Is Moderate Red Wine Consumption Safe in Inactive Inflammatory Bowel Disease?

Abstract

Background: Alcohol consumption is a potential trigger for inflammatory bowel disease (IBD) flare because of alcohol-induced oxidative stress and its deleterious effects on gut barrier function. Additionally, we have recently shown that alcohol consumption is associated with more symptoms in IBD. However, it is not known whether moderate daily alcohol consumption can modify IBD disease activity. To test what effects alcohol may have on patients with IBD, we evaluated the effect of moderate daily red wine for 1 week on two factors associated with recurrent IBD disease activity: intestinal permeability and stool calprotectin. Methods: To assess the effects of moderate daily alcohol consumption on intestinal permeability and inflammation, we recruited 21 patients: 8 with inactive ulcerative colitis (UC), 6 with inactive Crohn’s disease (CD), and 7 healthy controls. All participants with IBD completed a validated questionnaire on disease activity (Crohn’s disease activity index or ulcerative colitis clinical activity index), to confirm they had inactive disease. All subjects then underwent a baseline assessment that included a blood draw, urine collection after sugar challenge, and stool collection. Subjects then consumed 1–3 glasses of red wine a day for 1 week (approx. 0.4 g EtOH/kg), and repeated the three measures. Results: No subjects flared during the study. Moderate alcohol consumption did not significantly change either clinical disease activity scores or C-reactive protein. In contrast to healthy subjects, daily consumption of red wine significantly (1) decreased stool calprotectin in IBD subjects from baseline (p = 0.001) and (2) increased intestinal permeability as measured by urinary lactulose/mannitol excretion (marker of small bowel permeability) in CD (p = 0.028) or urinary sucralose secretion (marker of large bowel permeability) in UC (p = 0.012). Conclusions: One week of moderate consumption of red wine in inactive IBD was associated with a significant decrease in stool calprotectin and a significant increase in intestinal permeability. Our data suggests that patients with inactive IBD who drink red wine daily may be at an increased long-term risk for disease relapse.

Effect of acute and chronic red wine consumption on lipopolysaccharide concentrations

“…These results would indicate that the previous health status of the individual could modify the response to RW consumption. In contrast to Swanson et al (33), our data suggest that RW consumption for periods of time longer than 1 wk might be able to diminish gut permeability in healthy subjects. Prevotella is a Gram-negative bacterium belonging to the Bacteroidetes phyla.…”

“…However, additional human studies will be necessary to confirm this hypothesis. Swanson et al (33) have recently re-ported that RW consumption for 7 d increased gut permeability in subjects with inactive inflammatory bowel disease but not in healthy subjects. These results would indicate that the previous health status of the individual could modify the response to RW consumption.…”

Effect of Alcoholic Intoxication on the Risk of Inflammatory Bowel Disease: A Nationwide Retrospective Cohort Study

“…In that cohort, patients who had a relapse or disease flare over 1 year consumed 14 g of alcohol daily compared with 10 g daily in those who had no relapse [19]. Swanson et al discovered that patients with inactive IBD who consumed moderate red wine daily (approximately 0.4 g of alcohol/kg of body weight) are associated with a significant decrease in stool calprotectin and a significant increase in intestinal permeability, which made them at an increased long-term risk of disease relapse [20]. …”

‘Red Alert’ or Not? – Do We Give Our Inflammatory Bowel Disease Patients the Right Dietary Recommendations?

“…The data published in the article in this issue of Digestion obviously do not support the concept that 'the long term consequences of moderate alcohol consumption could be harmful because of the potential negative effects associated with gut leakiness on IBD disease course' [17] . For such a statement a prospective study with many more patients would be necessary.…”

“…In fact many patients ask whether moderate red wine consumption is safe in inactive IBD -as Swanson and colleagues did in their small study published in this issue of Digestion [17] . They…”