Can you drink alcohol on the low FODMAP diet?

Introduction

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

Most spirits, wine and beer are considered low FODMAP depending on their composition, quality and what you mix them with.

In this article I am going to explain what alcoholic drinks (including mixers) you can have on the low FODMAP diet.

I will also cover how alcohol impacts your IBS and give you some easy steps to help reduce your intake.

What is Alcohol?

Like fat, protein and carbohydrates, alcohol is a macronutrient. When you think about alcohol though, you are are more likely to be thinking of a drink which contains alcohol.

Alcoholic drinks contain a type of alcohol called ethanol. Alcoholic drink production has been going on for centuries and is made through the fermentation of grains, fruits or vegetables.

If you use alcohol in cooking, this will not impact your body in the same way as the active ingredient, ethanol, is burnt off in the process.

How Is Alcohol Digested?

Alcohol is distributed throughout your body in water and so all areas of your body are exposed. However, your liver gets the biggest hit as blood comes here directly from the stomach and small bowel.

Your blood alcohol concentration will be impacted by many factors such as your sex, weight, medications, stage of menstrual cycle and what you have eaten.

More than 90% of the alcohol you drink will be metabolised by your live and around around 2-5% is excreted whole in your urine, sweat or breath (1).

If you are a regular or heavy drinker, you may find that alcohol doesn’t impact you or you feel you build a ‘tolerance.’ This is a dangerous assumption. Your body had simply adapted some of its chemical pathways to cope. Long-term this can be disastrous for your health (1).

How Do Alcoholic Drinks Impact IBS?

When it comes to IBS, there are 2 potential triggers in alcoholic drinks that we must consider. Firstly, the pharmaceutical affect of ethanol (alcohol) and then any potential FODMAPs.

The Impact of FODMAPs in Alcoholic Drinks

FODMAPs may be naturally occurring in some alcoholic drinks or mixers, they may also be added in some cases.

You can find out more about how FODMAPs impact IBS symptoms in my other post here.

The Impact of Alcohol on IBS

The below is a list of how drinking alcohol may impact your gut. This list is based on studies that do not specifically look at IBS (1, 2).

1. Delays stomach contents emptying (gastric emptying)
2. Reduces absorption of nutrients.
3. Alters motility in different parts of the bowel.
4. Inteferes with digestive enzymes such as lactase.
5. Alters microbiota levels.
6. Acts as a diuretic which could lead to dehydration and constipation.

Here is another blog on IBS symptoms.

We currently have limited research on how alcohol specifically impacts your gut when you have IBS. My ‘educated’ guess would be that the above impacts are worse as your bowel is already sensitive.

We do have 2 studies that looked at IBS. One, showed that IBS symptoms worsened with alcohol consumption in women with IBS. It also showed that this impact was worst after a ‘binge,’ which was classed as 5 drinks in 1 sitting (4).

Another study of IBS sufferers pin-pointed alcohol as the second most common trigger for their loose stools (first being cream) (6).

How Does Alcohol Impact The Body?

As a drug, alcohol impacts your whole body. Here is an interesting overview from Drink Aware.

The Impact of Alcohol and Mental Health

We know that anxiety and depression are linked with IBS.

Using alcohol to manage your anxiety can lead to alcohol dependance and is not recommended.

We also know that alcohol can interfere with many nerve-chemical systems within our bodies which regulate mood. Depression has been linked to heavy drinking (5).

The Impact of Alcohol and Sleep

Isn’t it nice to come home and have a glass of wine? Do you feel relaxed? Perhaps you find alcohol helps you drift off to sleep?

Well, there is a reason for this and it is not good! Alcohol is a drug and the impact of that drug is partly as a mild sedative.

Whilst alcohol may help you drift off to sleep, it actually disrupts your sleep cycle. This is why you may wake up feeling groggy. Poor sleep will worsen your IBS.

How Much Alcohol is Safe to Consume for IBS?

Sadly, I can not provide you with any specific IBS guidance on this as there is none. Instead, I advise that you minimise your intake to no more than 14 units a week. This is in line with general guidance from the UK.

What does 1 unit of alcohol look like (approx)?

• 1 shot of spirit
• 1 small glass of wine

You can assess your alcohol unit intake using the Drink Aware calculator.

What Alcohol is Low FODMAP?

Low FODMAP Spirits

Spirits give you the most options when it comes to alcoholic drinks on the low FODMAP diet. Most spirits are low FODMAP with the exception of rum (7).

Low FODMAP Beer

You may automatically think that beer is now allowed on the low FODMAP diet. But, this is not the case at all.

1 can (375mls) is considered low FODMAP by Monash (7). Although there is no information on what would be the upper limit of this.

Low FODMAP Wine

You may find that wine is a huge culprit for your IBS. Even in the 10 years I have been a dietitian, I have seen a large cultural shift with alcohol and wine is a big issue.

It now seems socially acceptable, rather middle class, to sit and drink a couple of large glasses of wine each night. But this is 6 units a night and 42 units a week!

When it comes to FODMAPs, wine is allowed but it depends on the type and quantity. Sweet wine such as port or dessert wine is high in fructose. But regular red, white or sparkling wine is allowed within certain portions.

For the exact portions please check out the Monash FODMAP app.

Low FODMAP Alcohol Mixers

We have covered how alcohol impacts IBS and the potential high FODMAP content of alcoholic drinks. Now it is time for you to understand about mixers.

Most mixers that are high FODMAP contain fructose, a high FODMAP polyol sweetener or a high FODMAP fruit.

As a side note, there are more triggers than just FODMAPs and alcohol. Carbonated drinks and caffeine can also worsen IBS, so please be mindful of the amount you consume.

Low FODMAP Alcohol Mixers List

• Schweppes diet tonic water.
• Schweppes diet ginger ale.
• Coca-Cola Coke.
• Diet Coca-Cola.
• Lemon juice.
• Fever Tree Indian tonic water.
• Earl grey tea.
• Expresso.
• Cranberry juice (check for added fructose).

High FODMAP Alcohol Mixers List

• Orange juice (all)
• Juice made from high FODMAP fruits: apples, mango, watermelon 
• Some ‘sugar free’ 
• Schweppes ginger ale.
• Schweppes tonic water.
• Fever Tree Light Indian tonic water.

Video Tutorial on Making Low FODMAP Alcohol and Non-Alcohol Cocktails.

Credit to FODMAP EveryDay.

Tips To Avoid Alcohol Induced IBS Symptoms

1. Reduce your intake as much as possible.
2. Appreciate that the UK alcohol guidelines are general may be too high for someone with IBS.
3. Have alcohol free days.
4. Drink on a full stomach – this avoids a rapid increase in absorption of alcohol.
5. Opt for flat drinks rather than carbonated – this will reduce the rate at which alcohol is absorbed and may help prevent bloating (1).
6. Tackle mental health appropriately, by seeking help from your doctor or a trained psychologist.

Take Home Message

Alcoholic drinks contain 2 potential triggers for IBS: alcohol itself and some drinks contain FODMAPs. Even if you consume a low FODMAP alcoholic drink, it may trigger symptoms.

How much you can tolerate will depend on many variables but you should not exceed 14 units of alcohol per week