher risk of obesity when food and alcohol are combined. In fact, the group most likely to see a negative effect from alcohol consumption on weight are those that are already struggling with obesity and in this group alcohol is associated with further weight gain. This longitudinal study showed that increases in alcohol consumption over time are also associated with increases in BMI and waist circumference. Anecdotally, most people I talk to about their drinking habits report slowing increasing use over time which puts them at risk for weight gain. Choices in beverage type also may play a role in weight gain as demonstrated here. Beer with its dense carbohydrates not surprisingly had the strongest association with weight gain. Lastly we know that those struggling with weight have some component of metabolic dysfunction and unfortunately this metabolic dysfunction puts them at higher risk to be negatively impacted by alcohol consumption as shown in this controlled experimental study.
The effect on fat/lipid metabolism clearly explains why weight loss and maintenance are challenging during use but the decreased metabolism of stored fat (lipolysis) also results in a greater amount of fat in the bloodstream as triglycerides. Higher levels of fat in the blood stream is strongly associated with heart disease and this effect explains in part why alcohol consumption is associated with heart disease. Popular media outlets like to report on studies that show heart health benefits with alcohol but this study shows that those with a high BMI may want to reconsider their own consumption and that population based studies are designed to look for an effect on the group level not the individual level. The 2011 study broke down the lipid response of alcohol consumption by BMI and found that for those who had a BMI under 25 alcohol consumption produced a reduction in triglycerides. Unfortunately, as the subjects BMI went up so did their triglyceride response. This response puts those struggling with obesity who are already at higher risk for cardiovascular disease at even higher risk with alcohol consumption.
Another effect alcohol has on the body related to weight is on gut health. Light to moderate use will change the gut microbiome. This retrospective review found that alcohol was a strong risk factor for developing Small Intestine Bacterial Overgrowth (SIBO) and this review paper shows that even a single episode of excess alcohol consumption can result in structural changes to the gut and gut lining. These changes can result in ulcers, gastritis and increased permeability to toxins and other antigens and ultimately decrease the immune capacity of the gut.
In conclusion, the evidence strongly supports the cessation of alcohol during weight loss efforts. Weight maintenance will ultimately be easier without it. The metabolic dysfunction associated with obesity reduces the body’s tolerance to alcohol consumption. The worsening of the already altered leptin/hunger axis, worsening of food addiction behaviors, worsening of critical sleep and the profound lipid response increasing the risk of cardiovascular disease all suggest that alcohol should be avoided once weight gain has become an issue. There may be some good news in that genetic variation appears to play a role in the power of the effect and that multiple polymorphisms are implicated. These studies suggest that there will be some variation and that you may tolerate alcohol better than some, but personal experimentation is required to identify your unique response to alcohol. The results of these experiments should determine if alcohol at any level should be a part of your life.
There are a number of resources available for alcohol cessation. PHD certified coaches are trained to talk clients through reducing and ultimately abstaining from alcohol should they need or desire to. However, some people need additional support in weight loss or during maintenance. For those that want to explore cutting back or sobriety I recommend the approach by author Annie Grace. Her first book This Naked Mind is a great review of alcohol and presents a nice approach to cutting back. She has developed multiple resources that can be explored here. For those that would like to stop drinking indefinitely and would like the support of others who have struggled with alcohol I recommend considering a 12 step program. These free programs can provide 24/7 support for sobriety. Ultimately, alcohol consumption is a personal choice. You will have to decide how alcohol fits into your life and what it provides for you. Evaluating all of the evidence both positive and negative is required to make an education.
Supporting your Performance, Health, Diet, PHD
Douglas E Lucas, DO
Chief Science Officer
PHD Weight Loss and Nutrition