22 January 2018
We know from research that the low FODMAP diet doesn’t work for everyone. This series of blog posts will provide you with information about other evidenced based dietary strategies to help you to manage your IBS. It is important to remember, that a low FODMAP diet has the best results when you work with a FODMAP specialised dietitian who will also be able to guide you with some of these adjunct therapies.
Many people feel that alcohol exacerbates their IBS symptoms, but is it necessary to restrict alcohol to manage symptoms? Studies have shown that in relation to IBS, alcohol consumption does not seem to be a contributing factor. At present, no randomised controlled trials (RCTs, the ‘gold standard’ of studies) have been completed on alcohol consumption and IBS symptoms but observational studies and anecdotal evidence tells us that about 1/3 of people with IBS feel alcohol is a trigger for their symptoms (1-3).
Alcohol has a direct effect on the gut and can be a gut irritant; it can affect intestinal motility, permeability and intestinal absorption.
Alcoholic drinks also contain FODMAPs, which may trigger symptoms in some people. We have currently tested 12 types of alcoholic beverages so check your app to find out more and if you are sensitive to certain FODMAPs choose the most appropriate option for you.
Not all of the common IBS guideline documents discuss alcohol. The UK’s NICE guidelines (4) suggest a decrease in alcohol consumption (as well as fizzy drinks often used as mixers) and the ROME foundation (5) suggests similar.
Our recommendation regarding alcohol consumption and controlling your IBS is to work with your dietitian to identify whether alcohol could be contributing to your current symptoms. Also, because alcohol is often consumed in social settings and with food, it can be helpful to consider what you are eating at the same time, and how your stress levels are.
Finally, when considering the role of alcohol in triggering IBS symptoms, it is important to drink within healthy limits. In Australia, guidelines for the general population recommend that men and women above the age of 18 (3):
Drink no more than 2 standard drinks on any day to reduce their lifetime risk of harm from alcohol related disease or injury
Drink no more than 4 standard drinks on a single occasion to reduce their risk of alcohol related injury arising from that occasion.
Simren, M., et al., Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion, 2001. 63(2): p. 108-15.
Bohn, L., et al., Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol, 2013. 108(5): p. 634-41.
Hayes, P., et al., A dietary survey of patients with irritable bowel syndrome. J Hum Nutr Diet, 2014. 27 Suppl 2: p. 36-47.
National Institute for Health and Care Excellence. Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. (Clinical guideline 61.) 2008. www.nice.org.uk/guidance/cg61/evidence.
Drossman, D.A., Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology, 2016.
Australian Government National Health and Medical Research Council. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. 2017. www.nhmrc.gov.au/health-topics/alcohol-guidelines