It is a truth universally acknowledged that a grown adult surviving modern times must be in want of a drink – at least once in a while. But for those with ulcerative colitis, the question of alcohol consumption, even in moderation, is complicated by the fact that drinking is heavily associated with a higher risk of disease relapse.
Still, many IBD patients understandably want to know if there are less harmful alcoholic beverages for those special occasions, religious holidays, and life milestones. Here’s where the research currently stands, and how you can navigate a healthy relationship with alcohol as a UC patient.
The Role of Alcohol in Inflammation & IBD Symptoms
Not only does most alcohol increase intestinal inflammation, worsening IBD symptoms, but it can interfere with the way the body metabolizes many medications. In one study, alcohol consumption also negatively impacted the outcomes of hospitalized IBD patients, causing increased intestinal infections and the requirement for antibiotics.
This is thought to be mainly due to the ethanol, sulfur, and sugar levels in alcohol, which trigger different inflammatory pathways in the gut.
Ethanol & Spirits
Ethanol is one of the main components of most alcoholic beverages, and a main offender when it comes to intestinal inflammation. Distilled spirits such as whiskey, gin, and vodka contain roughly 40-50% ethanol, with lower levels in wine, ranging from 5% to 23%, and only 4% in beer.
Ethanol causes intestinal inflammation by disrupting the epithelial barrier right down to the cellular level. This increased gut permeability (a main element of IBD pathogenesis), exposes the submucosal immune system to bacteria and endotoxins that trigger pro-inflammatory cytokines associated with IBD flare-ups.
Sulfur & Sulfate
You may have heard that a glass of red wine can be anti-inflammatory. While it’s true that wine contains antioxidants and may increase anti-inflammatory bacterial groups, other components of the beverage are not so kind to the intestines.
In one short-term study, researchers tested a small group of 14 Crohn’s and colitis patients in remission before and after one week of deliberate daily red wine consumption (one to three glasses daily). Interestingly, stool calprotectin levels were reduced significantly, while conversely, intestinal barrier function was negatively impacted and disrupted. This suggests a possible mixed effect of red wine which may reduce inflammation short-term but can increase relapse risk in the long term.
These effects may be related to sulfur and sulfate, which are found in high levels in wine, especially white cask wine. These additives are associated with the disruption of the mucosal barrier and increased disease activity in UC patients.
If you are going to indulge, it’s best to choose red bottled wine, which contains lower levels of sulfites than cask wine and white wine.
Sugar & Hydrogen Sulfide
In addition to sulfites, sugar is a major stressor for those with IBD. A cohort study from 2007 showed a direct link between abdominal pain and blood sugar after consuming high-sugar alcoholic beverages. Interestingly, the sugar had a much stronger impact on abdominal symptoms than the level of alcohol in the drinks.
If you have UC, it’s best to limit any drink with high sugar levels such as gin, dark beers, dessert wines, sherries, liqueurs, and pre-mixed drinks. Cocktails are likely not your friend. Pina colatas and daiquiris are best avoided altogether.
Another additive to watch out for is hydrogen sulfide, found in wine, beer, and other yeast-fermented drinks. Hydrogen sulfide also contributes to increased gut permeability and loss of barrier function, exasperating IBD symptoms.
Alcohol & Ulcerative Colitis Medications
Concerns over alcohol and medications are mostly due to alcohol’s impact on the liver. Heavy alcohol consumption can induce an enzyme called cytochrome P450, which is involved in the metabolism of drugs and chemicals. The alcohol and the medication then must compete for breakdown by cytochrome P450.
This causes delays in the breakdown and excretion of certain medications. One of the risks of this interaction is the accumulation of increased medication levels in the bloodstream that can become toxic, as well as exasperated side effects.
Unfortunately, many IBD-specific medications interact with alcohol, including antibiotics, 5-ASAs, immunosuppressants, and biologics. Studies also show that heavy alcohol consumption along with methotrexate medication can increase the risk of liver damage.
Put simply, heavy alcohol consumption can either decrease the efficacy of some medications, delay their breakdown, increase their concentrations, or pose the potential threat of liver injury.
Managing Alcohol Consumption with Ulcerative Colitis
When navigating alcohol consumption with UC, there are a few important factors to consider.
- The amount of alcohol consumed
- The sugar, ethanol, and sulfur content of the beverage
- Your level of disease activity
- Your current medications
For those suffering a flare, or who are easily triggered by certain foods, it’s best to avoid alcohol altogether.
For those in a more stable state of remission, a glass of dry red wine once in a blue moon shouldn’t hurt. Spirits may be fine in extreme moderation, as they do not contain sulfites.
All UC patients should be aware that alcohol does stimulate the bowels and dehydrates the body, so it’s always best to drink minimally, with caution, stay hydrated, and check with your doctor for any potential drug interactions beforehand to be on the safe side.
Tessa Eskin
