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Q. After quitting alcohol, I face stomach bloating and discomfort. Why?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 09, 2020 and last reviewed on: Sep 02, 2020

Hello doctor,

I am 32 days sober. I am a 4-year-old female. I drank about half a bottle of wine at night for the past year. Prior to that, I had a couple of drinks a night about two nights a week. I also had a very bad sugar and carb habit. In the second week of sobriety, I cut out almost all sugar and limited carbs.

I noticed some bloating in week two of sobriety. About ten days ago, this got severe. I look like I am six months pregnant. I have also had symptoms of IBS, and heartburn but they are getting better daily. I have no blood in my stool, my skin looks great. Bloating is the horrible thing that I am facing. I am drinking a large amount of water, but urinating only a little.

Is this just my body resetting itself? I know alcohol is very damaging to the digestive system. I cannot tell is this bloating is gas or water. I am worried at this point because I want it to resolve and it is giving me anxiety.

Dr. Ajeet Kumar Lohana

Medical Gastroenterology
#

Hello,

Welcome to icliniq.com.

Well, congrats for able to cut down your alcohol intake. That is really wonderful to hear. But are you completely abstinent fron it or have moderated the amount?

Yes, you are right this is possibly a resetting within the body. The body do adopts things particularly within liver, and gastrointestinal tract after abstinence of alcohol and after setting withdrawal symptoms. The alcohol particularly common to causes slowing of bowel and can causes various mineral deficiencies and vitamin deficiencies which could manifest once alcohol is stopped even. I am writing some multivitamins which you should take for one month time.

For bloating, I am sure, since you have been cutting carbs and sugar in your diet, that the part of gas production in the gut is secondary to food we take in. The carb is one such food content that can ferment within human gut and can produce excessive gases.

Plus there is a long list of foods with high FODMAPs content. And they should be avoided as well. I suggest you to take tablet Metoclopramide 10 mg thrice daily half an hour before meals for a two week duration. I really hope with the food precaution as mentioned above, and with this medication, you would have your problem solved.

Update me in 2 week time if symptoms still persist, I may consider giving you some investigations and some add on treatment, should the problem persist.


Treatment plan:

Tablet Revital once daily. Low FODMAPs diet. Take tablet Metoclopramide 10 mg thrice daily half an hour before meals for two weeks.

Regarding follow up:

Follow up as specified.


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Thank you doctor,

I am finished with alcohol. I never had a problem in my life and was a very light social drinker. My father passed a year and a half ago and my use increased, and then the pandemic really ofcourse unsettled me and I started drinking wine daily night. Prior to this, I drank Bourbon. I have a feeling I probably have this gut issue because of the yeast in the wine. I grew tired of my behavior and feel strong enough now to deal with my grief and fear issues. I have a psychotherapist and that has been very helpful. So far, I have had no problems with quitting except for this gut issue. No cravings and no interest, happy to feel clearer now.

I have secured a similar vitamin to Revital and I am taking it. I am excited about the FODMAP diet and started following it yesterday. Metoclopramide is the prescription only here, so I am not sure how I am going to obtain that. Do you feel it is absolutely necessary to recover?

Lastly, I know everybody is different, but can you estimate how long before I start feeling and seeing some relief from the bloating? It is just so uncomfortable and is majorly interfering with my sleep.

Dr. Ajeet Kumar Lohana

Medical Gastroenterology
#

Hello,

Welcome back to icliniq.com.

Well, alcohol is basically a fermentation of the carbohydrates like fructose, and sugar polyols such as sorbitol, etc. The part of this fermentation ofcourse carried out by yeast, but in it is purified form, no traces of active yeast is present. So unlikely that be the reason of your bloating. However, as I said in my previous response, the alcohol does cause slowing of the bowel and stomach, and can also alter the microbiota (the microorganism present in human gut harmlessly). These microbiota are basically the reason of excessive production of the gases. Actually, slowing of bowel and excessive of gas producing bacteria are both autonomously perpetuated by one another. The long term symptoms control would be with alcohol abstinence which you have been successful to do already, the second thing to control for a long term is food precaution and some antibacterial medications (Rifaximin to be precise) followed by a course of probiotic medication.

The Metoclopramide is basically to control your bloating for a short term, to span the time until the avoidance of FODMAPs starts working. So to answer your concern if is really necessary, the answer is no.

The reason why I asked you to follow after two weeks was to assess your symptoms whether FODMPAs avoidance correct the problem. In case, it does not, then I would consider giving tablet Rifaximin 200 mg thrice daily for three weeks. I am afraid that it is also a prescription medication. So what now I suggest you that, start avoiding high FODMAPs diets, and tablet Metoclopramide (if available OTC), or Motilium (Domperidone) 40 mg one tablet thrice daily half an hour before meals, or tablet Ondansetron 8 mg thrice daily half an hour before meals can be used for a period of two weeks only.

I hope Motilium is OTC, if I am not wrong. So lastly, I really hope that your symptoms should start showing some improvement nearly 50% by this two-week time period. If nothing improves, I would suggest you tablet Rifaximin 200 mg thrice daily for 21 days.

I hope this helps.


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Again, thank you for your kindnesses and vast knowledge. I appreciate it all so much. I will check in within 14 days and let you know how things are!


Warmly,

Renna

Dr. Ajeet Kumar Lohana

Medical Gastroenterology
# It is all my pleasure. Thanks for such kind remarks. I appreciate it too.
Sure we can discuss things after 2 weeks, and will take from there.
take care and have a great day.

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