Why alcohol’s suddenly making middle-aged women sick. I used to love to drink… now I can’t handle half a glass. And doctors have told me the astonishing reasons: ANGELA EPSTEIN

Flopping on to the sofa, glass in hand, I’m waiting for my hard-earned gin and tonic to deliver a warm rebuttal to the stresses of the day. What it does instead is make me feel nauseous.

Not in a run-for-cover-I’m-going-to-throw-up kind of way. Rather, I feel like I’m suffering from a bout of motion sickness.

Yet, ironically the cause of this isn’t what you might think – in fact, I’ve barely managed a third of my drink. What’s more, it’s my first and only one of the day.

Until recently I was able to enjoy more than a drop of the hard stuff – and could down three drinks of an evening on a social basis – without much effect. I’m no lightweight. My tipples of choice, including neat vodka, have never floored me.

But for several months now, the impact has been quite different and alcohol – any alcohol – makes me feel sick.

That extends to the smallest amounts of the most benign drink, such as a flute of low-proof sparkling wine.

It’s a situation which is both baffling and infuriating in equal measure.

I still want a well-deserved kick of alcohol – not only after a long day, but also when I’m out socialising with friends. It just no longer wants me.

And increasingly friends and colleagues of a similar age bracket – mid-40s onwards – say they are experiencing the same involuntary rejection of booze. 

(Meanwhile, there have been anecdotal reports of people having a similar reaction to alcohol after a Covid infection.) The question is, why?

It seems that broadly speaking once we hit middle age, our ability to metabolise alcohol declines.

‘Liver function tends to decrease with age,’ explains Rajiv Jalan, a professor of hepatology at University College London.

‘As such, the capacity of the body to detoxify the liver of alcohol seems to reduce with age, and that may well have an impact on the way people feel when they drink – and cause symptoms such as sickness.’

This might be over a period of time such as a few hours. Or, as in my case, immediately.

‘The sickness we might feel relates to the change as we age in production and activity of alcohol dehydrogenase [ADH, an enzyme which helps break down alcohol] which is an extremely nauseating substance,’ adds Professor Jalan.

‘That’s why it makes you feel sick when you drink, as the toxins will build up in the liver rather than be broken down.’

One problem is that women produce less ADH.

‘These liver enzymes are fantastic at breaking down alcohol but since women are smaller than men, they produce less ADH,’ explains Professor David Lloyd, a consultant hepatobiliary surgeon at University Hospitals of Leicester.

‘So they are more likely to feel unwell after a smaller amount.’

This becomes more problematic for women as our body composition changes – in contrast to men, we have a higher ratio of body fat, lower ratio of water – hence we tend to feel tipsy more quickly (and that is increasingly true post-menopause).

As fat doesn’t absorb alcohol, it stays in the bloodstream at higher concentrations.

Consequently, explains Professor Jalan, the effects of alcohol are increased because it is more concentrated in the body than it was when we were younger.

According to Dr Catherine Carney, a psychiatrist with a specialist interest in addiction treatment based at the Delamere Health clinic in Cheshire, the impact on women in their 40s and 50s can be even more noticeable due to hormonal change around the perimenopause and menopause.

‘During the perimenopause, the liver may become less efficient and it may start to metabolise alcohol more slowly,’ she says.

‘Levels of ADH and ALDH [aldehyde dehydrogenase, another enzyme involved in the breakdown of alcohol] can dip, leading to reduced tolerance and increased propensity to hangover symptoms.’

Yet while women in middle age may struggle to drink much at all, men can continue to enjoy booze as normal, which may explain why men aged 55 to 74 are the UK’s heaviest drinkers — with many admitting they consume almost four times the recommended amount.

Given that I’m still negotiating symptoms of the menopause, it offers some kind of explanation.

But there are other reasons someone can go off alcohol – for example, following an infection, as happened with Gogglebox star Mary Killen six years ago when she was in her early 60s.

After being struck down by campylobacter, a form of food poisoning suspected to have been caused by unwashed home-grown vegetables, she developed an aversion to alcohol so intense that even the very smell of it made Mary sick.

She said: ‘Alcohol made me recoil – reminding me of when I was pregnant with our two daughters, both of whom are now in their 20s. It has completely lost its appeal. I don’t even like the smell of it.’

‘Any kind of previous gut infection may lead to an intolerance of alcohol,’ explains Professor Jalan.

‘This relates to the microbiome – microorganisms which live in the gut and which are needed for our good health. Any kind of gut infection where there is change in the bacteria in the gut may make you intolerant to alcohol.’

The exact mechanisms are not clear but changes to these micro-organisms in the gut can affect the way alcohol is metabolised, making it more difficult to tolerate drink and could lead to nausea.

The same is true of inflammatory conditions – such as rheumatoid arthritis, adds Professor Jalan, as these can impact the gut microbiome. Which in turn could increase production of ADH and so make us feel sick. (As someone with a dodgy knee, it does join up some of the dots.)

Like many aspects of the ageing condition, there doesn’t seem to be anything I can do about my much-missed pleasure of drinking.

It’s hardly likely that I’ll find a doctor who will prescribe something so that I can enjoy alcohol more.

The irony is that in my youth I never needed alcohol either for the buzz or as a way to relax.

It was only as I started juggling work as a journalist with raising four children that I saw its benefits, but strictly at the weekend and rarely more than three glasses of wine, vodka or gin and tonic.

Even so I never felt ill unless, on the rare occasion, I drank too much. (At a friend’s 40th I managed to polish off almost an entire jug of a neon-coloured cocktail and was horribly sick for two days afterwards.)

Irritated as I am, it means seeking other ways to relax.

I’m a huge fan of the Great British pub and enjoy all the other benefits – from the easy camaraderie to the open fires.

My tipple is now a slimline tonic (or even chamomile tea). Hardly a wild choice – but at least it doesn’t make the room spin.