HIV 101














Alcohol & HIV Nutrition:
Everything You Wanted To Know But Were
Afraid To Ask

By: Alan Lee, RD, CDE, CDN, CFT

Once upon a time, many HIV specialists may have made a blanket “Just Say No” recommendation to you about not drinking alcohol, but as life expectancy for people living with HIV is getting better, a more nuanced approach may make sense. As a Registered Dietitian, I get asked many times during the course of a therapeutic relationship with people living with HIV whom I am counseling–can I drink alcohol? The answer to that question for you can be answered only when a clinician knows your entire health/medical history, family history of alcoholism and addiction, and what other chronic conditions you may be living with.

This article will explore the nutritional value of alcoholic beverages, alcohol’s effect on essential nutrients, evidenced-based hangover remedies, risks vs. benefits of alcohol, and guidelines for what the definition of moderate drinking is.

Humankind knew how to brew before we learned how to bake. Alcoholic beverages are usually compromised of water, pure alcohol (ethanol – chemical name), and variable amounts of calories. You have probably heard that alcohol calories are “empty calories” and this is because alcohol provides little amounts of vitamins and minerals. What kind of nutrient is alcohol? Is it a carbohydrate, protein, or fat?

None of the above. Alcohol is its own nutrient! And as you can see in the table below……it is closer in caloric density to dietary fat than it is to starches or carbohydrates! As a diabetes educator, I remind people living with diabetes that alcohol DECREASES blood sugar and it is a nutrition myth that alcohol increases blood sugar levels.

Nutrient (Macronutrient) Calories per gram
- Protein ---------------------- Four (4)
- Carbohydrate -------------- Four(4)
- Fat -------------------------- Nine (9)
- Alcohol -------------------- Seven (7)

What counts as one (1) alcohol choice? (Each choice is 12-14 grams of ethanol)
- 12 ounces beer
- 5 ounces of wine
- 1.5 ounces of distilled spirits

Alcohol is also a drug and is legally available in the United States for adults over the age of 21 years. Some enjoy alcohol in moderation for a lifetime and a good amount of research has shown that people who choose to drink “moderate” amounts of alcohol regularly are potentially less likely to have heart disease, type 2 diabetes, and gallstones. Remember the French Paradox in the news? There appear to be polyphenols in red wine (namely reservatrol and quercitin) that may have a cardio-protective effect.

A hangover (defined as feeling sick and tired, headache, dry mouth) is a very common effect after an episode of heavy drinking. Excessive or binge drinking is not recommended as it can lead to vomiting, amplified emotional reactions, poor motor skills, and unconsciousness. Binge drinking is defined as (4) four or more drinks within two hours for women and (5) five or more drinks within two hours for men.

Heavy drinking is defined as more than (3) drinks on any day or more than (7) seven drinks a week for women and more than (4) four drinks on any day or more than 14 drinks a week for men.

There are no known evidence-based hangover cures. Purported hangover remedies can alleviate the symptoms of a hangover and lessen the perception of the time it takes to get over one. A recent study done in Australia looked at pear juice and preliminary evidence that it may inhibit a key enzyme in alcohol metabolism. But nothing definitive seems to work.

Alcoholism can be a major cause of nutritional deficiency in people living with HIV. Those who take in more than 30% of their total calories from alcohol are more likely to have significant deficiencies in micronutrients such as folate, thiamine, riboflavin, vitamin B6, vitamin A & C as well as all macronutrients.

  • Drinking patterns matter. Whether you drink wine or beer may matter less than how you drink. Having six drinks in one evening and then not drinking the rest of the week is not the same as having about one drink per night.

  • Wine with a meal is more enjoyable and potentially more beneficial than having it alone. Some nutrition research suggests that the components of wine may be prohibitive of fatty acid absorption.

  • The risks and benefits of moderate drinking shift over a lifetime. Risks exceed benefits until middle age, when heart disease begins to be a greater burden of morbidity and mortality.
  1. For a 60 year old man without a predisposition to alcoholism, according to the Cardiovascular Health Study, a drink a day may offer protection against heart disease that is likely to outweigh potential harm.

  2. For a 60 year old woman without a history of alcoholism who is at moderate to high risk for heart disease, the possible benefits of a daily drink need to be balanced against the small increase in risk of breast cancer.

In conclusion, alcohol is a nutrient that has two distinct faces. On one hand, moderate drinking is associated with lower rates of some conditions. On the other hand, heavy drinking can damage the liver/heart, lead to cancer, and interfere with relationships for you. If you choose to drink alcohol, then do so in moderation. Moderation means no more than two (2) alcohol choices for men and one (1) alcohol choice for women per day according to the USDA. If you do not already drink alcohol regularly, there is not enough evidence to suggest that you should start drinking.

About the author:

Alan Lee, RD, CDE, CDN, CFT has over 18 years of experience as a nutritionist for people living with chronic diseases such as HIV, hepatitis C, and diabetes. He works as a primary care dietitian at The Family Health Center Of Harlem and the APICHA Community Health Center. He is also a nutrition consultant for Montefiore Health Systems, Division Of Substance Abuse in the Hepatitis C Program, TOUCH, Inc. in Rockland County, NY, and SAGE-USA in New York, NY. He maintains a private practice based in NYC and is a recognized speaker on nutrition and HIV. For the last five years, he has been a special guest speaker at Teacherís College at Columbia University for their Medical Nutrition Therapy course on HIV nutrition. He can be reached at (212) 229-2298 and AlanLeeRD@yahoo.com.  

Copyright 2018, Positive Health Publications, Inc.

This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!