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Question: Does alcohol consumption by patients with diabetes have a beneficial effect on triglyceride levels?
Answer: People with diabetes are often advised to avoid alcoholic beverages under the assumption that alcohol raises triglyceride levels, especially if patients are hypertriglyceridemic. Elevated triglyceride levels are assumed to be a risk factor for cardiovascular disease.
However, observational epidemiological studies, small clinical trials, and
meta-analysis of these studies show little if any association between alcohol
intake and triglyceride levels and even show benefit from alcohol consumption
on cardiovascular risk in patients with and without diabetes. In these
studies, one beverage containing alcohol is defined as 12 oz beer, 5 oz wine,
or 1.5 oz distilled spirits. Each contains 
15 g alcohol (ethanol).
EPIDEMIOLOGICAL STUDIES
Analysis of data from 8,125 participants in the National Health and Nutrition Examination Survey revealed that mild to moderate alcohol consumption (1–19 drinks of alcohol per month) was associated with a lower prevalence of cardiometabolic risk and significantly and inversely associated with three of its components—low serum HDL cholesterol, elevated serum triglycerides, and hyperinsulinemia.1
In a study of 14,077 British women, those who consumed 1–14 drinks of alcohol per week compared with nondrinkers had a reduction in coronary heart disease associated with the lowest triglyceride levels and highest levels of HDL cholesterol.2 Women in the Kaiser Permanente Women Twin Study with light intake (less than one drink per week) and moderate (one to two drinks per week) had triglyceride levels that averaged 93 mg/dl compared with an average triglyceride level in nondrinkers of 106 mg/dl.3
In men with type 2 diabetes, light drinkers (zero to four drinks per day) had an average triglyceride level of 115 mg/dl compared with 132 mg/dl in nondrinkers and 190 mg/dl in heavy drinkers (more than four drinks per day). Excessive alcohol intake and elevated glucose concentrations were reported to be the cause of secondary hypertriglyceridemia, particularly in obese patients, based on a 1972 study published in Lancet.4
The effects of moderate alcohol intake alone in persons with hypertriglyceridemia remains unclear.5 To answer this question, Henry Pownall, PhD, and colleagues studied persons with fasting triglyceride levels of 200–750 mg/dl compared with persons with normal triglyceride levels (90 mg/dl). Two alcoholic drinks per day or water were consumed, and there were no significant differences in their effect on triglyceride levels. The authors concluded that acute alcohol intake is not an important determinant of triglyceride concentrations in individuals with hypertriglyceridemia.6
However, another short-term study demonstrated that moderate alcohol intake improves triglyceride levels. In a trial of healthy women, none, one, or two drinks per day of alcohol were consumed for 8 weeks.7
MULTIPLE STUDIES ON RISK
Thirty-two studies were reviewed in order to determine how alcohol use affects risk for or management of diabetes.8 They showed that among people who did not have diabetes, moderate drinkers (1–3 drinks per day) developed 33–56% fewer cases of diabetes compared with those who did not consume any alcohol. Heavy consumption (more than three drinks per day), however, was associated with a 43% increased incidence of diabetes. In persons with diabetes, moderate alcohol use was associated with a 34–55% lower incidence of diabetes-related coronary heart disease. But the researchers concluded that more extensive studies are needed to assess the long-term effects of alcohol on glucose and noncardiac complications in persons with diabetes.
With such promising research, one might ask why alcohol use isn't recommended for people at risk for or with diabetes. Obviously, abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia.9
Furthermore, the American Diabetes Association notes that only
observational studies and small clinical trials have been reported and,
therefore, the data do not support recommending alcohol consumption in
individuals at risk for or with diabetes. If these individuals consume
alcohol, they should follow recommendations from the 2005 Dietary Guidelines
for Americans that suggest no more than one drink per day for women and two
drinks per day for men. 
Footnotes
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A complete list of references will be available on the Web version of this article.
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