More often than not, “digestive issues” and “subtle” don’t exactly go together. The way your stomach balloons after beer? Hard to miss. But alcohol is bad for digestion in less obvious ways too — and, surprise surprise, sometimes even good for it.

Before cocktail hour, you’ll want to learn what’s what.

For advice, we turned to gastroenterologist Neil D. Parikh, MD, who practices at Hartford HealthCare locations throughout Hartford County.

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In excess, alcohol is bad for digestion at every level.

The indignities don’t end with bloating — or, for that matter, begin there. “Alcohol can negatively impact every layer of your GI tract,” says Dr. Parikh.

Alcohol can:

  • Immediately change how the muscles in your esophagus work, leading to acid reflux.
  • Over time, erode the protective mucous in your stomach lining, affecting your ability to absorb nutrients.
  • Change the balance of good and bad gut bacteria in your intestines, causing diarrhea and bloating.
  • Scar your liver. In severe cases, this becomes irreversible and leads to liver failure.
  • Inflame the pancreas, a painful condition leading to long-term digestive issues.

> Related: Tips to Settle Your Stomach After Overeating

Even in small amounts, alcohol causes acid reflux.

When your favorite alcoholic beverage hits your throat, it relaxes the band of muscles that usually police the passageway between your esophagus and your stomach. Instead of keeping traffic flowing north to south, suddenly some stomach contents may slip back up.

Enter: acid reflux. Many people don’t realize this can happen right away, even just a few sips in.

“If you’re experiencing acid reflux and you drink alcohol even moderately, alcohol is likely contributing,” says Dr. Parikh.

It also raises your risk for GI cancers — as much as smoking.

“Alcohol, once it’s used beyond moderation, is going to lead to serious trouble down the road,” says Dr. Parikh. “That includes cancer.”

In fact, alcohol is considered a carcinogen by most studies. Among many other types of cancer, it’s a common contributor to esophageal, colon and liver cancer.

But there’s an exception: red wine.

If you’ve been skimming in desperation for good news, here it is.

“Not all alcohol is necessarily bad for you. There may be some benefits from drinking red wine,” says Dr. Parikh.

Studies show red wine may boost the diversity of good bacteria in the gut, similar to probiotics and fermented foods. This is largely attributed to polyphenols, compounds found in the skin of red grapes, which have antioxidant and other health benefits.

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Do any other types of alcohol have digestive benefits?

A major 2020 study found that red wine had the most positive potential effect on gut health. White wine was a distant second. No other alcohols even made the list.

For what it’s worth, we lay people aren’t the only ones excited about the red wine effect. In a recent scientific talk about the gut microbiome, Dr. Parikh’s slide about red wine’s benefits was by far the most popular among his peers.

“This is not to say that everyone should go home and drink a bunch of red wine,” says Dr. Parikh. “But it’s certainly interesting.”

In other words, it might be time to reconsider your signature drink. Who needs the indignity of beer bloat, anyway?