Should You Be Drinking Alcohol If You Have IBS?

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There is no getting around the fact that alcohol plays a large role in our culture. Many people choose to have a drink when they are out socially or when they are just looking to ease their stress and feel better emotionally. However, alcohol is a known digestive system irritant.

For a person who has a chronic digestive health disorder like irritable bowel syndrome (IBS), the question as to whether or not to enjoy some drinks is a complicated one.

Many people who have IBS avoid alcohol altogether due to the fact that they perceive it to be a trigger for their symptoms. If you are wondering if that is necessary, this overview will provide you with the information that you need to make an informed decision for yourself as we will cover the pros and cons of drinking, the research on alcohol use and IBS, and offer some tips so that you can make an informed decision for yourself.

Alcohol and Your Digestive System

Alcohol affects the working of your digestive system in many ways. Heavy alcohol use can cause signficant damage to digestive system organs and the lining of the tissues found throughout your digestive tract. But even moderate use of alcohol can have a negative effect on digestion. Alcohol has a weakening effect on the esophageal sphincter which can lead to acid reflux. In the stomach, alcohol can cause an increase in acid secretion and slow down stomach emptying, leading to irritation and feelings of nausea or at higher amounts, episodes of vomiting.

In the small intestine, alcohol can reduce the absorption of nutrients. This malabsorption, particularly of carbohydrates, can contribute to problems with gas and diarrhea as these substances interact with bacteria in the large intestine. Alcohol can also speed up the movement of the muscles of the large intestine, further contributing to the risk of diarrhea.

How Much Is Too Much?

The effect of alcohol on your digestive system is of course going to depend in some part to how much you drink. The U.S. Office of Disease Prevention and Health Promotion Dietary Guidelines say that if you are going to drink, moderate drinking for women should consist of no more than one drink a day, and for men no more than two drinks a day. People who are over the age of 65 should limit themselves to no more than one drink a day.

The Dietary Guidelines define binge drinking as having four or more drinks on a single occasion if you are a woman, and five or more drinks on a single occasion if you are a male. Heavy drinking in women is defined as drinking eight or more drinks a week and for men 15 or more drinks a week.

Health Risks Associated With Drinking

The more you drink, the more you raise your risk for detrimental effects on your health. Even moderate drinking can raise your risk for some types of cancer, for example, breast cancer. Excessive and binge drinking are associated with a wide variety of health and safety risks.

In addition to raising your risk for acute alcohol poisoning, excessive alcohol use raises your risk for a variety of other health problems, including:

  • alcohol dependence
  • heart disease
  • high blood pressure
  • cancers (including mouth, pharynx, larynx, esophagus, breast, stomach, colon, and rectum)
  • cirrhosis of the liver
  • birth defects
  • miscarriage
  • stroke

Excessive alcohol use can also contribute to risk of injury through violence, falls, and car accidents. Alcohol use raises your risk of health problems stemming from risky sexual behaviors. Excessive alcohol use is associated with mental health problems, such as anxiety and depression. Last, excessive alcohol use can have a negative effect on your family and work lives.

You Shouldn't Drink at All If...

The Dietary Guidelines place some restrictions on their recommendations for alcohol use. Thus, you should avoid alcohol if you:

  • don't want to drink
  • are younger than the age of 21
  • are pregnant
  • are taking medications that interact with alcohol
  • have a history of alcohol dependence
  • driving or operating machinery
  • have certain kinds of cancers

If you are breastfeeding you should discuss with your doctor whether or not you should be drinking and how much alcohol use on your part will be helpful for your baby.

Health Benefits of Moderate Drinking

The news about alcohol use isn't all bad. Research appears to suggest that low or moderate drinking can reduce your risk of coronary heart disease. What is unknown is whether the lower risk of coronary heart disease is due to the drinking itself or to other related lifestyle factors. Another area where moderate alcohol use might be beneficial is in terms of reducing your risk for dementia.

IBS and Alcohol

The research on the relationship between IBS is pretty rare, and studies that have been done to date have yielded mixed results. In general, there does not seem to be any clear evidence that alcohol use raises your risk for developing IBS.

One recent study gathered information regarding drinking and next-day digestive symptoms in a group of 166 women, ages 18 to 48 who were diagnosed as having IBS. No differences were found as to how much alcohol was consumed when compared to a group of 48 women who do not have IBS. However, the experience of next-day digestive symptoms was different between the two groups.

When the study women who had IBS engaged in binge drinking, they were more likely to experience diarrhea, nausea, stomach pain and indigestion the following day. Moderate or light drinking was not so clearly associated with these symptoms.

Interestingly, the association between drinking and next-day symptoms was more likely to be seen in the women who had diarrhea-predominant IBS as opposed to those who had constipation-predominant IBS or mixed-type IBS.

Thus the researchers conclude that alcohol use is especially problematic for women with IBS-D who binge drink. As always, please keep in mind that these are just the findings from one study that looked specifically at the association between having some drinks and how a person with IBS might feel the next day. Such findings would have to be replicated, (and include men!), in further studies before any firm conclusions can be drawn.

Drinking and FODMAPs

FODMAPs is the collective term for a group of carbohydrates that have been associated with contributing to digestive symptoms in people who have IBS. Researchers from Monash University have shown that following a low-FODMAP diet can be effective in bringing about symptom relief in a large majority of people who have IBS.

Whether you choose to follow the diet or not, you can use the information about specific drinks that the Monash researchers offer based on laboratory testing of the FODMAP content of certain drinks to help you to choose drinks that might be less likely to set off your symptoms. In general, the recommendation out of Monash University is to keep your alcohol intake to a minimum. Here is some information as to specific drinks and their FODMAP content:

Low-FODMAP drink choices (all in one drink serving sizes):

  • beer
  • red wine
  • white wine
  • gin
  • vodka
  • whiskey
  • sparkling wine
  • sweet wine

Rum has been found to be high in FODMAPs due to its fructose content. If you have fructose malabsorption, you will want to avoid mixed drinks containing rum.

The researchers do not appear to have tested tequila yet for its FODMAP content. They do provide information about "low glycemic index" wine, noting that it is also high in fructose.

You should also consider what you are mixing your drinks with, as many fruit juices are high in FODMAPs. Cranberry juice and tomato juice appear to be low-FODMAP choices.

So Should You Be Drinking If You Have IBS?

Because there is little information as to the interaction of IBS and alcohol, the answer as to whether or not you should be drinking if you have IBS seems to be that it is a fairly personal decision. If you see an association between drinking and your IBS symptoms, you may choose to abstain. You can keep in mind that the silver lining of this choice is that not drinking alcohol at all may end up being good for your overall health and serve to protect you from more serious diseases.

If you do choose to drink, here are some tips to reduce your risk of dealing with worsened IBS symptoms the next day:

1. Limit yourself to one drink per day.

2. Drink plenty of water when you are drinking alcohol to keep your body well-hydrated. This may also serve to dilute the alcohol, causing it to be less irritating to the lining of your digestive system.

3. Be sure to eat a meal before or alongside your drink. Having food in your stomach should also help to protect the tissues lining your digestive system from being irritated by the alcohol.

4. If you do choose to have more than one drink, slow down your intake. This will give your digestive system more time to process the alcohol which theoretically may serve to prevent next-day symptoms. And never do shots! Shots overwhelm your body's ability to process alcohol and can significantly impair your judgement, which can put your health at risk.

Sources:

"Dietary Guidelines for Americans 2015 - 2020: Appendix 9. Alcohol" Office of Disease Prevention and Health Promotion

"Fact Sheets - Alcohol Use and Your Health" Centers for Disease Control and Prevention

"Health Risks and Benefits of Alcohol Consumption " 2000;24:1:5-11.

Monash University Low FODMAP Diet App Accessed Feb. 16, 2015.

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" The American Journal of Gastroenterology 2013;108:270-276.

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