To drink or not to drink, that is the burning question! The science behind how alcohol affects the body has gone through some radical changes over the past few years. Lot of guidelines still remain outdated, or focus on heart health or cancer risk. But what do you need to know about the effect of alcohol consumption on PCOS?
In this post we take a closer look at:
- What is even PCOS?
- What’s insulin resistance and how does it relate to PCOS?
- Alcohol and insulin resistance
- Alcohol’s effect on your sleep
- How much alcohol is safe to drink?
- A few strategies for choosing your drink
Hopefully by the end of this article, you’ll know the latest science on alcohol and its effect on PCOS so you can make an informed decision about your alcohol intake.
What is PCOS?
PCOS (or polycystic ovary syndrome) is one of the most common hormonal disorders affecting an estimated 8-13% of women [1,2].
PCOS is often undiagnosed or misdiagnosed, with the World Health Organization suggesting that up to 70% of cases may remain undiagnosed [3]. As a result, the true prevalence is likely higher than the estimated range.
PCOS is characterized by hormonal imbalances, primarily involving insulin resistance and elevated levels of androgens (such as testosterone). These hormonal imbalances can lead to a range of symptoms, including irregular or absent menstrual periods, acne, excessive facial and body hair (hirsutism), hair loss (alopecia), anxiety, depression, and metabolic issues like appetite dysregulation, sugar crashes, cravings, stubborn weight gain, and fatigue.
While undeniably, there may be some genetic factors underlying the development of PCOS symptoms, lifestyle and nutritional interventions can offer some of the most effective solutions for women looking to improve their PCOS symptoms.
PCOS and insulin resistance
As we’ve mentioned, PCOS and insulin resistance are closely interlinked. In fact, the most recent International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome notes that insulin resistance in PCOS is common, affecting 75% of lean women and 95% of women with a BMI over 25 kg/m² [4]. Insulin resistance is when the body's unable to effectively utilize insulin, the hormone responsible for regulating blood sugar levels. When this happens, the transport of sugar from the blood into the cells is limited meaning that more of this sugar remains in the blood. To compensate, the pancreas makes even more insulin (this is known as hyperinsulinemia). High insulin can cause and exacerbate a number of PCOS symptoms. The more insulin that is made, the more resistant the cells become to it. So, managing blood sugar levels is an important step to reducing these high insulin levels and thus controlling PCOS symptoms.
Insulin resistance and alcohol
Sweet or carbohydrate-heavy alcoholic beverages like cider, beer, and cocktails, especially those mixed with fruit juices and sweet mixers, can cause dramatic blood sugar spikes. This can wreak havoc on your blood sugar levels and in turn raise your insulin levels even higher. This can worsen pre-existing insulin resistance!
Binge drinking [5] appears to be particularly detrimental. It is defined as consuming 5 or more drinks on an occasion for men or 4 or more drinks on an occasion for women and is the most common and costly pattern of excessive alcohol use in the United States.
The reason why it’s particularly problematic for women with PCOS is because binge drinking may alter the brain's response to insulin [6,7], worsening insulin resistance. On top of this systemic effect, binge drinking often coincides with consuming processed foods high in fats and refined sugars, or indulging in binge eating. These foods and activities can further exacerbate insulin resistance [8], leading to a vicious cycle.
Alcohol and sleep
Sleep quality and quantity and insulin resistance are linked and alcohol can have a major effect on your sleep [9].
Although many people believe alcohol helps them fall asleep, it actually causes a more disturbed sleep as the night wears on [10]. In addition to this, alcohol is a diuretic. This means on nights that you drink, you may be getting up more frequently to urinate which can further disturb your sleep! The problem with this is that not getting enough sleep can aggravate insulin resistance [11,12], which is already a major problem in many women with PCOS. Getting enough quality sleep is one of the most important lifestyle changes that you can make for your metabolic health, so avoiding alcohol (especially near bed time) is a step in the right direction to achieve that.
Alcohol and medications
Many women with PCOS are prescribed Metformin as insulin sensitizer. Metformin is a common medication prescribed to manage blood sugar problems in type 2 diabetes, but is also frequently prescribed ‘off label’ for PCOS. Consuming alcohol while on metformin can increase the risk of low blood sugar and a rare but serious condition known as lactic acidosis, where lactic acid builds up in the blood. So those taking Metformin need to be especially vigilant of their alcohol intake.
So how much alcohol is safe to drink?
As you can see, drinking if you have PCOS could be worsening insulin resistance and interacting with your medications. In addition to this, alcohol consumption comes with a variety of other health risks, including an increased risk for various cancers [13]. Due to the numerous health risks associated with alcohol consumption, the WHO [14] has recently stated that there is no ‘safe’ level of alcohol consumption and that the risk starts from the first drop! Some health authorities, like the CDC [15], recommend that women have no more than 1 alcoholic drink per day, but with all the overwhelming evidence against it, less than that is definitely better, especially if you’re someone with PCOS.
What to consider when choosing a drink
Drinking alcohol is one of those social norms that is doing us more harm than good and something that could potentially be worsening your PCOS symptoms. While the evidence is clear that there is no safe amount of alcohol to drink, here are a few things to consider if you do decide to drink:
- Avoiding it altogether is your best bet, but if you enjoy drinking occasionally, setting weekly goals to reduce the amount you drink can be the first step towards getting you to zero.
- If you often have a craving, an effective way to reduce alcohol consumption is to find a go-to low-sugar alternative that you enjoy and can switch to during the times you would reach for alcohol.
- There are so many great non-alcoholic options currently available from low sugar kombucha to non-alcoholic cocktails and G&T’s or even a seltzer with some fresh lime! When choosing a non-alcohol alternative, be careful to always check for the sugar content. You don’t want to choose a mocktail full of syrup and still end up spiking your blood sugar and worsening your insulin resistance.
- If you choose to drink, always make sure you had a proper meal before. Drinking after a meal can slow the absorption of alcohol, and mitigate how much your blood sugar spikes.
- Choose your alcohol wisely. Alcoholic drinks are not made equal and can contain different levels of sugar. If you decide to drink, opt for low-sugar options.
Not sure if you’re more susceptible to the effects of alcohol?
The relationship between alcohol and your body is complex, especially for women. How alcohol affects your blood sugar, hormones, cycle and overall health can vary greatly from person.
At Mohana, we understand that every woman's body is unique. That's why when working with women to improve their hormonal symptoms, we use tailored biomarker-tests to help you uncover your unique biology and risk factors. Our functional tests help women understand if they are at a higher risk of alcohol consumption such that they can make informed decisions about their bodies.
Ready to decode your body's signals and take control of your hormonal health? Discover how Mohana can help you unlock the power of your personal biology and optimize your well-being.