Gut Health
GABRIELLA NAGY
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How Does Alcohol Affect Your Gut Health?

How Does Alcohol Affect Your Gut Health?

Before you read this article, you should know that I am not anti-alcohol. Yes, I choose not to drink now but I drank for years and had many enjoyable occasions under the influence. Alcohol is viewed in many cultures as a tonic for relaxation and relieving stress, to celebrate and to commiserate. In this article, I look at what alcohol is and how our bodies detoxify it. We'll check on the risks to drinking alcohol and provide tips to stay healthier if you choose to drink.

What is alcohol?

Wine, beer, spirits are made through a process of fermentation which creates ethanol (alcohol). Grains, fruits and vegetables are put through this process. Yeast and bacteria react with the sugars in the food. As a by-product, ethanol and carbon dioxide are produced. 1 As well as drinks, ethanol is used in solvents, perfumes, toiletries, disinfectants, preservatives, polishes, fuel additives and in the manufacture of plastic, rubber and drugs. If we have had one too many drinks, the side effects of ingesting ethanol can be mood changes, slower reaction times, uncoordinated movements, slurred speech and nausea. If we expose ourselves to higher amounts the list includes blurred vision, vomiting, coma, low temperature and fitting.2

Health risks?

A combined review in 2016 of 87 studies on alcohol with all causes of death3 concluded that drinking in low volumes was as harmless as not drinking. So, does this mean we can drink small amounts safely? What is classified a low volume drinker? In the review, a low volume drinker was someone who consumed less than 30g of alcohol per day. Although difficult to be specific,4 this is roughly equivalent to two 5% beers of 12 fl oz (340ml) or two glasses of 12% wine of 5 fl oz (147ml) or two 1.5 fl oz (44ml) shots of 40% spirits.5 However, in contrast, a larger review in 2012 of 222 articles concluded that light drinking, up to one drink per day, increases the risk of cancer of oral cavity and pharynx, oesophagus and female breast.6 The UK government published a paper in 20157 concluding that drinking alcohol has been shown to increase the risk (or chance) of getting some types of cancer. With regards to heavier drinking, risk increases significantly. Binge drinking is classified by the NHS as drinking more than 6 units for women or 8 units of alcohol for men in one sitting. For context, 6 units is equivalent to 2 pints of strong beer or 2 large glasses of wine. The World Health Organisation8 recognises that alcohol contributes to 3 million annual deaths worldwide and is responsible for the poor health of millions worldwide. It causes significant disease including alcoholic fatty liver; alcoholic hepatitis and cirrhosis.9 

Alcohol and the gut

There have been many studies examining the effects of heavy drinking on gut health, showing changes in the gut bacteria and induction of gut inflammation and leaky gut.10, 11 In particular changes in the gut bacteria induced by alcohol seem to promote leaky gut12 and increases the fungus, Candida, have been seen in heavy drinkers.13 The imbalance in gut bacteria induced by alcohol results in an increase in toxins, body-wide inflammation and tissue damage outside of the gut10 and these effects have been theorised to contribute to the link between cancers and other diseases and over-consumption of alcohol. However, it may not be all bad news, the plant chemicals (phytonutrients) found in wine and beer have been suggested to have beneficial effects when drinking is kept to a low volume,14, 15 such as in the much-vaunted Mediterranean diet.

In summary, is it risk-free to drink a low volume of alcohol? Probably not. Are there things we can do to support our bodies to cope with alcohol? Definitely yes.

Detoxifying alcohol

Detoxification is a multi-stage process of turning fat soluble toxins and xenobiotics (external chemicals such as pesticides) into water soluble compounds that can be excreted. For this article, I am concentrating on the two middle phases of detoxification. Phase 1 is where the toxin reaches the liver. There are a number of reactions that take place here using enzymes (catalysts) produced by the liver. Firstly, ethanol permeates through virtually all tissues in the body.16 When we detoxify ethanol in phase 1, our bodies produce a substance called acetaldehyde.17 This substance is toxic to the body and is associated with swelling of the liver.18 Phase 1 can easily become overloaded due to high toxic loads. Therefore, we need to quickly get acetaldehyde into the next phase of detoxification. We don’t want it to be hanging around unchecked inside the body as it can cause damage to our cells. Phase 2 is a series of reactions that bind the phase 1 products to make them water soluble ready for excretion. If you find that you feel the effects of alcohol very quickly then it maybe that your phase 2 pathway needs some support to remove the toxins more effectively. Other signs of impaired detoxification may include dry skin; itching; dark circles under eyes; poor concentration and brain fog; constipation; tiredness.

Supporting our bodies with alcohol

  1. Ensure adequate water intake of at least 2 litres filtered water daily to help with excretion.
  2. Increase soluble fibre (beans, avocado, root vegetable etc) to support elimination from the body.
  3. Remove unnecessary toxins to slow down Phase 1. This could include harsh cleaning products and smoking.
  4. Go organic with foods as this will minimise pesticides and other xenobiotics.
  5. Foods high in B vitamins are great for Phase 1 enzyme production: include liver and organ meats, salmon, and leafy greens.
  6. Eat a rainbow of colours with your fruit and vegetables. This will provide antioxidant support to mop up the damage of Phase 1 compounds.
  7. Cruciferous vegetables (broccoli, brussels sprouts, cabbage etc) are great to support Phase 2.
  8. Sulphur rich foods, such as onions support Phase 2.
  9. Asparagus increases the activity of detoxification enzymes.19
  10. Red beetroot supports detoxification in Phase 2.
  11. Support a healthy range of gut bacteria. Some gut bacteria can help to detoxify alcohol. 20

Last Orders

If you do choose to drink alcohol, there are many things you can do to balance some of the side-effects.

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    References
    1. Drinkaware.co.uk, [Online]. Available: https://www.drinkaware.co.uk/facts [Accessed February 2021].
    2. Public Health England, [Online]. Available: https://assets.publishing.service.gov.uk [Accessed January 2021].
    3. Stockwell, T., Zhao, J., Panwar, S., Roemer, A., Naimi, T., & Chikritzhs, T. "Do "moderate" drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality.," Journal of Studies on Alcohol and Drugs, vol. 77, no. 2, pp. 185-198, 2016.
    4. Ferner, R., & Chambers, J., "Alcohol intake. Measure for measure," BMJ, vol. 323, no. 7327, pp. 1439-1440, 2001.
    5. National Institute on Alcohol and Alcoholism, [Online]. Available: https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption [Accessed January 2021].
    6. Bagnardi, V., Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V., & La Vecchia, C. "Light alcohol drinking and cancer: a meta-analysis.," Annals of Oncology, vol. 24, no. 2, p. 301–308, 2012.
    7. Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the environment (COC). , [Online]. Available: https://assets.publishing.service.gov.uk [Accessed January 2021].
    8. World Health Organisation, [Online]. Available: https://www.who.int/health-topics/alcohol [Accessed January 2021].
    9. National Health Service, [Online]. Available: https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/ [Accessed January 2021].
    10. Engen, P. A., Green, S. J., Voigt, R. M., Forsythe, C. B., & Keshavarzian, A. "The Gastrointestinal Microbiome: Alcohol Effects on the Composition of Intestinal Microbiota," Alcohol Research, vol. 37, no. 2, pp. 223-236, 2015.
    11. Bishehsari, F., Magno, E., Swanson, G., Desai, V., Voigt, R., Forsyth, C., & Keshavarzian, A. "Alcohol and Gut-Derived Inflammation.," Alcohol Research, vol. 38, no. 2, pp. 163-171, 2017.
    12. Grander, C., Adolph, T. E., Wieser, V., Lowe, P., Wrzosek, L., Gyongyosi, B., et al. "Recovery of ethanol-induced Akkermansia muciniphila depletion ameliorates alcoholic liver disease.," Gut, vol. 67, no. 5, pp. 891-901, 2018.
    13. Yang, A. M., Inamine, T., Hochrath, K., Chen, P., Wang, L., Llorente, C., et al "Intestinal fungi contribute to development of alcoholic liver disease.," The Journal of Clinical Investigation, vol. 127, no. 7, pp. 2829-2841, 2017.
    14. Quesada-Molina, M., Muñoz-Garach, A., Tinahones, F. J., & Moreno-Indias, I.  "A New Perspective on the Health Benefits of Moderate Beer Consumption: Involvement of the Gut Microbiota.," Metabolites, vol. 9, no. 11, p. 272, 2019.
    15. Zorraquín-Peña, I., Esteban-Fernández, A., González de Llano, D., Bartolomé, B., & Moreno-Arribas, M. "Wine-Derived Phenolic Metabolites in the Digestive and Brain Function.," Beverages, vol. 5, no. 1, p. 7, 2019.
    16. Molina, P & Nelson, S. "Binge drinking’s effects on the body.," Alcohol Research, vol. 39, no. 1, pp. 99-109, 2018.
    17. Wilson D.F. & Matschinsky F. M., "Ethanol metabolism: The good, the bad, and the ugly.," Medical Hypotheses, vol. 140, no. 7, p. 109638, 2020.
    18. Lieber, S. "Metabolic effects of acetaldehyde.," Biochemical Society Transactions, vol. 16, no. 3, pp. 241-247, 1988.
    19. Lee, D. Y., Choo, B. K., Yoon, T., Cheon, M. S., Lee, H. W., Lee, A. Y., & Kim, H. K. "Anti-inflammatory effects of Asparagus cochinchinensis extract in acute and chronic cutaneous inflammation.," Journal of Ethnopharmacology, vol. 121, no. 1, pp. 28-34, 2009.
    20. Kirpich, I. A., Solovieva, N. V., Leikhter, S. N., Shidakova, N. A., Lebedeva, O. V., Sidorov, P. I. et al. "Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a pilot study.," Alcohol (Fayetteville, N.Y.), vol. 42, no. 8, pp. 675-682, 2008.

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