Theo Nash
Alcohol intolerance is a condition where the body cannot break down alcohol efficiently. It is caused by a genetic mutation that affects the body's ability to produce certain enzymes, namely alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), which are responsible for metabolizing alcohol. People with alcohol intolerance may experience unpleasant symptoms such as flushing of the skin, nausea, stuffy nose, and headaches even after consuming small amounts of alcohol. These symptoms can appear quickly and usually subside once the alcohol is metabolized or leaves the system. While alcohol intolerance is typically a lifelong condition, it can also develop suddenly due to changes in enzyme activity caused by age, hormonal shifts, or other triggers. Additionally, certain medications can interfere with the body's ability to process alcohol, leading to similar symptoms. The only way to prevent these symptoms is to avoid alcohol or limit consumption, as there is currently no cure for alcohol intolerance. It is important to distinguish alcohol intolerance from alcohol allergy, which is an immune system response to ingredients in alcoholic beverages and can cause severe allergic reactions.
| Characteristics | Values |
|---|---|
| Alcohol Intolerance | Skin feels warm, nausea, skin flushing, stuffy nose, headache |
| Alcohol Allergy | Rashes, itchiness, swelling, stomach cramps, hives, swollen lips or throat, difficulty breathing, anaphylaxis |
| Alcohol Use Disorder | Craving the next drink, withdrawal symptoms, drinking despite health, safety and relationship risks |
| High-Risk Drinking | Drinking more than 14 units of alcohol a week, heavy drinking, drinking heavily in a short amount of time (binging) |
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What You'll Learn
Alcohol intolerance
The symptoms of alcohol intolerance include flushing (a red face), rapid heart rate, headache, low blood pressure, hives, runny nose, dizziness, and stomach pain. These symptoms typically appear quickly and usually resolve when alcohol is metabolized or removed from the system. Alcohol intolerance can also cause immediate, uncomfortable reactions after drinking alcohol, even in small amounts. The most common signs are a stuffy nose and skin flushing.
It is important to note that alcohol intolerance is not the same as an alcohol allergy, which involves the immune system reacting to specific components in alcoholic beverages. Alcohol intolerance is a lifelong condition with no cure, and the most effective strategy to manage symptoms is to limit or avoid alcohol consumption. However, some lifestyle adjustments can help, such as choosing drinks low in sulfites and other preservatives, staying hydrated, and eating before consuming alcohol.
If you are experiencing any unpleasant symptoms after drinking alcohol, it is important to consult a healthcare professional to determine whether you have an alcohol intolerance or allergy and to receive guidance on managing the condition effectively.
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Alcohol allergy
Alcohol intolerance is distinct from an alcohol allergy. Alcohol intolerance is a genetic metabolic disorder of the digestive system, whereas an alcohol allergy is an immune system response to an ingredient in alcohol.
An alcohol allergy is an immune system response to an ingredient in alcohol. It is not an allergy to alcohol itself, but rather to substances in alcoholic drinks, such as:
- Chemicals, grains or preservatives
- Sulfites
- Sodium metabisulfite (a preservative found in beer, wine and champagne)
- Salicylates
- Egg and seafood proteins
- Fruit or nut-based liqueurs
- Hops
- Barley
- Wheat
- Rye
- Histamines (found in red wine and some beers)
Symptoms of an Alcohol Allergy
The symptoms of an alcohol allergy are often more painful and uncomfortable than alcohol intolerance symptoms. They include:
- Rashes
- Itchiness
- Swelling of the lips or throat
- Severe stomach cramps
- Difficulty breathing
- Anaphylaxis
Diagnosis of an Alcohol Allergy
If you suspect you have an alcohol allergy, it is important to consult a healthcare professional. Diagnosis can be made through a combination of self-observed symptom tracking, a detailed medical history, and a physical exam. Allergy tests such as skin prick or blood tests may also be conducted to identify specific allergens.
Treatment of an Alcohol Allergy
The only way to prevent an allergic reaction is to avoid alcohol or drinks containing the substance causing the allergy. An elimination diet may be recommended, which involves avoiding the suspected allergen to see if symptoms improve.
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Alcohol use disorder
Alcohol intolerance is a common reason why some people don't handle alcohol well. It is caused by a genetic condition that affects the body's ability to break down alcohol efficiently. Even a small amount of alcohol can cause an unpleasant reaction, such as flushing of the skin, nausea, congestion, or headaches. These symptoms usually resolve when alcohol is metabolized or removed from the system. Alcohol intolerance is not an allergy, but allergies to ingredients in alcoholic drinks, such as grains or preservatives, can also cause adverse reactions.
In addition to alcohol intolerance and allergies, some people may have alcohol use disorder (AUD), which is characterized by an impaired ability to stop or control alcohol use despite adverse consequences. AUD is considered a brain disorder that can be mild, moderate, or severe, and it is often perpetuated by lasting changes in the brain caused by alcohol misuse. A person's risk factors for developing AUD include the amount, frequency, and speed of alcohol consumption, as well as age, gender, genetics, family history, and mental health conditions.
The severity of AUD is assessed by healthcare professionals using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is classified as mild, moderate, or severe based on the number of criteria met, with mild AUD exhibiting two to three criteria, moderate AUD exhibiting four to five criteria, and severe AUD exhibiting six or more criteria. Some of the criteria used to assess AUD include whether drinking has interfered with taking care of personal or family responsibilities, caused job or school problems, led to risky situations, or caused an individual to give up important activities.
Treatment options for AUD include behavioral therapies, mutual-support groups, and medications. Behavioral treatments aim to change drinking behavior through brief interventions, reinforcement approaches, motivation-building, teaching coping skills, and mindfulness-based therapies. Mutual-support groups provide peer support for stopping or reducing drinking and are often available at low or no cost in local communities. Three medications approved by the U.S. Food and Drug Administration to help reduce drinking and prevent relapse are naltrexone, acamprosate, and disulfiram, which can be used alone or in combination with behavioral treatments or mutual-support groups.
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Hormonal changes
Alcohol can have a significant impact on hormonal changes in both men and women. When alcohol enters the body, it passes through the small intestine and into the bloodstream, where it can travel to the brain and disrupt the activities of chemical messengers, i.e., hormones.
In men, sustained heavy drinking is likely to result in reduced testosterone levels, negatively affecting overall health. Drinking can also increase oestrogen levels, decrease sexual arousal and function, and alter sperm count and structure, affecting fertility.
For women, heavy drinking can result in increased levels of oestrogen, testosterone, and androgen, leading to alterations in secondary sex characteristics, such as facial hair and muscle mass. Alcohol can also disrupt the menstrual cycle and negatively impact fertility. During menopause, alcohol can worsen symptoms such as insomnia, night sweats, and hot flashes. Additionally, low oestrogen levels caused by heavy drinking can lead to cellular and tissue ageing, impaired immune response, and an imbalance between antioxidant formation and oxidative stress.
Both men and women can experience hormonal imbalances due to alcohol's impact on cortisol, the stress hormone. Chronic alcohol consumption disrupts cortisol regulation, resulting in elevated cortisol levels. Prolonged elevation of cortisol can negatively affect metabolism, immune response, and mental well-being.
Alcohol also interferes with glucose regulation by impacting the hormones insulin and glucagon. This interference can lead to either hypoglycemia or hyperglycemia and can be particularly dangerous for individuals with diabetes.
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Medication and interactions
Medication and alcohol interactions can be dangerous and even deadly. Alcohol can alter the metabolism and pharmacological effects of many common medications, and, conversely, medications can alter the absorption and metabolism of alcohol. People aged 65 and older are at a particularly high risk of harm due to age-related changes in their physiology and their increasing use of medications that could interact with alcohol.
It is important to be honest with your healthcare provider about how much alcohol you regularly drink, as they may use this information to choose which medication to prescribe. For example, if you are taking opioids for pain, you should inform your healthcare provider if you regularly drink alcohol, as they may prescribe an alternative pain medication. Similarly, if you are taking medication for anxiety or sleeping problems, mixing these with alcohol may lead to serious consequences, including fatal overdose.
Antidepressants are another class of medications that can interact harmfully with alcohol. Alcohol may increase the side effects of antidepressants on the central nervous system, such as drowsiness and dizziness, which can raise your risk of falls and car accidents. Alcohol may also reduce antidepressant response and increase feelings of depression or hopelessness. Furthermore, some antidepressants, such as monoamine oxidase inhibitors (MAOIs), can cause a dangerous rise in blood pressure when mixed with tyramine, a byproduct found in beer and wine. Other antidepressants, such as bupropion (Wellbutrin), may lower the threshold for seizures, and alcohol may further increase this risk. Duloxetine (Cymbalta) may cause liver damage, and combining it with alcohol may further increase the risk of liver toxicity.
Other common medications that should not be mixed with alcohol include antibiotics, anticoagulants (blood thinners), arthritis medications, and pain relievers, including over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol). Antibiotics such as Flagyl (metronidazole) can cause a severe reaction when mixed with alcohol, leading to nausea and vomiting. Alcohol can also reduce the effectiveness of antibiotics in treating infections. Anticoagulants, or blood thinners, increase the risk of internal bleeding, and even an occasional drink can increase this risk. Arthritis medications, when combined with alcohol, can increase the risk of stomach ulcers, bleeding, and liver damage. Finally, mixing pain relievers such as NSAIDs and acetaminophen with alcohol can lead to gastrointestinal upset, ulcers, stomach bleeding, tachycardia (racing heart), and liver damage.
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Frequently asked questions
Alcohol intolerance can be caused by a genetic condition in which the body can't break down alcohol efficiently. Symptoms include skin flushing, nausea, a stuffy nose, and headaches. If you experience these symptoms, it is best to consult a healthcare professional.
An alcohol allergy is an immune system response. Even trace amounts of alcohol can trigger severe allergic reactions such as hives, swelling, difficulty breathing, and, in extreme cases, anaphylaxis. If you experience any of these symptoms, seek medical attention immediately.
Regular heavy drinking increases your tolerance for alcohol and puts you at risk of becoming dependent on it. It also increases your risk of developing a range of health problems.
Alcohol use disorder (sometimes called alcoholism) is a common medical condition in which people can't stop drinking, even when it negatively affects their health, safety, and personal relationships. Other signs include craving the next drink, experiencing withdrawal symptoms, and drinking to avoid these symptoms. If you think you may have alcohol use disorder, consult a healthcare professional.
