Suddenly, drinking alcohol makes me sick!

Dear Alice,

I have never had a problem with alcohol tolerances in the past. I could drink at least four or five drinks and be fine that night and the next morning. Now, I find myself getting violently sick after drinking just one or two. Even after a glass of wine I want to puke it up. Is there something physically wrong with me? I know the obvious solution is to stop drinking entirely. But, I shouldn't be this sick after drinking just one drink. Have you ever heard of this before? Can you help me figure out the problem?

Dear Reader, 

Although frustrating, it’s possible to develop a resistance to a specific food or drink later in life that never caused any problems in the past—even with alcohol, many people notice changes in how much quicker they feel the effects even after years of drinking. These changes can be caused by biological, psychological, and social factors that influence how you feel when you drink alcohol including age, diet, the type of alcohol consumed, or even past experiences with that drink.  If you're concerned about your physical well-being, consider visiting a health care provider to discuss what steps you can take to prevent this sickness in the future. 

As you age, your body will start to process alcohol more slowly, which means it takes fewer drinks to become intoxicated. The older you get, the stronger the effects of alcohol may feel, even when you drink the same amount as before. Drinking without eating beforehand can also increase the chances of feeling unwell, as the food helps slow the rate of alcohol absorption. Alcohol contains biologically active compounds, known as congeners, which contribute to the taste, smell, and look of a beverage. Drinks with fewer congeners may lead to less severe hangover symptoms, including nausea, than drinks with more congeners. Often drinks containing a higher content of pure alcohol, such as gin or vodka, have fewer congeners compared to drinks with less pure alcohol, such as red wine or whiskey. 

Certain medications can also affect how one’s body metabolizes alcohol such as: 

  • Aspirin: increases risk of stomach or intestinal bleeding 
  • Antihistamines: including cough suppressant and allergy medicines can causes sleepiness 
  • Acetaminophen: increases risk of liver damage when taken in large doses 
  • Medicines with high alcohol content (cough syrups, laxatives): compound alcohol effects 
  • Sleeping pills, pain pills, anxiety/anti-depression medicine: can be deadly 

List adapted from National Institute on Alcohol Abuse and Alcoholism

While the list is by no means exhaustive, it can serve as a starting point in helping you to understand why you may feel the way you do after drinking if you are someone who takes these medications. It’s recommended to consult with a health care provider prior to taking any medications to discuss potential drug interactions. You can also consult the medication’s warning label to understand whether it should be avoided in combination with alcohol. 

It’s also possible that your alcohol-induced nausea is a gastrointestinal issue. Alcohol irritates the lining of the stomach and intestines and slows digestion, which increases fats in the liver and stomach and secretions from the pancreas. This can cause an upset stomach and nausea. Over time, if continued alcohol consumption causes enough damage to the stomach lining, it can result in the development of a condition called alcoholic gastritis. Alcoholic gastritis is one of many health conditions, such as high blood pressure, ulcers, sleep apnea, and severe acid reflux, that require abstinence from alcohol altogether in order to treat symptoms. 

Feeling sick after just one drink could also mean that you’ve developed an allergy to something in that drink. A few common ingredients found in alcoholic beverages that can cause an allergic reaction are sulfites and histamines, both byproducts of fermentation, as well as certain types of grains. Sulfites are often used as a preservative to make the alcohol last longer, while also helping to prevent contamination from bacteria or other microorganisms. An allergy to any of these ingredients can cause nausea, as well as rash, swelling, stomach cramps, and difficulty breathing. 

Finally, there is a genetic condition called metabolic intolerance, in which one of the enzymes that helps the body to break down and process alcohol is missing or not as effective, which can cause people to feel sick when drinking even a small amount of alcohol. Although alcohol intolerance can affect anybody, those of East Asian origin are more likely to inherit the genetic mutation that causes alcohol intolerance, making them more susceptible to developing the condition. 

With so many potential factors, it's hard to know for sure what's caused this shift in your body's response to alcohol. Considering the myriad of possibilities behind your sudden nausea and lowered tolerance for alcohol, you may find it helpful to make a list of any recent changes in your life like new medications, other medical conditions, dietary changes, stressful events, and anything else you think could be related. After making a list, you may choose to meet with a health care provider to discuss the changes you've observed and gain insight into your situation. 

In health, 

Last updated Jun 02, 2023
Originally published Apr 09, 2004

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