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Alcohol, Appetite, Digestion, Nausea, Diarrhea and Constipation

Alcohol and Appetite

In moderate drinkers, alcohol, when consumed within one hour before a meal, may stimulate appetite and therefore food and calorie intake [1,2].

Red wine may stimulate appetite more than beer, and beer more than a soft drink [3].

Substances other than ethanol in bitter aperitifs may stimulate appetite [30].

Poor appetite in chronic alcoholics may be due to depression, anxiety, nutrients deficiency (vitamins B1, B12, folate, magnesium), gastritis [4], alcoholic hepatitis [5], advanced liver cirrhosis [6] or cancer.

Alcohol and Digestion

Alcohol may slow down digestion, but does not necessary cause abdominal discomfort in healthy people. Alcohol can slow down gastric emptying [7,9]. In one 2008 study, 40 mL of various alcohol digestifs (40 vol% alcohol) drunk after a solid meal did not significantly stimulate or slow down gastric emptying, though [8].

Alcohol, Nausea and Vomiting

Different people may experience nausea or vomiting after drinking different amounts of alcohol. According to several blood alcohol concentration charts, a drinker may vomit when reaching blood alcohol concentrations between 0.12-0.25 g/100 mL blood or higher (for example, after 5-10 drinks or more in one hour by a 160 lbs man), depending on the drinking experience [10,11]. Repeated vomiting after drinking speaks for severe alcohol intoxication.

NOTE: Vomiting may eliminate some alcohol from your body only as long alcohol is in your stomach, that is roughly 5-30 minutes after drinking on an empty stomach or up to an hour and half when drinking after a meal.

Causes of ACUTE nausea or vomiting related to alcohol:

  • Stomach irritation
  • Psychological aversion to alcohol
  • Hypersensitivity or allergic reaction to ethanol, sulfites [13], histamine [12] or other substances in alcoholic beverages
  • Deficiency of aldehyde dehydrogenase (ALDH2), a genetic disorder found mainly in the East Asians causing “Asian flush reaction” with facial flushing and nausea [14]
  • Hangover [3]
  • Alcohol withdrawal syndrome [15]
  • Drinking alcohol during travel may aggravate symptoms of the motion sickness [17].
  • Disulfiram (a drug to discourage drinking) may cause nausea within minutes of starting drinking [16].
  • Combining alcohol with drugs, such as acid-lowering drugs (cimetidine), analgesics (phenacetin, phenylbutazone), antiasthmatics (albuterol, theophylline), antibiotics (cefamandole, chloramphenicol, griseofulvin, isoniazid, metronidazole, nitrofurantion, nitromidazole, sulfamethoxazole, tolbutamide), antifungals (ketokonazole), antidiabetics (chlorpropramide, tolbutamide), nitrates (isosorbide dinitrate, nitroglycerine) or chemotherapy.

Causes of PERSISTENT nausea or vomiting related to alcohol:

Alcohol and Constipation

In individuals with irritable bowel syndrome (IBS), alcohol may trigger or aggravate constipation [20].

In the first days of alcohol abstinence after long-term drinking, constipation may develop, especially in depressed individuals [21].

In those who drink heavily for 10 or more years, a nerve damage called alcoholic neuropathy may result in constipation, numbness, “pins and needless” in hands and feet and muscle weakness, which may improve after stopping drinking and proper diet [22,23].

Alcohol and Diarrhea

Acute Diarrhea

  • Even in healthy people, binge drinking may trigger diarrhea [24].
  • Diarrhea may be one of the hangover symptoms [3].

Chronic Diarrhea

In individuals suffering from irritable bowel syndrome (IBS), drinking even moderate amount of alcohol, especially beer or red wine, may trigger diarrhea [20].

Chronic alcoholics may have diarrhea due to increased colon motility [25], lactose intolerance [26], poor diet resulting in a deficiency of folatevitamin Avitamin C or zinc, or damaged nerves (alcoholic polyneuropathy) [22]. All these conditions may improve after stopping drinking and proper diet.

In chronic drinkers with advanced chronic pancreatitis or liver cirrhosis, steathorrhea (fatty diarrhea with pale stools) may occur due to fat malabsorption.

In individuals with celiac disease, beer, barley malt beverages, wine coolers and certain liqueurs that contain gluten may trigger diarrhea [27]. Most ciders (not containing barley malt) and unflavored wines, sherry, mead, wine and fruit brandies, gin, martini, vermouth, whiskey, rum, tequila, ouzo, vodka and other unflavored spirits should be gluten-free [27].

In cancer patients on chemotherapy, alcohol may make diarrhea worse [28].

Lactose Intolerance

In individuals with lactose intolerance, certain beers, ciders, liqueurs and other sweetened alcoholic beverages that contain lactose may trigger diarrhea. Chronic alcohol drinking reduces the activity of the small intestinal enzyme lactase, which may result in lactose intolerance in black, but not white Americans [1,2,29].

Ethanol inhibits absorption of sodium and water in the small intestine what may result in diarrhea [3].

Alcohol and Obesity

Alcohol drinking by itself does not cause obesity; it is a total calorie excess that results in obesity. In general, regular moderate drinking does not seem to be associated with obesity [31].

Heavy drinking and binge drinking in drinkers who eat regularly often lead to obesity, but in drinkers who do not eat regularly, it may lead to malnutrition and weight loss.

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  2. Caton SJ et al, 2004, Dose-dependent effects of alcohol on appetite and food intake  PubMed
  3. Buemann B et al, 2002, The effect of wine or beer versus a carbonated soft drink, served at a meal, on ad libitum energy intake  PubMed
  4. Shai I et al, 2007, Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: a multicenter, randomized, clinical intervention trial  PubMed
  5. Marsano LS et al, 2003, Diagnosis and Treatment of Alcoholic Liver Disease and Its Complications  National Institute on Alcohol Abuse and Alcoholism
  6. Cirrhosis  National Institute of Diabetes, Digestive and Kidney Diseases
  7. Franke A et al, 2005, The effect of ethanol and alcoholic beverages on gastric emptying of solid meals in humans  PubMed
  8. Franke A et al, 2008, Postprandial walking but not consumption of alcoholic digestifs or espresso accelerates gastric emptying in healthy volunteers  PubMed
  9. Heinrich H et al, 2010, Effect on gastric function and symptoms of drinking wine, black tea, or schnapps with a Swiss cheese fondue: randomised controlled crossover trial  PubMed
  10. Alcohol and the human body  Intoximeters
  11. Alcohol Problems in Intimate Relationships: Identification and Intervention  National Institute on Alcohol Abuse and Alcoholism
  12. Maintz L et al, 2007, Histamine and histamine intolerance  PubMed
  13. Grotheer P, 2005, Sulfites: Separating Fact from Fiction  University of Florida, IFAS Extension
  14. Brooks PJ et al, 2009, The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption  PubMed Central
  15. Trevisan LA et al, 1998, Complications of alcohol withdrawal  National Institute on Alcohol Abuse and Alcoholism
  16. Disulfiram side effects Drugs.com
  17. Lawther A et al, 1988, A survey of the occurrence of motion sickness amongst passengers at sea  PubMed
  18. H. pylori infection symptoms  Mayo Clinic
  19. Ansstas G, Alcoholic Ketoacidosis Clinical Presentation  Emedicine
  20. Irritable bowel syndrome causes  Mayo Clinic
  21. Andersohn F et al, 2004, Depressive Mood and Craving During Alcohol Withdrawal: Association and Interaction  University of Göttingen
  22. Alcholic neuropathy  The University of Chicago
  23. Alcoholic Neuropathy  MedlinePlus
  24. Chiba T et al, 2000, Alcohol-related diarrhea  PubMed
  25. Bouchoucha M et al, 1991, Recovery from disturbed colonic transit time after alcohol withdrawal  PubMed
  26. Keshavarzian A et al, 1986, Intestinal-transit and lactose intolerance in chronic alcoholics  PubMed
  27. Gluten-free alcoholic beverages  Celiac.com
  28. Eating Hints: Before, During, and After Cancer Treatment  Cancer-gov
  29. Perlow W et al, 1977, Symptomatic intestinal disaccharidase deficiency in alcoholics  PubMed
  30. Westerterp-Plantenga MS et al, The appetizing effect of an apéritif in overweight and normal-weight humans  PubMed
  31. Suter PM, 2005, Is alcohol consumption a risk factor for weight gain and obesity?  PubMed

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