Alcohol and IBS

It’s 3 PM on a Friday afternoon when your coworker proposes happy hour. You have IBS and are worried about the consequences of drinking, but you don’t want to miss out. What do you do?

Alcohol is well established as a gut irritant and in IBS it is a common trigger for symptoms. But most people don’t have to take it off the table entirely. So read on to see if happy hour might still be in the cards for you.

In this article we will review:

  • How alcohol intake impacts the gut in healthy individuals
  • The effects of alcohol on IBS
  • Alcohol and a low FODMAP diet
  • Tips for when you drink

Alcohol and Gut Health

According to the CDC, over 60% of adults in the US drink alcoholic beverages, and about 5% engage in heavy drinking. Heavy drinking is defined as more than 7 drinks per week for women and more than 14 for men.

Heavy drinking is defined as more than 7 drinks per week for women and more than 14 drinks per week for men

Heavy drinking can cause damage to the gut in many ways. However, in moderate or low amounts alcohol is less likely to cause a problem.

Effects of Alcohol on the Microbiome

Alcohol can change your microbiome – that is the bacteria, fungus, and yeast in your gut. Chronic or heavy alcohol use is associated with an increase in bacteria in the small intestine – a condition called SIBO.1

Most of our gut bugs should be hanging out in the large intestine. When there is an overgrowth of bacteria in the small intestine it can lead to a lot of nasty symptoms like bloating, abdominal pain, nausea, diarrhea, and even malabsorption of nutrients.

Heavy drinkers may also experience dysbiosis, an imbalance between “good” and “bad” bacteria in the gut.

“Bad” bacteria are present even in a healthy gut. And under normal conditions, they do not cause any problems. But when the gut becomes imbalanced, higher levels of “bad” bacteria produce toxins that can damage the cells of the small intestine.

Polyphenols in red wine can be good for gut bacteria - in moderation.

However, if you are a wine lover, there is some good news. In moderate amounts, alcohol that is rich in polyphenols – like red wine, may actually increase the “good” bugs.2 I repeat… in moderation! More is definitely not better here.

Damage to the Gut

Alcohol is a known carcinogen that is associated with an increased risk of cancer throughout your body, but especially in the gut.3 Your digestive tract is your body’s first point of contact with alcohol, so it is logical to assume that alcohol may take a toll on cells throughout the gut.

Cancer types associated with alcohol: lip and mouth, throat, larynx, esophagus, colon/rectum, liver, breast

Damage to the cells of the small intestine can lead to intestinal permeability, sometimes referred to as “leaky gut”.

The full effects of intestinal permeability are not clear, but it is thought to contribute to inflammation throughout the body. It may increase the risk of liver failure and other diseases.

Inflammation

We’ve already established that disruptions to the gut microbiome and “leaky gut” can increase inflammation.

But another way alcohol contributes to inflammation is through a byproduct called acetaldehyde. This is a toxin that is formed when your body breaks down alcohol. Acetaldehyde causes oxidative damage, harming cells throughout the body and further contributing to inflammation.

Immunity

Seventy percent of our immune cells are in the gut. So, it should come as no surprise that if alcohol can mess up your gut, it can impair immunity as well. People who drink heavily are known to get sick more often from illnesses like the common cold.

Alcohol and IBS

People with IBS often notice worse symptoms with alcohol intake.

Alcohol and IBS - a common trigger

Just how much alcohol someone with IBS can tolerate varies. Some people report that any amount of alcohol causes symptoms. Meanwhile their IBS drinking buddy who had twice as much alcohol might not have any symptoms at all. But for the most part, symptoms seem to be worse with higher alcohol intake.

In one study, binge drinking (defined as 4 or more drinks on one occasion) was strongly associated with diarrhea, nausea, stomach pain, and indigestion the next day. Lighter drinking did not cause significant symptoms.

Symptoms were most severe in those with IBS-D (diarrhea) versus IBS-C (constipation) or IBS-M (mixed).4

Of note, if you are sensitive to FODMAPs some types of alcohol are better choices than others (more on this below).

Alcohol and the Gut-Brain Axis

What affects the gut can affect the brain due to the gut-brain axis. This is a two-way communication system between the gut and the brain.

Many people feel more relaxed when they drink. Relaxation is good for the mind. So logic would suggest that alcohol can be helpful for the gut and the brain, right?

Not so fast.

The problem is, if you drink alcohol to de-stress you run the risk of becoming dependent.  As your body gets used to alcohol as a tool for relaxation, you may start drinking more often and in larger amounts to get the same effect you used to get from a single glass of wine.

If you find yourself drinking a lot of alcohol you could be at higher risk for anxiety and mood disorders. And anxiety is a non-food trigger for IBS.

There is a strong association betwen anxiety, mood disorders and alcohol use disorders.

Plus, it has been suggested that alcohol induced gut permeability and changes to the gut microbiome can increase depression, anxiety, and behaviors.

For more on how alcohol influences stress, anxiety, and sleep (another important factor in gut health), check out this article from The Mental Wellness Dietitian.

How to Tell if Alcohol is a Trigger

So, how can you tell if alcohol is triggering your IBS symptoms?

Cut it out! Eliminating alcohol for 2-4 weeks is a great way to determine tolerance. Monitor your symptoms during your period of abstinence. Then re-introduce a small amount of alcohol.

If you feel alcohol might trigger your symptoms try just ½ a drink when you reintroduce and slowly increase toward your usual intake.

Now if your usual intake is more than 1 drink per day for women or 2 drinks per day for men, you might want to consider cutting back even if you are not experiencing IBS symptoms.

Alcohol and FODMAPs

If you follow a low FODMAP diet, you may be wondering how alcohol fits in. Fortunately, if you like the occasional drink, you have many low FODMAP options to choose from.

See the list of high and low FODMAP alcohol below and remember to consider your mixers if you are making a cocktail. To learn more about FODMAPs check out The FODMAP Elimination Diet: What to Know Before You Start.

Alcohol and IBS: Choose low FODMAP alcohol and mixers

High FODMAP Alcohol

Dessert wine

Liqueurs

Rum

Low FODMAP Alcohol

Beer

Brandy

Gin

Tequila (gold and silver)

Vodka

Whiskey

Wine, red (up to 5 ounces)

Wine, sparkling and white

Low FODMAP Mixers

Cranberry juice

Lemon juice

Lime juice

100% orange juice (up to 4 ounces)

Sparkling water or club soda

Most soft drinks (check the ingredients)

Tonic (check the ingredients)

*Note that carbonated beverages can trigger symptoms in some people, especially with larger amounts.

Tips for Drinking Alcohol with IBS

The most obvious tip here is to avoid alcohol if you think it might be a trigger for your gut symptoms. However, if you are reading this section, you are probably here because you want to know how you can continue to enjoy the occasionally drink.

I’ll spare you the preaching on abstaining, because friends – I enjoy a cold beer, a glass of wine, and an occasional cocktail myself.

So without further ado…  My top tips for drinking alcohol with IBS:

Tips for drinking alcohol with IBS: mix it up with mocktails, set your limit, hydrate, consider low alcohol drinks, watch out for FODMAPs.
  1. Mix it up with mocktails. I know I just said I wouldn’t preach about abstaining, but hear me out. If you know you can’t tolerate any alcohol mocktails are a great way to make it feel (and look) like you are drinking. Or you can alternate cocktails and mocktails to make sure you don’t get too carried away with the booze.
  2. Set your limit and stick to it! Ideally this limit would be one drink for women and two drinks for men. But I get it, sometimes you are going to challenge the “rules”. So if you know you will exceed the recommended intake, think about how many drinks you normally tolerate. For example, if at the last holiday you felt terrible after four glasses of wine, maybe your limit is three glasses.
  3. Hydrate. Have a glass of water for every alcoholic beverage you have. This will slow you down and prevent you from getting too dehydrated which can contribute to the next day’s misery.
  4. Consider low alcohol drinks. These have become super popular in recent years and are widely available. If you are a beer drinker – look for light beers or “session” ales. If you are making cocktails, simply cut the amount of booze in half. You can even lighten up a glass of wine by adding sparkling water or club soda to make a spritzer.
  5. Watch the FODMAPs. There are many low FODMAP alcohol choices. Cocktails are where it gets a little more tricky. Be sure to read the ingredients on the mixers you use and stick to low FODMAP options when you can.

Final Thoughts

Alcohol can impact gut health, but is less likely to be harmful at low or moderate levels. Heavy alcohol consumption can cause shifts in your gut microbiome, damage to the cells of your digestive tract, increased inflammation, and suppressed immunity – even in people with a healthy gut.

Alcohol and IBS don’t always play well together. Alcohol is commonly identified as a trigger for uncomfortable symptoms. But many people can tolerate some alcohol. Eliminating, then slowly re-introducing alcohol can help you determine your level of tolerance.

 Many people with IBS also have poor tolerance to carbohydrates called FODMAPs. There are some alcoholic beverages and mixers that are high in FODMAPs. The best drinks for IBS are probably going to be those lower in both alcohol and FODMAPs.

If you choose to drink, know your limits, alternate alcoholic and non-alcoholic beverages, and consider cutting back in general.

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

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You may also enjoy this article on Coffee and IBS.

References:

1.         Bishehsari F, Ph D, Desai V, et al. Alcohol and Gut-Derived Inflammation. Alcohol Res Curr Rev. 2013;38(2):163-171.

2.         Engen PA, Green SJ, Voigt RM, Forsyth CB, Keshavarzian A. The gastrointestinal microbiome: Alcohol effects on the composition of intestinal microbiota. Alcohol Res Curr Rev. 2015;37(2).

3.         Rehm J, Shield KD, Weiderpass E. Chemico-Biological Interactions Alcohol consumption . A leading risk factor for cancer. Chem Biol Interact. 2020;331(May 2019):109280. doi:10.1016/j.cbi.2020.109280

4.         Reding KW, Cain KC, Jarrett ME, Eugenio MD, Heitkemper MM. Relationship between patterns of alcohol consumption and gastrointestinal symptoms among patients with irritable bowel syndrome. Am J Gastroenterol. 2013;108(2):270-276. doi:10.1038/ajg.2012.414

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