What are the implications of different types of alcohol in regard to PCOS? Will alcohol negatively impact your PCOS symptoms? And are the effects of cocktails, beer, wine, and spirits all the same? Those are the questions we’ll be answering in this article. We will examine: The different types of alcoholic drinks What is in them What ingredients may negatively impact PCOS Useful tips to consider when drinking alcoholSuggestions for PCOS-friendly alcoholic beverages Alcohol is a staple component of many cultures, found in both foods (especially fermented ones!) and beverages, and so – if you do drink – balancing both enjoyment and health is key, especially as it relates to managing your PCOS symptoms. Afterall, depending on your drink preferences, alcohol consumption has the ability to dangerously drop your blood sugar. Particularly for those with advanced insulin resistance and diabetes it is critical to not only monitor consumption frequency, but mitigate the physiological implications of drinking with other behaviours – such as snacking or consuming a meal during or before drinking. It is important to make sure the meal or snack is balanced, so that stable blood sugar is maintained. Less blood sugar swings means less impact on insulin resistance, cravings, or potential binges. For meal suggestions, refer to our PCOS Diet article. As a general rule, trying to include veggies, starches, protein, and some fat is a great place to start. Snacks are also a good option, and as long as they have at least ⅔ macronutrients (fat, protein, carbohydrates) and/or fiber, they should generally sustain stable blood sugar levels. We include some easy examples later in this article. Let’s dive into what you can do to prevent potential negative effects of alcohol consumption on your PCOS, while still enjoying your favorite drinks now and then. The different types of alcoholic drink Okay, so the first question to cover is: what exactly goes into an alcoholic drink? We can’t address the question of alcohol’s effect on our body if we don’t know what we’re consuming. Unsurprisingly, there are a lot of alcoholic beverages out there, and much variation between them. For the purposes of this article, though, we’ll break alcohol down into 4 categories: Spirits Cocktails Beer Wine Spirits Liquor, or spirits, is a type of alcoholic drink made from the distillation of grains, fruits, or vegetables that have gone through alcoholic fermentation. The distillation process concentrates the liquid, so it increases its alcohol by volume (ABV). You may have seen ABV percentages on the back of liquor bottles, and ABV is part of what makes a spirit a spirit. Standard spirits are unsweetened, distilled drinks that have an ABV of 20% and above. Most spirits have an ABV of 35-40%: this means that 40% of the liquid you see in the bottle is pure alcohol. The higher the ABV, the higher the potency of the spirit (though this rule applies to almost all alcoholic drinks). Examples of popular spirits include: whiskey, rum, vodka, vermouth, and gin. Interestingly, without added dyes or colors, you may not be able to tell these liquors apart: all liquors are initially colorless, but through aging or additives, they can turn a golden brown hue and other colors. In terms of what’s in spirits? There is nothing but ethanol and water. That means there are no carbohydrates, proteins, fats, minerals, or fiber to be found in unsweetened distilled spirits. That doesn’t mean no calories, though: depending on the ABV value, the calorie count runs on a sliding scale. Cocktails This type of alcoholic beverage’s profile is especially difficult to pin down since cocktails can vary so much in their contents. Typically, however, they have some mix of the following: Spirit Sweetener or cordial Juice Note here: Most fruit juices have higher sugar content, while lime and lemon juice have much less!Soda water, club sodaNote here: tonic is typically higher in sugar Fruit slice for garnish Let’s take a popular recipe as an example of what may go into a traditional cocktail: the mojito. Descending from Cuba, this drink’s ingredient list can vary, but a basic variation follows this format: white rum (liquor), fresh lime juice (juice), 2 teaspoons of sugar, soda water, and mint. Sometimes at bars or restaurants in the US, the teaspoons of sugar are swapped out for plain simple syrup or lime flavored cordial. Now, this doesn’t mean you shouldn’t order the drink you like – but consider cutting down the sugar content by asking the bartender to half the quantity of simple syrup included in the mix. In this scenario, a 10g sugar cocktail would be reduced to a 5g cocktail (the Dietary Guidelines For Americans recommends staying under 50g of added sugar per day)! You don’t have to be scared by having a little bit of sugar or sweetness in your drinks, especially if you don’t drink often. Remember, blood sugar can dip from alcohol consumption, and sugar gives you energy (AKA calories) to keep the party going. Beer and wine Wine is made from fermented grapes. Similar to cocktails, exactly what is in wine will depend on the type of wine and how sweet you want it. Red, dry wines typically have a few grams of carbohydrates and minimal – if any – added sugars, while a sweeter white wine will likely have a higher carbohydrate content owing to sweetening agents. Beer is also made from an intensive fermentation process: the 3 basic ingredients of beer include water, malted barley (or another starch source), and a flavoring. Additionally, it may help to keep in mind that ciders, kölsch, shandies, fruity beers, and radlers are all a bit higher in sugar than classic beers. What are the impacts of these ingredients? Carbohydrates found in some of the aforementioned alcoholic beverages have the potential to worsen some symptoms of PCOS, in particular, insulin insensitivity and inflammation. In the case of insulin resistance, consuming high-sugar foods or drinks – without a source of fats, fiber, protein along with it – means they are absorbed quickly into your bloodstream. This can aggravate insulin resistance over time, as the body pumps out high amounts of insulin to get the sugar into the cells and out of the bloodstream quickly. We dive more into the specifics of PCOS and sugar intake here, but the main takeaway is that whatever you consume (whether it is carbohydrates, protein, fat, or alcohol) is eventually broken down into sugar. The question then is learning how to prevent blood sugar spikes and crashes, as much as possible. Maintaining better blood sugar control has been shown to: Help control type 2 diabetes Improve weight loss Offer anti-inflammatory benefits It’s important to point out that sugar is not a nutrient that should be demonized: it certainly has a role to play in many recipes and social occasions. At the same time, it is worth pointing out that if you have PCOS, using glycemic index (GI) or load (GL) to guide your food choices could offer immense value. (We have an entire article dedicated to creating a PCOS diet, which you can check out here!). For instance, you might find you feel better throughout the night, or even the next day, when you opt for a low GI meal before drinking a high GI drink, since this can help balance sugar levels and allow you to enjoy your evening while not suffering a sugar crash at the end. Low GI foods are typically higher in protein, fiber, and fat. Useful tips to consider when drinking alcohol So now we understand what’s in many alcoholic beverages, as well as the role of sugar in aggravating PCOS, let’s discuss some concrete tips and advice that you can turn to when consuming alcohol. Alcohol is best consumed in moderation For the average American woman, that means 1 or less alcoholic beverages per day. If you tend to drink just a couple of days out of the week or month, no more than 3-4 servings of alcohol are recommended per “episode” of drinking. Consume a balanced meal with, or before, consuming alcohol Whenever indulging in alcohol, we recommend preceding drinking with a balanced snack or meal. This means it should ideally include carbohydrates, fiber, protein, and fat. Balanced snacks and meals help reduce the spikes and lows that alcohol can trigger, since it interferes with blood sugar management. These ‘highs’ and ‘lows’ can worsen insulin resistance over time, and trigger unmanageable cravings or binges. Consider the following foods before your next night out: Whole wheat crackers, full-fat cheese, and vegetables Whole wheat pita, hummus, olives (or veggies)Whole milk yogurt with berries, nuts, and whole grain granola Pretzels and nut/seed butterNuts and popcornNachos with/ tortilla chips, cheese, and proteinTortilla chips with/ salsa, guacamole, bean dip, etc.Most hors d’oeuvres/appetizers will do Opt for lower sugar drink options when you can As a general rule, the less alcohol you consume, and the less frequently you consume it, means it will have less of an effect on your health. As such, if you drink relatively frequently, it may be worth remembering what drinks are frequently high in excess sugars, and which aren’t. As a general rule, for instance, straight spirits such as gin with club soda or soda water, rather than tonic, are some of the lowest sugar options. Asking for ½ the added sweetener, or less sweet juices (like unsweetened cranberry juice over sweetened) will translate to less sugar than a classic Cosmopolitan cocktail, for example. A balance might also be alternating between cocktails and lower sugar alcoholic drinks, and consuming your higher sugar drinks with snacks such as tortilla chips and guac. Concluding thoughts and suggestions This is not at all to say that some beverages are ‘bad’ or ‘good.’ If you want to celebrate an occasion with a glass of champagne, relax after work with a glass of wine, or enjoy a night out with cocktails – for many women with PCOS, there is value in enjoying an alcoholic beverage (whether it’s high carb, high sugar or not). Part of your PCOS journey will likely be balancing food, mind, and body, like so many women who are diagnosed with PCOS have to do! Of course, it’s best that this enjoyment takes place in moderation and with full knowledge of the potential effects on PCOS symptoms. That way, you can still maximize your enjoyment, while minimizing the spike (or drop) to your blood sugar. It’s possible to dramatically lower the sugar content of your drinks with some easy swaps, as opposed to denying yourself altogether. Below we have some suggestions for alcoholic drinks that are typically lower in sugar, as well as some alternatives you can try out to reduce your sugar intake when consuming popular beverages: Low sugar drinks: Hard seltzer Dry red wineMerlot, Cabernet Sauvignon, Pinot Noir, TempranilloDry white wineChardonnay, Pinot Grigio, Sauvignon Blanc Sparkling white wine: Prosecco, Brut Champagne, Cava Vodka (or any other spirit) with club soda and squeeze of limeRum and soda (or the mojito mentioned above)Whiskey on the rocks Old-fashioned Easy swaps: Ask for the drink to be made ½ as sweet (w/ half the simple syrup, sugar, etc.)Unsweetened cranberry juiceThis is a great alternative to sweetened cranberry juice Muddled fruitParticularly good for fruity drinks, up the ratio of muddled fruit and reduce the quantity of simple syrupTeaspoon of agave or honeyExchange syrup for honey, or go half and half Freshly squeezed juicesGreat for tropical drinks, opt for a squeeze of lime or orange, as opposed to a flavored cordial Now, we’d like to emphasize that if you don’t drink frequently (less than 2 times a month), it’s less important to choose a low sugar drink than to just enjoy your party! Don’t sacrifice your preferences if this is a blue moon event! In this case, it will be more important to keep your blood sugar stable by having snacks or a meal with your drink to prevent cravings and blood sugar swings. For those who drink more often (2+ times a month), it is worth being cognizant of the sugar content in various beverages to limit its effects. Disclaimer: Alcohol should never be consumed while pregnant or trying to conceive, and always remember to drink responsibly. Cheers! Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.