Can you drink alcohol on the low FODMAP diet?

Yes, you can drink alcohol on the low FODMAP diet. 

In this article, you will learn how alcohol affects digestive health and IBS and whether people with IBS should eliminate alcohol to avoid IBS symptoms.

Moreover, you will also get some simple tips on minimising the possible symptoms after having a drink and which drinks are less likely to cause a flare-up. 

WHAT IS ALCOHOL?

Alcohol is a macronutrient like fat, protein and carbohydrates. But unlike other macronutrients, we do not need alcohol in our diet at all.

Alcohol acts in our body as poison, so the liver breaks it down as a priority. During the breakdown of alcohol, the body produces substances harmful to health (1).

How does alcohol affect our digestive health?

The research on alcohol and IBS is explicitly limited, we will take a look at how alcohol affects healthy people in the long term.

Drinking alcohol harms our digestive tract because it triggers intestinal inflammation through multiple pathways, including:

• Negative changes in gut microbiota and its function (2, 3)
• Oxidative stress due to ethanol metabolism (4)
• Damage of the gut mucosa (lining) (5)
• Increased intestinal permeability (6, 7)

Another way how drinking alcohol can impact our health is by causing anxiety (short and long-term) and depression (8).

As we know, our brain and gut communicate via the gut-brain axis, and anxiety or depression could potentially worsen IBS symptoms. 

To learn more about mental health and IBS, read our article: Stress, anxiety, depression and IBS: managing mental health to help IBS.

There are also many other adverse effects of alcohol on our health, which you can read about here: Alcohol use and your health.

The Impact of Alcohol on IBS

Around 1 in 3 people with IBS find that alcohol worsens their IBS, which makes alcohol one of the triggers for IBS symptoms (9, 10). 

Sadly, there is only 1 study looking at IBS and alcohol specifically (11). 

In the study, scientists discovered binge drinking (> 4 alcoholic drinks in one day) is associated with gastrointestinal symptoms the following day but only in those with IBS and not those without. 

This finding suggests that people with IBS have a more sensitive digestive system, which can overreact to triggers like alcohol, causing symptoms that do not affect people without IBS.

Symptoms related to drinking alcohol in women with IBS were:

• Diarrhea
• Stomach pain
• Intestinal gas
• Nausea

Alcohol had the most significant effect on women with IBS-D.

How does alcohol impact the gut?

Below are the main ways in which alcohol impacts the gut in general but it is likely that in those with IBS, these symptoms are much worse due to the gut already being dysfunctional..

1. Changes in the speed of gastric emptying

Alcohol consumption changes the rate at which stomach contents are emptied (known as gastric emptying). Some research has shown that gastric emptying is delayed when the alcohol content is above 15% but sped up for drinks such as beer and wine (12). 

Rapid gastric emptying is linked to symptoms such as bloating and diarrhoea, which is a commonly reported IBS symptom after drinking alcohol (9).

2. Reduced nutrient absorption 

Alcohol can reduce the absorption of nutrients, such as B vitamins and zinc (13). Over time, alcohol can also damage the lining of your gut, which may further reduce nutrient absorption (5).

3. Effect on gut microbiota 

Alcohol can alter the microbiota in your gut, as there have been correlations seen between alcohol consumption and gut bacteria (14, 15).

4. Causes dehydration 

Alcohol acts as a diuretic, meaning it can draw water from your body and increase urination by decreasing how much vasopressin your body makes (16).

Vasopressin normally helps your body hold onto more water, so when its levels are decreased you need to urinate more frequently, losing water and leading to dehydration.

The colour of your urine is a good indicator of how hydrated you are, and you should be aiming for a pale yellow colour.

Should I stop drinking alcohol if I have IBS?

The British Society of Gastroenterology guidelines suggest that people with IBS should limit alcohol intake (17).

This is due to the many links we have already discussed that show alcohol consumption is likely to make your symptoms worse.

However, whether you need to completely ‘t-total’ is not entirely clear and likely will vary from person to person. 

Consulting with a registered dietitian can provide personalized advice that can help you control your symptoms.

If you decide to have a drink occasionally, these tips may help reduce the impact of alcohol on your IBS:

1. Drink on a full stomach for slower absorption and experience less irritation of the stomach.
2. Avoid binge drinking. Have one drink if you are a woman and up to two if you are a man.
3. Have alcohol-free days.
4. Choose a drink with a lower alcohol content.

What drinks should you avoid with IBS?

Alcohol (ethanol) is only one of the triggers in alcoholic beverages.

Yet, you should also keep in mind that fizzy drinks (such as beer or mixers) and FODMAPs can also exacerbate IBS symptoms.

It is not possible to give a general recommendation on drinks to avoid as each person with IBS has different tolerance levels to specific triggers (FODMAPs, alcohol, carbonated drinks).

Is wine low FODMAP?

Most wines are low FODMAP for 150ml serving sizes, including red, white, rose, and sparkling (18). However, there can be high fructose levels in fortified wines like Sherry and Port, so you should avoid these if you are on a low FODMAP diet. 

Is beer low FODMAP? 

One can of beer (375ml) counts as a low FODMAP option (18). 

Beer is made from ingredients that contain FODMAPs. However, the beer-making process breaks down the fructans, leaving a low FODMAP alcohol option.

But please note that for some people, the bubbles in beer can affect symptoms such as bloating and gas (non-FODMAP related).

Other low FODMAP alcoholic drinks

You may be surprised that you can still drink some wine and beer while on the low FODMAP diet, but the options do not end there. If spirits are your tipple of choice, the following options are low FODMAP (18):

• Gin 
• Vodka
• Tequila 
• Whisky
• Brandy

Low FODMAP mixers 

It’s not just the alcohol part that you need to consider! Many popular mixers are also high in FODMAPs.

Mixed drinks often include fruit juices or fizzy drinks, both of which can trigger IBS symptoms due to their FODMAP content.

This applies to both regular and sugar-free fizzy drinks. While sugar-free drinks are low in carbohydrates overall, they can still be high in FODMAPs if they contain certain high FODMAP sweeteners, such as sorbitol and mannitol.

One of the most popular mixers is Coca-Cola. According to Monash University, the leading authority on FODMAP testing, both the regular and zero versions are considered low FODMAP in servings of around 150 ml.

However, it’s important to note that commercial soft drinks like Coca-Cola may have different formulations depending on the country.

Ingredients such as high-fructose corn syrup or certain sweeteners may vary, potentially altering the FODMAP content. For this reason, it’s always a good idea to check the ingredient label to identify any high FODMAP ingredients.

Some low FODMAP options are (18):

• Cranberry juice (check for added fructose)
• Club soda
• Schweppes diet ginger ale
• Fever-Tree Indian Tonic Water
• Tomato juice
• Lime juice

However, beware of non-FODMAP-related IBS triggers such as carbonated drinks. The bubbles in fizzy drinks can cause bloating and gas in those who are sensitive (19).

Long-term effects of alcohol on the digestive system

We have provided you with some useful information and tips on how to enjoy alcohol with IBS in the long term. However, it is important to highlight that alcohol can damage the parts of your digestive system, including the mouth, oesophagus, and stomach. 

Alcohol can also put you at greater risk of developing certain types of digestive cancers, such as mouth and throat cancers.

It may also cause damage to the lining of the digestive system and damage the muscles that prevent food from coming back up – this means you can get acid reflux (20).

IBS and alcohol – what is the overall advice?

The British Society of Gastroenterology advises that people with IBS should reduce their alcohol intake (17).

Whilst The British Dietetic Association suggests that people with IBS should try to have less than two units of alcohol per day, and have at least two alcohol-free days per week (21).

But the reality is that there is no known ‘safe’ level of alcohol for people who have IBS. And given that even one alcoholic drink can impact your body, the likely ‘safe’ amount is none.

For some, going t-total is a realistic goal. But for others, finding ways to simply reduce down will improve their symptoms and be a more realistic long-term solution.

Some top tips to reduce alcohol-induced IBS symptoms are: 

• Avoid drinking alcohol at home as you could make it a habit (e. g. a glass of wine with dinner) or it could lead to overconsumption.
• Have alcohol-free days.
• Try non-alcoholic alternatives.
• Eat food with your alcoholic drinks – this reduces the rate of alcohol absorption and therefore potentially the impact.
• Opt for flat drinks rather than carbonated ones – this will reduce the rate at which alcohol is absorbed and may help prevent bloating.
• Try ‘low alcohol’ content drinks like wine spritzer or cider.
• Drink water in between alcoholic drinks to stay hydrated.
• Drink slowly.
• Avoid drinking late in the night as it can disrupt your sleep.
• Avoid drinking if you are dealing with stress and during a flare-up.

And of course, if FODMAPs are a problem for you, then pick the low FODMAP options listed above.

Summary

Alcohol is one of the IBS triggers, and therefore, you should limit the intake – max. one drink if you are a woman and two drinks if you are a man, per occasion.

Long-term alcohol consumption has many adverse effects on gastrointestinal and overall health.

If you are on a low FODMAP diet, you can still enjoy a drink if you want to. Low FODMAP alcohol options include most wines, beers and many spirits. But don’t forget about mixers – you will need to choose low FODMAP options there too!

Besides FODMAPs, gas in the drinks can also trigger IBS symptoms, so you might want to choose the noncarbonated option.

Working with a registered dietitian can help you discover if your symptoms are related to drinking alcohol and what is the safe limit for you.

Written by Barbara Lešnik, RD, MSc, reviewed by Kirsten Jackson, Consultant Dietitian BSc Hons, RD, PG Cert