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Medscape

Booze, Bubbles, and Blood Sugar Trouble

Understanding how malt, brewing methods, and a beer's glycaemic index (GI) affect the body is crucial for anyone monitoring blood sugar levels. Craft and specialty beers are becoming increasingly popular, but their effects on glucose levels are often overlooked. Even nonalcoholic beer, commonly considered a 'healthier' choice, can carry hidden risks. A closer look at what is in the glass reveals the gap between perception and reality. Alcohol and GI Controlling blood glucose levels is essential for individuals with type 2 diabetes (T2D). Alcohol can affect glucose metabolism in several ways. It inhibits gluconeogenesis and the production of new glucose in the liver, which can lead to hypoglycaemia, particularly in patients taking glucose-lowering medications, such as insulin or secretagogues. Many alcoholic beverages also contain carbohydrates that increase blood sugar levels. The carbohydrate content of beer varies according to its type, brewing method, and alcohol content. Light lagers and pilsners contain up to 3.5 g/100 mL. A 0.5-L glass delivers roughly 12-18 g, similar to a small slice of bread. Wheat beers can contain up to 4.5 g/100 mL. This is due to the type of malt, the top-fermentation process, and the richer sugar content of the original wort, the sweet liquid extracted from malted grains before fermentation. Therefore, a standard pint can deliver more sugar than expected from a 'light' beer. Jever Pilsener, a classic German pilsner, contains 4.9% alcohol. According to the manufacturer, 100 mL of this beer provides 157 kJ (40 kcal), 0 g fat, 1.1 g carbohydrates (of which sugars are less than 0.5 g), less than 0.5 g protein, and 0.02 g salt. The combination of alcohol and rapidly absorbed carbohydrates can be potent. Blood glucose levels increase rapidly, triggering insulin release. Insulin drives glucose into muscle, liver, and fat cells. These levels can drop sharply, sometimes below normal, causing fatigue, irritability, poor concentration, and food cravings. Nonalcoholic Beer Nonalcoholic beer (≤ 0.5% alcohol) does not cause alcohol-induced hypoglycaemia. However, many varieties contain 4-6 g of carbohydrates per 100 mL. In stopped fermentation, one method of producing nonalcoholic beer, fermentation is interrupted early. This leaves more fermentable sugars, such as glucose, fructose, and maltose, which are normally converted to alcohols. These sugars rapidly increase blood glucose levels. Nonalcoholic beers often have a high GI because short-chain sugars are rapidly absorbed. GI measures how quickly and strongly a carbohydrate-containing food raises blood glucose levels compared with pure glucose (GI = 100). Clausthaler Original, one of Germany's most widely exported alcohol-free beers, provides 108 kJ (26 kcal), 0 g fat, and 5.6 g carbohydrates (including 2.8 g sugars) per 100 mL, less than 0.5 g protein, and less than 0.01 g salt, according to the manufacturer. Beer and Maltodextrin Nonalcoholic beer often contains maltodextrin to improve mouthfeel, stabilise foam, or enhance body and viscosity despite the absence of alcohol. Its sweetness is low (less than 20% of that of sucrose), but its GI is high because amylases in the small intestine rapidly break it down into glucose. Low-carbohydrate beers are brewed to ferment almost all sugars, leaving only small amounts of dextrins or other nonfermentable carbohydrates. This results in a lower glycaemic load and usually avoids additives such as maltodextrin. Maltodextrin is often used in nonalcoholic beers to improve texture but can raise blood glucose quickly. Low-carbohydrate beers tend to have a higher alcohol content and a drier and sometimes bitter taste. Alcohol inhibits gluconeogenesis in the liver, an effect that is important for insulin-dependent diabetes, as it can increase the risk for low blood sugar overnight. In the EU, food labelling rules do not require maltodextrin to be listed as 'sugar' because it is chemically a polysaccharide. It usually appears on labels simply as 'maltodextrin,' and when used as a technical additive, it may not appear at all. Alcohol-free beers can be marketed as 'low in sugar' while still raising blood glucose significantly. Conclusion Therefore, individuals with T2D should consume beer with caution. Alcoholic beer can trigger hypoglycaemia by affecting liver glucose production, particularly in patients taking glucose-lowering medications. Both alcoholic and nonalcoholic varieties may contain rapidly absorbed carbohydrates. Nonalcoholic beers made with stopped fermentation or maltodextrin may have a high glycaemic load despite being marketed as healthy. Low-carbohydrate beers generally have a lower glycaemic load but usually contain more alcohol than regular beers. The effects vary depending on an individual's metabolic status.