As some of you may unfortunately be all too familiar, Inflammatory Bowel Disease (IBD) affects over 5 million people throughout the world, and is characterized as having waxing and waning courses, with periods of flares (symptoms) and remission (no symptoms).¬† It is still unclear what the causes of these flares are, though studies have identified some environmental factors that may trigger these symptomatic events.¬† By identifying the causes and triggers of IBD, the use of steroids and hospitalizations would likely decrease.¬†
One environmental factor that has been studied in IBD is cigarette smoking.¬† In Crohn‚Äôs Disease (CD), it has been shown that smoking increases the need for steroids and surgery, while quitting smoking improves the symptoms of the disease.¬† Conversely, with Ulcerative Colitis (UC), another IBD, smoking actually reduced the risk of colectomy and decreases disease symptoms.¬†
Alcohol is another environmental factor that may play a role in the incidence and severity of flare ups in IBD.¬† Studies have shown that alcohol consumption can disrupt intestinal barrier function, as well as alter the microbial population in the intestinal tract.¬† As a result, alcohol may impact the course of IBD, though surprisingly little research has been done to support or refute this hypothesis.¬† One study examining patients with UC found that those with diets high in either alcohol or meat were at a higher risk of flare ups than those with diets low in alcohol or meat.¬† On the other hand, another study found that there was no difference in alcohol absorption or abdominal pain from five different alcoholic beverages and that it was likely that the high sugar content in some of the drinks were responsible for the flare ups.
At the time of publication, there were no studies directly assessing the effect of moderate social drinking on symptoms and disease progression of IBD.¬† The study presented today aimed to determine the effect of daily red wine consumption in inactive IBD patients on clinical disease activity and noninvasive markers of disease activity (including C-reactive protein, stool calprotectin and intestinal permeability).
Study participants were recruited from a GI clinic at the Rush University Gastroenterology Department in Chicago, IL from January 2007 to December 2009.¬† Only those patients diagnosed with either CD or UC and currently in remissions, plus healthy controls were included in the study.¬† All participants were social drinkers and willing to drink a glass of wine per day for 7 days.¬† Participants filled out questionnaires on demographic data, disease activity data, as well as alcohol consumption patterns.¬† Light drinkers were defined as having less than 3 drinks per week.
Participants were asked not to drink alcohol for one week prior to the baseline appointment.¬† During the baseline appointment, participants underwent a blood draw, stool collection, and urine collection after consuming a sugar mixture.¬† Each participant then consumed between 1 and 3 glasses of red wine per day (0.4g of alcohol per kg body weight) for 7 days in a row.¬† The red wine was the same for each participant: a 2003 vintage Chilean Cabernet Sauvignon.¬†¬† Participants were asked to not consume any other alcohol during the duration of the 7 day study.¬† After the 7 day period, participants returned for another blood draw, stool collection, and urine collection after consumption of a sugar mixture.
The 7 day period was chosen to limit the study dropout rate, and also because this length of time corresponds to two half-lives for the intestinal mucosa, so any change in intenstial mucosal immune activity or function should be noticed.
All of the IBD patients in the study had biopsy-proven CD or UC and currently were in an inactive phase of the disease.¬† Participants were excluded from the study if they reported flares within 3 months of the study or if they were on biological medications for maintenance.¬† All participants included in the study were on a stable dose of IBD medications for at least 3 months and were not on any NSAIDS for at least 4 weeks prior to the study.¬† Participants were excluded from the study if they had any prior alcohol or drug abuse.
- ¬† ¬† ¬† 21 participants completed the trial: 8 with UC, 6 with CD, and 7 healthy controls.
- ¬† ¬† ¬† Median age was 45 years in UC subjects, 31 years in CD subjects, and 24 years in the healthy controls.
- ¬† ¬† ¬† The majority of IBD subjects were male (88%), while the majority of healthy controls were female (56%).
o¬†¬† Even though these values were different, there were no significant differences in age and gender between IBD patients and controls.
- ¬† ¬† ¬† 75% of the IBD subjects had colonic involvement, and 36% were on an immunomodulator.
- ¬† ¬† ¬† The amounts of alcohol consumed prior to baseline were slightly more in patients with CD than UC.
- ¬† ¬† ¬†¬†¬†No participants experienced a flare or worsening of symptoms during the study.
- ¬† ¬† ¬†¬†¬†There was no significant difference between UC and CD patients at baseline, nor was there a change in clinical disease activity index after wine consumption.
- ¬† ¬† ¬† There was no change in C-reactive protein levels after wine consumption.
- ¬† ¬† ¬† Baseline stool calprotectin levels varied significantly, with 88% of UC patients and 67% of CD patients having elevated levels at baseline.¬† Levels were low for healthy controls.
- ¬† ¬† ¬†¬†Alcohol had no significant effects on stool calprotectin in healthy controls.
- ¬† ¬† ¬† Daily consumption of wine significantly affected stool calprotectin in IBD subjects.
o¬†¬† There was a significant reduction in stool calprotectin in IBD subjects compared to their baseline levels.
- ¬† ¬† ¬† Baseline values for urinary L/M ratios (marker for small bowel permeability) were not significantly different in IBD patients from the healthy controls.
- ¬† ¬† ¬† Urinary sucralose (marker of gut permeability) was not significantly different between all groups.
- ¬† ¬† ¬†¬†Urinary L/M ratios and urinary sucralose were not significantly affected by 1 week of wine consumption in the healthy controls.
o¬†¬† Daily wine consumption DID affect Urinary L/M ratios and urinary sucralose levels in IBD subjects.
o¬†¬† There was a significant increase in urinary L/M excretion in CD subjects but not UC subjects after 1 week of wine consumption.
o¬†¬† Urinary sucralose levels were significantly increased in UC subjects but not CD subjects after 1 week of wine consumption.
According to the results of this study, there was no change in clinical disease activities or C-reactive protein levels in subjects with inactive IBD after consuming 1-3 glasses of red wine for 7 consecutive days.¬† Consumption of red wine also significantly impacted both stool calprotectin and intestinal permeability.¬† The results showed significant reductions in stool calprotectin levels after 1 week of moderate red wine consumption, which is interesting considering higher levels of stool calprotectin are associated with recurrence of disease in IBD (more important in UC than in CD).¬† The authors speculated that this reduction was likely due to alcohol‚Äôs inhibition of the systemic immune system and neutrophil migration, which ultimately reduce inflammation in the intestines.¬† This reduction could also be due to other components in the red wine (such as resveratrol), and not alcohol, though more work would be required to confirm or refute this.
The results of this study also found that moderate daily consumption of red wine for one week disrupted the intestinal barrier function in IBD subjects.¬† Specifically, small bowel permeability was significantly increased after 1 week of moderate red wine consumption in CD subjects, whereas it remained unchanged in patients with UC.¬† Conversely, total gut permeability was found to be significantly increased after 7 days of moderate red wine consumption in UC patients, but remained unchanged in patients with CD.¬† The authors suggest that these results mean that moderate alcohol consumption disrupts intestinal permeability only in those parts of the gut that are already injured by disease, and therefore are more susceptible to changes induced by alcohol consumption.
In summary, from these results it‚Äôs difficult to make any sweeping determinations of the clinical consequences of red wine consumption on IBD.¬† It appears as though it may be more disease-specific, with one type of IBD responding differently to alcohol consumption that another.¬† It is possible that long-term alcohol consumption would be overall detrimental, as intestinal leakiness could continue to increase overtime and cause significant harm to the body.¬† It is also possible that alcohol will do damage to those areas already injured by IBD, but no harm would be done on areas unaffected by the disease.
Overall, this study was interesting; however I had a big problem with the sample size in the study.¬† 21 subjects is a very small sample size, thereby any statistical test that did not succeed in rejecting the hypothesis (i.e. any ‚Äúnot significant‚ÄĚ result) makes me question its validity.¬† Were the results really insignificant? Or was there a Type II error occurring due to very low sample size?¬† I can‚Äôt imagine the power of these tests were very strong; however, the authors didn‚Äôt mention anything about power, so I don‚Äôt know for sure.
Also, the duration of the study was very short, and may not have been enough time to shown longer term effects of red wine consumption on IBD symptoms.¬† The authors also loosely go back and forth between the terms ‚Äúred wine‚ÄĚ and ‚Äúalcohol‚ÄĚ, which could be problematic.¬† I don‚Äôt believe one can extrapolate the results found from red wine consumption to all types of alcoholic beverages, especially since we‚Äôve seen in other types of studies that different types of alcoholic beverages act differently in different situations. ¬†Future studies should include several different types of alcohol, and non-alcohol controls with similar composition to other alcoholic beverages.
What do you think about this study?¬† Am I crazy for being so skeptical of it? What other things would you have liked to see the authors investigate?¬† Feel free to leave your comments below (no html tags)!
Source:¬† Swanson, G.R., Tieu, V., Shaikh, M., Forsyth, C., and Keshavarzian, A. 2011. Is Moderate Red Wine Consumption Safe for Inflammatory Bowel Disease? Digestion 84: 238-244.
I am not a health professional, nor do I pretend to be. Please consult your doctor before altering your alcohol consumption habits. Do not consume alcohol if you are under the age of 21. Do not drink and drive. Enjoy responsibly!