7 things you need to know about
alcohol and a low-carb or keto diet
About six months into his keto journey, however, Clay knew alcohol was causing too much havoc in his life, harming his health and hurting people he loved. He had to stop drinking.
“I realized the way I ate and the way I consumed alcohol were very similar. Once I started, I couldn’t stop. It was hard for me to do anything in moderation,” says Clay, 28, who is in the military.
At the time of this writing, he has been sober for 2.5 years and on the keto diet for 3 years (except for 8 weeks in boot camp). He feels wonderful, both because of his diet and his sobriety. He is a lean, muscular 185 pounds (84 kilos) and feels fit, strong and clear-headed. He enjoys working out regularly. The cravings for both his trigger foods and for alcohol are gone. He sees the two as being very closely related. And he will never risk bringing up those cravings again.
“A few potato chips from time to time might not kick me out of ketosis, but it could very well awaken the cravings in me… so that saves me from taking the first bite. And I stay away from alcohol entirely. It is not worth taking a single sip, knowing where my mind goes when I drink.”
Alcohol consumption and the keto diet is a hot topic. Many people who want to shed pounds come to ketogenic eating and are delighted that, unlike many diets, alcohol isn’t strictly forbidden when going low carb, high fat. While it may slow weight loss for many people, the occasional glass of dry white or red wine, champagne, or even distilled liquor may be okay — as long as it has no sugar. For the best options, see our guide, Top 5 low-carb alcoholic drinks.
In fact, back in 1964 a slim bestseller called The Drinking Man’s Diet, by Robert Cameron, was one of the first to tout a low-carb diet as a way — in that Mad Men era — to have one’s steak and martini, too. Cut out the sugar and carbs, Cameron said, and moderate alcohol was not a problem.
But is that true for everyone? Well, not exactly. The relationship between sugar, carbs and alcohol — and the caveats around smart consumption when on the ketogenic diet — are not as simple and straightforward as Cameron’s 1960s advice.
For this post, we researched the medical literature and sought input from an array of experts about alcohol and a low-carb or keto diet. Here are 7 essential points to know:
1. Moderation is key
For those who have healthy livers, not much weight to lose, and no trouble stopping at one drink (for women) or two (for men), the occasional imbibing of a low-carb alcoholic drink is probably not going to cause any harm, and may even help with cardiovascular health and joie de vivre.1
Swedish diabetes researcher and medical specialist Dr. Fredrik Nyström, head of internal medicine at Linköping University, has studied dietary intake in various populations and has the same advice for generally healthy people: a daily glass of wine, combined with a low-carb diet, can be good for your health.
Nyström notes that alcohol is actually the fourth macronutrient after protein, fats and carbohydrates, and that in many nutrition studies its intake is often overlooked.2 In Mediterranean countries like Greece and Italy, alcohol makes up about 10 % of caloric intake and may partially contribute to the touted benefits of the Mediterranean diet, Nyström says.Drinking alcohol, however, may slow weight loss for some. The late Dr. Sarah Hallberg used to advise her patients who were trying to lose weight and/or reverse diabetes to have a maximum one glass of wine for women and two for men, and not every day. “If they experience any weight stall, I recommend they stop the alcohol completely,” said Hallberg.3 Both Dr. Jason Fung and Dr. Ted Naiman discourage any alcohol use among patients in their care who are still trying to lose weight, reverse diabetes or heal a fatty liver (see point 5). “I find alcohol is not conducive to steady weight loss,” says Fung.4 Keto nutritionist Maria Emmerich notes that one reason alcohol slows weight loss is that it temporarily prevents the body from utilizing fat stores for energy.5 Of course, depending on the drink, alcohol can provide a significant number of calories, which may impede weight loss.6 Further, alcohol tends to reduce inhibitions and increase cravings, often leading to choosing less healthy foods and eating more of them.7 The takeaway: small amounts of low-carb alcohol are fine, but if your weight loss stalls or you still have issues with poor metabolic health, consider abstaining, at least for now.
2. Moderate drinkers: fundamentally different?
Many studies have shown that alcohol consumption when graphed against mortality risk is a J-shaped curve. Abstainers have slightly higher mortality risks than moderate drinkers and heavy drinkers have the highest risks of all.8
In a 2007 New York Times article, Gary Taubes says he is suspicious of these sorts of epidemiological findings: “The question I always had about these studies was whether or not people who drink alcohol in moderation are just different than the teetotalers, who drink none, and the binge drinkers, who drink to excess. Maybe by looking at a glass or two of alcohol a day you’re selecting out for people who live their entire lives in moderation, people capable of living well without excess.”
The takeaway: Be honest with yourself. Can you easily stop at one or two drinks max? If you can’t, our experts say be very cautious with alcohol and consider abstaining. Dr. Naiman notes that at higher levels of consumption, alcohol may be toxic to multiple organ systems and is linked to hypertension, nerve damage, cancers and cognitive decline.9
3. Can’t easily stop? It’s your brain chemistry
Many people who have trouble moderating their eating or drinking may often beat themselves up. Clay describes his feelings of self-hatred for his once uncontrolled eating and drinking. But as Bitten Jonsson — a registered nurse who specializes in sugar addiction — states: the inability to quell cravings and moderate one’s consumption — whether of high-carb foods or alcohol — has less to do with willpower and more to do with the altered biochemistry of the brain.
“The brain chemistry that drives the addict to seek pleasure beyond the point of satiety is similar, whether the user favors Jack Daniels or Jack-in-the-Box,” says Dr. Vera Tarman, author of Food Junkies, a book that Jonsson recommends for all sugar addicts.
Dr. Robert Lustig agrees, noting that neuroscience and addiction research shows that the brain’s dopamine (reward system) pathway is the same whether it is sugar, alcohol, nicotine, cocaine…whatever.10 “All hedonic (pleasure-causing) substances and all hedonic behaviors work through the same dopamine pathway,” says Lustig, the best-selling author, anti-sugar advocate and pediatric endocrinologist.
Even if you are able to successfully stop one addiction, addiction transfer, also called addiction-interaction disorder, is a well-known phenomenon. Jonsson notes that many sugar addicts may become alcoholics.11 Likewise, alcoholics who quit drinking may turn to sugar in an attempt to control cravings. Studies show that patients undergoing bariatric surgery, who can no longer overeat, have a 20% higher rate of post-operative problems with alcohol dependence.12
“When you are addicted to one substance and find yourself abstaining, your dopamine’s modus operandi is to find a substitute trigger,” says Lustig.
The takeaway: if you are doing a low-carb or keto diet to help deal with a disordered or addictive relationship to carbs or sugar, addiction transfer to alcohol may occur. Our experts recommend abstaining.
4. An adaptive trait that helped, now harms
Our innate dopamine reward system, which says “this is good, I want more” was likely a highly functional trait for survival in our primate and hunter-gather days, but our stone-age genes have not adapted to the modern world.13
The evolutionary theories of why our brain biochemistry may drive some to overeat or drink to excess are fascinating and varied, but most have to do with the ancient need to consume large amounts of high-calorie fruit and carbs in season in order to pack on fat to live off of during lean seasons and food shortages.14
In 2014 researchers in Florida sequenced human and primate genomes and worked backward to find the common ancestor 10 million years ago that first began to efficiently metabolize ethanol (fruit alcohol) found in fermenting fruit lying on the forest floor!15
The takeaway: some people find more self-acceptance — and a better ability to understand and control their cravings — by knowing about a once-helpful ancient trait that in modern times is a liability. As Lady Gaga sings in her anthem to self-acceptance: “Rejoice and love yourself today, ’cause baby you were born this way.” Since you can’t change your biology, avoid the trigger — alcohol — and prevent overconsumption.
5. Fatty liver? Lay off the booze until it heals
Non-alcoholic fatty liver disease (NAFLD) is a huge health epidemic, impacting increasing numbers worldwide — including 25% of the US population.16 Research suggests that one of the major contributors is the overconsumption of fructose and sugar sweetened beverages.17 Dr. Evelyne Bourdua-Roy wrote about how common NAFLD is among the patients in her GP practice — but also how reversible it is on a low-carb, low-fructose, high-fat, no-alcohol diet in her article How fat is your liver?
Dr. Lustig notes that unlike glucose, fructose and alcohol go straight to the liver, where they are metabolized almost exactly the same way. “Fructose is alcohol without the buzz,” says Lustig. Ethanol and fructose are metabolic cousins and when consumed in excess, both may promote fatty liver, leading to eventual liver fibrosis, scarring and potentially cirrhosis, liver failure and even liver cancer.18
The takeaway: Anyone with any fatty or fibrotic liver issues should avoid fructose and alcohol until the liver has healed. “If you have liver problems you should avoid alcohol under all circumstances,” says Lustig.
6. Lower tolerance, worse hangovers
Many people posting in forums and discussion groups about the ketogenic diet report that their alcohol tolerance is much lower, and their hangovers much worse on a low-carb diet.21 However, there isn’t much scientific research yet to explain why tolerance seems to be reduced, just theories. But it does appear that people on a low-carb or keto diet can become intoxicated at lower levels of alcohol consumption. While you should never drink and drive, you may need to be even more aware of the risk for impairment when following a low-carb or keto diet. (Note: even if you have not drunk very much, ketones in your breath may make you blow over in a breathalyzer, as some case reports have noted.)22
More severe hangovers may possibly be the result of dehydration and electrolyte imbalances, although the precise mechanism responsible for hangovers has yet to be determined.23 Carbs tend to cause the body to hold on to water, whereas a low-carb or ketogenic diet increases fluid loss, especially in the beginning. Alternate water between any alcoholic drinks, and consider adding some salt and taking magnesium and potassium supplements.24 Read our electrolyte supplementation guide for further details.
In addition, alcohol may lower blood glucose because the liver is busy metabolizing the alcohol and unable to produce glucose through gluconeogenesis.25 Here is another important caution: for those doing the keto diet and intermittent fasting, a sudden episode of heavy binge drinking could even predispose some individuals to the dangerous situation of alcoholic ketoacidosis, in which ketones are very high in the blood, but unlike diabetic ketoacidosis, blood glucose is normal or even dangerously low.26“Theoretically, there would be an increased risk of alcoholic ketoacidosis if binge drinking and fasting,” said Dr. Fung.
The takeway: be careful. Alcohol and its harms are much more potent on a ketogenic diet. See point 1: Moderation is key.
7. The keto diet can reduce alcohol cravings and may even help curb alcoholism
Many people, like Clay, have found the keto diet greatly helped reduce their cravings for both sugar and alcohol and reduced their urge and need to drink. Discussion threads on the popular social media site Reddit have many posts from people who found adopting the ketogenic diet helped them lower their consumption or even kick their alcohol addiction.27
“Once you get past the carb addiction and become a fat burner, your body has that other fuel (fat) that it can use instead of carbs and ethanol, and because it’s so satiating, both the carb and ethanol cravings subside,” said “Rockithound” in a Reddit discussion.
Film director Tom Naughton, who made the documentary Fat Head, says that when he was a vegetarian he craved alcohol and had trouble stopping once he started drinking. He lost the craving and desire to drink when he went LCHF. “I thought I needed a 12-step program. Turns out I actually needed a medium-rare steak,” he says.28
A keto diet may potentially even help alcoholics detox. The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) in Bethesda, Maryland is currently in the recruiting stage for a clinical trial to investigate the use of the ketogenic diet during detox for alcohol dependency.29 Principal investigator Corinde Wiers, PhD, notes that a number of studies and observations on brain energetics suggest that the ketogenic diet is a promising supplementary intervention for alcohol use disorders (AUD).30 “We will test if the ketogenic diet has an effect on withdrawal symptoms, craving, alcohol cue-induced brain reactivity and sleep quality,” says Wiers. If it does, then the ketogenic diet could become part of the arsenal of therapy for alcoholics who want to quit, she says.
The takeaway: although the evidence is weak to very weak, the ketogenic diet could help you reduce your cravings for alcoholic drinks, or even help you quit altogether.
In short, drink moderately and stop if weight loss stalls. Be careful how alcohol triggers your own cravings for overconsumption. Watch out for lower tolerance and other harmful effects of mixing alcohol with low carb or keto (especially if you have fatty liver disease), and note the possible beneficial impact on cravings with keto. Finally, of course, never drink and drive.
For Clay, he is happy that more people are talking about the ketogenic diet and alcohol. “I wish I had known about it earlier.”
If you want to know more about what alcoholic drinks are low-carb or keto, check out our low-carb alcohol guide.
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Alcohol and the keto diet: 7 things you need to know - the evidence
This guide is written by Anne Mullens and was last updated on June 17, 2022. It was medically reviewed by Dr. Michael Tamber, MD on November 30, 2021.
The guide contains scientific references. You can find these in the notes throughout the text, and click the links to read the peer-reviewed scientific papers. When appropriate we include a grading of the strength of the evidence, with a link to our policy on this. Our evidence-based guides are updated at least once per year to reflect and reference the latest science on the topic.
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Moderate alcohol intake has been linked to lower risk of heart disease in several clinical trials and observational studies:
Wiener Klinische Wochenschrift 2017: Moderate alcohol consumption and atherosclerosis : Meta-analysis of effects on lipids and inflammation [systematic review of randomized trials; strong evidence]
BMC Medicine 2014: Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers [systematic review of observational studies; very weak evidence] ↩
Although alcohol is technically a macronutrient because it contains calories, it does not provide any of the essential vitamins and minerals found in food. ↩
This is based on consistent clinical experience of low-carb practitioners. [weak evidence] ↩
This is based on consistent clinical experience of low-carb practitioners. [weak evidence] ↩
After being absorbed into the bloodstream, alcohol travels to the liver to be preferentially metabolized, which can temporarily halt ketosis and fat burning:
Clinics in Liver Disease 2013: Alcohol metabolism [overview article; ungraded] ↩
Even a low-carb glass of wine may have 100 calories, while a mixed drink can have 500 calories. ↩
British Journal of Nutrition 2019: The effect of alcohol consumption on food energy intake: a systematic review and meta-analysis [strong evidence]
Appetite 2015: Moderate alcohol consumption stimulates food intake and food reward of savoury foods [crossover trial; moderate evidence]
Appetite 2010: Short term effects of alcohol on appetite in humans. Effects of context and restrained eating [crossover trial; moderate evidence]
Health Psychology 2016: Alcohol’s acute effect on food intake is mediated by inhibitory control impairments [randomized trial; moderate evidence]
There has been debate about whether the teetotalers group includes former heavy drinkers now abstaining, hence the worse result. And as we have noted before, observational trials such as these do not prove cause and effect.
Alcoholism: Clinical and Experimental Research 2013: Alcohol consumption, heavy drinking, and mortality: rethinking the j-shaped curve [observational study; very weak evidence]
Journal of Studies on Alcohol and Drugs 2016: Do “moderate” drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality [systematic review of observational studies; very weak evidence]
The Medical Journal of Australia 2013: J-curve revisited: cardiovascular benefits of moderate alcohol use cannot be dismissed [overview article; ungraded]
International Journal of Cardiology 2013: Alcohol and the heart: to abstain or not to abstain? [overview article; ungraded] ↩
Mayo Clinic Proceedings 2014: Alcohol and cardiovascular health: the dose makes the poison…or the remedy [overview article; ungraded]
British Journal of Clinical Pharmacology 2012: Alcoholic neuropathy: possible mechanisms and future treatment possibilities [overview article; ungraded]
Nutrition and Cancer 2011: Alcohol consumption and cancer risk [review of observational studies; very weak evidence]
Neurodegenerative Disease Management 2016: Alcohol-related cognitive impairment: current trends and future perspectives [overview article; ungraded] ↩
Nature Reviews. Neuroscience 2017 The dopamine motive system: implications for drug and food addiction. [overview article; ungraded] ↩
Although there isn’t a lot of published research on this topic, there is some evidence that people who have a strong preference for sweets may be at increased risk of alcoholism:
Alcohol and Alcoholism 2018: Identifying and characterizing subpopulations of heavy alcohol drinkers via a sucrose preference test: a sweet road to a better phenotypic characterization? [non-controlled study; weak evidence]
Journal of Psychoactive Drugs 2010: Sweet preference, sugar addiction and the familial history of alcohol dependence: shared neural pathways and genes [overview article; ungraded] ↩
Surgery for Obesity and Related Diseases: Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study 2017: [observational study; very weak evidence] ↩
The American Journal of Medicine 1988: Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective [overview article; ungraded] ↩
American Journal of Physical Anthropology 2017: Current views on hunter-gatherer nutrition and the evolution of the human diet [overview article; ungraded]
Journal of the Addiction 2002: Fermenting fruit and the historical ecology of ethanol ingestion: is alcoholism in modern humans an evolutionary hangover? [overview article; ungraded] ↩
A genetic mutation was found that linked to a time when primates were coming down out of trees, the earth was cooling off, and food sources were changing. Primates who had the mutation could eat the fermenting fruit on the ground in the limited time it was available, metabolize the ethanol 40 times more successfully, get the extra calories and thrive. The researchers hypothesized that hominid brains then evolved to link its pleasure pathways to alcohol consumption because it was associated with finding and consuming a key high-calorie food source in season.
Proceedings of the National Academy of Sciences of the United States of America 2015: Hominids adapted to metabolize ethanol long before human-directed fermentation [historical data; ungraded] ↩
World Journal of Gastroenterology 2017: Clinical epidemiology and disease burden of nonalcoholic fatty liver disease [overview article; ungraded] ↩
American Journal of Clinical Nutrition 2012: Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study [randomized trial; moderate evidence]
Gastroenterology 2017: Effects of dietary fructose restriction on liver fat, de novo lipogenesis, and insulin kinetics in children with obesity [nonrandomized study, weak evidence]
Journal of Hepatology 2018: Fructose and sugar: a major mediator of nonalcoholic fatty liver disease [overview article; ungraded] ↩
Advances in Nutrition 2013: Fructose: It’s “alcohol without the buzz” [overview article; ungraded] ↩
Best Practice & Research. Clinical Endocrinology & Metabolism 2016: Non-alcoholic fatty liver disease and risk of type 2 diabetes[review of observational studies; very weak evidence]
World Journal of Gastroenterology 2014: Non-alcoholic fatty liver disease and obesity: Biochemical, metabolic and clinical presentations[overview article; ungraded]
World Journal of Gastroenterology 2014: Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome [review article; ungraded] ↩
World Journal of Gastroenterology 2014: Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease [overview article; ungraded] ↩
International Journal of Obesity 2007: False-positive breath-alcohol test after a ketogenic diet [case study; very weak evidence] ↩
Alcohol and Alcoholism 2008: The alcohol hangover–a puzzling phenomenon [overview article; ungraded] ↩
This is based on consistent clinical experience of low-carb practitioners. [weak evidence] ↩
The American Journal of Physiology 1998: The inhibition of gluconeogenesis following alcohol in humans [non-controlled study; weak evidence] ↩
Journal of the Royal Society of Medicine 2009: An obscuring cause of wide-anion-gap metabolic acidosis in alcoholic patient: an interesting case [case report; very weak evidence]
The British Medical Journal 2014: Ketoacidosis is not always due to diabetes [very weak evidence] ↩
The NIAAA team is recruiting male and female subjects who are dependent on alcohol and want to stop drinking. These people will be admitted for an all-expenses-paid residential treatment program for alcoholism for three weeks and randomized into the ketogenic diet or the standard American diet while undergoing otherwise normal detox therapy. Then after discharge, the patients will be followed for a year to assess drinking behavior and relapses, if any. The authors estimate the study will be completed by the end of 2023. ↩
Neuroimage 2013: Acute alcohol intoxication decreases glucose metabolism but increases acetate uptake in the human brain [placebo-controlled trial; moderate evidence]
The Journal of Clinical Investigation 2013: Increased brain uptake and oxidation of acetate in heavy drinkers [observational study; very weak evidence]
Neuropharmacology 2017: Neurochemical and metabolic effects of acute and chronic alcohol in the human brain: Studies with positron emission tomography [overview article; ungraded] ↩