Some people are reporting alcohol intolerance after a COVID-19 infection. There’s little research on the symptoms, and doctors believe it could be a form of long COVID.
Last December, only three months after my first COVID-19 infection, I got the latest vaccine booster. The next day I felt unwell, and the day after that I tested positive a second time for the virus.
It was a bad stroke of luck to catch COVID before the vaccine had time to build resistance in my body. Thankfully, I was negative within a week — a mild case, or so I thought. Immediately after recovering, I noticed something was off. Every time I drank alcohol my face would feel hot and flush red. Then I’d get dizzy and a deep exhaustion would set in.
Three months later, those reactions haven’t gone away. If I have even one drink, I’m so lightheaded and fatigued that I can’t even contribute to a conversation. It’s beyond simply feeling tired or sleepy — more like a deep lethargy that even makes sitting upright on a barstool difficult. The experience of drinking has become so unpleasant that I’ve pretty much stopped entirely, forfeiting the nightly glass of wine I usually sip while I cook dinner. Gin, I’ve discovered through trial and error, is tolerable in small doses, but even then, I don’t feel great.
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Turns out, it’s not just me.
Last month, I posted about the phenomenon on Instagram, and a dozen friends said they were experiencing the same thing. Many had symptoms like mine.
“I’ve been avoiding going out to drink because I almost instantly feel exhausted,” one friend told me. “I just want to go home and lie in bed.”
The more I talk about my symptoms, the more people tell me they’ve noticed the same thing happening to them.
So, I reached out to UCSF to see if doctors were on the case. They referred me to Stanford University, where long COVID specialists had conducted a small study on alcohol intolerance post-infection.
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The study reviewed the symptoms of only four patients, but all of them had a noticeable and severe reaction to alcohol after a COVID infection. They reported horrible hangovers, headaches and a breakout of rashes after just one drink. Notably, researchers wrote that the exhaustion immediately experienced after drinking sounded a lot like what happens to people with chronic fatigue syndrome, another common form of long COVID.
That my newfound alcohol intolerance could be a form of long COVID shook me. I’d always associated that with severe and disabling problems, not something as inconvenient as feeling exhausted after drinking a glass of wine.
Curious about what was happening inside my body, I called Dr. Hector Bonilla, co-director of the Stanford Post-Acute COVID-19 Syndrome Clinic, and an author of the study.
Unfortunately, he didn’t have definitive answers.
“What happens to these patients, and why they are alcohol intolerant, it’s not clear,” he told me.
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One theory in the study is that changes in the gut microbiome after infection could affect the absorption of alcohol. Another theory Bonilla has explored is that inflammation caused by COVID may weaken the blood-brain barrier, which could increase sensitivity to alcohol.
“The brain is very selective,” Bonilla said, calling the barrier “a gatekeeper.” If that barrier is compromised, he told me, it can result in the types of symptoms he’s witnessed in his clinic.
When I asked if I would ever be able to drink again, Bonilla said he didn’t know.
“We have no data on if it fades over time,” he told me. “We don’t know if the brain will heal in these patients or not.”
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I left the call feeling even more unsure about what was happening to me.
Had COVID really done something to my brain? How serious was this?
I reached out to my doctor, who hadn’t heard of alcohol intolerance developing after infection. A gastroenterologist who reviewed my symptoms said I could have an enzyme deficiency that affects my ability to metabolize alcohol — something commonly seen in patients of Asian descent (of which I am not). They ordered blood work to study my liver enzyme levels but cautioned me that it may be inconclusive.
“I don’t know if we can say with any kind of certainty why your body is responding this way,” I was told.
The test results came back the same day I’d had blood drawn.
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“I am happy to inform you that the results of your recent liver lab work are fine,” my doctor said.
I felt mixed. On the one hand, a healthy liver is nothing to be upset about. My alcohol intolerance isn’t life-threatening, and considering how severe long COVID can get, I’m lucky. But the mystery of what has happened to my body remains. While I never drank a lot, it’s changed my social life. Bars don’t have the same appeal, and I’ve found most non-alcoholic drinks on offer at my favorite dives to be uncreative and disappointing.
Beyond this inconvenience, however, is a newfound knowledge of how COVID can affect our bodies and lives beyond what research has taught us. There’s so much we don’t know about this virus.
And it scares me.
I’m now back to wearing a mask on public transit and in grocery stores, and I feel skittish about attending events with lots of people. If alcohol intolerance happened to me after a fairly mild bout of COVID, what could happen after another infection?
I don’t want to find out.
Reach Nuala Bishari: nuala.bishari@sfchronicle.com
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