Can I drink alcohol with IBS?
Are you feeling confused about drinking alcohol on the low FODMAP diet? If you’re reading this and you have IBS, you may already know that alcohol can be a bit of a gut irritant. In this blog I cover why alcohol may be a problem, what your low FODMAP options are and some tips for a happier gut
What do the guidelines say?
At present, there are no randomised controlled trials (the ‘gold standard’ of studies) that have been completed specifically on alcohol consumption in IBS. However, observational studies tell us that about ⅓ of people with IBS feel alcohol is a trigger for their symptoms.
In Australia, the official guidelines for people with IBS remain the same as the general public:
No more than 10 standard drinks per week and
No more than 4 standard drinks per day
Avoid alcohol if you are pregnant
As a dietitian working in the IBS space, I often recommend my clients choose low FODMAP alcohols if they do choose to drink and then we personalise strategies to help them drink in moderation. I will share some of these strategies with you below
What alcohol can I have on the low FODMAP diet?
The good news is, there are plenty of low FODMAP alcohol options that you are able to enjoy on the diet. The bad news is, low FODMAP alcohol may still trigger symptoms, I'll explain why.
Top low FODMAP drink choices
Beer (375ml)
Red, white and sparkling wine (150ml)
Gin (30ml)
Vodka (30ml)
Whiskey (30ml)
High FODMAP drinks to avoid
Dessert wines
Spirits with high FODMAP mixers (e.g. containing high fructose corn syrup)
Rum
Low FODMAP mixed drink ideas
Gin + lime juice + water
Vodka + cranberry juice
Whiskey + lemon juice + sugar
Why does low FODMAP alcohol still trigger my symptoms?
As discussed above, alcohol is a ‘gut irritant’ regardless of the FODMAP content. Essentially what this means is that alcohol can irritate the gut and trigger symptoms such as bloating, pain and diarrhoea, even if it is low FODMAP. This is because alcohol can act as a stimulant (speeds things up), impact digestion, and disturb the absorption of some nutrients in the gut. It also can impact some digestive enzymes such as lactase.
In addition to this, it is common for people to eat high-fat or high FODMAP foods at the same time as drinking alcohol. Or turn to alcohol in periods of high-stress. These reasons in themselves can be a problem and combined with alcohol, can trigger symptoms.
How does alcohol impact gut health?
This is a great question and the short answer is that there is little currently known about the effects of alcohol consumption on the gut microbiome. However, there are some preliminary studies completed in rodents that show a reduction in the diversity of gut bacteria with moderate alcohol ingestion. In contrast, alternate data indicated that regular drinkers (about half of which reported drinking red wine) exhibited greater bacteria diversity than non-drinkers. The polyphenol content of red wine may lead to beneficial changes to the gut microbiome, but only in moderation.
Excess alcohol consumption is also associated with dysbiosis (characterized by increased levels of potential pathogens), and liver disease (which can be brought on by excess alcohol consumption) is associated with an increased risk of intestinal permeability (“leaky gut”).
In summary, more research is needed to understand the role of alcohol and gut health. Moderate alcohol intake of red wine may have a positive impact on bacteria diversity and excess alcohol in any form is likely associated with dysbiosis.
Practical Tips
I am always one for practicality and looking at how to apply the research realistically to our behaviours. These are some tips I use with my clients:
Choose low FODMAP alcohol options and mixers to help reduce IBS-related symptoms
If you are at a social event, choose lower FODMAP food options alongside your alcohol
Monitor your stress and anxiety levels and speak to a psychologist if alcohol is used as a primary stress reliever
Have a glass of water between each alcoholic drink
Focus on nourishing your community of microbes the day after drinking and add some plants and fibre into your day
Written by,
Crystal Austin
IBS Dietitian & Nutritionist