ME Association Website Survey: Alcohol Intolerance: ME/CFS and Long Covid

In ME/CFS and Long Covid we know that alcohol intolerance can be an issue for some people, that it is regarded as an additional diagnostic symptom in ME/CFS, and that alcohol consumption can cause an exacerbation of other symptoms. Other people refrain from drinking alcohol because they are too unwell and feel it is sensible or have chosen to abstain from alcohol completely. 

Alcohol intolerance can cause an immediate or delayed (20-30 mins) uncomfortable reaction. Common reactions include nasal congestion, skin flushing (redness), headaches, low blood pressure, nausea, and vomiting. 

We don’t know:  

• why some degree of alcohol intolerance frequently occurs in ME/CFS or Long Covid, 
• if intolerance might be affected by medications, 

Intolerance and adverse reactions to alcohol do sometimes occur in people who have other medical conditions – for example pain after drinking alcohol can be an important early warning symptom of a serious condition called Hodgkin’s Lymphoma. 

There have been 2 research studies completed on this topic in ME/CFS. The 2004 study supported the anecdotal belief that people with the condition reduced or ceased alcohol intake. Two-thirds of those in the study reduced alcohol intake because it increased symptoms, and one-third ceased because ‘it seemed sensible’. The 2023 study indicated that people with ME/CFS were more likely to experience alcohol intolerance, and that those with this symptom experienced more symptoms overall. 

• Woolley, et al. Alcohol use in chronic fatigue syndrome | February 2004. 
• Maciuch, et al. Alcohol intolerance and ME/CFS | May 2023. 

In section 1.2.4 of the NICE Guideline on ME/CFS, it recommends that alcohol intolerance is considered an example of other symptoms: 

“Be aware that the following symptoms may also be associated with, but are not exclusive to, ME/CFS:  

• intolerance to alcohol, or to certain foods and chemicals.” 

Alcohol intolerance – often complete but sometimes partial – is a very characteristic symptom of ME/CFS that can happen quite suddenly right at the start of the illness. We don’t know why alcohol intolerance occurs – partly because very little research has been carried out. There hasn’t been any research on this topic in Long Covid. 

As ME/CFS does not normally affect liver function, where alcohol is metabolised/broken down, it is unlikely that the problem lies there. A more plausible explanation, which links in with the increased sensitivity to drugs that act on the central nervous system in ME/CFS, is that there is a similar sensitivity that involves chemical transmitter systems in the brain that are affected by alcohol. 

Some people report that they are able to start drinking small quantities of alcohol again as time goes on – especially if their health is improving. There is no certain answer as to whether drinking alcohol again is going to cause any harm or delay any natural recovery process if you feel able to drink again.  

Based on patient testimony, it seems that this is safe to do so if this is one of your pleasures in life – providing intake is not in excess, is limited to times when your illness is stable or improving, is not contra-indicated by any medications, and that you are not experiencing any adverse effects after drinking alcohol.

Dr Charles Shepherd, Trustee and Hon. Medical Adviser to the ME Association.

More information 

• Medical matters and alcohol intolerance.   

We’ve received many comments over the years from people with ME/CFS describing their experiences with alcohol. Here is a selection of quotes: 

I used to be able to drink several Cointreau and orange, but on my parents 40^th Wedding Anniversary in 2007 – 3 years after falling ill – half a one sent my head spinning. 

I have noticed, without question, that I am unable to handle and tolerate alcohol to the level that I was able to before ME/CFS. Although I have never been a big drinker, I was able to tolerate alcohol with a likely hangover. Now, I am unable to drink any more than 2 glasses of wine without vomiting a few times. 

From my experience, I have found that my ability to tolerate alcohol has decreased quite considerably. I was never a big drinker, but around the time of being diagnosed with ME/CFS I found that the smallest amount of alcohol impacted my ability to use my legs and since then I have really abstained from it. 

I have had ME for 10 years. I have alcohol intolerance. I am not even able to drink a small bucks-fizz. If I do I get terrible stomach cramps and would feel nauseated or would be sick. I just avoid alcohol completely.  

I have alcohol intolerance. I can get sozzled on half a pint of not that strong cider and go very red in the face. It seems to have got worse the longer I have had the M.E, which is nearly 30 years now. 

I became intolerant to alcohol after ME/CFS started. It’s almost like my body sees it as a poison. 

After getting ME/CFS, I have developed a clear intolerance of alcohol. It triggers a PEM type response – or it feels more like a hangover, but only 30 minutes after consuming. I no longer drink any alcohol. 

We also had comments from other people who do not experience any problems with alcohol, e.g.,:

In 30 years of M.E. I haven’t noticed any adverse effect from the very small amount of alcohol I drink. 

Feedback 

Do you drink alcohol? Have you noticed an intolerance since developing ME/CFS or Long Covid? We would love to hear about your experiences. Email: feedback@meassociation.org.uk 

Please note that we may use selected quotes from the feedback we receive in the literature we produce, on the website or social media. If we do use your quotes they will be anonymised.