Alcohol on keto

This article isn’t about alcohol tolerance.  It’s about your liver.

Tl;dr: with a basic knowledge about alcohol metabolism and ketoadaptation, drinking on keto gives me pause.

It might be nothing, but it gives me pause.

Alcohol is metabolized primarily by alcohol dehydrogenase, producing acetaldehyde and reducing equivalents as NADH.  This pathway produces energy.

Some alcoholics are skinny, in part, because of the other pathway: CYP2E1 (MEOS).  CYP2E1 actually consumes energy to metabolize alcohol (it’s like “negative calories” in this #context).  Recall this blog post, where it was shown that chronic alcoholics would gain weight if extra calories were given in the form of chocolate but not alcohol.  It’s because alcoholism enhances CYP2E1.  Downside is that CYP2E1 produces superoxide and lipid peroxides which contribute to inflammation, fibrosis, and eventually liver failure (eg, Porubsky et al., 2008).


CYP2E1 lipid peroxidation


An old rule of thumb is that it takes about 15 years of heavy drinking in an otherwise healthy person to induce liver failure.  That seems way too specific, imo, but whatever.





What else increases CYP2E1?

-Fasting (eg, Johansson et al., 1988).  Drunkorexia, or fasting prior to drinking to offset the alcohol calories.  This also applies to intermittent fasting.  You can offset the calories by fasting, but increased CYP2E1 makes this practice particularly nefarious.

-Ketogenic diet.  There are no studies on alcohol ingestion in people following a ketogenic diet, but given the known impact of CYP2E1 on liver pathology, this way of eating might take that theoretical 15 years down to 10.  Or something.  Guessing here, but I don’t think drinking on keto is healthier than drinking on LC/Paleo/whatever other diet… probably the opposite.  Maybe it’s a matter of goal posts.



CYP2E1 has a function, and it produces oxidative stress with substrates other than alcohol… that is, even if your not imbibing, CYP2E1 still works if it’s upregulated by other factors (eg, ketogenic diet, intermittent fasting)… so might not want to add more fuel to the fire by adding an additional CYP2E1 enhancer and substrate (ie, alcohol).

#context and further considerations:

1) most people following a ketogenic diet are health-conscious, so a few drinks now and then are probably fine.

2) keto is a therapeutic intervention.  If you’re in a state where such an intervention is required, should you really be drinking anyway?

3) there are no direct studies on this.  Like I said, “it gives me pause.”  I have no idea the extent to which this might apply.



THAT SAID, if you still choose to imbibe, it may be prudent to consider these… considerations

-Long and medium chain saturated fats: swap out some of your other cooking fats for cocoa butter and coconut oilThese are strongly protective against alcohol-induced liver damage, possibly due to their intrinsic molestation-resistance.

I’m not suggesting dumping all your butter and olive oil, just swap out some.

-Coffee.  Yay!  There are many epidemiological & mechanistic studies showing a hepatoprotective effective of coffee & coffee polyphenols, and even some specifically in models of alcohol toxicity … sorry, yes, alcohol is still pretty much justifiably classified as a toxin… yeah yeah yeah dose makes the poison, but still.

-Asparagus, Brussels sprouts, broccoli, artichokes, and a variety of LC plants* to bolster endogenous antioxidants.  Also, some supps like NAC, silymarin, and maybe TUDCA might be helpful here, too.

*LC plants: I specify LC in this context because high carbs + alcohol = no bueno. In her excellent book “Lights Out!,” T.S. Wiley frequently groups alcohol together with carbs.  I concur.

Just some food for thought.

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