Tastings School - Blood sugar blues

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Blood sugar blues

Daniel Cooper looks at the problems faced by diabetic beer lovers.

Many of us will probably remember the televison adverts for Holsten Pils which stated that it was fermented so that “all the sugar turned to alcohol.” It was an interesting marketing strap-line which may or may not have helped to boost sales of the beer in question. However, as it turns out, this rather technical statement was quite pertinent if you are a sufferer of diabetes mellitus who has to carefully control sugar intake.

According to the diabetes charity Diabetes UK there are currently more than 2.5 million people in the United Kingdom who suffer from diabetes and it has been estimated that there are also more than half a million people with the condition but who do not yet know it. Furthermore, there have been suggestions that the number of sufferers could rise to four million by 2025, no thanks in part to modern diets which are high in fat and sugar.

Diabetes is a condition where the body has difficulty controlling the level of glucose (sugar) in the blood. Typically diabetes is due to either the body producing insufficient amounts of insulin or that the insulin the body does produce does not work effectively.

Insulin is a hormone produced by the pancreas and it acts by moving glucose from blood into the body’s cells where it is used to provide us with the energy we require.

Thus, if there is insufficient insulin or it does not work effectively, it is difficult for the body to regulate the level of glucose in the blood leading to harmful high (hyperglycaemia) or low (hypoglycaemia) concentrations in the blood.

This can lead to a number of immediate complications such as lack of energy, increased thirst and the need to urinate more frequently. But over time high blood glucose levels can have a negative impact on the eyes, kidney, nerves and heart.

Most of us recognise that diabetes is broken into two types: type 1 and type 2. Type 1 diabetes, or if we use the old title of “insulin dependent diabetes,” is caused by the body’s inability to produce insulin. Type 1 diabetes is often called juvenile diabetes or early onset diabetes because it usually appears before the age of 40.

Type 2 or “non insulin dependent” diabetes is the most common form of diabetes accounting for around 90 per cent of all sufferers. It is caused by the body producing insufficient quantities of insulin or not using what it produces effectively. Type 2 diabetes is usually more common in people over the age of 45 although younger sufferers are being diagnosed all the time.

So can diabetics consume alcohol and if, as the advert states, all the sugar is fermented to alcohol is beer more or less of a problem for sufferers of diabetes?

According to Diabetes UK under normal circumstances there is no need for a diabetic to give up drinking alcohol. However, the advice that they give is that, as for anyone consuming alcohol, moderation is the key. Stick to the guideline daily amounts of two units for women and three units for men where, for beer, a unit is half a pint of ordinary strength beer. But if you want to be able to calculate your daily intake more precisely you can use the following equation – alcoholic strength of drink (ABV) multiplied by the volume in millilitres divided by 1000. Therefore for a pint (568ml) of lager beer with an alcohol by volume of 5.2% the number of units is (5.2 x 568)/1000 which equals 2.95 units.

There does appear to be some confusion as to whether consumption of beer can lead to hyper or hypoglycaemia. However, both Diabetes UK and the American Diabetic Association state that consumption of alcohol makes hypoglycaemia more likely and can be more difficult to spot as many of the symptoms can be confused with drunkenness.

Again both organisations recommend sticking to moderate consumption but also suggest not drinking on an empty stomach and to snack on something starchy if you are going to be drinking for a prolonged period of time.

So is beer a particular problem for diabetics?

During the brewing of beer the starch from malted barley is broken down into simple sugars, such as glucose, and more complex carbohydrates.

During fermentation practically all of the sugar is fermented by the yeast into alcohol and carbon dioxide, whereas the complex carbohydrates are left untouched as brewing yeast does not synthesise the enzymes required to bring about further breakdown of these complex carbohydrates.

As a brief aside it is important for beer to have a certain level of carbohydrates. This is due to the important role that complex carbohydrates play in the creation of body or mouthfeel in beer. Beers that have a low level of complex carbohydrates tend to feel thinner on the palate whereas beers which contain more complex carbohydrates feel fuller on the palate.

The amount of total carbohydrates does vary from beer to beer but is largely made up of the complex carbohydrates that the yeast cannot use, typically two grams per 100ml of beer and a smaller amount of the simple sugars, generally less than one gram per 100ml of beer. Compare this to soft drinks such as a cola drink which can contain more than 10 grams of sugar per 100ml of liquid.

Brewers do add sugar in the brewing process after fermentation as it does provide a number of technical benefits. For example, traditionally after fermentation brewers might use sugar for priming, which they add to unfined beer when filling into cask or in the brewing of bottle conditioned beer.

By adding priming sugar brewers achieve more controlled secondary fermentation and therefore a better conditioned beer. However, if there is insufficient yeast remaining in the beer or the yeast present is not in a healthy and viable condition, that priming sugar may not be completely fermented and so will remain in the beer.

Furthermore with a flourishing bottled beer market brewers have started experimenting with novel flavours such as vanilla, peach blossom and elderflower, and have found that by using different sugars those added flavours gain better definition leading to a balanced, well rounded beer.

Unfortunately brewers are under no obligation to label where sugar has been used as a postfermentation additive which can make things complicated for diabetics trying to keep a strict control of their sugar intake.

There are some products, often referred to as “diet beers” that sit in the higher alcohol range which have less carbohydrate and almost no simple sugars. These have reduced energy content because of their lower carbohydrate content and are perhaps useful for those who want to control their calorie intake.

Similarly, reduced alcohol or light beers as they are known in some countries are lower in energy because of their lower alcohol content. They often contain amounts of carbohydrate and simple sugars similar to full-strength beer so as to provide fullness and flavour.

From a weight control viewpoint, these types of beer provide some advantages, and from a diabetic’s perspective, low alcohol beers may be a better choice than low carbohydrate beers. This is because not only is the energy content low but the presence of the carbohydrate can help to mitigate the effects of the alcohol and reduce the risk of hypoglycaemia.

With all this in mind the final decision whether to drink beer and which beer to drink lies with the individual. But it remains essential that if you are a diabetic and you want to drink beer then medical advice should be sought.