Women's taste in wine can change drastically when they hit perimenopause. Photo / 123RF
Why does tolerating alcohol become so much harder when we're middle-aged? Kate Spicer who has given up white wine, finds out.
Having lunch with four men recently, it came to my turn to choose a bottle. As soon as I tasted the mouth-puckeringly dry Nebbiolo Italian red I was satisfied. This won't give me a hangover, I thought, relishing it's astringency while clocking the visible distaste from the Malbec and Shiraz loving males.
My taste in wine has changed drastically since I hit perimenopause. I've grown to love almost gritty and clear reds because they keep my head clear during and after drinking. Show me a Shiraz and I start sneezing.
I am not alone. Hormonal changes and booze are a favourite topic among friends. "Red wine + menopause + not good news." "Can't drink beer any more, makes me violently ill." "Fine with gin, but I miss wine." "I'm more sensitive now and have become super nerdy about what works for me. Good tequila and lighter reds."
It might not be a randomised controlled trial, but safe to say, tolerance and sensitivity to alcohol changes in menopause. My appalling, call me an ambulance, hangovers after only a few glasses of wine stopped when I went on HRT, but still, I only have to look at white wine and feel the beginnings of a slight headache.
Alexandra Martin, the director of a bakery business in Devon, started noticing around her mid-forties that the glass or two of wine she looked forward to drinking to destress after work, "Was starting to give me allergic reactions. Sneezing and almost flu-ey feelings. My reactions were so bad to the wines I love, which were big ripe and fruity New World reds, it's totally put me off."
The new menopausal aversion to certain drinks is not a problem common to all women, some are just immune or choose to ignore it, as Jo - ex Mrs Ronnie - Wood likes to tell friends, "Didn't have time for the menopause, I was on tour with the Stones," And some women - among my acquaintance any way, believe that alcohol is the only way to get through the damn thing. "Oh, I'm drinking my way through mine," as a friend cheerily told me when I mentioned this piece.
This isn't quite as irrational as it sounds. David Nutt is Professor of Neuropsychopharmacology at Imperial College and says. "There are big changes in hormones, particularly progesterone, in menopause. Progesterone has a particular effect on the brain's GABA system. High progesterone levels makes us calm, when progesterone falls anxiety goes up, it's what causes the menopausal miseries." So when people say they are "drinking through it" what they may technically be doing is trying to recreate the calm that progesterone once did."
This approach worries Dr Louise Newson of Newson Health, a GP who believes hormone replacement therapies are essential for an ageing woman's health, "We see many women in my clinic who tell us they are drinking more alcohol to numb their symptoms and help them sleep. However, this can increase their future risk of osteoporosis and breast cancer, so it's important if women are struggling with menopausal symptoms they receive individualised and evidence-based advice."
Nutt's new book, Drink? The New Science of Alcohol and Your Health has an overarching message is that we should drink significantly less than we currently do as a nation. Menopause also, "Makes you more vulnerable to alcohol withdrawal."
Reassuringly, pleasingly even La Parisienne is not immune. Caroline de Maigret, admits in her co-authored book about midlife, Older but Better but Older, that she no longer drinks white wine because it gives her palpitations, "Which is too bad because I love it but now it gives me nightmares, calf cramps and really hard hangovers. I find myself googling how many aspirins you can take at once as even a little wine leaves me feeling like I'm being hit on the head with a hammer. When 30-year-olds complain about their hangovers, I'm like, 'You just wait…'."
Menopausal or not, male or female, our endocrine system is knocked out of whack by alcohol. Nutt dedicates a section of Drink? to alcohol and sex hormones. Hormones are thrown out of balance by alcohol at any time of life. It's well-known drinking reduces both male and female fertility, for example.
Nutt says, "Menopause is a massive disruption to your brain function. You live 30 years with all these hormones and then suddenly you have none and it can affect taste, your sensitivity to irritants, to flavours and different chemicals in a similar way that women crave odd things like pickled onions when they are pregnant."
Then, throw in the boringly inevitable ageing body. I remember my Dad announcing "No more brown drinks," in his mid-sixties, and in Nutt's book the reason is explained. The more complex, or aged, or colourful a drink is, the more compounds called congeners there are for the liver to process. In tasteless clear spirits there are fewer congeners than in a fine old Burgundy or an Islay malt, which may, as Nutt's book says, contain up to 400 different alcoholic compounds.
What struck me was how everyone's experience was different. Where one held up a low tannic, Austrian red saying, this is all I can drink these days another made signs of the cross with their fingers and backed off weeping praising the merits of good tequila. Anna Tresserra Rimbau is a researcher in human nutrition at the University Rovira i Virgili, "People are different. Our response depends on many factors such as the amount of alcohol consumed, age, gender, genetic, body composition, medical history, drug use, and dietary habits and other factors."
These include loss of an essential alcohol processing enzyme in women's livers, dehydrogenase, and the disruption to our unique microbiomes. But, she adds, "The type of alcoholic beverages consumed is also important since some contain more contaminants or additive such as "sulfites" that may also explain part of the adverse effects observed."
The EU have designated an "acceptable daily intake" of 0.7mg of sulphur per kg of body weight a day, which, with some commercially produced white wines, is no more than one large glass for a 10 stone (63kg) woman - there is less sulphur generally in red wines, though they have more congeners. Could it be sulphites that cause the morning after horrors, and not the booze (in moderation) itself?
Alexandra Martin doesn't take HRT and says she can manage unhappy menopausal symptoms simply by: "Stopping drinking - the price I pay is too high. I now know it's not the wines per se causing it, as I've started getting the same worsening of my menopause symptom from certain foods, so it must be the preservatives or some other allergen I'm reacting to."
"People find their tolerance changes," says Newson, "because the way the liver mops up and clears toxins is negatively affected when oestrogen is low."
The same gut instinct that repelled me from certain wines drew me to ale for the first time in my life. Tresserra Rimbaud co-author of a review paper called, Beer Polyphenols and Menopause: Effects and Mechanisms says that hops contain a number of phytoestrogens, including 8-prenylnaringenin, which is one most potent phytoestrogens known, "these compounds may be useful to relieve menopausal symptoms. The concentration of these compounds in beer are low compared to the HRT. Nevertheless, some animal studies with hop extracts have had promising results."
I ask if an ale a day might keep menopause symptoms at bay and she demurs, admitting the polyphenols have benefits, but, "The recommendation is not to encourage drinking."
Were those phytoestrogens helping my liver process the alcohol, or was it just mind over matter? I mention this to Newson who seems alarmed that someone might think real ale a good adjunct to carefully titrated HRT. We, humans, are odd beasts and it's hard to tell whether the mind or the matter is responsible.
Richard Hamblin runs More Wine, which specialises in what are known as 'low intervention' wines. He says many of his customers are middle-aged women. "There's a definite customer that finds her way to me who can't drink red or white wine any more; they do seem to get on better with our wines. I can't say whether it's the power of placebo or the fact that they are drinking our simpler wines, 'cleaner' if you like, chemically speaking."
Group Evolution run 'Embrace Change' residential retreats at a chateau in the Loire. Co-founder, Barry Williams says " We encourage guests to relax and have a great time, whilst also educating them in effective strategies to cope with their menopause."
This includes, "Looking at how to reduce alcohol's worst side effects by alcoholic drinks with high levels of impurities (wines, some beers, ciders and whiskies), being careful with mixers and maintaining a healthy liver. There's some evidence that alcohol, in moderation and in the right social situation, can boost your mood and your ability to open up to friends about what you're going through."
De Maigret agrees, alcohol might be bad for our ageing bodies but it can, however controversial it might be to say it, be a tonic (even if the doctor didn't order it), "I actually enjoy the feeling of a hangover, it's a strange feeling, you are dead in your body yet alive with the good feelings and memories of a night out with friends when you let it all go and didn't care about anything except to party and laugh - just never with white wine any more."
Dosage
Are you drinking far too much? Watch out for large glasses of wine and double measures. Your average Martini is four units.
Water and electrolytes
Aging is dehydrating, as is menopause. Double whammy. Low water levels in the body will impede the body's ability to do a lot of things, including metabolising alcohol. It not just about the H2O, it's the mineral electrolytes too, so just chugging a pint of water before bed may not be enough to stop things like cramping. Try drinking more water with an electrolyte mix in, a pinch of salt or some Epsom salts should do it. It could make a big difference.
Sulphites
Sulphur dioxide (SO2) is a common food preservative and antioxidant. It is also a natural byproduct of in bottle fermentation so you can never exactly escape it but you can look to reduce your intake by opting for low to no sulphur wines. White wine generally has more sulphites than red wine. Wines should have the actual quantity of sulphur dioxide added to the booze (something that has been happening with wine for thousands of years) written on the back of the bottle. Ask your wine merchant, and if he or she can't tell you about sulphur levels in their individual wines then get a new wine merchant.
Congeners
As a general rule, the darker and more complex a drink the more different congeners or compounds your body will need to process. A study comparing hangovers in vodka and bourbon drinkers found the brown drink 11 times more likely to cause a hangover. It goes without saying, combining more congeners than strictly necessary (mixing your drinks) is a fool's game.
Pesticides
This is a controversial claim, but anecdotally, biodynamic wines are less likely to cause hangovers. Organic wines, in theory, should also but with organic wines no one knows what is added at the wine making stage. All the great wines of the world farm biodynamic, meaning they shun all man-made chemicals and extreme tweaking at every stage of the process.
Bubbles
Be it cheap fizzy lager or the finest champagne, carbonation will speed up the absorption into the body and overload the liver sooner.
Red wine — 13% ABV
• Small: 125ml 1.6 units
• Medium: 175ml 2.3 units
• Large: 250ml 3.2 units
White wine — 11% ABV
• Small: 125ml 1.3 units
• Medium: 175ml 1.9 units
• Large: 250ml 2.7
Spirits — most spirits are 1 unit per 25ml
• Although spirits used to be commonly served in single 25ml measures (1 unit) measures, many pubs and bars now serve them in 35ml or even 50ml measures.
Champagne/Prosecco — 12% abv
• 175ml – 2.1 units
Pint of beer — 5% abv
• 2.8 units
Bottle of beer — 5% abv
• 330ml bottle 1.6 units
Margherita
• Typically contains 4.5 units
Martini
• Typically 4.5 units
The strength of wine and beer in can vary, so check the % ABV.
Source: DrinkCoach
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