Since the dawn of civilization, the consumption of alcohol has been deeply ingrained in our culture, nestled in religious tradition, social bonding, and life milestones. So it stands to reason that giving up entirely seems a bit drastic, even for those with Crohn’s disease (CD).
While a small amount of alcohol consumption can be mostly harmless for those with Crohn’s disease, like all good things, it is best taken in moderation, and certain drinks should be avoided altogether – especially during a flare-up.
Here’s what you need to know about alcohol when it comes to Crohn’s disease according to the evidence.
Alcohol & Crohn’s Disease: Understanding the Relationship
In 2010, researchers evaluated the effects of alcohol consumption on GI symptoms in patients with IBS and IBD, 52 of whom had Crohn’s disease. Those with inactive IBD reported worse gastrointestinal symptoms after drinking alcohol than those with IBS.
This followed a survey of CD patients in which 40% reported worsened symptoms following alcohol consumption. A similar survey of CD patients in New Zealand found that 55% of patients with CD reported worse symptoms with beer consumption, as well as energy drinks.
There is evidently a connection between alcohol and exasperated IBD symptoms. This may be because alcohol can interfere with the metabolism of several medications, which could lead to adverse events or even loss of efficacy.
Alcohol also plays a role in inflammation due to the effects of ethanol (which is present in beer, wine, and spirits) on the epithelial barrier.
The Role of Alcohol in Inflammation
The epithelial barrier is the cellular layer that lines the digestive tube. This layer regulates nutrient absorption but is also meant to keep partially digested food, toxins, and pathogenic bacteria from entering the underlying mucosal immune system.
Alcohol disrupts the barriers of the epithelial cells and impairs intestinal absorption, leading to increased gut permeability. In IBD, this permeability allows luminal bacteria (that should remain within the tube of the intestines) into the submucosal immune system. These luminal products then activate proinflammatory immune mediators like tumor necrosis factor–α, interleukin (IL)-1, and IL-6.
This in turn leads to mucosal ulcerations, damage to the colonic epithelium, and the accumulation of inflammatory cells in the gastrointestinal tracts, resulting in a flare-up.
Can Alcohol Cause Crohn’s Disease?
Studies on the impact of alcohol on IBD development have offered rather contradictory results.
A 2016 retrospective study involving over 250,000 participants from Taiwan showed that those who had been hospitalized for alcohol intoxication had an increased risk of an IBD diagnosis over a 10-year period. But in 2017, a cohort study in Europe with 262,451 participants found “no evidence of associations between alcohol use and the odds of developing either UC or CD.”
A meta-analysis of 16 epidemiological studies also found no significant association between alcohol consumption and the development of Crohn’s disease. They did find an association between a high intake of soft drinks and an increased risk of CD. This is likely because soft drinks usually include artificial sweeteners which contribute to the development of IBD.
One should keep in mind that the extent of alcohol consumption that results in hospitalization would likely be quite extreme and cause more damage, whereas casual or moderate drinking may not have the same impact. Alcohol abuse requiring hospitalization would have a very different effect on the body than a glass of red wine with dinner now and then.
Alcohol and Crohn’s Disease Medications
Due to certain enzyme interactions, alcohol ingestion can delay the breakdown of medications.
IBD-specific therapies with potential interactions with alcohol include:
- Antibiotics
- 5-ASA
- Immunosuppressants
- Biologics
Please note that immunomodulators like azathioprine or methotrexate can cause liver damage. As alcohol consumption also puts a strain on the liver, you should monitor your liver health and limit alcohol if you are taking these medications.
Beer and sugary alcohol may also make it difficult to tell whether your medication is working, as they can cause diarrhea and exasperate symptoms.
Managing Alcohol Consumption with Crohn’s Disease
Although we do not have evidence that alcohol universally raises the risk of developing IBD, we do know it can cause a flare-up and should definitely be avoided during a flare-up.
Here’s your guide to drinking responsibly with IBD:
What Alcohol Causes the Least Inflammation
It’s common knowledge that a spot of dry red wine at dinner can have some health benefits. This is due to red wine being rich in antioxidants, which should make it somewhat anti-inflammatory. Moderate red wine consumption has also been associated with a reduction in fecal calprotectin and higher levels of anti-inflammatory bacterial groups such as Bifidobacterium.
Despite the reported benefits, red wine is still associated with increased gut permeability, which worsens intestinal inflammation so it’s best to keep consumption very minimal.
What Alcohol Can You Drink with Crohn’s Disease?
When picking one’s poison with IBD, red wine remains a lesser evil compared to more sugary drinks.
Cocktails and sugary drinks like daiquiris and coladas have a laxative effect as they cause the intestines to absorb extra water which can lead to diarrhea. Beer can also cause diarrhea as people tend to consume it in larger quantities than wine or hard liquor.
How Much Alcohol Can You Drink With Crohn’s
It seems that a drink now and then shouldn’t hurt, as long as you are not in an active flare-up.
The key is moderation, timing, choice of drink, and listening to your body. In fact, having a drink on a special occasion is an important part of maintaining quality of life for patients, as it holds a place in many religious and cultural traditions.
Just the same for those who don’t have inflammatory conditions, don’t go overboard. Here are the general rules:
- Limit yourself to one or two drinks every once in a while
- Prefer dry red wine over sweet drinks, vodka, gin, and beer
- Don’t drink during a flare-up
- Drink plenty of water!
Evinature
