Can You Drink Alcohol With Crohn's Disease?

People with Crohn's disease, a type of inflammatory bowel disease (IBD), learn to avoid food and drinks that trigger their symptoms. For some people with Crohn's, one of those triggers is alcohol. Alcohol can trigger digestive symptoms like pain, bloating, and diarrhea. But others with Crohn's may find that alcohol is not a problem. What people with Crohn's disease can or cannot tolerate varies based on the person.¹

Defining alcohol intake

Different types of adult beverages have different alcohol content. A standard drink is generally defined as follows:²

• Beer – 12 ounces
• Hard seltzer – 8 to 10 ounces
• Wine – 5 ounces
• Distilled spirits – 1.5 ounces

Moderate alcohol intake is considered:³

• Women – 1 drink daily
• Men – 2 drinks daily

Heavy alcohol intake is considered:³

• Women – more than 3 drinks on any day or more than 7 drinks per week
• Men – more than 4 drinks on any day or more than 14 drinks per week

A study that looked at people with Crohn's disease who were enrolled in Medicaid found that they used drugs and alcohol at higher rates than the general population. The researchers also found that people who increase their alcohol use after being diagnosed with Crohn's are more likely to be hospitalized.⁴

Does alcohol make Crohn's symptoms worse?

Some studies point to alcohol's role in causing intestinal inflammation. Others show no clear link between alcohol intake and the risk of developing Crohn's. Red wine has even shown possible benefits.¹

Moderate alcohol use does not seem to increase the risk of IBD. But long-term heavy alcohol use is linked to an increased risk of IBD relapse and worse outcomes.^1,5

How does alcohol affect the intestines?

Alcohol impacts the digestive system in 3 main ways:^1,5,6

• Changes in the gut bacteria (microbiome) – Long-term alcohol use causes an imbalance of gut bacteria. The number of good bacteria decreases, and the number of harmful bacteria increases. Long-term heavy drinking also results in an overgrowth of the total number of bacteria in the intestines. These changes increase the risk of inflammation.
• Damage to the intestinal lining and increased gut leakage – Injury to the cells lining the digestive system causes the normal intestinal barrier to weaken. When this happens, bacteria or other harmful substances can leak through the intestinal lining and cause illness.
• Activation of the immune system – Alcohol can damage the cells that line the intestines. This triggers the immune system to release substances that worsen inflammation.

More research is needed to fully understand alcohol's role in Crohn's. Other factors that play a role in how alcohol affects people with Crohn's may include:^1,4,5

• Genetics
• Age
• Diet
• Smoking
• Sleep patterns
• Weight
• General health

Does the type of alcohol make a difference?

Different types of alcohol impact the intestines in different ways. Red wine seems to increase gut bacteria linked to reduced inflammation. Other adult beverages (like spirits) have been linked to increases in bacteria that promote inflammation.¹

Sulfites are a common preservative added to adult beverages like wine and beer. Sulfites can increase symptoms in people with IBD. High sugar levels in some drinks may also contribute to digestive symptoms.¹

It is not clear whether red wine, beer, or spirits are better or worse for people with Crohn's. Much like tolerance for different foods, tolerance for different types of alcohol varies from person to person.¹

Alcohol and medicine interactions

Alcohol can interact with medicines used to treat IBD. Common interactions include:¹

• Antibiotics – Alcohol can cause a reaction with flushing, headache, nausea, vomiting, and stomach cramps. Reactions are most likely with metronidazole and cephalosporins.
• Cyclosporine – Alcohol can decrease the effectiveness of cyclosporine.
• Methotrexate and azathioprine – Alcohol increases the risk of liver damage from these drugs.
• Biologics – Alcohol may increase the risk of liver damage from these drugs.

Choosing for yourself

If you choose to stop drinking alcohol because of your Crohn's, plan ahead. Saying no to alcohol can be a challenge in social situations. Think about how you will respond if someone offers you a drink. Or you may choose to avoid situations where you feel pressure to drink. Try planning an activity with friends that does not involve alcohol.²

If you choose to drink alcohol, research suggests it is best to avoid heavy drinking. There is not enough information to recommend specific types of alcohol for people with Crohn's disease.¹