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Everything you need to know about alcohol and Crohn's/colitis

Written by
Brittany Rogers, MS RDN
October 21, 2022
A group of friends drinking

Alcohol is a part of every day life but how does it affect Crohn's disease, ulcerative colitis, 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?

There is currently no evidence that alcohol consumption causes Crohn’s disease or ulcerative colitis.

In a large observational study of 856 people with Crohn’s disease or ulcerative colitis, researchers from Massachusetts General Hospital and Harvard Medical School found no association between alcohol consumption and the development of Crohn’s disease or ulcerative colitis.

More research is needed to confirm the results of this study and to understand if the type or amount of alcohol consumed over time changes one’s risk of developing IBD (1).

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 (2).

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 (3).

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 the gut microbiome?

Alcohol appears to be associated with changes to the gut microbiome that are associated with disease, such as changes in the amount of certain bad gut bacteria, what they do in your body, or where they’re located (4). 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) (4). Sulfur & sulfate are common additives to alcohol, and have been suggested to be inflammatory for people with inflammatory bowel diseases (IBD) like Crohn’s disease or ulcerative colitis (4).

Does alcohol increase risk of active disease?

According to the International Organization for the Study of Inflammatory Bowel Diseases, there isn’t enough evidence to support changes to low-level alcohol consumption guidelines set for the general, healthy public (5). 

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 2.7x more likely to have active disease compared to those with the lowest alcohol consumption (6).

Another small study with 21 patients with Crohn’s or ulcerative colitis in 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 in the long haul (7).

Does alcohol trigger symptoms?

Alcohol is reported to be one of the most commonly avoided beverages by people with IBD (8-13) with 21-75% of patients in recent studies reporting that alcohol worsened their symptoms (4, 8).

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 (10).

In another study of IBD and IBS patients (90 with Crohn’s disease or ulcerative colitis and 39 with IBD) in the United States, 75% of the IBD patients that drank alcohol reported it triggered symptoms (7).

Lastly, in different study, alcohol consumption was found to significantly worsen symptoms in CD patients without an ostomy or pouch and UC patients with and without a pouch (9).

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 with 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 (14). 

How does alcohol affect medications? (4)

  • Antibiotics (metronidazole, cephalosporins): alcohol can cause nausea, vomiting, flushing, dizziness, throbbing headache, and other symptoms
  • 5-ASA’s (sulphasalazine, mesalazine): alcohol may decrease efficacy 
  • Thiopurines: alcohol may decrease efficacy
  • Methotrexate: may increase the risk of liver damage
  • TNF-inhibitors/Biologics: may increase the risk of drug-induced liver injury

Should people with Crohn’s disease or colitis 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.

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
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