“Can I drink alcohol on keto?” comes up almost daily on some forums. The short answer is yes. But you know me. It comes with caveats.
We’re all adults, and drinking is a choice. Alcohol is also a big part of Australian culture, whether we like to admit it or not. It’s so embedded that when you study nutrition, alcohol gets its own line in the energy calculations, right alongside protein, fat and carbs.
For spoonies, though, there’s more to think about than ketosis. Alcohol interacts with a lot of medications, including many of the ones used for chronic pain. Some interactions just make you feel more drunk. Others are more serious: extra drowsiness, slowed breathing, or changes to your blood pressure. So please, please, please check your medications and talk to your GP, pharmacist or specialist about what booze does with your meds.
What alcohol on keto does to ketosis
The carb count is usually the first question, and I’ll get to it. But what actually happens in your body is more interesting.
Your body treats alcohol as a toxin and puts clearing it at the top of the queue. Most of the work happens in the liver, with a little in the stomach. An enzyme called alcohol dehydrogenase turns alcohol into acetaldehyde, another enzyme turns that into acetate, and your body then uses the acetate for energy. While all this is happening, your liver puts burning fat on the back burner. Since ketones are made from fat, ketone production slows down until the alcohol is cleared. How long that takes depends on how much you’ve had and on your own metabolism.
Two things about this surprise people:
- Alcohol doesn’t act like sugar. It doesn’t raise your blood glucose the way carbs do. It can actually push glucose down, because a busy liver is slower to release glucose. That matters if you’re eating very low carb, and it matters even more if you take diabetes medication. If you do, talk to your doctor before combining keto and alcohol. This is especially important for the SGLT2 inhibitor medications.
- It still has energy. Alcohol provides 29 kJ (about 7 calories) per gram. That’s nearly as much as fat, and it comes with no nutrients. There’s more on how energy is counted in Macros Made Simple.
Alcohol is also a diuretic, so you lose more fluid and electrolytes. Keto already does that, especially in the early weeks, so the two together can leave you feeling flat. Have water between drinks and keep your electrolytes up.
Plenty of people on keto say alcohol hits them harder and faster than it used to. Researchers are still studying why, so start slow and assume your tolerance has changed.
So does alcohol on keto kick you out of ketosis? It can certainly pause it for a while. Alcohol is a “discretionary” item in the Australian Dietary Guidelines, a nice way of saying it’s optional. The national alcohol guidelines recommend no more than 10 standard drinks a week, and no more than 4 on any one day.
Which drinks are lowest in carbs?
All alcohol starts with sugar. Yeast ferments the sugar in grapes, grain or whatever else into alcohol. Some sugar usually gets left behind, and that leftover (residual) sugar is where most of the carbs in your glass come from.
Here’s my rule of thumb. It isn’t scientific by any means. For no-carb and low-carb drinks, I count 5 g of carbs per standard drink in my macros. It keeps me honest about how many drinks I’m having, and it covers the drinks where I can’t find a carb count. It works for me. As adults, we all get to decide how we count our own macros.
(In Australia, a standard drink is 10 g of alcohol. The number of standard drinks is printed on every can and bottle.)
Wine
I love my wine. The bad news is that carb counts for wine are annoyingly hard to find. You’ll rarely see a nutrition panel on a bottle, because Australian wine doesn’t have to carry one. Some brands put the details on their websites, usually the ones selling lower-alcohol or “keto-friendly” wines. If you want the numbers for a particular wine, search its name plus “tech sheet”, “fact sheet” or “RS” (residual sugar). Winemakers’ technical notes often list them.
Two things worth knowing:
- “Dry” doesn’t mean zero sugar. Dry wines can still carry a few grams of residual sugar per litre, and a touch of sweetness often makes a wine more appealing without tasting sweet.
- Higher alcohol means more energy, not more carbs. The carbs come from residual sugar. I still lean towards wines around 13.5% ABV or less, because fewer kilojoules and less alcohol suit me better.
Rough carbs per standard drink:
- Sweet wines like moscato, port and dessert wines are high in sugar. These are the ones to skip.
- Dry whites like pinot grigio, chardonnay, dry riesling and sauvignon blanc: about 1.5–4 g.
- Dry sparkling like champagne and prosecco: about 1.5–4 g. Look for “brut” (up to 12 g sugar per litre), “extra brut” (up to 6 g) or “brut nature” (under 3 g).
- Dry reds like pinot noir, tempranillo, cabernet sauvignon, merlot and chianti: about 3–5 g. They also tend to be higher in alcohol.
Beer
Most of the low-carb beers in Australia are full-strength lagers. Annoyingly, you usually have to dig around online for the carb counts and ingredients.
I don’t drink much beer any more because of the gluten. The risk-to-reward ratio just isn’t there for me. An icy cold beer on a hot Queensland day is hard to beat, but I’ve found pre-mixes I enjoy more.
- Better Beer is a zero-carb lager, and it’s pretty good. At 4.2% ABV, a 375 mL can is 1.2 standard drinks. It has no carbs but it does still have kilojoules, so count it in your day.
- Burleigh Brewing Co. Bighead No Carb Lager is a full-strength beer made in Queensland. At 4.2% ABV, a can is 1.2 standard drinks. It’s probably my pick of the two. That might be Queenslander bias, but I think it has more flavour.
Pure Blonde, Coopers, Carlton Dry and James Squire all have low-carb ranges, though they aren’t as low as those two. More craft options keep turning up too.
Spirits
Plain spirits like vodka, whisky, rum, gin and tequila have no carbs. The carbs sneak in with the mixer.
- Flavoured spirits like flavoured vodkas and gins, honey whisky and spiced or coconut rum often have added sugar.
- Tonic water is sugary. It’s not just bitter fizz. Ask for diet or zero-sugar tonic.
- Zero-sugar soft drinks are an easy order at a bar.
My go-to is gin or vodka with soda and fresh lime. If I’m feeling adventurous with my carbs, I’ll add a few frozen raspberries.
Pre-mixes
Ready-to-drink pre-mixes are notorious for sugar, so it’s been nice to see more low-sugar and low-carb options arrive in the past few years. Some of them even taste halfway decent. Check the brand’s website for the sweetener and ingredients before you decide whether it’s something you want to drink.
My current favourite is Suntory -196, a blend of shochu, vodka and soda. I love the tartness of the Double Lemon, which has 0.3 g of sugar per can. Be aware that at 6% ABV, a can is 1.6 standard drinks.
Vodka Cruiser has a zero-sugar range too. Like most zero-sugar pre-mixes, it uses artificial sweeteners such as sucralose, stevia or erythritol.
What does alcohol do to pain?
For me, in the short term, I tend to feel some relief from the pain. That isn’t just in my head. A 2017 meta-analysis in the Journal of Pain found that a blood alcohol level of around 0.08 reduced pain ratings in lab settings. But the researchers were clear about the limits. It was short-term, experimental pain, and keeping that effect going for chronic pain would take more alcohol than any safe drinking guideline allows.
The days after are a different story. Heavy or regular drinking promotes inflammation. As your body breaks alcohol down, it produces reactive oxygen species and other by-products that cause oxidative stress, which damages cells and sets off inflammation while the body repairs them. Alcohol also messes with sleep, especially in the second half of the night, and poor sleep makes pain worse. That combination is often why the next day hurts more.
Additives matter for some of us too. As much as I love red wine, I rarely drink it now, because I’ve worked out that the sulphites seem to trigger flare-ups for me. That’s my experience rather than settled science, but it’s worth paying attention to your own patterns.
Low and no-alcohol options take the alcohol out of the equation. Many still contain additives and preservatives, though, so check the ingredients for anything that sets you off. If you’d rather skip the booze altogether, an iced coffee still feels like a treat, with none of the hangover admin.
If you’ve noticed that pain sends you looking for sugar, alcohol included, you might find is pain fuelling your sugar cravings? interesting.
So, alcohol on keto: what’s the skinny?
- We’re all adults, and drinking is a personal choice.
- Check your medications first. This is especially important for pain medications, anything that makes you drowsy, and diabetes medications.
- Eat first and alternate with water. Expect your tolerance to be lower on keto.
- Count carbs per standard drink, not per glass, and watch the mixer.
- Don’t mix your drinks, and make a note of your pain the next day. That way you can work out whether you’re more sensitive to one type of alcohol than another.
If you’re still deciding how strict you want to be with carbs, keto vs low carb explains the difference.
