Drinking with irritable bowel syndrome (IBS): How much is too much, and is it worth the potential flare-up? While you may enjoy an occasional drink, it’s important not to overlook your drinking habits when considering your triggers. If you have IBS, try monitoring the effect alcohol has on your body to better understand how much alcohol you can drink without irritating your gut. Some people with IBS decide to eliminate alcohol altogether, while others choose to enjoy alcohol in moderation.
Read on to learn about the effects of alcohol on IBS, discover which tipples are the most gut-friendly, and read some tips on how to drink responsibly with IBS.
What is IBS?
What causes IBS?
- Food and beverages: Some food and drinks are known to worsen symptoms of IBS, this includes alcohol.
- Hormones: As women have IBS at higher rates than men, some researchers believe hormonal changes may worsen symptoms.
- Stress: Stress and anxiety from work or family life has been strongly linked to symptoms of IBS.
How does alcohol affect IBS?
Simply put, alcohol is a toxin and has many effects on the digestive tract. So, while a glass of red might be nice, you should also keep in mind that alcohol can irritate the gastrointestinal (GI) system and may worsen your gut symptoms.
Alcohol affects different GI organs in different ways, for instance:
- The small intestine: Alcohol reduces the absorption of nutrients in the gut. This malabsorption of nutrients can cause IBS symptoms when these substances interact with bacteria in the gut. Alcohol can also speed up motility (the speed in which matter moves through the digestive tract), increasing the risk of diarrhea.
- The esophageal sphincter: Alcohol can weaken the esophageal sphincter (the ring of muscles that prevent stomach contents from returning up the esophagus) triggering acid reflux.
- The stomach: Alcohol can increase acid secretion in the stomach, and slow down stomach emptying. This can cause feelings of nausea and vomiting.
Can I drink alcohol if I have IBS?
There is no clear answer as to whether alcohol should be a no-go for someone with IBS. Each person’s sensitivity to alcohol may vary—some people may experience IBS symptoms after just one drink while other people can consume larger quantities of alcohol before IBS symptoms kick in. Make sure you go slow; take some time to see how your body reacts and adjust your intake accordingly
A 2010 study published in the Journal of Gastroenterology and Hepatology suggests that women who have IBS are more likely to experience symptoms such as diarrhea, nausea, stomach pain, and indigestion after a night of drinking than men.
The study also observed that drinking and next-day symptoms were more likely in women who have IBS-D (diarrhea-predominant) than those who had IBS-C (constipation-predominant) or IBS-Mixed. This is not too surprising, as even in people without IBS alcohol is known to speed up the rate of digestion, causing diarrhea.
When deciding whether to drink alcohol or not, it’s worth considering the national guidelines regarding maximum alcohol consumption. The U.S. dietary guidelines for Americans recommends alcohol be consumed in moderation—no more than one drink per day for women, and two drinks per day for men. This is not recommended as an average over several days, but rather the maximum amount consumed on any single day.
The guidelines suggest you should avoid alcohol if you are:
- Below the age of 21 (in the US)
- Taking certain medications
The guidelines also advise avoiding alcohol if you have a history of alcohol addiction
If you are unsure of how alcohol affects your IBS, try eliminating alcohol completely and see if symptoms subside. Once symptoms are stable, see if reintroducing alcohol triggers your gut symptoms. You can try this method with different alcoholic beverages such as beer, wine, and spirits and note whether some are more tolerable than others. Just remember to drink in moderation—no more than one or two standard drinks per day.
Which alcohol is safest for IBS?
Different alcoholic beverages may be more likely to cause flare-ups than others. Some people notice relief when they cut back on alcohol, or avoid certain types of alcohol, such as beer. It's worth noting that the FODMAP (carbohydrates that often trigger symptoms of IBS) and gluten content of your drinks can be linked to digestive troubles. For instance:
- Beer and ale: These types of drinks are low in FODMAPs, despite being made from barley, wheat and rye which are all high in FODMAPs. This is because the manufacturing process converts the fructans into alcohol. That said, the final beer product generally contains a small amount of gluten. If you have celiac disease this may be enough to trigger a reaction.
- Cider: This beverage is generally made from fruits such as apples, pears, or berries. The FODMAP content of cider has not been tested. During manufacturing, fructose, sucrose, and glucose sugars are converted into alcohol. However, it is possible that some sugar alcohols that are FODMAPs (such as glycerol) remain after fermentation, or that sugars such as fructose may also be added as sweeteners. Therefore, ciders may not be low in FODMAPs. Ciders may also vary in gluten content, so check the label if you are unsure.
- Wine: Most wines including red, white, dry, sparkling, and sweet wines are low in FODMAPs if consumed in one glass (150ml) serves. The fructose content is acceptably low at this serving size. Fortified wines such as sherry and port contain excess fructose and are not low FODMAP.
- Spirits: Most spirits, including gin, vodka, and scotch are low in FODMAPs at a serving size of one glass (30ml). The only exception is rum, which is high in FODMAPs and should be avoided. Spirits are generally gluten free.
Mixers can also trigger IBS
Even if you consume a low FODMAP alcohol, mixers in alcoholic drinks can often cause digestive problems too. Beverages commonly used in mixed drinks, such as fruit juices and soda tend to be high in fructose, high fructose corn syrup, and sugar alcohols, all of which are high FODMAP that can cause digestive troubles.
However, there are lower FODMAP mixers available to reduce the chance of symptoms, including:
- Cranberry juice (without added high fructose corn syrup)
- Club soda (watch out if you're sensitive to carbonated drinks!)
- Small amounts of lemon, lime, or orange juice
- Unsweetened iced tea
- Vegetable juice
Tips for alcohol consumption if you have IBS
If you continue to drink alcohol, consider how the amount and type of alcohol affects your IBS symptoms. As there aren’t a lot of scientific studies available that focus on the interaction between alcohol and IBS, the decision is a fairly personal one—find out what works for you! If you decide to continue drinking, keep these tips in mind:
- Limit consumption: Stick to a maximum of two drinks per day for men, and one drink per day for women, according to US guidelines.
- Choose your alcohol wisely: Ensure the alcohol and mixers are lower in FODMAPs and gluten (if you have a gluten sensitivity).
- Slow down your consumption: If you choose to drink, try and slow down your intake of alcohol. This will provide an opportunity for your digestive system to process the alcohol, and reduce IBS symptoms.
- Drink water between alcoholic beverages: Drinking water can help to dilute the alcohol and reduce the impact on IBS symptoms.
- Eat food when you drink: Food can help to protect the lining of your gut from irritation.
- Choose your mixers wisely: Most fruit drinks, except for Cranberry juice, are high in FODMAPs
- Watch your symptoms: if symptoms worsen, consider eliminating alcohol from your diet.
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Other methods of managing IBS
If you experience symptoms of IBS even after abstaining from alcohol, there are several effective therapies and relaxation techniques available that have shown to reduce symptoms. You might want to consider trying:
- Gut-directed hypnotherapy: This IBS management tool is a form of hypnosis that has been proven to be one of the most effective treatments for relieving symptoms of IBS.
- A low FODMAP diet: This diet was developed by Monash University to relieve symptoms of IBS. It consists of an elimination phase, in which all high FODMAP foods are excluded, followed by a reintroduction phase in which foods are slowly reintroduced. This diet is as effective as hypnotherapy for IBS, but some people find it to be restrictive and difficult to follow.
- Meditation: Mindfulness meditation has been shown to reduce stress and lower symptoms of IBS. It is thought to work by improving the gut-brain connection.
- Yoga: This ancient practice involves physical exercises and breathing techniques that have been shown to reduce stress and IBS symptoms.
- Probiotic supplements: probiotics are ‘good’ bacteria that increase gut function, and may reduce IBS symptoms.
The wrap up
Love an occasional drink but hate IBS flare-ups? With a little bit of extra care you may be able to enjoy a glass or two without your gut paying the price. Although there are limited studies available evaluating the effects of alcohol and IBS, there is evidence to show that alcohol can negatively affect digestion. So, if you want to drink, make sure you do so in moderation, monitor your symptoms, and choose gut-friendly beverages, such as low FODMAP wines or spirits. If you’ve cut out alcohol and find that your symptoms persist, you may want to look into other ways to manage your IBS, such as starting a low FODMAP diet or trying gut-directed hypnotherapy.