This post was updated on August 23rd, 2022
By Kym Campbell, BSc. | Updated August 23rd, 2022
You probably already know that getting your diet right is key to managing PCOS. If you’ve taken part in my free 30-Day PCOS Diet Challenge, then hopefully you’re seeing the results for yourself. If not, then download this free 3-Day meal plan and start today.
But where does alcohol fit into things?
As I explain below, there are risks associated with PCOS and alcohol. But there are also ways to manage these hazards.
1. How Alcohol Affects Your Health
Everyone knows that alcohol isn’t good for you. At least from a health perspective anyway. But for women with PCOS, there are extra risks. For example, even rare alcohol consumption in PCOS women is associated with non-alcoholic fatty liver disease . This is a common problem for women with PCOS, even those that are lean .
Studies show that moderate alcohol consumption may adversely impact the ratio of estrogen to progesterone . Since these hormones are already imbalanced in many women with PCOS, alcohol may make matters worse.
Alcohol has negative effects on other aspects of your lifestyle too. At all dosages, alcohol reduces sleep quality . This is a particular problem since quality sleep is one of the most important natural treatments for PCOS. Alcohol is also known to reduce self-control and increase cravings . That’s bad news if you’re working on your diet or exercise habits.
When it comes to mental health, there’s an important distinction to make. It’s widely claimed that alcohol consumption causes, or is linked to depression. This is true for people with alcohol use disorder, but the opposite is true for moderate drinkers. Studies show that light and moderate alcohol consumption is negatively associated with depression [7, 8]. This isn’t to say that alcohol is protective. But it doesn’t appear to cause depression in moderate consumers.
2. Drinking Alcohol While On Metformin
There are at least five good reasons not to take metformin for PCOS. But alcohol isn’t one of them.
Yes, excessive alcohol is a risk factor for people taking metformin. It can lead to lactic acidosis. Drinking excessively while on metformin can also cause hypoglycemia. But these risks say nothing about the effects of low to moderate consumption.
In 2009 researchers investigated alcohol consumption in diabetes prevention program participants. They found a reduced risk of incident diabetes in people who drank moderately while taking metformin .
A 2021 review also found a favorable effect in light to moderate alcohol drinkers . Moderate drinking was defined as approximately 1-2 standard drinks per day. There’s little doubt that heavy and binge drinking is dangerous. But for people with metabolic disease, moderate alcohol consumption may be helpful. This of course assumes they’re also following a healthy lifestyle.
It’s important to note the limitations of this 2021 review. This study did not separate men from women in their analysis. Other analyses have found an increase in all-cause mortality among those who consumed more than seven standard drinks per week . This dose is much lower than what is normally considered “moderate”.
As much as I hate saying this, more research is needed.
3. The Hazards Of Other Ingredients
Much like PCOS and coffee, alcoholic drinks need to be assessed in their entirety. The hazards aren’t limited to the active ingredient.
Sugar and gluten are both on my list of 7 foods to avoid with PCOS.
Most beer contains gluten. These proteins make PCOS worse by damaging the gut lining [12, 13]. This promotes inflammation, which is one of the underlying causes of all PCOS symptoms [14, 15]. The fructose in sugar also damages the gut and adds a burden to the liver [16-20]. Some experts argue that fructose is essentially just “alcohol without the buzz” .
The glucose content of sweetened alcoholic drinks is also unhelpful for women with PCOS. Regulating insulin secretion is central to managing a PCOS diagnosis [22, 23]. A sweetened cocktail is an ultimate insult to this goal. The sugar content can cause a spike in insulin, followed by a crash. This creates a significant disturbance to healthy hormone regulation.
4. Best Alcoholic Drinks For PCOS
If you understand the hazards, but you want to drink anyway, then there are smarter ways to go about it.
Red wine is one of the best alcoholic drinks for PCOS. Red wine contains resveratrol, a potent antioxidant . This compound has shown potential as a therapeutic agent for PCOS [25-27]. Ultra-Brut Champagne and other dry wines are also reasonable options. These have the lowest sugar content.
Drinking a pure liquor is another way to drink alcohol that’s more suitable for women with PCOS. Gin, vodka, whiskey, tequila, and rum are >98% alcohol and water mixtures. So long as you’re not mixing them with something sweet, then your hazard is limited to the alcohol content (plus the limited quantity of impurities).
When it comes to PCOS and beer I’m much less of a fan. Beer contains gluten and carbs. While carbs aren’t intrinsically bad for PCOS, as I explain here, the carbs in beer aren’t the kind we want.
If you’re open to going teetotal, there are plenty of fun alternatives to alcoholic drinks. Coconut water, kombucha, homemade gingerade, or seltzer water are easy places to start. If you have a little more time on your hands, then there are many great non-alcoholic cocktail recipes to try. Strawberry daiquiri, for example, is a popular favorite from my PCOS meal planning platform.
5. Final Tips If You’re Going To Drink
Regardless of what you’re drinking, remember there are common-sense steps you can take to reduce the harm from alcohol.
- Make sure to eat something substantial beforehand.
- Stay well hydrated.
- Limit how much you drink on any given day.
- Keep your health and fertility goals in mind.
The Bottom Line
Heavy drinking is hazardous to anyone and may be more harmful to women with PCOS. But light to moderate alcohol consumption may fit within your risk tolerances.
Like all diet decisions, how you choose to enjoy alcohol is totally up to you. If and when you do imbibe, choose less harmful drinks. These include red wine, dry white wines, and pure liquors. Limit consumption, stay hydrated, and always enjoy your drink with some PCOS-friendly food.
Ready To Try A PCOS Diet?
Since 2010, Kym Campbell has used evidence-based diet and lifestyle interventions to manage her PCOS. After getting her symptoms under control and falling pregnant naturally, Kym now advocates for dietary change as part of any PCOS treatment plan. Combining rigorous science and clinical advice with a pragmatic approach to habit change, Kym is on a mission to show other women how to take back control of their health and fertility. Read more about Kym and her team here.
1Hossain, N., et al., Non-alcoholic steatohepatitis (NASH) in patients with polycystic ovarian syndrome (PCOS). Scand J Gastroenterol, 2011. 46(4): p. 479-84.
2Gambarin-Gelwan, M., et al., Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Clin Gastroenterol Hepatol, 2007. 5(4): p. 496-501.
3Gill, J., The effects of moderate alcohol consumption on female hormone levels and reproductive function. Alcohol Alcohol, 2000. 35(5): p. 417-23.
4Anwar, M.Y., M. Marcus, and K.C. Taylor, The association between alcohol intake and fecundability during menstrual cycle phases. Hum Reprod, 2021. 36(9): p. 2538-2548.
5Ebrahim, I.O., et al., Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res, 2013. 37(4): p. 539-49.
6Remmerswaal, D., et al., Impaired subjective self-control in alcohol use: An ecological momentary assessment study. Drug Alcohol Depend, 2019. 204: p. 107479.
7Gémes, K., et al., Moderate alcohol consumption and depression – a longitudinal population-based study in Sweden. Acta Psychiatr Scand, 2019. 139(6): p. 526-535.
8Lina-Jolien, P., et al., Moderate alcohol consumption and depression prevention: A critical review. Actas Esp Psiquiatr, 2022. 50(3): p. 126-133.
9Crandall, J.P., et al., Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr, 2009. 90(3): p. 595-601.
10Sun, F.R. and B.Y. Wang, Alcohol and Metabolic-associated Fatty Liver Disease. J Clin Transl Hepatol, 2021. 9(5): p. 719-730.
11Wood, A.M., et al., Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet, 2018. 391(10129): p. 1513-1523.
12Caio, G., et al., Effect of Gluten-Free Diet on Gut Microbiota Composition in Patients with Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity. Nutrients, 2020. 12(6).
13Hollon, J., et al., Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients, 2015. 7(3): p. 1565-76.
14Popovic, M., G. Sartorius, and M. Christ-Crain, Chronic low-grade inflammation in polycystic ovary syndrome: is there a (patho)-physiological role for interleukin-1? Seminars in Immunopathology, 2019. 41(4): p. 447-459.
15González, F., Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 2012. 77(4): p. 300-5.
16DiNicolantonio, J.J., et al., Fructose-induced inflammation and increased cortisol: A new mechanism for how sugar induces visceral adiposity. Progress in Cardiovascular Diseases, 2018. 61(1): p. 3-9.
17Jones, N., et al., Fructose reprogrammes glutamine-dependent oxidative metabolism to support LPS-induced inflammation. Nat Commun, 2021. 12(1): p. 1209.
18Todoric, J., et al., Fructose stimulated de novo lipogenesis is promoted by inflammation. Nat Metab, 2020. 2(10): p. 1034-1045.
19Jensen, T., et al., Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol, 2018. 68(5): p. 1063-1075.
20Dornas, W.C., et al., Health implications of high-fructose intake and current research. Adv Nutr, 2015. 6(6): p. 729-37.
21Lustig, R.H., Fructose: it’s “alcohol without the buzz”. Adv Nutr, 2013. 4(2): p. 226-35.
22Wang, J., et al., Hyperandrogenemia and insulin resistance: The chief culprit of polycystic ovary syndrome. Life Sciences, 2019. 236.
23Barrea, L., et al., Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome. Nutr Res Rev, 2018. 31(2): p. 291-301.
24Castaldo, L., et al., Red Wine Consumption and Cardiovascular Health. Molecules, 2019. 24(19).
25Iervolino, M., et al., Natural Molecules in the Management of Polycystic Ovary Syndrome (PCOS): An Analytical Review. Nutrients, 2021. 13(5).
26Brenjian, S., et al., Resveratrol treatment in patients with polycystic ovary syndrome decreased pro-inflammatory and endoplasmic reticulum stress markers. Am J Reprod Immunol, 2020. 83(1): p. e13186.
27Shojaei-Zarghani, S. and M. Rafraf, Resveratrol and Markers of Polycystic Ovary Syndrome: a Systematic Review of Animal and Clinical Studies. Reprod Sci, 2021.