How Alcohol Affects Crohn's and Meds That Treat It

When you have a disease that inflames your digestive tract, you have to think carefully about your diet. What you eat -- and drink -- can affect your symptoms.

If you've ever wondered whether it's safe to drink alcohol with Crohn's disease, the short answer is yes, but with caution.

"I think it's safe for Crohn's patients to drink alcohol, but you need to do it in moderation and you need to make good, common-sense decisions," says Garth Swanson, MD, an associate professor of medicine and director of the Crohn's and Colitis Center at Rush University Medical Center.

How Alcohol Affects Crohn's Disease

In small amounts, alcohol suppresses the immune system, Swanson says. That's a good thing in people with Crohn's disease. An overactive immune system is what attacks and inflames your digestive tract and sets off symptoms such as diarrhea and belly cramps.

Swanson studied the effects of alcohol on a small group of people with Crohn's disease. He found that people who drank one to three glasses of red wine each day for a week had lower levels of a protein called calprotectin, which is a sign that they had less inflammation in their intestines.

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But in large amounts and with frequent use, alcohol can irritate the lining of your GI tract and make your gut more leaky. Normally, the intestines are lined with a tight barrier that keeps out partially digested food, toxins, and germs. A breakdown of this barrier can let these substances get into your intestines and trigger more inflammation.

"That is one of the hallmarks of predicting disease flare long-term for Crohn's patients," Swanson says. "If they have a leaky gut, their risk of a flare-up is high."

It's also possible that you'll feel the effects of alcohol faster. People with Crohn's disease are more likely to be malnourished or underweight because the disease affects the way their bodies absorb nutrients from food.

Alcohol Type Matters

How you feel after drinking depends on the type of alcohol you have and what you mix it with. Sugary mixed drinks like daiquiris and coladas act like laxatives in your body. They cause your intestines to pull in extra water, which leads to diarrhea.

Beer can also set off diarrhea because people tend to drink a higher volume of beer than they do wine or straight alcohol, Swanson says. If you find that certain types of drinks upset your stomach, limit them to special times, like holiday or birthday parties, when you know you won't have anywhere to go the next day.

Should You Drink During a Flare?

"If you're in an active flare, I would not recommend drinking alcohol," Swanson says. It's best to wait for that glass of wine or beer until your symptoms are under good control.

Drinking can also make it harder to tell whether the medicine you take to treat Crohn's disease is working. It might not be obvious whether diarrhea is a result of your disease or alcohol use. That can make it harder to manage your condition.

Alcohol and Crohn's Medications

A drink or two shouldn't be a problem if you're on a biologic drug like adalimumab (Humira) or infliximab (Remicade). "There's no real interaction with alcohol, so those all should be safe," Swanson says.

You do need to be cautious when you take immunomodulators like azathioprine (Azasan) and methotrexate, though. These drugs can scar and damage your liver. Alcohol increases the risk of liver damage. Your doctor should monitor you for liver problems if you take any of these drugs, Swanson says.

Other medicines you take might also cause problems with alcohol. Don’t drink if you’re taking Flagyl, an antibiotic. It isn’t a treatment for Crohn's disease, but doctors often prescribe it for complications of Crohn's such as abscesses, says Reezwana Chowdhury, MD, an assistant professor of medicine, gastroenterology, and hepatology and an IBD specialist at Johns Hopkins Medicine.

Bottom Line

If you enjoy alcohol, you can allow yourself a drink or two from time to time. In general, it's safe for people with Crohn's disease to drink alcohol in reasonable amounts.

"Particularly when it's the holidays or a special occasion, that can be an important quality-of-life factor. I think that's fine for Crohn's patients to do, as long as it's in moderation," Swanson says.

Check with your doctor first, and limit yourself to one or two drinks per day to be on the safe side. Also be mindful of what you drink, knowing that sweet drinks could leave you with an upset stomach the next day.

WebMD Feature Reviewed by Neha Pathak, MD on December 17, 2020

Sources

SOURCES:

Mayo Clinic: "Crohn's disease."

Crohn's & Colitis Foundation: "Malnutrition & IBD," "Substance Abuse," "What Should I Eat?"

Garth Swanson, MD, associate professor of medicine; director, Crohn's and Colitis Center, Rush University Medical Center.

Digestion: "Is Moderate Red Wine Consumption Safe in Inactive Inflammatory Bowel Disease?"

Lab Tests Online: "Calprotectin."

Harvard Medical School: "Leaky gut: What is it, and what does it mean for you?"

Annals of Gastroenterology: "Alcohol and narcotics use in inflammatory bowel disease."

American College of Rheumatology: “Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo).”

National Health Service, U.K.: “Azathioprine.”

Reezwana Chowdhury, MD, assistant professor of medicine, gastroenterology, and hepatology; IBD specialist, Johns Hopkins Medicine.

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