Alcohol and eczema: what alcohol can you drink with eczema?

The science is clear: the more you drink, the more you damage the gut microbiome by triggering small intestinal bacterial overgrowth (SIBO). This means more inflammation and eczema rashes.

Maternal drinking during pregnancy also increases offspring susceptibility to eczema.

The simple solution is abstinence - ban alcohol entirely.

But life is not always about rules and rigor. There is middle ground. What alcohol can you drink with eczema? Which are eczema-friendly drinks and which ones to avoid? How to enjoy a glass or two without worrying too much?

This article will assess the different types of alcohol and how much an eczema patient can drink.

1. Beer 

Beer is created from the fermentation process where wort is mixed with yeast. Wort is malted grains mixed in water at different temperatures, in addition to flavoring like spices and fruits. 

Most beers use barley, but wheat, oats, rice, corn are also used. 

The usual alcohol content in beers is 4-7% but beers can go beyond 10% which taste more bitter.

Given there are countless variations of beer, here are broad steps to evaluate their eczema-friendliness:

1. Allergen avoidance: If you are restricting gluten, then you might have to forgo beer entirely for simplicity and opt for wine or spirits not made with gluten-containing grains like wheat, barley and rye. Alternatively, drink lesser-available corn or rice-based beers - you will need to check the brewery’s website or ask the bartender for details.
2. Opt for simple, un-enhanced beers. Some beers like Somersby will add apples or berries for sweetness. The sugar content will spike up (and we’ve already covered the sugar-eczema relationship here). Opt for simple beers without flavoring, which you can identify easily from the taste and product label. If you enjoy sweet beer but don’t want actual sugar content, try beers with hinted flavors, e.g., Kronenbourg 1664 with ‘a hint of citrus’ - it has a sweet undertone and is certainly better than the highly sugary Somersby.
3. Aim for low-alcohol content beers. Aim for as low as possible, given the dose-dependent damage of alcohol on the immune system. Check the following list.

Beers by alcohol content examples:

• 2% beers: Miller 64
• 3% beers: Amstel Light, Heineken Light, Modelo Chelada, Michelob Ultra Pure Gold
• 4% beers: Bud Light Next, Corona Light, Bud Light, Guinness Draught, Miller Lite, Budweiser Select, Pabst Blue Ribbon (PBR) 
• 5% beers: Budweiser, Fosters, Heineken, Asahi, Stella Artois, Blue Moon Beer, Icehouse, Mickey’s, Natural Ice

Finally, you might wonder if you must avoid gluten. It depends if you were diagnosed with gluten intolerance by a doctor. Statistically, 1% of people have a medical necessity to avoid gluten due to celiac disease. But in recent years thanks to marketing, people claim to feel better after removing gluten from their diet. Overall, it’s complicated scientifically and it’s best if you conduct a personal test by restricting gluten for 3 weeks and check for potential relief. If you don’t experience any noticeable change, you can rule out gluten intolerance at the dose you tested for.

In summary, if you have mild to moderate eczema, an unenhanced, low alcohol content beer or two will do you fine.

2. Wine 

Wine is fermented with grapes. This gives a peace of mind to those who are actively consuming a gluten-free diet. But wine allergy appears to be a distinct problem:

• A 2005 study found that 83% of respondents reported allergic symptoms from drinking red wine, whereas 31% reported symptoms with white wine.
• The difference between red wine and white wine? Red wine is fermented with grape skin and white wine without. So those who react with red wine (but not to white wine) are likely to react to proteins found in grape skin.

But it could also be other allergens present in both wines. What types of allergens are in wine?

• Grapes, including specific proteins found in them e.g., endochitinase 4A
• Ethanol, the specific type of alcohol that’s present in wine
• Yeast, which ferments the sugars from the grapes into ethanol
• Sulfites, which can be produced naturally in wine or added by winemakers as preservatives
• Fining agents, which are added during production and can include proteins derived from milk, eggs, and fish

Another key difference is that wine is intentionally kept to age for years, versus beer which is usually produced and consumed within months. Although it is hard to obtain a research paper describing the chemical load composition of a longer-aged alcohol and potential to cause inflammation, I personally suspect that the more fermented a food or beverage is, the more pro-inflammatory it can be for digestion, and thus higher potential to provoke eczema. 

Nevertheless, most of us consume wine produced within the same year or so, it wouldn’t be a major concern.

What about sparkling wine? Can eczema patients drink champagne or prosecco? Does sparkling wine have alcohol?

Sparkling wine is simply wine with an additional fermentation process which traps carbon dioxide into the wine inside the bottle. In fact, it increases alcohol content by a percentage point. Nevertheless, the following steps to assess wine consumption remain. 

So can you drink wine with eczema? How to assess? 

1. Test if you have wine sensitivities. Try a glass of red wine or two, and don't drink anymore alcohol for the next 3-5 days and monitor for any abrupt symptoms. Do the same for white wine and see if it makes any difference. It could be that you react only to red wine but not to white wine. It is also about the number of glasses, so you could check for your personal threshold by testing only one glass at a time and build it up the next time you drink. If you experience allergic symptoms, it might not be worth the symptoms to drink wine and you will have to opt for beer or other spirits.
2. Drink less sugary wine. The more sugar, the more inflammation to the gut. Check the nutrition label. Examples of low-sugar wines: dry reds often have under 1g of sugar per five-ounce pour: Pinot Noir, Cabernet Sauvignon, and Syrah/Shiraz. Dry whites have 1-1.5 g of sugar per five ounces: Pinot Grigio, Chardonnay, and Viognier. 
3. Opt for newer wines within the past 3 years. This rests on my theory that the longer a product is fermented, the more metabolites or substances are released and can provoke eczema more. I might be wrong, but this is worth considering for those who are very careful. Don’t drink wine (or any alcohol in fact) that is too old, only drinks within the year.
4. Choose wine with lower alcohol content. Most wines are about 12% but can go up to 20s. Anything 12% or lower is considered low alcohol content. Check the product label. 

For wine it is easy to order a bottle and refill mindlessly compared to popping a can of beer. To benchmark your alcohol consumption, it helps to remember how many standard drinks you’ve had - for example, a 5% can of beer has the same amount of alcohol as a glass of table wine at 12%. 

One standard US drink (or one alcoholic drink equivalent) has 14 g of pure alcohol, found in:

• 12 ounces of regular beer, which is usually about 5% alcohol
• 5 ounces of wine, which is typically about 12% alcohol
• 1.5 ounces of distilled spirits, which is about 40% alcohol

In summary, choose dry wines over sweet sparkling wines which tend to have higher alcohol content. A glass or two for the night will do fine. 

3. Spirits/Liquors

Spirits are alcohols made from fermenting grains and fruits. But some are distilled, i.e., water content is extracted, increasing the total alcohol content.

There are also 6 primary types of hard liquor aka. base liquors for creating cocktails:

Brandy: 40-60% alcohol

• Composition: a distilled wine made with fruit, primarily grape, but can also be other non-grape fruits like apple, plum, pear, nuts, oak. 
• Cocktails: sidecar, brandy old fashioned, Brandy Alexander, Corpse Reviver.

Rum: 40-75% alcohol 

• Composition: made with sugarcane molasses or sugarcane juice.
• Cocktails: rum and coke, daiquiri, Mai Tai, piña colada.

Gin: 40% or above alcohol

• Composition: a wheat/barley-based alcohol, redistilled with a mix of seeds, berries, roots, and herbs, most famously the use of juniper berries. 
• Cocktails: gin and tonic, Negroni, gimlet, martini, Tom Collins.

Whiskey: 40-68% alcohol 

• Composition: grain mash that typically includes a blend of barley, corn, rye and wheat. 
• Cocktails: whiskey sour, Rob Roy, Manhattan, Sazerac, Jack and Coke.

Vodka: 40-95% alcohol

• Composition: can be made with a variety of fermented grains like sorghum, corn, rice, rye or wheat, or from potatoes, sugar beet molasses or even fruit. For example, Smirnoff Vodka is distilled from corn (gluten-free), Absolut Vodka, Ketel One and Greygoose from wheat, Belvedere from rye.
• Cocktails: vodka martini, Bloody Mary, screw driver, cosmopolitan, kamikaze

Tequila: 40-55% alcohol

• Composition: distilled from the succulent agave. A variation ‘mixto’ is made with 51% agave and rest sugarcane spirit. 
• Cocktails: margarita, Tequila Sunrise, paloma

Gin is aged in six months or less, and vodka is not aged at all (it’s meant to be pure and smooth across time). The other base liquors are aged from years to decades, especially whiskey.

So can you drink cocktails and ‘hard’ liquors with eczema? 

1. Screen for allergens. Assess the base liquor and check if it is gluten free, if you are actively restricting gluten. Brandy, rum, tequila, and some brands of vodka would be appropriate gluten-free options. Although if you are sensitive to wine and thus grapes, you should probably avoid brandy as well.
2. Drink it pure on the rocks if possible. A shot is technically better than a cocktail that is mixed with coloring and syrup, or shots laden with the sugary Redbull, or dairy-containing baileys (lactose being another potential allergen). Alternatively, you can mix your drink with sugar-free soda water to add more volume while still getting the buzz.
3. Opt for ‘middle range’ liquors. If beer and wine are considered low alcohol content, and cocktails are considered high alcohol content, then drinks that fall between 10 to 30% alcohol content can be considered ‘middle ground’: plum wine (made from plums, 10-15%), sake (made from rice, at 13-17%), soju (made from a mix of rice and starches, may contain gluten, typically <20%).

So what are eczema-friendly spirits and cocktails?

• Plain plum wine 
• Sake 
• Tequila shots
• Rum and soda
• Old Fashioned*: Brandy, Angostura bitters (herbal mixer), orange slices, 1 sugar cube
• Piña colada: white rum, coconut cream, pineapple juice
• Daiquiri*: white rum, lime juice, simple syrup
• Vodka martini: vodka, dry vermouth (wine), and ice
• Bloody Mary: vodka, tomato juice, and other spices and flavorings including Worcestershire sauce, hot sauces, garlic, herbs, horseradish, celery, olives, pickled vegetables, salt, black pepper, lemon juice, lime juice and celery salt
• Screwdriver: vodka and orange juice
• Cosmopolitan*: vodka, cranberry juice, lime juice, and triple sec (syrup)
• Kamikaze: vodka, lime juice and orange liqueur
• Margarita: tequila, orange liquor, lime juice 
• Tequila Sunrise*: tequila, orange juice and grenadine (syrup)
• Paloma*: tequila, grapefruit juice, lime juice, sparkling water, agave nectar (syrup)

Drinks marked with asterisk contain syrup for those who want to completely avoid it. Obviously the recipe varies by bartender. For vodka drinks you’ll have to check if it is gluten-free based on the brand used. 

What about non-alcoholic beer?

There are different ways to make non-alcoholic beer and liquor, but essentially it involves removing the alcohol content to as low as possible. Some brands are able to have a near zero alcohol percentage, but some contain 0.5%. So double check the product label if you need to drive.

Does drinking non-alcoholic drinks mean you can drink as many as you want? 

Well aside from accumulating calories, you can drink a few more cans without having to worry too much because there isn't the alcohol content to create significant inflammation damage to your gut microbiome. The same rules would still apply, e.g., avoid those with many flavor enhancers.

Final tips for alcohol and eczema - for those who enjoy social drinking:

• Test your sensitivity with alcohol. Find out which ones you react with. Drink a certain drink only (no crossing) for the same night, and check how you feel the next 2-3 days. Try the same for another drink next time. Compare to see which drink made you (potentially) feel more discomfort, if any.
• Pace yourself with water when drinking. Some nice principles to have: one glass of water for one drink, or drink a big sip of water every time you come back from the bathroom. Or every cup of water for every shot.
• Set a rule in advance. In social outings where you know people will drink more than a glass, set yourself a rule before you head out and stick to it. ‘Tonight I will only have two glasses max, no exceptions.’
• Drink before you head out. If you’re particular about your alcohol choices, such as only drinking gluten-free drinks or simple low-sugar cocktails, but you still want the buzz, then you might want to pre-drink before heading out. It also makes sense for the wallet.
• Don’t drink on an empty stomach. Prefer to have it at least halfway through the meal. This might be easier on the digestive system.

This photo shows low-calorie drinks for those who care about weight control:

In final summary: 

• If you have mild to moderate eczema: don't worry too much and enjoy a beer or two, ideally low alcohol content and not enhanced with special flavors. For wine it depends on whether you react to it or not. For cocktails and spirits, ideally opt for low sugar drinks. Pure spirits over cocktails.
• If you have moderate to severe eczema: the simple suggestion is abstinence. If you must, then set a personal rule. For example, I can only drink one beer once every two weeks or once per month. Or I can only drink a gluten-free low alcohol content spirit like plum wine or sake once every few weeks. Or I can only drink during public holidays. Or during special occasions.

Do you have any tips or questions? Email me and share them over and I can include them in this article.

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