Alcohol and SIBO: The Dietitians’ Definitive Guide
Do you like to enjoy a drink or two with friends? Or maybe you like to have a glass of wine with dinner? If so, you may be wondering if there is any connection between alcohol and your SIBO symptoms.
Can SIBO flare up after drinking alcohol? Is it better to avoid alcohol altogether if you have SIBO?
In this blog post, we will answer all of your questions about the (many!) connections between SIBO and alcohol. We will discuss the effects that alcohol can have on SIBO symptoms, as well as answer all of your questions, helping you make an informed decision about whether or not to drink.
Link to image: https://unsplash.com/photos/C8eSYwQkwHw
What is SIBO?
First things first: what is SIBO, exactly?
SIBO stands for Small Intestinal Bacterial Overgrowth. This condition occurs when there is an overgrowth of bacteria in the small intestine, which can lead to a variety of symptoms including bloating, gas, abdominal pain, diarrhea, and more. We are supposed to have bacteria in our digestive tract, but their home is supposed to be primarily in the colon (1).
When the little bugs set up shop in the small intestine, you start to feel crummy. By the way, SIBO isn’t an infection, it is a case of the right bacteria and other organisms in the wrong place.
SIBO is often caused by a combination of factors, including diet, low stomach acid, changes in the anatomy of your digestive tract, and more. And spoiler alert: alcohol consumption increases your risk of SIBO, too (2). SIBO is a complicated condition to properly diagnose as well as treat (3).
When your digestive system is inflamed and irritated, you’re looking for answers and relief.
With a proper diagnosis (I don’t recommend self-diagnosing), the first step of a treatment protocol is to remove anything that might be making your symptoms worse. A break gives your digestive system an opportunity to rest and recover, kind of like an afternoon on the couch with Netflix gives your brain and body a much-needed break.
But for your digestive tract, this break – dun dun dun – will probably include alcohol.
P.S. Drinking alcohol before doing diagnostic testing for SIBO can throw a wrench in obtaining accurate results. There are very specific foods that can be eaten prior to taking a SIBO test. Each company has its own guidelines, the basics are lean meat, poultry, fish, plain steamed jasmine or basmati rice, eggs, meat broth, salt/pepper, weak black tea or coffee with no additives, and plain water. Some protocols allow you to eat small amounts of fats or oils for cooking. But alcohol? It is a major no-no before test prep and will result in invalid results.
Why remove alcohol?
For as much as we are an alcohol-loving society, asking anyone to abstain can feel like a real bummer.
Let’s talk about the “why” here so that you better understand that this break from alcohol may be necessary to see true healing from your SIBO.
What’s wrong with alcohol? Alcohol is an irritant (4). When your digestive tract is already irritated and inflamed, alcohol simply makes things worse - what a bummer, right?
When working with a digestive health dietitian, we’re using a specific treatment protocol to help you get better. This protocol is called the 5R Protocol. It is a systematic way to identify what you need to do to get better as quickly as possible - no more guessing!
Curious about the 5-R protocol? Check out this post: The Best Gut Healing Protocol to Resolve Your Symptoms.
The first step on this journey is “Remove”. This means removing anything that is not serving your healing. This includes:
● Infections (could mean a round of antibiotics)
● Foods that you’re sensitive to
● Supplements that are causing unwanted side effects
And yes, this will probably include alcohol, at least for a bit.
So, what’s the big deal with alcohol?
Alcohol can have a big impact on your digestive tract…and not in a good way.
Less stomach acid
Alcohol can affect your body’s ability to make stomach acid. Having low stomach acid is a risk factor for developing SIBO in the first place (5).
Your digestive tract has a cool web of muscles that – when healthy – keep things moving along. If this motility is curbed, your risk of SIBO goes up. And unfortunately, alcohol does just that: pumps the brakes on the regular movement of your digestive tract (6, 7).
Next issue? Alcohol can get in the way of your body making the enzymes that it uses to digest food normally. Enzymes are powerful little proteins that allow your body to take apart food so that the body can absorb and use the tiny pieces. When your meals are not digested as well, you have more symptoms as well as less absorption of the nutrients from your food.
In a person with a healthy digestive tract, their colon is home to a diverse and robust community of bacteria and other little critters. These healthy bacteria help to keep our intestine healthy, boost our immune system, and contribute to our overall wellness.
Unless: the mix is off.
When the microbiome is out of balance, the effect can be far and wide. In most cases, alcohol can make this community worse.
Inflammation is your body’s natural and normal response to irritation or injury. When you get a paper cut, your skin looks red and swollen as your immune system rushes to the scene to keep bad guys out and let the injured area heal.
Alcohol can cause inflammation - big time (8)!
It is probably worth mentioning (but also probably not a surprise) that alcohol is no friend to your liver.
Why? Alcohol reduces the absorption of nutrients in the small intestine and increases the transport of toxins through the intestinal walls, which might contribute to liver and other organ damage (9, 10).
And that’s not all…
And as a general note, alcohol has 7 calories per gram: almost as much as fat. And unlike fat, alcohol offers your body zero nutritional value. It can also wreak havoc on your blood sugars and even raise triglycerides (which is a risk factor for cardiovascular disease). So while it can feel fun and social to enjoy alcohol, it is not without risk.
To recap - alcohol can affect stomach acid production, slow down motility of the GI tract, reduce the number of enzymes the body produces (so food doesn’t digest well contributing to digestive symptoms), increase the risk of developing SIBO, can lead to or worsen leaky gut, can disrupt the normal balance of flora (which many times is already imbalanced), increases inflammation in the gut (which we are trying to heal), not to mention the effect it has on organs such as the liver and pancreas.
All alcohol? Really?
Is there any kind of alcohol that is safer than another?
This is a tricky question. In otherwise ordinary, healthy people – who are not the people coming to me for help – a moderate 1-3 drinks of red wine includes a potential benefit. The polyphenol content has been shown to help promote diversity in the microbiome (11). However, for the folks I’m helping – clients who have been fighting gut infections like SIBO, leaky gut, food sensitivities, and inflammation – I recommend skipping every drop of alcohol, even red wine.
What can be confusing is that some spirits are actually considered to be low FODMAP, so people want to take that as the go-ahead for drinking. However, while they may be low in certain carbohydrates that are irritating to folks with digestive issues, they still have alcohol, so they’re not going to help you to recover from SIBO.
Time for the tough talk: if a person has a serious digestive issue like SIBO, the answer to "is there a safer type of alcohol?" is a big fat NO. In fact, it's pretty much non-negotiable for me: if a client is serious about healing their gut, alcohol has to be out while we do the work.
When can you drink again?
You’re not going to like this answer, but I always aim to be as upfront with my clients as possible.
Here’s the lowdown: I recommend not consuming alcohol at all during your treatment program (remember that “remove” part of the 5R protocol we talked about earlier?).
Once you are in remission from your SIBO symptoms, I recommend starting your clock…and waiting for six months of symptom-free living before trying alcohol again.
How do you know it is ok to try alcohol again?
Once you’ve clocked in with six months of symptom-free living, you may want to try a tiny amount of alcohol to see how things go.
My recommendation? Plan to keep things very minimal. Maybe a glass of wine with dinner every now and then or have a cocktail at a special event, like a wedding.
Ultimately though, if you have had past struggles with SIBO, IBS, or IBD (which is managed and not cured), alcohol is one of those things that should really be eliminated long-term. This is kind of like someone with non-celiac gluten sensitivity or celiac disease: there is no such thing as 95% gluten-free, you either are gluten-free or you aren't.
(On a related note, my clients often ask about gluten hanging around and their symptoms, so I wrote this post: How Long Does Gluten Stay in Your System After You Stop Eating It?)
In my experience with many clients, most of the time, bringing alcohol back into the equation on any kind of regular basis is setting the person up for symptom relapse down the road. Healing the gut is a long enough journey that I can't imagine intentionally setting yourself up to have to do it all over again.
Link to image: https://unsplash.com/photos/YNMjGIPgD_c
What can I drink instead?
So, I know that you’re going to want something besides a boring glass of ice water. Let’s discuss a few fun alternatives to try while keeping alcohol in time out.
There are so many products available these days to make mocktails. A couple of delicious options include:
You can also use seltzer waters, teas, and juices to make your own custom blends. The TAZO tea company has mocktail recipes and a Berry Hibiscus Margarita base (which is fabulous! I mix it with lemon or lime La Croix).
A lot of the appeal of having a drink in the evening is about the ritual of unwinding and relaxing; a signal that the work day is done. As important as it is to remove alcohol for the sake of your digestive health, it is also important to replace that drink with something new that you actually enjoy…otherwise this booze-free period is going to be much more of a drag.
A new drink is a great place to start. You may also enjoy a nudge to journal, do a few stretches, have a peaceful walk, or read a few pages of a delicious novel. You’re worth having a fun new custom that better supports your digestive healing.
SIBO and alcohol are not a good mix.
Ultimately, continuing to drink is going to slow your progress in healing the gut…especially if you’re dealing with SIBO. These journeys can be long enough, so why add to them and undo some of the work that’s being done? Alcohol creates a two-step forward, one-step back scenario.
Your digestive health can quickly get complicated. One thing going awry can cause a domino effect and make it harder and harder to actually get better.
If you suspect that you’re dealing with SIBO, please feel welcome to get started by scheduling an initial visit so that we can chat. You deserve to have an expert to guide you through this process and actually make a recovery.