How alcohol affects gut health

Tina Aswani-Omprakash vividly remembers the day that led her to stop drinking for good.

Her inflammatory bowel syndrome (IBS) had been in remission for two months and she felt as if her life had returned to normal. But that didn’t last long. At a work event, after just a few drinks, she started feeling sick and vomiting so violently that a friend took her to the emergency room. When the 23-year-old New Yorker asked her doctor about the experience, he suggested she stop drinking if it was making her symptoms worse. Wanting to protect her health, she decided to give up completely.

But for someone in their early 20s who worked a high-pressure job that required a lot of socializing with customers, it was difficult. “In addition to being diagnosed with a lifelong illness at the age of 22, I was unable to do one of the things that allowed me to integrate with my peers, colleagues and clients,” says Aswani-Omprakash, now 40. Friends, boyfriends and co-workers sometimes looked at her as if she had “nine heads,” she says, when she didn’t order a drink.

“Initially, I didn’t handle the situation well,” says Aswani-Omprakash. “But then I learned to order a non-alcoholic drink – cranberry juice, mocktail or even water – with a piece of lemon or lime on the side. That way, no one would know what I was drinking.”

There’s no single answer to whether people with IBS or inflammatory bowel disease (IBD) can consume alcohol, experts say. As with certain foods, experimentation is necessary to determine personal tolerance.

But the question of whether a person should continue to drink is not simply a question of tolerance. This is because alcohol can affect the effectiveness of some IBD medications and interfere with test results. It’s best for patients who want to continue drinking to talk about the issue with their doctors, experts say.

What does alcohol do to the intestine?

Even in people with healthy digestive systems, alcohol can wreak havoc, says Dr. Alexandra Gutierrez, professor of medicine and medical director of the IBD Center at Columbia University’s Vagelos College of Physicians and Surgeons.

While light drinking – a maximum of one drink per day for women and two for men – is unlikely to cause serious problems, excessive alcohol consumption can harm the microbiome, leading to an increase in the bacteria that cause inflammation and a decrease in the bacteria that cause inflammation. help us. digest food, says Gutierrez. Even among those who don’t drink much, some experience diarrhea and cramps.

Increased inflammation associated with excessive alcohol consumption can also interfere with nutrient absorption. Even worse, it can damage the intestinal lining and possibly cause “leaky gut.” This condition can cause microbes, food, and toxins to escape from the intestines, potentially causing problems in other parts of the body.

Even among those who follow alcohol guidelines, some will experience digestive issues, such as changes in bowel habits and worsening acid reflux, says Dr. Reezwana Chowdhury, assistant professor of medicine and IBD specialist at Johns Hopkins University School of Medicine. .

See more information: How to be a healthier drinker

What about people with IBD?

Although occasional drinking does not always cause harm, “there is a proportion [of people with IBD] who will certainly feel worse when they drink because of the worsening of the disease,” says Dr. Jessica Philpott, a gastroenterologist at the Cleveland Clinic. “Often a patient will say, ‘I went out for a beer with some friends and felt bad the next day.’”

When patients ask if they can drink in moderation, “I tell them it’s OK if they don’t have liver disease and that it’s no more than two drinks in 24 hours for men and no more than one drink in 24 hours for women.” women,” Chowdhury says. “When I go over their story, many will say, ‘When I drink I don’t feel good,’” she adds. “It’s not uncommon for a patient to say, ‘I used to be able to have three or four drinks on the weekend, and now I don’t feel well after just one beer.’”

Some patients pay attention to what their bodies are telling them, but “some just continue to fight that feeling,” says Chowdhury. “I worry about alcohol causing harm. My general conclusion is that drinking is not recommended.”

Alcohol can also affect the body’s ability to make the most of the foods people consume. This is because it pushes everything through the intestine quickly, so there is less time for nutrients to be absorbed — which in turn magnifies what IBD patients are already experiencing, says Dr. Nirupama Bonthala, assistant professor of medicine. and director of Women’s Health Inflammatory Bowel. Disease at the University of California, Los Angeles.

Perhaps even more concerning is the impact alcohol can have on certain IBD medications. “There are some medications that alcohol can make less effective,” says Bonthala. “And it can cause a lot of test abnormalities, especially liver function tests. It can be difficult to tell whether what we’re seeing on tests is a medication problem, or alcohol, or liver problems caused by IBD.”

Depending on when a patient drinks, some medications may take longer to metabolize, resulting in higher than ideal levels of the medication in the person’s body, says Gutierrez. Some doctors ask their IBD patients about their alcohol consumption and counsel them about the problems drinking can cause. Unfortunately, this is not true for all of them.

Aswani-Omprakash says she has never had a doctor talk to her about the potential impact of alcohol on IBD. Some doctors, however, think it is very important to discuss.

“I ask every patient about alcohol,” says Dr. Baldeep Pabla, assistant professor at Vanderbilt University Medical Center.

This is because, along with the potential impact on IBD symptoms, heavy drinkers can experience damage to the liver and other organs, explains Pabla. “Alcohol is a heterogeneous and complex substance,” he adds. “So it affects people differently. And it is one of the main causes of liver disease.”

A large percentage of patients, about 20% to 30%, take these dangers seriously, restricting themselves because they feel alcohol makes their symptoms worse, Pabla notes.

See more information: Why bathroom access is a public health problem

Does everyone have to stop drinking?

It’s possible that at least some people with bowel problems drink in moderation. Laura Goldenkranz was diagnosed with IBD when she was 36, and years later gave up alcohol completely. “I was going through difficult times with serious crises,” she says. “And with the combination of not feeling well on all the medications I was taking, I just abstained completely.”

But many things changed when Goldenkranz was given a new medication – and that included his relationship with alcohol. Rinvoq put the 44-year-old New Yorker into remission and she now feels comfortable having the occasional nightcap. “I know that for some people, alcohol can really make symptoms worse, but luckily I’m well enough now that I haven’t noticed any impact.”

When it comes to drinking, Goldenkranz is glad he didn’t develop symptoms in his 20s. “I think it makes a big difference when you’re younger,” she says. “If I was dealing with this when I was in college, it would have been a problem. I was drinking more at that time. When I was diagnosed in my early 30s, it didn’t matter because I didn’t drink much.”

There’s no doubt that younger people can feel stigmatized when they’re the only ones who can’t drink at social gatherings, says Pabla. The growing non-alcoholic drinks market can help with this, highlights Pabla.

Are there certain types of drinks that are better than others?

There is some research that suggests that red wine may be the best choice for people who want to drink occasionally. In fact, says Pablo, some small studies have found that 1 to 3 grams of red wine per week can improve inflammation in the intestine. In contrast, another study found that people who drank beer “had significantly worse endoscopic disease,” he says.

It makes sense that red wine is the best choice, as it’s rich in phenols, known to have anti-inflammatory properties, says Gutierrez.

See more information: How to Navigate Dating When You Have IBD

Are there signs that suggest it’s time to cut down or stop drinking altogether?

Whenever symptoms worsen, it makes sense to consider the possibility that alcohol may be the cause. To determine whether alcohol consumption is causing digestive symptoms, “you can perform an experiment,” says Pabla. “Stop drinking and, if alcohol is the cause, you will see improvement within weeks.”

Routine testing can also reveal problems. “If there are real laboratory anomalies, it’s a sign that you need to take a break,” says Bonthala. Alcohol is not essential to your life. Good gut health is.