She was flushed in the face – and it wasn’t because she was excited or had been exercising. The annual Christmas function was underway and the waiters were pouring the wine. As the glass emptied, she had beads of sweat appearing on her brow and her face was red. I had so much sympathy for her. Because that used to happen to me too.
It’s hard to know exactly when I made the connection between alcohol and my own hot flushes, poor sleep and embarrassing red face and menopause. But I found that all my usual wines that I had enjoyed for years, I wasn’t tolerating any more. On reflection, it was when I moved from peri-menopause into post-menopause that I really noticed it. I wasn’t surprised when I saw research supporting the effect that alcohol has on our hot flushes and red face in menopause. And it’s to do with our ageing liver.
As we move through menopause, our lovely liver doesn’t quite do the job that it used to do. It’s to do with our changing enzymes – in particular, the enzymes that help to break down alcohol compounds and metabolise them in the body.
These enzymes are called ADH and ALDH and if you don’t have enough of them, you cannot convert all that alcohol through the usual pathways in the liver.
These enzymes are crucial to converting the alcohol to energy, which your liver uses to maintain the metabolism of alcohol. The more you drink, the harder your liver is working. The bad news is, that if you are overweight, then your liver is using alcohol for energy, and not the precious fat that you need to burn instead. That’s why excess alcohol consumption over many years, can contribute to a fatty liver. When alcohol energy is always available, fat starts to accumulate in the liver cells, resulting in fatty liver, with or without the weight gain. Even for those of you who are thinner and leaner and aren’t overweight, this fatty liver can still occur. Some of you may have found that your liver function tests reveal quite a different picture of your health. So, if you want to get levels of these enzymes tested sometime, then ask your Doctor to test them with your liver function tests the next time you visit.
Much of the calorie energy in alcohol can’t be stored in the body. When we have a tipple, the alcohol (ethanol) is burned off as heat … and dissipated through your skin. If you’re like me, that skin is on your face. A red flushing face when you have alcohol means that your body isn’t very tolerant of alcohol. And although you have an initial burst of energy, your blood sugar levels can crash afterwards leaving you exhausted. I wish I knew this when I was in peri-menopause.
When we have a drink, alcohol (in the form of ethanol) distributes from the blood into all tissues and fluids in proportion to their relative content of water. So, if you also think about the fact that our muscles lose density as we get older, then we don’t have the same propensity to store water in muscle tissue that we used to when we were younger. This affects our ability to metabolise alcohol and yes, we differ from men. So if the men in your life keep topping up your glass, you might want to slow them down a bit and tell them to grab you a water instead. Your tolerance to alcohol is lower due to menopause.
For those of you in peri-menopause, you might be fine with alcohol if you like a wee drink. The effect of your biological ageing hasn’t quite hit your liver, gut, muscles or blood vessels yet. You still have some way to go before structural changes begin in your liver and you lose your alcohol-converting enzymes.
For those of you in post-menopause however, it’s these structural changes to our liver and the bio-chemical changes to our enzymes, that help to explain why that glass of wine starts to make you feel hot and sweaty when it hasn’t had this effect on you before.
This is why alcohol is associated with a higher risk of hot flushes when women are in post-menopause (and a higher risk of breast cancer, but that’s another story). But there’s another issue too. And this is to do with our post-menopause hormone, testosterone. Yes, even though we are females, our body still produces some testosterone, especially if women still have their ovaries as they move into post-menopause.
When women in post-menopause drink more than 2-4 glasses of alcohol a week or at once, a hormone that is related to testosterone, increases in the bloodstream. This hormone is DHEA-S and it is related to our adrenal or stress hormones. This powerful hormone helps to make a number of the major sex steroids (oestrogen, progesterone, and testosterone) but alcohol and DHEA-S production don’t go well together. This is why, for women in post-menopause, the blood levels of DHEA-S are higher than the potent form of oestrogen, called oestradiol. Higher levels of DHEA-S increases the production of testosterone which upsets the balance of oestrogen in the body.
Testosterone is the hormone we can blame for our quick bursts of anger, frustration, weight-gain and even the growth of hairs on our chin as we move through menopause and into post-menopause. Too much testosterone production messes up our blood-sugar regulation hormone called insulin as well as causing excess oestrogen to be stored in fat cells as blood sugar levels increase. It’s why women in post-menopause may put on lots of body-fat and head down the slippery slope towards heart disease.
Not only can alcohol cause more hot flushes but so too does the extra weight. Add to this, our stressful lives this year, alcohol consumption and other lifestyle factors that cause us to produce more testosterone and the hot flushes and post-menopause weight gain may become worse.
If you are still producing oestrogen and are only in peri-menopause, the relationship between alcohol and your hot flushes may not have come onto your ‘hot-flush’ radar.… yet.
Alcohol consumption is well known to increase glucose levels in blood too. So, it makes sense that women who have elevated glucose levels (measured by HbA1c) may already have reached the threshold of glucose that their ageing (and shrinking) liver can deal with clearing. If you’re on a high-fat or high-protein diet and you have a fatty liver, as well as being in post-menopause, your liver is also working hard to clear saturated fats from animal sources of fat. Add to much alcohol to your day and your liver works even harder.
Alcohol is loved by your liver, because it supplies a ready and steady source of glucose (sugar) and glycogen (stored glucose) reserves.
At the same time however, whilst your liver is trying to take up the glucose from the alcohol, it is also trying to clear the toxins and preservatives in alcohol in order to protect your brain. The alcohol is therefore, preventing the liver from absorbing glucose and storing it, which is what the liver wants to do. Hence, many women have cravings for more and more alcohol as the need for glucose in the liver is so great.
This is why, in the MyMT™ programmes [choose between Circuit-Breaker or Transform Me depending on whether you need weight loss or not], I take you through an entire module called Liver-Lover and teach you how the liver changes as you go through menopause and why you need to focus on it, especially in order to lose weight if you have been putting on weight.
But sitting down and having a drink is also relaxing for many of you because it’s a time for social connection and helps to lower cortisol. This has been a consideration of why people live longer in many Mediterranean countries where they drink wine and socialise later at night too (One of you asked this a while ago, so I looked into it!). So, if you like to have a drink then this is another important aspect for our ongoing health as we age. The power of relaxing and social connection are also important determinants of women’s healthy ageing.
I think that getting through this year has been a major accomplishment for all of us, so yes, a celebratory drink is fine on this programme. But I always advocate that ‘knowledge is power’ so in order to keep loving your liver as you do this programme and as you lead up to Christmas, then perhaps try a different tipple.
With this in mind, I have these things for you to try, so you reduce your hot flushes when you have alcohol:
- Buy an organic wine that is lower in sugar and alcohol content. Take this to the party if your host doesn’t usually have organic wine available. You don’t want the chemicals and excess of sugar nor do you need the high ethanol content which is all just ‘overload’ for your liver to process.
- Have some protein if you are drinking, rather than high sugar treats or high salt carbohydrates. Protein will help to lower the effect of insulin production from your pancreas so your blood sugar doesn’t spike.
- Ask for sparkling water or bottled water as well. This way you have a balance of water and alcohol to slow down your drinking.
- Don’t eat a high fat meal before going out. Your liver will be too busy trying to process the fats and not the alcohol and excess glucose. It can’t do both.
I hope that you have a wonderful Christmas wherever you are and if your menopause symptoms or weight have been getting you down in 2020, then I invite you to join me on either of the MyMT™ programmes on my ANNUAL SALE which you have the choice of also purchasing my separate exercise programme, called Rebuild My Fitness – with savings of over $300, after the ‘year that was’, this is my best deal ever.
Women’ around the world call these programmes “life-changing”. I would love you to as well. I’ve made you a short video to explain the programmes to you.
Brady, C. (2015). Liver Disease in Menopause. World Journal of Gastroenterology, 21(25), 7613 – 7620.
Cogger, V., Hilmer, S. & Svistounov, D. (2011). Current Gerontology and Geriatrics Research, Article ID 150364, 1-3.
Hee Kim, Kisselina, T & Brenner, D. (2015). Aging and liver disease. Curr Opin Gastroenterol. 31(3): 184–191.
Roeca, C., Al-Safi, Z., & Santoro, N. (2018). The Post-Menopausal Women. https://www.ncbi.nlm.nih.gov/books/NBK279131/
Schilling, C. et. al (2008). Current Alcohol Use, Hormone Levels, and Hot Flashes in Midlife Women. Fertil Steril., 87(6): 1483–1486. National Institute of Health.