Ask the GP: My face and neck go red when I drink – is this alcohol intolerance down to menopause?

The relaxation of blood vessels while drinking alcohol can cause flushing, but there are other triggers too. Photo: Getty Images/iStockphoto — © Getty Images/iStockphoto

Jennifer Grant

Question: I’m in my early 50s and have started to notice that not only my face goes red after drinking alcohol, but lately (especially after drinking gin) my whole neck, back and shoulders have started to go red as well, and I get slightly shortness of breath. It doesn’t happen all the time, just once or twice recently, and I’m wondering if this alcohol ‘flush’ is intolerance because of my age as I’ve also heard about increased histamine levels when you are menopausal. Do I have to stop drinking or is there such a thing as a ‘healthy red wine’ to drink? It doesn’t seem to happen as much with red wine.

Dr Grant replies: The average age of onset for the menopause is 51.5 years old. Menopause-associated hot flushes tend to last from three to five minutes and may occur up to 20 times per day.

You describe what is known as flushing with alcohol ingestion, especially gin. There are a few different types of flushing — it can be episodic (occurring now and again), transient (comes and goes) or in some cases, constant. But it is caused by an increased blood flow in the skin secondary to a relaxation of the blood vessels in the skin (vasodilation).

Various stimuli can cause vasodilation and trigger autonomic nervous system responses within the blood vessels of the skin and underlying smooth muscle. Flushing brings a warm sensation to the area of skin involved (most commonly the face) and is accompanied by transient redness lasting from 30 seconds up to 30 minutes.

The face, neck, ears, chest, upper stomach region, and arms may be involved in a flush. Some of the most common causes include emotional blushing, acne, rosacea, alcohol, fever, exercise, exposure to heat, hyperthyroid disorders and the menopause. Of course, you may have both the menopause and alcohol causing your symptoms.

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Just to mention a few medications that may cause flushing as a side effect, such as some antihypertensive agents or chemotherapeutic agents, opioids and sometimes anti-inflammatory painkillers. Some medication only causes flushing when alcohol is consumed at the same time, such as antibiotics metronidazole, ketoconazole, cephalosporins and antimalarials.

Thankfully, in your case, the trigger is known. The rate of ingestion of alcohol and the rate your liver metabolises alcohol by the enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) often determine your tendency to flushing.

The common sense approach is to simply avoid drinking gin, as this appears to be your main culprit. Unfortunately for you, there is no such thing as a ‘healthy’ alcoholic drink. Wine contains many vasoactive substances such as tyramine, histamine, and sulphites that may all contribute to flushing.

It is highly recommended to quit drinking alcohol altogether for overall longevity. Alcohol has negative effects on your quality of deep sleep, mental health, digestive system, your triglycerides and LDL bad cholesterol, your blood pressure, your waistline, your risk of developing diabetes, heart disease and some cancers to name but a few reasons. Maybe substituting alcohol with a healthy lifestyle habit such regular cardiovascular exercise, weight resistance training, reducing sugar and refined carbohydrates would be something you might consider?

Lastly, certain food, especially those containing capsaicin (think chilli, bell, cayenne or jalapeno peppers) can also trigger flushing. Other less well-known food triggers include those containing sodium nitrate (used to preserve cured meats) and sulphites (often found in wine) that can be naturally occurring in some food, or added to preserve it for longer.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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