Table of Contents
Many of us enjoy a glass of beer or wine from time to time but how does it affect our Crohn's disease, ulcerative colitis (UC), or microscopic colitis? In this post we share a comprehensive overview of the current research and answer your most commonly asked questions about alcohol and IBD.
Does alcohol cause Crohn’s disease or ulcerative colitis?
Meta-analyses combine multiple studies to analyze outcomes and are considered the highest quality level of research. The most recent meta-analyses found no association between alcohol consumption and the risk of developing UC or Crohn’s disease.1-2
Since these meta-analyses were published, there were two large observational studies that showed conflicting results.
One study found that consuming more than 4 servings per week of liquor was associated with an increased risk of UC.3
The second study, which did not differentiate between Crohn's disease and UC, found that red wine consumption up to 5 glasses per week was associated with a 12 to 16% decreased risk of developing IBD, whereas all other alcohol types (white wine, champagne, beer, and cider) were associated with increased risk of developing IBD with more consumption associated with higher risk.4
More research is needed to confirm the results of these studies and to understand if the type or amount of alcohol consumed over time changes one’s risk of developing IBD.
Does alcohol cause microscopic colitis?
In a recent study, people who consumed 1 serving of alcohol daily were 1.9 times more likely to develop microscopic colitis than those who did not consume alcohol at all.5
Another study found that those who had a high alcohol consumption (>16g/day, or just over 1 standard alcoholic drink per day) were 1.89 times more likely to develop microscopic colitis.6
Researchers do not fully understand how alcohol increases the risk of developing microscopic colitis, so more research is needed to confirm the results of these studies.
How does alcohol affect your gut microbiome?
Alcohol appears to be associated with changes to the gut microbiome that are associated with disease, such as changes in the amounts of certain bad gut bacteria, what they do in your body, or where they’re located.7 This is often referred to as dysbiosis of the gut microbiome.
Alcohol appears to also increase gut permeability (which is a breakdown of the protective gut lining in the intestines).7 Sulfites and added sugars are common additives to alcohol, and have been suggested to be inflammatory for people with inflammatory bowel diseases.7
Does alcohol increase your risk for active disease?
According to the International Organization for the Study of Inflammatory Bowel Diseases, there isn’t enough evidence to recommend changes to low-level alcohol consumption for people with IBD.8
While more research is needed to draw any meaningful conclusions, higher levels of alcohol consumption have been shown to be associated with higher risk of active disease in IBD patients.
In a study with 191 patients, those who consumed the most alcohol were 2.7 times more likely to have active disease compared to those with the lowest alcohol consumption.9
Another small study with 21 IBD patients in clinical remission found that daily consumption of 1-3 glasses of red wine for 1 week significantly decreased fecal calprotectin levels but increased intestinal permeability, indicating that daily consumption actually increased the risk for active disease over time.10
Could alcohol trigger your symptoms?
Alcohol is reported to be one of the most commonly avoided beverages by people with IBD11-17 with 21-75% of patients in recent studies reporting that alcohol worsened their symptoms.7,11
In a study including 400 patients seen at an IBD clinic in the UK, 22% of patients reported avoiding alcohol and 21% reported that alcohol worsened their symptoms.13
In another study of IBD and IBS patients (90 with Crohn’s disease or UC and 39 with IBS) in the United States, 75% of the IBD patients that drank alcohol reported that it triggered symptoms.17
Lastly, in a different study, alcohol consumption was found to significantly worsen symptoms in Crohn’s disease patients without an ostomy or pouch and ulcerative colitis patients with and without a pouch.12
Does wine cause less symptoms than beer?
More research is needed to draw any conclusions about whether wine consumption causes fewer symptoms than beer or other types of alcohol.
However, in one small study of 20 individuals with Crohn’s & 12 healthy individuals, abdominal pain was significantly more pronounced when the Crohn’s disease patients consumed smirnoff ice or beer compared to white or red wine.18
How does alcohol affect medications?
- Antibiotics (metronidazole, cephalosporins): alcohol can cause nausea, vomiting, flushing, dizziness, throbbing headache, and other symptoms7
- 5-ASA’s (sulphasalazine, mesalazine): alcohol may decrease efficacy7
- Thiopurines: alcohol may decrease efficacy7
- Methotrexate: alcohol may increase the risk of liver damage7
- TNF-inhibitors/Biologics: alcohol may increase the risk of drug-induced liver injury7
Should people with IBD avoid alcohol?
The diet and nutrition guidelines from the International Organization for the Study of Inflammatory Bowel Diseases say that there’s insufficient evidence to recommend changes to low-level alcohol consumption.
So, we recommend to drink what you want, when you are really going to enjoy it, and drink in moderation.
More research needs to be conducted before making any definitive statement on alcohol and IBD. Talk with your IBD care team about whether your preferred level of alcohol consumption is safe for you.
- Nie JY, Zhao Q. Beverage consumption and risk of ulcerative colitis: Systematic review and meta-analysis of epidemiological studies. Medicine (Baltimore). 2017 Dec;96(49):e9070. doi: 10.1097/MD.0000000000009070. PMID: 29245319; PMCID: PMC5728934.
- Yang Y, Xiang L, He J. Beverage intake and risk of Crohn disease: A meta-analysis of 16 epidemiological studies. Medicine (Baltimore). 2019 May;98(21):e15795. doi: 10.1097/MD.0000000000015795. PMID: 31124976; PMCID: PMC6571365.
- Casey K, Lopes EW, Niccum B, Burke K, Ananthakrishnan AN, Lochhead P, Richter JM, Chan AT, Khalili H. Alcohol consumption and risk of inflammatory bowel disease among three prospective US cohorts. Aliment Pharmacol Ther. 2022 Jan;55(2):225-233. doi: 10.1111/apt.16731. Epub 2021 Dec 8. PMID: 34881819.
- Liu BX, Yang J, Zeng C, Dai XJ, Chen Y. Risk of inflammatory bowel disease appears to vary across different frequency, amount, and subtype of alcoholic beverages. Front Nutr. 2022 Jul 27;9:918754. doi: 10.3389/fnut.2022.918754. PMID: 35967782; PMCID: PMC9363781.
- Niccum B, Casey K, Burke K, Lopes EW, Lochhead P, Ananthakrishnan A, Richter JM, Ludvigsson JF, Chan AT, Khalili H. Alcohol Consumption is Associated With An Increased Risk of Microscopic Colitis: Results From 2 Prospective US Cohort Studies. Inflamm Bowel Dis. 2022 Aug 1;28(8):1151-1159. doi: 10.1093/ibd/izab220. PMID: 34473269; PMCID: PMC9340522.
- Larsson JK, Sonestedt E, Ohlsson B, Manjer J, Sjöberg K. The association between the intake of specific dietary components and lifestyle factors and microscopic colitis. Eur J Clin Nutr. 2016 Nov;70(11):1309-1317. doi: 10.1038/ejcn.2016.130. Epub 2016 Jul 27. PMID: 27460269; PMCID: PMC5107968.
- Piovezani Ramos G, Kane S. Alcohol Use in Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2021 May;17(5):211-225. PMID: 34924888; PMCID: PMC8667378.
- Levine A, Rhodes JM, Lindsay JO, Abreu MT, Kamm MA, Gibson PR, Gasche C, Silverberg MS, Mahadevan U, Boneh RS, Wine E, Damas OM, Syme G, Trakman GL, Yao CK, Stockhamer S, Hammami MB, Garces LC, Rogler G, Koutroubakis IE, Ananthakrishnan AN, McKeever L, Lewis JD. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020 May;18(6):1381-1392. doi: 10.1016/j.cgh.2020.01.046. Epub 2020 Feb 15. PMID: 32068150.
- Jowett SL, Seal CJ, Pearce MS, Phillips E, Gregory W, Barton JR, Welfare MR. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004 Oct;53(10):1479-84. doi: 10.1136/gut.2003.024828. PMID: 15361498; PMCID: PMC1774231.
- Swanson GR, Tieu V, Shaikh M, Forsyth C, Keshavarzian A. Is moderate red wine consumption safe in inactive inflammatory bowel disease? Digestion. 2011;84(3):238-44. doi: 10.1159/000329403. Epub 2011 Aug 26. PMID: 21876358; PMCID: PMC3180655.
- Vagianos K, Clara I, Carr R, Graff LA, Walker JR, Targownik LE, Lix LM, Rogala L, Miller N, Bernstein CN. What Are Adults With Inflammatory Bowel Disease (IBD) Eating? A Closer Look at the Dietary Habits of a Population-Based Canadian IBD Cohort. JPEN J Parenter Enteral Nutr. 2016 Mar;40(3):405-11. doi: 10.1177/0148607114549254. Epub 2014 Sep 4. PMID: 25189173.
- Cohen AB, Lee D, Long MD, Kappelman MD, Martin CF, Sandler RS, Lewis JD. Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Dig Dis Sci. 2013 May;58(5):1322-8. doi: 10.1007/s10620-012-2373-3. Epub 2012 Aug 26. PMID: 22923336; PMCID: PMC3552110.
- Limdi JK, Aggarwal D, McLaughlin JT. Dietary Practices and Beliefs in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2016 Jan;22(1):164-70. doi: 10.1097/MIB.0000000000000585. PMID: 26383912.
- de Vries JHM, Dijkhuizen M, Tap P, Witteman BJM. Patient's Dietary Beliefs and Behaviours in Inflammatory Bowel Disease. Dig Dis. 2019;37(2):131-139. doi: 10.1159/000494022. Epub 2018 Nov 2. PMID: 30391940; PMCID: PMC6381876.
- Hou JK, Lee D, Lewis J. Diet and inflammatory bowel disease: review of patient-targeted recommendations. Clin Gastroenterol Hepatol. 2014 Oct;12(10):1592-600. doi: 10.1016/j.cgh.2013.09.063. Epub 2013 Oct 6. PMID: 24107394; PMCID: PMC4021001.
- Triggs CM, Munday K, Hu R, Fraser AG, Gearry RB, Barclay ML, Ferguson LR. Dietary factors in chronic inflammation: food tolerances and intolerances of a New Zealand Caucasian Crohn's disease population. Mutat Res. 2010 Aug 7;690(1-2):123-38. doi: 10.1016/j.mrfmmm.2010.01.020. Epub 2010 Feb 6. PMID: 20144628.
- Swanson GR, Sedghi S, Farhadi A, Keshavarzian A. Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease. Alcohol. 2010 May;44(3):223-8. doi: 10.1016/j.alcohol.2009.10.019. PMID: 20682190; PMCID: PMC3708696.
- Hey H, Schmedes A, Nielsen AA, Winding P, Grønbaek H. Effects of five different alcoholic drinks on patients with Crohn's disease. Scand J Gastroenterol. 2007 Aug;42(8):968-72. doi: 10.1080/00365520701452241. PMID: 17613927.