Alcohol on keto and what it means for pain

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“Can I drink alcohol on keto?” is almost a daily question on some forums. The short answer is yes. But you know I’m going to tell you that it comes with caveats.

We’re all adults. Drinking alcohol is a choice. And alcohol is a rather large part of Australian culture whether we like to admit it or not. So much so that the Australian Dietary Standards and nutrition is being taught with alcohol as a food group.

For spoonies, alcohol has other considerations than just the impacts on ketosis. Alcohol interacts with more medications than it does not. Some of these interactions means it will make you feel more drunk, others are more sinister and can have serious impacts on blood pressure amongst other things. Please, please, please check your medications and speak to your GP or specialists about potential impacts of booze and your meds.

What alcohol means for ketosis

While the carb and calorie content is probably the first thing people ask about, there is a little more too it. Yes, there is a growing range of sugar-free and low carb pre-mixes available. Some of them even taste halfway decent. And yes, accounting for the carb count in your daily macros is absolutely the way to go if you are wanting to lose weight.

Funny thing is that booze is broken down in our bodies very differently than other calories.Alcohol is treated like a sugar, irrespective of it’s sugar content. When we drink alcohol our bodies essentially treats it as a toxin and prioritises its metabolism over everything else. A helpful little enzyme known as alcohol dehydrogenase helps with some of the work. Through our liver, stomach, and kidneys, enzymes help break down the calories in booze. Our bodies essentially hit pause on processing (metabolising) all other macro and nutrients while it’s processing the booze. This can have a temporary impact on the production of ketones while the liver processes the alcohol.

We’re still not sure if the calories we burn from drinking are as good as other calories. How long it takes to metabolise will depend on how much you’ve had to drink and your natural metabolism.

Being a diuretic also has a part in it. Increasing the need to urinate can lead to dehydration which effects our electrolyte balance which has a flow on affect to ketosis.

Essentially, alcohol may kick you out of ketosis. But it will slow down any weight loss progress. Alcohol is a discretionary food item anyway. So it should always be consumed in moderation.

What types of alcohol are keto friendly

Let’s stop and consider this for a second. The alcohol content comes from the fermentation of the sugar in the various base ingredients. Yes, sugar is consumed as part of the fermentation process, but there is often residual sugar content in the end product. The body also treats alcohol like a sugar regardless of the remaining overall sugar content.

As a rule of thumb (and this is not scientific by any means), for no carb and low carb alcohol I tend to account for 5g of carbs per standard drink in my macros. Firstly it keeps me accountable for the number of drinks and it provides some allowance for the metabolism of the alcohol. It works for me. As adults we all get to make our own choices for how we count our macros.


I love my wine. With the exception of beer, it does tend to have the highest carb count. There is a lot of conflicting information about the actual carb count of wine. Typically the higher the alcohol content, the higher the carbs are going to be. Ideally, a keto wine should have low alcohol (13.5% ABV or less) and little to no residual sugar.

We are told that dry wines are fine on keto. But many wines marketed as “dry” have anywhere from 0–30 grams per liter of residual sugar. Surprisingly, they taste dry. Leaving some residual sugar in dry wine can increase the “likeability factor.”

Carb counts on wine can be extremely annoying to find and you rarely find nutrition labels on wine bottles. Some brand’s websites do include macros. Though these tend to be brands that manufacture and market lower calorie, lower alcohol or ‘keto friendly’ wines. If you want to hunt down the exact macros, you can also use search terms like “fact sheet,” “tech sheet,” “rs,” or even “pH” to search for a specific wine’s technical information quickly.

  • Sweet wines like Moscato, ports and dessert wines have a higher sugar content and are better off avoided.
  • Dry whites like a Pinot Grigio, Chardonnay, dry Riesling or Sauvignon Blanc range from 1.5-4g per standard drink.
  • Dry sparkling like Champagne and Prosecco tend to range from 1.5-4g per standard drink. Look for the words “brut,” “extra brut” or “brut nature” to ensure it’s dry, and you tend to be on the low carb path.
  • Dry reds like Pinot Noir, Tempranillo, Cabernet Sauvignon, Merlot and Chianti have a tend to higher alcohol content and range from 3-5g per standard drink.


Most of the low carb beers available in Australia are lagers and full strength. Dan Murphy’s currently stock 25 different low carb beers. The slightly annoying thing about alcohol product labelling is that most of the time you need to dig around for the macros and ingredients.

Personally I don’t drink a lot of beer anymore because of the gluten; the risk to reward ratio just isn’t there for me. While an icy cold beer on a hot Queensland summer day is refreshing, there are a heap of pre-mixes that I find I enjoy more.

  • Better Beer is a zero carb larger which is pretty good. A tinnie is 1.2 Standard Drinks (4.2% ABV). In Australia it comes it stubbies and tinnies. While it has no carbs, it still has calories albeit lower than brands. I don’t tend to count calories as a whole but it is something you want to consider in your overall daily macros.
  • Burleigh Brewing Co. Bighead No Carb Lager is a full strength beer made in Queensland. A tinnie is 1.2 Standard Drinks (4.2% ABV). I probably prefer it to the other brands. It might be a Queenslander bias happening but I do think it has more flavour.

Pure Blonde, Coopers, Carlton Dry and James Squire also have low carb beer ranges but are not as low as the two above. There are more craft beer options coming onto the market.


Spirits like vodka, whiskey, rum, gin, and tequila are generally considered keto-friendly because they contain zero carbohydrates. The carbs sneak in with the mixers we tend to add with them.

Flavoured spirits like flavoured vodka and gins, honey whiskeys and spiced or coconut rums can have added sugars and tend to be avoided on keto.

Sugar-free soft drinks like Coke Zero and Sprite Zero can be popular mixes and are an easy option when ordering at a bar.

Personally, I like gin or vodka with just soda and lime. If I’m being adventurous with my carbs I will add some frozen raspberries.


Over the past few years there has been a boom in the number of low sugar, low calorie and low carbohydrate ‘Ready to Drink’ drinks come onto the market.

Pre-mixes are notoriously high in sugar. So it’s been nice to see lower sugar options becoming available. It is worth checking the brand’s website to double check the mixer ingredients to see if it’s something you want to be having.

My current favourite is Suntory 196 which is premix blend of shochu, vodka and soda. It’s flavoured with either lemon, grape or peach. I love the tartness of the lemon. It is sweetened with Surclose though 🙁

Vodka Cruisers have a sugar free range are typically sweetened with artificial sweeteners such as sucralose (Splenda), stevia, or erythritol.

What does alcohol do for pain?

For me, in the short term, I tend to feel some relief from the pain. But alcohol is innately inflammatory and can have a bigger effect on pain for spoonies on the days that follow.

Alcohol metabolism produces reactive oxygen species (ROS) and other toxic byproducts, leading to oxidative stress. Oxidative stress can damage cells, proteins, and DNA, triggering inflammation as the body attempts to repair the damage.

Some additives and ingredients can also increase inflammation. As much as I love my red wine, I rarely drink it anymore because I’ve worked out that the sulphites in the wine tend to trigger flare ups for me.

There are low alcohol and no alcohol alternatives available. While this negates the inflammation caused by alcohol, it’s worth checking the ingredients because many of them still contain additives and preservatives than can trigger a spoonie.

So what’s the skinny?

We’re all adults. Drinking alcohol is a personal choice.

Check that there are no adverse medication interactions before you choose to have a few drinks.

Make a note of your pain the next day. Ideally don’t mix your drinks so that you can better understand if you are more sensitive to one type of alcohol than another.



Disclaimer: No Spoons to Cook is based on our own experience and research, and what we know works best for us. It is not medical advice. Our recipes focus on low inflammatory ingredients, whole foods and are founded in ketogenic and low carb ways of eating. We encourage spoonies to stay curious, ask questions, do your own research, listen to your body and to work with a Registered Dietitian or Medical Professional when appropriate to tailor your nutritional needs to support your care plan and goals.

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