It is well known that diet and lifestyle influence outcomes for patients with type 2 diabetes mellitus, but often carbohydrates take much of the blame. This is natural considering the defining physiological change in diabetic patients is elevated blood glucose levels. However, research suggests that dietary carbohydrates that directly increase blood glucose levels might not always be the best target for weight loss and diabetes management.
It is also well known that type 2 diabetes is linked with obesity, and that weight management and weight loss are effective in reducing the severity of type 2 diabetes. A recent study from the University of Pennsylvania suggests that alcohol consumption may be an important player in preventing long-term weight loss.
This new study examined the effects of alcohol consumption on participants engaged in an "intensive lifestyle intervention." The study found that after one year, participants lost an average of 9% of their body weight. After four years had passed, participants still kept off much of the weight they lost, but participants who consumed alcohol regained more weight than those who consumed none in a roughly dose-dependent fashion.
Now you might know that ethanol itself has caloric content, so one might suspect that these extra calories alone could contribute to that weight. However, the ILI participants who regained the most weight from the 1-year to 4-year mark (the consistent heavy drinkers) also exhibited the greatest overall reduction in daily calorie intake--alcohol included! This suggest that, over and above the effects of the extra calories alone, alcohol use might make weight loss even more difficult than usual.
Alcohol can be converted to acetyl-CoA in the liver, and excess alcohol consumption can lead to elevations of acetyl-CoA which can in turn lead to reduce rates of glycolysis. The body can then convert this excess acetyl-CoA to fatty acids, but may also be metabolically backed-up to the point where this acetyl-CoA reduces the consumption of glucose by cells, leading to elevated blood glucose levels. Thus, alcohol can reduce normal carbohydrate metabolism and can be directly converted to fat which inhibits weight loss even in diabetics who successfully reduce the overall number of calories they consume.
It seems to me that alcohol is detrimental to diabetics in two ways. One, it exacerbates the already abnormal use of insulin, because the cell aren't needing glucose via glycolysis because ethanol is already being used in the cells, leaving elevated blood glucose levels. Two, ethanol can be used in oxidative phosphorylation to make ATP by entering the Kreb's cycle as Acetyl CoA, but any excess can be stored as fat. Knowing the link between obesity and type II diabetes, this makes the treatment an terrible, uphill battle. The question that resided in my head throughout your post and the article, is what are some methods to treat these patients? How could we approach these topics in our patient education? I thought it was hard enough to make lifestyle changes in diabetes simply with dietary consumption with food. Educating patients to stop drink their beer may be even more difficult.
ReplyDeleteI work as at Orangetheory and I have actually noticed a correlation between people who complain of drinking the night before workouts consistently and the amount of weight they tend to lose! I am constantly wondering how some people can come to the gym every single day and still be over weight but this is a really awesome explanation. It's cool to take an observation and apply science to it.
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