How Does Long COVID Affect Alcohol Intolerance and Hangovers?

Since the COVID-19 pandemic started, we’ve been wishing for it to go away. Although developments have been made to lessen the detrimental effects the virus has on our health, long COVID continues to impact us in multifarious ways.

New research has suggested that long COVID may be linked to changes in alcohol tolerance and hangover symptoms. Could a lingering virus be the unsuspecting cause of alcohol intolerance and hangovers? Let’s take a closer look at the science that may help explain this phenomenon.

What Is Long COVID?

Long COVID is a condition marked by long-term symptoms and conditions that occur after the acute two-week period of a COVID-19 infection. The condition is more common in those of us who have had a severe COVID-19 infection or are not vaccinated. However, long COVID may affect anyone. Long COVID symptoms can be ongoing or intermittent and can go on for weeks, months, or years. 

Long COVID Symptoms 

Symptoms vary greatly and continue to be recorded and researched. Due to the wide variation in experiences, symptoms are broken down into smaller categories:

• General. Common feelings of illness such as fatigue, post-exertion malaise, and fever may occur.
• Respiratory. Long COVID sufferers report difficulty breathing, lingering cough, chest pain, and heart palpitations.
• Neurological. Neurological symptoms vary from headache, brain fog, sleep disturbances, dizziness, and pins and needles to depression and anxiety or changes in smell or taste.
• Digestive. Diarrhea, nausea, and stomach pain are common gastrointestinal symptoms.
• Other experiences. Other commonly reported experiences include joint/muscle pain, rashes, and changes in our menstrual cycle. Other long COVID symptoms can be difficult to explain but are similar to those with myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).

Long COVID is associated with a wide range of symptoms; could it also affect our drinking experience?

The Connection Between Alcohol and Long COVID-19

Alcohol has acute and long-term effects on our health, which can directly intersect with COVID-19. While causes of long COVID remain inconclusive, Harvard researchers have found that lifestyle influences could affect the risk of developing long COVID. One of these influences is (drumroll, please) alcohol, but that street can go both ways. 

Research done on post-COVID syndrome notes that poor mental health resulting from disabling post-COVID symptoms could lead to alcohol dependence. This suggests a reciprocal relationship between COVID and alcohol. On one hand, drinking alcohol could increase the risk of developing long COVID. Similarly, long COVID could prompt increased consumption of alcohol — creating a toxic cycle with serious impacts on our health.

In addition to an increased risk of developing long COVID and substance dependence, recent developments suggest a more surprising link between alcohol and long COVID. Anecdotal reports record a sudden onset of alcohol sensitivity and worse hangovers in long COVID patients. Could the virus be the cause?

Does Long COVID Cause Alcohol Intolerance?

Unfortunately, there isn’t a yes or no answer. Long COVID isn’t listed as a definitive cause of alcohol intolerance, although patients have reported symptoms indicative of intolerance. While more research is still needed, at least one peer-reviewed study concluded that long COVID has a causal link to increased alcohol intolerance.

The findings were limited to four patients who were treated at Stanford’s Post-Acute COVID-19 Syndrome (PACS) Clinic. Through these case studies, the researchers concluded that long COVID has similar overlapping symptoms with myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Similar mechanisms that cause intolerance in ME/CFS are used to explain experiences of long COVID:

• Orthostatic intolerance (OI) and autonomic dysfunction. OI is an abnormal response of the nervous system to gravitational changes that lead to inadequate blood flow to the heart and brain. Individuals with OI, commonly seen in patients with ME/CFS and long COVID, may get lightheaded when in an upright position. It's suggested that since alcohol dilates our blood vessels and increases dehydration, it could exacerbate OI and intolerance symptoms. 
• Neuroinflammation. An inflammatory response within the brain or spinal cord has effects on our blood-brain barrier. This change increases sensitivities to alcohol and other substances that can take advantage of a faulty blood-brain barrier.
• Gut microbiome changes. Researchers speculate that changes in the gut microbiome may change the way our body absorbs alcohol. In addition, alcohol also alters the gut microbiome and increases permeability. This can further exacerbate inflammation of our gut, liver, and other parts of our body. 
• Mitochondrial dysfunction. Patients with long COVID are reported to have elevated prostaglandin E2 levels, which causes more severe infections. This can contribute to alcohol sensitivity that is also commonly seen in patients with Hodgkin’s lymphoma, also characterized by elevated prostaglandins.

While mechanisms of ME/CFS help explain the onset of alcohol intolerance in long COVID patients, additional research is needed. Along with sudden alcohol intolerance after COVID, anecdotal reports and the four individuals listed in the case study reported varied symptoms of alcohol hangovers.

Effects of Long COVID on Hangovers

Alcohol intolerance is typically an inherited metabolic disorder that is marked by a genetic mutation in the gene that helps us metabolize alcohol. Since those of us with alcohol intolerance are not able to efficiently break down the toxins in alcohol, they have the opportunity to cause greater harm to our body — leading to worse hangovers. Long COVID appears to heighten those impacts: 

• Exacerbated symptoms. Since alcohol intolerance makes it more difficult to process and eliminate the toxins in alcohol, they sit in our bloodstream for longer and have more time to damage our internal functioning. Alcohol intolerance amplifies the toxic qualities of alcohol, leading to a more painful aftermath. 
• Prolonged recovery time. Long COVID can prolong the recovery time of an alcohol hangover. During a hangover, our body works hard to eliminate the toxins in alcohol and return to normal body functions. However, if our normal systems are already impaired, it may take our body longer to heal from the damage of the toxins. 
• Ongoing hangover repercussions. Alcohol can play the Uno reverse card on Long COVID. While Long COVID may exacerbate hangovers, the damper on our immune and other system functions can further wreak havoc on post-acute COVID experiences.

Aside from long COVID, other factors can also contribute to alcohol intolerance and hangovers.

Public Health Impacts of Long COVID, Alcohol, and Their Link

COVID itself has caused devastating impacts on our public health.

Alcohol has also further complicated COVID-19. According to a recent report by the Centers for Disease Control (CDC), indirect impacts of COVID have also caused drastic increases in alcohol-related mortalities during peak COVID years.

Even though we’re supposedly past “peak COVID” years, alcohol-related deaths are on an upward trajectory. While alcohol intolerance and hangovers can often be brushed off as symptoms of drinking, it has greater impacts than we may realize. 

• Alcohol-related diseases. Alcohol intolerance impacts the way our body processes alcohol. Difficulties with metabolizing alcohol not only lead to worse hangovers but also to a greater risk of developing alcohol-related diseases and all types of cancers. 
• Alcohol-related deaths. Long-term health conditions are already the leading cause of alcohol-related mortalities. Since long COVID may trigger the onset of alcohol intolerance, alcohol-related health conditions may be even more common. As a result, alcohol-related deaths may continue to rise at an even more alarming rate.  

The recent developments linking long COVID and alcohol intolerance don’t only serve as additional clarity on the condition. They also present a wake-up call for those of us who have had COVID in the past (or not) to be mindful of our drinking habits.

Should You Drink Alcohol With COVID-Positive Tests in the Past?

Many of us have tested positive for COVID-19 in the past. Is it still okay to drink? New studies confirming the link between long COVID and alcohol intolerance may suggest that quitting or cutting back on alcohol is the best course of action. 

Research is still in its early stages regarding the causes of symptoms of long COVID, but alcohol has been studied for a long time and has conclusively negative health effects. If you choose to drink, the guidelines for moderate drinking will help you navigate a healthy relationship with alcohol.

Navigating Long COVID and Alcohol

Long COVID can be a difficult experience and condition to navigate. Alcohol only adds to that equation. Mindful drinking and intentional practices can help us prioritize our health:

• Cut back/quit alcohol. Quitting or cutting back on alcohol isn’t only for those of us who may be dependent or have an unhealthy relationship with alcohol. Every day is a good day to reduce the intake of toxic substances; it can only help! When recovering from long COVID, our healthy self has the best chance of fighting off the condition.
• Monitor symptoms. Tracking our drinking habits and monitoring symptoms of long COVID and hangover experiences can help us better prevent them. We can identify patterns and triggers that may be unhealthy.
• Explore treatment options. Since long COVID manifests in many ways, modes of treatment options can vary. Common treatment options include occupational therapy, cognitive behavioral therapy, physical therapy, and medication. Many of these can be used to help reduce alcohol consumption as well. 
• Focus on health and well-being. There’s currently no cure or preventative for long COVID, but lifestyle changes are reported to help. Prioritizing a healthy lifestyle through a balanced diet, daily movement, and proper hydration can set us up for success. 

Viruses can be frustrating and fickle, but the more we take care of our body, the better equipped it will be to fight them off.

The Bottom Line

Long COVID symptoms seem to include everything under the sun. Recent studies have added alcohol intolerance and exacerbated hangovers to that list. While these complications are frequently brushed off as side effects of drinking, the consequences urge us to proceed with caution. A horrible hangover, hives, and facial flushing — all symptoms of alcohol intolerance — serve as a big red warning sign  that something is wrong. 

Long COVID is still being studied, but what is conclusive is that drinking alcohol will do more harm than good.