Is alcohol healthy or not? The answer could be both. Obviously, alcohol in excess for a long period can cause a range of problems including alcoholism, cirrhosis, and neurological problems. On the other hand, people who drink modest amounts of alcohol have a lower risk of developing heart disease. The issue of ulcerative colitis and alcohol is even trickier. One published study reported that alcohol consumption has a protective effect against the development of ulcerative colitis.1 However, in diagnosed cases of ulcerative colitis, results vary significantly. Indeed, many patients report that alcohol can provoke flares. The answer, just like the disease itself, is complicated. 

Studies That Suggest Alcohol Consumption Is Bad

Individuals who are suffering from chronic inflammatory bowel conditions are at higher risk of developing frequent and more severe flaring with substantial alcohol intake; however,  some individuals can tolerate moderate amounts of alcohol without any flaring. Healthcare providers suggest limiting the intake and, in case of flares associated with intake, sometimes maintaining total abstinence from alcohol.

Researchers surveyed 129 patients with gastrointestinal diseases (38 patients with ulcerative colitis) and found that roughly six out of 10 considered themselves “drinkers.”2 Approximately three-quarters of people with inflammatory bowel disease reported a significant worsening of gastrointestinal symptoms when they consumed alcohol. Interestingly, drinking more alcohol did not make the symptoms proportionally worse. The authors concluded that alcohol and alcoholic byproducts aggravate inflammatory responses in the gut and make ulcerative colitis worse.

The same researchers found that one week of alcohol consumption decreased protective molecules in the gut and increased bowel permeability (both of which are markers of worsening ulcerative colitis).3 A study in Japan found that smoking and alcohol were both independently associated with ulcerative colitis flares.4 Indeed, current recommendations are that people with ulcerative colitis should avoid alcohol (and smoking).5 

Studies That Suggest Alcohol Consumption Is Good

On the other hand, a very large study examining the outcomes of 304,000 patients suggested that alcohol may actually exert a protective effect on ulcerative colitis.1 Of that large number of patient records, the researchers found 209 cases of ulcerative colitis with enough supplemental information to determine if caffeine and or alcohol affected the development of the disease. Coffee intake (consumption, amount, or duration) did not relate to ulcerative colitis. Surprisingly, alcohol consumption before ulcerative colitis starts seems to keep people from developing the disease.1 The study design and the way that the authors came to these results has many limitations, but it does raise an interesting point of contention: Could alcohol be protective in ulcerative colitis?

What Happens When Someone with Ulcerative Colitis Drinks Alcohol?

Common effects reported in ulcerative colitis patients after alcohol consumption are:

  • The risk of flaring or relapse in the form of a severe and acute attack.
  • The liver is the primary and most important detoxification center of the body that purifies and filters blood, excretes toxins, and produces a variety of chemical mediators and hormones to help the body perform important functions. However, with significant consumption of alcohol, the liver may undergo substantial injury due to buildup of toxins that damage the gut and liver lining.
  • Besides acute liver damage, chronic alcohol consumers with a history of ulcerative colitis are at higher risk of chronic liver injury and ultimately to liver failure. Clinical data suggest that the risk of developing chronic liver disease in the setting of ulcerative colitis is five to 15 percent.6
  • Alcohol consumption in the setting of ulcerative colitis increases the risk of gastrointestinal irritation symptoms like nausea, vomiting, upper gastrointestinal bleeding, diarrhea, and other similar features.
  • Alcohol may also interact with an ulcerative colitis drug regimen that may increase the degradation of drugs or alter the excretion of active drug molecules, leading to elevated liver damage and complications as a result of active drug chemicals.

So Is Alcohol Good or Bad?

Anyone who has struggled with ulcerative colitis for some time has a reasonable idea of his or her particular triggers. Generally speaking, patients with ulcerative colitis should avoid alcohol intake per current recommendations.5 This is certainly true for moderate to large amounts of alcohol—this can cause problems regardless of inflammatory bowel disease. That said, it is not entirely clear from the existing data that modest alcohol consumption is a major trigger for relapse. It is likely best to avoid alcohol consumption when socially possible and to limit consumption even when you do drink. On the other hand, if you have consumed alcohol in the past without provoking a flare, you may be someone who can tolerate it. Likewise, it is you who will suffer if you cannot tolerate it.