Alcohol Intolerance: Causes, Symptoms & Treatment

A hangover in the morning, feelings of warmth and facial flushing after drinking alcohol are probably familiar to everyone. But what if these symptoms occur after drinking very little alcohol, no more than a quarter? Then one speaks of a pathological alcohol intolerance and colloquially of an alcohol intolerance.

What is alcohol intolerance?

Those who suffer from alcohol intolerance should rather refrain from drinking alcohol. When alcohol is consumed, symptoms such as facial flushing or a strong heat radiation usually follow initially. An intolerance to alcohol, that sounds to non-affected people at first like an excuse of a dry alcoholic or teetotaler. Until he experiences the affected person under the slight influence of alcohol. Then a drunkenness, as it would be expected only with 2 per mille, a strongly reddened and swollen face, heart palpitations, stomach pain, hot flushes and a hangover lasting for days occur, if the meal contained an amount of alcohol, which others would hardly notice or only a sip was drunk. These strong reactions are known from Asians, whose alcohol intolerance is attributed to a genetic cause, and in cases of liver damage. However, healthy people in Western Europe who do not need to take medication can also suffer from these severe, allergy-like, reactions to alcohol.

Causes

The causes of alcohol intolerance are mostly gene mutations and a reduced performance of the alcohol- and aldehyde-degrading enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase 2 (ALDH) due to these mutations. Due to the deficient performance of ADH and ALDH, alcohol levels rise faster and fall slower than in people not affected by this genetic defect. Not only the alcohol intolerance is problematic, but also the increased concentration of alcohol and acetaldehyde in the body caused by it. This is because an excessively high level of alcohol in the blood represents a poisoning of the body, which can cause further damage to the person affected. It is scientifically proven today that Asian population groups, i.e. Vietnamese, Japanese, Koreans and Chinese suffer more frequently from alcohol intolerance than Europeans and Americans. The reasons for this significant increase are not sufficiently researched. Evolutionary biologists suspect the strong selection pressure of the Middle Ages as the cause. While in the European Middle Ages people with a pronounced resistance to alcohol were in demand, in the Asian region of the time alcohol played a less dominant role. Another reason could be that since ancient times in Europe drinks were often mixed with alcohol, for example wine or beer. In Asia, on the other hand, tea was mostly drunk. This could have led to a gene mutation in Europe. Other causes of alcohol intolerance are liver and kidney damage, for example due to increased alcohol consumption in the past, and autoimmune diseases. In particular, sufferers of the thyroid disease Hashimoto report severe reactions to alcohol. A rare cause of alcohol intolerance is temporary and becomes apparent when taking medication.

Symptoms, complaints, and signs

Alcohol intolerance typically manifests as headache and nausea. If larger amounts of alcohol are consumed, redness and swelling of the face occur. Accompanying this, the heart rate increases – heart palpitations and, rarely, cardiac arrhythmias occur. Blood flow to the vessels also increases and there is increased heat radiation, so-called hyperthermia. This increases the risk of hypothermia, which in turn is manifested by shivering, freezing, a slow pulse and a blue coloration of the lips and fingers. The digestive tract is unable to process the alcohol, which can cause stomach pain, diarrhea and constipation. Externally, alcohol intolerance can be recognized by the rapid appearance of redness on the face and a glazed look after alcohol consumption. Gait disturbances and functional deficits may also occur. Alcohol intolerance also causes typical symptoms of an allergic reaction. Those affected often suffer from dizziness, fever or skin irritations. Typical signs also include muscle and limb pain and a long-lasting hangover. Alcohol intoxication is associated with severe malaise and gastrointestinal complaints.In severe cases, withdrawal symptoms such as the characteristic finger tremor and elevated blood pressure occur.

Diagnosis and course

There is no definitive diagnosis of alcohol intolerance. This is because, although some holistic medical practitioners include alcohol intolerance among the food allergies, recognition and research into it have been omitted. While many food allergies can be clearly identified by the prick test and other allergy tests, those affected by alcohol intolerance are dependent on self-diagnosis. This requires good, realistic self-observation: just because you reacted violently to alcohol once does not mean you suffer from alcohol intolerance. Circumstances can also be decisive, for example, you may not have eaten enough that day. However, if one always reacts violently and far more extremely than others to even very small amounts of alcohol, one should avoid it and assume an intolerance.

Complications

Alcohol intolerance occurs in only a few people and is rather uncommon in Europe and the West. Those who suffer from alcohol intolerance should rather refrain from drinking alcohol. When alcohol is consumed, symptoms such as facial redness or a strong heat radiation usually follow. The affected person feels sick and becomes warm. The body cannot break down the alcohol properly, which can also lead to panic in some people. In a few cases, alcohol intolerance is also followed by increased heart rate, headaches and also problems with the stomach. These mainly occur when alcohol intolerance is developed due to abuse of alcohol. However, alcohol intolerance can also be genetic and can occur even if the sufferer has never consumed alcohol. There is no really recognized treatment, because the liver cannot be trained to break down alcohol better. The affected person should therefore not consume any alcohol and always prefer the non-alcoholic variant when drinking alcoholic beverages. This protects the liver in particular. As a rule, the symptoms are similar to those that occur in a healthy person. However, in people with alcohol intolerance, only a very small amount of alcohol is necessary for this.

When should you go to the doctor?

If signs of intolerance keep appearing after alcohol consumption, a doctor should be consulted promptly. An immediate visit to the doctor is recommended if severe physical symptoms such as fever, chest pain or stomach cramps occur. Medical advice should also be sought for symptoms such as diarrhea, itching or skin changes, so that the cause can be clarified quickly and appropriate therapy can be started. In the case of mild symptoms, an allergy test at the family doctor is recommended. Repeated complaints after drinking alcohol are a sign of alcohol intolerance. A visit to the doctor is necessary if the symptoms mentioned are unusually severe or recurrent. High-risk groups such as pregnant women and people with pre-existing cardiovascular conditions should see a doctor immediately if they experience symptoms of this kind in order to avoid health complications. If severe symptoms such as vomiting, shortness of breath or cardiovascular problems occur, a hospital should be consulted. If anaphylactic shock is suspected, emergency medical services must be called in immediately. Accompanying first aid measures must be initiated, as there may be acute danger to life.

Treatment and therapy

For understandable reasons, there are no measures against alcohol intolerance:

If such a remedy were to be marketed, it would simultaneously enable those not affected to consume more alcohol. This is because the enzymes ALDH and ADH react to drugs, but they cannot regulate themselves whether the alcohol level is still within limits or is excessive. Drugs that can enable its consumption in the case of alcohol intolerance or avert severe symptoms after accidental ingestion would therefore not be approved and, accordingly, are not part of research.

Outlook and prognosis

As a rule, alcohol intolerance does not lead to any particular complications or symptoms if the affected person abstains from alcohol.Although this renunciation can restrict everyday life and the quality of life for some people, it does not represent a restriction for the health of the affected person. However, if the patient consumes alcohol despite an alcohol intolerance, redness of the skin and swelling of the face may occur. Likewise, there is a faster heartbeat and patients often suffer from severe stomach complaints and pain in the abdomen. Furthermore, there is also a relatively long-lasting hangover. Patients also experience headaches and aching limbs. Alcohol intolerance can be detected relatively easily by an allergy test, so there is no need for delayed diagnosis or treatment. The treatment itself usually takes place through the exclusion of alcohol from daily life. This allows the complaints and symptoms of alcohol intolerance to be completely isolated. The life expectancy of the patient is also not reduced by this disease. It is usually impossible to predict whether alcohol intolerance may spontaneously resolve later in life.

Prevention

Affected individuals are therefore advised to take preventive measures to adjust to their intolerance. Due to the very different tolerance levels, so some sufferers tolerate a few milliliters and others not a sip, attention must be paid to the individually correct amount. It is important for many sufferers to know that, contrary to popular belief, alcohol does not boil away. In fact, such a large residual amount of alcohol remains with each method of preparation that sufferers can experience symptoms when apparently “enjoying” it. After being diagnosed with alcohol intolerance, patients face a high level of personal responsibility. They must limit or even completely stop the consumption of alcoholic beverages and foods. The decision to take alcohol represents a volitional decision. Medications for alcohol intolerance do not exist. They would raise the tolerance of alcohol, which is counterproductive in view of the health risks. Examinations by a physician have no influence on the occurrence. They can only document the actual condition. Thus, follow-up care is not of considerable importance. However, if sufferers cannot keep their hands off alcoholic products and the familiar complaints of alcohol intolerance keep recurring, a doctor can prescribe therapy. It helps those affected to develop a willpower in everyday life that leads to no ingestion in the first place. Since temptations are present throughout life, this is extremely useful. Forms of aftercare outside the psycho-social field are not possible. In the end, the fact that a life without alcohol is simply happy also causes the lack of importance of aftercare. Drinks or dishes without the addition of the liquid are available on the market in masses. If they are prepared themselves, affected people can usually do without the alcohol content without loss of taste.

Aftercare

After being diagnosed with alcohol intolerance, patients have a high level of personal responsibility. They must limit or even completely discontinue the consumption of alcoholic beverages and foods. The decision to intake represents a volitional decision. Medications for alcohol intolerance do not exist. They would raise the tolerance of alcohol, which is counterproductive in view of the health risks. Examinations by a physician have no influence on the occurrence. They can only document the actual condition. Thus, follow-up care is not of considerable importance. However, if sufferers cannot keep their hands off alcoholic products and the familiar complaints of alcohol intolerance keep recurring, a doctor can prescribe therapy. It helps those affected to develop a willpower in everyday life that leads to no ingestion in the first place. Since temptations are present throughout life, this is extremely useful. Forms of aftercare outside the psycho-social field are not possible. In the end, the fact that a life without alcohol is simply happy also causes the lack of importance of aftercare. Drinks or dishes without the addition of the liquid are available on the market in masses. If they are prepared themselves, affected people can usually do without the alcohol content without loss of taste.

Here’s what you can do yourself

The most effective remedy for alcohol intolerance is to refrain from alcoholic beverages and foods.Depending on the severity of the intolerance, alcohol consumption must then either be greatly reduced or completely stopped. It is advisable to note down the type and severity of the symptoms in a complaints diary. In this way, it can be determined whether the complaints are related to alcohol and which ingredients are responsible for the physical symptoms. In discussion with the doctor, suitable measures can then be taken against the alcohol intolerance. The typical measures help against the actual complaints: drinking a lot, exercise and home remedies such as ginger or chamomile tea. In addition, alcohol intolerance can be mitigated by consuming only unsweetened, chilled beverages. Fresh air and mineral water prevent a hangover, as do a refreshing shower and a full meal before bed. If alcohol intolerance occurs in conjunction with histamine intolerance, dietary supplements such as cromoglicic acid and antihistamines can be taken. In general, however, with a pronounced alcohol intolerance, excessive alcohol consumption should be avoided. If severe symptoms occur quite suddenly, a visit to the doctor is recommended.