Understanding the Impact of Alcohol on GERD: 7 Tips for Management

Published on Monday, August 28, 2023 by Elyse Krawtz

Navigating the Intricate Link Between Alcohol and GERD: A Closer Look at Risk Factors and Management

Individuals living with GERD frequently report that alcohol triggers their symptoms, so it makes sense that alcohol could increase GERD risk. But the relationship between alcohol and GERD is more controversial than you would think.

A 2019 meta-analysis concluded alcohol consumption is associated with GERD in observational studies. Possible ways that alcohol may increase the risk of GERD or acid reflux symptoms, according to the meta-analysis and an earlier review, include:

Damaging the esophagus and the stomach
Changing lower esophageal sphincter (the valve that keeps the stomach contents in the stomach) activity
Altering GI motility or peristalsis (changing how food moves through your digestive tract)
Generating the metabolite acetaldehyde, which can be toxic to both esophageal and stomach cells
Changing the stomach’s pH (level of acid) or emptying speed

Yet, the American College of Gastroenterology (ACG) 2023 GERD practice update authors classified alcohol cessation as a “not generally [recommendable]” modification for GERD management.

Why the discrepancy? The ACG rates the evidence for alcohol cessation for GERD as weak; they consider the mechanisms by which alcohol can cause symptoms inconclusive; and assert that the effects differ for different alcoholic beverages.

In addition to clarifying the various ways different types of alcohol could affect GERD risk and symptoms, researchers must also explore facets of bio-individuality that could influence individual responses, such as:

Genetic risk of GERD
Alcohol intake habits
Esophageal microbiome dysbiosis

But if you or a loved one has GERD or acid reflux, don’t lose sight of common sense for the research communication confusion. Yes, GERD and alcohol research has a long way to go, and more research will be helpful. No, not everyone benefits from the same interventions. But here are seven takeaways about alcohol and GERD to cut through the clutter:

1. Alcohol could be a GERD trigger for you. Your symptoms and your triggers matter most. If your symptoms worsen when you drink, then skip it. Suppose you have no symptoms when you drink in moderation or less. In that case, you may not need to eliminate it if you have no other reason to avoid it, like pregnancy, medications, or a history of bariatric surgery or alcohol abuse. Talk to your physician and dietitian about making a plan to identify your triggers and about whether alcohol cessation might be best for you.

2. Drinking less is best. Drinking too much increases your risk of multiple problems, likely including GERD. Even if alcohol doesn’t trigger your symptoms, prudence dictates moderate intake. Women should beware that they will face more alcohol-related consequences at lower intake levels than men and have a higher breast cancer risk if they drink rather than abstain. If you don’t drink, there is no reason to start.

Pro tip: Moderate and binge drinking intake levels are typically less than people think. One serving of alcohol is considered 12 fl oz beer, 5 fl oz wine, or 1.5 fl oz distilled spirits. Moderate alcohol intake is <2 servings for men and <1 serving for women daily. Experts consider five or more servings daily for men and four or more for women binge drinking, even if it averages to <1 drink over the week.

3. Consider YOUR drinking culture. Limiting or avoiding alcohol might not be the only diet or lifestyle intervention necessary for symptom management. People tend to pair with other common GERD triggers, like large or high-fat meals, smoking, late-night eating, or stress. Mind your drink of choice: don’t choose doubly-problematic drinks for GERD with multiple servings of alcohol per portion or additional triggers.

4. Alcoholic beverages’ Calories can add up quickly. Excess central body weight could increase GERD risk, and losing excess weight may help manage symptoms. Drinking Calories in sodas, sweet teas, juices, sports drinks, and alcoholic beverages can be a sneaky way to gain weight. Many alcoholic beverages are even higher in Calories than sugar-sweetened beverages for the same portion.

5. Neither medication nor food elimination can compensate for alcohol abuse. NIH’s Rethinking Drinking has resources to help you find information, professional help, and support groups if you or a loved one is struggling with changing habits and addiction.

6. Build your barriers--don’t break them. Alcohol can damage the cells and lining of your GI tract, whether or not it triggers symptoms. A healthy GI tract should be able to repair small amounts of damage caused by the occasional drink, but a drinking habit can be harmful to your barriers--which are vital to your GI tract and your immune system.

7. Consider your options. Non-alcoholic beverages and mocktails can be good options to decrease alcohol intake. Check out reflux-friendly tips and mocktail recipes by dietitian Savannah Duffy for socializing without alcohol.

_{Pan, J., Cen, L., Chen, W., Yu, C., Li, Y., & Shen, Z. (2019). Alcohol Consumption and the Risk of Gastroesophageal Reflux Disease: A Systematic Review and Meta-analysis. Alcohol and alcoholism (Oxford, Oxfordshire), 54(1), 62–69. https://doi.org/10.1093/alcalc/agy063}
_{Chen, S. H., Wang, J. W., & Li, Y. M. (2010). Is alcohol consumption associated with gastroesophageal reflux disease?. Journal of Zhejiang University. Science. B, 11(6), 423–428. https://doi.org/10.1631/jzus.B1000013}
_{Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. The American journal of gastroenterology, 117(1), 27–56. https://doi.org/10.14309/ajg.0000000000001538}
_{An, J., Gharahkhani, P., Law, M. H., Ong, J. S., Han, X., Olsen, C. M., Neale, R. E., Lai, J., Vaughan, T. L., Gockel, I., Thieme, R., Böhmer, A. C., Jankowski, J., Fitzgerald, R. C., Schumacher, J., Palles, C., BEACON, 23andMe Research Team, Whiteman, D. C., & MacGregor, S. (2019). Gastroesophageal reflux GWAS identifies risk loci that also associate with subsequent severe esophageal diseases. Nature communications, 10(1), 4219. https://doi.org/10.1038/s41467-019-11968-2}
_{D'Souza, S. M., Houston, K., Keenan, L., Yoo, B. S., Parekh, P. J., & Johnson, D. A. (2021). Role of microbial dysbiosis in the pathogenesis of esophageal mucosal disease: A paradigm shift from acid to bacteria?. World journal of gastroenterology, 27(18), 2054–2072. https://doi.org/10.3748/wjg.v27.i18.2054}
_{Centers for Disease Control and Prevention. (2022, April 19). Facts about moderate drinking. Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm}
_{U.S. Department of Health and Human Services. (n.d.). Rethinking Drinking. National Institute on Alcohol Abuse and Alcoholism. https://www.rethinkingdrinking.niaaa.nih.gov/}