DR MEGAN ROSSI: How to enjoy a festive drink without the hangover! trends now

Are you the sort who feels rotten after just one glass of wine, while your friends can down half a bottle or more and feel just fine?

There are many reasons people react to small amounts of booze badly — even the make-up of your gut microbes can play a part — and there are steps you can take to help.

People who feel ill after only one or two drinks often presume they have some sort of allergy to alcohol. In fact, a true allergy is really rare and the symptoms, such as difficulty breathing and abdominal pain, for example, tend to be severe enough to ensure you never touch a drop again.

More common is an alcohol intolerance. This is usually linked to a genetic fault, which means you produce a less active form of an enzyme called aldehyde dehydrogenase.

The liver initially breaks alcohol down into acetaldehyde and, at this point, this enzyme should get to work turning it into acetic acid (the main component of everyday vinegar).

If aldehyde dehydrogenase doesn’t do its job, then acetaldehyde, which is toxic, lingers in the body, causing a cascade of symptoms that often include nausea and vomiting as the body tries to expel it — as well as headaches. It can also cause the blood vessels to widen, leading to facial flushing and a stuffy nose.

How much alcohol anyone with an intolerance can withstand before feeling sick varies — I see people in clinic who can hold a few glasses fine and others who can barely sniff a drink. I’m afraid the only way round this one is to find your limits.

For others, it may be a component of booze — not the alcohol itself — that’s the problem: for instance, the gluten in beer or sulphites added as preservatives to wines and also present on the grapes (levels tend to be higher in white wines). 

Sulphites can trigger a range of symptoms including stuffy nose, wheezing, hives and bad hangovers — people with eczema and asthma can be especially sensitive to them.

Swapping to organic wines might help — while they’ll have some sulphites from the grapes, they won’t have added sulphites, so might be easier to tolerate.

A study published in the European Journal of Clinical Nutrition in 2019 found that switching to organic wine led to fewer alcohol-induced headaches among those sensitive to sulphites.

Histamines in wine and beer can also cause a problem. This chemical is produced as part of the fermentation process and can trigger a hot, red face, hives, nausea or diarrhoea when you drink.

The histamine level can vary with the drink, depending on the vintage, type and fermentation process (red wine contains more than white, with 60 to 3,800 micrograms per litre, while white has between three and 120 micrograms), so it’s a question of trial and error to see which suits you.

A more surprising factor in all this is the health of your gut microbes. Research suggests that they support the work of the liver — the so-called gut-liver axis.

So, if your gut microbes are not in good shape, your liver might not be processing alcohol as effectively as it could.

While our understanding of the link between gut microbes and liver function is still in its infancy, one study from the Institute of Liver and Biliary Sciences in New Delhi, India, in 2017, found that giving people with liver disease a daily faecal transplant (ie, a treated stool transplant, which provides a new community of gut microbes) for a week brought about ‘significant’ improvements in liver function, and that improvement remained a year later.

What we do know for certain is that excess alcohol can impact our gut microbes, especially those higher up our gut, where the alcohol is absorbed.

In turn, they produce less of the organic fatty acids such as butyrate that help fuel the protective gut lining: at the same time, alcohol itself

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